Today’s podcast episode is a big one. I got a chance to sit down with the U.S. Surgeon General, Dr. Vivek Murthy, to talk about social media. It perhaps reveals something about my own parenting stage, but this feels to me like one of the hardest issues we face as modern parents. We don’t have our personal history or our own parents to fall back on. The data is (as Dr. Murthy and I discuss) basically quite poor. The possible risks seem enormous — and there are risks to both having and not having social media. It is at once infinitely important and completely impossible to make the right choice.
In this conversation, we talk about Dr. Murthy’s perspective — both professional and personal — what we want out of the data, and where the role for parents ends and the role for policymakers begins. Stick around until the end here, since we’ve got some great ideas from a few other guests on how to parent around phones.
Transcript
This transcript was automatically generated and may contain small errors.
Emily Oster: This is ParentData. I’m Emily Oster. There are many hard questions in parenting. Among the hardest: when should I get my kid a phone? But even harder than that: when should I get them access to social media?
Newsclip 1: For decades, there’s been that Surgeon General’s warning on packs of cigarettes. But this morning, for the first time, a new warning about something else: social media and what it means for kids’ mental health.
Newsclip 2: The nation’s top doctor sounding the alarm on the impacts of social media on our children.
Newsclip 3: This morning, the US Surgeon General taking a stand against kids on social media, saying 13 is still too young.
Emily Oster: For many of us, social media is terrifying. We worry about what our kids might be exposed to, about being exposed to things before they’re ready. We worry about bullying happening through their phones. But on the flip side, we have many of the same concerns if we don’t give our kids social media, maybe then they will be bullied. Maybe then they will feel left out. This is such a hard balance, and it’s an example of a question where mostly, as parents, we’re going to struggle to solve it on our own. There’s a lot of discussion these days about the role of policy, the role of companies, and the role of the government in regulating what kind of social media access kids can have, and when. To a large extent, this probably is a collective problem which may need collective solutions.
So today I’ve got the US Surgeon General, Dr. Vivek Murthy, who has been very vocal about changes that are needed, in his view, to social media platforms, and limits on when kids can get access to these tools. Dr. Murthy and I talk about why he is interested in setting those limits, and I push back a little bit on some of the concerns I think parents have on the other side.
Dr. Murthy and I both love data. We talk about how we want more of it, and we’re also both parents, and we talk about how hard it is to make these decisions for yourself and also think about them for everyone else. I really appreciated this conversation and I hope that you will too.
After the break, Surgeon General Dr. Vivek Murthy.
Emily Oster: Welcome, Dr. Murthy. I am so happy to have you here. Thank you for joining me.
Dr. Vivek Murthy: Well, thanks so much, Emily. I’m glad that we’re having this conversation.
Emily Oster: So I want to start by asking you about the stand that you took this summer on social media for kids. You linked social media use to mental health issues in children. You argued effectively for a ban on social media until at least age 13, or at least that’s how I read it. As the search in general, I would’ve thought you get a limited number of bites at the apple in terms of taking stands on topics. And so I want to know why you picked this one.
Dr. Vivek Murthy: Well, good question. Well, Emily, one thing I learned during my first stint as Surgeon General was that while you may come up with certain ideas, come into office with certain ideas of what you want to address, that just like in medicine, it’s important to listen to the patient, to listen to the public in this case about what they care about, what they’re concerned about. And what I was hearing almost consistently in every single visit that I made to communities was concern from parents about youth mental health. And the most common questions I would get about that were questions about social media where parents would ask me, “Hey, is this really safe for my kids? I feel like it’s harming my children. What am I supposed to do about it?” And it was for that reason that I decided to actually dig into this topic and to put out an official surgeon general’s advisory on the topic to help parents understand what we know, what we don’t know, where we need more research and study, and what steps we can and should be taking, not just as individuals, but as policymakers as a society to address the concerns that I think many parents rightly have.
Emily Oster: And certainly as a parent of a 12-year-old, I have many of those concerns. I actually want to talk mostly about two pieces of pushback. So one, this is a podcast about data, so it’s about data. And then I also want to talk about some practicality issues. But on the data, so my read of the data is actually we don’t really know for sure what the social media impacts are on kids, and in fact that they probably vary. And you should tell me if you disagree, but that’s my initial read. And also the quality of data is very poor. There’s nothing randomized, there’s a lot of cross-sectional evidence. And we’ve seen things like this before. So we’ve seen these kinds of similar types of studies, sometimes similar kinds of rhetoric around things like screens, maybe even video games, and some of those results didn’t ultimately hold up when we had better data. So for someone who comes in, they say the data doesn’t really support your view that social media is the problem. What do you say? I mean, do you read that data differently?
Dr. Vivek Murthy: Well, I think you have to step back and ask what’s the question that we’re trying to answer here? And I think if you’re, to me as a parent myself as well as a doctor and surgeon general, the most important question that I have is a question that parents were asking me. Which is “is this safe for my kids?” That’s a different question, and I think the right question. And it’s a question that we ask actually often with medications, with children’s toys, with other things that we expose kids to. And one of the key conclusions we make, in fact one of the very first ones that I make in the advisory, is that to your point we don’t have enough data to actually say with clarity that this is safe for our children, number one. There are open questions that we need to answer. And part of the challenge that I worry about is that we don’t have full access to the data we need to do the analysis that researchers want.
This is a theme we constantly heard from researchers, regardless of their views on this issue, across the spectrum which is that they felt that they were not able to get full access to the data from social media companies. So that’s the most important conclusion we make and a point of concern. But with regard to harms, I think there is certainly a lot of correlational evidence that we have. And I know in some of your writings you’ve pointed that out that there’s obviously a difference between correlational data, causation data. That’s something that we’ve got to think about.
The causation data that we have, arguably we would love to have more of that has stronger analysis. There are small studies that are done, some natural studies based on the rollout of platforms like Facebook at college institutions, which those results, while they’re concerning, we cite some of them, they’ve been published. Ideally we’d want more of these. But one of the most important points that came to my mind and the reason that I was really pushed to do this is that I believe we should be functioning from a safety first principle here when it comes to social media and our kids, which is to ask ourselves, “is this safe?” And if we don’t have enough data to say that it is sufficiently safe for our kids to ask ourselves, “how can we make it safer?” How can we get the data to more fully understand the consequences here?
Emily Oster: So can I push a little bit on this issue of safety? Because I think you’re absolutely right. As a parent what I want, one of the main things I want, is for my kids to be safe. But also there are different kinds of safe and there’s physical safety, there’s emotional safety. But I think someone could argue that it’s not safe for my kid not to have a phone and not because I need to be able to track them. It’s not safe for them not to have a phone because the friendship downsides for not having access to being able to text their friends. That’s not safe, that’s harming them in some other way. And so in a sense, you’ve got one side of safety or one type of safety, but safety is broad. So I think it’s hard to say this is the safe way to behave. As is true for anything you could say, don’t let your kid go play outside because it’s not safe. What if a meteor hit them? Okay, well what if they don’t get enough exercise and then that’s not safe?
Dr. Vivek Murthy: Well, I don’t think that’s inconsistent at all, right?
Emily Oster: Okay.
Dr. Vivek Murthy: Because safety doesn’t mean that you don’t look at the balance of risks and benefits, but safety is an important component. Again, let me draw the correlation here to medications before your child or my child or any child out there takes a medication, those medicines are assessed for safety and then for efficacy, and then there’s a balance that’s assessed and then a recommendation based on that. But that’s what we have to do here, and it’s frankly what we have not done here over the last 20 or so years that social media has been made available. Let me just also say this. If I told you that there was a medication that was just put onto the market that hadn’t really been studied, but it was out there, millions of people were using it, we were getting thousands and thousands of complaints reflecting millions of people’s concerns about the impact this medication was having on their health, concerns from their families about what they were seeing in terms of the impact.
We wouldn’t just blow by that and say, “yeah, nothing to see here. Let’s just wait until other 10 years until we get data”. That would be irresponsible. What we’d say is that we would take those concerns seriously and we would say, “yes, look, maybe some people are being helped. Maybe some people are being harmed. We need to understand this more fully and approach this with caution”. And we’ve done that in the past with medications. We’ve put pauses on medications to assess them more deeply and we made things safer. One other parallel to note here is with motor vehicles. When I was growing up, and you and I are similar age ranges, so when you and I were both younger, we know that there was a time when motor vehicle accident deaths were incredibly high.
Emily Oster: Yeah.
Dr. Vivek Murthy: Now, what we didn’t say in that case is, “you know what cars are not safe. Let’s go back to horses and buggies”. We didn’t say that.
Emily Oster: There were some push for that, but yes, I agree. Not a widespread, absolutely.
Dr. Vivek Murthy: Not a widespread. But we also didn’t say, “you know what this is just modernity. This is just the new way, the new normal. We just have to accept this and move on”. We didn’t say that either. What we said is, “you know what things are evolving, technology is evolving. How do we make this safer for our children and for all of us?” And so we put in place motor vehicle safety standards that help us get airbags into cars, seat belts into cars, and a host of other safety standards. And those are actually enforced. It wasn’t left up to the companies, by the way, to enforce these. We had standards and we enforced them, and as a result, we were able to save thousands and thousands of lives. And that’s what we need here. One of the things I call for in this advisory, in addition to the data transparency so that every researcher, every parent out there has access to the data that the companies have is I also call for actual safety standards that we put in place.
And are these easy to figure out? None of this is easy. None of this is simple. This is complicated. But I think we owe it to our kids, we owe it to parents to do the hard thing here, which is to have the debate of what these safety standards should be and actually put them in place. Because the current approach of just allowing companies to figure it out on their own and to just assure us without data transparency that they’re doing the best they can. This is not cutting it and it’s not fair to our kids or frankly to parents on whose shoulders the entire burden of managing this has been placed.
Emily Oster: And we’re going to get to that. But I want to ask you one question about the data because I think I’m extremely aligned in the view that just we need more data on these questions in some way. Let’s say you were in charge of a government agency and a very important person, what is the study you would design? What is the thing you would want to do in the data? What do you want to see?
Dr. Vivek Murthy: Yeah, that’s a good question. And I laid down the advisory number of questions that we need to answer from a research perspective. And look, here’s some things I really want to understand. I want to understand which children are most at risk, recognizing there’s a heterogeneity in differences across kids in response. Some might be fine, others have terrible impacts when it comes to social media use. The second thing I want to understand is what kind of utilization generates harm versus benefit? And that has to do with how I’m using it, what time of the day I’m using it, how much I’m using social media. One of the things that concerned me is that a third of adolescents say that they’re staying up till midnight or later on their screens. A lot of that is social media use, taking away from children’s sleep-
Emily Oster: Sleep, which is-
Dr. Vivek Murthy:… Extraordinarily-
Emily Oster: Is so important.
Dr. Vivek Murthy: So important. And we know, I just want to say this to be clear for all the parents out there that when kids sleep is compromised, that puts them at increased risk for a host of bad outcomes including poor mental health outcomes. So that’s a second piece that I’d want to understand. But the other big thing I want to understand is around interventions. The companies are telling us that they are putting measures in place to keep our kids safe. Are those actually working? We should take a data-driven approach to understanding the answer to that question. So these are some of the things I think are critical for us to understand. In an ideal world, if we had this data, not only could we tailor public policy appropriately, but we could empower parents to better understand whether their kids may be at risk or not, how to think about when it’s safe for their child to start using social media and in what manner. And right now, parents just don’t have those tools right now because we just haven’t done the research to help them understand how to manage this incredibly challenging and complex phenomenon, which is social media.
Emily Oster: And I think what’s interesting and hard about those questions is I agree that they’re the right questions. And I think the last piece, which is what happens when you put regulations on these or restrictions on them, that’s something actually the company alone could tell you a fair amount. They could show in principle, if you had access to all of their data, you could see when you introduce this restriction, how does that change usage? I mean, that’s a mineable thing out of sort of just data that is obviously exists somewhere in the back end of TikTok or… Probably can’t get out of TikTok, but out of back end of an Instagram or Snapchat or whatever. The thing that’s much harder is the first pieces you said, which is what happens, which kids are most affected? What happens when you change the timing of things? I mean, I can imagine experiments that would say we’re going to take a group of kids and half of them were going to make their phone turn off at eight o’clock and half of them were not. But those are experiments that I would almost say you need researchers to run those experiments that companies are not going to run those evaluations for you. That’s something-
Dr. Vivek Murthy: Oh 100%.
Emily Oster:… That people need to do.
Dr. Vivek Murthy: And in no way do I think that we should be relying entirely on companies to do this. I think we need to let researchers do what they do well, which is to conduct an independent analysis and to design the appropriate experiments to execute them, to do the analysis, and then to share that data with the public openly and freely. Look, I’ll just say this, I come to my job first and foremost as a parent, and particularly to issues around youth mental health, which is why I’ve made this such a focus of my time as surgeon general. But as a parent, I never want to feel like things are being hidden from me about the impact of the things my kids are using, whether they’re toys they’re using, medications they’re using, anything. And in this case, when I talk to parents around the country, which I do all the time, parents I think appropriately feel frustrated that they aren’t being given the full story here about the impact that these platforms may be having on their children.
And look, it’s not like parenting got easier over the last 20 or 30 years, right? Parenting has always been challenging, but what we have asked parents to do now is on top of everything that was hard, take on an entire new phenomenon and somehow manage it even though we haven’t had clear recommendations from medical societies and others on how to actually manage it. So I just think that at a time where parents themselves are struggling, at a time where we know that the mental health of parents is being profoundly challenged by all the circumstances they’re dealing with, and when we know that the mental health of parents impacts the mental health of kids, I just think we’ve got to have parents’ backs on this. And this is why I’m really pushing in this for policymakers to step up, provide the funding we need for research, ensure that we have the data transparency from companies and put these safety standards in place. We’ve got to start now, kids only have one childhood. A year in the life of a child matters immensely and we just don’t have time to wait.
Emily Oster: So from the parenting standpoint, I think what is most, there’s really two challenging pieces here. So one is knowing what’s right for my kid and feeling like I have the data transparency, and I think everything you said makes a lot of sense. As a parent, those are things that I would like. The other piece is that it is extremely difficult to enforce limits of this type on your kid given their social environment. So I’m going to give you an example. We are specifically talking about social media, but there is a general related question about phones. And the world is not well-designed for your child to not have a phone. My 12-year-old did not have a phone, so she finished sixth grade. In the middle of sixth grade, she had no phone.
And last year at school they told us, download this bird app on your phone. Download the bird sound app on your phone. So I told somebody this once and they were like “the bird app, like Twitter?” I was like, “no, an educational app about birds”. But she didn’t have a phone. And generally the school is great and they don’t let you use phones at school. They have a sort of pretty aggressive, no middle school phone policy. But there was this underlying assumption that was like, of course your kid has a phone where at home they can go walk around their backyard and record birds. And in the end we worked around it, but ultimately we got her a phone basically because it felt like she needs this to navigate through pieces of her world that sort of have nothing to do with like the social environment’s not well set up for me to wait until my kid is in eighth grade to get them a phone because I need the bird app. And even if they don’t need the bird app, then people worry, well, my kid’s going to be ostracized. There’s a group chat. What about Snapchat? Their friends are planning things, they’re left out. And so what do you tell parents [inaudible 00:15:59] I can’t hold this line, I just can’t hold it.
Dr. Vivek Murthy: It’s a really good question, Emily, and I think it’s the right question to ask because I do think it’s incredibly hard, especially if you’re the only parent out there who’s trying to put some sort of guardrails around social media use for your child and everyone else around them is using devices, is on social. It can almost become isolating for them to be the one who’s left out. And we hear this, I hear this from parents all the time. But I think the couple of things to keep in mind here, one is partly how we got here is that social media and technology more broadly just rapidly infiltrated our lives and our kids’ lives. And it almost, we sort of assume that this is just the normal. So when you talk about schools, for example, making the assumption that every child has a smartphone and can use apps and download apps, et cetera, that is a piece of that.
But here’s what I think we have to do. Number one, I think we should make a distinction between social media and technology more broadly. From a safety purposes, I can absolutely understand that someone might want their child to be able to make phone calls or texts, have access to maps, to be able to navigate the world for their safety and to reach out to their family if they have an emergency. And then you can do that, actually it turns out without necessarily having social media on your phone. And we can in a separate conversation, talk about how to do that, how we can help design technology that makes that possible. Some of it’s actually going back a little closer to what we think of as a dumb phone era. But the point is there’s a distinction between tech and social media. But the second thing I think to remember here is that this is hard to do alone, which is why I think it’s so important for parents to increasingly support one another and partner with one another in this regard.
Because it’s harder to do these changes alone but if you are part of a group of two parents, three parents, four parents who are actually trying to make these changes for their kids, not only do you have more support, but your children also may start to get the sense they’re not the only ones alone. Finally, let me just say this, I have now met and spoken to many parents and kids across the country who made a decision during early adolescence not to use social media. This is a minority of children, to be very clear. It’s a small minority. And it wasn’t easy for those parents either. A lot of times they didn’t have other parents who are doing the same thing. They’re the only ones out there, and that was really tough for them. But almost to a T, all of them, especially the kids, say that they’re grateful that they went down that path of delaying use or having guardrails around their use of social media because even though they were frustrated and angry in the beginning, they now feel the benefits of it and can see it. And specifically benefits and not necessarily being subject to the kind of anxiety that they see in their friends and not having their attention constantly diverted to devices, detracting from sleep, conversation with others, et cetera.
I’m not saying any of this is easy, but we’ve gotten ourselves into a deep hole. Digging out of it is not going to be simple, but one thing I think that can make it easier is if we work together, support one another and partner as parents. It’s something that my wife and I are planning to do as our kids get older. My kids right now are five and six, and as young as that may seem-
Emily Oster: Have they started asking you for a phone?
Dr. Vivek Murthy: Are you kidding? If it was up to them, they would have our phones all the time and they would be using them constantly. And so we’ve already had to negotiate that with them. But even more so, Emily, my five-year-old before she finished preschool, she came home one day and she asked me and my wife if we could post a picture that we took of her on social media. We were flabbergasted. We’ve never talked to her about social media, she’s in preschool for God’s sakes, but her classmates are talking about social media and about posting pictures on there. So we know that this age of 13 that people seem to think is the age at which it’s then you’re allowed to get on social media. That is an artificial barrier. We know 40% of kids eight through 12 are on social media, even though 13 supposedly the restriction that platforms put in place.
So we’ve got to do this together as parents, and I think doing it alone is incredibly hard. I really sympathize with parents out there who are navigating this, and all of us are kind of in a similar boat here because this is not easy. Which is again, finally why we need the support and assistance of policymakers here to establish manageable standards here so that we can make it a bit easier for parents, give them more clarity and guidance and ensure that, look, I don’t have to think when I buy a toy in the store about whether or not there’s lead paint on that toy, whether it’s going to poison my child. I shouldn’t have to think about that. When your kid turns 16 and you perhaps want to get them into a car, we don’t say to you, “you know what why don’t you as a parent, go assess the brakes by yourself? Make sure that the frame is strong enough so can sustain either a collision, make sure that the airbags are up to standard”, we don’t say that because that’s ridiculous. These are complex technologies that we need independent standards and we need independent enforcement. And that’s what we’ve got to have with social media too.
Emily Oster: Yeah, I agree with that. I mean, I think that I would say there’s got to be kind of two parts to this. So the regulatory side does seem like we can help people, but at the end of the day, this is effectively a within family negotiation. And I think what you said is very interesting about kids reflecting if they in a situation in which they wanted social media, they didn’t get social media, now they feel good about it. And I do get the sense that there are opportunities to engage one’s kids even in experimentation around let’s try not having our phones after 8:00 PM or let’s try not having our phones one day on the weekend, or let’s try… Let’s actually think about how we feel about that or how that goes. And does that improve things? Does that make things worse? Did you actually miss anything? Oh you didn’t, didn’t actually miss anything leaving your phone for four hours. So I struggle sometimes with, I think our instinct to just think about putting restrictions in place, fighting up against what may be for me is almost more necessary, which is trying to figure out how we can help people navigate this.
And I do think these restrictions can be part of this, but ultimately it is about navigation. Eventually your kid is going to have a phone, very likely most adults do, and we don’t want it to be like we tell them they can’t drink, and then on their 21st birthday, they have 21 shots. We don’t want it to be, you can’t have any phone. And then as soon as you get your phone, like, all you do for 24 hours a day is post these pictures that you wish your dad had posted of you on social media just in a crazy manner.
Dr. Vivek Murthy: Yeah. That is true, Emily. But what I do think is important here is this isn’t either or. We need to have sensible regulation in place, and we need to be able to help families make the decisions that are appropriate for their children, recognizing that kids mature at different ages and they’re ready at different ages. We actually, to come back to motor vehicles, this is actually what we do with motor vehicles. We don’t mandate that every child starts driving at 16. What we do is we have standards in place to ensure cars are safe. We have laws to make sure that there’re speed limits, et cetera. But then we also support parents in having a discussion with their child, assessing when they’re ready, what situations are appropriate for them to drive in, counseling them about drinking and driving. So you’re right that we have to take a combination approach here, and I think that if we put it entirely on parents or if we put it entirely on regulation, I think we will miss the boat here and miss an opportunity.
And finally, I would just consider this too. No parent wants to feel like they’re being told exactly how they should be parenting their child. Or as parents, and I feel this too, I want to be able to know what the guidance is, what the data says, and then look at my child and figure out how it applies to them. But I think that’s not the circumstance, and I don’t think we should take that right away, but that’s not the circumstance that we’re in now. We’re in a circumstance where parents are just being utterly overwhelmed by new technology that they didn’t grow up with that’s rapidly evolving, that is frankly different from other tech advances in the past. Sometimes people think, Hey, is this the same moral panic that we experienced when TV came on the scene, when telephones arrived?
Emily Oster: Victorian novels, ladies reading too many novels.
Dr. Vivek Murthy: Yeah, I remember that too. And the truth is, yeah, look, every time there’s a major shift in society, there are voices that will say, “Hey, is this good for us? Is this going to cause harm”, et cetera. But here’s in my belief what is different about social media. Social media has changed the fabric of our social interactions with one another in a profound way. Like number one, it has to do with volume. The sheer amount of content coming at our kids through social media just dwarfs anything that children encountered with TV, with other forms of technology, with the telephone. The second thing though is just to think about the pervasiveness. When I was growing up and there was a TV in the house, I couldn’t carry my TV into my bedroom with me, put it in my bed and watch it until four in the morning.
You couldn’t do those things. But now with your smartphones in particular, people have 24/7 access, and we know our kids are actually losing sleep literally as a result of these devices. And finally, these devices are also designed to maximize the amount of time spent on them. And what I care about as a doctor is the quality of time that kids are spending on them. But the platforms are maximizing quantity because that is what the revenue models are based on. In that universe, when you’re pulling kids in more and more and more, keep in mind that kids are not little adults, as you know well, Emily, and as all parents know too, they’re at a unique stage of brain development, particularly in early adolescents where we know in that phase of early adolescence, kids are more prone to being influenced by social comparison and by social suggestion, both of which are bound in overwhelming abundance on social media. So this is why I actually think what we’re dealing with with social media is fundamentally different and more transformative than what we saw with prior technologies. And I do think the concern that you’re hearing, and I’m hearing all the time from parents, is actually warranted. I don’t think it’s something to be blown off as just routine concern about technological advances.
Emily Oster: I agree. Thank you for your work on this. I think from the standpoint of a parent, I really, I’m glad we’re trying to get some help. So thank you. Thank you for trying to help.
Dr. Vivek Murthy: Well, thank you also for trying to help Emily, and not just on this, but I know you’ve worked hard to be there for parents on a host of other issues, especially during those last few years. So thanks for all you do as well.
Emily Oster: Thank you so much for joining us.
Dr. Vivek Murthy: Of course.