Imagine setting a New Year’s Resolution — and actually achieving it! Living healthier and losing weight accounts for more than 40% of all New Year’s resolutions. But actually achieving them? That’s a different story. To be sure, “personal fortitude” and “effort” pale in comparison to the role of place and resources when it comes to our health. But for so many of us, even when all the other variables line up, our goals feel a bit too daunting. Abdul reflects on what makes setting big goals so challenging — and why so many of us struggle with our health goals. Then he sits down with Professor Katy Milkman, a behavioral science professor at Penn’s Wharton School, and author of “How to Change: The Science of Getting from Where You Are to Where You Want to Be” to talk about the science of sticking to those New Year’s resolutions.

TRANSCRIPT

[AD BREAK] [sponsor note]

Dr. Abdul El-Sayed, narrating: [music break] Congress passed a major health policy law right before they shut out the lights for the holidays. The FDA announces that abortion pills, which were previously limited to specially certified clinics, can be sold at retail pharmacies, vastly expanding abortion access. Life expectancy dropped to its lowest level since 1996, in 2021. COVID surges in China after the country reverses course on its zero-covid policy. And here at home, XBB.1.5 is spreading across the US. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] New Year, new you, right? The majority of New Year’s resolutions have something to do with our health, get healthy or lose weight or exercise more. But if you’re like me, you’re probably already falling off the bandwagon. You start off strong, new gym membership or unboxing that exercise bike you got for Christmas, and then you go back to work. That eight a.m. meeting coupled with the Netflix binge the night before, means no morning workout. After work you’re spent, so you’ll do it tomorrow and tomorrow turns into next week, next week turns into next year, and then you’re right back to where you started. Here’s the worst part. The door hits you on the way out. After giving up on your resolution, you feel even less capable of achieving it next time or because you’re starting a new diet next week so you think you may as well just eat that extra scoop of ice cream right now. Instead of moving forward, we move backward. Today, we’re going to talk to someone who literally wrote the book on how to change. She’ll share more on the best tips and tricks to making and keeping that resolution, particularly when it comes to health. But before we get there, I want to step back here and acknowledge how fraught the whole idea of quote “self-help” and quote “change” can sometimes be. There’s a whole discourse that assumes that our choices really are only ours to make, but that can lead to three pretty awful consequences. The first is that we end up excusing a whole bunch of industries that spend billions to make sure we make the decisions that end up putting as much of our money in their pockets, not that are best for us. I’m going to stop procrastinating, except that all of social media is built to facilitate that for you. I’m going to eat healthy, except that the food industry has spent billions to lobby government to make sure that the least healthy foods are the cheapest and most plentiful and billions more on top of that to advertise the least healthy foods with the social media giants that are so busy stealing your focus. I’m going to exercise, except that we have to spend 30 minutes on average in a car every single day just to get to work because the auto industry lobbied to plan our communities around making sure we could never walk or take public transit. There’s a second issue, though, and that’s not assuming that our outcomes, our weight or mental health are ours alone to make means that failing to make the right decision becomes, well, blameworthy. And collectively that blame turns into stigma and we stigmatize obesity or mental illness, even though our society is built to maximize them. Which gets to the third and most egregious issue, that any choice we do have isn’t evenly distributed. Some of us, by virtue of our income or wealth or the color of our skin, face far easier choices ahead of us. Discrimination hasn’t compounded to leave us working the least desirable jobs, making peanuts under the thumb of someone else who sets our schedule for us. We make enough to get to choose to buy two bags of spinach at a nearby grocery store instead of a cheeseburger at a nearby McDonald’s, or spend hundreds a month on a gym that we can drive to in a car that we pay yet hundreds more for. Pretending health inequities is a matter of choice can leave us blaming marginalized people for their own marginalization. And I’ve seen firsthand the consequences of that kind of attitude for how we use public policy to marginalize them further. So today we’re talking about setting and sticking with New Year’s resolutions, with the understanding that there’s only so much we can actually control, that if we can control it, it really is a privilege. And I can think of no better person to have that conversation with than our guest today, Professor Katy Milkman. She teaches behavioral economics at the Wharton School of Business. Her work explores how we can manage our own environment and our sense of time to set and maintain our goals and actually achieve them. Her book is super insightful about how to work smart against the forces that work so hard against us, and I’ve personally implemented some of the recommendations and they’ve been really effective. What I love about Professor Milkman’s approach is that she’s taken her thinking beyond self-help to think about public policy, community help to create more choices and opportunity for folks for whom it’s too often been denied. My conversation with Professor Katy Milkman after this break. 

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Dr. Abdul El-Sayed, narrating: Here’s my conversation with Professor Katy Milkman. 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 

Katy Milkman: Sure. I’m Katy Milkman and I’m a professor at the Wharton School at the University of Pennsylvania and author of the book How to Change. 

Dr. Abdul El-Sayed: Katy, Hi. 

Katy Milkman: Hi. 

Dr. Abdul El-Sayed: I’m the problem. It’s me. [laugh] Tell me how to change? 

Katy Milkman: [laughing] Oh, well um, I have this book, no I’m just kidding. Um. It depends. And that’s actually one of the things most of us get wrong is that we think there is a shiny solution that’s off the shelf that will solve all our problems. And we look for that, whether its set big, audacious goals or visualize success. And we actually don’t do the hard work that’s so important, which is trying to figure out what are the obstacles that are in your way in the first place. 

Dr. Abdul El-Sayed: Mm. 

Katy Milkman: And once you actually can diagnose what those barriers are, then you’re going to do a lot better with tailored solutions. So science offers a bunch of answers. But the key is that the right one for you is going to depend on why you’re facing an uphill battle. 

Dr. Abdul El-Sayed: I love how you fit tailored in there, but uh [laugh] you know, uh [laughter] this is not that kind of podcast um because I was going to go down that path, I really would have followed you. We you know, I started it and you kept going. So I was like, you know, we could just make this a Taylor Swift Appreciation podcast. But-

Katy Milkman: I always enjoy a little–

Dr. Abdul El-Sayed: A lot of us–

Katy Milkman: –Taylor Swift appreciation. 

Dr. Abdul El-Sayed: Who doesn’t, right? I mean, um yeah. Thank you, Taylor. Um. So obviously, we’re doing this episode because uh it is New Year’s and a lot of folks have reinvested in themselves in a certain way. They have different goals. Many of them are health related goals. In fact, if you look at a survey of the most common types of New Year’s resolutions, they tend to be health related resolutions. And yet, you know, by the time we get to the end of January and for the holders on February or March, um people have dropped off. And, you know, the reason I wanted to chat is because I think sometimes we don’t take an evidence driven approach to thinking about personnel change. And part of me has always been dubious of this because so much of even what you talk about in your book and what I understand about change has a lot less to do with, you know, us and our willpower and what we do as individuals and a lot more to do with the environments in which we uh live and learn and work and play. And those environments um are built to keep us from changing. You know, you think about our food environment and the ways in which we have artificially cheap, um really bad for you food and, um you know, similarly artificially expensive good for you food. You think about uh the fact that you, like have to get in your car, which is the principal reason you don’t get physical activity to go and get a workout in. Um. That’s that’s kind of absurd. You think about, uh you know, even our our time and procrastination. There are multiple billions of dollars organizations that are dedicated specifically to stealing our focus from us. And so for all of those reasons, it’s just really, really hard. And in some respects, like what we’re trying to do is manipulate the micro environment. Now, you know, the notion of a of a New Year’s resolution is actually, um from what I learned in your book, like it’s actually an evidence based thing. Can you talk a little bit about um the idea of a fresh start and why um, you know, this rather arbitrarily moment on the calendar where the year changes is actually a really important fresh start for a lot of people? 

Katy Milkman: Yeah, I’d be delighted to. And by the way, that was such an elegant summary of what we’re up against when we try to achieve our goals and how important the environment is. But the fresh start effect is um one of my favorite things I’ve ever studied. It’s this really fascinating phenomenon uh where we are more likely and more motivated to pursue goals at any new beginning. So New Year’s is the one we’re all familiar with, but there are other fresh start dates too, like every Monday and the start of a new week and the celebration of a birthday and certain holidays that we associate with new beginnings. And we’ve actually shown in um many data sets that there’s simply natural upticks in people’s engagement and goal pursuit at those moments. So if you look at when people search for the term diet on Google, when they make uh and set goals on popular goal setting websites uh about everything from their finances to their health to their education, um and even when people visit the gym at the highest rate, you see these upticks at all of these fresh start dates. And you asked why. And I think it’s a really, really interesting question. It actually we’ve traced it back and I should say this is research with uh Hengchen Dai of UCLA and Jason Riis of Wharton with me, we’ve trace it back to some research that’s been done on autobiographical memory or the way we think about our lives. 

Dr. Abdul El-Sayed: Mm. 

Katy Milkman: And it’s so interesting. We actually don’t think about time linearly. We think about our life as if we are characters in a book and we’re living out chapters. And uh those bookends for those chapters, they might be things that are really massive, like, you know, those were the college years or these are the years I was living in Boston or these are the years I was working at Deloitte or, you know, they can be things like that, but they can also be these very minor temporal landmarks that come up on the calendar and they create these chapter breaks. And when we have a chapter break, we feel more disconnected from our past self. You can say, oh, that was the old me last year that didn’t quit smoking. But the new me is going to be different. So that disconnect gives you optimism about what you’re capable of because you can set your failures in the past and leave them there. And it also tends to make us think bigger picture about our goals to be able to sort of reflect and step back at those landmarks. So fresh starts are really fascinating. And New Years is the most well known and famous, but we do it throughout our lives and I think it’s really useful to peg um fresh starts as opportunities for change. It gives us renewed hope. And uh you know, of course, we can all benefit from making some changes in our lives. 

Dr. Abdul El-Sayed: Yeah, I appreciate that. I wonder if there’s not a unintended negative consequence. So I think about myself and, um you know, I’m like, alright, New Year, new me. And then by February, I’m like, turns out new me is just like old me. Um. And I’m wondering if, you know, that there is so much about sort of achieving a goal is about momentum on the path to that goal. And if you sort of are a [laugh] we’ll call this the chronic fresh starter, um I can imagine that like once you sort of chronically fresh start like ah I’ll start that diet next week after you eat like a hot pastrami sandwich or pizza or hamburger or whatever it is that you, you know, had been wanting. And then you do this over and over again, it sort of kills the opportunity to have a fresh start. And I can imagine you sort of setting in a pre baked sense of yourself as being someone who can’t have fresh starts right like you because you always just rumble over them. In your research, have you have you sort of looked at that or is that sort of a psychological possibility of like consistently fresh starting? And I guess maybe the the alternative way to ask the question is how important it is to get the fresh start right? [laugh] And like, how deleterious can the consequence be of consistently getting the fresh start wrong? 

Katy Milkman: Yeah, well, your question triggers a few thoughts about what we know. Um. One is that Hengchen Dai of UCLA uh who has done some research on what happens when we’re approaching a fresh start, and she has shown that leading up to fresh start dates, we sort of procrastinate more because we think, oh yeah, after New Year’s, I’m going to start the diet. So like, might as well binge now. Um. So that is a negative effect for sure. 

Dr. Abdul El-Sayed: Mmm. 

Katy Milkman: Uh. But in terms of, you know, when we keep having these fresh starts and and not getting to our goal, which P.S. is not always the case. Right. Plenty of fresh starts and New Year’s resolutions and other resolutions do lead us to achieve our goal. But when it happens over and over again, you might expect people would just stop setting resolutions altogether. What I think is actually so fascinating is how persistent fresh start effect are. We haven’t seen correlations with age, meaning like it’s not like over the lifespan, people obviously become less motivated to pursue their goals at fresh start moments. That’s not something we’ve seen in our data, although maybe it’s there, it just hasn’t popped out for us. Um. And I think the fact that 40% of Americans make a New Year’s resolution every year is actually proof that we are constantly bouncing back and perpetual optimists, despite the fact that something like 80% of them don’t work out. I think that’s very advantageous for humans. Now, I’m not an evolutionary psychologist, but you can pretty easily see why it would be adaptive to have this trait of finding ways to wipe the slate clean and start again. Because if you just become uh discouraged every time something goes wrong and you never try again, not much is going to get done in this world. Right. So so I actually think um it makes sense that we have adapted this way to have these optimistic beliefs about our capabilities that spike around fresh start moments. And uh given that many goals do succeed. I’d rather see more people using those fresh starts to take another shot, then then throwing in the towel. And I think that you know, that’s what we see on average. 

Dr. Abdul El-Sayed: Yeah. So we’re we’re at that point now um where people are starting to potentially throw in the towel on that [laugh] uh on that fresh start. Um uh I wanted to ask, you know, just doing the math, if 40% of Americans set New Year’s resolutions and 80% of them don’t succeed, that means about 10% of Americans will have changed. That’s pretty good. Like that really is pretty good for a completely arbitrary thing that we decided in our mind. Right. 

Katy Milkman: Pretty amazing, really. Yeah.

Dr. Abdul El-Sayed: It is. It is. So what are the key things that people who are a part of that um that 10% do that the others don’t do? 

Katy Milkman: Yeah, well, let’s talk about one thing that is universal uh and then we can start getting into some of the, the solutions that are going to depend on what obstacles you face. And again, one of the things that people who succeed often do is they think about those obstacles. But one thing that’s universal is the way you set the goal. So it’s really important not to say something vague like, I’m going to exercise more this year or I’m going to learn a new language. That that’s nice, you can start with that, but you can’t stop with that. You need to be much more specific. So successful goal setters typically um set a much more concrete goal and actually think through when, where, and how they’ll do it. This is based on research by NYU’s um Peter Gollwitzer, so he found that when people set these vague goals, they have worse outcomes than when they say, you know, I’m going to exercise on Tuesdays, Wednesdays, and Thursdays at 5 p.m. for half an hour, that’s much more specific. You’ve defined when you’re going to do it, what you’re going to do, um maybe even you want to think through how you’re going to get there. That’s called an implementation intention. It makes it more likely you’ll remember that you have to actually enact your goal, less likely to procrastinate, because now that’s not putting off a vague intention, but it’s it’s actually a concrete act that you’ve committed to and now you’re not doing it at the time you said you would. Um. Another thing that’s really valuable and that my research has looked at is choosing a bite sized approach, meaning I’m going to say I’m going to work out 4 hours a week instead of more this year uh or instead of 200 hours uh this whole year. You know, break it down into what’s this week’s goal? In one study that was led by my student Anish Rye at Penn, we found that a volunteering organization that encouraged everyone to sign up for 200 hours of volunteering a year and then would nudge them and remind them, hey, you know, do some hours this week, they got 10% more volunteering when they reminded people to do 4 hours every week as opposed to some hours every week towards that goal. Because when we make it concrete, what that bite sized unit is, uh we achieve a lot more. So plan exactly when, where, and how you’ll do it and figure out what the weekly bite size commitment is as opposed to the sort of year long objective. And that’s important for everyone, regardless of the obstacles you may face. 

Dr. Abdul El-Sayed: Yeah, you can you can see how that plays out, right? Because if if you’re sort of thinking, well, you know, I’ve got 200 more hours to go, that 200 seems so daunting that you might as well give up now rather than saying, you know what, I’ve got 4 hours to do this week. I can fit in an hour on Wednesday, an hour on Thursday, maybe 2 hours over the weekend, and I’m there. Um. I wanted to ask you, you know, health related goals um are so much more personal and so much more pressing. And we spend a lot of time on this podcast thinking about the ways that you know health is a little bit different. Right? It is the it is the final resource in some respects. And, you know, it is also something that is so imminently easy to ignore when your health is still not bothering you. Right. And I don’t mean to say quote “good or bad”, but it’s not a constant reminder of either pain or dysfunction in your life. And it’s in some respects why we um as a society are so bad at preventing illness, because we assume that the good times are going to continue to roll forever. Um. And so the things that we do to maintain our health uh can be a lot harder. And then once we are experiencing pain or dysfunction or even potential loss of function or loss of life, um then all of a sudden when it’s too late, we we sort of jump in when we could have been doing all of these things uh in the past. And at the same time, there’s just a lot of stigma and self-blame. Right? And part of the, the challenge um that I often have with the discourse about about weight and we’ll be exploring that quite a bit in the next couple of months uh on the show is that um we sort of we ignore all of the things that that society has done to make our um society so much less likely to eat healthy and exercise. And then um rather than thinking about weight status as an environmental uh circumstance that some people are more susceptible to, we think about it as a personal failure. And then the idea of sort of setting weight based goals just reinforces that thinking. And it tells people that I must be a bad person because I cannot achieve X weight uh or or X outcome. And then, you know, you know, because that is reinforced in society across society, people are judging you for um what they perceive you are not doing uh for your own health. Right. And um and so, you know, there are a lot of ways that I can think about that that make health based goals so much different. Um. I’d love to ask you, are they different when when you sort of think about probability of people um executing on a goal plan or uh achieving a particular goal? Um. How how do they show up differently versus other goals? 

Katy Milkman: Yeah, that’s a really great question. I actually haven’t analyzed to look at, say, you know, by health versus financial versus, you know, educational, what are those success rates? And um I’m sure someone has that data at their fingertips. I don’t, what I will tell you is that um I got interested in studying this because of data I’d seen on health. And that’s what motivated me to devote my career to studying behavior change. And specifically one statistic that that stands out for me that I think you’ll find interesting, which is I learned that um uh based on estimates from a 2007 paper, about 40% of premature deaths in the U.S. are due to daily decisions uh that we could change. And I want to actually just emphasize for a moment, I 100% agree with you. We should not be blaming people or claiming this is a willpower issue. Uh. This is not a willpower issue. The the environment, our financial status, um you know, our social supports are are driving this our, you know, the the marketing that’s being thrown at us, the government policy policies that we are surrounded by. So this is not an individual’s fault. However, individual decisions and daily decisions accumulate in an enormous way. And this statistic blew my mind. So the decisions we make about what we eat, um whether or not we’re physically active, uh whether we’re safe when we get in cars, whether or not we drink, whether we smoke, they just accumulate enormously. And I honestly had no idea how big those consequences were. Um. Once you recognize how big they are, you start to appreciate why so many New Year’s resolutions are about health, because um this matters just immensely. And one of the challenges, besides all the things you just mentioned and that I wanted to reinforce regarding sort of the environment we live in and how that pushes us in, in directions that can be challenging for our long term health is also just the way we’re wired. So even if none of those problems existed, we as humans are wired to overvalue instant gratification and dramatically undervalue and discount delayed rewards. Um. 

Dr. Abdul El-Sayed: Mm. 

Katy Milkman: It’s called present bias. If you’re, you know, a nerd and like to read the economics and psychology literature. And– 

Dr. Abdul El-Sayed: So really we all live in the moment too much? [laughing] 

Katy Milkman: Exac– Well, I don’t [laughter] you know, we can debate whether it’s too much and you can understand, again, I’m not an evolutionary psychologist, but you could understand why it might have been adaptive at some point and maybe even now. Right? To sort of seize the day. Right? That’s a there’s a reason that’s a popular expression, um but it does cause problems when there’s a disconnect between our actions and the consequences in terms of time. And health is obviously an area where that’s a huge deal. Right? Choosing the pizza over the salad today, it feels better. It has these really long term consequences and I have to somehow convince myself uh to focus on those very delayed rewards to make the the right choice. Um. So between that and all of the marketing that’s being thrown at us, all of you know the environmental factors that make it challenging, it is really, really difficult um to make those daily decisions that can reduce your uh chance of premature death so dramatically. 

Dr. Abdul El-Sayed: One of the hard parts, right, is, you know, you cited that that 40% statistic, one of the challenges and, you know, as a as a behavioral economist, we sort of think through you think through all the ways that society sets up decisions to be made in certain ways. Right. Um. And we talked at the jump about the ways that decisions sort of get made because of the environments that are created. And I guess this is a two parter here. How many of those, that 40% of decisions that wind up in premature death, how many of those, you know, are predetermined? And you particularly as you think about the inequities in who experiences premature death, a lot of that has to do with do you have a walkable environment? Can you afford two bags of spinach versus the two burgers that um you can buy for the same price? Can you even get to a grocery store that sells um that those two bags of spinach in the first place? Um. You know, do you have uh a community where you can reliably get to a job that’s close to your home that you could potentially walk to or take public transit to? Right. These are all all circumstances that set up those decisions. And, you know, for some people working against those circumstances, quote “making the right health decision” is just so much harder because the set up is so much worse. Um. How much of those those decision do you feel like are actually surmountable? Like are actually makeable? 

Katy Milkman: Yeah. 

Dr. Abdul El-Sayed: Because I think about my life and I um, I am privileged and um the decisions I make about food and exercise really are a function of an open playing field. 

Katy Milkman: Yeah. 

Dr. Abdul El-Sayed: Whereas I could imagine a counterfactual of myself where um I have substantially fewer resources and circumstance dictates a lot of my optionality um where I’m consistently making, quote, “bad decisions” and then because we architect them as decisions, um society blames me for the bad decisions that I make. 

Katy Milkman: Yeah. 

Dr. Abdul El-Sayed: How much of that decision making do you think is dictated? And then the second question is how do we empower people to have agency in circumstances without the consequential blame that comes with, quote, “making the bad decision”? 

Katy Milkman: Well, first of all, uh I 100% agree with you that we exhibit actually something called the fundamental attribution error, which is we we blame the individual for choices when in fact their circumstances dictate far more of their choices than we recognize. So this is sort of the, the person cuts you off on the highway and you think, what a jerk. But like what you don’t think about is what must have led them to cut you off. Like maybe there’s a pregnant person in the passenger seat who’s, you know–

Dr. Abdul El-Sayed: Mm hmm. 

Katy Milkman: –they’re rushing them to labor. But we always jump to the individual as the problem as opposed to the situation. Um. So that’s a fundamental attribution error. It’s been demonstrated time and again. It’s so important to keep in mind. Uh. And and you’re absolutely right, there’s no question that in terms of agency and the ability to um make changes, using the best science to achieve your goals and to reduce your risk of premature death, that comes far easier to those of us with privilege uh because our our situation facilitates using all the best tools and makes it easier. That all said, there is an opportunity to use science to help individuals make change. I don’t think that should be the primary tool. We need policymakers recognizing how huge the situation is and and creating a more level playing field so that everyone can go and buy spinach and eat healthy foods and uh get their exercise and, uh you know, live a life that supports quitting smoking, avoiding alcohol, uh or at least alcohol in excess and so on. So so I 100% agree with you. On the other hand, um what I study and what I have to offer the world is sort of how individual decisions can be improved and the tools are more likely to help people who have better situations. There’s no question. 

Dr. Abdul El-Sayed: Yeah, I appreciate that. And um I think that sometimes deterministic thinking, it tends to pull us away from the agency that does exist. And that’s the hard part, right? I think, you know, there are sort of two strains in social science. One is, you know, in frankly, in public policy is like one is people have of agency entirely, and then the other one is people’s choices are fully and 100% determined. And the truth is somewhere in the middle, right? Is that there are there’s a lot of um environmental determinism that does happen. And if we ignore it, we end up attributing uh blame in the wrong directions. And then people do have agency and they do make choices. And the choices that we make do have impact. So, you know, for a lot of our listeners, they will have made New Year’s resolutions. And part of why I wanted to bring up the role of environment is because so many of the tips, the evidence driven tips that you offer in your book are really about controlling environments um and sort of altering the micro environment in which you live, such that you’re more likely to make the right decision. Can you talk a little bit about the evidence around what works in maintaining and keeping a goal? We talked about fresh starts, but what are some of the other ones that folks should be thinking about? 

Katy Milkman: Yeah, well, again, it depends on the barriers, but a very common barrier um is that your environment is not set up to facilitate making healthy or or, you know, financially wise choices. So to the extent that there’s more friction, it’s it’s harder to do the things that are in your best interest, you’re going to be a lot less likely to do them. This is not rocket science, and yet it’s something we neglect because we figure, oh yeah, you know, of course I’ll I’ll do the right thing or I’ll like cook the healthy meal for myself. Um. Defaults or what’s available most easily and readily have this enormous impact on our choices. And so that suggests you may want to set up your environment, your home, your workplace, um your routines in a way that very deliberately reinforces the kinds of choices you’d like to make. So what do I mean by that? Um. What you keep in your pantry, what you keep in your freezer, uh you know, if you have cookies and ice cream and junk food readily available, um that’s your default. That’s the first thing you’re going to reach for. If those things are not available now I have to walk to the grocery store when I’m craving ice cream or drive to the grocery store when I’m craving ice cream because it’s not in my house, but I have healthy snacks. Uh. Well, now the default is very different. You can create frictions in all parts of your life by you know choosing um what kinds of transportation you make available to yourself on a daily basis and and where you insert frictions by how choosing how close you live to certain um resources. And of course, going back to privilege, not all of us have the privilege to choose um to live in places that support healthy habits. But to the extent that you do have any um agency over, you know, what’s in your home, what’s in your environment, the easier you can make it to reach for healthy, uh you know, financially wise choices, the better. Um. And there are simple things you can do, like thinking about defaults. Uh. Let’s talk about finances. We’ve been talking about health. If you’re thinking about your finances, one of the most powerful findings from actually the whole behavioral economics literature is that when your employer automatically enrolls you in their retirement savings program, you’re dramatically more likely and you can opt out, you’re dramatically more likely to be a saver than when they um give you the option to enroll yourself to opt in. Uh. You see about a 40 percentage point jump in the rate at which people are saving for retirement just based on what the default is on the first day they go to work. Um. And by the way, now it’s tax advantaged and uh for your employer to automatically enroll you, you can use that insight, though, in your own finances by thinking about setting up automatic uh deductions saved from every paycheck that go into a savings account in addition to whatever’s happening with your employer. Um. You can set up auto payment on your credit card so you’re not going to get dinged each month with fees if you aren’t paying attention and don’t remember um to hit your payment on time. So uh think about ways that you can structure your environment so that the defaults, whether it’s the snacks that are available to you when you reach into your pantry or whether it’s, uh you know, what happens to your paycheck the minute it hits your bank account are going to facilitate the kind of choices you’d like to be making, as opposed to requiring a little extra effort. 

Dr. Abdul El-Sayed, narrating: We’ll be back with more with Professor Katy Milkman after this break. 

[AD BREAK]

Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Professor Katy Milkman. 

Dr. Abdul El-Sayed: I was uh reading your book and then reflecting on um a helpful metaphor, which I found really engaging, which is yeah I just got a new car and it’s um I’m driving a lot more given a new job. And uh there are two versions of lane assist. One is where the car steers for you, which you can steer it out of what it’s trying to get you to steer into. But for the most part, it’s steering you down the course, right? And then the other one is, if you don’t have that option on, you’ll get a little rumble every time you get close to the lane marker. And [laugh] um you can kind of think about that as a default versus a friction. Right. 

Katy Milkman: Mm hmm. 

Dr. Abdul El-Sayed: And um if every time you’re sort of veering off course, you get a little bump and it it kind of pushes you back in. Um. That’s helpful. And, you know, you think about those as safety mechanisms. The whole point is that, you know, nine times out of ten, there’s not another car in that other lane. But, you know, one time out of ten there is. And so you you play the probabilities and you’re preventing a certain number of accidents that might have happened had you not had those functions. And you know when you think about um the ways that that people use these kind of tools in their lives, um can you give us a couple of good examples of the ways that people use defaults from a health perspective in particular? 

Katy Milkman: We sort of already talked about one right? Which is uh what you stock in your house, like the food you have. That– 

Dr. Abdul El-Sayed: Right. 

Katy Milkman: –I think that’s the best example of defaults for health is just thinking carefully about what the default foods are that are available when when it’s time to eat. Um. And another one certainly is how easy you make it for yourself to exercise. Right. And that’s that’s a friction. It’s a little hard to call it a default. Exactly. But but basically, the more frictionless, the closer you are to a default. Uh. So thinking about things like uh can you have workout equipment in your house as opposed to having to go to a gym and have that commute uh could really matter. Um. Thinking about whether or not there’s a way you can walk to work or bike to work as opposed to it’s a drive only situation that you’ve set yourself up for. Those are the kinds of frictions that you want to try to remove when you’re thinking about healthy choices. One of the challenges with health, frankly, is that defaults are harder to set. It’s much easier to do in financial decision making to right set that auto deduction from your bank account and you set it and forget it and it’s done and there’s literally no more work you have to do. It happens every month like clockwork. The really hard thing about healthy eating and exercise is you can’t sign yourself up automatically to eat the right foods or to get to the gym. I think that’s why these are much harder problems and they require some different tools. But starting with removing as many frictions as possible is a great option. 

Dr. Abdul El-Sayed: A friend of mine who um threw away all of his pajamas and uh now sleeps in workout clothes because then when he wakes up, he has to make a conscious choice to change out of his workout clothes. And uh he you know he used to tell me he’s like, the worst thing about waking up [?] we both live in Michigan is that, you know, changing your clothes in the morning is just awful. And so he’s like, I’d wake up. It was cold. I didn’t want to change into my gym clothes and go to the gym. So I just realized, I just start wearing my gym clothes to bed. And then I’d wake up in my gym clothes and I could literally roll out the bed and go work out. And it was sort of a– 

Katy Milkman: –Friction reducer. 

Dr. Abdul El-Sayed: –A nifty, exactly right is like one less thing I have to think about um in order to um to change my engagement. 

Katy Milkman: Do you know the great story of Victor Hugo and his clothing strategy? 

Dr. Abdul El-Sayed: No, I’d love to hear it. 

Katy Milkman: So Victor Hugo was having trouble uh finishing The Hunchback of Notre Dame. Right he had a contract to write it and just wasn’t getting it done. And apparently he really liked to socialize and was, you know, out in Paris partying all the time and realized that was not working. He wasn’t he wasn’t getting this done. So the legend is that he locked away his clothes. 

Dr. Abdul El-Sayed: Wow. 

Katy Milkman: So all he had was a shaw– a writing shawl and he couldn’t go out and hang out with his friends any more and he finished The Hunchback of Notre Dame. 

Dr. Abdul El-Sayed: Wow. 

Katy Milkman: So it’s another clothing uh access strategy. It’s this one’s called what I would call a commitment device. Um. Preventing yourself from having access to something is a bit different than making it easier to get to the gym because you’re already wearing your clothes. But they’re both clothing based strategies. [laugh]

Dr. Abdul El-Sayed: Who knew? Like clothing was such a such an important piece of this. Um. [laugh] So my biggest my biggest challenge to working out is waking up on time. I really cannot stand waking up. I I was, I’m one of those people who aspires to be a morning person but is decidedly not. Um. But, you know, given the structure of of uh our lives, that that is the best time to work out. And so, you know, in thinking about um how to wake up on time, I’ve [laugh] I’ve downloaded this ridiculous alarm clock app called AlarmMe uh which forces me uh when I wake up to do complex math problems. And then because I was I realized that like the way around it in my stupor was to just pull up my calculator app and do the complex math problems on the calculator and then turn it off. It makes me rewrite um a set of statements like retype them and I have very large thumbs and so I constantly make mistakes. And then um once I realized like how I could game that I um it makes me do squats. So um in order to turn off my alarm, I literally have to do five math problems. I have to retype two sentences, and then I have to do squats. And it’s actually really a sad like it’s a sad thing, part of me is just like, this is a sad comment on uh the world in which we live. And at the same time, I haven’t you know not woken up on time in in weeks, which is which is really lovely. Um. Uh.

Katy Milkman: That’s an amazing commitment device. I love that. 

Dr. Abdul El-Sayed: Yeah. 

Katy Milkman: I’ve heard of Clocky, which is a physical, it’s an alarm clock that runs away from you uh and–

Dr. Abdul El-Sayed: Oh wow. 

Katy Milkman: –You know, so it forces you to like, chase it around your bed– it has wheels. Um. That was invented for a similar reason. But I haven’t heard of this app, so I’m going to have to check that out. 

Dr. Abdul El-Sayed: I’m afraid that if I had a Clocky, I probably would throw it off the balcony. I’d be like–

Katy Milkman: You might not be alone. 

Dr. Abdul El-Sayed: –I’d catch it and be like, you’re done.

Katy Milkman: I’m sure that’s happened. [laughter]

Dr. Abdul El-Sayed: Like you’re going to run away from me at 6:00 in the morning. Watch, watch, watch what’s going to happen. [laughing]

Katy Milkman: Well what you’re what you’re doing there is you’re um basically increasing the price. Uh. You know, it’s not a cost in the traditional sense, right? Like you’re not paying money, but uh it’s a cost because you’re having to do all these activities. You’re increasing the price of your vice. So that’s one really effective way to increase the likelihood of succeeding on goals. And economists call it a commitment device. The most traditional examples are where you actually put money on the line that you’ll have to forfeit if you don’t achieve a goal. And one of my favorite research studies um done by uh Xavier Giné and Dean Karlan and uh Jon Zinman looked at what happened when smokers had an opportunity who, smokers who wanted to quit, I should say, had an opportunity to put money on the line that they’d have to forfeit if they didn’t quit smoking six months later and and then they couldn’t cheat. So this was measured by a urine test. 

Dr. Abdul El-Sayed: Mm. 

Katy Milkman: So they randomly assigned some people to have a way to put money on the line. They’d have to forfeit if they don’t pass this urine test, um these smokers. And the other group gets sort of all the traditional tools for quitting smoking. And what they found is a 30% higher quit rate among the group that was given access to this way of fining themselves if they failed to quit. So really powerful tool and your your example there is sort of a a cost that you’re imposing on yourself cognitively instead of on your bank account. But both come out of the same tradition that um if we can increase the price or the cost of whatever bad behavior we want to quit, we succeed. And of course, policymakers know this, right? That’s why we have fines and taxes on bad behaviors and whatnot. Um. But you can do it to yourself, and and that could be very useful, too. 

Dr. Abdul El-Sayed: Hmm. There’s there’s two other pieces I wanted to um ask you about. One is, is the ability to use cues. Um. Or even uh like sort of stacking activities. Um. Can you talk about how that works and why it’s so helpful? 

Katy Milkman: Yeah, absolutely. So one of the reasons we don’t do the things we want to do is that they’re not top of mind, our attention isn’t drawn to them, and we forget. Uh. It sounds ridiculous. We actually dramatically underestimate the likelihood we will forget to do the things that are important to us. We’re like, of course I will. And then, oops. Um. So people undervalue things like reminders and timely reminders are particularly important. When you make a concrete plan and choose a date and time, you’ll do something, which is something we talked about earlier, is a powerful and important part of goal setting. Um. One of the functions that has is that it creates a cue to action. And just like an actor needs a cue to know when to say their lines, your mind needs that cue to jog at that oh, this is the time when I said I would do X, right? So if you choose a date and time, for instance, when you intend to get a flu shot, if you’re prompted, just think through that. It dramatically increases the likelihood you follow through uh dramatically. I shouldn’t say because it’s more like a four percentage point increase, but dramatically at such a low cost uh if we send you a mailing that reminds you to to pick a date and time. Same is true for voter turnout. There’s really great research showing when voters are not just reminded to vote but asked um to state, you know, what time will you vote? Uh. How will you get there? Um. Thinking through that concrete plan, now there’s a cue, a time that you intend to do it. You’re more likely to put it on your calendar and get a reminder from a digital assistant uh that is really, really valuable. But it is important when we think about reminders to make sure that the moment you remind yourself is a moment when you can take action. This sounds, I think, um maybe more trivial than it actually is, because a lot of the time you’ll you know write something down on a notepad or ask your spouse to remind you to do something or partner to remind you to do something or your roommate. Uh. But if that reminder then comes at a moment when you can’t follow through, right? So, um you know, your spouse reminds you in the morning, don’t forget and to pick up milk on the way home. Like by the time you are on your way home, that is unlikely to still be in mind. So uh although there is a cue, so it’s a little better if they say on the way home, then sometime today uh ideally you are actually creating reminders that will pop up in your life at the exact moment when you can pick up the milk and so on. Um. So cues are really important. 

Dr. Abdul El-Sayed: That’s that’s really helpful. Um. One thing we we talked about in the conversation earlier was the sort of tradeoff between short term and long term, like we are wired to want long term pleasure. I mean, short term pleasure. Um. And–

Katy Milkman: If only we were wired–

Dr. Abdul El-Sayed: –Yeah if only–

Katy Milkman: –to want long term. 

Dr. Abdul El-Sayed: –long term pleasure, right? Um. 

Katy Milkman: Yeah. 

Dr. Abdul El-Sayed: Uh. 

Katy Milkman: Well, we would have no problems. 

Dr. Abdul El-Sayed: No, I mean, I think life would be a pretty drab place, to be honest, though. 

Katy Milkman: Agreed, it would be. That’s true. We would [laughing]. 

Dr. Abdul El-Sayed: We would– 

Katy Milkman: We would all save all day. 

Dr. Abdul El-Sayed: Yeah. 

Katy Milkman: No one would ever go to you know the movies or [laugh] out to dinner. 

Dr. Abdul El-Sayed: I think the entire entertainment industry would be, like, destroyed. 

Katy Milkman: Yeah. 

Dr. Abdul El-Sayed: Um. 

Katy Milkman: Yeah. No parties anymore. 

Dr. Abdul El-Sayed: I could Netflix, but instead I’m going to study for my exam. [laughter]

Katy Milkman: Yeah. Binge watching isn’t a thing. 

Dr. Abdul El-Sayed: I’m going to binge study. It’s going be great. Uh. I wonder, though, there are some activities that are actually truly pleasurable in the moment. It’s just that the cost of doing them is super high. I mean, I think about two of them um is one that you and I do quite a bit of, uh which is writing, um which, you know, when you think about I have to write something there is this like need to push away from it in the short term. And then once you actually get writing, it’s actually quite pleasurable. It’s like a lot of fun because you’re plumbing your mind and there’s something really um engaging about the quote, flow activity of it all. Working out is similar right? You say I don’t really want to work out, but then while you’re doing it, you’re like, oh, this is this is great. I feel good, all of the sort of chemical release that you get, plus the feeling of having done it, which you get a certain uh enjoyment out of. You know, we talked a little bit about commitment devices, but are there ways to to get us past that hump of dread, of starting an activity to get to the point where you’re enjoying that activity? 

Katy Milkman: Yeah, absolutely. And um this is really important. If if the barrier to your goal achievement is present bias, that the thing that I want to do feels like a chore. It’s not fun in the moment. I know it’s important, but I am dreading it. Um. One of actually my favorite findings in the last decade in behavioral science is that we underestimate the importance of, actually don’t place much weight at all on the importance of enjoying the activities that we need to pursue. We think, you know, that long term goal is enough. 

Dr. Abdul El-Sayed: Mm hmm. 

Katy Milkman: But in reality, if we don’t enjoy it in the moment, we don’t persist. Um. So how do you how do you make it fun to do the things that feel like chores? Actually answering that question turns out to be one of the keys to success, and there’s a bunch of different ways you can do it. One is selecting different activities to begin with to pursue your goals. So say you want to get in shape and you’re thinking the most efficient strategy for that is going to be hop on the the Stairmaster for 45 minutes a day and just grind it out. But that’s miserable. Um. You would probably be much better off, even if it’s less efficient choosing to go to a Zumba class with a friend because you’re going to enjoy it and so you’re going to keep doing it. Mm hmm. So you can choose different activities, choose a way to exercise or, um you know, eat that that’s actually enjoyable in the moment. Another strategy, and this is one I’ve studied, is what I call temptation bundling, and that is uh only allowing yourself to enjoy a temptation, something that you’ll look forward to. That’s a real treat while you are simultaneously engaging and goal pursuit. 

Dr. Abdul El-Sayed: Mm hmm. 

Katy Milkman: Something that otherwise would feel like a chore. So going to the exercise example, you know, you can only binge watch your favorite show on Netflix while you’re exercising at the gym. Um. Those two things are inextricably intertwined, and now you start craving trips to the gym to find out what happens next to your favorite characters. Time flies while you’re there because you’re distracted and actually maybe you waste less time binge watching TV when you could be doing something productive um outside of uh the gym. So that’s an example. And of course, you can use it in lots of domains, not just with exercise, right? It can be. I only open my favorite bottle of wine when I’m cooking my family a fresh meal. I only listen to my favorite podcast while I’m doing household chores. Say a certain restaurant that’s not so healthy, but that I crave their burgers. I only go there with a difficult relative. You know, there’s lots of different ways. I talk to my students about picking up the Starbucks drink they crave only on the way to hit the books at the library. So temptation bundling is another big opportunity to make it more fun to pursue your goals. And then the final one is actually just making it social. We often forget about how much pleasure we get from doing things with other people, things that might otherwise feel like a chore. Um. And I have some recent research led by Rachel Gershon that I got to be involved with that looked at what happened when friends signed up to try to work out more um together. They signed up for a program together and we randomized whether or not they were each individually paid a dollar every time they came to the gym or they were each paid a dollar, only if they came to the gym at the same time. 

Dr. Abdul El-Sayed: Mm. 

Katy Milkman: So it’s harder to earn that dollar when you have to coordinate with your friend. Should be less effective according to economic theory, it’s harder to get your incentive, but it leads to about 35% more workouts. And when we look at why, there’s two reasons. One, people say it’s way more fun to exercise with their friends, and two, they feel accountable to someone. So going back to that sort of commitment and what’s interesting is if you and your friend are signed up for this program, you can each earn a dollar together. You could coordinate your workouts, you could just do that. You don’t have to be forced to. But people don’t realize that intuitively how valuable it will be if they pursue their goals with a friend. And uh so I think we should use that tool more to make it fun. And one of my favorite examples is of my dad, who I think figured this out. He uh figured out that to get his taxes done every year, uh the best strategy was to have a long dinner with a lot of wine with his accountant, who was a good friend, and uh to go through that financial planning exercise and that financial um tax paying exercise um in a way that was enjoyable and social. 

Dr. Abdul El-Sayed: Well, we really appreciate that. And I think um these are really helpful approaches to thinking about um how to maintain those New Year’s resolutions. And I really appreciate you thinking with us about some of the ways we think about choice and um and whether or not choices are as much choices for for some people and not others. Our guest today is Katy Milkman. She is the James G. Dynan professor at the Wharton School of the University of Pennsylvania um and also holds an appointment at Penn’s Perelman School of Medicine. Um. She’s also the author of the excellent book, How to Change. Uh. Katy, thank you so much for taking the time. 

Katy Milkman: Thanks so much for having me. [music break]

Dr. Abdul El-Sayed, narrating: Here’s an extended version of what I’ve been watching since the New Year. Just before the holidays, way back in the bad old days of 2022. Congress passed an omnibus spending bill that doubled as a major health policy law as they shut out the lights before the holidays. 

[clip of unspecified news reporter] Breaking news here in Washington. The House just passed that massive $1.7 trillion dollar spending bill to avoid a government shutdown. 

Dr. Abdul El-Sayed: Let me give you a rundown of what’s in it. First, the Centers for Medicaid and Medicare Services who decide on physician reimbursements, were proposing a 4.5% cut in what physicians would be reimbursed for caring for Medicare patients in the new year, which, of course, you can imagine doctors opposed. They don’t want to get paid less for what they do. In the end, this bill ended up reducing that cut to about 2%. Spending cuts sound like a good idea in principle. After all, don’t we all want to reduce the cost of health care? Well, yes, but the real problem isn’t how much doctors make, which is less than about 20% of the value of all health care spending. It’s how much huge gatekeeping corporations make. Hitting doctors for our corporatized medical system. Well, that’s just not the move. On top of that, so much of the opposition among doctors for public health care, like Medicare for All, is that public insurance programs like Medicare already reimburse way less than private health insurance programs. This just makes that problem worse. Since the pandemic, there’s been a freeze on kicking folks off of Medicaid, which is the government insurance program for low income people operated by states. Congress also voted to end that freeze. I don’t have to tell you, but this sucks for millions of Americans. On the upside, though, Congress did vote to extend CHIP, a version of Medicaid for kids. It also voted to guarantee at least one year of Medicaid eligibility for moms, babies, and others who delivered after birth in states that had already moved to do that. That’s 33 states, and that is a big win. Congress extended pandemic era telehealth provisions. Those provisions that allowed you to, well, use telecommunications like a protected version of Zoom to see a patient. They extended that for two years. And I kind of just wish they made them permanent because well, Internet? And then there was the Prevent Act, which transforms America’s pandemic response apparatus. It creates an office of pandemic preparedness and response in the White House. While I love the idea of that kind of an office, I wonder how it will actually work in practice. Sometimes as someone who works in government public health, I can tell you that more bureaucracy sometimes means less action. And I wonder how between this office, the CDC and the Assistant Secretary for preparedness and response in the Department of Health and Human Services, they’ll actually coordinate action. What’s that they say about too many cooks in the kitchen? The law also makes the CDC director’s appointment conditional on Senate approval. While it may sound like a good idea, I’m not so sure. Remember, the Senate weights votes in Wyoming at 67 times votes in California. Simply because both states have two senators. Wyoming is blood red and California ocean blue. Are we sure that we want the Senate overseeing who runs the CDC? At the same time, though, you can imagine Senate confirmation as a check on a potential president, Ron DeSantis. I hate that I just had to say that. Appointing an anti-vax wahoo for the role. More in Government news: 

[clip of unspecified news reporter] The FDA has finalized a rule change yesterday that broadens availability of abortion pills. 

Dr. Abdul El-Sayed: To get an abortion pill, you used to have to go in person to a specialized clinic. And the FDA, well, they just changed that rule. So now abortion pills can be picked up or delivered from certain local retail pharmacies. The change in rules will vastly increase access to safe legal abortions, particularly in states where abortion remains legal. However, pills will remain unavailable in states that have banned abortions and specifically abortion pills. Most legal experts say that the rule change will set up years of court battles as both sides test the limits on how these competing regulations will apply. At the end of 2022, new 2021 life expectancy numbers came out showing what we all kind of already knew. That 2021 was a terrible year for Americans’ health. Life expectancy continued its downward trajectory, dropping to its lowest point in 25 years. That’s 1996, you know, back when Tupac was alive, Michael Jordan was still in the league. The Internet made funny noises. The drop, as you could imagine, was a consequence of the Omicron variant, which took more lives in 2021 than every COVID variant that came before it. But it wasn’t just COVID, it was all the despair that COVID also created. Suicide and overdose deaths, sadly, were way up too. Meanwhile Covid, well, still ain’t over. New Year, new variant. This time it’s XBB.1.5, which started December at just 2% of all cases, and now claims more than 40%. As always, there are four questions we should be asking. Is it more transmissible? Is it more immune evasive? Is it more virulent? Meaning does it cause more serious illness? And does it evade our treatments? The W.H.O. has called this the most transmissible variant yet because the virus can bind more efficiently to our cells than any variant before it. It’s also more immune evasive. That said, if you’ve had a recent infection in the past 3 to 6 months or you’ve gotten a new bivalent vaccine, those are still showing good protection as far as we know. And Paxlovid should continue to be effective against XBB.1.5 too. But as always, if you really want to minimize your exposure, well, a well-fitting N95 mask will do the trick. And as children go back to school following the holidays, mixing with their classmates and teachers after a festive holiday season. It’s really worth considering putting a mask on those little faces as they go back to school. Especially in the first two weeks. But that’s all here in the U.S., of course, in China COVID is rampaging. 

[clip of unspecified news reporter] Now to China, where a rapid surge of COVID 19 infections is overwhelming hospitals across the country. Some health experts predict China could suffer up to a million COVID deaths in the next few months. 

Dr. Abdul El-Sayed: Surge is a perfect storm because of China’s draconian zero-covid policies. Most people in China have had very little exposure to the virus, meaning their immunity is quite low. Meanwhile, China’s Sinovac is only marginally effective against Omicron and its subvariants and uptake has been dreadfully low, particularly in the most vulnerable. That being seniors. Now that China has let the virus rip, it’s hitting an immune naive population and flooding the country’s hospitals. The usual suspects here in the U.S. are using that to argue that allowing the virus to spread here in the U.S. was a good idea. But that’s both dumb and self-serving. China, with its autocratic regime, was never a good example of how to fight the virus. Their approach never won the trust of the population, as evidenced by the very low vaccination rates. Instead, look at leaders like New Zealand, where high vaccination rates, coupled with smart, thoughtful containment, kept disease rates low throughout the pandemic. All right. That was a lot. But we’re finally done for today. I promise you, next week, uh quite a bit shorter. I had a lot to make up for. On your way out. Do not forget to rate and review our show, please. It goes a long way. Let’s start 2023 off with a bang. Also, if you love the show and want to rep us, we’ve still got some America Dissected merch. You could add some science to your drip, so I hope that you’ll check us out at the Crooked store. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and Ines Masa. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez, and me, Dr. Abdul El-Sayed. Your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veterans Services. [music break]

Katy Milkman: Uh. Now I have a question. 

Dr. Abdul El-Sayed: Sure. 

Katy Milkman: Is that a Ruth Bader Ginsburg bobblehead in the background? 

Dr. Abdul El-Sayed: Oh, absolutely it is.

Katy Milkman: So cool. I have serious bobble head envy. 

Dr. Abdul El-Sayed: We have we have RBG. We have uh Ali. We have, can you guys see Bernie here? You probably can’t. No. [?]

Katy Milkman: No, I couldn’t. Okay. That’s amazing. 

Dr. Abdul El-Sayed: There’s Ali, all the homies. 

Katy Milkman: [laughing] That’s great.