Who knew “take a hike” was really powerful health advice? Abdul reflects on the power of one of the most basic things humans can do. Then he speaks with Neuroscientist and author Shane O’Mara about his book “In Praise of Walking,” about the power of a walk, and why so many of us rediscovered it during the pandemic.

Transcript

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Dr. Abdul El-Sayed: The CDC issued a new framework for COVID masking guidelines. A new vaccine from Sanofi and GSK showed 100% effectiveness against serious illness and death. Russia invades Ukraine, bringing war back to a region that hasn’t experienced it at the scale in nearly 80 years. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. Though I hate to admit it, one of the reasons I know I’m getting a little older is because my habits are changing. My morning coffee is definitely the best part of waking up. I enjoy word games—Wordle anyone? And I love my morning walk. That’s probably the most surprising. See, I grew up playing sports, and I’ll be honest, there’s something about being a former athlete that messes with your psychology. To this day, if I’m not drenched on the floor afterwards, it’s not a workout. And setting fitness goals is a bit of a challenge. If I’m not trying to win a game or even increase the metric, then is this just managed decline? Well, yes, kind of. I’m never going to be as strong or as fast as I used to be. So now it’s about being a strong or as fast, or even just as fit, as I can be. When I was young, I could never figure out why my parents used to enjoy walking so much. They’d go out for a long walk after dinner, sometimes for five miles or more, and they’d come back refreshed or rejuvenated. They’d asked me to come. I could never figure out why we were doing it. If you wanted to work out well, you should run or bike or lift weights or play sports, and if you want to get somewhere, well, walking doesn’t seem particularly efficient. But as I’ve, yes. Gotten older, I find my morning walk such a powerful way to start the day. To be sure, I still enjoy a good workout, but my walk is more than just a way to get my muscles working, it’s also about what the walk does for my mind. There’s something about watching nature or other people that operates like a prism. It changes the way you think about the things you’re thinking about. And that’s just my usual morning walk around my neighborhood. When I’m visiting a new place, there’s absolutely no better way to experience it than taking a nice long walk. There’s also the social experience of it. When I’m alone, I, like you, enjoy a good podcast, preferably about health and society. But when I’m with my friend or a loved one, I find that the flow and range of conversations just, they’re just better when we’re out on our feet. I have to admit that daily walk probably wouldn’t have even transpired, at least not for a while, we’re not for the pandemic. I don’t travel nearly as much as I used to, and because I work from home all day, the opportunity to get out of the house for a while is one of the reasons I started walking every day in the first place. But as we get back to the normal swing of things, I do hope that a daily walk isn’t something I let go of. It’s one of those pandemic habits I picked up, like making pizza which I know I’m probably not letting go of anytime soon, that I hope I keep with me. It may be strange that I’ve just spent the last ,what, five minutes of this introduction talking about my love for walking with you all, but that love led me to pick up a very special book, In Praise of Walking by Dr. Shane O’Mara, who himself listen to this podcast on his walks. Dr. O’Mara’s book is about all the ways that walking benefits us, but also all the ways that it makes us humans. He’s a neuroscientist. He brings an unusual perspective to the study of walking, showing us what it does for our brains, our emotions, and our health. After reading this book, I want to learn more, so I invited him to join us on the pod. My conversation with Dr. Shane O’Mara after this break.

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

Dr. Shane O’Mara: Yes, I can. I’m Shane O’Mara. I’m a neuroscientist, a writer, and a psychologist at Trinity College Dublin. And I have written a book called In Praise of Walking, which is a neuroscientist’s view of how it is that we humans have come to walk.

Dr. Abdul El-Sayed, narrating: Now, you might wonder why a neuroscientist would write a book about walking, but after meeting Shane and reading his book, In Praise of Walking, it was clear to me why. His perspective on walking really opened my eyes to just how valuable that daily walk can be for body and mind.

Dr. Abdul El-Sayed: Well, I really appreciated the book. And I have to say that most neuroscientists don’t spend their time writing books about walking, so what got you interested in walking generally, and why did you decide to write a book about it?

Dr. Shane O’Mara: So I’ve always loved to walk. I’m a very poor runner. I was always that guy at the rear of the group when we went running in school, but I was a very good walker. I mean, walking is something I’ve always loved to do, especially when I go to visit new cities and new towns, new places, walking around them is perhaps the very best way to get to know a town or a city. And in the case of this specific book, I have to be honest, the idea for the book was not mine. It was actually my agent’s. We were talking about books. I had written a previous book on the neuroscience of torture, and we had a lot to talk about. And he said, Let’s not talk about books. Let’s talk about ideas and things. What do you like to do? And I said, Well, I like to walk. And I had just taken a walk from North London to the center of London where he was. And he said, How about a book called In Praise of Walking? And I thought, Oh gosh, yes, I have to write that book.

Dr. Abdul El-Sayed: So you’re telling me you’ve written a book about walking and torture, and I feel like, you know, the Freudian in me has to, has to connect those two. But you say walking is really good for you. You argue, actually, that it’s a uniquely human activity. And I really found that compelling, particularly as you develop the argument in the book. Can you talk to us a little bit about what makes humans so suited for walking and what makes walking such a human activity?

Dr. Shane O’Mara: Yes. So humans are adapted in all sorts of ways from walking that other species aren’t. We’re very, very good at walking very long distances and have done so. And this is indeed, I’ve in other places described it as our kind of superpower. And by that, I mean something very straightforward. Humans walked out of Africa, probably on multiple occasions, from somewhere around about 100,000 years ago, perhaps up to about 50,000 years ago, and populated the planet. And we did this on foot without mechanized transport. We did it with even small family groups. We did it in small bands, in small tribes. We island-hopped and we did all sorts of things, but the bottom line is that we ended up occupying every corner of the planet, and we did that on foot. Now how do we do it on foot? Well, to be able to do this draws on some really unique neural capacities that humans have. We’re able to visualize the future. We’re able to engage in mental time travel. We’re able to plan our movements through time: I’m going to walk to there tomorrow, but I’m going to do it with that particular goal of getting to somewhere else. So we have brains that are evolved that allow us to engage in this kind of mental time travel, monitoring our physical time travel, but doing it socially. And this is the thing that humans do that is really remarkable. We walk together in groups and we’re socially attuned to each other in groups. An example I like to give is when was the last time we observed a primate troop, troop of chimpanzees, going out to protest against a political order that they disagree with? They do not do this. No other species does this, but we humans do it.

Dr. Abdul El-Sayed: Wow. So one of the pieces there is also something that is unique to humans is the degree of verbal communication that we partake in, as you and I partake in verbal communication here. And part of what makes walking so profound is the ability, as you said, to do it with others, but to do it with others because you also have the capacity to talk. Is there a way that there’s some synergistic combination between walking and talking that makes this so profoundly human, that that accentuates the experience of doing this thing?

Dr. Shane O’Mara: Yes. So there’s a couple of things to say, and the word synchrony is going to appear several times in the explanation that I give. So first of all, when you’re walking together with somebody, you’re walking toward somewhere, typically towards the horizon in some sort of way. So you’re both focusing your attention, not on each other, but somewhere else. To stop and talk and look at each other, you actually must interrupt where you’re walking and you must look at each other. So typically, we will walk, and we will walk with our direction of gaze towards whatever our goal happens to be. So our bodies are synchronized when we’re walking. People with long legs typically will slow down a little. People with short legs will speed up a little. And when I’m speaking while you’re walking, you engage in an anti-synchrony with me. You will be breathing, getting ready for me to stop so you can start speaking, and I will do the reverse. So we have this turn taking going on constantly. So it’s kind of anti-correlated but you can see that we’re in synchrony with each other, it’s just out of phase with each other where walking is concerned. And walking is profoundly goal-oriented. You are going somewhere. Even if you’re just out for an amble, you really do have to have a sense of not wanting to get lost. And you do this on the fly. You don’t have to be conscious of it. It’s called latent learning and has been, has been studied for many years now. So conversation, to my mind, is a core part of walking. If you’re walking in a group, you need to synchronize what people are doing. We’re going to go down this way, we’re not going to go down that way. By the way, that guy back there is an idiot, don’t listen to him. We’re going to get lost if we go that way. So we’re all able through the medium of conversation, through language, to synchronize our thoughts and our behaviors in time. And again, this is something that’s unique to humans. You know, when birds are moving, they follow a simple rule. It would be something like keep us close to the center and copy the guy in front of me. And they’re all flipping position in that kind of way. When herds engage in this kind of behavior, that’s the kind of movement, rule that they’re engaging in. But humans can stop. We can turn. We can engage in chanting. We can protest. We can do all sorts of things that other species just can’t and don’t do.

Dr. Abdul El-Sayed: So walking is almost a, an accentuate of our collectivity, the ways that we be together. You capture them so critically when you’re walking and talking and sharing in a collective exercise of frankly, trans-locating ourselves to something or someone that we want to be with. I want to ask you, what are some of the other characteristics of walking? Of course, you know, increasingly nowadays we live in societies where most of our predominant movement isn’t, isn’t through walking. Oftentimes where we’re leveraging machines to get us to where we want to go. But what are some of the benefits of the kind of walking we might do in a morning, just a stroll about our neighborhood or in the community, get our coffee?

Dr. Shane O’Mara: Yes, so there’s you can think about this a kind of multiple level. And one of the simplest things to do is to think about it from a brain’s-eye view. Just think about what happens in the brain to get you walking. So standing up out of a chair offers a challenge to the brain. Balance, when you’re being seated, is actually something that’s not much of a challenge to a brain. But once you stand up, your brain has to coordinate the muscles and the bones of the body to ensure you don’t fall over. Seems like a trivial thing if you’re a fit and healthy 35-year old, but actually could be a very, very difficult thing to do if you were a frail 85-year old getting up and moving around. So it’s a challenge to the body and it’s a positive challenge, it offers a positive stress. So then you have to think about, I’m going to move, where am I going to move to? So a command signal has to come from somewhere in the head, typically in centers of the brain that are concerned with intention so somewhere like the frontal lobes. I’m going to go to the local shop, I’m going to go to the local café and when I’m there, I’m going to get my cappuccino or my flat white or whatever are poison happens to be. So you’ve got a goal. So parts of the brain that are concerned with movement have to talk to parts of the brain that are concerned with goals, and they have to talk to parts of the brain that are concerned with understanding where you are in the world. So how do I get to my local cafe? I walk out my front door. I turn right. I go 500 meters down the street, I turn left, I cross the street, try not to get run over or whatever it happens to be. So you’re giving all these positive challenges to yourself that you wouldn’t have if you were just rambling about your kitchen or just being seated in one place. Then you have the wonderful thing that happens when you’re out walking, you have the chance encounters with others. So you’re offering yourself this opportunity to have conversations with people that you mightn’t otherwise have. Humans are, as you’ve already said, a really social species. We love interacting with each other. So even if it’s just a chat with the barista while you’re getting your coffee, that’s great. You’ve given yourself something that you wouldn’t otherwise have done. And then you have the challenge of getting back to wherever it is that you came from. So that’s kind of a very high level. If you think of it, when you drop down a couple of levels, your muscles are moving. This is a good thing for you. There’s a slogan in medicine, which is movement is medicine. And we know that’s the challenge of walking and other forms of exercise for the body produce wonderful molecules known as myokines, which offer reparative of protective kind of benefits to the body. So that, you know, you can think about it on multiple levels. And then a walkable neighborhood is a neighborhood that people want to live in. You know, if you look where I’m lucky enough to live, there are very, very good streets to walk on, there’s lots of green—all those kinds of things. So people pay a premium to live in the quote unquote “leafy neighborhoods.”

Dr. Abdul El-Sayed: You know, one of the fascinating things about all of the benefits that you shared is that they have to do with the way that walking provides a positive stressor on your brain. It’s the executive function of planning a walk and then executing on it, the social and emotional function of sharing conversation, and even if it’s a small smile interpreting that communication, and executing that, which implies that the walking itself isn’t usually what we associate with walking, which is I am moving my legs in a particular direction. And what’s fascinating to me is that if you divorce the act of walking from the context of walking that you share, you get something like walking on a treadmill. And what’s become really en vogue these days is that, you know, in our sort of capitalism-obsessed, production-driven society, people say, Well, I’m going to get my walk and I’m going to do my work and I’m going to have a walking treadmill. What do you make of that? And how do we think about that form of walking? And as someone who’s written a book about the benefits of walking? What are your recommendations on that front?

Dr. Shane O’Mara: So I think the simplest thing to say is being sedentary is bad for you. OK? So we know with a very high degree of certainty that the less movement you engage in, the worse the outcomes are for every aspect of your being, from heart health to brain health to stomach health and everything else. So getting up and moving is a good thing. But I think you know, what we need to do is recognize that the brain and the body need different types of stressors, they need up time and they need downtime. So, you know, part of healthy living is to sleep and to sleep really well. A part of healthy living in my mind, where walking is concerned just to walk with no purpose, not for the purpose of productivity, not for the purpose of doing anything like that, but to give your brain the chance to flicker in and out of what is known as the default mode, so this kind of mind wandering that we engage in for lots of our waking hours. Why, if you want to tag a productive thing hang on to it, your creative juices flow best when you’re flickering between these different modes of thinking, where you’re focused on a big picture and not thinking about anything in particular, and you’re focused in on detail. So you know, if you have a problem at work that’s driving you crazy, stop banging your head off the keyboard. Get up, leave it, walk away, think about something else and come back. The problem will have diminished in size, and you’ll probably have a solution for it as well.

Dr. Abdul El-Sayed, narrating: We’ll be back for more with Shane O’Mara after this break.

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Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Shane O’Mara.

Dr. Abdul El-Sayed: I want to ask you, you know, as we think about this then, what is the optimal walk? Is it longer or is it shorter? You already talked about, you know, if you can walk with others, that just so much more beneficial, but if you can’t, and a lot of folks can’t, particularly considering the circumstances we’re in right now, is it better to listen to something or, you know, just observe the world around you? What is the best walk in terms of optimizing the benefits of walking?

Dr. Shane O’Mara: So that’s a hard question to answer cleanly and fairly for you. So what I would say is the best walk is the one that makes you feel great after you come back from it, so you don’t necessarily know before you go out whether or not you’re going to really enjoy the walk or not. So I think it depends on the purposes of the walk. So, you know, if you’re feeling stressed, if you’re feeling anxious, if you need to clear your head, going for a walk without anything in your ears is possibly a very good thing to do. But it may equally be the case that going for a walk and playing some favored piece of music is a very, very good thing to do. I think it depends on the circumstances. It may equally be that going out and talking with somebody where you’re in problem-solving mode with that person to try and help get through the problem rather than just ruminating on the problem, is a very good way of doing it. So I think what we really need to do is to think about the purpose of the walk. And the problem is we’ve got this one verb “to walk” but it’s got all these multiple attributes. So what we need is lots and lots of new words to describe, you know, social walking, all walking, other sorts of qualifiers that allow us to tap into the other aspects of why walking is good for you.

Dr. Abdul El-Sayed: Hmm. I really appreciate that. You know, it’s fascinating the point that you bring up about the restriction of our particular language on this particular concept, right? A lot of sociologists and linguists have talked about the way that, you know, words for love in different languages change the very act of loving and how you love someone. But it’s interesting that, you know, we only have really one word. I guess people talk about rambling or rambling, but yeah, walking is not always the same, especially when you watch the Olympics and you look at power walking. That look just looks like something very different entirely. A lot of people have taken up walking actually in the midst of this pandemic. I think folks who have been stuck in their homes have needed an opportunity to escape lockdowns. And I think as we start thinking a bit about getting back to our usual lives, for those of us who may not live in communities where walking is a mode of transportation from one point to another, what do you recommend to folks as they think about trying to fit back in their usual day-to-day, pre-pandemic day-to-day, and why it’s so important to keep that walk that they may have developed in there?

Dr. Shane O’Mara: Yeah! So, it’s a question that has lots of complications and wrinkles to the answer. So the first thing to say is if you want to get into a regular walking habit, I think turn on the pedometer on your phone and track the number of steps that you do per day. Most people don’t walk very much. You’d be surprised at how little you actually do walk. The second thing I think to say is that you should walk in bursts rather than reserving it all for a one-hour walk at night. Try and engage in 10 or 15 or 20-minute walks several times during the day. That’s hard. Try and get up from your laptop or whatever it is you’re working on every 50 minutes or 40 minutes and just go for a walk. Even a short one around your kitchen, where I’m seated at the moment, is better than than nothing. But I think also your question hints at a really important issue to do with inequalities of access where walking is concerned. So, you know, if you’re a person who has a mobility impairment, for example, you might have a visual impairment, you might have a motor impairment, the design of the streets around you is really important. Are the crosswalks designed so that they don’t have dips so you can walk across easily? What has priority, traffic or pedestrians? Do you have, as we call them, footpaths, as you call them, sidewalks, that are sufficiently wide so that people can walk easily without feeling that they’re always dancing around another person to get past. These are kind of structural issues that are beyond the capability of a single individual to solve. So, town councils, city council’s, transport planners all have a really important role to play in designing movement back into our lives. So just to give you a simple example, in the building I work in in Trinity College, so it’s a very nice 7-story from basement-to-roof building. When you walk in the front door, you have the elevator, as you call it, in front of you. The lift, as we call it. If you want to get to the stairs to walk to my office on the third floor, you have to go through three fire doors. But if you want to have a passive form of transport, it’s just there. Now we need passive forms of transport, again, for people with mobility impairments, but building design prioritizes particular types of movement. And we run into this issue all the time, that architects and engineers and others aren’t necessarily considering what’s best for the person in terms of what they can do in terms of movement. They’re thinking about how can we get so much function per square meter of a building, or whatever it happens to be?

Dr. Abdul El-Sayed: Yeah, I really appreciate it. Two points that you made there. You know, the first in the United States, we just passed a major bipartisan infrastructure reform package. And you know, the irony of it is that despite really, really fantastic research and a far better understanding of how to build mobility-focused infrastructure, a lot of it came back down to roads and bridges. Which, you know, which is really quite frustrating to think it through, especially considering the fact that we do have such an inequity in this country about access to walkable space. And you know, that’s everything from whether or not your neighborhood has a sidewalk, to whether or not you can, you know, take a walk after dark in your community without fear of being victimized by either a neighbor or the state itself in the form of the police. And these are considerations that we have to, we have to take into account as we think about walking equity, and the responsibility that we all have to advocate for equitable walking opportunities. And then the other point that you made, which was a question I was about to ask, is, you know, not everybody can walk. Are there other activities for folks who may have disabilities that keep them from walking or walking regularly, that capture a lot of the same benefits?

Dr. Shane O’Mara: Yes. So again, that’s a simply-expressed question, which unfortunately wraps lots of complications into it. So in the case, for example, of the visually impaired who have no other motor impairments, towns can design things to make life much more easy for them. So you can have sidewalks that have little bumps on them to signal crossing points. You can have sound at the appropriate crosswalks so that they can time themselves when they’re walking across. And you can have motor impairments that are not going to cause you to end up in a wheelchair or something like that, but nonetheless cause you a problem. So I highlight a study that was conducted in the UK in my book of about 3,000 people age 65-plus. And the key finding of that study was that people age 65-plus, 85% of males and 95% of females had a walking impairment such that they were walking more slowly than the average 20 or 21-year old, quite substantially more. That doesn’t sound like a big deal in itself, until you realize that crosswalks are designed for the walking speed of a 21-year old, not a 65-year old. So what we’re basically saying to those people is you might be walking with a cane, you might be walking with a frame, but you’re going to be trapped on one side of the road because we’re not designing our crosswalks for you so that you can get across. So we can improve things substantially so that people with impairments can get around. I think for people who’ve got larger and more substantive motor impairments, really what you need to do is work through a program with a physiotherapist or a physician to ensure that you’re getting the kinds of exercise that you might otherwise be lacking. And I think a very good slogan from the whole physical health literature is a very straightforward one,, what’s good for your heart is good for your brain. So engaging in aerobic activity that improves heart health will have the effect of improving brain health as well.

Dr. Abdul El-Sayed: I really appreciate that. I want to finish out, I would just ask you, what is your favorite walk?

Dr. Shane O’Mara: I have lots of them.

Dr. Abdul El-Sayed: I would imagine.

Dr. Shane O’Mara: So, I’m going to make it a social walk, a walk with my wife and daughter, anywhere.

Dr. Abdul El-Sayed: I appreciate that. Well, that was neuroscientist Shane O’Mara. His book is called In Praise of Walking. And we’re really grateful to you for coming and sharing your insights and your perspective with our audience. Thank you so much, Shane.

Dr. Shane O’Mara: Thank you so much. I really enjoyed that.

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. Last week, the CDC issued new COVID masking guidelines. They revised away from the current approach that universally recommends masks be worn in indoor crowded settings, where case transmission in a given county is substantial, or high. The new guidance uses three main metrics: COVID case rates, COVID hospitalizations, and the proportion of hospital beds occupied by COVID patients in a given county. It uses these metrics to determine if a county is at low, medium, or high risk. In low-risk counties, it advises that people can safely opt against masking in indoor settings. In medium-risk counties, it advises that people talk to their doctor about whether or not they should wear masks, presumably to ensure that high-risk individuals continue to mask. And in high-risk settings, it recommends people wear their masks in indoor public settings. First, here’s what the CDC guidance gets right: it recognizes that with Omicron, which is far less severe, case transmission doesn’t mean the same thing as it used to. Instead, it includes a measure of severity, in hospitalization rate, and a measure of health system capacity, in the proportion of beds occupied by COVID patients. It also allows precautions to scale should there be a new variant that begins to spread or is in fact more severe. But here’s the challenge, the algorithm may be too slow to contain a new variant, after all, hospitalizations are a lagging indicator so a new variant would have had time to spread for a while before it started to impact the hospitalization metrics. The other issue is that recommendations are also bulky and complex, meaning that it’s not altogether obvious what risk category your community is in. And because these new recommendations are coming so late, it puts states and municipalities in an awkward place. If they’ve already rolled back their mask recommendations but the CDC metric places them in high risk, it’s unlikely that these communities are going to change their recommendations, meaning they’ll still be at odds with CDC guidance. That disjointedness, it just fuels mistrust and misunderstanding. Data are in for a new COVID vaccine that looks to be safe and effective.

[news clip] Drug maker Sanofi and Glaxo Klein Smith—Smith Kline, will seek U.S. and European approval for a new COVID vaccine.

Dr. Abdul El-Sayed: This new vaccine, like its predecessors, is extremely safe and effective. They found that it was 100% effective against preventing COVID deaths, 75% effective against moderate to severe illness, and 58% effective at preventing any symptoms at all. What’s important and interesting about this vaccine is that it’s not based in the mRNA technology, about which misinformation has inspired some hesitation. This is a traditional vaccine which shows your immune system a piece of the virus’s spike protein, rather than a piece of mRNA, which your body then translates into that protein. The hope is that it might inspire folks who may have qualms with mRNA, to consider this vaccine. While I think it’s great that we have a new vaccine, I’m not convinced that enough people are hesitating simply because of the nature of the vaccine. But maybe I’m wrong. Another important use might be as a booster to give our immune system another view of the virus to improve our immune responses. And finally, a piece of news that’s on everyone’s mind.

[news clip] Russian forces launching a full-scale invasion about 24 hours ago. More than 100 Ukrainian soldiers and civilians have been killed, hundreds more have been wounded.

[clip of President Biden] Putin chose this war, and now he and his country will bear the consequences first.

Dr. Abdul El-Sayed: My heart goes out to the people of Ukraine, who are enduring the first real conflict on European soil for nearly a century. War is the anti-public health. It’s the worst thing humans do to each other, packing violence, destruction, and hate in its wake. Lasting for decades. What makes this even more galling is that this war is being driven by one man’s narcissistic pursuit of empire. Importantly, President Biden has taken war with Russia off the table, after all, we’ve never had two nuclear power squaring off with each other for a reason. I hope for all of us that we never do. We must continue to press for peace. But even as we watch Ukraine, don’t forget that our attention itself is a resource, and so often we fail to give it to places we’ve been told are hopeless. There are millions of people suffering the consequences of war that we’ve ignored in places that we ignore, simply because we essentially those places as being, quote unquote “war -torn.” in Yemen, our country is backing a Saudi-led blockade that is causing famine that is killing hundreds of thousands of children. Not to mention Afghanistan, where the consequences of 20 years of U.S.-led war has left millions without basic food or provisions. And since, we’ve cut the country off from the aid that they’ve come to rely on. Imperialism is that, full stop, no matter where it is and no matter who does it. We are right to hold Putin accountable for his imperialism and we should also hold our own country accountable for ours. I wrote a bit more about this in my newsletter, The Incision. Check it out at abdulelsayed.substack dot com. And finally, I want to take a moment for a quick tribute. Last week, our world lost someone who insisted that every life deserves equal access to dignity, peace, and prosperity. World-renowned medical anthropologist, physician, and humanist, and founder of Partners in Health, Dr. Paul Farmer, passed away last week. He was 62-years old. I read the biography about Farmer, “Mountains Beyond Mountains” when I was in college. It’s a big reason I went into public health. In the 80s, he began working in Haiti to provide cutting-edge health and health care in a time when public health authorities would have called providing leading-edge health care services in low-income countries a waste of money. The organization he founded, Partners in Health, is now a leading humanitarian organization globally, providing leading-edge health care in countries all over the world. I leave you with this excerpt from a conversation Dr. Farmer and I shared on the show back in 2021.

Dr. Paul Farmer: Medicine and public health, and I’ll give one example. You know, if I had not spent a year in Haiti and I heard another eminent Harvard professor ask us, Well, here’s your ethical choice, should we invest more money in NICU’s or pay attention to prenatal care among African-American women in Boston? That was a classic. I’m sure you ran into that at Columbia. I saw everybody nodding again and I thought, Wait, why would we choose between a NCCU and prenatal care? If you have prenatal care, you’re less likely to need an NICU, and if you have family planning, you’re less likely to need prenatal care. But really, those are the choices that we’re forced to make. And the COVID epidemic is playing out with the same public health Luddite commentary. Without ICUs, we’re going to lose a lot of elderly people and some younger people too. So right now, before we get on to your question of how has this way of seeing medical dilemmas hamstrung us? I’m just saying the public health people are still often getting it wrong—and by public health people, I’m not talking about the global health equity public health people—I’m just saying, Really? A choice between prenatal care and a NICU? That’s dumb. Let’s not make some more bombers or something, or some other malignant process. Let’s not privatize all of Detroit and sell it off.

Dr. Abdul El-Sayed: It’s a reminder of the kind of fiercely urgent approach to health and health care that Farmer imbued in so many of us who he inspired, that the tradeoffs we make in health care often assume that some lives just aren’t worth the same as others. Dr. Paul Farmer’s legacy will have been to demand that we treat every life equally. He will be missed, particularly in times like these. That’s it for today. On our way out, I want to ask you to do me a favor. If you haven’t rated and reviewed the show, please do. It really helps us get it to a new audience. And if you love the show, I hope you’ll drop by the Crooked store for some America Dissected drip. We’ve got our logo mugs and t-shirts, our Science Always Wins t-shirts, sweatshirts, and dad caps, and our Safe and Effective tees, which are on sale for $10 off while supplies last.

America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. The 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.