The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody. Welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week’s biggest healthcare stories. I’m your host, Rachael Robertson.

Today we’re starting off with Michael DePeau-Wilson on the details you may not have known to look for on your at-home COVID tests. Sophie Putka is telling us more about a scam impacting medical meetings. And lastly, I’ll tell you about the latest pop psychology craze sweeping TikTok.

But before we get into the show today, I want to give a quick shout-out to everyone who’s been listening to our show the past 2 months. We’re enjoying bringing you medical news every other week – and we hope you’re enjoying hearing MedPage Today stories in a new format.

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Enough housekeeping – on to our first segment.

The first story this week is about at-home rapid COVID-19 tests, and whether they can reveal more about a person’s Viral Load than a simple positive or negative result. Despite the official position from the FDA that these tests do not show quantitative results, experts have been saying that there is more to rapid antigen testing than people may know. And knowing how to read the nuance in the test results could help people better understand their infection, if they are positive for COVID. Michael is here with us now to further explain his reporting on this.

So Michael, before you talk about how to understand the different clues on rapid tests that give more information about a person’s COVID-19 infection, can you first explain what people mean when they say that these at-home tests are quantitative?

Michael DePeau-Wilson: Right. So quantitative results on rapid antigen COVID-19 tests refers to this idea that the result is more than just a yes/no answer about whether you have the virus in your nose. So there’s a gradient or a range of viral load that is detected by those tests, which gives you a quantity read on the test kit.

So if you remember back to the last time you took one of these tests, you swabbed your nose, swirled it in the solution, added a couple of drops in the test strip. Well, then you had to wait for the control line to appear and then a little longer for the test line to appear. Well, the way that the test works is it traps that virus particle from the swab on this thin strip on the test and dyes it to produce the test line. So essentially, the more virus, the darker the line, and the more virus the faster the line appears. So these are the quantitative measures that experts are referring to with these tests. If you have a very dark line that appears very quickly, then you have a very high viral load. And if you have a light line that appears right around the 15 minute mark, then your viral load is likely very low. And then there’s everything in between those outcomes.

Robertson: Got it. So there’s a lot of nuance there. How can people interpret these results? Like how do they know how sick or contagious they are based on that?

DePeau-Wilson: Right. Well, I spoke to Michael Mina, who is the chief science officer for eMed, and has been a well known public health expert who shares his expertise and views about this very topic on social media and in several other news sites. And he recently shared a graph that showed a pretty simple breakdown of how to use this information on your next COVID test. We linked to the chart in the story. But for the sake of our listeners, I’ll give it a shot to describe it a little bit.

So the chart has an X axis that represents the darkness of the line on your test strip, and a Y axis that represents the amount of time from basically zero seconds to about 15 minutes. And so if you think about this chart, and the top left side of the chart, the lightest possible line, 15 minutes is your top left. And as you move kind of toward the right and down, you’re starting to get closer to these darker test lines that are showing up in a shorter amount of time. And so that kind of chart gives you an idea of how to interpret your test strips. We’ve even heard some people say that the test strip shows up before the control strip in their tests because the viral load is just so high that it basically appears immediately. That means you have about as high of a viral load as you can possibly have on one of these test strips. And then on the other side of it, very light takes a long time to show up, which means that there’s very little viral load in there.

And you know, the critical part about this graphic is actually that it has a key that kind of gives you an idea of how to interpret those two outcomes, and then the range of outcomes within. And what it suggests is that anyone who has this light line in the 15-minute mark, they’re likely not very infectious, there’s not a lot of viral load, it takes a long time for it to show up. It probably means that their infection is not as contagious, they’re not as contagious at that point in their infection. On the other hand, if you have one of these very dark lines, and it shows up right away, that means that you potentially could be a super spreader – that you’re extremely contagious, you’re putting out a lot of virus in a very short period of time.

Robertson: Okay, so the tests, they can show your viral load – so how contagious you are and how much virus you have, to a certain extent. I’m curious that since the FDA has not officially come out to endorse that capability of the tests, what are experts saying about how people should use the tests? Is there concern that identifying these nuances and using them in your life could do more harm than good?

DePeau-Wilson: Absolutely. Mina stressed that the nuances of these test kits is meant to give people more information about their bodies, and about their potential infection. But if someone is unsure about how to interpret their test result, beyond it being positive, he really suggested that you just consider that to mean you’re infectious, and that you should take all the necessary precautions.

The idea behind sharing this information, for the experts that are out there sort of publicly promoting this idea, is just to help people understand a little bit more about their infection and hopefully make a little bit more informed decision. Because the test kits are capable of showing you the sort of gradient of how infectious you are, you know, it’s a tool that you actually have access to that you could use. And that’s why they want to sort of promote this. You know, this is kind of especially important, if you consider that, you know, COVID-19 measures have relaxed, and the onus has really been placed on individuals, and a lot of cases to make the right decision if they are positive for COVID.

You know, so if a person’s, for example, exposed to COVID-19, doesn’t have any symptoms, and then they test and they have a very dark line that shows up very quickly, you know, that could show them despite the fact that they have no symptoms that they need to isolate, that they’re giving off a lot of viral load, you know, shedding the virus, and at that time. As Mina noted, if a person is symptomatic, and they’re testing, maybe regularly to kind of see like, are they coming out of it, and they just keep seeing a darker line that’s showing up faster, each time that they take the test, that’s probably an indication that you’re not doing very well with the infection, and you probably should seek additional medical help.

There is one last note about this. And the experts really wanted to stress – a lot of this conversation is about what happens when it’s positive, and the varying, the nuanced kind of outcomes with a positive test. However, if you do have a negative test, they really emphasize that that doesn’t mean that you have no viral load at all, you may still be infected with COVID-19, but there is a threshold that these tests have and it won’t show positive unless you have a certain amount of viral load in your test strip. So it doesn’t mean that you don’t have the virus, it might just mean that you’re early on in your infection, and therefore it’s not showing up on your test strip. And so they suggest if you’ve been exposed, you should definitely continue to test to make sure that you’re not infected and that you’re not contagious at that time. So that’s an important caveat there as well. So there’s a lot of additional information besides just positive and negative that you can kind of glean from these tests. And that’s what they’re trying to get out there for everyone to understand.

Robertson: And you said that the graph that you were describing earlier, when you look at it, you can kind of see examples of what the different lines may look like. Is that right?

DePeau-Wilson: Yeah, I mean, I think it’s mostly an approximation, but it gives you an idea if you kind of see, you know, a very faint line, like the colors kind of in that chart a little bit to show you what that faint line might look like. And then obviously the darker lines and where you might kind of fall on that range. And it’s really a very simple, easy-to-understand chart and I found it to be very helpful. It’s one of the reasons we wanted to talk to Dr. Mina about this topic because he’s done such a good job of explaining it in very simple terms.

Robertson: So again, listeners if you want to look at this chart, go ahead and click on Michael’s story, which is linked in our show notes. Thanks so much, Michael.

DePeau-Wilson: Anytime.

Robertson: Next up, pirates – but probably not the kind you’re thinking of.

Medical meeting scams pop up every year to wring money from unsuspecting attendees. These “pirates,” as they’re known, run what are sometimes pretty elaborate schemes to impersonate medical associations and third-party companies that register doctors for annual meetings or arrange housing for them at a host city. The tactics they’re using, like fake websites and phishing scams, aren’t new. But meeting hosts say that they’re broadening their reach and getting help from new tools. Sophie Putka is here to tell us more.

Sophie, can you start off by telling me what these scams usually look like?

Sophie Putka: Hi, Rachael. Sure. So, I spoke to Bill Reed, the chief event strategy officer for the American Society of Hematology or ASH, who told me one of the most common scams would be a bad actor, usually operating from overseas, sets up a series of fake websites that look like the organization made them. They might carry the same logo or use a URL like “23annual.com/ash,” and have text pulled from the actual association website.

So when an attendee searches for a way to book a hotel for the upcoming meeting, they click the fake site, enter their information and get a call from someone who promises them a room, for example, and gets their credit card information. They might actually have a block of rooms reserved, but tell you the official block is sold out to create a sense of urgency and then jack up the price of their room a lot, or there might not be a room at all. In the worst-case scenario, they’ve taken your credit card info and can use it fraudulently. In another version, they charge you an inflated registration fee and send back a confirmation email copied from the association themselves, and someone flies out to the meeting only to find that they’re not registered at all.

Many associations have warnings on their site to only purchase registration and hotel rooms from their official sites. They will list their URLs and those of their third parties that might be registering people for a hotel room and tell attendees not to respond to emails or phone calls asking for credit card information. This can have really serious consequences for people who can never recover the money. Reed also said that the few people that do fall prey to the pirates may be coming from abroad and are tempted to buy a package deal from the scammers. These may be the same people who have saved up all year to attend the meeting.

Robertson: That sounds very stressful. So we know these kinds of scams aren’t just happening to people going to medical meetings. And in your story, you actually point to a letter that was signed by dozens of professional organizations, not just medical ones, to the FTC asking them to crack down on impersonation fraud. Is there anything that makes medical meetings a target in particular, and are scammers changing these tactics that they’re using over time?

Putka: So this problem isn’t unique to medical meetings and there’s no one really keeping data on the scope of the problem. But Bill Reed told me there are a few reasons he thinks that medical meetings might be particularly lucrative for scammers. This year alone, ASH picked up on about 25 pirates targeting their attendees. Medical meetings tend to be huge, thousands of people, and with many more potential marks that way. He also told me in general, many in the healthcare ecosystem have a little bit more money. So if their ultimate intent is to get someone’s credit card, “I’d much rather have the credit card of someone with money than someone who doesn’t have money.”

He also said maybe because the scientific process in medicine involves a lot of collaboration with colleagues, medical meetings are more frequent, which increases opportunities for scammers. The American Association for Cancer Research and the Association for Research in Vision and Ophthalmology said the pirates used to target exhibitors at these meetings but expanded to attendees with hotel scams, and since the pandemic stopped travel, registration scams. They and Reed said even when organizations can get the sites taken down, they pop back up faster than ever with slightly different URLs. They might even be using AI to speed up the process and make more convincing sites more quickly.

Robertson: Oof. So what are medical meeting organizers doing to keep on top of all of these scammers?

Putka: They typically have legal teams that can flag fake sites, who then send out cease-and-desist letters to the owners of the website’s domain, which sometimes does get the site taken down. Reed told me they also buy up every possible domain that could be used to impersonate them. But of course, you can’t think of every possible combination. Also, when sponsored scam sites show up higher in Google searches than the official ones, they’ll even out-buy the scammers on Google to push their site back up. But a lot of the time, these fixes don’t totally fix the problem. It’s costly to go after bad actors overseas where cyber crime may not be as tightly policed. Bill told me, “It’s like playing a game of Whac-A-Mole. Often the best they can do is prepare attendees by communicating with them ahead of meetings.”

Another expert I talked to from the Healthcare Information and Management Systems Society, Lee Kim, said organizations should stay on top of their domains and make sure they’re up to date, and can also request a regular report on domain names that sound like theirs, or start a dispute process through ICANN, which keeps track of domain registrants. If worse comes to worse, they can also sue.

Robertson: Wild stuff there. Thank you so much for sharing Sophie.

Putka: Thank you.

Robertson: Now it’s time for Sophie to take the host seat for a little bit.

Putka: The latest pop psychology sensation on TikTok right now is “shadow work.” You may not have heard of it, but your Gen Z patients probably have. That’s in part because of a very popular book called The Shadow Work Journal. Scrolling through TikTok, it’s as common to see video testimonials of people filling out the journal as it is to see ads promoting the book. It’s sold nearly 350,000 copies on TikTok’s shopping platform and is a best seller on Amazon. Rachael is going to tell us a little bit more about it.

So first up, what is shadow work and where did it come from?

Robertson: So shadow work is derived from the ideas of Carl Jung. He described the shadow many many years ago as “that hidden, repressed, for the most part inferior and guilt-laden personality whose ultimate ramifications reach back into the realm of our animal ancestors.” Basically, the more unconscious and sometimes negative parts of a person.

But more recently, this decades-old concept has struck a chord with Gen Z on TikTok. And that’s mostly because of the new book that you mentioned before called The Shadow Work Journal, which is written and self published by a young author named Keila Shaheen.

The journal starts with Shaheen’s take on the history and tenets of shadow work before moving into some self guided exercises and writing prompts. An example page that’s particularly popular online, you’ll see a lot of videos of this on TikTok, it says this: “As a child, I was yelled at for ____. My response was to ____ and ____. After this, I’ve always been ____.” People are supposed to fill in the blank with whatever comes to mind from their experiences.

Putka: That sounds like it could bring up a lot. Is shadow work considered a therapeutic technique?

Robertson: I spoke with Dr. Willough Jenkins, a psychiatric emergency and consultation liaison at Rady Children’s Hospital in San Diego. She’s also on TikTok sharing her expertise there. She told me that what is being referred to as shadow work lines up with what a lot of therapists do in their practice, such as helping people recognize and disrupt their unconscious behaviors and patterns and ways of interacting with people that might be negatively impacting their lives.

However, shadow work is not a treatment itself. People don’t get prescribed it. And therapists aren’t like alright, now it’s time to do shadow work. And it’s definitely not something that’s generally done in a self directed way, like the way that The Shadow Work Journal operates. Here’s what Dr. Jenkins told me:

Jenkins: So I don’t want to say that you know, all self-help books don’t serve a purpose. But there’s a difference between somebody who’s relatively mentally well looking to seek deeper understanding, and somebody who’s struggling with mental illness that is looking for treatment.

Robertson: For some patients, doing shadow work prompts without the support of a mental health professional could unlock trauma. Jenkins said that if people are interested in shadow work, you could direct them toward therapists with backgrounds in psychodynamic or psychoanalytic treatment, because those techniques might get at some of the same ideas that are appealing about shadow work.

Putka: Okay, so how does the shadow work trend line up with other pop psychology trends online?

Robertson: To be honest, it seems like it’s the latest and shiniest thing. It’s likely that something else will pop up soon in the self help space online. That’s something Dr. Jenkins and I talked about too – how fast pop psychology and mental health trends move online. She put it this way:

Jenkins: If a patient of that age group is coming to you, you know with a mental health concern, it’s very likely that they have consumed mental health content on social media, whether it be TikTok, whether it be another platform, and being very direct and asking patients what they’ve been seeing, what their thoughts are, can be very, very helpful in guiding treatments.

Robertson: Basically, you’re not ever going to see the exact same things as your patients, so asking them is one way to get on the same page. And another thing I should mention is it’s always important to look into who is promoting these kinds of ideas on social media and what their background and credentials are. For instance, Shaheen is not a doctor, she doesn’t have a PhD or anything. She’s a 24-year-old who actually used to work for TikTok and did a CBT certification online. And so while some of the things she says might be helpful, and it might be impactful for people, it’s not quite the same as like going to your doctor and getting an evidence-based treatment.

Putka: That’s really good to know. Thanks, Rachael.

Robertson: Thank you, Sophie.

And that’s it for today. Again, if you like what you heard, leave us a review wherever you listen to podcasts, and hit subscribe if you haven’t already. Subscribing helps us bring you the news you need from people you can trust. Thanks so much and see you again in 2 weeks.

This episode was hosted and produced by Rachael Robertson. Sound engineering by Greg Laub. Our guests were MedPage Today reporters Michael DePeau-Wilson, Sophie Putka, and Rachael Robertson. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today. For more information about the show, check out medpagetoday.com/podcasts.