In This Episode
What would have happened if, like flouride, the COVID vaccine would have just been in the water? That’s one of the questions Malcolm Gladwell asks in his latest season of Revisionist History — a season about how we know what we know, and how we implement that knowledge to help people. He joins Abdul to talk about the science and practice of public health, how the way we talk about it gets in the way, and how to fix it.
TRANSCRIPT
[sponsor note] [AD BREAK] [music break]
Dr. Abdul El-Sayed, narrating: President Biden declares the pandemic over. But is it really? Polio is a full fledged public health emergency in New York. President Biden kicks off America’s cancer moonshot, which aims to cut cancer mortality in half within the next 25 years. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Today we’re talking to bestselling author Malcolm Gladwell about the interplay between science and action, the subject of the most recent season of his podcast, Revisionist History. But first, I want to lay out the story of what the CDC calls one of the ten greatest public health achievements. In the early 1900s, a dentist trained in the Northeast moved to Colorado Springs to start a dental practice, only to realize that the folks in his town had these big brown splotches across their teeth. But he realized something else, too, that despite the discoloration, well, their teeth were unusually resistant to tooth decay. After all, at the time, a dentist’s job was mainly pulling corrupted teeth that caused people horrible toothaches. The dentist, Dr. Frederick McKay, set out to figure out why his patient’s teeth were splotched and ultimately ended up changing his field as we know it. Collaborating with dental scientists from around the country. His research led the team to a town in Arkansas, which was run by Alcoa, an aluminum conglomerate. Residents of that town Bauxite also had the same big brown splotches, despite the fact that residents of another town just five miles away didn’t. But Bauxite had something Colorado Springs did not, sophisticated chemical equipment. And one enterprising Alcoa chemist ran a photo spectrograph analysis on the local water. He found that it had startlingly high levels of fluoride, whereas neighboring towns water did not. It was fluoride that was staining the residents teeth brown. Wait. What? Isn’t fluoride supposed to be good for teeth? Yes. The finding kicked off a whole line of research about fluoride’s effect on teeth, and they learned that in large amounts Fluoride leads to what’s called fluorosis, the pitting and staining that they’d observed. But in smaller amounts, Fluoride makes tooth enamel more resistant to tooth decay without any of the side effects. And in 1945, the city of Grand Rapids, you know, I had to throw in a Michigan angle, became the first community to add fluoride to its water in the first large scale test of the effects of water fluoridation on dental health. For the next 15 years, scientists tracked the rates of cavities among children in the community. And they were down 60%. Today, water fluoridation is common practice around the world, and it’s transformed the practice of dentistry from pulling rotting teeth to keeping teeth from rotting in the first place. And oral health isn’t just about cosmetics. After all, the mouth is the main entryway to the body, and cavities are bacterial infections at the body’s gateway. Poor oral health has been tied to high rates of all sorts of other health outcomes. But there’s a broader story to tell about water fluoridation. See, the citizens of Grand Rapids were never enrolled into a study. They were never given the right to informed consent, never told of the potential positives and negatives of participation. Their city council just made the decision for them and that was that. And for the 200 million Americans who drink fluoridated water now, there is no opting out. Unless, of course you just buy bottled water to drink. In his new season of Revisionist History, Malcolm Gladwell thinks through the implications of big public experiments like these and asks whether or not science has swung too far in the other direction. Don’t get me wrong. Informed consent, enrollment, these are critical things for the advancement of science. But at the same time, a lot of great science, a lot of great public health happened because we thought about them differently in the past. After all, Malcolm’s latest season, it was motivated by, well, this:
[clip of unknown anti-vaccine person] I’m the only one in my family that hasn’t gotten the vaccine. It’s not approved by the FDA. I don’t know what’s in that. Women are miscarrying. People are having their DNAs wiped out.
[clip of unknown speaker 1] No vaccine’s ever been proven safe and no vaccine has ever been proven effective.
[clip of unknown speaker 2] We know that’s not true.
[clip of unknown speaker 1] Please allow me to answer the question.
[clip of unknown speaker 2] Millions and millions of lives have been saved by vaccines.
[clip of unknown speaker 1] Simply not true.
[clip of unknown speaker 2] They’re some of the safest medicines ever invented. That’s just nonsense.
Dr. Abdul El-Sayed, narrating: Vaccine hesitancy has left nearly 30% of Americans unvaccinated, and the vast majority of COVID deaths and hospitalizations are among those who’ve chosen not to be vaccinated. But what if COVID prevention was just in the water? How would that change uptake? And what would the response have been? Would it have saved lives? I sat down with Malcolm to discuss what he learned about the history of science, the state of science today, and how we implement what we know. Here’s my conversation with Malcolm Gladwell.
Malcom Gladwell: Do you want me to wear the headphones?
Dr. Abdul El-Sayed: No I don’t think we need to. Okay. Can you introduce yourself for the tape?
Malcom Gladwell: My name is Malcolm Gladwell. I’m the host of Revisionist History.
Dr. Abdul El-Sayed: You’re also someone who needs no introduction. And um in some respects, one of the things I love about this most recent season of Revisionist History is that you’re uh almost delving into um the space that you’ve written in a lot of your career, which is to sort of take details and then blow them up and think about the long, larger term implications of them. And a lot of this is the implicit logic behind um natural experiments. Uh, we we sort of identify these contrasts that naturally exist in the world. And then we seek to ask what the implications of those contrasts really are for people on the other sides of them, and then what they tell us about how we should be thinking about public policy. So so what was it about this moment um that led to the creation of this season of Revisionist History, this focus on experiments?
Malcom Gladwell: Well, I mean, for a whole series of reasons, but one of them is that there is this sort of interesting opportunity post pandemic to talk about medicine and science because because the population has been educated in that subject, in I mean, it’s one of the few upsides of what we’ve been through. I hear ordinary people. I say ordinary like people who aren’t scientists or, you know, on the street talking about clinical trials and, you know, stage 2, you know, data and what the FDA is or isn’t doing. It’s kind of this amazing moment, if you’re interested in those subjects, to have a sophisticated conversation with people because people now know what you’re talking about. So that was part of it. And part of it as well was that um in a very kind of ideologically divided time. It’s great to talk about experiments because they require that you put your ideology aside.
Dr. Abdul El-Sayed: Hmm.
Malcom Gladwell: And I thought that was a lovely counterpoint.
Dr. Abdul El-Sayed: You know, that’s interesting because from some from the perspective of someone who’s um who’s thought a lot about trials and epidemiologic uh data well before the pandemic ever happened, there has been this moment where people have a lot of insights or a lot more insight into the process that produces the information that allows us then to act in terms of health and disease and in both public health and medicine. And at the same time, there is a risk of uh you know it’s the Dunning Kruger effect.
Malcom Gladwell: Mm hmm.
Dr. Abdul El-Sayed: Where uh people have just enough language to get it wrong sometimes. And there is the lack of insight around the depths here. And I think for a lot of public health, I think I think this is, like you said, a really good moment for more teaching, right? I think this is the moment to lean in. I worry that for a lot of public health, the response here has been, you know, why can’t we just keep doing this in the shadows? Because this is really frustrating.
Malcom Gladwell: Mm hmm.
Dr. Abdul El-Sayed: And one of the interesting aspects of your choice to highlight this in this particular moment is the contrast that you’re really picking up around who gets to know what science is being done when. And, you know, you open up the season with a focus on natural experiments, which are experiments in, you know, in theory that people don’t know they’re a part of because they’re not intentional.
Malcom Gladwell: Mm hmm.
Dr. Abdul El-Sayed: Right. Nobody’s ever been enrolled into a natural experiment. It’s just something that happens, uh that exists and that scientists leverage to try and understand the world around them. Um. How should we, we be thinking about natural experiments and the ones that you picked to highlight um what did they teach you about the way that science and then policy gets done in the world?
Malcom Gladwell: Yeah, well, I, I had one episode that was very explicitly about a natural experiment, and it’s about this um very obscure law that govern in certain states that governed the prescribing habits of doctors. Back in the 1930s, California passed this rule which which was that every doctor, whenever they were prescribing a Schedule C drug, so a painkiller or something that is potentially addictive or dangerous, they had to fill out a prescription in triplicate and send one copy to the state for safekeeping. One copy to be held by the pharmacists and one copy they had to keep in their own files. And it was a way of monitoring the prescribing behavior of doctors. Doctors hated it. Very few other states took up the same reform, if you want to call it that. And what we discovered quite by accident in the last two years was that the states that happened to have these obscure laws on the books, about three copies of a prescription had a far easier time through the opioid epidemic.
Dr. Abdul El-Sayed: Mm hmm.
Malcom Gladwell: Than those that didn’t. And it’s a beautiful example of a natural experiment, because the the passage of triplicate laws had nothing whatsoever to do with the opioid epidemic.
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: Predated it by, in some cases, many decades. No one was even noticing it. So it wasn’t like there was any potential bias. We just these laws that were like on the books forgotten. And then a couple of economists almost by accident discovered this weird effect that and the difference is quite dramatic. So New York State and Massachusetts are on virtually every measure you can use very similar states.
Dr. Abdul El-Sayed: Mm hmm.
Malcom Gladwell: Except when it comes to the opioid epidemic.
Dr. Abdul El-Sayed: Mm.
Malcom Gladwell: Massachusetts got hammered.
Dr. Abdul El-Sayed: Mm.
Malcom Gladwell: New York got off, relatively speaking, pretty lightly.
Dr. Abdul El-Sayed: Mm hmm.
Malcom Gladwell: What’s the difference? New York had a triplicate prescription program in place since the, I think sixties.
Dr. Abdul El-Sayed: Mm.
Malcom Gladwell: Massachusetts never did.
Dr. Abdul El-Sayed: Mm.
Malcom Gladwell: Um. So that’s a kind of, economists love, of course, natural experiments, because they free you up from the tricky and complicated business of setting up an experiment and gathering data by yourself. And also, you get to skip over all the kind of ethical questions about whether it’s appropriate to do one thing or another. I mean, you couldn’t actually do a triplicate experiment in real life, could you?
Dr. Abdul El-Sayed: No.
Malcom Gladwell: So what I’ve seen actually from particularly economists, they seem to be the ones who are most creative in locating natural experiments where they exist. Uh I remember one study that I always loved was a guy in Oregon. Oregon passed a state measure that limited property taxes with the result that um funding levels to local police departments were cut back.
Dr. Abdul El-Sayed: Mm.
Malcom Gladwell: And many police departments did the same thing, which is they cut back patrols, traffic patrols. And this guy simply looked at the difference between the jurisdictions that cut back traffic patrols and the ones that didn’t.
Dr. Abdul El-Sayed: Mm hmm.
Malcom Gladwell: And saw a quite a dramatic increase in traffic fatalities in the ones as a result of the ones who acted this way after the tax limitation. That’s a natural experiment.
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: You would never do that in real life. But. So there’s a real fascinating creativity, I think, in the um academic world right now into locating them and drawing interesting conclusions from them.
Dr. Abdul El-Sayed: Yeah. You know, as an epidemiologist, it’s it’s one of those spaces where and just, you know, to nerd out here on on causal inference, um there is an obsession among epidemiologists because we’re close enough to the biological sciences to want to have the same kind of control as other biological scientists do, while recognizing that there is a challenge of equipoise, which is to say that the minute you hypothesize that something can hurt somebody, you actually can’t do it to them. And so, you know, we don’t have causal studies, truly causal studies that show the relationship, for example, between smoking and preterm birth. Because the moment you think that smoking can cause preterm birth, there’s nothing you can do to tell somebody to smoke, to prove out your hypotheses. And so we’re always sort of one step behind from our own hypotheses, which frustrates our science, similar to economists. And there’s something about the natural experimentation. And at the same time. Right, even if you were to design your preterm birth experiment. Right. That I just that I just sort of highlighted the hard part is that you really have to get to as close to random as possible. And so, you know, what makes these natural uh experiments so interesting is that you really do want to show that the the populations you’re comparing kind of like you did with Massachusetts and New York are as similar as they possibly can be independent of this one, this one change, this one alteration, because it gets you as close as you can to attributing the differences that you identify to that particular change. And what makes them so interesting is that instead of creating them right, which is how we think about science, i.e., you know, I sit with my four year old and I talk about how to experiment on something. We say, Well, what are all the things that could influence the outcome, your dependent variable, and how do we control them? Whereas here you’re saying, how do I find a place where everything is controlled but one and then identify as much as I can infer and then start asking questions about mechanism of action, which is really, really fascinating. The other implication here, which which I really appreciate you drawing out, is that none of these things actually matter until your asking a question about what then you can replicate out of the natural experiment. It’s not of interest necessarily to know uh that, you know, a change in uh allocation of funding uh straps stops traffic fatalities unless you’re interested in stopping traffic fatalities, which of course we are. But then you have to ask, all right, how do I replicate this policy to actually get the possible outcome?
Malcom Gladwell: Mm hmm.
Dr. Abdul El-Sayed: And the thing about public health beyond that is, you know, in this obsession that we’ve often had with inferring causation is a is forgetting the fact that we actually have to do something on the back end. Right. All of this is about educating public policy change. Um. And so one of the, part of what you focused on here is sort of iodize and salt. Right. People don’t really realize why we have iodine in salt um and that’s because of goiters. Um uh. You think about fluoride in water, right? We put fluoride in water because it’s good for your teeth. Part of that, in some respects implies a willing paternalism on the ethical side of saying, we’re going to go ahead and do this for everybody. Uh. We’re going to check you out of being able to make a choice about whether or not this is going to be done onto you, because we have really good evidence to suggest that this is in your best interest. Similarly, on the study side, we’re not going to enroll you in to a study. We’re just going to study what happens after the world enrolls you into a study and we identify it. How do you think about the ethics of translating experimentation um that nobody chose to be a part of into public policy that nobody chose to be a part of?
Malcom Gladwell: Yeah. Yeah. So this is a reference then in the second episode of the season, we um I tell the story of why we have iodine in salt. And it’s because goiter, you know, the these large growths on your neck from an enlarged thyroid were incredibly common. Strikingly common, and people don’t realize this. In a if you walked around Cleveland, Ohio or a city in the mountains of Switzerland or a city in Idaho and anywhere where um a series of, there was a lack of iodine in the soil naturally. You would see I mean, 20% of the population might have these incredibly large, unseemly growths on their neck. And we finally figured out that the way to treat it was to introduce iodine into people’s diet. There was a study done in Akron, Ohio, in 19– just just at the end of the First World War. And then a decision was made without the government, by the way, just that the a bunch of scientists got together with the salt companies and said, let’s stick iodine in salt.
Dr. Abdul El-Sayed: Mmm.
Malcom Gladwell: Just put it. And they actually, in when they began. They didn’t get the dose right. And so uh if you have too much iodine and you’re someone who’s been deprived of iodine your whole life, some very nasty things–
Dr. Abdul El-Sayed: Bad things happen yeah.
Malcom Gladwell: Um. But it was a kind of it’s one of the it’s one of the largest and most consequential public health interventions in the history of the world. Right. The whole world’s–
Dr. Abdul El-Sayed: Mm hmm.
Malcom Gladwell: –gone to basically iodized salt in the last 70 years. And there was no formal you say, like you say no formal procedure based on one really on one or two, quite small but definitive studies. Um. There was uh nobody was asked whether they wanted iodine in salt or not. It just was stuck in. I mean, you could find non iodized salt, but in the main, all the salt you got starting from the 1920s on had Iodine in it. Right. Um. It’s kind of amazing. You know, had they done it the trad– the way we do it now and ask everyone to sign off first, would it have would it have taken 50 years? I mean, maybe?
Dr. Abdul El-Sayed: Mm.
Malcom Gladwell: The reason I wanted to tell that story in the episode of Revisionist History was I wondered as a thought experiment whether if we put COVID vaccine in salt like, hypothetically, would that have been a better strategy? Just like stick it in there and not make a big deal out of it. And [laughing] and I have I shocked myself in having a surprising amount of sympathy for the max paternalistic option.
Dr. Abdul El-Sayed: Mm.
Malcom Gladwell: Um didn’t think I would, but I was so exhausted. By the kind of endless, pointless, stupid debates about COVID that I was like, F it. Why don’t we just, if we could, couldn’t we just stick it in salt and call it a day?
[AD BREAK]
Dr. Abdul El-Sayed: So this is an interesting point. Right. And I don’t want to, I want to pick out three different pieces of it. The first is the most powerful intervention in public health is norm. Whatever is normal. I mean, iodized salt is normal. You see, iodized, if you saw non iodized salt, you’d kind of look at this and be like, am I missing something here? Is there something? Is this bad salt? Um. But iodine in salts has become so normal that when we see iodized salt, the majority of the population doesn’t actually know that iodized means that there’s iodine in it. They probably don’t know what iodine specifically is or what it is supposed to be doing or why we even put it in salt. It’s just how you’d get salt.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: Um. And so norm is is a huge. Is a huge intervention on the public’s health. What we make normal is critical. And what was so interesting about this particular vaccine, of course, is that it was in the midst of a pandemic, which brought a lot of attention to this particular moment. And it is something that has to pierce your skin. And in that respect, the idea of putting something in your body. Right. This is a much more forceful putting in the body versus by mouth or by nose. So a couple of questions here is as you think about, you’re somebody who spent your your entire career making interventions on the public conversation. Right? That’s what that’s what books are. That’s what podcasts are. You’re trying to change the way people think. Um. How do we start to think a little bit more about the ubiquity, the normal that we sometimes miss in our public conversation? And how in your work on the season, how have you seen different types of institutions do that thing? And then the second question is if that is true, if normal is is so powerful, the null hypothesis here, right? Whatever it is that we’ve been doing, we will continue to do. How important is it that we think about, you know, something as small as mechanism of action? Right. So the fact that we have a vaccine that you actually have to, you know, get a jab to get versus a vaccine that you can just inhale something through the nose or something that you can take by by mouth. How important is it when you think about the way that people think about this thing and the the potential to sort of repel it or, you know, to build a whole set of narratives against it.
Malcom Gladwell: You know, uh in answer to the second part of your question first, how important is that kind of stuff? Insanely important. In fact, the thing I think that strikes me when I look back on how COVID vaccine was handled over the last three years, four years is incredible amount of sloppiness on the part of public health authorities. I mean, in retrospect, what on earth were they thinking? First of all, I think that people in medical professionals are very aware that the word vaccine refers to uh medical intervention that can do any number of a number of things. Right. There are some vaccines that 100% prevent infection. There are some that simply allow you to be infected, but they diminish your illness there I mean, you know, all this kind of list. And so to a professional, those distinctions are all consistent with the term vaccine. The public has a much more kind of rudimentary understanding of what a vaccine is. They think a vaccine is something that 100% prevents infection. If a vaccine comes out that fails to do that, you’re going to sow all kinds of doubts. So if you have a vaccine that’s not immunizing, it’s not 100% effective. Don’t call it a vaccine! How hard is this? This drove me crazy during, to this day, you can go online and see intelligent people saying, oh, yeah, like “vaccine” in quotes. And then my neighbor, my neighbor who is fully vaccinated just got it. See I mean, like A.) B.), you know, probably know the science better than me. My understanding was a nasal version, nasal spray version of COVID vaccine. There aren’t there weren’t great technological hurdles to it. It was something we could do right now. I think there are all kinds of nasals, nasal sprays in the works at the moment. Hugely significant, 25%. In that episode of revisionist history, I had someone, a public health person, tell me that 25% of the American population has is deathly afraid of needles as a real serious [?].
Dr. Abdul El-Sayed: Including me.
Malcom Gladwell: Oh, really?
Dr. Abdul El-Sayed: I’m a grown man.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: So I never show my fear.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: But when I was a kid, my parents, I mean, it would take three or four people to hold me down to get a vaccine. Now, you know, as a hazard of my profession and the fact that I don’t want to be ashamed for being a you know 200 and some pound man who’s afraid of getting shots. I get my shots, but I hate it because I don’t like the idea of someone bringing a needle and me willingly let them stab me with that thing. So, yeah, I hear you.
Malcom Gladwell: So it’s like given that that’s been we know we’ve known that is the case for the longest time. Why weren’t we thinking, oh, if we from the get go, what we really want is a nasal, is a nasal spray here because that’s we don’t want to fight this battle all over again with something as and even more so as vaccines themselves got so politicized in the last ten years. I mean, like the idea that there’s a kind of stubbornness sometimes, a rash of a stubbornness borne of rationality in the medical community and the scientific community, which says that if I give you something, if I create something that on its rational merits is something you ought to take, then you ought to take it. They forget that they’re dealing with real human beings who have all kinds of phobias and irrationalities. And if we were going to redo this from the get go, I feel we would have done it totally differently.
Dr. Abdul El-Sayed: Hmm.
Malcom Gladwell: And I feel like people like Fauci would have I mean, lowered the bar on the vaccine. Just say it’s going to help. Might save your life. There should have been low expectations going in, not high expectations.
Dr. Abdul El-Sayed: So undersell, overdeliver.
Malcom Gladwell: Exactly. And let people, you know, kind of um discover anecdotally just how effective it is.
Dr. Abdul El-Sayed: The degree to which having a intramuscular injection is a barrier to getting this important, effective medical intervention. I really I think the fact that we sort of started out with with shots being the mechanism of transmission or the mechanism of uh introduction and then kept with that uh is profound. And I, to your point, I think it speaks to a level of there is a level of elitism within the scientific community.
Malcom Gladwell: Mm hmm.
Dr. Abdul El-Sayed: That assumes that everyone needs to understand the world in the same way that we do, and that the failure to understand the world in the same way that we do is not our failure to translate, but other people’s failure to understand. And, you know, I talk to a lot of my students. I always tell them you’re being mismented right now and, um you know, we know what dementia is right? When you lose your cognitive capacities. But mismentia is the is the the changing of your cognitive capacity to the point where you forgot how you used to think. And we we go through for, you know, in many cases, 11 years of education to learn how to think empirically. But that that proves how unnatural it is to think empirically. We think in stories, and then we fail to tell the story of what we’re doing. And then all we do is point to the data and say, trust the science, assuming that everyone sees the data and understands the science in the same exact way we do. Um. And I just think it is one of the biggest failures of the biomedical establishment generally. Um. And I think we’ve we’ve been shown exactly how big a failure that is, because what it reads to folks who don’t have that training is you think you’re better than me, you think you can tell me what to do and you think you can make me do it? And um and I think it has really hurt us. I want to move to the Minnesota starvation experiment because you do a three part series uh in this season on that experiment and it’s such a profound contrast to the natural experiments that we’ve been talking about. This is um an experiment. Actually I’ll let you explain the Minnesota uh experiment here.
Malcom Gladwell: So middle of the Second World War, a lot of people become aware of the fact that there are millions of people starving in Europe as a and Asia as a consequence of the war. But we know precious little about what prolonged uh malnourishment does to the human body and what the best way to um help someone recover from prolonged malnourishment. And so an experiment is conducted on the campus of the University of Minnesota to try and answer those questions. The lead investigator was a man named Ancel Keys, who in his day was one of the most famous. He was the celebrity doctor of America in the 19– in the mid-century. To this day where his work is kind of, you know, central in our understanding of nutrition. And he gathers 36 healthy, young male volunteers. They’re all conscientious objectors, and he puts them in a dorm underneath the football stadium of University of Minnesota. And he starves them systematically, starves them for a period of six months and notes what happens to them. And when I say starve, he was like severe calorie restriction, a compulsory regimen of quite substantial physical exercise, and then a battery of tests, daily tests, monitoring everything that you could conceivably monitor.
Dr. Abdul El-Sayed: Hmm.
Malcom Gladwell: And the men go through. In part one of the of the series, we talk about what the men went through. It’s pretty brutal.
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: I mean, it makes you aware of I mean, the first thing they learned is that to starve someone for an extended period of time is a kind of torture.
Dr. Abdul El-Sayed: Mm hmm.
Malcom Gladwell: It’s not an inconvenience. Your brain shuts down and you this is a very trivial story, but it gives you a sense of what these guys were like. You know, they would go to the movies and the only thing they could pay attention to in a movie was if one of the stars of the movie uh was eating.
Dr. Abdul El-Sayed: Wow, wow.
Malcom Gladwell: So lost interest in the sex scenes, in the romance, in the thriller plot, in the you name it. But, you know, one guy was talking about going to see a Humphrey Bogart movie. Bogie goes to a bar and people around him are eating. And that’s the only time he kind of like snapped to attention during the–
Dr. Abdul El-Sayed: –Wow.
Malcom Gladwell: And then I sort of walk through the kind of ethics of this experiment. Is it something that we should have done? Is it something that we could do today that we should do today? And I was again radicalized by the experience. Most medical ethicists will tell you that we could and should never do an experiment like this today, you cannot take 36 healthy people and essentially starve them to the point of death over the course of six months. My position is you absolutely can. I have become convinced that the kind of nervousness and uh timidity in the scientific community about what kind of experiment you can run on people is a problem.
Dr. Abdul El-Sayed: Hmm. Walk me through them.
Malcom Gladwell: Well, there was a, the reason we are as the reason we can’t do something like the American Minnesota starvation experiment today is, of course, two things that happened. One is that. Simultaneously during the Second World War, Hitler is doing some unspeakable experiments on people.
Dr. Abdul El-Sayed: On people who are not volunteers.
Malcom Gladwell: Who are not volunteers. And secondly, there is a whole legacy of experiments done in the American scientific community in the 1950s and sixties, which um in retrospect are highly questionable, if not outrageous. The Tuskegee Syphilis Experiment, where a group of young Black men are misled into enrolling in an experiment where these are men with active syphilis, whose syphilis was not treated so that we could study what happens to people whose syphilis is not treated. So there were some, a series of really scarring experiences that led the medical community to say this is really problematic. We’ve got to put some real safeguards on our experimentation. But. I think we threw out the baby with the bathwater. We overcorrected. And the Minnesota starvation experiment is a different thing. It’s a group of men. First of all, as I reveal in the, one of the episodes, the experiment was the idea of the volunteers. So they didn’t just volunteer for it. They dreamt it up themselves. They were conscientious objectors who wanted to contribute to the war effort. So. At this point, you’re like, Oh, this is a very, very different kettle of fish than what was going on in the concentration camps of Germany or in Tuskegee, Alabama. And secondly, what they were doing is not much different from what we ask of soldiers who go off to battle. Right.
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: We ask them to risk their lives on behalf of some larger cause. So I don’t know why, sim– why we would say it’s fine to send young men to fight in Iraq or Afghanistan in the course of a completely, utterly fruitless, pointless conflict. That’s fine. But if you want to sign up for a human challenge trial around COVID vaccine. Oh, no. That raises all kinds of ethical questions. Give me a– can I swear on this? Give me a fucking break. Like the kind of the idea the medical community has that they are operating in this kind of holier than thou, you know, marble temple on a hill where, oh, you, you know, the command to not do any, to first do no harm means you can’t actually have people volunteer to help expand the frontiers of human knowledge.
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: It is just maddening to me.
Dr. Abdul El-Sayed: And what was interesting to me is that, you know, the big fundamental difference between the Minnesota study and the two examples you brought up, Tuskegee, And we just did an episode with uh Professor Reuben Warren about that in the 50th, 50th year anniversary. And and, of course, the the awful experimentation that was done in the concentration camps uh in Germany, is that it was voluntary and there was a clear out for everyone in the experiment and they understood what they were signing up for.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: And that point, right, that ability to check out, that ability to know exactly what’s happening and to have agency over your engagement, um I think is is the sort of profound ethical fault line here.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: Um.
Malcom Gladwell: And a clearly articulated and scientifically consequential goal.
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: Right. And that is that can fundamentally change treatment and policy for a–
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: –Lot of other people. And to your point. Right, the sort of ethical um comparison that you establish with war is that, yes, people sign up. You know, we don’t we have an all uh conscript army, but people don’t sign up knowing exactly what their mission is going to be. Whereas when you enroll in a study, you know exactly what is going to happen to you. You know, the the interesting setup here, right. To just sort of step back and compare what we found here to what you found when you were thinking about some of the natural experiments. Is that. There is a level of knowledge and a level of agency. That even participants in very intense experimentation, sign up for knowingly that folks in natural experiments don’t actually know they’re a part of which sort of turns some of the ethics of experimentation on its head. Um. What did you learn about the long term consequences both of for the people who who participated in the Minnesota study and then for what came out of the science from that study?
Malcom Gladwell: Yeah, well, the so the long term, the the third episode in our series is all about one of the volunteers, a man named Lester Glick. And what happened to him over the course of the rest of his life and. The first thing you discover when you hear Lester Glick’s story is that being a participant in the Minnesota starvation experiment changed his life irrevocably. I mean, he had an eating disorder till the end of his days. He was obsessed with food. He carried a photograph of cinnamon buns in his wallet. His entire life.
Dr. Abdul El-Sayed: Wow.
Malcom Gladwell: He would compulsively make food for family members. He would keep a bar, a bag of candy under the seat in his car. I mean, on and on. The year he spent in Minnesota permanently altered his. It made him anxious and obsessed about the possibility that there may be not enough food. Right. That’s the downside. On the upside, and this is what the episode is all about. It completely and profoundly changed his moral understanding of humanity and about what his role ought to be. His daughter said, there is something very beautiful to me that my father made it his mission to end hunger wherever he found it. And he defined hunger broadly. He understood that being hungry spiritually, physically, physiologically, whatever is the one of the worst states a human being can be in. And so he after he left the Minnesota program, he spent the rest of his life. He got a Ph.D. in social work. He spent his last rest of his life building schools of social work around the country.
Dr. Abdul El-Sayed: Hmm.
Malcom Gladwell: Um. Because he understood that there are people out there who are hungry for social support and spiritual sustenance. And he was going to make it his mission to to extinguish that hunger. And that was a 100% a consequence of learning what a terrible, terrible, terrible thing hunger is.
Dr. Abdul El-Sayed: Hmm.
Malcom Gladwell: In the course of his year at Minnesota. So not for a moment did Lester Glick ever regret his participation in that study.
Dr. Abdul El-Sayed: Wow.
Malcom Gladwell: And not only that, they would have all of the volunteers, all of them who suffered equally to Lester Glick. They would have these reunions in the years that followed. And they would always ask the question, would you do it again? And almost to a man, they said they would do it again. So this brings up this other thing, which is part of our aversion to asking people to participate in these kinds of experiments is that we misunderstand the meaning of we’ve forgotten the meaning of sacrifice. These men saw themselves as making a noble sacrifice to advance an incredibly important cause. You know, today I was in that last episode or one of the episodes was really interested in the controversy about human challenge trials for COVID vaccines, which hypothetically a human challenge trial can be a lot quicker and more efficient and certainly cheaper way of testing a candidate vaccine, somebody who’s, you know, not been vaccinated, shows up and you deliberately infect them with the virus and then you. Oh, yeah. So you you you give them a shot of your candidate vaccine and you deliberately expose them to the virus. And you can find out in three weeks whether your candidate vaccine works. The amount of uh discomfort in the medical community towards that kind of experiment is enormous. And I don’t understand why. If I’m a healthy 30 year old man and I see millions of people around the world dying of a of a disease, and I think I can, by taking a risk, advance the level of scientific understanding of how to save lives around the world. Why shouldn’t I be allowed to make that choice?
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: Why is that not a kind of thing we would celebrate as opposed to sit back in our cubicles at some Ivy League university and go, tut, tut, tut, tut, tut. These people drive me fucking nuts. I mean, I can’t tell you how upset I am at this. It’s like so, anyway.
Dr. Abdul El-Sayed: I hear you on that I think to play uh we’ll say IRB advocate here for a second, they would say it’s very very difficult to disaggregate a choice from the structural circumstances of that choice. And they’ll say too often we have compelled marginalized folks, for want of you name the incentive on the back end to participate in some of these things. And we worry that we can’t fully pull that choice out of the structural circumstances in which people are making it. I disagree with that. I think you’re right. I think you can do those things and I think you can be really thoughtful. And on top of that, for good science, you have to do those things right, because if–
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: –You’re disproportionately–
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: –uh recruiting a certain group of people into a study, you’re not going to actually get inference that is generalizable across the whole population. But that is where I think they would fall. What would you what would you say to them?
Malcom Gladwell: Well, I would say if you’re worried that you are that people’s choices are incentives are a little bit tangled, then spend a little more time explaining what you’re doing. I mean, like this isn’t the first time this problem has happened in human communication. So just be clear.
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: So, you know, and I think that that anyone who does a human challenge trial is they’d probably go further than they need to in explaining the possible risks and benefits. The thing that gets me is the assumption on the part of medical ethicists that subjects in trials are dumb, are easily misled, don’t know what they’re getting into, haven’t thought it through.
Dr. Abdul El-Sayed: Mmm.
Malcom Gladwell: There’s just a kind of level of condescension that I find reprehensible. They’re not dumb. These are people who maybe are wired a little different than the rest of us. You know, they’re one of the things in this in my series on the Minnesota starvation experiment that is really important. I have a part of one episode where I talk a lot about, these were men who are conscientious objectors, whose religious beliefs made it impossible for them to take up a rifle and fight in a war. These people, who in other words, whose sense of moral purpose is the central part of who they are and how they think of themselves in the world. It is very clear and a very easy step for people who are motivated in that way to sign up for an experiment that requires some portion of sacrifice on their part. They’re fine with that. That’s how they find meaning in the world.
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: You know, there’s like, if we were to compel everyone to be a participant in a challenge trial, I’d have a problem with it. But if you need if you’re if you’re canvasing a company a country of 380 million people and looking for 1000 volunteers, I think you can find a thousand volunteers who know what they’re talking about.
[AD BREAK]
Dr. Abdul El-Sayed: What I really appreciate about your point here is that we have failed to highlight the upside of the science that we do. And I have often worried it’s a big reason why I left formal science um as a public health professional is that we’ve cloistered science in a way that fails to engage the public, and what we do is truly and deeply, profoundly public. It changes the horizon of human understanding, the the set of policies that we can engage in in moments of crisis like a pandemic. And I think the fact that we’ve cloistered science as far as we have has created these kinds of, you know um, [laugh] too cute by half ethical standards that um that that sometimes get in the way and fail to fully engage the upside, the opportunity um that exists for someone to take to be on the on the horizon of scientific development. And then also it’s failed when it comes to actually explaining to people how we know, what we know. And more than anything else, you know, if you think about it, we were in a challenge. We were in the middle of a challenged natural experiment with the COVID vaccines. The minute they rolled out, everyone in living in society was at risk of COVID, and we were asking people to get vaccinated. And you had this profound politicization in large part because I think we have failed to validate the way we know what we know. I think a lot of people who push back against the science of vaccines, who are more liable to consume and believe in mis in disinformation, oftentimes it’s because the nature of science itself hasn’t been presented well from the jump. And we have cloistered it. It has become this sort of thing for nerdy people out there. You got that that the guy from uh Big Bang Theory, who is the you know, the scientist. Science isn’t cool people who do science aren’t cool. Um. And in our culture, it just has lost a lot of the shine that it had in the sixties, in the fifties and sixties. Um. And I think that that is in part why it was so easy to attack. I want to ask you, as someone who’s been thinking about this space for a while, that space where science meets psychology, if you had two or three recommendations to public health folks, to public health scientists, um what would what would they be?
Malcom Gladwell: Oh, wow, I mean, one is I would like to elevate in or at least restore the kind of um social prominence of the surgeon general. You know, if you think back on in recent memory, we had one great surgeon general. You know, Everett Koop’s role during the AIDS crisis was, I think, in retrospect, exemplary. And he became a kind of public voice for for science, for more than that. He had a kind of moral authority that that proved to be really important in preparing this country for how to deal with with HIV um and alerting and educating the country. That strikes me as having someone who’s outside of politics um and who has a kind of pulpit is really important. And I think we should do more to kind of to raise up that position. And so that would be one suggestion. Um. Another suggestion would be to uh I do think that it’s possible to be a lot more transparent in the way I mean, here’s a good example. You know, when you’re watching television, there’s an ad for a prescription drug and then they do in really, really fast talking at the end. [laughter] They do all–
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: –big counter indications, all of the problems.
Dr. Abdul El-Sayed: For erections lasting more than 4 hours.
Malcom Gladwell: [making fast speaking sound] That’s not helpful.
Dr. Abdul El-Sayed: No.
Malcom Gladwell: Right.
Dr. Abdul El-Sayed: No.
Malcom Gladwell: You know, first of all, it doesn’t contextualize side effects. You have no idea whether everyone gets those side effects or 1% of people in a very small study got those side effects. Secondly, it just it’s frustrating because you realize that a 30 second television ad is wholly inappropriate for describing something as complicated as. So you’ve got to sort of find a better way to have discussions about prescription drugs are a big part of how people think about medicine these days or learn about medicine or experience medicine. They go to doctors and they demand certain–
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: –Pills. And so we have to find a better way to kind of handle this, the kind of commercial aspects of of prescription drugs. And the third thing would be that public health officers need to spend an awful lot more time talking to people who know about what it means to speak to the public.
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: You know, like savvy PR types and such. There needs to be a conversation there because right now, like it goes back to our earlier conversation about how I think the rollout of COVID vaccines were botched. That’s like we could walk two blocks and find we’re in midtown Manhattan right now, find 20 people who are seasoned PR people who would have told you that was going to end badly. I mean.
Dr. Abdul El-Sayed: Yup.
Malcom Gladwell: There’s a level of expertise out there that’s just not being used.
Dr. Abdul El-Sayed: Yeah. And I think I think so to to that point, I think there is we have long taken for granted in public health that expertise is authority and those two things have decoupled. Expertise is expertise. But increasingly the nature of our our disaggregated media implies that everyone has a platform and you don’t get to just dominate a platform and be taken seriously just because you have expertise. So expertise is no longer authority.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: And we’re going to have to have other ways in. And I think in a lot of ways, we have to compete for people’s attention by telling great stories, by being able to to offer really engaging content that pulls people in and gets them to listen. And our failure to do that is, frankly, our failure. Public health people will make and I say this as a as a tried and true public health person, we make all kinds of excuses about why people don’t listen to us. And, well, I know as a content creator that if you want people to listen to you, you’ve got to make stuff people want to listen to. The other side of that tweet to your point about about pharmaceuticals, I really appreciate that point because we have allowed the commercial interests of what is ultimately a very small part of what we do to dominate the public communication of what we do.
Malcom Gladwell: Mm hmm.
Dr. Abdul El-Sayed: And when most people’s interaction with science communication is someone trying to sell them a prescription drug, it’s it will fundamentally alter the fundamental premise uh within which people understand health and disease. I mean, you think about I was watching a cable news television channel and there are ads for tardive dyskinesia medication. Tardive dyskinesia is a side effect for a treatment for a particular kind of serious mental illness that affects 3% of people. And about 10% of those 3% who are treated will get tardive dyskinesia. So you think about the degree to which this industry is making, how much money right that they have, the marketing budget to market, a drug that affects 10% of 3% of the population.
Malcom Gladwell: Mm hmm.
Dr. Abdul El-Sayed: 0.3% of the population. And that kind of skew in where we talk and how we talk, I think has has really thrown off people’s expectations. And I hear this all the time. You know, as someone who has been, you know, quite critical of the pharmaceutical industry, a lot of folks will come to me and say, look, I trust you, but I don’t trust necessarily the big pharmaceutical corporations who are making the vaccines. And then you have people like Albert Bourla, the CEO of Pfizer, who’s on Twitter every other day being like, oh, one more round of vaccines. And you’re like, you seem to want this too much. And you probably should chill out on Twitter a little bit because now you’re playing to a lot of fears that people have.
Malcom Gladwell: Yeah. Yeah.
Dr. Abdul El-Sayed: Um. And so disaggregating some of these aspects, what is science versus what is marketing versus, you know, what is medicine and how do these things interact? And where should you have a level of skepticism about what’s being sold to you and what’s being told to you is important. The problem now is that people don’t know what to be skeptical of, so they’re skeptical of the whole thing. That creates a vacuum within which people who want to spread myths and disinformation can do exactly that.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: Because there is a mistrust and a skepticism that unfortunately, I hate to say it is well earned from from the industry.
Malcom Gladwell: [?] when at the beginning of the pandemic, I began listening to this podcast which I’m sure you’re familiar with, TWiV this week in Virology.
Dr. Abdul El-Sayed: Mm hmm.
Malcom Gladwell: These a group of pretty big name virologists get together every week and they talk about things virological. I should talk about one of them, one of their episodes on in part of the in the Minnesota Starvation series of Revisionist History. And, um you know, I learned much of what I know about COVID from that show. It was a fantastic kind of education. And of course, one of the first things you realize in I realized in listening to it was in their world, SARS has been around for a while.
Dr. Abdul El-Sayed: Right.
Malcom Gladwell: This class of viruses is not a, didn’t pop up yesterday. It’s something that they have known about and have in one sense or another been preparing for. For when was the first SARS epidemic? Uh.
Dr. Abdul El-Sayed: 2003.
Malcom Gladwell: 2003. Yeah. 20 years.
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: And just knowing that it was 20 years and we we’ve been dealing we’ve been prep– and as a [?] they had, they would have guys on the show, men and women on the show, virologists, whatever who had been working on SARS virus, you know that class of viruses for their whole career. Yeah, their whole career.
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: This is like just that simple detail fundamentally changes the way you think about whatever we come up with to challenge SARS-CoV-2. It’s like, I think a lot of it just the failure to stand up and say, you know, this is something we know a lot about. We’ve got a whole series of people who’ve devoted their lives to this. We’re hopeful we can come up with some solutions in a relatively short period of time because of that body of expertise. Just saying that in the first two weeks would have been really, really useful. Right?
Dr. Abdul El-Sayed: Yeah.
Malcom Gladwell: As opposed to kind of going into full fledged panic mode, reminding people that science is both an institution and a process. And a lot of these things that we think are just like people hatching crazy stuff in labs is actually no no no. There’s a whole system in place that is designed to solve problems like this, right? This is actually what we’re good at.
Dr. Abdul El-Sayed: Mm yeah.
Malcom Gladwell: Like the weird and heartbreaking paradox of vaccine hesitancy is that people are, have skepticism and hesitancy about literally the one part of modern Western society that works better than anything else. It’s like if you were going to pick somebody to have a quarrel with, right, or to be skeptical of, the last person you would pick is the, you know, that section of the scientific community coming up with novel ways to defeat viruses. They’re like way ahead of the rest of us.
Dr. Abdul El-Sayed: And it’s worked multiple, multiple times.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: This is the this is the thing that that’s crazy to me. So uh we hosted I hosted up the first season of America Dissected was a ten part series, and we did one on the anti-vaxxer movement. This was before the pandemic. And I interviewed my grandparents, right, who were young enough to be some of the first people vaccinated for polio right back when the Salk vaccine came out. And both of them are actually from in Michigan. And so that was, you know, it rolled out in Ann Arbor. And they were talking about how there was some worry about what the side effects would be. But every single week there was some worry about an outbreak of polio. And they saw kids who lost the use of their legs because of polio. And so the obvious consequence of not being vaccinated was so clear that the tradeoffs were obvious. The problem now is that vaccines have become, in some respects, a victim of their own success. They’ve been so effective.
Malcom Gladwell: Yeah.
Dr. Abdul El-Sayed: That we forgot their record. They vanquished all the foes and so we think we live in a world without foes anymore. And then when one of them arises, it’s like we forgot what to do and we start second guessing what has worked in the past. Um. I really, really appreciate you uh highlighting experimentation and you know, therefore science on on on this season of revisionist history. I appreciate you coming on the pod, uh to talk about our guest today is someone who needs no introduction. Malcolm Gladwell, author of uh five New York Times bestselling books. I hope that you’ll check them out and of course, make sure that you check out uh this season of Revisionist History. Malcolm, thank you so much for taking the time. Really appreciate you.
Malcom Gladwell: Thank you. It’s really fun.
Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. This was WHO Secretary-General Tedros Ghebreyesus on the state of the pandemic.
[clip of Tedros Ghebreyesus] Last week the number of weekly reported deaths from COVID 19 was the lowest since March 2020. We have never been in a better position to end the pandemic. We are not there yet. But the end is in sight.
Dr. Abdul El-Sayed, narrating: We have never been in a better position to end the pandemic. Thems fighting words from Tedros. And he’s right. The number of COVID 19 deaths globally is as low as it’s been since the pandemic started. But this was President Joe Biden in an interview with 60 Minutes.
[clip of President Joe Biden] The pandemic is over. We still have a problem with COVID. We’re still doing a lot of work on it. Uh. It’s. But the pandemic is over.
Dr. Abdul El-Sayed, narrating: Over. Is it? Here in the U.S., a receding pandemic has confounded historically based predictions of a fall COVID surge. That’s great, because well there’s been a surge in cases every single fall since the pandemic started. And yet right now, even as kids are back in school, cases are down 30% over the past two weeks, hospitalizations down 11% and deaths down 6%. Great news so far. But is the pandemic really over? The thing about pandemics is that it’s really hard to declare them over in real time. It’s kind of like a hurricane. If the rain and wind and destruction stop, it’s either because the hurricane has passed or you’re in the eye of the storm. Look, we’re not likely to be in the eye of the storm. We’re probably near the end. But I’d be a lot more comfortable if the president of the United States waited a bit longer before declaring the thing as past. Pandemics have a way of embarrassing early predictions. It’s about more than words. Right now, the federal government has spent $3.2 billion dollars for another round of COVID boosters. This one a new cocktail of the original vaccine and one reformulated against BA.5, which is still the dominant variant. Given how long BA.5 has sustained its dominance, it seems unlikely to me that we’re going to see another major surge of BA.5. But that doesn’t mean that we’re not going to see another surge of COVID. We’ve been planning around the virus continuing this zig. But what if it zags? There’s always the possibility that the next variant isn’t an Omicron sub variant at all. The virus evolves a different set of mutations entirely. There’s something more. The highest probability of hospitalizations and deaths and long COVID is still among people who haven’t been vaccinated at all, meaning that getting people their first shots ought to be a higher priority than getting people their fourth. Don’t get me wrong, I certainly hope that this trend continues, that we keep watching COVID recede and that we don’t see a jump this fall. And I. Well, I’m going to spend this fall boosted, but we may just have to wait and see to really declare this thing over. Meanwhile, I literally never thought I’d say these words, but polio is a public health emergency in New York. In fact, the W.H.O. just added the United States to the list of countries where there are polio outbreaks. I want to walk you through how this happened. The vast majority of people in America are vaccinated against polio. 93% of Americans have had three doses of polio vaccine. If you’re vaccinated, you have nothing to worry about. The problem, though, is that the 7% of people who are unvaccinated, well, they tend to live in the same communities and interact with each other. That means that if one of them is infected, they’re unprotected by herd immunity. The way that living among vaccinated people protects you from being exposed, even if you’re unvaccinated. So that clustering of unvaccinated people, well, it allows the virus to spread and multiply rapidly. What that reminds us is that the viral spread of well viruses isn’t the only thing we’re worried about. It’s also the viral spread of mis and disinformation that leaves people susceptible to the viral spread of viruses. In other news, this was President Biden this week at an event in Boston where he launched his cancer moonshot.
[clip of President Joe Biden] Cancer does not discriminate red and blue. It doesn’t care if you’re a Republican or a Democrat. Beating cancer is something we can do together. And that’s why I’m here today.
Dr. Abdul El-Sayed, narrating: The goal is to achieve half the amount of cancer death over the next 25 years. This, of course, is personal for President Biden. His son, Beau, died of an aggressive form of brain cancer. Before I offer my take, I want to be clear that an investment in ending cancer is a far better place to put our taxpayer money than so much of the other stuff our government does. There’s no doubt that this infusion of funds, about $1.8 billion dollars will lead to a number of critical discoveries. And I love that for us. But I also want to offer a few notes of sobriety. There’s not one cancer. There’s as many possible kinds of cancer as there are different types of tissue in our body. So curing cancer isn’t just one thing. It’s trying to do many things well. There’s another piece here. Like almost all diseases, an ounce of prevention is better than a pound of cure. If we were willing to invest as much into preventing cancer, I think our money would go a long way. It reminds us that in this country, we almost always bias technology and novelty over basic public policy done well. Our public health system remains profoundly and fundamentally broken. I really wish we were as focused on rebuilding it. Now to prevent cancer. Yes. But all of the other preventable diseases we don’t pay nearly enough attention to. That’s it for today. On your way out. Don’t forget to rate and review the show. It really does go a long way. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. We’ve got our logo mugs and T-shirts. Our Science always wins sweatshirts and dad caps are available on sale. Oh, and a whole new batch of progressive merch. Just drop at the Crooked store. Tees, hats, bumper stickers, all about demanding reproductive justice, cancelling student debt and making our democracy work. You can show where you stand even while you sit in traffic. Head to the Crooked store and pick out something to wear to the voting booth or just on your morning coffee run. You guys do know how T-shirts work. Check them out at Crooked.com/store. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Tara Terpstra. Veronica Simonetti mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening.
