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The Interview
Dr Vivek Murthy: loneliness is public health risk
00:22:59
Katty Kay speaks to Dr Vivek Murthy about how to tackle the challenge posed by loneliness
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Dr. Vivek Murthy
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Dr. Vivek Murthy
You don't look like.
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Katty Kay
Please see. I'll take that as a compliment.
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Katty Kay
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Katty Kay
Hello, I'm the BBC's Katty K and this is the interview from the BBC World Service. The best conversations coming out of the BBC people shaping our world from all over the world.
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Dr. Vivek Murthy
There have been so many disagreements between me and my family.
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Dr. Vivek Murthy
Only the things that you can't solve with government and private sector is where you bring philanthropy in. There's no place in the world where women are equal. Every generation, every generation has to fight to maintain democracy.
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Katty Kay
For this interview, I met Dr. Vivek Murthy, the former Surgeon General of the United States, on a video call where he was joining me from Washington, DC. Dr. Murthy, the first person of Indian descent in the post, was appointed during the second Obama administration. He then returned in 2021, serving until the beginning of this year. The Surgeon General's job is to provide the American public with the best scientific information available on how to improve their health and reduce the risk of illness and injury. They also oversee the country's 6,000 public health professionals who respond to national health threats and public health crises. It's it was during his second term under the Biden administration that Dr. Murthy first started expressing concern about the impact of social media on the mental health and well being of young people. He described the loneliness epidemic of social isolation as a risk to public health akin to smoking and diabetes. In this interview, he examines the scale of the challenge posed by loneliness and how artificial intelligence, or AI on the one hand, is being used to tackle it, but may also be simultaneously adding to the problem.
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Dr. Vivek Murthy
What I want to be very clear on is that whether it helps us or hurts us, one thing that is clear to me is that technology cannot be a substitute for authentic human connection. That is not a recipe for well being.
- [03:16]
Katty Kay
Welcome to the interview from the BBC World Service with Dr. Vivek Murthy. Dr. Murthy, I want to talk to you about whether AI as a technology is something that can be helpful or harmful in terms of tackling what you've called a crisis of loneliness at the moment. But before we get to what AI is doing and how it's becoming more popular, set the landscape for me from your point of view as a doctor and a medical practitioner, on what the loneliness crisis is doing to Americans and how prevalent it is.
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Dr. Vivek Murthy
Well, this caddy is something I did not learn in medical school and I did not realize during my medical training and residency, which is that loneliness and isolation have become one of the most salient and important public health challenges that we face. Not just in the United States, but in many countries around the world. We have extraordinarily high rates of loneliness across the population. In the U.S. for example, about 1 in 3 adults are struggling with loneliness, but that number actually is higher when you look at young people, where it's closer to one in two. And the consequences of this are quite significant both to mental and physical health, with increased risk of anxiety, depression, and suicide, with social disconnection, but also increased risk of heart disease, stroke, dementia, and premature death. And when I was growing up, experiencing a lot of loneliness myself, feeling a lot of shame around it, quite honestly, I thought that this was just a bad feeling. I thought there was something wrong with me. I just needed to get over it. And I never told anyone, including my family. But what I've since come to realize is that a lot of people are suffering in silence. This is what I heard from people all across the country as I traveled. And many of them don't recognize that not only are they not alone, but that there are real consequences to our physical and mental health when we struggle with loneliness for a long time.
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Katty Kay
Has it got worse recently? And is it the same for all cohorts of the population, or are you seeing some people suffer more than others?
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Dr. Vivek Murthy
Well, that's an interesting question. I do think that we saw certainly an increase in loneliness during the pandemic, and we saw some improvement afterward, but the levels of loneliness are still extraordinarily high. There are more people struggling with loneliness and have diabetes in the United States. I mean, that's extraordinary. And think about how much time and effort we rightly spend focused on issues like diabetes. And there are more people who struggle with loneliness and smoke in the United States, which is another critical public health issue. So this is truly a big deal, and it's something that we haven't attended to for a long time. But what I see, though, is a growing awareness in the population that this is real. More conversation about it that's taking place, more stigma that's reducing as people come to realize that they're not alone.
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Katty Kay
What's the difference between a normal level of occasional loneliness, which I. I imagine every single human being on the planet faces at some time, even if they have kind of healthy relationships with other people, and what might be deemed chronic loneliness that could have a health impact, whether it's a mental health or a physical health impact. How would you quantify that?
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Dr. Vivek Murthy
Well, loneliness that we feel episodically and that goes away once we experience human connection, that is quite normal. So, for example, I just got back from, from a work trip. I was gone for three days, and I felt lonely at times because I was away from my family and I wasn't seeing friends. I was just going from event to event. But then I came home and I'm spending time now with my family and I'm reconnecting with some friends, and that feeling of loneliness went away. That is normal. What is concerning is when we feel loneliness for a prolonged period of time, when days and go into weeks, go into months, and we just feel a chronic low level of loneliness in our lives. And loneliness, it's important to be clear, is a subjective feeling. It's a subjective feeling that the connections I need in my life are greater than the connections I have. And in that gap, I experience loneliness. I might be lonely even if I'm surrounded by hundreds of people at work events and at conferences. What really matters is the quality of those relationships. Do I have people in my life who truly know me, where I can be myself, where I can be open and vulnerable?
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Katty Kay
Let's talk about this new phenomenon of people turning to artificial intelligence to, to try and relieve some of these symptoms of loneliness? When did you first start becoming aware of it, as somebody who studies this, that AI chatbots were a form of companionship becoming a form of companionship for people?
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Dr. Vivek Murthy
Well, the truth is, Katty, years ago, I was building a technology company many years ago, prior to my serving as surgeon general. And in that time, because I was in the Technology universe. Sometimes I would hear people talk about this dystopian vision of a world where people no longer talk to friends, but they talk to machines. But that was seen as dystopian at the time. This was about maybe 20 years ago. Today, I hear that conversation spoken about with enthusiasm from certain technologists and entrepreneurs as the new future. And I started coming onto my radar there more and more as I was traveling the country and actually outside the United States as well, and hearing people starting to talk about their experiences with AI companions and more. So asking me the question at events, is this going to solve the loneliness crisis? Is this the future? And what I want to be very clear on is that technology can be powerfully helpful to us in our lives. I'm a believer in technology overall, but I think whether it helps us or hurts us is determined by how it's designed and then ultimately how it's used. And we. One thing that is clear to me also, though, is that technology cannot be a substitute for authentic human connection. Can it be a bridge to us getting together with our friends in person? Yes, that would be a positive use of technology. Could it help us understand what we may be doing that may be preventing us from building meaningful relationships with others? Yes, it can be helpful in giving us insights. But what's happening right now is that many of the companions people are using have not been adequately tested for safety. Many of them have been designed to almost substitute for real human connection. And so you have safety issues. You have people developing attachments to AI companions instead of building stronger attachments to people in person. And that is not a recipe for well being.
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Katty Kay
There was an extraordinary study that came out this year from Common Sense Media that found that 70% of American teenagers have turned to an AI companion. One in three say they find it as satisfying as talking to a human friend. What do you think it is? What is it about an AI chatbot that can be fulfilling and provide some sense in the moment of relief from loneliness to a teenager or to a young adult? What are they getting from those relationships?
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Dr. Vivek Murthy
So I think it's important to distinguish momentary relief from lasting relief. And I think what these companions can do very well is they can reflect what you're saying, they can give the appearance of listening, they can express empathy. And in the moment, if you, especially if you're not experiencing human connection, if you feel invisible, like no one understands you, that can feel good in the moment. But what's really important to understand is that that can, over time, become a crutch for people as well. And if the technology is not nudging them and pushing them and enabling them to build relationships offline, in person, in real life. And unfortunately, that's what we see happen very often. What concerns me as well, about the data, and you mentioned that nearly 3/4 of young people say that they have used AI companions. What's also concerning to me is that a significant number, 1 in 8 kids who actually use AI chatbots say, say that they do so because they have no one else to speak with, no one else to speak with. And when you look at kids who are at higher risk, maybe who have undergone trauma or abuse, who are struggling with their mental health, that number nearly doubles. And so we have to recognize that kids are crying out for help. A lot of times they're struggling with loneliness, and they're reaching to these AI companions in part because it's easier to do so. They're right there, and it can feel safer to do so as well. But we are, I think, misleading them when we create an environment where they become. These companions, become substitutes for real human relationships. And finally, it's just worth mentioning the safety issues, which I'm deeply concerned about as well. Through some of these companions, kids can get exposed to harmful content. They can also, if they are in extremis, if they're experiencing, for example, suicidal thoughts or ideations. And it's not always clear that the companion knows what to do or directs them in a helpful way. We have seen too many stories that have already come out public, stories about young people who lost their life, who took their own lives after interaction with AI companions over time, where it became clear that in some cases a companion was encouraging them or guiding them in how to go about organizing the process of taking their own life and harming themselves over those cutting themselves or hanging themselves. And look, as a parent myself, I cannot even imagine what it is like to know that your child not only went through that experience, that you lost your child to suicide, but then to realize that they were having conversations with an AI companion that knew that they were struggling, but did not bring in help from the outside and maybe even enable them in some way. We have to subject these companions to strong safety standards.
- [13:01]
Katty Kay
You're listening to the interview from the BBC World Service people shaping our world from all over the world.
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Katty Kay
For this episode of the interview, I'm speaking to Dr. Vivek Murthy, the former Surgeon General of the United States. He's one of the leading voices on the negative impacts that loneliness and isolation can have on our health. And throughout our interview, it was clear that he's spent a lot of time thinking about how we ought to respond to that crisis. But the part of our conversation I found most interesting was this somewhat thornier question. Is talking to an AI chatbot preferable in his mind to people experiencing loneliness? It's a question without a simple answer, but a question that seems more and more relevant each week as these AI platforms continue to grow. Okay, let's return to my conversation with Dr. Vivek Murthy. You raise a lot of very legitimate concerns and their concerns as a, you know, parent of four kids that I have as well. And some of the cases that we've seen that have been in the press about legal suits against AI chatbots, AI companies, because of the harm that has been done for children, are particularly worrying. But I want to frame it another way to you because I do think it's a nuanced issue. And you raise a question of mental health. And let's take a child who's in a difficult situation at home, who does not have the resources or the financial means or a teenager to get a therapist, right? To get an intermedical professional like yourself. But in the psychiatric field, it's just not an option for them. And they're struggling and they're lonely. And as you say, they're probably ashamed of their own loneliness, as you say you were when you were a child. Isn't it better in those circumstances that that that teenager has somebody to reach out to? Or do you think actually it's always damaging and that actually even the Lack of judgment could, in and of itself be harmful.
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Dr. Vivek Murthy
So that's an important question. And I think for me, again, both as a doctor and as a parent, what that tells me is that we need. There is a gap in. In the help that we need to be able to provide kids between the help they need and the help that we have available in terms of professional mental health providers. And we need to be able to close that gap. And I think technology can help us do that. But right now, parents and kids are being asked to take unacceptably high risks just to get that help through technology. Like if I told you, for example, that your child is going to get a car that they can use to drive to school, drive to the store, et cetera, but the catch is that there are no seat belts in that car. The brakes don't work so well. They're going to be driving on roads with no speed limits and with no traffic lights. How would you evaluate whether that's okay? Like, for your child?
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Katty Kay
Yeah, I'd say, take the keys away right now.
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Dr. Vivek Murthy
You'd say take the keys away. And look, it might be that half the time your kid goes in the car and nothing happens. Right. But we can't use that example that sometimes it goes right to justify the widespread use when we know already kids are being harmed. And so that's why I actually feel a great sense of urgency for us to make these chatbots, these companions, safer, because I do think there are circumstances where they can be helpful. But we are exposing kids and families to unacceptable risks. And if you are a parent out there, you know, one of the, unfortunately, many parents whose children have been harmed through these relationships with AI companions, you're feeling guilt, you're feeling anger, you're wondering, maybe I should have never let them use it in the first place. And so this is the dilemma that we are putting parents in as well, which I find just as a parent, to be one more source of stress and pain that we're adding to the already stressful lives that parents face.
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Katty Kay
Can we talk a bit more about this judgment factor and not really talking just here about children or children in danger. But I mean, you know, there are times when I have a very good relationship with my husband, but there are times where I just want him to agree with me and tell me that I'm perfect and that everything I say is great and everything I want to do is. Is absolutely excellent. And you know what? He's a human being and he doesn't do it. I have friendships that can be Complicated and messy. And I'm wondering whether if we start relying too much on AI and, and these relationships that do reflect back to us exactly what we want to hear about ourselves, we're actually somehow missing out on having to learn the skills of dealing with. And this does apply to young people who are starting out in their lives, you know, dealing with complicated relationships and dealing with people who disagree with you sometimes.
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Dr. Vivek Murthy
So I think this is a very interesting point. It gets to the question of what makes for a healthy relationship. And I think what we see with technology is that you can build technology that empathizes with you, that seems to always agree with you, that reinforces your point of view, that helps you do whatever it is that you want to do, whether it's plan a vacation or in some tragic circumstances, harm yourself. And we've seen AI companions do all of these things. But when we think about the relationships in our own lives, whether it's our spouses, friends, et cetera, the relationships that have been most powerful in our lives, it's often people who challenge us, Sometimes they agree with us, sometimes they don't. Sometimes they give a great response when we're in pain, sometimes they don't. They have imperfections, they have rough edges. But we grow through that. We learn from them. And sometimes we need to be challenged, like in our own perspectives and point of views. And good relationships where you have built trust, they can be fantastic for that. But that is not what we find like often with AI companions. So I do think that there's, while you get there, short term, perhaps easing of pain when you have an interaction with a companion, AI companion that agrees with you and empathizes with you. The question is, is that really the ideal kind of long term, healthy relationship that you need in your life?
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Katty Kay
I mean, ironically, these relationships that you're having with an AI companion could end up making you lonelier in the real world because they are not giving you the skills to deal with real world relationships.
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Dr. Vivek Murthy
That's right. And this is actually one of the many reasons that having unstructured time to play, having opportunities to collaborate with other kids on projects, or to play games jointly, which is a different form of collaboration. This is actually why this is all very important. Because it may seem to us like, hey, that's not advancing an academic agenda. You can't put that on your resume. It's not going to help you get into whatever the next step is, college, trade school, whatever. But the reality is that the important skills you're learning, how to negotiate conflict, how to collaborate with people, how to have conversations and dialogue and find points of agreement. These are the kind of skills you learn when you play in that fashion. So I do think that these are the real life skills that actually I found kids need more than ever. You know, I'll lastly tell you, Katty, When I was Surgeon General, I spent time going on a college campus tour, visiting various universities, talking about social connection, trying to understand the loneliness that young people were experiencing. And one of the first schools I went to, I actually thought that we got the date wrong for our visit because I walked into the dining hall and it was quiet. And I remember the dining hall from my time in college. It was the loudest place on campus because everybody was talking, catching up. But I looked around and I saw there were actually a lot of students there, but they were all on their devices. They had earbuds in and they were listening to something. They were looking at their phones. They weren't talking to each other. And the students on that tour helped me understand something very important, which is that in their words, they are growing up in a culture where it is no longer the norm for people to talk to each other face to face in person. And when you don't do that, your social muscle gets weaker and weaker and weaker, and it becomes harder to use it when you need to, whether it's in work, you know, or at home or in your neighborhoods. And I worry that in the same way the young people would tell us that they would go to college mixers and happy hours, but then just turned to their phone because it was easier and less stressful than talking to a stranger, I worry that AI companions may end up being the same path of least resistance that people go down when they're feeling lonely. And in addition to not solving their loneliness problems, it may expose them to some of the safety concerns that we're hearing about more and more.
- [22:28]
Katty Kay
So what's your advice then, doctor, to young people in how to get safe? Some of the benefits that could be out there from AI companions, but not some of the harms that may come from them. How do you encourage people in a way, since it doesn't look like this is going to be regulated externally, how do you get people to self regulate? What's your advice to young people in particular?
- [22:53]
Dr. Vivek Murthy
Well, it's a good question. I don't think that these are going away and we don't want AI to disappear and it's not going to. And it's actually, there are ways in which it can truly help us. But. But for the time being, I would be very reluctant to let my children use technology, specifically AI companions that have not been tested for safety and that actually have the power to draw kids in more and more and give them the allure of connection without providing true human connection. So I would advise my kids not to use them and I would advise other parents the same. What I would say if you are in a situation where your child is using an AI companion, I would try to understand more deeply how it is making them feel like talk to them about it. Ask them what are they talking to the companion about, what kind of subjects are they talking about, how do they feel after a conversation with an AI companion. But lastly, I would say the very important thing that we have to do is also make sure that our kids have opportunities for in person interaction with friends, with family members, with neighbors, with other people in our community. Because that is getting squeezed out and so establishing tech free zones in our lives, whether that's the dinner table and where we say mealtimes are going to be tech free, whether that's before bedtime, an hour before bedtime, and then throughout the night. So kids aren't up talking to AI companions throughout the night as they have in often with social media, or whether that's time during play or exercise, where we say, okay, this is just going to be time. We're just with people, we're not with devices. This is becoming increasingly important. We didn't have to do that proactively 20, 20, 30 years ago because it just happened. You had those opportunities. But what we're finding is that they're getting squeezed out of people's lives and now we have to fight to protect them.
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Katty Kay
Thank you for listening to the interview from the BBC World Service. You'll find more in depth conversations on the interview wherever you get your BBC podcasts, including episodes with Yoshua Bengio, widely regarded as one of the godfathers of AI, the education campaigner Malala Yousafzai and global music icon Stevie Wonder. Until the next time. Bye for now.
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