From the New York Times, I'm Sabrina Tavernisi, and this is the daily. A rising tide of mental health problems among teens has sent parents, teachers, and doctors searching for answers. This week, the nation's top doctor offered one. Today, I talked with Surgeon General Vivek Murthy about his plan to take on what he sees as a central threat facing american teens, social media. It's Friday, June 21. Doctor Morthy, nice to see you.

Hey, Sabrina. It's good to see you, too. You can call me Vivek, by the way. I'm very informal.

Vivek. Okay. Well, you know, being the nation's top doctor, I'm inclined to call you doctor, but we can go with Vivek.

I'll tell you, Sabrina, I still think of Doctor Murthy as my dad.

Aha.

Interesting. So you are the country's surgeon general, and we're talking to you today because earlier this week, you made a pretty big announcement about the dangers of social, social media for young people, and you suggested a potential fix for it. You actually announced this move by writing an op ed in the New York Times. But before we get to that fix that you're proposing, let's talk about the problem. When did you start thinking of this as an issue that you should be focused on?

Well, I first started seeing the roots of the youth mental health crisis during my first term as surgeon general. This was during 2014 to 17. I was traveling the country, listening to communities in big cities and small towns, and I was hearing often about these struggles that young people were having with loneliness and isolation, with depression and anxiety. Over the course of two terms, I have seen this ratchet up with the pandemic pouring fuel on a fire, but a fire that was already burning before the pandemic arrived.

And what specifically were you hearing? I mean, was there a patient you saw, or was it something that happened to a friend or your own family that made this problem especially real for you?

Well, actually, there have been a series of things that made it real. One is my own experience personally. You know, as a young person, I struggled a lot with my mental health, with feeling alone and isolated. I was very shy and introverted as a child. And at that time, I thought I was the only one who was struggling. It was only years later, Sabrina, that I actually realized a lot of my classmates were struggling, too. But then I think about the conversations I had as surgeon general. Then I heard some stories I expected, but many I did not. I remember stopping at a college, and one young woman said to me, I feel like I'm on this campus surrounded by thousands of other students, but nobody really knows me. And I feel like I can't be myself. And I feel all alone. I think about the moms and dads who have come to visit me, who have talked about how social media has impacted the mental health of their kids. The one mother whose son was also shy and introverted and struggled a lot with his mental health, was being bullied and was having a really difficult time.

And then the algorithm on his social media platforms started suggesting to him that he take his own life and started directing him as to how to do that. And he ultimately followed his directions and took his own life. I heard just countless stories like this of young people who are struggling, parents who are struggling as well, and those have stuck with me, and those go along with the many statistics we now have that demonstrate that we are indeed living in a profound mental health crisis.

Okay, so you're noticing this problem or this looming problem, and you're hearing these really tragic stories. How did you go from that kind of anecdotal information gathering to actually studying this issue more closely, you know, to inspect this as a potential health hazard?

Well, once I started hearing those stories, and I hear them as such volume and consistency, they what really compelled me to dig more deeply into the data and to try to understand what is driving this deeper mental health crisis. It turns out it's not just one thing. Loneliness and isolation are contributing. The experiences of violence and the fear of violence, particularly gun violence, are contributing to the daily stress and strain that so many families are going through right now. But it turns out, again and again, the issue of social media kept coming up. So when I decided I needed to dig into this more deeply, I began essentially a research project with my team to understand more deeply what is the data telling us about social media and youth mental health. And the data tells us that there is, in fact, an association between social media use among young people and the mental health harms that they are experiencing. The second thing, though, that we know, and this is very important, is we know a lot based on what young people are telling us themselves. Six out of ten adolescent girls talk about being approached by strangers on social media in ways that make them feel uncomfortable.

A third of young people say they're staying up till past midnight on their devices. A lot of that is social media use. But nearly half of adolescents are also telling us on these studies that using social media makes them feel worse about their body image. And I want to just caveat this by saying there are still open questions like, we want to know more about which populations are most deeply impacted by social media, both positively and negatively. We want to know what types of use of social media seem to contribute to the most harm and the most benefit. These are really important questions to address, and we should be investing more research and understanding them.

I want to return to something that you said, which is that there's an association between social media use and mental health problems among young people. So this is a point of dispute with, in the scientific community.

Right?

Like, there are some studies that show that these two things are associated. In other words, that there's some relationship there, but there really isn't much evidence that one actually causes the other, that social media is the reason for the rise in mental health problems. One of my colleagues this week talked to the chief science officer at the American Psychological association, and she was asking about whether the time a child spent on social media contributed to poor mental health. And he said, and I quote, the results have been really mixed, with probably the consensus being that, no, it's not related. What is your response to that?

Well, I think, look, it's important to look at the research question broadly. What we're trying to understand, first and foremost is the answer to the question parents are asking us, which is, is social media safe from my kids? And if you ask researchers, what does the data tell us about safety? Where is the data that tells us these platforms are safe? That data is not there. So there's not evidence of safety. There is growing evidence of harm. There is data showing an association between social media use and youth mental health harm. Now, where there are debates and discussions in the research community is how big is that association? Is it bigger for boys versus girls? And it seems like it is bigger for girls. Does it differ based on your socioeconomic status, based on other indicators? And those are important questions to debate. But one of the things that you learn in medicine and in public health when you're faced with the real world problems is that you have to assess when you have enough information to act, recognizing that you want to continue to get clarity, that will continue to hone your approach as time goes on.

To give you an example from a clinical circumstance, if I have a patient in front of me whose blood pressure is dropping rapidly and who's in danger of losing their life, I have to rapidly assess what are the potential causes of that. There could be many different reasons. I've got to quickly assess it, and I've got to move forward with treating it. And I keep gathering data along the way, but the risk of inaction, of saying, hold on, let me not take action here until every question I have is answered. The risk of that is the patient's life, and that is literally what we are seeing taking place right now. It's not to say that there aren't kids who are having some benefits, but the measure of whether we should take action or not is not. Are some kids getting benefits from social media or not? That is not the threshold. I lay out in my advisory last year that there are certain benefits, but getting some benefits does not justify forcing kids to endure significant harms. We can make social media safer. We should, so that kids can get the benefits without having to sustain the harms.

So I want to talk more about the warning advisory that you issued last year. As you said, the moment when you first started to act on this, basically, your thinking was that there were these findings on social media and mental health. You know, they seem to be related. You were raising the alarm, and you called on parents, on tech companies, and on lawmakers to do more to protect young people. Why did you take that approach?

Well, because I think to address the harms of social media does, in fact, require all of us to ask the question, what can we do to protect our kids? And we all do have a role and responsibility here. But I do think up until now, the vast majority of the burden of managing the harms of social media has been placed almost entirely on the shoulders of parents and kids alone. Now, think about this for a moment, because the platforms themselves are designed by some of the best product engineers in the world, supported and resourced by some of the wealthiest companies in the world, and informed by cutting edge brain science, ultimately, to maximize how much time our kids are spending on the platforms, and to tell a parent who didn't grow up with these platforms that they should somehow manage these rapidly evolving tools and keep their kids safe when they don't even understand the full extent of harms here. That is both unreasonable and unfair. And that is why, in the advisory I issued, I called on a number of other players to step up.

And what did you hope would happen after you issued your report last year?

Well, my hope was that a few things would happen. Number one, that policymakers would respond and would come together to start putting in place the kind of safety standards and data transparency requirements and privacy protections that we need. My hope also was that parents and young people would feel seen, would recognize that they're not alone in their struggles. And finally, I wanted platforms to know that they also have a role here, that they still have an opportunity to fulfill. Social media has been around for nearly two decades. There's been plenty of time for platforms to make the experience of young people safe sufficiently safe. It's one thing to say we're implementing safety measures. It's another thing to actually provide evidence that those measures are working to keep our kids safe.

So now we come to this week when you decide to put forward your suggested fix to the problem. And that is a warning label, which is something we're used to seeing on cigarette packages. Surgeon general's warning. How exactly would a warning work in practice? I mean, which social media platforms are we talking about, and what would it look like in your ideal scenario?

So a warning label would be a digital warning. It would pop up at a regular basis when individuals used social media. There are important details of what that warning label looks like, what kind of font size it is with a literal wording of the warning label. Does it have graphics associated with it? What part of your screen does it appear on? Those questions are typically answered in a scientific process that takes place after Congress authorizes a label. Lastly, it's important for people to know that there is data about warning labels and their effectiveness. We have now decades of experience with tobacco and alcohol warning labels. And what they tell us, particularly from tobacco, is that these labels, when done right, can be effective in increasing awareness and changing behavior.

But what gave you the idea to propose this? Is it a reflection of any frustration that, you know, not enough has been done after you issued your report last year?

Well, it's a reflection more of the fact that we all have to look at every tool we have in our toolbox and use them to help address the harms that we may be seeing here with social media. And in our case, a surgeon general's warning is one of those tools. I want to be very clear that a warning label, in my mind, is not the entire fix to the harms that social media poses to our kids. I still firmly believe what I stated last year in my advisory and what I called for this week in the op ed, which is Congress ultimately needs to make social media safer. And the way to do that is by putting in place measures that protect kids from harmful content and from manipulative features that lead them to excessive use. That is what Congress has to do. Alongside that, a warning would help parents and kids understand the risks that we see. But let me separately say that if you're asking, am I frustrated or concerned that there hasn't been enough action, absolutely, yes. Look, I think all of us should be deeply concerned about how long it has taken for us to ultimately take action to make social media safer.

We've got to do better. And that starts ultimately with the platforms as well as with Congress stepping up to take action.

Well be right back.

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I wanted to ask you, Doctor Morthy, about the benefits, actually, because we're talking that this is a complicated problem, but that there are benefits, of course. You know, social media can be particularly helpful for marginalized kids, people maybe, who don't have access to a supportive group of people around them, that it is meaningfully good in their lives. So how do you think about putting a warning label, kind of just in a blanket way, on all social media platforms in that respect?

So I think about a warning label as providing people with information about their risk of harms. Now, risk of harm, it doesn't mean that every single person is harmed. It doesn't mean that there aren't benefits as well. That's true with tobacco, it's true with alcohol, and we have warning labels on both of those products. But what it does mean is that there are significant risks that people should be aware of. And when it comes to special populations and groups of people and individuals who are helped by social media, we also have to look at the full picture there. Think about LGBTQ youth for a moment. We do know that in some cases, social media can be a way for LGBTQ youth to find community, to find support that in some cases, they may not have in person. Right. That can be positive. But what is less mentioned is the fact that LGBTQ youth are much more likely to be bullied and harassed on social media compared to straight youth. So how do we put that together? How do we balance those? The bottom line is that we can't assume, as I worry we have been doing in some of the debate around this, that because there are some benefits that justifies all the harms, that means we shouldn't talk about the harms.

People have compared this moment in social media to moments in America when new media arrived on the scene and created a kind of social panic, or say new things arrived on the scene and created a kind of social panic, you know, tv, video games, that these things would be dangerous for kids, that these things would be bad for kids growing up and for their brains and all of that. What do you say to that criticism that maybe right now we're just in the midst of another moral panic about this because we don't quite understand it yet? What do you say to that?

Well, I think it's an important question to consider. We want to make sure our responses are appropriate to the gravity of the situation. But in the case of social media, there's something here that is fundamentally different from some of the other technologies that have propped up and created temporary moral panics, whether that was tv, radio, even going way back, the printing press and books. What's different here is that social media has fundamentally transformed childhood in a way that these previous technologies did not. When tv came onto the scene, I wasn't bringing my tv into my bed and watching it throughout the night. I wasn't able to be contacted by strangers through the tv in ways that would lead to bullying and exploitation. I didn't have my personal data stolen because I was watching tv in ways that also could lead to exploitation and abuse. All of these things are very unique to social media and the pervasiveness of it, the fact that young people can now carry it in their pockets and have 24/7 access to it, that has fundamentally changed the game. This point is just important to underscore. Adolescents are not little adults.

They are fundamentally in a very different stage of brain development. And in that stage of brain development, their impulse control hasn't developed as much. They are more susceptible to social comparison and social suggestion. So the things that even to us adults might seem as just willpower questions, you might just say it's a balance, just draw a few boundaries around your use of social media. No problem. One, I would argue it's quite hard for adults to do that, by the way, but especially for young people, this is exceedingly hard. And, Sabrina, I gotta say that, like, for me, and I know for many others, this is very personal. You know, I'm a father of two young kids who's watching them grow up, you know, faster than I would, like, every day, and who's seeing the world coming at them rapidly. And I know I'm not alone as a parent. And I think about the day when they come up to me and ask me if they can have a social media account. I think about what's going to happen when their friends are bullied and harassed online. How are they going to respond? Are their friends going to feel comfortable talking to them about it?

These are the questions that all of us have to grapple with as parents.

How old are your children?

My kids are six and seven now. And even though they're young, I will say that a couple years ago, when my daughter was in preschool, she came home one day and asked us about posting a picture on social media. That's how early it's coming at us.

And what did you say to her?

We said no, and she went on her way and she was fine. But this is going to happen more and more. It's happening earlier and earlier to kids, and parents are out there trying to manage this all on their own. There's no manual for how to manage social media for your kids. There's no set of ideal practices for how to tailor your kids needs to the evolving nature of social media. That's actually why I believe that parents need to also come together and support one another, you know, around taking a set of shared rules so that not only is it easier for us, but it's easier for our kids when we tell our kid, for example, as my wife and I are planning to do for our kids, that we are not going to consider than being on social media until at least after middle school. It will be helpful to us if there are other parents in our friend community and our school community who are doing the same, because then we can say, no, you're not the only one. But Bobby and Mary and Jack are also waiting until after middle school.

And are there other parents who want to do the same to wait until after middle school? Or are you guys outliers?

Well, so this is what has been fascinating, obviously, even in our own school community. In the last few weeks alone, there has been more conversation in our school about how to manage technology for our kids. And there are many more parents than I had even realized in our school who want to wait until later. But the reason many don't is because they want to assume that everyone is just doing this. They don't want their kid to be left out. So this is a collective action problem. But many of them are also unsure how to manage some of those harms, or may not even be sure what the harms are. And there's a lot of pressure, too. The number of parents I talked to who say, my child came up to me and said, if you don't let me open up an account on social media, I'll be the only one in my class. I'll be left out. Do you want me to be more lonely? And if you're a parent, face that, of course you don't want your child to be lonely. So I really feel for parents because our kids shouldn't be alone in this, and we shouldn't be alone either as parents and managing social media.

So as the daughter of parents who decided that their child should not have a television, I can identify with those kids who say, I feel more lonely. You're not part of the conversation. You can't participate in the games because you don't hear and you don't see. And it is difficult. It's the hardest thing for a parent. Right? Are you worried that could happen to you, that, you know, your kids would, you would somehow kind of deepen the loneliness? I mean, you yourself were a lonely child growing up. You said, how do you think about this?

Well, this is why I think it's so important for us to build this broader movement together, to re engineer the relationship that our kids have with technology. Because imagine if we delay the age at which kids start using social media. Imagine even after they use social media, if we build tech free zones in their lives in their days to protect sleep, in person interaction, physical activity, and learning, think about what we would do and could do with that time. I think about the school in Indiana that I went to, which had put in place restrictions around the use of social media and phones during class time. And they said that what they noticed was kids started playing games together in the library and in the hallway. They were talking more. The volume in the hallways went up. And this has been one of the most striking things to me about the college tour that I've done. I remember college as a time where the most noisy place on campus was the dining hall, because everyone was coming together to talk about what they did. It was just, you could barely hear yourself and think, right.

These days, when I go to college campuses and particularly the dining halls, it's quiet because people are on their devices. They're listening to music on their ipod. They're on their laptops. And one of the most chilling questions that I got on the college tour again and again from kids was, how are we supposed to build connection with one another when the culture isn't for people to talk to each other anymore? Just think about that for a minute. They're saying the culture is not for people to talk to each other anymore. We have to rebuild the spaces where people can talk to each other, where our kids can talk to each other, where they can discover things together, where they can agree and disagree together, but where they can do that in a way that helps them build healthy relationships, negotiate disagreement, and build friendships.

So let's say that Congress goes along with this, and warning labels start to appear on social media online. We're now almost 20 years since the advent of the smartphone. 2007 was the first iPhone I remember getting in one. Entire generations have formed their habits around these devices. And, you know, as we've discussed, there have been some real benefits, but also there are some steep societal costs. Someone I read somewhere put it that our kids are now this giant, human, real time, real life laboratory of what all of this is going to mean. So is a label actually going to unwind that? Is it too late to unwind this?

I don't think it's too late. I think about smoking in our country. In 1964, when the first surgeon general's report on tobacco was issued, at that time, 42% of Americans smoked. There were advertisements everywhere for smoking that kids could see. It was just seen as part of the culture. And there were people at that time who said, the notion that you're going to get people to stop smoking just seems unrealistic. But the combination of not just a report, but all of the action that that report helped to promote and unleash community education programs, advocacy from parents, legislation from Congress, and from state and local legislatures together over the years, that helped us take us from 42% to below 12%, that helped us save countless lives. So is it going to be easy to change and re engineer our relationship to social media and to make social media safer? No, it's not going to be easy. It's going to be complicated. But I firmly believe that as a nation, America can do hard things. We've done hard things before, and what better time than on this issue when what's at stake is the mental health and well being of our kids?

Do your kids know what your job is?

My kids now know that I'm the surgeon general, but I don't know that they know what that means? They know that I wear a uniform and they know that I do a lot of interviews and talks, but I'm not sure that they entirely know what my day job is. They just know it has to do with health in my house. When you ask who's a doctor in the house?

Yeah.

My kids point to my wife and we often have to remind them that, hey, daddy's a doctor too. So it's one of the humbling things about being a parent and I love it.

Do they know anything about what you did this week?

They know that I was doing a lot of media because they saw me on tv here and there when they were walking past their grandparents television. But they don't really know otherwise. They don't really know what really, what social media is at this point. But that is going to change any day now. It's coming.

Do you think that potentially what you're doing now means that they will be more protected?

I hope so, yeah. I mean, we, we do the work we do as parents. I do the work I do as a dad, not only because I want to serve, but because I want the world to be better for my kids. And that's what guides me here too, you know? I want my kids to grow up in a world where but the technology and the tools that are in front of them help them and don't harm them. I want them to grow up in a world where we are more connected with one another, where they can build friendships and they can seek out other kids who may be struggling with loneliness and help them feel less alone and know that there's somebody who's got their back. If I've learned one thing in my life, it's that we really do need each other. My wife and I, as much as we love our kids, we can make sure the whole world is safe for them by ourselves. We can make sure that they grow and encounter healthy levels of adversity just on our own. This is something we've got to do together as parents. And so I do hope that the work that I do will have some small contribution to making the world better for them.

But I also know that to fulfill that hope, it's going to take all of us working hand in hand and keeping our North Star clear, which is ultimately taking care of our kids. Because as a dad, I just don't know what's more important than that.

Doctor Morthy, thank you so much for your time.

Thank you so much. Sabrina, I really appreciate the chance to talk with you about this.

You can hear more discussion of the surgeon general's social media recommendation on this week's episode of Hard Fork. We'll be right back. Here's what else you should know today. On Thursday, the Supreme Court upheld a tax on foreign income that helped finance the tax cuts that President Donald Trump imposed in 2017 in a case that many experts had cautioned could undercut the nation's tax system. The vote was seven to two, with Justice Brett Kavanaugh writing the majority opinion. He was joined by Chief Justice John Roberts and by the court's three liberals. The ruling avoided what many feared could have been fiscal chaos by upholding, for now, the structure of the income tax system. And Donald Sutherland, the actor who played a laid back battlefield surgeon in the film mash and a soulful father in ordinary people, died on Thursday in Miami at the age of 88. Sutherland was known for his wide range. He had the ability to both charm and unsettle, to reassure and repulse. Across six decades, starting in the early 1960s, he appeared in nearly 200 films and television shows. Some years, he was in as many as half a dozen movies.

A quick reminder to catch a new episode of the interview right here tomorrow. This week, Lulu Garcia Navarro talks with Michigan governor Gretchen Whitmer about why she wants to meet one of the men convicted of plotting to kidnap her in 2020.

I'd like to understand what drove this group of people to undergo this exercise to try to kidnap me and kill me. I want to understand it, what is happening. I think there's something to understand. Maybe. Maybe there's not. But I'd like to see.

Today's episode was produced by Lindsey Garrison, Rob Zipko, Alex Stern and Ricky Novetsky. It was edited by Lexi Diaw and Michael Benoit, contains original music by Dan Powell and Chelsea Daniel, and was engineered by Alyssa Moxley. Special thanks to Ellen Berry. Our theme music is by Jim Brunberg and Ben Landsverk. Of wonderly. That's it for the daily I'm Sabrina Tabernaci. See you on Monday.