Hello, good morning.
Good afternoon say hello say
good morning
I'm surprised that this is on
zoom instead of a team's Hey
Hello, hello.
Hello, Jonathan a pleasure to
meet you even if it is virtually
all right, how's it going? Nice
to see you again. Are we too
too?
Yeah, I'm here for just a moment
my videos not on. You guys are
recording and it's a clear
connection and then I'm gonna
bail so you guys can enjoy your
conversation right and
if I say something stupid this
will be edited.
Yes.
Okay, when you say anything
stupid
Well, I mean, this is something
we can talk about is that you
know, reading back people's past
predictions of COVID have made a
lot of smart people look really
stupid.
Yes. For me, yes. Oh so much for
us to talk about.
People make make good prediction
mistakes.
All sounds good to me. So I am
out of here. I really I'm going
to try and leave this all
together without
just connecting you or I can try
to make this as much centers.
That's not bad. Right.
That looks great. Wonderful. I
enjoy. Thanks, Stacey. Thanks
for your help setting this up.
Yeah, and, you know, the list of
questions is fascinating.
There's just one that I just, I
just don't think I have much to
offer. And because I don't
really do it, and this is the,
um, what you know, how is a nice
book to list? You know, what do
I think is the most exciting
trend in the Behavioral Sciences
today? I don't know if I have
anything.
Brilliant to add there.
Okay, we can delete that. And we
can also kind of let things
evolve and also want you to feel
free to just talk about what is
right.
So when you get into a riff just
got it.
Yeah, we're about what you want,
and then we'll be splicing
things together. Including using
a little bit of that technique
where it's like the question
gets put on the slide. Okay? And
so and then put together in a
condensed format so I booked
this for a longer period of time
with a lot of questions. And
then what I'm going to want to
do is shrink it down to probably
the stuff that you say that's
just like oh, wow, that's that's
a really neat those are happens.
Yeah, that's cool insights like
out you know, so those are what
I'm gonna, I'm gonna try to set
you up for as much as possible
and it's just yeah, it's
wonderful to see you again. So I
will be introducing you and
another take just thanks for
sending your bio. And as we get
started, I wanted to share
something with you is much to my
delight. I bought this and I was
so excited to get started
reading it and I'd worked my way
through the introduction and a
couple of the earlier chapters.
And then I wanted to just
actually figure out which of the
essays in here were about
healthcare. And so I was like,
Oh, look at this one, I want to
read this one on the anti Vax
movement. What what an important
time for me to be reading that
essay? So I flipped ahead in the
book. Like, I want to read this
essay, and lo and behold,
exciting to be able to see you
again. So I love how I have
crossed paths serendipitously,
you know, twice with with your
work.
I'm glad that you liked it. That
chapter. I wrote that in my
sleep. I mean, I'm very
familiar, for better or for
worse. And, you know, a lot of
people are sort of scared of the
anti vaccine movement at this
time. But I mean, if God
willing, you know, at some point
in the future, you know, the
most optimistic I'm hearing is
the fall but we have a we have a
vaccine and there are people
saying I'll be last in line. All
right, fine with me.
So maybe,
maybe this is a time where the
anti vaccine movements, okay. I
mean, obviously, I'm joking.
But yeah, I mean, I was hoping
that maybe this would be a
chance to help people challenge
their fears. Maybe this will be
a time for them to learn more
about the science of vaccines,
maybe this would be a time where
they would feel that some of
those concerns that you raised
in the essay, maybe, maybe this
will be a time and maybe we can
make some progress.
Yeah. It's interesting. I mean,
you know, someone asked on
Twitter, you know, after this,
will there be anti vaxxers? And
was very clear that he didn't
know much about anti vaxxers.
Because, you know, and there's,
there's a range. I mean, it's
not, you know, yes. No, pro
vaccine, anti vaccine. I mean,
there's a range. I mean, even
now, you know, I said that
hopefully there'll be a Cronus
virus vaccine in six months. I
mean, would I take that? Well, I
don't know. I think I'd have to,
you know, read about it safety
and efficacy. And obviously,
these are very unprecedented
times I'm not a vaccine
researcher myself at all. I
think I have one paper paper on
vaccines and multiple sclerosis.
But I know a lot about the anti
vaccine movement just because
I've followed it for many years.
And processes that normally take
decades are being sped up in
months. And you know, one of the
main complaints that the anti
vaccine movement has is that
vaccines have never really been
studied, that there's no sort of
long term placebo controlled
safety studies. And you know, if
a vaccine is approved, too soon,
they'll be right. And that
doesn't mean that it's going to
be a bad vaccine necessarily.
But you know, they'll have a
point that safety studies were
rushed steps were skipped. It
still might not be the wrong
thing to do. I've myself
volunteered to be in a vaccine
trial here at NYU. We'll see if
they write me back. You know,
these studies only work if
people volunteer. So,
yeah, but those are those are
very logical and scientifically
based concerns around following
an appropriate protocol for the
best of science as we know it.
But one of the things that I
find so compelling about your
research is that it seems as if
you take the role of human
decision making and the
vulnerability to bias as serious
in your practice as a medical
practitioner, as you do the the
science and practice of medicine
itself, and I think that that
puts you in this very powerful
position and a very important
position and i i'd love to
understand more about how did
you come to have this passion in
in studying bias and making that
something that you seem to spend
so much of your free time
devoted to his studying and
understanding bias in things
like even even in the realm of
vaccine, how did this
I mean, a few a few caveats. You
know, I'm not, I don't do much
primary research in this I'm
sort of a collector. That's how
I describe myself you know, some
of my most of my other writing
is in neurology, I've written
sort of a, you know, textbook on
neuro radiology, neuro imaging,
same thing, there's nothing new,
but over the past decade, I've
collected everything that exists
in neuroradiology. And, you
know, wrote a wrote a page
summary about it. So I'm not
doing primary, you know,
research about this, um, you
know, a lot of the work of
people who are going to be doing
these talks, I is involved. And,
you know, I'm not the first one
to think about this, either.
There's, you know, Dr. Pat
cross, Gary, I think up in
Canada, you know, who's really
sort of studied in Jerome
groopman wrote this book, you
know, how doctors think, you
know, when I first entered
medical school, no, I thought
that sort of everything had been
studied and everything,
everything. I thought that
everything in medicine or law
Things were sort of like gross
anatomy, you know, we're not
going to discover any new bones,
any new nerves anytime soon, you
know, everything that we know
about we kind of already knew
and there's going to be new
treatments and you know,
potentially new emerging
diseases, but for the most part,
things have been really well
studied. And, boy, that's not
true. And what isn't taught in
medicine sort of critical
thinking, you know, how do you
think about what decisions you
make, you know, a patient could
go to two different doctors with
the same complaint, you know,
say a headache, and, you know,
one doctor could be very sort of
conservative and say, Okay,
well, I'll try Tylenol and call
me if that doesn't get better.
And another doctor can say,
okay, we're going to do an MRI,
we're going to do a spinal tap,
and we're going to do all of
these sorts of tests and we're
going to give you Botox and and
both doctors could potentially
justify their decision. And, you
know, how to how do people sort
of make those decisions and, and
where are they right and where
are they wrong? I think one
thing one mistake when people
talk about About biases is to
think that they're talking about
flaws or errors or mistakes.
And, you know, I think that's
why Pat Cross Carry sometimes
uses the term, cognitive
disposition to respond. It's a
little, it's a little clumsy,
but it but it sort of takes away
you know, the, the negative
connotation, right, again, back
to the patient was a headache,
you know, Doctor a might be sort
of very conservative and say,
you know, first do no harm and,
you know, you know, you probably
don't have a brain tumor, and
Dr. B might be sort of very
anxious and you know, oh my god,
what if I miss a brain tumor? So
that so that sort of thing. So
how to sort of doctors make
those decisions, and when are
they right and when are they
wrong?
That's very good. And also, in
addition to looking at
practitioners and and medical
practitioners, you also take
into consideration the role of
these, you know, cognitive short
cuts in patient decision making.
Right? I mean, you know, you
can't spend all day making every
single decision you know,
looking up every single study
that's been done and you can
sort of help how how a patient
makes you feel in some ways,
there are patients that we'd
like there are patients that we
may not like as much there are
diseases that I feel more
comfortable with, you know, even
things how much I've slept in my
hungry You know, all of these
factors can can affect decision
making, in ways that that are
sort of not thought about not is
becoming more thought about but
they weren't taught in medical
school to me at all. It's, it's
becoming a little bit more more
common to do that. And, you
know, I'm seeing this playing
out right now in front of me in
real time treating COVID
treating Coronavirus. So,
for example.
I can do Talk a little bit about
my experience being here in New
York City. But every patient
that was admitted to I work
primarily in Bellevue treating
this, but I think the same is
true NYU, and probably multiple
other cities, was placed on
Black Widow hydroxychloroquine,
this anti malarial or sort of
rheumatological drug based on
what, based on a couple of
stories and, you know, the right
wing media really, really sort
of promoting it, not that many
people who were using it,
probably were fans of sean
hannity and Donald Trump. So why
and I think a lot of that was
just this feeling that we got to
do something else, you know,
doing nothing is, you know,
unacceptable in the situation.
And, you know, I didn't take
that position. You know, I said,
you know, when I became, you
know, when I got my coven team,
I said, you know, we're not
going to do any experiments on
patients outside of clinical
trials. So that was my attitude.
Now, there might be some
situations where that is
actually the wrong thing to do.
So allow me to talk about one of
the myriad complications of this
disease is and it's been getting
a lot of presses that a lot of
patients are getting a lot of
blood clots. I've never seen so
many patients be so hyper
coagula. So we've seen young
people with strokes. We have
seen Pulmonary and belie that's
when a blood clot that probably
starts in your leg goes in your
lungs, you know, fatal often.
And I have seen patients lose
limbs due to blood clots in
their legs, or so. So some of
these patients are very pro pro
clot. And you know, some doctors
feel that we should not really
change our practice about how to
prevent clots in these patients
because this one virus doesn't
change everything. If we put
patients on more intense anti
coagulation. You know, we run
the risk of maybe then bleeding
and that would be problematic.
other doctors deal Holy smokes,
these patients are clotting left
and right in front of me, I'm
going to put everyone or at
least patients who I think are
high risk on the sort of higher
dose anticoagulation. So we're
having to make these decisions
in real time without a study.
studies are being done, but
they're not done yet. You know,
so what do you do, you could
make two mistakes, you could
fail to give one patient proper
dose of anticoagulation and they
could clot with catastrophic
consequences. Or you could be
sort of hyper aggressive and put
your patients at risk of
bleeding with also catastrophic
consequences. So how do doctors
balance those risks and make
those decisions in the absence
of evidence? Those are all
questions I find interesting.
That's excellent. And so how, I
mean, I let him follow that up
with so how do you reconcile
that? I think that that's one of
the things about behavioral
economics, there's there's this
fascinating tension between you
know, sometimes it's called kind
of the system In one and system
two, that's a very convenient
heuristic for how people think.
And there's a tension
fundamental tension within the
field between providing more
support and rationale and, and
confidence even in system one
thinking, because we can't
always take that super logical
balance, wait for the RCT, and
then act in that. So So how do
you balance? You know, using a
strong possible kind of system
one or we don't have the data to
guide to guide us and yet we
need to recognize the role that
bias could still play. How do
you How are you balancing that
in your clinical decisions?
You know, well, probably
unconsciously that's, you know,
I don't sort of you know, too
often think I am now using
system one. I'm now using system
two, you know, the controversy
with the anticoagulation. I
think that you know, that can be
seen system to, just in and of
itself. I mean, these are not
people making, you know, five by
instantaneous decisions and
instantaneous impressions. I
mean, we do that, you know, I
can see someone back when people
were walking down the streets
here, you know, walk in the
screen Reiko there's someone
with Parkinson's, there's
someone who has a cerebellar
problem with their feet are very
wide apart. So I could just make
these sort of, you know,
instantly, this does not take a
high degree of skill, but even
the sort of instantaneous
diagnoses are you know, exactly
where the problem is? Not always
right. But that's, that's a sort
of more system, one type thing.
You know, with the anti
coagulation issue, I think that
is, you know, two doctors could
get together and have a half an
hour discussion about what the
right thing to do is and it
reflects more their personality
at this point, than the right
thing to do when I if a patient
is going to have a bad outcome.
Would I rather have it be the
process of the natural disease
or something that I caused? No.
So some doctors may say no, you
know, Definitely don't want to
cause any problems. And the
problem that I cause is worse
than one that's natural. You
know, another doctor might say,
That's not true at all, and, you
know, patients throwing these
horrific clots is unacceptable,
and we have to do something
right now. So it was it was
fascinating to see that, um, you
know, I think probably the
hydroxychloroquine that is
system one a little bit, you
know, that is people just sort
of doing what everyone else is
doing, you know, assuming that,
you know, doctors like myself
who are a little bit bolder and
gray or you know, are starting
this medicine are wiser about
things and no more than they and
that's not true. We all heard
about this disease at the same
time. So I think that was
probably a lot more reflective
and thoughtless. And that's what
bothered me.
That's very helpful. And
understanding your perspective.
So So then what other what other
biases Have you seen play out in
turn? of decision making. During
so far in, in during the
pandemic,
yes. So, you know, I talked a
little bit about what I've seen
on the patient level. And then,
of course, what is pointed out
on the national and
international level. I think in
some ways in the United States,
a worst case scenario has come
true, where basic, basic facts
have become politicized, which
is a horrible situation to be
in. You know, who was the
senator Monahan? I think, once I
know everyone's entitled to
their own opinion, but not their
own facts. And now we have a
situation again, where no basic
facts, no, this is more
dangerous than the flu. This is
less dangerous than the flu. Or
it's the same as the flu. You
know, taken on a political tone.
If I was to say, this diseases,
you know, it's no worse than the
flu. You would immediately know
10 things about my other their
political views are you probably
suspect them and you would
probably be right. So I think
people's tribal natures have
really sort of taken over. And
in very, very unfortunate ways,
at least in the United States.
Yeah, I think unfortunately,
that seems to be true around
around the world that people
are, are driven along
ideological lines, but also
wishful thinking.
Yeah, I see that more here.
Obviously, I'm exposed to it
more. But I look at what other
countries are doing. And our
response seems to be the worst,
the United States in almost
every imaginable way. Maybe
maybe the UK and Sweden are sort
of up there. But it's, it's,
it's really unfortunate to see,
you know, not just the number of
deaths, which is obviously the
sort of primary metric. But, you
know, protesters bringing in
assault rifles to state, you
know, state senators offices,
you know, the sort of fusion of
that which actually the anti
vaccine movement, they're
ubiquitous at these at these at
these rallies and you know, the
white supremacists and neo
nazis, some of the worst, you
know, parts of society and to
see that being amplified at
times at a national level. You
know, there's good people on
both sides talk has really been,
you know, very disheartening.
What is interesting is Donald
Trump used to be very anti
vaccine variant, you know, but
he, if you just googling Donald
Trump vaccine tweets, you'll
find about 10 times where he
said, you know, children get
autism, I've seen it many times,
no many too many shots, doctors
just want to profit. And now
he's basically staked his whole
presidency on finding a vaccine
by the fall.
That's a very interesting point
to have rates. So low let's
let's let's hope that
you know, he's he's seen the
light on on science one issue at
a time.
But I mean he you know, he
really shows you know the power
of wishful thinking I've never
seen it quite so manifest I
think it's sometimes called the
ostrich effect you know, just an
ostrich sticks his head in the
sand which apparently they don't
really do but you get the point.
You know, just just him you
know, denying reality time after
time it's you know, it's going
away there's no such thing it'll
go away it'll be a miracle
hydroxy corking period it's
America will have a vaccine in
two weeks everyone can get a
test and you know, I know I'm
coming across as sort of hyper
partisan but I think as he was
leaving office, brock obama had
a line which always struck with
me, which was, you know, in
reality is something along the
lines of reality finds a way or
you know, reality, you know,
will kick in eventually and
Unfortunately it has.
Here we are.
And here we are. So we have so
many things ahead of us in terms
of understanding the root causes
of COVID-19. And how we ended up
here in the first place. I'd
love to hear your point of view
on that. And the role that
popular sentiment plays in the
origins of of COVID-19. I'd like
to know, your thoughts about
that. And then what kinds of
behaviors might need to change
as a consequence of it?
Yeah, I mean, you know, I have
no sort of inside knowledge. I
suppose you could say that the
Chinese officials were the
original sort of guilty party of
burying their heads in the sand
and suppressing reports about
this and minimizing its dangers
even after they apparently knew
about its effects. The you know,
they they had this big festival
in Rouhani 600,000 people
gathered together. So, you know,
they're there. They're sort of
really the original, you know,
ostrich in the sand type thing.
You know. So I think, you know,
the origins of it are pretty
clear conspiracy theories aside,
I mean, you know, it probably
Gabriel wildlife market, maybe
it came from the lab, even if
that was sort of an accidental
release. You know, that's not
completely implausible. But, you
know, I think the idea that I'm
sort of engineered by Bill Gates
to microchip us all is probably
a little bit far fetched. You
know, and then it's, it's, it's,
you know, it's really revealed a
lot about countries, a lot about
people. I mean, no traits that I
would have thought about in the
past, you know, that would have
been sort of, you know, good
American traits, you know, don't
seem to be serving as well
during this time. You know,
countries that are sort of very
obedient and compliant. I mean,
it's almost like a knife in my
heart to say yes, the citizens
should obey. Without their
government without question, you
know, what those are the, you
know, at least the kind of
country where there's a strong
trust in institutions, I should
say, you know, that, that if a
leader gets on TV and says it's
very important that you stay
inside for the next month, you
know, that its citizens don't
view that as, you know, an
attempt to, you know, you know,
become the police state forever
more than just an attempt to
stop the spread of a deadly
virus. And, you know, it's
really brought out the best and
a lot of people I mean, you
know, so many people flocked
here to New York City to help us
and that was very heartwarming.
I, you know, I think, you know,
a lot of people, you know, were
able to are donating to charity
now, and sort of helping
neighbors and, you know, this
sort of thing and so, that's,
that's the best and then, you
know, the worst is what I talked
about this sort of, you know,
you know, whether it's sort of
careless, careless college kids
being like, I'm gonna go party,
you know, screw Corona, you
know, I'll probably be fine. You
know, who cares about grandma
and some of the sort of really
more nefarious parts of our
society bonding together? and
scary ways?
Yes. So one of the things that
you've written a lot about is
is, is pseudo scientific belief
beliefs and the role that bias
plays in magnifying those? How
do you think people can
potentially overcome those
biases and why? Why do we have
such pervasiveness of pseudo
scientific thinking?
Yeah, so there was some research
that something like 40% of
Americans believed at least one
sort of conspiracy thinking very
interestingly, for the first
time, one of the conspiracies is
that there already is a vaccine
for this, but it's sort of being
hidden at that, in retrospect
was kind of a predictable
conspiracy, but usually vaccines
are sort of Bad, bad, bad, you
know, evil. So it's kind of
Interesting to see the reverse
conspiracy. And I, you know, I
think for a lot of people,
conspiracy theories are very
comforting. I you know, even if
someone who is sort of, you
know, bad and evil and very
powerful at least someone's in
charge someone is directing
this, you know, things aren't
sort of randomly happening. And
if you take the view that I do
that really no one's in charge
and things are kind of random,
just bad, you know, bad things
kind of randomly happen. I mean,
that's when it's really scary,
right? Because, you know, I
don't know how this is good. No
one knows how this is gonna end.
And I think that's sort of the
scariest part. You know, when
you look back on events like
this and the past, I mean, you
know, horrible times in the
past, you know, the depression,
World War Two, the 1918
pandemic, which never seems to
get a lot of attention is on the
health for what it's worth. You
know, those seemed looking back,
you know, what would have been
like to have been alive You
know, you can sort trick
yourself into thinking, Oh, it
wouldn't have been so bad
because you knew how it ended,
you knew the pandemic ended, you
knew the depression and you knew
World War Two ended with the
good guys winning and we don't
know that that's going to be the
case. I mean, we will end of
course, you know, this pandemic
is not going to go on for the
next hundred years, but we don't
know how we don't know when we
don't know if it's going to end
with a vaccine with a, you know,
viral mutation that makes it
more benign or with a lot more
graves yet to be dug. And so I
think the conspiracy theories
really give people some sort of
framework to think about things
and to to do to avoid that. And
the you know, the conspiracy
theories are very predictable in
that, you know, that that the
hardcore conspiracy theorists,
the ones who blame this on
vaccines are microchips. I mean,
they're not stupid people, you
know, RFK Jr. I think was even
sort of saying that. It's a plot
by Bill Gates to track us all
things like that. You know, you
know that they're going to be
against vaccine. So again, let's
say there's good news and then
six months, this group working
in the UK, you know, feels that
they're confident that this
vaccine is safe and it's
effective. And, you know, it's
given to 100 million people. And
bad things are going to happen
to some of those people after
they get the vaccine, if you
give it to that many people, and
invariably, the anti vaxxers
will say, the vaccine, you know,
cause this and they'll be
stories on the news, there'll
be, you know, heartbreaking
things, you know, my unhealthy
14 year old daughter was fine
until she got the corona virus
vaccine, and then, you know, now
she can't walk, you know, look
at look at her now. So that
those are going to be very, very
predictable, you know, if we get
a vaccine, and there's no
guarantee of that. So I, you
know, on the one hand, I have
some sympathy for some of these
conspiracy theorists, and that
they're just looking for an
organizing framework to sort of
make sense of the world. On the
other hand, I have very little
sympathy because they're
standing you know, in crowds now
protesting and doing everything
they can to spread the virus and
convince people that it's not a
big deal.
No, yeah. Yeah, it's a it's a,
it's a very, very dangerous way
to, to, you know, respond
because literally putting
themselves and their families in
in risk way when, you know you
might disagree with the public
policy but there's different
ways hopefully to express that
discontent that doesn't actually
put you in the line of fire but
but here we are
the most extreme you know,
people you know, say that it's a
hoax that, you know, there was
this movement in a film your
hospital I don't know, if you
saw that at all, you know, sort
of encouraging people to go
stand outside hospitals and film
them in here from the outside.
They looked exactly the same. I
don't you know, it wasn't a
movie scene. Maybe in some parts
of New York City. It was I take
that back, but, you know, most
hospitals were on the outside
relatively quiet, actually. No,
patients stopped coming to the
emergency room for non COVID
related things. It was this very
weird time or the whole hospital
was coven. And, of course, all
non emergent, you know,
surgeries were stopped. We
weren't having any visitors, we
still don't have visitors. You
know, so from the outside,
things look pretty tranquil. It
wasn't again, it wasn't a scene
out of movies, you know, a
contagion or pandemic, you know,
people sort of running wild and
screaming. And, you know, so so
at the, you know, I've had
people online tell me that I
have not seen what I've seen,
you know, I say, you know, there
are giant refrigerated trucks
outside my hospital to store the
dead bodies, you know, they're
not there to store the dead
bodies. They're there to trick
you. I've seen I've seen people
being carried No, no, you have.
So you know, the conspiracy
theory mind is the more you try
to counter the more in some ways
you can end up reinforcing it,
which is a very difficult thing.
You know, to try to do. And, you
know, I think in this point, I'm
pretty happy, although they
could do a little bit better
some of the social media sites,
you know, taking down some of
these really dangerous videos. I
mean, again, that's another
thing that sort of five years
ago would have been like a stake
in my heart. You know, YouTube
should ban this person, you
know, but, you know, when
they're out there saying, you
know, you know, don't take this
seriously go party with Grandma,
go visit her at the nursing, you
know, you know, quite heard that
but, you know, similar things
are equally dangerous things. I
have no problems with private
companies saying, you know, we
don't want this on our platform
any more than, you know, go
drive drunk or go shoot up, you
know, a mosque or a synagogue,
right? Or we're, you know,
shouting fire in a in a crowded
theater in a way that leads to
harm. So another thing then that
I think that you've been exposed
to through your career, just
building on your point about one
of the things that conspiracy
theories do is Help people have
a sense making mechanism. And so
they go about searching for
information to, you know, help
make sense of all of this. And
that's the role of people
falling prey to quacks versus
legitimate experts. And there's
a couple of questions that I
want to ask you about that and
let you respond to this and take
it apart how how you would like
to how should the average
layperson make a distinction
between a quote unquote quack,
how would they know that that
person is a quack versus
somebody who's actually it seems
as if they're putting forward a
controversial well thought out
point of view to protect other
people versus an expert and, and
I'd also like to relay that to
you, one of the things that we
talk a lot about one of the
challenges of science and and
that's reflected in this in this
book edited by James Kaufman and
Alison Kaufman is experts
playing in their own lane. Yeah.
So, so how so? How should the
lay person make that distinction
between an expert and a quack?
And then how do you as someone
who has studied the role of bias
is a scientific thinker and a
scientist?
And how do you make that
distinction?
Well, it can be very hard. I
think.
A lot of experts have been very
wrong about this disease. A lot
of very smart I think, well
meaning people have made really
wrong and potentially
catastrophic predictions, you
know, people who are clearly non
quacks, at least, to me, I
thought, you know, I think some
of the quacks are sort of pretty
easy to spot. I mean, Dr. Oz,
you know, Alex Jones and the
sort of very sort of far out
there people I know though they
Have a huge audience and a lot
of people sort of feel that
they're getting the truth, the
unvarnished truth. And what you
know, how do you spot the
experts, I suppose at this
point, the most humble person,
the person who says I don't know
the most, is probably the one
who I would trust the most,
because there's so many
mysteries about this disease,
both on an individual level and
on a larger level. You know, I
talked to you before about some
of the controversies about how
to take care of these patients.
I didn't even get into all of
them, you know, are we
intubating patients too soon,
you know, I was an intensive
care doctor. So I wasn't the
one, you know, deciding making
that decision. But you know,
that that's a big decision, you
know, a big sort of debate
amongst doctors, and then, you
know, other mysteries about this
disease again, on an individual
level, why does Why? It seems
most people have no symptoms.
I've read about, you know,
certain places where they've
tested nearly 400 people who
tested positive there was a poor
explain to durian, none of them
had symptoms, maybe they were
about to get symptoms if you
kept following them for a few
days. So they're maybe not
asymptomatic. Maybe they're pre
symptomatic, but that seems to
be common. You know, why do
other people die? Why are
children thank god that's the
only good thing about this
disease? Why are they with a few
rare exceptions not hit hard by
this disease, although it's not
zero. And then sort of on a
bigger level Why Why are some
cities hit so much harder than
others? I think New York City
had the worst in the world. Why
it was it? In any there's no
reasonable explanation for this.
You know, where people get into,
you know, close quarters, you
know, was one person on a subway
you rode with him for an hour
and they infected 50 people in
very close contact, you know,
because we tend to think about
people. I'm getting a little bit
off subject from the experts,
not x, but I'll get to that. You
know, is you know, we tend to
think about people infected or
not, that's probably not true
the modem infection and the
degree in severity of infection
may matter. You know, people 500
years ago knew that getting a
little bit of smallpox was
better than getting a lot of
smallpox, you know, so they
would, you know, ahead of an
epidemic, they would try to
infect themselves a little bit,
you know, very dangerous thing.
Don't try it at home. You know,
so what else about you know, but
that but the plenty places have
extremely cramped, you know,
dense quarters. are Americans
just unhealthier? Yes, you know,
you know, are those are more
serve obesity and diabetes and
hypertension, renal failure or,
you know, renal disease, that
that predisposes to this? Yes.
But it still doesn't explain to
me why New York City suffered so
horribly, and even different
neighborhoods in New York City
that were right next to each
other suffered massively
different rates of this. There
was an article in New York Times
about yesterday about the rapes
in two neighborhoods in Queens
Corona versus ironically Corona.
in Corona,
you know, had a much, much worse
time with this, and then
flushing and why are you know,
other areas have been very hard
hit, you know, UK Lombardy
region of Italy, France. But we
haven't heard and I hope we
don't, you know, and this is I
think we were all thinking this
I certainly was it this will
just sort of ravish African
countries and Asian countries
and, you know, South America and
maybe again, please, no, I hope
it doesn't maybe that's about to
happen. But you know, just not I
mean, countries like, you know,
Vietnam and Thailand. I think I
might be getting that wrong.
But, uh, you know, so, you know,
a lot of Singapore, I think,
have done a very, very good job
in it, but it's unclear why it's
not like they have, you know,
you know, they have, you know,
more health resources in the
United States, but maybe they
do. I mean, maybe, you know, one
of the health resources that
America is not invested in is
public health, and that you
know, when you're Public Health
Commissioner says stay inside
and wear a mask if you have to
come out those countries where
they can stand inside them and
wear a mask a path to come out.
And so, again, I think it's in
some ways very easy to spot the
sort of Uber quacks. You know,
one thing, one one
characteristic one rule of thumb
that always certainly was there,
they're the ones who are not
working with actual COVID
patients. So, you know, if
someone promises a cure, or says
that it's not real, or germ
theory isn't real, or who knows,
those are not the doctors who
you will find in the ER and the
ICU and sort of on the front
lines. And then when it comes to
experts, I mean, certain experts
have gotten this wrong. A man
who I admired his writings a
lot, I've never met him and
hopefully I'm gonna say his name
right, john, Iamites?   if
that's someone that that you've
heard of, but he was a he's an
epidemiologist at Stanford and a
really, you know, powerful
advocate for, you know, science
done well, and there's a lot of
bad stuff. It's being done right
now. And he consistently,
consistently minimized the
dangers that this would do.
Sometime in February or March,
he wrote an article now this
will lead to 10,000 deaths, and
then a few weeks later to lead
to 40,000 deaths, and went on
fox news shows and this is
someone who would none of us
have ever thought of thought of
as political before, and yet he
still may not be, but he's sort
of consistently underestimated
the harms of this disease. So
even with these experts, you
have to be careful as well. And
that's why I say a degree of you
know, the expert who says, I
don't know, we're still learning
about this, you know, is the one
that that you should trust the
most. And then when it comes to
sort of giving advice you know,
I think, you know, an expert can
sort of say, here's what I think
is going to happen, but we got
to plan for the worst case
scenario. Yes, we have to, you
know, I don't think the virus is
going to do much damage, but we
have to react if it is. And so
those are the experts that that
I would trust.
That's right. And I think that
it's it's just so unfortunate
that people like Dr. Oz and Alex
Jones have such a huge platform.
Because with that comes a
perception of authority and the
social proof that they get from
those mainstream platforms. It
must make your job just
exceptionally more difficult
when you are working with your
patients and helping to shape
and advise their treatment plan
or diagnostic acceptance. So So
this issue of how to understand,
you know, parsing out experts
and then the experts amongst the
experts and experts being wrong,
is an exceptionally challenging
exploration. That we have over
fellow citizens.
Yeah, I mean, I think working
with COVID patients, you know,
that hasn't been the problem
because all the ones I've taken
care of have been very sick,
sick enough to be in the
hospital. You know, I think
those people are probably doing
more harm on a societal level,
you know, by spreading by
minimizing this disease and
spreading, you know,
misinformation about this and,
you know, the social distancing,
you know, we don't need to do
that this sort of thing. So I,
you know, in my previous life,
which hopefully will return soon
as a multiple sclerosis doctor,
you know, there there, I saw
that a lot, you know, patients
sort of falling for, you know,
quick fixes and easy cures,
because let's face it, what I'm
saying right now, isn't cool,
fun, sexy, interesting. I'm not
a brave Maverick doctor, you
know, going against the grain
saying, you know, everyone else
is wrong. I'm not telling people
what they want to hear. Right. I
mean, I wish Dr. Imedies had
been right. I wish this was
going to cause 10,000 deaths or
40,000 deaths. I wish the How
would you rate turns out to be
less than one in 1000? And if we
just closed nursing homes, you
know, everything the rest of us
can get on about our lives, you
know? So it's not that I, again,
I don't want to put him in the
sort of Dr. Oz class quite yet.
You know, but but doctors who
convey humility and uncertainty,
and even the sort of mainstream
No, I'm not going to, you know,
get on fox news or, you know,
anything like that, you know,
I'm nobody, you know, there were
these two doctors to these two
emergency room doctors in
Bakersfield, California who made
this viral video about, you
know, so that they were no one
before. Nobody is consistently
downplaying the dangers of this
disease. And you know, that
that's just really unfortunate.
That's right. Yeah. And one of
the things that we learned in
terms of people's perception of
climate change was how much that
perception fell along
ideological lines in terms of of
belief or resistance. And one of
the pieces of research that
really struck me in terms of
trying to understand why do
things fall along those
ideological lines was the
concern about the means to read
to resolving that issue, become
things that hit against those
ideological beliefs. So a system
or solution that requires more
state level intervention,
centralization, in terms of
planning things that do go
against the grain of individual
freedom, then we've got those
and you know, kind of a lack of
trust in the government, then
then the if if the means to
solving the problem contravene
that underlying ideology, it
makes it harder to accept the
problem statement in the first
place. Yeah. That's right. And
so if we're able to actually
find where we can improve On on
the end state, then maybe we
could start to find those zones
of agreement and compromise
within the means to to get
there. And so COVID-19 seems to
be paralleling many of the
lessons that we've learned
through these other global type
problems that require global
type solutions. And so one of
the things that I have been
impressed by is when businesses
have taken active stances and
developing innovative solutions,
everything from helping to
develop, you know, masks,
there's a furniture company
that's been cranking out massive
quantities of masks for both
public consumption as well as
for healthcare workers. We've
seen innovation in terms of
trying to produce everything
from redesign and ventilators
generating ventilators
generating, providing the other
kinds of nebulizer And breathing
pumps, businesses responding
some, some and just mere
philanthropic ways, and others
in, you know, helping to
reengineer solutions. And, and I
think that bodes well for
potentially being able to
understand the severity of the
problem if we see a convergence
between business and public
health intervention on working
towards solutions.
Yeah. You know, that that goes
back to what I said before,
about, you know, how horrible it
is that this has been sort of
politicized. You know, just
basic facts. But, you know, one
potential upside of sort of
having a wall federal government
has been that it has, you know,
people have not sort of sat back
and said, you know, let me, you
know, let me be taken care of,
you know, what, you know, let's
find a solution. So I saw that,
you know, here in my hospital,
we were deluged, and, you know,
a lot of rooms were converted
like that to negative pressure.
rooms that you know, so the air
is blowing outside not not not
inside. A lot of very innovative
things happened, no IV Poles
were placed outside of patient's
room so that people could, you
know, change medications without
going into the room. And then
you know, the science here has
moved at a sort of work speed in
some ways, and the virus was
identified like that it was
sequence like that. tests were
developed like that PCR test,
even though the United States
got their version wrong. And I
hope that this continues at pace
I've read today that people are
trying to develop tests for it,
and maybe on their way to doing
it. They claim success as simple
as a home pregnancy test. And
when that'd be sort of amazing.
If you could take that antibody
test for developer those are
potentially problematic and, you
know, God willing, the most
important thing is the vaccine
will be developed. And let me
just backtrack a little bit to
what I was saying before about
experts and john Inidies is you
know him Under estimating the
severity of this disease that
was very common. I think a lot
of us probably all of us felt,
you know, this will stay in
China. This is what happened
over there. You know, this
happens in Iran, you know, this
is far away. We will this movie
stuff we won't see in our
lifetimes. On Twitter, at the
very end of February, a doctor
asked, you know, are you
concerned about COVID? And
probably half the responses were
more concerned about the panic
due to COVID and more concerned
about the flu. You know, I
wouldn't be bringing it up if I
didn't happen to sort of say
yes, I'm very concerned. You
know, what was interesting is my
hospital had an inspection
there's a, a regulatory body,
which which does inspections and
we had this in February, and you
know, we passed but if you look
back it was I want to say this
without getting in trouble, but
sort of all the nonsense you
know, You know, our nurses
drinking water at their nursing
station hours, every single
form, dotted that, you know,
documented that the patient has
spoken to in their native
language and the translators
document it, you know, it's not
quite nonsense, but in the face
of what to come, it was
nonsense. There was no sort of
thought that this could come
here. And you know, I was
thinking, I was thinking in
February, this could get really
bad. Why not? But I didn't go to
my hospital administrator and
say, you probably would have
thought I was crazy and say,
listen, we got to prepare like
this is coming here. We gotta
make sure that we have maps, we
got to make sure that we have
protection, we have to make sure
that we have a plan in place in
case 500 people show up to our
ICU, who need to be intubated.
You know, I wish I had done
that. I don't think it would
have changed anything that he
probably would have thought of
me as a lunatic and then sort of
profit of science. But But you
know, so we all had our head in
the sand that there were a few
People who were sort of saying
ahead of time, you know, you got
to take this very seriously
very, very early on. I think Joe
Biden was one so
very good.
And even, you know, the
infrastructure to deal with
these wasn't there, you know, so
so it was it's not it wasn't a
failure just in January in
February in March. It was a
failure in the years before
that, under Trump.
One of the other things that I
was curious about your point of
view on is telemedicine and how
that's changing so quickly.
Yeah, so I mean, there are going
to be sort of silver linings to
all of this badness and I think
the, you know, tablet, the
speeding up of telemedicine,
something that would have taken
a decade before now took a
month. I think that was a good
thing. It depends on what sort
of field you practice? You know,
I imagine certain doctors could
do 100% telemedicine, they might
disagree with me but sort of
endocrinologist in treating
diabetes or thyroid problems
where the physical exam isn't
superduper important and then
other doctors obviously you have
to be in the room. I think for
me, it's been great at least
with patients who have known for
many years and I know that what
they're what they're like, and
they can tell me if they're
different and I don't have to
start from scratch. It's a
little bit hard to do a neuro
exam via zoom or via Skype or
what have you, but it can be
done. I think for newer
patients, it's not quite as good
because I don't feel I know them
yet. And there are certain
things that I can't do look in
the back of their eye, if their
knees with a hammer, you know,
as a neurologist, we really sort
of value those low tech high
yield physical exam things, but
from a patient's point of view
is great. You know, they they
Sometimes had to travel an hour
to see me and pay by the time
they're done, you know, $50 in
parking and, you know, for some
of our more disabled patients,
especially having to, you know,
get transportation and it would
take two hours each way and
that, you know, so I think
speeding that up, you know,
we'll be very good. Invariably,
there'll be things that will be
missed, there'll be things that
I will miss in a telemedicine
visit that maybe I would have
found in person and it's still
not as intimate. You know, I
think, you know, this is why
we've chosen, you know, as long
as possible to meet face to
face. This is why telemedicine
didn't occur already. But I
think it will have all those
advantages and you could
potentially see patients from
very far destinations and really
change things and I think
that'll be an advantage.
What kind of advice would you
give to a new doctor who
currently the curriculum based
On the research that I've looked
at, has very little information
about a decision making biases
and errors. What kind of advice
would you give to our new
healthcare or emerging
healthcare workers about how to
inform their practice with this
with these insights?
Yeah. So it's questionable
whether learning about these
biases really helps you overcome
them. If that was the case, I
would never make a mistake
again, I suppose. And, you know,
I have, you know, as I was
writing certain chapters, I was
sort of in the process of making
those mistakes in real time with
with certain patients. You know,
there was a, you know, a
prisoner who came in and I saw
him and I'll try to be very
vague about the details, but we
see a lot of people in police
custody here and a lot of them
my initial Reaction about this
is that they're faking it. And
it's am I saying this in a proud
way. But you know, I've seen a
lot of guys who would rather be
here than in central booking and
or Rikers Island, and I don't
blame them, I think that can be
very, I would rather be here
than there too. So that's my,
over the 15 years I've been
doing this, that's my sort of
gut instinct. And there's a guy
who came in with, you know, leg
weakness, and he really wasn't
cooperating, you know, can you
lift up your legs? Or when did
this begin a while ago? You
know, How bad is it? Not bad,
you know, just, you know, wasn't
really kind of helping me. So I
did some of the studies I needed
to do to rule out a severe
process, but not all of them.
And he came back the next day,
with with stuff that he couldn't
fake, he couldn't move his
facial muscles. So being aware
of these biases doesn't prevent
you from making them but but it
can help in certain ways. And
that sort of as an individual
level, you can sort of say,
Okay, I'm going to see a
prisoner right now. I know my
tendency is to not believe them.
I'm not proud of this fact. And,
but but it is, it's who I am.
It's an involuntary thing and
sort of maybe I can sort of
overcompensate in the opposite
direction. And then I think
having structural things, things
that you can't do quite as
individually, maybe you can do
them as an individual. But
recognize that if you're feeling
tired, you're not making your
best decisions recognize that if
you're hungry, you're not making
your best decisions. I was sort
of taught, you know, saying I'm
tired is a sign of weakness. I
think that's a little bit
changing in medicine, but you
know, if I'd said, as a medical
student, I'm tired, you know, I
need to go take a little nap and
I think I'll be a better doctor
after a 30 minute nap. That
would have been, you know, as if
I was like, I'm gonna go, you
know, have a few beers on the
job. And setting things up to
where if if other people feel
you're making a mistake, they're
not afraid to speak up. So for
example, one thing that I
sometimes try to do it Assign
people and assign one person on
the team to tell me everything
I'm doing is wrong. And their
job is to say no here, you know,
here's why you're wrong. So that
makes sure that that people
aren't afraid to speak their
minds. And if they counter act,
if they contradict me, I'm not
going to be mad at them, you
know, sort of quite the
opposite, and even sort of very
subtle things about how cases
are presented. So to go back to
that prisoner, if the case was
presented to me as follows, you
know, this is a 23 year old
prisoner who comes in with two
days of leg weakness, I'm going
to feel differently about that
than if I hear this is a 22 year
old medical student who comes in
with you know, I'm just gonna
have a very natural, you know,
different feeling about those
two cases and the likelihood of
it being real. So the best way
to present it is this is a 22
year old man who comes in with
two days of leg weakness. And so
that's what I try to teach
students to do. But one of the
themes that I'm not the first
one to think about This, there's
an emergency room doctor who
wrote a blog who really sort of
clued me into this as a lot of
these biases are sort of
opposite of each other.
Basically, every mistake in
medicine can be doing too much,
or doing too little, being too
soft, being too hard, not
aggressive enough, too
aggressive. And if you're going
to correct for one mistake,
you're more likely to make the
other so I just got done saying,
you know, I'm gonna go into this
prisoner thinking in that he's
fake it so maybe I'll take an
extra seriously. Okay. And so
that may lead me to do
unnecessary potentially
dangerous studies, maybe I know,
every prisoner who comes in with
a headache gets a CT scan. And
over the course of the year,
I've radiated 100 brains that I
didn't need to radiate. So, you
know, I'm a little skeptical
that that just knowing about
these biases can help you avoid
them, and ultimately be a better
doctor. No, mostly, I think it's
just interesting.
Some ways that's a very
depressing, very depressing
response. That it's that it's
just interesting when when I do
think that it has had a positive
impact in terms of how you think
about your own practice and your
ability to at least have the
ability to kind of diagnose
mistakes that have been made in
the past so that we can
potentially learn learn from
those scenarios or build those
little decision aids in the
moment, but there's definitely
so much so much work to do. And
in terms of our response to
COVID-19, as well, all of us I
think, are are guilty of wishful
thinking, confirmation bias, our
own perception of risk, these
things are, are getting in the
way of some good decision making
that we need to make and embrace
and support collectively.
Yeah, I mean, there there are
other strategies too. I mean,
you know, some, you know,
doctors use you know without
knowing that they're the you
know that they're trying to
overcome biases but you know,
what is it to force yourself to
think, you know, there's a well
known mnemonic and medicine
vitamins, which is just a just a
waste of category of disease. So
vascular inflammation, trauma,
autoimmune metabolic, by means
of, you know, neoplastic,
traumatic, idiopathic,
congenital I kind of got out of
track, you know, so that if
someone comes in with a symptom
to sort of force yourself to
think about everything in this
category, or I sometimes trying
to think about things, you know,
again, someone with a headache,
you know, how probable is a die
a certain diagnosis, so, you
know, migraines are very common.
How alarming is it you know,
migraine, individual migraines,
not dangerous, the disease as a
whole is very disabling but you
know, if you, you know, Miss
diagnose a migraine, it's not a
big deal. And then how treatable
is it so if you miss diagnose a
non treatable disease, you're
not necessarily making a
mistake. As I miss diagnosing a
treatable disease, so, you know,
I might with the headache
patient say how probable is a
subarachnoid hemorrhage? Not
probable? How alarming? Is it
extremely? How treatable Is it
very. So that's not a diagnosis
that you want to miss. So it's
trying to take into account all
of those sorts of things. And at
least that's how I think about
and I think sometimes you sort
of forcing strategies can be
very helpful that way.
Excellent.
Well, that was the core set of
questions and topics that I
wanted to explore with you. And
that's been fantastic.
Well, thanks for having me on.
How are you doing up in Toronto
and how are things?
Yeah, it's, it's, it's
fascinating, to have some of the
comforts of feeling that we're
in a fairly well managed country
that responded, not super We're
early, but apparently it looks
like early enough to keep
ourselves in that threshold.
Where are our hospitals and our
ICU aren't aren't overwhelmed.
So that's very reassuring.
There's definitely still many
problems that we face around
first of all testing, getting
the right number of tests
available, having the right
people, you know, taking those
tests, that's been frustrating.
The data reporting and the lag,
you know, how can people be
taking weekends off? So it
really messes with the data, our
data collection procedures, lag,
so it's very difficult to have,
you know, anything close to real
time so at best, we're three
days behind, but at least it's
only three days behind before we
have a composite picture.
I think one of the things that's
been helpful
was the premier of the province
of Ontario, in partnership with
our public health officials put
forward a very explicit goal,
which is we need to see fewer
than 200 new cases per day. And
90% of them need to be traceable
within 24 hours in parallel with
other things that are more in
the responsibility of of
government investment things
like the policies around our
long term care facilities, our
policy around our vulnerable
populations or policies around
our prison population, our
policies around our condensed
our workforces that share
residential, so agricultural and
other community based residences
pertaining to employment. So, so
there's those categories and
then there's those which, you
know, every citizen has some
control over which is around,
you know, community spread and
the impact that social
distancing plays on helping
mitigate that. So having that
very clear, specific goal, yes.
And then seeing like, a
articulation of we need to
sustain that for two to four
weeks. And then we will move
into quote unquote, phase one,
which looks like this and here's
why it'll be these kinds of
stores with this number of
people within that building,
maintaining you know, high
ventilation, maintaining high
disinfectant, you know,
procedures over over common
touchpoints that level of
clarity and kind of precision. I
have found to be very helpful.
Both As a citizen as well as a
business leader, and helping me
think through the planning, and
also just somebody who wants all
of this to go away. So knowing
that there's a sense of, you
know, what would be a healthy
turn on the epidemiological
models, if we see these things
happen, then we can enjoy a
reduction in restrictions. So I
find that level of clarity and I
know it's still not perfect, but
I find that to be very helpful.
And so I'm logging in and
seeing, you know, what's our
case rate data, what's our
accuracy on our reporting,
taking into consideration some
of the lags and gaps in that
reporting, but it gives me that
sense of control that it's like
I'm continuing to contribute to
the social goal. So that's one
of the things that's been
happening here and, and the
other thing that's very
fascinating is wild You know,
some of us are doubling down on
our commitment to doing things
like social distancing wearing
masks when we go outside,
ensuring you know, rigor around
our hygiene practices. At the
same time as we're like doubling
down on that commitment to
achieve those goals. We need to
start thinking about return to
work. And the same premier who
supported this kind of this is
what we need to see before we
can consider reducing the
restrictions. A couple of days
later said business leaders I
need you to start planning for
return to work. And this is a
very complex time because I it's
will not be a level playing
field we have different people
with different levels of risk or
perceived levels of risk. How
are we going to accommodate
individual level preferences
individual level real risk
independent of Those actual risk
scenarios to protect our to
protect our workforce. And so
this is the other work that I'm
involved with now, which is
fraught with all kinds of
misperceptions about risk. It's
either over or under. People
need to be informed about what
are appropriate level responses
to make safe workplaces. And
they, these are now individual
employees trying to say, Well,
I'm not going to go in unless
you know, all of these things
true. And so we've got a lot of
work ahead of us balancing what
epidemiology and public health
suggests needs to be in place
with what's practical with with
what individuals are choosing.
So those are, those are some of
the things I'm tackling now.
Well, it's tough. I mean, you
know, we're seeing the same
thing here. You know, Governor
governor, I think is after being
too Slow initially has done a
very good job. You know, and as
much as I've said, the United
States has had the worst
response in the world. I think
that's at a national level. I
think some of the governors, you
know, really shine and I read
one article that every single
state, you know, the citizens
rank their governor, you know,
ahead of our president. You
know, in some, some, some local
officials, you know, the mayor
of San Francisco, the governor
of California and Ohio and
Washington State, you know, did
really well. And if you took New
York State out of the mix, the
United States actually wouldn't
be doing so horribly. It seems
so. Um, so I think, you know,
the weaknesses in the strengths
of the United States have been
revealed. One of the strengths
been, I suppose, federalism, you
know, and, you know,
traditionally, I think most
Americans have thought that
sales is sort of very mobile
and, you know, I could go
anywhere and you know, I'm
hoping for the next, you know,
until this is over, however,
That is, you know, people don't
move on. I certainly don't want
people from, you know, coming
here, you know, in potentially
importing disease, again, now
that we finally have gotten
under control here. Another
interesting thing that that is
how data and how numbers are
presented in how misleading some
of those graphs can be, you
know, some of those logarithmic
graphs and you see it sort of
being flattened out, you know,
but but, you know, when you
realize, Oh, that's a
logarithmic graph, going from
here to here is going to go from
10,000 to 20,000 where as going
from here to there is going from
five to 10. And, you know, in
all the incidents, fatality
rates, the case fatality rates,
and, you know, how many cases
are there? How many tests are
being done, even very
interesting metrics of, you
know, of the tests that are
being done, how many come out
positive, it's all very
innumeracy of a lot of people,
myself included. And you know,
is It was fascinating to see
play out in real time. Now that
it always takes me a few
minutes. And I didn't think
about it at the beginning until
I saw a video and I was like,
Oh, yeah, that's logarithmic.
You know, that's, it's like
this, but that's really not
actually flat. You know? So
anyways, I hope that you and
yours are saying I hope these
interviews go well, you know,
let me know when it's out. What
what are the what? How many of
these have you done?
Your my first? Yeah, the one we
were supposed to do last last
week. She had some childcare
challenges. And so we've, she's
actually now at the back of the
pack instead of being at the at
the beginning. I'm very excited
to have the opportunity to do
this. It's such a it's such a
wonderful way to think about,
you know, the the challenges
that we're facing from this,
like, you know, how does
behavioral science and
scientific thinking, help us
tackle these challenges?
Yeah, I mean, I didn't bring his
name up, but one of the people
you're interviewing gotta kind
of got this wrong. You know,
Cass Sunstein, you know, wrote
wrote an article for Bloomberg
News, which is essentially, you
know, why people are more afraid
of things and they should be or
so, you know, and in retrospect,
you know, I know that people
sort of online were like, you
know, the article started out,
you know, we don't know much
about this disease, but people
are more afraid of it than they
need to be. And and they were
sort of saying, Well, how do you
know that if you don't know that
much about this disease, so
he may be one of the very smart
people who sort of felt like it
can't happen here. But
that's right. Yeah. I think I'm
in the same campus as you I was.
I've, I've been one of those
people who, you know, there's a
when I go to Burning Man,
there's this one group. It's,
it's a club dedicated to
existential risk. And we all
talk about what we think the
greatest existential risk is to
humanity. And one of the
sessions that that I attended
and kind of have been holding on
to this That I've considered
was, you know, antibiotic
resistant pathogens. And I come
at this as a as a vegetarian as
well. And I'm aware of the
challenges that we face in in
animal agriculture and the use
of antibiotics and the risk that
we have from, again, this, this
potential vector of these
antibiotic resistant pathogens,
but also what we see with exotic
animals, the trade or the, you
know, keeping up exotic animals,
your you know, for pleasure, and
then also the moving into
natural habitats and the
continued exposure that we have
to pathogens there. So, I was
one of the folks who early on
saw some of the news coming in
in January, so I was I had no
problem stocking up on my set of
n 95 masks. I was looking at
hazmat seats I didn't have that
it was gonna get, you know, in
January, we were stocking up on
beings and all of that. And I'm
lucky, my my partners and open
minded nurse who's like, sounds
pretty, pretty serious. And I
was like, Well, at the time that
was, you know, it's just a
danger, then it became an
epidemic. And then I remember,
you know, kind of monitoring
accounts. And I remember the day
where it was like, I was like,
when are they going to clear
this thing, a pandemic, it seems
to fit the definition, like, why
is this so slow? Why is this not
happening? And, and at that
point, we had moved into
actually, just just social
distancing. I mean, I was lucky,
it was easy. We were working on
my book, and we were already
kind of in a remote town. And so
I was kind of balancing, you
know, working on the book with,
I think that things are about to
get very scary. And so we
started social distancing and in
February, so we've been at this
for a long time. And it's been
phenomenal watching this science
unfold. And it's also been very
complex seeing the role that
behavioral science can play has
played for both better and
worse. Yeah, I want very much
for behavioral science to walk
away from this pandemic, with
the opportunity for a lot of
reflections and learnings. Some
of those early position
statements were were wrong. And,
you know, as you said earlier,
you know, great scientists can
make bad calls. And one of the
things that we need to do to
help advance science is we need
to reflect on those. So we need
to reflect on David helper and
talking about herd immunity, we
need to talk about the
statements that were made about
perception of risk and and
conflating the risk of This
scary pathogen in a way that, it
turns out it is scary.
It sounds like you were ahead of
the game. I mean, when I look
back on sort of my early
thinking about this is twofold.
It was intellectually, this
could happen. But practically
nah, you know, sort of like, the
risk of a house fire. Sure, why
not? You know, Am I really that
prepared? Do I have do I, you
know, if you asked me, you know,
do I know where my fire
extinguishers are? Like, yeah,
I'd have to think about it. But
you know, that's something that
you probably should have like
three or four, you know, in your
house, you know, one in every
room and know exactly where they
are and how to use them. You
know, like I was even in 2019. I
would have otherwise forgotten
this, but I sent this tweet, you
know, he sure we could
definitely have a pandemic
tomorrow. Why not? You know, but
even when I saw that sort of
coming, it was unreal. Like I
hung out with my parents in
February and we were watching
some video from China and some
people and they make some of the
Chinese people have made  like A
funny video, you know, like,
quarintine day 70. And they were
joking around it was kind of
funny. But um, you know, I
remember saying to my mom like,
this could be us and she was
like, Yeah, maybe. I was like,
Yeah, maybe. Yeah, but we didn't
really didn't have that like,
yeah, this could be us. Yes.
Yeah. Where are you now? Are you
in Toronto? Are you still?
I'm in Toronto. We we came up
back in March. Yeah. When the
prime minister said that we'll
be we'll be closing the border
soon. And we want the folks you
know, the Canadians to come
back. So we, we we drove up and
used our hand sanitizer and
gloves and masks, all the way
all the way up in in March.
Yeah. hard drives. So we're back
here. One of the other things
that was very unexpected of all
of this was, Bart has to take
his nursing exam to finish his
status to become a registered
nurse, and the morning that he
was supposed to take the exam.
We went to the campus and the
doors were locked and some other
students were all kind of
milling around thinking, you
know, maybe the proctor was held
up by something. And then they
the students found out that the
exam had been canceled the night
before. And that day began NCLEX
or Pearson, Vue shutting down
all of the locations. So all of
the different exams for many
different fields and licensure
exams were postponed. Yeah. And
they were postponed and
postponed until May. So Bert
actually has not been practicing
as a nurse all of this time,
because he hasn't been able to
take his exam. There are 25,000
nursing students on boarded per
month in the United States that
are now stalled because they
don't have access to their
exams. So their their
reverberations of this are
profound. And I'm surprised I
did my best to try to get
awareness of this issue. And it
hasn't been picked up by by
mainstream media at all, nor
talked about by our politicians.
Hopefully you won't need it.
Hopefully you only knew that I
know here. They graduated
medical students early and you
know,
yeah. And so here they recalled
retired nurses. Yeah. So that's
interesting and and some of the
research that actually was
pointed out in your book, I
think that's where we first kind
of followed it through was that
there are some fields where more
experience helps you be a better
practitioner. Nursing is one of
those fields so Bart's like To
be honest with you, if I had a
choice between a retired nurse
being recalled, versus, you
know, fresh nurses, his
perspective was like, hum humbly
I submit that, you know, good.
I'm like, What? Come on, you
should fight the fight. And he
said, to be honest with us,
like, I think that bringing back
some of those retired nurses to
help manage the pandemic is
actually better, especially
those who lived through SARS,
CoVi-1 one to live through MERS.
You know, of course, that makes
sense. But just generally, the
more experienced nurse he felt
is a better practitioner right
now. I thought that was an
interesting point of view, given
that I was like, but this
affects your livelihood. This
affects your your career and
your and your passion. So here
we are, it's actually may and
the exam still hasn't been
rescheduled so many months out,
following finishing all of the
academic requirements and the,
you know, the residency, the
equivalent of a residency that a
nurse does all of that's been
completed and he just needs to
do the credential exam. And he
hasn't been able to take it yet.
No, that's yet. That's not just
Canada, that's the United
States. And that's other places
as well. We saw that with
doctors. In like the UK, they
were taking doctors in there.
The only completed third year,
perhaps, or partially through
their third year and bring them
into the field. So, so it's
interesting. So we're so we're
still working on the book and
spending our time that way.
All right. Listen, I got another
Thank you. This was fun. Let me
know when it's up. And, you
know, let me know when the other
ones get published too. And, you
know, be safe. I hope your book
is coming along. Well, and
thank you. Thank you. Thank you.
Thank you for reaching out.
Hopefully, I'll get up there in
person one day.
I look forward to it. I'm sure
I take care. Bye Bye.
 
