The Elephant In The Room: Social Media’s Public Health Crisis

14 min readOct 6, 2020

“We don’t smoke that shit. We just sell it. We reserve the right to smoke for the young, the poor, the black and stupid.” — R. J. Reynolds executive’s reply when asked why he didn’t smoke according to Dave Goerlitz, lead Winston model at R. J. Reynolds

Doctors recommend Camels over any other cigarette. I’m sure most read this statement and smile given how absurd it sounds today. Though smoking is still a part of society, its harm to the user and those around them is generally accepted by the populace. As a result, this public awareness has decreased the consumption significantly over the past few decades. What’s most interesting about this period of decline in cigarette smoking is the length of time between the U.S. Surgeon General’s first report on the dangers of smoking and the admission of this harm from cigarette companies. This report made its debut in 1964 declaring that smoking caused lung and laryngeal cancer. Nevertheless, tobacco companies through the Committee for Tobacco Research and the Tobacco Institute would continue to cast doubt on this conclusion until 1998 when they were disbanded as part of a lawsuit settlement.

34 years between the established realization of harm and the reluctant consensus from tobacco companies is a long time. A lot of unnecessary suffering and discreditation of people seeking truth can happen in such a lengthy period. When we ask the question of why, the answer seems pretty clear. Cigarette companies had a vested interest in not admitting that their product caused cancer or that nicotine was addictive. As the saying goes: cigarettes cause cancer, except for our brand. Through the ensuing battle with health officials and lawsuits with individuals, the cigarette companies used many legal maneuvers, spurious scientific claims, and aggressive marketing tactics to fight to ensure their survival. It started with the assertion that there was no scientific proof that cigarette smoking caused lung cancer. Then it evolved to the assertion that the plaintiff did not have lung cancer as claimed. When that failed, they claimed the plaintiff had a type of lung cancer not associated with cigarette smoking. The nuance continued at every step and the tobacco company legal teams would only cede as little ground as possible with each losing battle.

The libertarian in me is okay with an individual’s right to do anything that doesn’t harm others; emphasis of course on “harm to others.” Cigarettes are ostensibly an individual’s choice, but for the fact that secondhand cigarette smoke killed millions of people that didn’t smoke and continues to kill almost a million people worldwide every year. There is also the concern about putting addictive products into the hands of adolescents; a market that was strongly sought after by tobacco companies. They knew if smoking was considered cool it wouldn’t matter that the negative publicity around the dangers of smoking was growing. What that would mean for these adolescents both developmentally and in the long term was irrelevant.

On a societal level there are many behaviors we look at and collectively agree that there is harm or addiction at play when an individual chooses to engage with that specific action. But sometimes these responses are not proportional to the degree to which harm exists or are even absent from the discussion. This is especially true the more the associated harm manifests as psychological versus physiological symptoms, or in substances where harm is not a universal outcome but varies between individuals and groups. In this vein, there is a substance that billions use; one that can easily be obtained by adolescents and adults alike. It doesn’t have any warning labels on the package or visible campaign speaking out against it, similar to the anti-smoking movement. This substance has a variety of negative effects that are unevenly distributed amongst their users which makes it difficult to speak about their ills due to the confounding nature of the individual experience. The substance I am referring to is social media.

Addiction Is The Best Marketing

“Habit-forming products often start as nice-to-haves (vitamins) but once the habit is formed, they become must-haves (painkillers).” — Nir Eyal

Controlling the decision of a consumer is nothing new. Many companies used the ideas infamously laid out by Robert Cialdini in the 1980s from his book “Influence: The Psychology of Persuasion.” There are many tricks of the trade that convince the consumer that they are ultimately in control of their decision when in reality they are not. But there are two crucial differences between a physical store using these tricks versus the social media app that sits in your pocket all day. The first is known as a stopping cue. We are entering an age in which the stopping cues in many aspects of our life have disappeared. Technology is fast, but evolution is slow. For a human in a pre-agrarian society that experienced food scarcity, it wasn’t a big deal to stumble upon some fruit or honey and gorge on it because the supply was extremely finite. That was a natural stopping cue, similar to a kid going to an arcade in the mall but ultimately having to leave at some point to go home. Today is much different. We can order right to our door almost any kind of sugar imaginable and in quantities that even recent generations would be baffled by. We can binge on Netflix without ever running out of new films to consume. This applies similarly to social media. Without a stopping cue, the design is to continue scrolling and viewing for as long as possible.

The second difference is the financial transaction. A traditional brick and mortar company has the customer pay for the product. Optimizing for time spent in the store isn’t the goal. Spending as much money as possible is. There is a sense of finality in each interaction as it is constrained by how much money the customer is willing to spend. That’s not the case with social media. The company is still profit maximizing but in this new business structure there are three players: the platform, the advertiser, and the consumer. Except that the consumer is also the product. Thus for the platform to win big, they must keep producing as much of the product as possible by harvesting attention. This is what ultimately changed the stopping cue.

Enter the cell phone. It’s really important to mention that many of the apps on our phones that are linked to addiction, depression, and other mental health conditions, have just as much to do with the phone as with the app itself. News on a newspaper is a very different behavioral consumption than on the phone, and the two business models appropriately reflect this difference. Once again, the newspaper has a stopping cue. There are no infinite scrolls of newspaper. The same is not true for social media. Similarly, social media on the computer has many of the same elements of social media on the phone, but it is the phone that creates the habit with its 24/7 accessibility.

The Kids Aren’t Alright

“Long after adolescent preoccupation with self-image has subsided, the cigarette will even preempt food in times of scarcity on the smoker’s priority list.” — Quote from a presentation to the Philip Morris board of directors in 1969

Like many potentially harmful activities, the results of obsessive social media use are magnified in the pubescent mind. For teenagers, especially, the risks are quite systemic. During the critical years of puberty the developing limbic system can increase sensitivity and self-conscious behavior, resulting in teens feeling watched and judged by those around them. At the same time, the reward circuitry in the brain is also forming but is not as inhibited during this period from the prefrontal cortex. This is also a pivotal stage of learning reward-based behavior that activates pleasure (or the absence of pain). Combined with these challenges is the increased need for peer approval; an important reward piece of the teen mind. This partly explains why teens are more likely to take risks around other teens, and, more importantly, take these risks even if they just think that their peers are watching. All of these developments can be challenges by themselves for a teenager. Throw social media into the mix and you get a disaster for many teens that includes increased rates of depression, anxiety, and sleep deprivation. Peer approval, be it bullying or getting likes, is no longer something that a teenager can step away from. Gone are the days when leaving school in the afternoon or going home after hanging out with friends acted as a natural stopping cue from continuous peer approval. Because of the smartphone accessibility to social media, every second from the minute a teen wakes up until the minute they go to sleep can now be shared and judged by others without reprieve. This emotionally taxing behavior is unsustainable for many teenagers without experiencing negative behavioral effects.

For those of us not in this age group, the risks are still there. Where the teenage anxiety and depression may stem from cyberbullying or feelings of inadequacy from constantly seeing “facetuned” pictures, adults are facing these same issues with politics and news in social media. While it is true that social media allows people to be more connected, this “connectivity” has also left many feeling more isolated or polarized than ever before. The beauty of the social media feed is that it evolves to you. Well, at least a part of you. That’s the greatest danger. The algorithms that power these platforms in their quest to maximize your attention have figured out a lot about human behavior. The goal is not to learn who you are in all your multifaceted capacities, but to learn which of these capacities will keep you lost in the screen the longest. For most people, this takes the form of outrage porn. Looking at a heartwarming story or a picture of a kitten may make you feel good, but it certainly isn’t going to get you to engage with other people on a platform the way a scissor statement like “All Lives Matter” will. If social media engagement were a virus and we were to genetically modify it to become as contagious as possible, we would choose joy over sadness, but rage overall. This rage effect becomes exponential because it also creates echo chambers, thereby matching the anger of one with the anger of many who collectively agree. Misery loves company.

It Was The Best of Times…

“If it can’t be used for evil, it’s not a superpower.” — Nir Eyal

From a harm standpoint, social media is much more difficult to understand than cigarettes due to the confounding and highly differentiated effects on the individual. It’s easy for an actuary to calculate your life expectancy and corresponding increase in health insurance premium if you check “yes” next to the smoking question. It unequivocally harms the body in ways that are easily measurable with a sufficient sample size of smokers. The same cannot be said for social media. Many other questions would have to also be asked for this same actuary to get a sense of whether social media was negatively or positively impacting your health. Aside from an increase in sedentariness, most of the ill effects are psychological. But that is not a reason to dismiss the significance of the problem. Even if only 10% of users are negatively affected, it’s still a staggering number of people given that more than half the world’s population interacts with these apps in some form. From the simple standpoint of observing how these apps change the reward circuitry in our brains, make us more impatient, or give us anxiety when we can’t check them, this taps into all of us. Some are more high risk than others, but the point is that we are all at risk, especially as the algorithms behind these apps improve.

Equally as important, the nature of collective conversation has been co-opted by the algorithms behind these platforms. Algorithms that optimize for attention are neither malicious nor benevolent, but they do amplify the rabbit hole you’re in to keep you there. And though it is an uncomfortable and often unsaid truth, the best way to optimize for attention is by creating addiction. This collective addiction fuels the smokescreen that everyday terrible things are happening in the world around us. By tapping into our deepest evolutionary mechanisms to prioritize awareness to the negative in order to survive, we become enthralled by the negative news and comments. Most of these events give us false positive signals in our evolutionary programming because our physical survival is usually not at stake. Stress of this magnitude was designed to be resolved quickly. You either outran the lion in the savannah or you died. Repeatedly going through this type of stress on a daily basis is literally killing people.

A lone drug addict at the brink of despair sees no light in the world. The smell of rain, the sound of music, or a beautiful sunset are all lost to the perpetual feelings of impending doom. But the solitary addict has limits on how this energy can be spread to others. This is not the case for social media. It creates the medium to channel these heightened feelings of despair to anyone and everyone based on a system we do not control. Though no one can see the future, one thing is certain: there will be tragedy in the future and there will be adversity that all of us will have to face. These are part of the human experience, but they are not the only part. Today’s social and political upheaval are not abnormal in comparison to most of history. If anything, it is probably on the more tame side of historical events when factoring in war, famine, and disease. What is abnormal is the degree to which we are bombarded by every detail of negative events without reprieve. Perception of these human experiences that we face today have been hijacked by an external force that feeds onto a very specific part of who we are; one that by itself is healthy, but left unchecked can create the world of despair like the addict described above.

Breaking The Cycle

“Here is my theory: If smoking is really good, you should be able to smoke and do nothing else at the same time, really focusing all your attention on smoking and how it makes you feel.” Gudjon Bergmann

What can be done to balance this external force? I don’t think regulation in itself is the cure, nor can we expect policy or the benevolence of social media companies to do what’s best for the consumer. This is especially true if a proposed solution conflicts with the objectives of shareholders. The problem is deeper than that. It is a question of what technology we should be building given the optimization trap that creates divergent incentives for companies and the health of consumers. It is re-examining why we want algorithms that amplify collective suffering in society and lead people to seek these tools to escape or self-destruct. It is a question of long term consequences versus short term gains. Getting rid of the 24 hour news cycle, clickbait headlines, and social media would temporarily help, but it wouldn’t be a permanent solution (nor would it be feasible). New technology would fill its place and use the same gamified tactics to hijack our brains into complacent dopamine junkies once more. We cannot go backward. This is both scary and hopeful.

As individuals, we must fight to stay conscious. It is easy to fall into the trap of thinking that these problems only affect others and that one is “smarter” than the time trap and emotional outrage the algorithms encourage. Empirically this could be true, but the only way to know is to become aware of what content you are engaging with and how often that response is fueled by anger and fear. To stop the virus we must deprive it of its host. That means recognizing the anger in ourselves but also in others. You don’t have to engage with the random troll on the internet. You can vaccinate yourself by controlling what you consume. There are many underrated features on social media platforms that allow you to mute words or users, block users, or set standards of privacy that curate your engagement. Use them. If seeing the word Trump makes you angry all the time, is that something you want to continually see? Similar to how shopping in a grocery store on an empty stomach can lead to purchasing items you wouldn’t have intended, you can take an emotional temperature check when choosing to engage social media. I’m not saying throw your phone away, uninstall social media, or become apathetic to what is happening around you. You can still fight for justice and genuinely care about what is happening in the world without succumbing to the anger being thrown at you by social media. That person is not you, but rather a piece of you under the influence of a machine tapping into many sophisticated pieces of your brain unbeknownst to your conscious will.

It feels important to say that I don’t think any of these companies were created with malicious intent or that they could’ve foreseen the extent to which the current problems exist. Most of these issues are emergent properties of the system. It is, however, telling when some of the executives at social media companies send their kids to school where screens are banned until seventh grade because of the belief that technology can “hamper their ability to fully develop strong bodies, healthy habits of discipline and self control.” Or when other executives go as far as to put into the contracts of their nannies that they are not allowed to have their phones out in front of their children. This feels like a massive cognitive dissonance given the lack of conversation around the dangers of adolescent social media use. As Upton Sinclair once said, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”

The algorithms themselves have also evolved in the last ten to fifteen years. It can be tough to narrow down the specifics given that the system parameters are also changing. There have been good faith efforts by some companies to try to understand how some of the social feed algorithms could be improved, but again, this is a delicate problem in terms of censorship influence and conflict with the bottom line of the company. All of us may realize that giving people what they want isn’t always the right thing, but it’s tough to promote this message when the incentives aren’t there. As many competitors with alternative business models are aware, if you don’t build it, someone else will. It is a race to the bottom, behaviorally speaking, because that is what makes the most money.

Perhaps it is best to look at social media like a casino, which, not coincidentally, shares many of the same gamification strategies. Playing against the house has a negative expected value, but it doesn’t stop the fantasy of winning from bringing people to play. Some of these people can look at the time and money they spent in a casino as a form of entertainment. They weren’t expecting to win, but to have an experience. On the other side, there are those who scrape together their last dollar to go to the casino. There is no joy when they put it into the slot machine. In their eyes, they must win. The ingrained habit of pulling the lever or pushing the button has largely become an unconscious action. They need to play. The next time you open social media on your phone, ask yourself this: Is opening the app similar to the planned vacation to Vegas for fun, or is it the emotional equivalent of scraping your last dollar to pull the lever unconsciously?