Podcasts about gawande

Anish Gawande, born in Mumbai and educated at Columbia and Oxford as a Rhodes Scholar, is India’s first openly gay national spokesperson for a mainstream party (NCP SP). Founder of Pink List India and the Dara Shikoh Fellowship, he led major COVID-19 relief via Youth Feed India. He translated queer literary works by Ramchandra Siras and The World That Belongs To Us. A fierce critic of Israel’s pinkwashing and Maharashtra's Mahayuti govt, Gawande advocates for abolishing criminal defamation, inclusive welfare, LGBTQ+ rights, caste equity, and climate justice. He blends U.S./U.K. campaign tactics with a “politics of care” to reshape Indian politics.See omnystudio.com/listener for privacy information.

Elon Musk and DOGE have been taking a chainsaw to the federal government since Trump was re-elected. It could take us generations to fully recover from the damage inflicted by the careless and cruel nature of these cuts. We're joined by American surgeon, author, and public health advocate Atul Gawande to discuss just how devastating these actions are. During the Biden administration, Gawande was a senior official at USAID. He walks us through many of the great works the program did around the world… and the damaging and deadly road that lies ahead now that it's been gutted.We also discuss the state of our healthcare system and the popularity of Medicaid expansion. The Affordable Care Act has improved the lives of millions of Americans, but Donald Trump and the Republicans threatened to take it away from Americans in his first term. Does he dare try again?To hear more from Atul, check out his recent piece in The New Yorker about the chaotic attempt to freeze federal assistance: https://www.newyorker.com/news/the-lede/behind-the-chaotic-attempt-to-freeze-federal-assistanceSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Atul Gawande is a surgeon and a public health expert. He's also the former head of global health at the U.S. Agency for International Development (USAID), an agency that the Trump administration has prioritized for dismantling since its first day in office. On today's episode, Executive Editor Natalie Orpett sat down with Gawande to discuss what USAID does, the consequences of destroying it, and why public health is so important to U.S. national security.Editor's Note: This episode was recorded on March 27, 2025. The following day, the Trump administration announced that USAID would be dissolved by the end of this fiscal year. To receive ad-free podcasts, become a Lawfare Material Supporter at www.patreon.com/lawfare. You can also support Lawfare by making a one-time donation at https://givebutter.com/lawfare-institute.Support this show http://supporter.acast.com/lawfare. Hosted on Acast. See acast.com/privacy for more information.

Two weeks after the Inauguration of Donald Trump, Elon Musk tweeted, “We spent the weekend feeding USAID into a wood chipper.” Musk was referring to the Agency for International Development, an agency which supports global health and economic development, and which has saved millions of lives around the world. “A viper's nest of radical-left lunatics,” Musk called it. U.S.A.I.D.'s funding is authorized by Congress, and its work is a crucial element of American soft power. DOGE has decimated the agency with cuts so sudden and precipitous that federal workers stationed in conflict zones were stranded without safe passage home, as their own government publicly maligned them for alleged fraud and corruption.  Courts have blocked aspects of the federal purge of U.S.A.I.D., but it's not clear if workers can be rehired and contracts restarted, or whether the damage is done. In January, 2022, Atul Gawande, a surgeon and leading public health expert who has written for The New Yorker since 1998, was sworn in as assistant administrator for global health at U.S.A.I.D. He resigned as the new administration came to power, and is watching in shock as Trump and Musk make U.S.A.I.D. a guinea pig for the government-wide purge now under way. U.S.A.I.D. was, he admits, a soft target for MAGA—helping people in faraway countries. Gawande calls U.S.A.I.D. “America at its best.” But with Trump and Musk, “there's a different world view at play here,” he says. “Power is what matters, not impact.” Learn about your ad choices: dovetail.prx.org/ad-choices

Two weeks after the Inauguration of Donald Trump, Elon Musk tweeted, “We spent the weekend feeding USAID into a wood chipper.” Musk was referring to the Agency for International Development, an agency which supports global health and economic development, and which has saved millions of lives around the world. “A viper's nest of radical-left lunatics,” Musk called it. U.S.A.I.D.'s funding is authorized by Congress, and its work is a crucial element of American soft power. DOGE has decimated the agency with cuts so sudden and precipitous that federal workers stationed in conflict zones were stranded without safe passage home, as their own government publicly maligned them for alleged fraud and corruption.  Courts have blocked aspects of the federal purge of U.S.A.I.D., but it's not clear if workers can be rehired and contracts restarted, or whether the damage is done.    In January, 2022, Atul Gawande, a surgeon and leading public health expert who has written for The New Yorker since 1998, was sworn in as assistant administrator for global health at U.S.A.I.D. He resigned as the new administration came to power, and is watching in shock as Trump and Musk make U.S.A.I.D. a guinea pig for the government-wide purge now under way. U.S.A.I.D. was, he admits, a soft target for MAGA—helping people in faraway countries. Gawande calls U.S.A.I.D. “America at its best.” But with Trump and Musk, “there's a different world view at play here,” he says. “Power is what matters, not impact.”

According to surgeon, author, and thought leader, Atul Gawande: "Everyone deserves a coach."In this week's episode, I explore whether Dr. Gawande is right.Noted professor, facilitator, and executive coach, Ted Witherell, and I discuss this topic and ponder some deep questions such as: (1) Are you worthy of an investment? and (2) How do you process inspiration?For more information about Ted, please see here.

Dr. Atul Gawande, assistant administrator for Global Health USAID, discusses the future of global health with Thomas Bollyky, inaugural Bloomberg Chair in Global Health at the Council on Foreign Relations. In particular, Dr. Gawande examines the role of artificial intelligence, the importance of building government trust, and USAID's key accomplishments since the COVID-19 pandemic.

In this episode, Dr. Atul Gawande joins Dr. Patrick Georgoff to share his experiences as a surgeon, writer, and global health leader. From his innovative work at Ariadne Labs and Lifebox to his current role as Assistant Administrator for Global Health at USAID, Dr. Gawande discusses the challenges and rewards of creating large-scale impact. He reflects on balancing creativity in writing with precision in surgery, lessons learned from managing teams, and the critical importance of strengthening global health systems.  Enjoy! Dr. Atul Gawande is the Assistant Administrator for Global Health at the U.S. Agency for International Development, where he oversees a bureau that manages more than $4 billion with a footprint of more than 900 staff committed to advancing equitable delivery of public health approaches around the world. The Bureau for Global Health focuses on work that improves lives everywhere--from preventing child and maternal deaths to controlling the HIV/AIDS epidemic, combating infectious diseases, and preparing for future outbreaks. Prior to joining the Biden-Harris Administration, he was a practicing surgeon at Brigham and Women's Hospital in Boston and a professor at the Harvard Medical School and the Harvard T.H. Chan School of Public Health. He is the founder and was the chair of Ariadne Labs, a joint center for health systems innovation, and of Lifebox, a nonprofit making surgery safer globally. From 2018-2020, he was also the CEO of Haven (an Amazon, Berkshire Hathaway, and JP Morgan Chase healthcare venture). In addition, Atul was a longtime staff writer for The New Yorker magazine and has written four New York Times best-selling books: Complications, Better, The Checklist Manifesto, and Being Mortal. Visit https://www.usaid.gov/organization/atul-gawande to learn more about our special guest.  To learn more about the Global Health Bureau, please visit https://www.usaid.gov/global-health.  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

In this episode, we discuss Indian politics, take a hard look at the newsroom, talk about building solidarities, and unpack queerness alongside the intersection of class and caste privilege. And also the important question: who really owns Sula Wines? A fun discussion with sharp insights and lots of laughs! Anish Gawande is the National Spokesperson for the Nationalist Congress Party (Sharad Pawar) and founder of Pink List India, an archive supporting LGBTQ+ rights. A Rhodes Scholar with degrees from Columbia and Oxford, he's written for publications like Times of India and CNN. Anish has also worked with UNESCO, Borkowski PR, and curated shows at major galleries while earning recognition as one of GQ's 50 Most Influential Young Indians. If you like our work then consider supporting:  1. Patreon: https://www.patreon.com/anuragminusverma 2.BuyMeACoffee: https://www.buymeacoffee.com/anuragminus 3.UPI: Minusverma@upi 4.RazorPay: https://pages.razorpay.com/pl_NM7M52cur24w7k/view My website: www.anuragminusverma.com  Sound by  : Nilesh Jatwa 

Sulochana Gawande is the author of the book “Revealing the Secrets of Cancer: An Informative Guide to Treatment, Prevention and Recovery”. Previously, she studied and led cancer-specific research for 4 decades in India and the US at Novartis, Eli Lily, Cancer Research Institute (Mumbai), Tata Memorial Center. --- Support this podcast: https://podcasters.spotify.com/pod/show/theindustryshow/support

Dr. Atul Gawande is the assistant administrator of Global Health at the U.S. Agency for International Development, or USAID, an independent federal agency that aims to increase global stability through economic, development, and humanitarian assistance. But Dr. Gawande's leadership in public health stretches back long before his time at USAID, as does his background as a bestselling writer. In this episode, Rotary International General Secretary John Hewko sits down with Dr. Gawande to discuss Rotary's partnership with USAID, the role of civil society organizations in achieving global health goals, and personalized care in end-of-life decision-making.

Join us as we delve into the intricacies of the World Happiness Report with the distinguished Professor Emeritus John Helliwell. As a founding editor of the report, Professor Helliwell shares the origins of the report, the methodology behind measuring happiness, and the profound implications of the findings. Discover the pivotal role of the 2011 UN Resolution supported by Bhutan, the importance of subjective well-being data, and how the report has evolved to influence global perspectives on happiness and well-being. Learn about the top-ranking countries and the factors that contribute to their success, as well as surprising findings from this year's report. Professor Helliwell also explores the significance of social connections, trust, and benevolence, shedding light on how these elements impact our daily lives and national policies. This episode is a deep dive into the science of happiness and a call to integrate well-being into every aspect of decision-making. Tune in to understand how we can all contribute to a happier, more compassionate world.   Resources The World Happiness Report 2024: https://worldhappiness.report/ed/2024/ The Gallup poll: https://news.gallup.com/poll/612125/happiest-country-earth.aspx Sustainable Development Solutions Network: https://www.gallup.com/analytics/247355/gallup-world-happiness-report.aspx What's the happiest country in the world? https://news.gallup.com/poll/612125/happiest-country-earth.aspx   The Wellbeing Research Centre, University of Oxford: https://wellbeing.hmc.ox.ac.uk/   Professor Helliwell's book recommendation: Gawande, A. (2014). Being mortal: Medicine and what matters in the end. Metropolitan Books/Henry Holt and Company. https://atulgawande.com/book/being-mortal/   Where to listen to this episode  Apple podcasts:  https://podcasts.apple.com/us/podcast/the-next-page/id1469021154 Spotify: https://open.spotify.com/show/10fp8ROoVdve0el88KyFLy YouTube: Content    Guest: John Helliwell Host, producer and editor: Amy Smith Recorded & produced at the United Nations Library & Archives Geneva 

Chapter 1:Summary of Being Mortal"Being Mortal: Medicine and What Matters in the End" by Atul Gawande, published in 2014, tackles the delicate topic of aging and death, and how modern medicine has influenced our perspectives and handling of these inevitabilities. Gawande, a surgeon and public health researcher, explores the limitations of medicine in the context of aging and terminal illness and emphasizes the importance of prioritizing the quality of life when it may no longer be possible to extend life.The book begins by examining the historical changes in how societies care for the elderly. Gawande contrasts traditional methods—where elderly family members remained at home with the family until death—with modern practices, where the elderly often end up in institutions like nursing homes. He discusses the development of geriatrics as a medical specialty and how it focuses on health management in older adults to improve functionality and well-being, rather than merely extending life.A large part of the narrative is dedicated to the processes and decisions involved in end-of-life care. Gawande criticizes the current medical approach which often prioritizes survival through invasive procedures and long-term treatments that might not necessarily align with the patient's personal desires or lead to a meaningful quality of life. He argues for a shift in perspective towards understanding and respecting the end-of-life wishes of patients, including the acceptance of mortality.Gawande uses personal stories, including those of his patients and his own father, to illustrate the struggles and decisions many face as they approach death. These stories highlight the complex interplay between medical interventions and the personal values and preferred lifestyles of individuals.He advocates for palliative care and hospice as important options that should be better integrated into end-of-life care. These approaches focus on comfort and support, not just survival, emphasizing symptoms management and quality of life.Overall, "Being Mortal" encourages readers—both healthcare professionals and the general public—to rethink how society deals with aging, serious illness, and dying. It promotes a vision of respect for individual desires and dignified treatment that values life quality over mere life extension.Chapter 2:The Theme of Being Mortal"Being Mortal: Medicine and What Matters in the End" is a non-fiction book by Atul Gawande, which was first published in 2014. The book explores the intersection of medicine, aging, and end-of-life care. Dr. Gawande uses a combination of personal narratives, medical insights, and philosophical musings to address how modern medicine handles aging and dying, and how it can do so with more empathy and effectiveness. Given the non-fiction nature of the book, the "characters" in play are real people, including patients, doctors, and the author himself, and the "plot points" refer to key thematic explorations and narrative anecdotes used throughout the book. Let's discuss the key themes, notable anecdotes for character development, and overarching plot points. Key Plot Points1. Introduction to the Problem: Early in the book, Gawande discusses how modern medicine is phenomenal at solving treatable problems but often falters in the face of terminal illness and natural aging. He raises fundamental questions about the goals of medicine and how it can improve in dealing with the processes of aging and dying.2. The Experience of Aging: Gawande discusses the physical and mental experiences of aging through various stories. He highlights the medical community's struggles to accommodate the chronic conditions and dependency that often accompany old age.3. Institutional Failures: There is an exploration of nursing homes and assisted living facilities. Gawande critiques these for often...

In this episode of PsychChat, I discuss the pervasive behaviour of defensive decision-making in the workplace. Listen to this episode, where I share tips to mitigate such behaviour in the workplace.ReferencesArtinger, F., Petersen, M., Gigerenzer, G., & Weibler, J. (2015). Heuristics as adaptive decision strategies in management. Journal of Organizational Behavior, 36(S1), S33-S52.Brockner, J., & Higgins, E. T. (2001). Regulatory focus theory: Implications for the study of emotions at work. Organizational Behavior and Human Decision Processes, 86(1), 35-66.Edmondson, A. C. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383.Gigerenzer, G. (2014). Risk savvy: How to make good decisions. Penguin.Greenhalgh, L., & Rosenblatt, Z. (1984). Job insecurity: Toward conceptual clarity. Academy of Management Review, 9(3), 438-448.Higgins, E. T. (1998). Promotion and prevention: Regulatory focus as a motivational principle. Advances in Experimental Social Psychology, 30, 1-46.Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513-524.Hobfoll, S. E., Halbesleben, J., Neveu, J. P., & Westman, M. (2018). Conservation of resources in the organizational context: The reality of resources and their consequences. Annual Review of Organizational Psychology and Organizational Behavior, 5, 103-128.Marx-Fleck, S., Junker, N. M., Artinger, F., & van Dick, R. (2021). Defensive decision making: Operationalization and the relevance of psychological safety and job insecurity from a conservation of resources perspective. Journal of Occupational and Organizational Psychology,  Vol 94 (3), 485-788.Mello, M. M., Chandra, A., Gawande, A. A., & Studdert, D. M. (2010). National costs of the medical liability system. Health Affairs, 29(9), 1569-1577.

Chapter 1:Summary of Better"Better" by Atul Gawande is a book that explores the concept of continuously striving for improvement in various aspects of our lives, particularly in the fields of medicine, healthcare, and education. Gawande argues that by seeking out ways to make small changes and adjust practices, we can make significant improvements in our work and lives. He provides examples of individuals and organizations that have successfully implemented this approach, and discusses the importance of embracing a mindset of continuous learning and adaptation. Ultimately, Gawande's message is that by constantly looking for ways to do things better, we can achieve great results and make a positive impact on the world around us.Chapter 2:The Theme of BetterKey plot points in "Better" by Atul Gawande include:- Gawande's exploration of the healthcare system, focusing on improvements that can be made to enhance patient care and safety- The importance of implementing checklists and guidelines in medical practice to reduce errors and improve outcomes- The use of innovative technology and new approaches to surgery and patient careCharacter development in "Better" primarily focuses on Gawande himself, as he reflects on his own experiences as a surgeon and examines his own attitudes and practices. Gawande's growth as a physician and advocate for improved healthcare is a central aspect of the book.Thematic ideas in "Better" include the importance of continuous improvement in medicine, the role of collaboration and teamwork in healthcare, and the need for medical professionals to prioritize patient safety and well-being above all else. The book also explores the ethical dilemmas and challenges that medical practitioners face, as well as the potential for positive change and progress in the field.Chapter 3:Meet the Writer of BetterIn his book "Better: A Surgeon's Notes on Performance," Atul Gawande demonstrates adept writing skills and a clear, concise language style to convey the emotions and meanings of his work. He utilizes these elements to effectively communicate the complexities of the medical field, the challenges of making decisions under pressure, and the importance of continuous improvement in healthcare.Gawande's writing is engaging and accessible, using simple language and straightforward explanations to make complex medical concepts understandable to a wide audience. He avoids jargon and technical language, instead opting for clear and concise prose that allows readers to follow along easily. This language style allows him to convey the emotions and meanings of his work in a way that is relatable and impactful.Additionally, Gawande's writing skills are evident in his ability to craft compelling narratives that draw readers in and keep them engaged throughout the book. He uses anecdotes and personal stories to illustrate key points and provide insight into the challenges and triumphs of practicing medicine. By incorporating these personal experiences, Gawande is able to connect with readers on a deeper level and convey the emotions and meanings of his work in a more personal and relatable way.Overall, Atul Gawande's writing skills and language style play a crucial role in conveying the emotions and meanings of "Better." Through clear, concise writing and engaging storytelling, he is able to shed light on the complexities of the medical field and the importance of continuous improvement in healthcare. His ability to connect with readers on an emotional level allows him to convey the significance of his work and inspire others to strive for excellence in their own lives.Chapter 4:Deeper Understanding of BetterBetter by Atul Gawande has had a significant impact on society, particularly in the field of healthcare. The book explores the concept of...

Send us a Text Message.A slightly crunchier than usual Wednesday crossword, unsurprising when Alex Eaton-Salners is at the helm (and editor Joel Fagliano's on the crows nest). We had some literary clues, such as 3D, _______ Gawande, author of the 2014 best seller "Being Mortal", ATUL; and 4D, Poet Pablo, NERUDA.We had product placement clues, such as 17A, Nail polish brand with colors like "Berry Fairy Fun", and "Aurora Berry-alis", OPI and 57A, Rival of Chanel, DIOR. Most impressively, however, we had the themed clues, which we dive into, at length, in today's episode.Just a casual reminder to please leave us a 5 star review wherever you get your podcasts, that really helps get the word out.Show note imagery: Olympic gold medalist APOLO OhnoContact Info:We love listener mail! Drop us a line, crosswordpodcast@icloud.com.Also, we're on FaceBook, so feel free to drop by there and strike up a conversation!

Join hosts Mike and Mark for a new episode as they dive into Atul Gawande's The Checklist Manifesto.LinksBuy The Book on AmazonBecome a Moonshot MemberWatch this episode on YouTubeINTRO Atul Gawande introduces us to the transformative power of checklists. He explains how these simple tools can enhance the performance of experts and foster closer teamwork. By breaking down complex tasks into manageable steps, checklists ensure that crucial details are not overlooked, thus improving efficiency and outcomes. Clip: The value of checklists (3m26)IMPORTANCE AND DIFFICULTY OF CHECKLISTS Atul discusses the initial resistance to adopting checklists and systems. He highlights how checklists shift from our usual values of autonomy and individual expertise to a more collaborative and systematic approach. This transition can be challenging but ultimately leads to better results. Clip: Resistance to checklists (1m55)In a compelling story, Atul recounts how medical teams operate like a pit crew, following a step-by-step checklist to save a life. This illustrates the power of checklists in high-stakes situations, demonstrating how structured teamwork can lead to miraculous outcomes. Clip: The Frozen Girl (4m02)SET GOALS Brian from Optimize shares an anecdote from Atul about the rock band Van Halen and their use of checklists. The band famously included a clause about brown M&Ms in their contract to ensure venues paid attention to the details. This story underscores how daily checklists can drive excellence and prevent oversights, even in unexpected ways. Clip: Brown M&Ms (2m55)OUTRO Atul emphasizes the need for a new way of thinking to improve ourselves. He stresses the importance of accepting our fallibility and using checklists to mitigate errors and enhance performance. This mindset shift can significantly improve both personal and professional arenas. Clip: Accept your fallibility (2m54)About Atul Gawande - The Checklist Manifesto: How to Get Things Right by Atul Gawande explores the critical role of checklists in managing complex tasks and improving outcomes across various fields, from medicine to aviation. Gawande uses real-world examples and in-depth research to demonstrate how simple, well-designed checklists can reduce errors, enhance performance, and ensure consistency. The book shows that even experts can benefit from the humble checklist to achieve excellent reliability and success.For a detailed summary, visit Checklist Manifesto Book SummaryLinksBuy The Book on AmazonBecome a Moonshot MemberWatch this episode on YouTubeAbout Moonshots Podcast: The Moonshots Podcast is your go-to source for unleashing the best possible version of yourself. Hosts Mike and Mark delve into the secrets of success by dissecting the mindset and daily habits of the world's greatest superstars, thinkers, and entrepreneurs. Join them as they learn out loud, exploring behind the scenes to discover actionable insights that can be applied to your life. Thanks to our monthly supporters Fabian Jasper Verkaart Ron Chris Turner Margy Diana Bastianelli Andy Pilara ola Fred Fox Austin Hammatt Zachary Phillips Antonio Candia Mike Leigh Cooper Daniela Wedemeier Corey LaMonica Smitty Laura KE Denise findlay Krzysztof Diana Bastianelli Roar Nikolay Ytre-Eide Stef Roger von Holdt Jette Haswell Marco Silva venkata reddy Dirk Breitsameter Ingram Casey Nicoara Talpes rahul grover Evert van de Plassche Ravi Govender Craig Lindsay Steve Woollard Lasse Brurok Deborah Spahr Barbara Samoela Christian Jo Hatchard Kalman Cseh Berg De Bleecker Paul Acquaah MrBonjour Sid Liza Goetz Konnor Ah kuoi Marjan Modara Dietmar Baur Ken Ennis Nils Weigelt Bob Nolley ★ Support this podcast on Patreon ★

Read the longform article at:https://gettherapybirmingham.com/healing-the-modern-soul-part-2/   The Philosophy of Psychotherapy The Corporatization of Healthcare and Academia: A Threat to the Future of Psychotherapy The field of psychotherapy is at a critical juncture, facing numerous challenges that threaten its ability to effectively address the complex realities of the human experience. Chief among these challenges is the growing influence of corporate interests and the trend towards hyper-specialization in academic psychology, which have led to a disconnect between the profession and its roots, as well as a lack of understanding of the physical reality of the body, anthropology, and the history of the field. In this article, we will explore the ways in which the corporatization of healthcare and academia is impacting psychotherapy, and argue that in order for the profession to remain relevant and effective, it must embrace a more holistic and integrative approach that recognizes the interconnectedness of the mind, body, and spirit. This requires a renewed commitment to developing a coherent concept of self, a shared language and understanding of implicit memory, and a vision of psychotherapy as a means of empowering individuals to become more effective at being themselves in the world and, in turn, better at transforming the world for the better. The Corporatization of Healthcare and Academia The influence of corporate interests on healthcare and academia has had a profound impact on the field of psychotherapy. The pressure to maximize profits and minimize costs has led to a shift away from comprehensive diagnosis and towards a reliance on quick fixes like medication and brief, manualized therapies. This trend is particularly evident in the way that psychiatry has evolved over the past few decades. Psychiatrists used to spend an entire hour with their patients doing psychotherapy, but now the majority of the profession relies solely on drug therapy. In fact, a staggering 89% of psychiatrists used only drug therapy in 2010, compared to just 54% in 1988 (Mojtabai & Olfson, 2008). Patients are often left feeling frustrated and unheard, with many giving up on medication after their psychiatrist writes a script in the first and last five minutes of their first session. The same forces are at work in academia, where the cost of education has skyrocketed and the focus has shifted towards producing "products" rather than fostering critical thinking and innovation. Adjunct professors, who often lack the expertise and experience to teach psychotherapy effectively, have replaced tenure-track faculty, and students are graduating with a narrow understanding of the field that is ill-suited to the realities of private practice (Collier, 2017). The result is a profession that is increasingly disconnected from its roots and the physical reality of the body. Anthropology, humanities and the history of the profession, which offer valuable insights into the nature of the human experience and the evolution of psychotherapy, are largely ignored in favor of a narrow focus on cognitive-behavioral interventions and symptom reduction pushed largely to help psychopharm companies' bottom lines (Frances, 2013). The current academic publishing system is also broken. Academics work hard to come up with original ideas and write papers, only to give their work away for free to publishers who make trillions of dollars in profits while the authors get no compensation (Buranyi, 2017). Peers often cite papers to support their own points without actually reading them in depth. And the "best" journals frequently publish absurd psychology articles that would make you laugh if you said their main point out loud, but hide their lack of substance behind academic jargon (Sokal, 2008). Meanwhile, students spend years in graduate school being forced to research what their advisor wants, not what's truly innovative or needed to advance the field. After a decade of study and compromise, the pinnacle achievement is often creating a new 30-question screener for something like anxiety, rather than developing therapists who can actually discern and treat anxiety without needing a questionnaire. The system fails to properly vet or pay therapists, assuming they can't be trusted to practice without rigid manuals and checklists. This hyper-rationality, the madness arising from too much logic rather than too little, is very useful to moneyed interests like the Department of Defense in how they want to fund and control research. Large language models and AI are the pinnacle of this - spreadsheets sorting data points to mimic human speech, created by people so disconnected from a real sense of self that they believe you can turn people into robots because they've turned themselves into robots (Weizenbaum, 1976). But psychology and therapy can't be reduced to hard science and pure empiricism the way fields like physics can (at least until you get to quantum physics and have to rely on metaphor again). We can't remove all intuition, subjective experience and uncertainty (Rogers, 1995). The reproducibility crisis in psychology research shows the folly of this over-rationality (Open Science Collaboration, 2015). Studies that throw out any participant who dropped out of CBT treatment because it wasn't helping them are not painting an accurate picture (Westen et al., 2004). Developing a Coherent Concept of Self A History of the Self Our understanding of the self has evolved throughout history: Ancient Greek Philosophy (6th century BCE - 3rd century CE) Socrates introduces the idea of the self as a distinct entity, emphasizing self-knowledge and introspection (Plato, trans. 2002). Plato's concept of the soul as the essence of the self, distinct from the physical body (Plato, trans. 1997). Aristotle's notion of the self as the unity of body and soul, with the soul being the form or essence of the individual (Aristotle, trans. 1986). Medieval Philosophy (5th century CE - 15th century CE) St. Augustine's concept of the self as a reflection of God, with the inner self being the source of truth and self-knowledge (Augustine, trans. 2002). St. Thomas Aquinas' synthesis of Aristotelian and Christian concepts of the self, emphasizing the soul as the form of the body (Aquinas, trans.1981). Renaissance and Enlightenment (16th century CE - 18th century CE) Descartes' famous "cogito ergo sum" ("I think, therefore I am"), establishing the self as a thinking, conscious being (Descartes, trans. 1996). Locke's idea of the self as a blank slate shaped by experience and the continuity of consciousness (Locke, trans. 1975). Hume's skepticism about the self, arguing that it is merely a bundle of perceptions without a unified identity (Hume, trans. 2000). Romantic Era (late 18th century CE - mid-19th century CE) The self is seen as a creative, expressive force, with an emphasis on individuality and subjective experience (Berlin, 2013). The rise of the concept of the "self-made man" and the importance of personal growth and self-realization (Trilling, 1972). 20th Century Philosophy and Psychology Freud's psychoanalytic theory, which posits the self as composed of the id, ego, and superego, with unconscious drives and conflicts shaping behavior (Freud, trans.1989). Jung's concept of the self as the center of the psyche, integrating conscious and unconscious elements (Jung, 1959). Existentialism's emphasis on the self as a product of individual choices and actions, with the need to create meaning in a meaningless world (Sartre, trans. 1956). The rise of humanistic psychology, with its focus on self-actualization and the inherent potential of the individual (Maslow, 1968). Postmodernism's deconstruction of the self, challenging the idea of a unified, coherent identity (Jameson, 1991). Contemporary Developments (late 20th century CE - present) The influence of neuroscience and cognitive science on the understanding of the self as an emergent property of brain processes (LeDoux, 2002). The impact of social and cultural factors on the construction of the self, with the recognition of multiple, intersecting identities (Gergen, 1991). The rise of narrative theories of the self, emphasizing the role of storytelling in shaping personal identity (Bruner, 1990). The influence of Eastern philosophies and contemplative practices on Western concepts of the self, with an emphasis on mindfulness and interconnectedness (Epstein, 1995). Psychotherapy and the Concept of Self Sigmund Freud (1856-1939) - Psychoanalysis: Freud, the founder of psychoanalysis, conceived of the self as being composed of three elements: the id, the ego, and the superego. The id represents the primitive, instinctual drives; the ego mediates between the demands of the id and the constraints of reality; and the superego represents the internalized moral standards and values of society. Freud believed that the goal of psychotherapy was to bring unconscious conflicts and desires into conscious awareness, allowing the ego to better manage the competing demands of the id and superego (Freud, trans. 1989). Carl Jung (1875-1961) - Analytical Psychology: Jung, a former collaborator of Freud, developed his own theory of the self, which he saw as the central archetype of the psyche. Jung believed that the self represented the unity and wholeness of the personality, and that the goal of psychotherapy was to help individuals achieve a state of self-realization or individuation. This involved integrating the conscious and unconscious aspects of the psyche, including the persona (the public face), the shadow (the repressed or hidden aspects of the self), and the anima/animus (the inner masculine or feminine) (Jung, 1959). Alfred Adler (1870-1937) - Individual Psychology: Adler, another former collaborator of Freud, emphasized the importance of social relationships and the drive for superiority in shaping the self. He believed that individuals develop a unique lifestyle or way of being in the world based on their early experiences and relationships, and that the goal of psychotherapy was to help individuals overcome feelings of inferiority and develop a healthy, socially-oriented way of living (Adler, trans. 1964). Fritz Perls (1893-1970) - Gestalt Therapy: Perls, the founder of Gestalt therapy, saw the self as an ongoing process of self-regulation and self-actualization. He believed that the goal of psychotherapy was to help individuals become more aware of their present-moment experience and to take responsibility for their thoughts, feelings, and actions. Perls emphasized the importance of contact between the self and the environment, and the need to integrate the different aspects of the self into a cohesive whole (Perls et al., 1951). Internal Family Systems (IFS) - Richard Schwartz (1950-present): IFS is a more recent approach that sees the self as being composed of multiple sub-personalities or "parts." These parts are seen as having their own unique qualities, desires, and beliefs, and the goal of IFS therapy is to help individuals develop a greater sense of self-leadership and inner harmony. The self is seen as the core of the personality, with the capacity to lead and integrate the different parts (Schwartz, 1995). As Schwartz writes in the introduction to his book on IFS, the model was heavily influenced by Gestalt therapy and the work of Carl Jung. Schwartz aimed to create a non-pathologizing approach that honored the complexity and wisdom of the psyche. IFS shares Jung's view of the self as the central organizing principle, surrounded by various archetypes or subpersonalities. It also draws on the Gestalt emphasis on present-moment awareness and the need for integration of different aspects of the self. However, IFS offers a more user-friendly language than classical Jungian analysis, without the need for extensive explanations of concepts like anima/animus. In IFS, a patient can quickly identify different "parts" - for example, a protector part that taps its foot and bites its nails to avoid painful feelings. By directly engaging with and embracing that part, the patient can access the vulnerable feelings and memories it is protecting against, fostering self-compassion and integration over time. The IFS model is an example of how contemporary approaches are building on the insights of depth psychology while offering more transparent, experience-near practices suitable for a wider range of patients and practitioners. It reflects an ongoing effort to develop a cohesive yet flexible understanding of the self that remains open to unconscious processes. Cognitive-Behavioral Therapy (CBT) - Aaron Beck (1921-2021) and Albert Ellis (1913-2007): CBT, developed by Beck and Ellis, focuses on the role of thoughts and beliefs in shaping emotional and behavioral responses. CBT sees the self as being largely determined by the individual's cognitions, and the goal of therapy is to help individuals identify and modify maladaptive or irrational beliefs and thought patterns. CBT places less emphasis on the unconscious or intrapsychic aspects of the self, and more on the conscious, rational processes that shape behavior (Beck, 1979; Ellis & Harper, 1975). Applied Behavior Analysis (ABA) - B.F. Skinner (1904-1990): ABA, based on the work of Skinner and other behaviorists, sees the self as a product of environmental contingencies and reinforcement histories. ABA focuses on observable behaviors rather than internal states or processes, and the goal of therapy is to modify behavior through the systematic application of reinforcement and punishment. ABA has been widely used in the treatment of autism and other developmental disorders, but has been criticized for its lack of attention to the inner experience of the self (Skinner, 1953; Lovaas, 1987). What is Self? One of the key challenges facing psychotherapy today is the lack of a coherent concept of self. The self is a complex and dynamic entity that is shaped by a range of internal and external factors, including our experiences, relationships, and cultural context (Baumeister, 1987). Unfortunately, many contemporary models of therapy fail to adequately capture this complexity, instead relying on simplistic and reductionistic notions of the self as a collection of symptoms or behaviors to be modified (Wachtel, 1991). To develop a more coherent and holistic concept of self, psychotherapy must draw on insights from a range of disciplines, including psychology, philosophy, anthropology, and the humanities (Sass & Parnas, 2003). This requires a willingness to engage with the messy and often paradoxical nature of the human experience, recognizing that the self is not a fixed entity but rather a constantly evolving process of becoming (Gendlin, 1978). The psychoanalyst Carl Jung's concept of the self as the central archetype, connected to the divine and the greater unconscious, offers a useful starting point for this endeavor. Jung believed that by making the unconscious conscious and dealing with ego rigidity, individuals could embody a deeper sense of purpose and connection to the universe (Jung, 1959). While we may not need to fully embrace Jung's metaphysical language, his emphasis on the dynamic interplay between conscious and unconscious processes, as well as the importance of symbol, dream, and myth in shaping the self, remains highly relevant today (Hillman, 1975). Other approaches, such as Internal Family Systems (IFS) therapy and somatic experiencing, also offer valuable insights into the nature of the self. IFS sees the self as a core of compassion, curiosity, and confidence that is surrounded by protective parts that arise in response to trauma and other challenges. By working with these parts and fostering greater integration and self-leadership, individuals can develop a more coherent and authentic sense of self (Schwartz, 1995). Similarly, somatic experiencing emphasizes the role of the body in shaping the self, recognizing that trauma and other experiences are stored not just in the mind but also in the muscles, nerves, and other physical structures (Levine, 1997). Models like IFS, somatic experiencing, and lifespan integration are appealing because they see the self as a dynamic ecosystem that is always evolving and striving for integration and actualization (Boon et al., 2011; Ogden et al., 2006; Pace, 2012). They don't try to label and categorize everything, recognizing that sometimes we need to just sit with feelings and sensations without fully understanding them intellectually. Lifespan integration in particular views the self as a continuum of moments threaded together like pearls on a necklace. Traumatic experiences can cause certain "pearls" or ego states to become frozen in time, disconnected from the flow of the self-narrative. By imaginally revisiting these moments and "smashing them together" with resource states, lifespan integration aims to re-integrate the self across time, fostering a more coherent and flexible identity (Pace, 2012). In contrast, the more behavioral and manualized approaches like CBT and ABA have a much more limited and problematic view. They see the self as just a collection of cognitions and learned behaviors, minimizing the role of the unconscious and treating people more like programmable robots (Shedler, 2010). If taken to an extreme, this is frankly offensive and damaging. There has to be room for the parts of the self that we can feel and intuit but not fully articulate (Stern, 2004). Ultimately, developing a coherent concept of self requires a willingness to sit with the tensions and paradoxes of the human experience, recognizing that the self is always in communication with the world around us, and that our sense of who we are is constantly being shaped by implicit memory and other unconscious processes (Schore & Schore, 2008). It requires remaining open to uncertainty and realizing that the self is never static or finished, but always dynamically unfolding (Bromberg, 1996). Good therapy helps people get in touch with their authentic self, not just impose a set of techniques to modify surface-level symptoms (Fosha et al., 2009). Understanding Implicit Memory Another critical challenge facing psychotherapy today is the lack of a shared language and understanding of implicit memory. Implicit memory refers to the unconscious, automatic, and often somatic ways in which our past experiences shape our present thoughts, feelings, and behaviors (Schacter et al., 1993). While the concept of implicit memory has a long history in psychotherapy, dating back to Freud's notion of the unconscious and Jung's idea of the collective unconscious, it remains poorly understood and often overlooked in contemporary practice (Kihlstrom, 1987). This is due in part to the dominance of cognitive-behavioral approaches, which tend to focus on explicit, conscious processes rather than the deeper, more intuitive and embodied aspects of the self (Bucci, 1997). To effectively address the role of implicit memory in psychological distress and personal growth, psychotherapy must develop a shared language and framework for understanding and working with these unconscious processes (Greenberg, 2002). This requires a willingness to engage with the body and the somatic experience, recognizing that our thoughts, feelings, and behaviors are deeply rooted in our physical being (van der Kolk, 2014). One way to think about implicit memory is as a kind of "photoshop filter" that our brain is constantly running, even when we are not consciously aware of it. Just as the center of our visual field is filled in by our brain based on the surrounding context, our implicit memories are constantly shaping our perceptions and reactions to the world around us, even when we are not consciously aware of them. This is why it is so important for therapists to be attuned to the subtle cues and signals that patients give off, both verbally and nonverbally. A skilled therapist can often sense the presence of implicit memories and unconscious processes long before the patient is consciously aware of them, and can use this information to guide the therapeutic process in a more effective and meaningful direction (Schore, 2012). At the same time, it is important to recognize that implicit memories are not always negative or pathological. In fact, many of our most cherished and meaningful experiences are encoded in implicit memory, shaping our sense of self and our relationships with others in profound and often unconscious ways (Fosshage, 2005). The goal of therapy, then, is not necessarily to eliminate or "fix" implicit memories, but rather to help individuals develop a more conscious and intentional relationship with them, so that they can be integrated into a more coherent and authentic sense of self (Stern, 2004). The Future of the Unconscious Many of the most interesting thinkers in the history of psychology understood this symbolic dimension of implicit memory, even if their specific theories needed refinement. Freud recognized the dynamic interplay of conscious and unconscious processes, and the way that repressed material could manifest in dreams, symptoms, and relational patterns (Freud, trans. 1989). Jung saw the unconscious as not just a repository of repressed personal material, but a deep well of collective wisdom and creative potential, populated by universal archetypes and accessed through dream, myth, and active imagination (Jung, 1968). Jung urged individuals to engage in a lifelong process of "individuation," differentiating the self from the collective while also integrating the conscious and unconscious aspects of the psyche (Jung, 1964). Reich connected chronic muscular tensions or "character armor" to blocked emotions and neurotic conflicts, pioneering body-based interventions aimed at restoring the free flow of life energy (Reich, 1980). While some of Reich's later work veered into pseudoscience, his core insights about the somatic basis of psychological experience were hugely influential on subsequent generations of clinicians (Young, 2006). More recently, emerging models such as sensorimotor psychotherapy (Ogden & Fisher, 2015), accelerated experiential dynamic psychotherapy (AEDP; Fosha, 2000), and eye movement desensitization and reprocessing (EMDR; Shapiro, 2017) aim to access and integrate implicit memories through body-based and imagistic techniques. By working with posture, sensation, movement, and breath, these approaches help patients bring nonverbal, affective material into conscious awareness and narrative coherence. Process-oriented therapies such as Arnold Mindell's process work (Mindell, 1985) offer another compelling framework for engaging implicit memory. Mindell suggests that the unconscious communicates through "channels" such as vision, audition, proprioception, kinesthesia, and relationship. By unfolding the process in each channel and following the flow of "sentient essence," therapists can help patients access and integrate implicit memories and in turn catalyze psychological and somatic healing. These contemporary approaches build on the insights of earlier clinicians while offering new maps and methods for navigating the realm of implicit memory. They point towards an understanding of the self as an ever-evolving matrix of conscious and unconscious, cognitive and somatic, personal and transpersonal processes. Engaging implicit memory is not about pathologizing the unconscious so much as learning its unique language and honoring its hidden wisdom. At the same time, this is tricky terrain to navigate, personally and professionally. As therapist and patient venture into the uncharted waters of the unconscious, it is crucial to maintain an attitude of humility, compassion, and ethical integrity (Stein, 2006). We must be mindful of the power dynamics and transference/countertransference currents that can arise in any therapeutic relationship, and work to create a safe, boundaried space for healing and transformation (Barnett et al., 2007). There is also a risk of getting lost in the fascinating world of the unconscious and losing sight of external reality. While depth psychology and experiential therapies offer valuable tools for self-exploration and meaning-making, they are not a replacement for practical skills, behavioral changes, and real-world action. We must be careful not to fall into the trap of "spiritual bypassing," using esoteric practices to avoid the hard work of embodying our insights and values in daily life (Welwood, 2000). Ultimately, the future of psychotherapy lies in integrating the best of what has come before while remaining open to new discoveries and directions. By combining scientific rigor with clinical artistry, cognitive understanding with experiential depth, and technical skill with ethical care, we can continue to expand our understanding of the self and the transformative potential of the therapeutic relationship. As we navigate the uncharted territories of the 21st century and beyond, we will need maps and methods that honor the full complexity and mystery of the human experience. Engaging with the unconscious and implicit dimensions of memory is not a luxury but a necessity if we are to rise to the challenges of our time with creativity, resilience, and wisdom. May we have the courage to venture into the depths, and the humility to be transformed by what we find there. Empowering Individuals to Be Themselves The ultimate goal of psychotherapy, in my view, is to empower individuals to become more effective at being themselves in the world and, in turn, better at transforming the world for the better. This requires a fundamental shift in the way that we think about mental health and well-being, moving beyond a narrow focus on symptom reduction and towards a more holistic and integrative approach that recognizes the interconnectedness of mind, body, and spirit. To achieve this goal, psychotherapy must embrace a range of approaches and techniques that are tailored to the unique needs and experiences of each individual. This may include somatic therapies that work with the body to release trauma and promote healing, such as somatic experiencing, sensorimotor psychotherapy, or EMDR (Levine, 1997; Ogden & Fisher, 2015; Shapiro, 2017). It may also include depth psychologies that explore the unconscious and archetypal dimensions of the psyche, such as Jungian analysis, psychosynthesis, or archetypal psychology (Jung, 1968; Assagioli, 1965; Hillman, 1975). And it may include humanistic and experiential approaches that emphasize the inherent worth and potential of each person, such as person-centered therapy, gestalt therapy, or existential psychotherapy (Rogers, 1995; Perls et al., 1951; Yalom, 1980). At the same time, psychotherapy must also be grounded in a deep understanding of the social, cultural, and political contexts in which individuals live and work. This requires a willingness to engage with issues of power, privilege, and oppression, recognizing that mental health and well-being are intimately connected to the broader structures and systems that shape our lives (Prilleltensky, 1997). It also requires a recognition that the goal of therapy is not simply to help individuals adapt to the status quo, but rather to empower them to become agents of change in their own lives and in the world around them (Freire, 1970). Therapists as Agents of the Post-Secular Sacred One way to think about this is through the lens of what depth psychologist David Tacey calls the "post-secular sacred" (Tacey, 2004). Tacey argues that we are moving into a new era of spirituality that is grounded in a deep respect for science and reason, but also recognizes the importance of myth, symbol, and the unconscious in shaping our experience of the world. In this view, the goal of therapy is not to strip away our illusions and defenses in order to reveal some kind of objective truth, but rather to help individuals develop a more authentic and meaningful relationship with the mystery and complexity of existence. This requires a willingness to sit with the discomfort and uncertainty that often accompanies the process of growth and transformation. It also requires a recognition that the path to wholeness and healing is not always a straight line, but rather a winding and often circuitous journey that involves confronting our deepest fears and vulnerabilities (Jung, 1959). Therapists of Agents of the Post Secular Sacred Riddle in the Garden by Robert Penn Warren My mind is intact, but the shapes of the world change, the peach has released the bough and at last makes full confession, its pudeur had departed like peach-fuzz wiped off, and We now know how the hot sweet- ness of flesh and the juice-dark hug the rough peach-pit, we know its most suicidal yearnings, it wants to suffer extremely, it Loves God, and I warn you, do not touch that plum, it will burn you, a blister will be on your finger, and you will put the finger to your lips for relief—oh, do be careful not to break that soft Gray bulge of blister like fruit-skin, for exposing that inwardness will increase your pain, for you are part of this world. You think I am speaking in riddles. But I am not, for The world means only itself. In the image that Penn Warren creates in "Riddle in the Garden" is a labyrinth leading back to the birth of humans in the garden of Eden.  Life itself is a swelling of inflammation from a wound or a need in both blisters and in peaches. You cannot have one part of the process without accepting all of it. The swelling in the growth of the fruit is also the swelling in the growth of a blister of pain. The peach must swell and become a sweet tempting blister or else no one would eat it and expose the "inwardness" of the seed to grow more trees.  exists to be eaten to die. We eat the peach to grow the next one. Not to touch the “suicidal” peach is not to touch life itself. For to live is to be hurt and to grow. To touch the peach is to become part of the world like Adam and Eve found out. It hurts it blisters us turning us into fruit.  For Penn Warren it is the separation of the self from the world of divine connection with nature that creates our need for meaning. This need is the reason that patients come to therapy. God tells us that “I am the lord your God” but Penn Warren tells us “I am not”. For “The world means only itself”. This process only has the meaning that we allow ourselves to give it. This is not a riddle, Penn Warren tells us.  It is only something we have to deal with but cannot not solve. The world means only itself. There is no gimmick or solution to the problem of being human.  In other words, the process of becoming more fully ourselves is not always easy or comfortable. It requires a willingness to confront the pain and suffering that is inherent in the human condition, and to recognize that growth and healing often involve an alchemical kind of death and rebirth. But it is precisely through this process of facing our fears and vulnerabilities that we can begin to develop a more authentic and meaningful relationship with ourselves, with others, and with the world around us. Ultimately, the goal of psychotherapy is not to provide answers or solutions, but rather to create a space in which individuals can begin to ask deeper questions about the nature of their existence and their place in the world. It is to help individuals develop the tools and capacities they need to navigate the complexities of life with greater courage, compassion, and wisdom. And it is to empower individuals to become more effective at being themselves in the world, so that they can contribute to the greater whole and help to create a more just, equitable, and sustainable future for all. The Future of Psychotherapy The corporatization of healthcare and academia poses a serious threat to the future of psychotherapy, undermining its ability to effectively address the complex realities of the human experience. To remain relevant and effective in the face of these challenges, the field must embrace a more holistic and integrative approach that recognizes the interconnectedness of the mind, body, and spirit. This requires a renewed commitment to developing a coherent concept of self, a shared language and understanding of implicit memory, and a vision of psychotherapy as a means of empowering individuals to become more effective at being themselves in the world and, in turn, better at transforming the world for the better. It also requires a willingness to engage with the full complexity and paradox of the human experience, recognizing that growth and healing often involve a kind of death and rebirth, and that the path to wholeness is not always a straight line. As the psychologist Carl Jung once wrote, "The privilege of a lifetime is to become who you truly are." Psychotherapy and the Dialectic of Self and World As we have explored throughout this essay, the self does not exist in a vacuum, but is always in dynamic interaction with the world around it. Our sense of who we are, what we value, and what is possible for us is shaped by a complex interplay of internal and external factors, from our earliest experiences of attachment and attunement to the broader social, cultural, and political contexts in which we are embedded. In many ways, psychotherapy can be seen as a process of exploring and working with the dialectical tension between self and world, between our innermost longings, fears, and aspirations and the often harsh realities of the environments we find ourselves in. When we enter therapy, we bring with us not only our own unique histories, personality structures, and ways of being, but also the internalized messages, expectations, and constraints of the world around us. For many individuals, these internalized messages and constraints can feel suffocating, limiting their sense of possibility and agency in the world. They may find themselves feeling stuck, trapped, or disconnected from their authentic selves, playing roles and wearing masks that no longer fit who they really are. In the face of external pressures to conform, to achieve, to fit in, the self can become fragmented, disempowered, or lost. The task of psychotherapy, then, is to help individuals rediscover and reclaim a sense of self that feels vital, authentic, and empowered, while also developing the skills and capacities needed to navigate the complexities of the world with greater flexibility, resilience, and integrity. This requires a delicate balance of supportive and challenging interventions, of validating the individual's unique experience while also gently questioning and expanding their assumptions about what is possible. On one end of the spectrum, an overly supportive or myopic approach to therapy can run the risk of enabling individuals to remain stuck in limiting patterns and beliefs, reinforcing a sense of helplessness or dependence on the therapist. While providing a warm, empathic, and nonjudgmental space is essential for building trust and safety in the therapeutic relationship, it is not sufficient for fostering real growth and change. Individuals need to be challenged to step outside their comfort zones, to experiment with new ways of being and relating, and to take responsibility for their choices and actions in the world. On the other end of the spectrum, an overly challenging or confrontational approach to therapy can be experienced as invalidating, shaming, or even retraumatizing, particularly for individuals with histories of abuse, neglect, or marginalization. Pushing individuals to "toughen up," to adapt to oppressive or toxic environments, or to simply accept the "reality" of their situation without questioning or resisting it can lead to a kind of false or forced adaptation, a loss of self that is no less harmful than remaining stuck. The key, then, is to find a middle path between these extremes, one that honors the individual's inherent worth, agency, and potential while also recognizing the very real constraints and challenges of the world they inhabit. This requires a deep understanding of the ways in which power, privilege, and oppression shape our experiences and identities, as well as a willingness to grapple with the existential questions of meaning, purpose, and authenticity that arise when we confront the gap between who we are and who we feel we ought to be. In practice, this might involve helping individuals to: Develop a clearer and more coherent sense of self, one that integrates the various parts of their personality, history, and identity in a way that feels authentic and meaningful to them. Identify and challenge limiting beliefs, assumptions, and patterns of behavior that keep them stuck or disconnected from their true desires and values. Cultivate greater self-awareness, self-compassion, and self-acceptance, learning to embrace the full range of their thoughts, feelings, and experiences with curiosity and kindness. Develop the skills and capacities needed to communicate effectively, set healthy boundaries, and navigate relationships and social situations with greater ease and confidence. Explore and experiment with new ways of being and relating in the world, taking risks and stepping outside their comfort zones in service of their growth and healing. Engage critically and creatively with the social, cultural, and political contexts that shape their lives, developing a sense of empowerment, agency, and social responsibility. Connect with a deeper sense of meaning, purpose, and spirituality, one that transcends the ego and connects them to something greater than themselves. Ultimately, the goal of psychotherapy is not simply to help individuals adapt to the world as it is, but to empower them to become active agents of change, both in their own lives and in the larger systems and structures that shape our collective reality. By developing a stronger, more integrated, and more authentic sense of self, individuals can begin to challenge and transform the limiting beliefs, oppressive power dynamics, and dehumanizing narratives that keep us all stuck and disconnected from our shared humanity. In this sense, psychotherapy is not just a personal journey of healing and self-discovery, but a deeply political and moral enterprise, one that calls us to envision and create a world that is more just, compassionate, and sustainable for all. As therapists, we have a unique opportunity and responsibility to support individuals in this process, to bear witness to their pain and their resilience, and to help them find the courage, clarity, and creativity needed to live a life of purpose, integrity, and connection. As the existential psychiatrist Viktor Frankl once wrote, "Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom." By creating a space for individuals to explore and expand their capacity to choose, to respond to the world with authenticity and agency, psychotherapy can play a vital role in the ongoing dialectic of self and world, of personal and collective transformation. 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China is an economic powerhouse, but could that change. Kishore Gawande, Fred H. Moore Centennial professor of international management at the University of Texas at Austin, digs in to find out. Kishore Gawande is a professor and chair of the Department of Business, Government & Society in The University of Texas at Austin's McCombs School […]

My guest for this episode is Laurence Lehmann-Ortega. Laurence is one of the world's leading experts on how existing firms can create innovative new business models. In this episode we discuss the newest edition of the her book, Re(Inventing) your Business Model: The Odyssey 3.14 Approach, co-authored with Helene Musikas and Jean March Schoettl. The book has also been adapted into a MOOC by Coursera. Like many of the best business schoolteachers, Laurence started her career in the consulting world before transitioning to academia, first at GSCM Montpellier and from 2010 at HEC Paris. At HEC she teaches strategy and business model innovation in the masters programs, the MBA, EMBA and in customised executive education programs. She has won multiple teaching awards at HEC. Laurence is also the Academic Director of the Masters in Strategic Management and our very own TRIUM EMBA program. In addition, she is the academic director on a number of large and complex programs in HEC's custom executive education portfolio. In this episode we discuss the problems of alignment between business models' value propositions and the existing firm's value architecture; the challenge of trade offs across different values – profit, people and planet – when evaluating the contribution new business models will make to the firm's goals; how to tell if a firm has a healthy innovation culture; the need for proper, scientific testing of innovation, and; the problem of applying ROI to innovation spending. We finish the discussion with a short conversation about the executive education industry. Laurence and I are both in the ‘supply side' of this business. Here, we put ourselves on the ‘buy side' and discuss what we would look for if we were making the decision to spend time and money on learning and development – both for the individual consumer and the corporate client. Laurence is one of the most talented teachers and academic directors I have ever met. I always look forward to our conversations because I walk away feeling like I've learned something. This conversation is no exception. I hope you enjoy!CitationsLaurence Lehmann-Ortega, Hélène Musikas & Jean- Marc Schoettl (2023) (Ré)inventez votre Business Model - 3e éd.: Avec l'approche Odyssée 3.14. English version to be available in June 2024.Gawande, Atul (2010) The Checklist Manifesto: How to Get Things Right. Picador Paper. Cylien Gibert & Sihem BenMahmoud-Jouini (2020) Créez le prochain Uber et soyez rentables d'ici la fin de l'année : Les managers de labs d'innovation face aux contradictions entre mandat et gouvernance. Revue Française de Gestion.Breaking Boundaries : The Science of Our Planet (2021) Netflix Series. Directed by Jonathan Clay. Hosted on Acast. See acast.com/privacy for more information.

Twila Reynolds and I talk about the inevitable moment coming to all of us: the day of our death.   Twila Reynold is retired.  She spent most of her professional years in the commercial insurance industry.  But, later, she changed fields and worked in the administrative medical field, which has always interested her. When she began working at the VA Medical Center, she started as an Invasive Procedure Coordinator in the CT area. She later moved to Human  Resources, where she handled all the worker compensation claims for that facility.   Twila directed me to the book Being Mortal by Atul Gawande. A PBS documentary by the same name is available on YouTube at  https://www.youtube.com/watch?v=lQhI3Jb7vMg Atul Gawande is a surgeon who explores the inevitable process of aging and ultimately death, and takes a critical look at how the medical profession does not yet have a firm grip on how to handle these processes well. He explores the birth of nursing homes, independent and assisted living facilities, and the various roles modern hospice programs can play to support those nearing the end of their lives. Gawande shares several stories of those who were adeptly aided through the process of growing frail as well as those were not so lucky. Finally, Gawande shares what he has learned about how each of us should approach our mortality as well as that of those we love.  

In the latest installment of "Influencing Safety," avid reader Bill Martin, president and CEO of Think Tank Project LLC, and podcast host Kate Wade discuss some of the books that have influenced the way Bill thinks about safety in the electric utility industry. Plus, check out his list of recommended books below!   1. Viskontas, I. (2017). Brain Myths Exploded. 2. Cialdini, R. (2021). Influence, New and Expanded: The Psychology of Persuasion. 3. Sharot, T. (2017). The Influential Mind: What Our Brain Reveals About Our Power to Influence Others. 4. Bohns, V. (2021). You Have More Influence Than You Think. 5. Kahneman, D. (2011). Thinking, Fast and Slow. 6. Gawande, A. (2009). The Checklist Manifesto. 7. Gonzales, L. (1998). Deep Survival: Who Lives, Who Dies, and Why. 8. De Becker, G. (2021). Survival Signals That Protect Us From Violence (Special Release Edition). 9. Klein, G. (2013). Seeing What Others Don't: The Remarkable Way We Gain Insights. 10. Bargh, J. (2017). Before You Know It: The Unconscious Reasons We Do What We Do. 11. Paul, A. M. (2021). The Extended Mind: The Power of Thinking Outside the Brain. 12. Barrett, L. F. (2020). 7 ½ Lessons on the Brain. 13. Clark, A. (2023). The Experience Machine: How Our Minds Predict and Shape Reality. Listen to the other 6 parts of this special series with Bill Martin, CUSP. To share feedback about this podcast, reach Bill at influenceteamdynamics@gmail.com and Kate at kwade@utilitybusinessmedia.com.   Subscribe to Incident Prevention Magazine - https://incident-prevention.com/subscribe-now/ ________________________________ This podcast is sponsored by T&D Powerskills. If you are looking for a comprehensive lineworker training solution, visit tdpowerskills.com today and use the exclusive podcast listener promo code podcast2023 to receive a 5% discount!

About ten years ago, Dr. Atul Gawande published Being Mortal and it became a New York Times bestseller. A trained surgeon, Dr. Gawande was trained to target a specific problem and fix it. In this book, however, he uses a mix of facts and stories to reveal a truth we must all accept. The body and the mind break down. Gawande skillfully captures the way people age and the ways we have supported older adults over time. More important, he issues a challenge. Over time, medicine, safety, and health standards have been given a supreme role in the care and support of older adults. Being Mortal warns against the over-medicalization of care for older people at the expense of finding what truly makes each adult's life worth living. Being Mortal is not just a reflection on the ideal form of caring for older adults. It's a call to accept that we will all become frail, to plan for that inevitable stage of life, and to consider what a good life will look like for us at that time.

The percent surface area burn for which half of patients survive, known as lethal area 50, or LA50 depends on where in the world the injury occurs. Calling all surgeons and trainees with an interest in providing more equitable delivery of global injury care - Join our Burn Surgery team as we welcome Dr. Manish Yadav, Plastic and Burn Surgeon at Kirtipur Hospital in Kathmandu, Nepal to discuss several recent challenging cases. We'll discuss the global burden of burn injuries, how emergency burn care systems reduce preventable morbidity and mortality, innovations in resuscitation of burn shock, use of checklists for critical care and safe early excision, and application of palliative care in different cultural contexts. (Co-hosts: Dr. Barclay Stewart, Burn and Trauma Surgeon at Harborview Medical Center and Paul Herman, UWMC/HMC Surgery Resident) Hosts: (affiliation and SM handles) 1.     Manish Yadav, Kirtipur Hospital, Nepal 2.     Barclay Stewart, Harborview Medical Center 3.     Paul Herman, UW/Harborview General Surgery Resident, @paul_herm  4.     Tam Pham, Harborview Medical Center (Editor) Learning Objectives 1.     Describe the global epidemiology of burn injury, disparities in burn injury and care, and highlight efforts to improve burn care in low and middle-income countries 2.     Discuss two cases at a burn center in Kirtipur, Nepal, highlighting challenges in burn care in LMICs and innovations to address these challenges and provide high level care a.     Highlight enteral resuscitation as an innovative strategy with advantages for treating burn shock in low resource settings b.     Discuss the key burn concept of early excision and steps to ensure safe application in low resource settings 1.     References a.     Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank. b.     Stewart BT, Nsaful K, Allorto N, Man Rai S. Burn Care in Low-Resource and Austere Settings. Surg Clin North Am. 2023 Jun;103(3):551-563. doi: 10.1016/j.suc.2023.01.014. Epub 2023 Apr 4. PMID: 37149390. https://pubmed.ncbi.nlm.nih.gov/37149390/ c.      Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744. https://pubmed.ncbi.nlm.nih.gov/29475744/ d.     Hebron C, Mehta K, Stewart B, Price P, Potokar T. Implementation of the World Health Organization Global Burn Registry: Lessons Learned. Annals of Global Health. 2022; 88(1): 34, 1–10. DOI: https://doi. Org/10.5334/aogh.3669 https://pubmed.ncbi.nlm.nih.gov/35646613/ e.     Jordan KC, Di Gennaro JL, von Saint André-von Arnim A and Stewart BT (2022) Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front. Pediatr. 10:954995. doi: 10.3389/fped.2022.954995 https://pubmed.ncbi.nlm.nih.gov/35928690/ f.      Mehta K, Thrikutam N, Hoyte-Williams PE, Falk H, Nakarmi K, Stewart B. Epidemiology and Outcomes of Cooking- and Cookstove-Related Burn Injuries: A World Health Organization Global Burn Registry Report. J Burn Care Res. 2023 May 2;44(3):508-516. doi: 10.1093/jbcr/irab166. PMID: 34850021; PMCID: PMC10413420. https://pubmed.ncbi.nlm.nih.gov/34850021/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here https://behindtheknife.org/listen/

Chapter 1 Reveal the true moral of The Checklist ManifestoThe Checklist Manifesto is a book written by Atul Gawande, an American surgeon and writer. The book discusses the importance of checklists in various fields, such as medicine, aviation, and construction, in order to improve performance, reduce errors, and enhance overall efficiency. Gawande argues that checklists provide a way to simplify complex tasks and prevent simple mistakes from occurring. He provides anecdotes and research studies to support how checklists can be effective in improving outcomes and increasing safety. The book highlights the power of simple tools like checklists in managing complex systems and emphasizes the necessity of adopting them in different industries.Chapter 2 Shall we Read The Checklist Manifesto ？Yes, The Checklist Manifesto by Atul Gawande is widely regarded as a good book. It has received positive reviews from readers and critics alike. The book explores the power of checklists in various fields, from medicine to aviation, and argues for their effectiveness in reducing errors and improving outcomes. It offers an engaging and thought-provoking perspective on the value of checklists and their potential to enhance performance, making it a recommended read for anyone interested in improving productivity and avoiding mistakes.Chapter 3 Key Points of The Checklist Manifesto "The Checklist Manifesto" by Atul Gawande is a book that explores the power of checklists in various professions, including medicine, aviation, and construction. Gawande argues that checklists can greatly improve the efficiency and effectiveness of complex tasks, helping to reduce errors and improve overall outcomes.The book begins by providing examples of catastrophic errors that have occurred in different fields due to the lack of simple checks and procedures. Gawande then looks at how checklists have been successfully implemented in aviation, where they have dramatically reduced accidents and increased safety. He emphasizes the importance of checklists in creating a culture of discipline and teamwork.Gawande then moves on to discuss how the use of checklists can be applied to the field of medicine. He describes how medical professionals can utilize checklists to ensure accurate diagnoses, minimize complications during surgeries, and prevent medical errors. He also acknowledges the challenges of implementing checklists in medicine, such as resistance from experienced professionals and the need for customization in different contexts.The author then expands the discussion to include other professions, such as construction and investment banking, where checklists have also proven to be effective tools. He highlights the importance of simplicity in checklist design and emphasizes the need for constant iteration and improvement.Gawande concludes by emphasizing the universal applicability of checklists and their ability to improve performance in a wide range of domains. He provides practical advice on creating effective checklists and encourages readers to start implementing them in their own fields.Overall, "The Checklist Manifesto" advocates for the use of checklists as a simple yet powerful tool to enhance decision-making, improve communication, and reduce errors across various industries.Chapter 4 The Checklist Manifesto Author Bio The book "The Checklist Manifesto" was written by Atul Gawande, a surgeon, writer, and public health researcher. It was first released on December 22, 2009.Apart from "The Checklist Manifesto," Atul Gawande has also written...

MISSION, TEXAS - The program notes for a recent healthcare conference in the Rio Grande Valley pointed out that the region's “expensive and tough-to-access” healthcare system came under the microscope in 2009 thanks to a landmark article in The New Yorker by Dr. Atul Gawande.The article, titled “The Cost Conundrum” became “mandatory reading during the debate surrounding President Obama's Affordable Care Act in 2010,” the program stated.Gawande's article was referenced a number of times by the conference's keynote speaker, Aneesh Chopra, president of Care Journey and former U.S. chief technology officer.The conference was titled Accelerator 2023, RGV Health Equity. It was hosted jointly by Western Governors University and AltaCair. It was held at Mission Event Center. In their program notes, WGU/AltaCair explained why they hosted the conference.“The RGV region has 24.7 percent of familiars living below the poverty level, nearly triple the percentage for the United States, according to the RGV Health Connect Organization. The population struggle with diabetes, obesity, and cervical cancer among other health issues. “The Rio Grande Regional Hospital states that an estimated 76,000 people in the region have diabetes. The COVID-19 pandemic further augmented the challenges of RGV with economic depressions and heightened inequities. The four RGV counties – Starr, Hidalgo, Willacy, and Cameron counties – are among the poorest counties in the nation and access to healthcare is unaffordable for many residents.”According to the US Census Bureau, 9.8 percent of people under the age of 65 do not have health insurance nationwide. But, the percentages for the four counties in the Valley are much higher:Hidalgo County: 33.1 percentCameron County: 29.9 percentStarr County: 28.9 percentWillacy County: 24.1 percent.Here is an audio recording of everything Aneesh Chopra said at the Accelerator 2023, RGV Health Equity Conference.To read the new stories and watch the news videos of the Rio Grande Guardian International News Service go to www.riograndeguardian.com.

Fourteen years ago, surgeon, writer, and public health researcher, Atul Gawande wrote his landmark article, The Cost Conundrum, about the healthcare challenges of the Rio Grande Valley (RGV) of South Texas. Gawande showcased the challenges that health systems confront when dealing with public and private insurers and the paradox between high-cost treatment options and low-quality outcomes. His careful assessment of McAllen, Texas, a small city on the border, found that it had the most expensive healthcare system in the nation.  This “cost conundrum” in the Rio Grande Valley inspired President Obama to pass the Affordable Care Act and begin a national movement to value-based care. Now that ACOs have reached a critical mass in the Rio Grande Valley we must now ask ourselves “to what degree can value-based care accelerate health equity?” Value-based care is the seed from which health equity transformation can bloom, nurturing a system that values every life, cultivates well-being, and harvests a future where health disparities are but a distant memory. Health equity transformation in underserved regions (like the RGV) is not just a matter of providing medical care; it's a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity. Equity transformation is currently underway in the Rio Grande Valley, one of the most underserved regions in the entire United States. The RGV – a 50-mile stretch of towns that span the border of Texas and Mexico – is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country. Issues like poverty and lack of access to healthcare burden the Valley. These factors are the leading cause of health problems like diabetes, obesity, and cervical cancer. Our guest this week is Dr. Edwin Estevez, a nationally-recognized value-based care leader and champion for health equity in the RGV.  His vision is to activate the local health ecosystem to expand access and promote inclusivity through the power of co-opetition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem. If you want to be a part of the health equity transformation in the Rio Grande Valley, register today for Accelerator2023 on October 17th!  (Attendees can attend in-person in Mission, Texas or virtually).  More information at www.equity-accelerator.org https://vimeo.com/decibelrocks/accel?share=copy Additional Resources: WGU Aims to Transform Rio Grande Valley's Healthcare A Vision of Pioneering Co-opetition for Health Equity Episode Bookmarks: 01:20 The landmark article, “The Cost Conundrum” about the healthcare cost crisis and how it inspired a national movement to value-based care. 01:45 Obama's Favorite New Yorker Article led to the passage of the Affordable Care Act and the development of ACOs. 02:00 Edwin Estevez returns to the Race to Value!  (Episode #1 with Edwin) 02:30 The underserved region of the Rio Grande Valley (RGV) as a focal point to create a replicable convening model of equity-based co-opetition. 04:30 Advancing health equity through a community-based ecosystem – Eric and Edwin discuss their upcoming collaboration in the RGV. 05:45 “Value-based care is a platform to shape policy, redirect programs, and understand services better through the lens of health equity.” 06:00 Edwin's prior VBC success with RGV ACO, one of the earliest (and most successful) physician-led MSSP ACOs in the country. 06:30 Edwin discusses AltaCair,

On Episode 10 of Season 3 , I spoke with my grandmother, Sydell Aaron. Ultimately, we all become consumers of Healthcare, like it or not. On Healthcare Reimagined, I typically showcase healthcare innovation - the truth is that innovations are only interesting in so far as they are making life  better for patients. Last week I spoke with my grandmother about her experience as a consumer of U.S. healthcare over the past 9 decades. Sydell, or Meema as I call her, was born in 1932. In 1929, 3 years before she was born, the first polio patient was saved.  In the 1940's when Meema was a teenager, scientists succeeded in isolating penicillin and antibiotics became widely available for the first time. Before that, you could die from a simple infection. The first kidney transplant was done in 1952, when Meema was 20.  In 1964, for the first time human blood was successfully stored. Meema was 32 years old, with 3 children.Meema has already lived 50% longer than the average life expectancy for a woman the year she was born (it was 62 back then). We spoke about her family doctor making house calls, the awe and wonder of medicine before technology that made medical information available to all, and about the trade off between safety and independence as one gets older.We discussed a few quotes from Atul Gawande's book Being Mortal, and the loss of independence as one ages.  One of the quotes from Gawande's book really captured the essence of the challenge Meema faces in her interactions with her adult children. They want the best for her, as she knows, but at times, they infringe upon her freedom in an effort to protect her: "We want autonomy for ourselves and safety for those we love.” We went on to discuss the framework in which death is addressed in U.S. Healthcare, and a system that selects for those who can and want to fix things (Doctors), when sometimes the best option is not to fix but to provide comfort in one's final days. We closed with a discussion about Meema's own hopes, desires, and observations after over 9 decades on this pale blue dot we all call home. Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content.

This episode is a live session from Jaipur Literature Festival 2023!

In this episode, we discuss the book, “The Checklist Manifesto,” by Atul Gawande. Gawande is a doctor, so the majority of his examples are from a doctor's perspective. However, many concepts are transferable between industries, including the legal field. Listen in as we go into where checklists came from, how they are beneficial, and their legal application. We are coming up on our 100th episode and second anniversary of Your Law Firm Is a Business – but we need your help. To celebrate, we want to add another 200 unique new listeners before we reach our 100th episode. You can help by sharing our show on social media and tagging us or leaving us a review on your podcast platform of choice. If we hit the goal, we will provide fun giveaways, including things from some of our tech tips episodes. Show Highlights: Why have a checklist, and how the checklist came to be The problems a checklist is designed to fix The legal application The difference between a checklist and a workflow Follow and Review: We'd love for you to follow us if you haven't yet. Click that purple '+' in the top right corner of your Apple Podcasts app. We'd love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a second and it helps spread the word about the podcast.  Supporting Resources: streamlined.legal  The Checklist Manifesto  Follow us on Twitter Follow us on Instagram Follow us on Facebook Book A Consultation at GNGF  The Legal Marketing Academy ACTION STEPS: Go back to your office and either look into your file or talk to your team and ask, “Do we have any file we consider a checklist?” I want you to take that checklist once you find them. Take a look at it and identify if it is a checklist or a workflow. If it is a checklist, then use it to build out some workflows in more detail. *** Episode Credits If you like this podcast and are thinking of creating your own, consider talking to my producer, Emerald City Productions. They helped me grow and produce the podcast you are listening to right now. Find out more at https://emeraldcitypro.com Let them know I sent you.

Atul Gawande is a surgeon and author who's well-known for his clear and eloquent writing on medicine. He was a staff writer for “The New Yorker” magazine from 1998 until 2022, when President Biden appointed him to lead global health at the ​​US Agency for International Development. Gawande is the author of four best-selling books including “The Checklist Manifesto,” and most recently, “Being Mortal: Medicine and What Matters in the End”. In that book, Gawande considers what medicine can not overcome - death. Along with the lessons he's learned treating patients who are facing death, Gawande writes about his own family's experience as his father's health declined. Dr. Gawande's unique perspective on the practice of medicine, especially things not so often discussed, has inspired us to invite him back to our stage numerous times. This conversation - with cognitive neuroscientist Indre Viskontas - is from 2017. It was recorded at the Nourse Theater in San Francisco.

Atul Gawande's "The Checklist Manifesto: How To Get Things Right" is a book that explores the power of checklists and how they can improve the performance of individuals and organizations in a variety of contexts. Some of the key themes of the book include: The fallibility of human memory: Gawande argues that humans are fallible and prone to forgetfulness, especially when dealing with complex tasks. Checklists can help ensure that critical steps are not missed. The value of simplicity: Checklists must be simple, concise, and easy to use. Complex checklists can be overwhelming and lead to errors. The importance of communication: Checklists can improve communication between team members, especially in high-pressure situations with a risk of miscommunication. The need for flexibility: Checklists should be adaptable to different contexts and situations and constantly updated and refined based on feedback. The potential for checklists to improve performance in various fields: Gawande provides examples of how lists have been successfully implemented in medicine, aviation, construction, and other industries. Overall, Gawande argues that checklists can be a powerful tool for improving performance and reducing errors in various contexts and that they should be an essential part of any organization's toolkit. ★ Support this podcast on Patreon ★

For some, pursuing a medical career is an all-consuming passion. What do you do if you have two? In this ASCO Education podcast, we look at the influences that propelled Dr. Lisa Rosenbaum to become a practicing cardiologist at Brigham and Women's Hospital in Boston and a national correspondent for the New England Journal of Medicine. Dr. Rosenbaum will explain the family legacy that impacted her choice to pursue medicine (1:46), her discovery of the love of writing (5:02) and what prompts her to write about specific topics (15:53). Speaker Disclosures Dr. Lisa Rosenbaum: None Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Resources:  Gray Matters: Analysis and Ambiguity by Lisa Rosenbaum, MD Podcast: Oncology, Etc. - In Conversation with Dr. Peter Bach (Part 1) Podcast: Oncology, Etc. – In Conversation with Dr. Peter Bach (Part 2) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed in the podcast page.  Pat Loehrer: Welcome to Oncology, Etc. an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson:  Hi, I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting people and topics in and outside the world of oncology, hence the "etcetera" in our name. Today's guest is an example of the "etcetera" aspect of our podcast. Dr. Lisa Rosenbaum is a practicing cardiologist at the Brigham and Women's Hospital in Boston and a member of the Harvard Medical School faculty. She's a highly respected national correspondent for the New England Journal of Medicine. Dr. Rosenbaum began her writing career while she was still an undergraduate at Stanford. She later attended med school at the University of California, San Francisco, completed an internal medicine residency at the Mass General Hospital in Boston, and a cardiology fellowship at Weill Cornell in New York. She spent an additional year of fellowship at The New England Journal, where she learned about writing, reporting, and investigative journalism. Subsequently, she was hired for an academic position at Brigham and presented with an opportunity to write on a regular basis for The New England Journal. She's written on a whole variety of topics, ranging from physician burnout to cognitive bias, resident duty hours, conflicts of interest, vaccine hesitancy, and many other topics.  So, Lisa, thank you for joining us today. We're very excited to have you on the program.  Dr. Lisa Rosenbaum: Thank you so much for having me. Dave Johnson: Well, perhaps we could start by asking you to just tell us a little about your background and your family. Dr. Lisa Rosenbaum: I grew up in Portland, Oregon. My parents are both physicians. My father is a rheumatologist and my mom is a cardiologist, and now my sister is also an endocrinologist. And we have several family members who are physicians, including my grandfather, who was also a rheumatologist and a writer and played a pretty pivotal role in my life, both in terms of my decision to become a physician and also a writer. When he was in his 70's, he got laryngeal cancer and he was treated with radiation therapy and cured. But after, he wrote a book about the experience of being a patient called A Taste of My Own Medicine, which I think was published in the late 80's. It's an autobiography. And then in the early 90's, Disney bought the rights to the book and made it into the movie The Doctor, starring William Hurt. He has a cameo, actually, and apparently it took him like 17 takes just to get it right, to wave his hand when he's sitting in the waiting room.   That was a pretty formative experience in my life, because basically he ended up, after writing that book and, you know, having a lot of success with it, wanting to write another book. And by then he was in his late 80's, and he ended up getting Parkinson's disease, which steadily progressed. He died at 94, so he lived a long, good life. But when I got into medical school, he decided he wanted to write a book with me and that it was sort of the follow up to A Taste of My Own Medicine, because he sort of recognized medicine's shortcomings in the book and asked a lot of questions, but he would always say, "I have more questions than I have answers." And when I got into medical school, he had this idea that we were going to come up with all the answers and make medicine as wonderful as it had once been for him. So obviously that was a big part of my life, both in terms of my career as a writer and also my career as a doctor. Though I think I really never questioned whether or not I wanted to be a doctor. That just sort of seemed so obvious to me as a kid that the work was so meaningful. And I don't know, there's something about growing up where everywhere you go, people tell you how one of your relatives made their lives better. That's pretty inspiring, as a kid.   Pat Loehrer: It's interesting that both your parents were physicians, but you claim that your grandfather is the one that got you into medicine. But I think your early career, I think you were actually kind of focused on writing and writing creative fiction, and there was another event in your life that kind of turned you back over to medicine too, right? Dr. Lisa Rosenbaum: Right, right. And I don't want to not give credit to my parents. They played a huge, wonderful role in my life as well, and they still do.  So anyway, I did take a detour in my career. So, in college I ended up, the fall of my junior year, taking a creative writing class. I'd done all the pre-med requirements by then and probably like many pre-meds, it felt very robotic to me. It's also, you're surrounded by all these people who are really ambitious, and you can feel like you're not very good, right? I remember I made a B-minus on my first organic chemistry exam, and I called my mom crying, and I was like, "I'm not going to be a doctor. This is a disaster." So all of a sudden, once I had gotten through those classes and I took this creative writing class, it was just this transformative experience for me because it was intensely creative. And I've always been just really interested in people, like what makes people do what they do, and character. I am just so fascinated by people's characters.  But the other part of the creative writing classes that I loved so much was just the sense of community. So you go from this setting where you're all sort of pitted against one another in these classes, and then you're in this place where everybody's trying to help each other and you're learning about each other through writing because we're all really just like writing about ourselves, even when we pretend otherwise. And I made some of the best friends of my life who've gone on to have actually remarkable writing careers. So sort of on a whim because it was so enriching for me and I felt like I couldn't live without it, I applied for MFA's in Creative Writing in my senior year, and I got rejected everywhere but waitlisted at Columbia. And then I got in. So I moved to New York in 2001, basically a week before September 11th, and I truly fell apart. Not in a way that I regret at all now. I think that a lot of us, when we are not productive, feel like our time is wasted. And I don't think I wrote a word that entire year. Like, I got really depressed and I just spent a lot of time wandering the city and I ate a lot of bagels, but I was really sad. I spent a lot of time downtown, like, looking at the faces of all these people who had died. And it was so unfathomable to me. And I wasn't able to use writing to cope with it as I might be able to now. I think I was just too young. And I had challenges with my writing professor who sort of felt like we shouldn't be writing about that.  And so I ran away from writing. I mean, I dropped out of creative writing school and went to medical school, and that was clearly the right move. More than anything in my life, I love being a doctor, so I don't regret that at all. And I think it actually was really helpful to me to recognize that I'm not cut out to just be a writer. I need to be inside people's lives, and there's no better way to do that than as a physician. And writing is this extra bonus that I have still that helps me just like it did when I was writing fiction, sort of try to understand the world. But I don't think I could function if I didn't get to take care of patients. And that became clear when I was 22 years old, essentially.  Dave Johnson: So, Lisa, you did this fellowship at the New England Journal of Medicine. Can you tell us about that? What was that like? And how much influence did that have in your current position?  Dr. Lisa Rosenbaum: It was awesome on so many levels. I think the first was that I really loved listening to people talk about science. That was new for me. And the rigor of the conversations at The Journal is really just hard to describe, and I just felt like I was like a kid in a candy shop. I'm interested in science, obviously, as a practicing physician, but I'm interested in science always in these meta ways. I'm interested in how we communicate science and the words we use and the conflicts that we focus on and those that we don't. And so much was always going on in my mind. ‘I was like, oh, my God, these are the data that are going to shape our practice. And then you have, like, a bunch of humans making these decisions.' And so that was inherently fascinating to me.  And the other thing that was really transformative was just sort of watching Jeff Drazen, who was the editor in chief at the time, and just how he led was so amazing to me. And I still think about it because, you know, in an ideal environment, I mean, people study this their whole lives, you know, organizational psychology and things like that. But, you know, to create a work environment where you can have, like, all these brilliant people sort of have a conversation and argue with each other and still come out friends was really remarkable to me. I don't think I could ever tell you what the recipe for that is, but I loved watching Jeff do his thing. And then, of course, on the most personal level, it was eleven years after I had tried and failed to be a writer in New York and all of a sudden I had medical training under my belt and I had a lot I wanted to say and I was capable in a way that I wasn't before of spending my days writing. So it turned out that I was able to structure my time and not just fall into a deep depression. So that was really important to me in terms of shaping my ambition. I still didn't believe that it was possible to have a job as a doctor and a writer until I was actually offered that job. But at least I knew that I loved it as much as I ever had.   They published what I wrote, and it's hard to describe, like, how that changes you in terms of realizing that, like, anybody might care what you had to say. You know, my experience until then had been writing this stuff with my grandfather, which was so inherently meaningful, but I could never get it published. I mean, the piece that I think that I'm still most proud of is what I ultimately wrote about my grandfather and this book project and it's called ‘The Art of Doing Nothing.'  I had a knee injury at the time, and I was in med school, and I couldn't get the doctor to do anything about it. And I was really compromised. I couldn't walk, and I was going into internship. And the prospect that I wasn't going to be able to do what I needed to do as an intern was just so terrifying to me. And so it sort of goes back and forth between that experience and my grandfather's ambition for us to fix medicine and his sense that something so fundamental had been lost. And it ends—I'm going to start crying when I talk about this—it ends with his death and how I wasn't planning to speak at his funeral, but then I just remembered this sense of something pushed me to walk onto the pulpit after all the other eulogies had been given. And I remember feeling the sense like, ‘Okay, he spent the last seven years wanting me to tell these stories, and I'm never going to be able to convey what he means or the point of his stories. And I could never describe the way he touched people's lives.' And I just remember when I was standing up there, I looked out and there were hundreds of people, patients, their children, who had just come to celebrate his life. And then this feeling that I didn't have to say anything because everybody already knew. So ‘The Art of Doing Nothing' is this idea that we're so reliant now on all these things that we can do. And my sort of tension with my own doctor was wanting an MRI. And by the way, I completely believe in a lot of the things we can do. I don't see how you could spend a day in the hospital as a cardiologist and not feel some awe for advances in our technologies and what they can do for patients. But I do think a lot of it has come at the expense of our humanity, not by the fault of any physicians, but in a system that just doesn't allow us to give people our time, our attention, or make them feel how much we care about them.  And so I think for me, the idea that my grandfather practiced at a time where he didn't have an MRI machine and he couldn't revascularize—I mean, he was a rheumatologist, but at that time, he would see patients having MI's and he did house calls and all these things, but that he could give them his love, for lack of a better word—it's a different type of love, but the love that we can give to patients, and that so many people then remembered him and showed up for him.  Pat Loehrer: If I can speak on behalf of your grandfather, if he was here, he would say that you have honored him.  Dave Johnson:Yeah, for sure.  Dr. Lisa Rosenbaum: That's very kind.  Dave Johnson: Lisa, you write about so many different things. They're all wonderful. I really appreciate your willingness to bear your soul, so to speak. And speaking of soul, one of my favorite pieces that you wrote was I think it was ‘Heart and Sole', where you talked about-  Dr. Lisa Rosenbaum: -broke my feet?  Dave Johnson: Yeah, your feet. That was great. You, in a sense, mentioned your father. And your father is also a Rheumatologist, actually, your father gave a grand rounds here about seven or eight years ago that was one of the best lectures I've ever heard on uveitis.  Dr. Lisa Rosenbaum: No, my dad is also huge. I've talked about my mom. I've talked about my grandfather. My dad is a huge part of my life, too. I just love him a whole lot.  Dave Johnson: Well, that came through in the article about your feet. What I wanted to ask you is obviously a lot of your ideas for writing come from personal experience, but you've also written about things like conflict of interest. You wrote a three-piece article in The New England Journal that actually generated some interesting conversation in the letters to the editor, including from former editors of The New England Journal. I wonder how you come upon these ideas. I mean, what prompts you to write about a particular topic?  Dr. Lisa Rosenbaum: The two things in my life that like, drive my writing. I mean, I'm not talking about medicine specifically, but I'm extremely emotional. I feel things very intensely, and I think because of that, I've always been interested in the way emotions affect reason, because it's been clear to me for a long time that my emotions could get in the way of my ability to make good decisions. So then I became very interested in sort of the nature of how we make decisions and the role emotion plays in that. And so conflicts of interest were, like, the perfect example of this, both at a very individual level of the way emotion shapes reasoning, but also I'm very interested in sociology, how humans affect one another's perceptions. And I think that series was published in 2015, so it was sort of a little bit before social media became so much more pervasive in our lives, but this idea of sort of collective pile-ons and canceling people that hadn't picked up as much.  But I was very interested in this tension between advancing care and how that had gotten lost in this sort of desire to vilify people who worked with industry, because it just seemed very obvious to me that we needed that. And I was perplexed as to why we sort of seized on this one aspect of bias when so many biases shape how we behave. And again, that goes back to the fact that I spend my entire life thinking about what is biasing my own behavior. And so I remember very clearly, and I tell this story in the series, in the second essay, how I used to get called when I was a cardiology fellow about transfers from other hospitals overnight and whether or not they should give TPA en route, because if you wait too long to revascularize them, at that time, people were getting TPA. I've only ever worked at a hospital where people get revascularized, so we don't really do it a lot. But anyway, I remember being so tired and so wanting to not go in that I would feel inclined to say, just give TPA, even though it would be better for the patient to get revascularized. And if they would get revascularized, it meant that I would be up all night, because after they would have, like, a sheath, and I would have to pull the sheath, and it was over. And so I remember thinking, like, ‘I'm making a decision out of, like, fatigue and laziness.' I mean, I didn't actually make decisions this way, but I remember how powerful those forces were in shaping my medical advice. And we all know when we practice in these busy hospitals that so many of our interactions are not about what the science says to do. There are other factors that come into play that are deeply embedded in sort of the sociology of medicine or people's feelings about one another or themselves. And so conflicts of interest was just like, at the nexus of all these things that fascinate me.  And then the third one was about sort of moral outrage. And again, this was before our politics were as polarized as they are today, for instance. But this idea that when you feel moral outrage, that you lose the ability to weigh trade-offs was extremely interesting to me because, again, it seemed to be at the crux of what was happening in sort of our ability as a profession to talk about how to optimize our relationships with industry so that we could get our patients the best treatments. And that instead of vilifying scientists who either had unique expertise that could be shared with companies to develop treatments, or who were on FDA panels because they were the ones who knew the most, it just seemed to me kind of strange that we weren't able to have those conversations.  And then when you mentioned all the blowback, I mean, that was the first time in my career, and I've since experienced it again and again. But that felt to me very much part of the problem in the first place, that that like, just saying that this was more nuanced than we were recognizing, you know, generated a lot of anger, and I was, like, totally okay with that, because it it was why I wrote it in the first place. And if I felt that in 2015, I feel that even more now, which is essentially you cannot write about anything interesting anymore without risking being canceled. Like, it's just things are so volatile, and everything I write, I think this might be the end of me. And you sometimes can't predict what is going to enrage people, but it feels, speaking of trade-offs, like a worthwhile trade-off for me because I could write what I know everybody wants to hear, or what they already know, and there's clearly a market for that. But that is so boring to me. And I don't learn anything, and I don't think readers learn anything, so that just doesn't feel like my role in this universe. Dave Johnson: When do you find time to read?  Dr. Lisa Rosenbaum: I read like, every night, every afternoon. I mean, I'm constantly reading or listening to podcasts and thinking about what I'm writing, or I'm interviewing people. I read like, all the time. Pat Loehrer: What are you reading now that you would recommend it?  Dr. Lisa Rosenbaum: The best books that I've read recently were Tomorrow, and Tomorrow and Tomorrow by Gabrielle Zevin. I don't know if you've read it. It's actually my computer is literally sitting on the book. She also wrote a book that has some oncology relevance. It's called The Storied Life of AJ. Fikry, I think. I finished it the night before I was going on the consult service, and for some reason I wept. There's a cancer part of the story, so you'll see when you read it, I don't want to give it away. But it was one of those moments I think I'll remember forever, just because even though I'm saying all these things about caring about humanity, I still lose it sometimes. And the consult service can be really hard because this goes back to this whole bias thing, because you're just going as fast as you can. It's not because you don't care, it's because there are ten people also who need to be seen. And so you're triaging your time, but also your emotional bandwidth, and you walk into the room and you just hope that you don't get asked a lot of questions and that you can move quickly so you can go see the next consult. And so I finished this book, and I hope it's not giving me too much away. But anyway, someone in the book has cancer and isn't treated very well by the medical system. And so it was like the night before I was going on consults, and it stayed with me in the same way my grandfather stays with me. Just like, take a deep breath, the week will end and you never get a second chance to see these people. So do it right. Pat Loehrer: I can't wait to read it. One of my residents, when I was an intern, I had a patient that died, and I was just really distraught, but she just quietly said that the beauty of medicine is that it has such a great joy, but it also has these downs, and that's unlike any other profession. And that's really what makes it such a marvelous profession, because of the feeling that you have.  You're a physician writer. Which physician writers do you think are the most meaningful? Or which ones do you admire the most?  Dr. Lisa Rosenbaum: I have to tell you, I teach a writing class.  Pat Loehrer: It's you.  Dr. Lisa Rosenbaum: For what?  Pat Loehrer: You're the one that you admire.  Dr. Lisa Rosenbaum: Oh, God, no. That wasn't what I was going to say. It's the opposite. So in the writing class, my editor of the journal and I teach a class to people, mostly to Brigham, but over the years, people from all over have started to join, and we do it on Zoom. And I have to say that there are some people in the class I just think are so talented. And what has struck me most about the experience beyond their talent, is just that physicians often just don't have an opportunity to get to write. And so I lucked out, like I really did. I lucked out in terms of having the opportunity to journal. I lucked out to grow up in a family that was just so loving toward me, telling me I could do whatever I wanted. But not everybody has that luck or privilege. And so to get to be in this writing workshop and see all these people who are just having their first chance to process what they've experienced and narrate it has been really awesome for me. And so they are not the people who are household names yet, but I have been struck by many of their talents. And also my editor and I taught one at Colorado this past summer, and there were some people who are just so equally talented. So that said, I think Gawande is like a masterful storyteller. He's able to sort of narrate in a way that is so accessible to people, and I think that is a mark of genius. So I do find myself studying his work. I have to tell you that I read mostly fiction, so I don't read a ton of doctor writers anymore. I used to when I was, before I was more established as a doctor writer, and I would do it to study them. But now I just find myself wanting to either read about culture or some sort of nonfiction that is unrelated to medicine or just read pure fiction. I'm mostly interested in how people tell stories and develop characters, and I could think about that forever. It never stops. Dave Johnson: What advice do you have, Lisa, for young physicians who may be contemplating a career with writing as a part of it? What advice do you have for them? Dr. Lisa Rosenbaum: When you write, you have to expect to fail. And I think that one of the hardest things about being within the institution of medicine and trying to be a writer is that we have these metrics for success that we're all so accustomed to in terms of publications and putting things on our CV and also how those are valued in advancing our careers. And if you really want to write, if it's really important to you, you have to let all of that go. And again, if people meet me at this moment in my life, they don't realize that I had this chunk of time for seven to ten years where I was writing and writing and writing, and I wasn't publishing anything, and I was getting rejected all over. And I did it because it meant so much to me and it meant so much to my grandfather. But if it becomes this thing that is meant to, like, advance your career, I think first of all, it becomes much more frustrating, but also you take away what makes it so meaningful, and I think that ends up detracting from the writing itself because it's just like the purity of it goes away. So I think that's one thing I would say.  The other thing is if you want to write, you just have to write. There's no other way about it. It's not fun. I mean, I wish people could see how much of my writing gets thrown away. It's so bad. But if you think of it as an act of discovery, which it is, I never know what I'm going to say until I get there. Then you can sort of forgive yourself for all of that time wasted. But it's pretty empathetical to how we function as doctors. I mean, when I go into the hospital, it's like a switch flips in my brain. I move into this extremely efficient, concrete sort of way of existing, and it's just so different from the mode I'm in when I'm creating.  Dave Johnson: That's extremely helpful. Thank you for that Lisa.  We want to thank all of our listeners of Oncology, Etc. This is an ASCO educational podcast. This is where we will talk about oncology medicine and beyond. So if you have an idea for a topic or a guest you would like us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. Thanks again.  Pat Loehrer: Hey, Dave, I got something for you. Dave Johnson: A present?  Pat Loehrer: No. A question for you. Which knight of King Arthur invented the roundtable? Sir Cumference. Doesn't get any better than that.  Dave Johnson: No, the snail joke was better. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of Asco. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Listen to ASCO's Journal of Clinical Oncology essay, “Preparing for the End Game,” by Dr. William Beck, a University Distinguished Professor Emeritus and Professor of Pharmacology and Molecular Genetics at The University of Illinois at Chicago. The essay is followed by an interview with Beck and host Dr. Lidia Schapira. Beck reflects on his own mortality and what it means to live, following his good friend's illness and death from lung cancer.   TRANSCRIPT  Narrator: Preparing for the End Game, by William T. Beck, PhD (10.1200/JCO.22.01758) Recently, Jordan, a dear friend who had stage 4 lung cancer, died of his disease, a year and a half from his diagnosis. His tumor had activating mutations in the epidermal growth factor receptor, making him a candidate for treatment with osimertinib, a targeted therapy, one of the recent rewards of the remarkable advances in precision medicine. Jordan was my age, late 70s when he died. He was a lifetime nonsmoker, had several outstanding lung cancer oncologists, and was determined to fight his disease. That said, 3-year and 5-year survival rates for people with his disease are not high, but living beyond those years is statistically and biologically possible. That was not so in Jordan's case. Jordan's illness was distressing to me because he was my good friend. We went back decades and began our academic careers together, and we bonded through our shared academic experiences and our love of good wines, food, books, humor, and politics. Over the course of his illness, I tried to think of how I could be there for Jordan and his wife, also a good friend, as he went forward on this very difficult journey. Jordan was very fortunate to have state-of-the-art medical care, a loving wife and adult children, and many close and caring friends who wanted to walk with him on this journey to the extent that he wanted us with him. Because I was in the cancer field, I was able to help him and his wife better frame the questions to ask his oncologists, understand the tests ordered and drugs he was taking, identify other oncologists for second opinions, and search the literature to help them find the best treatments to hold the tumor at bay.   Jordan's illness, however, was distressing to me for another reason. It made me think about my own mortality and how, if it were me, would I want to spend my last months and years, knowing that the end is now a reality. Jordan was a retired academic, scientist, and long-term and consequential university administrator. Like my friend, I have been retired for a few years, having run a productive academic cancer research laboratory and having held a number of administrative positions as well. My distress was compounded by external events over these past few years. We have seen the deaths of so many people from COVID-19 in this country and the world, all so painful and many unnecessary. We have also seen the continued violent deaths due to guns and drugs. These, however, were largely deaths in the abstract; they did not have a face for me. That began to change with the extraordinary culmination of the epidemic of Black deaths at the hands of the police, especially the murder of George Floyd. These deaths brought home to me the face and randomness of death and fragility of life, writ large. The past year brought more faces of death to me: many prominent artists and baseball players, whose careers I had followed; internationally impactful cancer scientists and physicians, many of whom I knew personally; and the untimely death of the famous architect, Helmut Jahn, at age 81 years, in a bicycle accident. All these passings have given me pause in a way that I had not expected and starkly reminded me that there is absolutely no guarantee of a tomorrow. Indeed, I will no longer live by the brilliant conceit offered by William Saroyan: “Everybody has got to die, but I have always believed an exception would be made in my case. Now what?”1 Now what, indeed. One frequently hears about people who have survived near-death experiences or those who have been diagnosed with a terminal illness, having an epiphany and wanting to live each day to the fullest extent possible. One also hears about realists who exhort us to live every day as if it were our last. Certainly sound advice. But do we normals really adhere to these dictums? Many people probably do, but my experience, both personal and from talking with friends, is that most of us still go about our lives doing the quotidian things that we have always done. There is always tomorrow, but Jordan's illness has caused me to rethink that. Indeed, it has become increasingly clear to me, finally, that I should not put off doing things for another tomorrow, a tomorrow that is not guaranteed. Despite knowing—in the abstract—that much more of my life is behind me than in front, my good health and full days have led me to think that this can go on for some time, with the inevitability of death still relatively far in the future. Jordan's situation, however, has changed that perception and has got me thinking about how I would like to spend my remaining days, hopefully many, and thinking about how to really prepare for this end game, taking these final laps. Paul Kalanithi, a young surgeon, wrote so tenderly in When Breath Becomes Air2 about his struggles while suffering the ravages of lung cancer and his hopes for his wife and young children. Even at my advanced age, I too have similar hopes for my wife, children, and grandchildren. And Christopher Hitchens chronicled, in Mortality,3 his last year with esophageal cancer as fiercely as he had always done in his critical atheist's view of the world. But it was not until Jordan's sickness and death that I have taken Hitchens's clear view of life's limitations to heart. In his book, Being Mortal,4 Atul Gawande, the physician-writer, has chronicled both the advances and limitations that modern medicine has brought us as we face the end, including the complications that limit our autonomy in this passage. Gawande notes that as we age and become infirm, either as a normal process or because of disease, we become more dependent on medical and social networks that may, unfortunately, effect on our independence. Gawande suggests that a good death may be difficult to achieve but a good life less so. I saw this good life in Jordan's terminal illness. Indeed, another physician-writer, Oliver Sacks, emphasized in a short collection of four essays entitled Gratitude,5 the utility of a good and fulfilling life in helping us cope as we approach the end. Near the end of his life, as his body was being consumed by cancer, Sacks continued to do what he always did, for as long as he could: His days were always full, and he wrote beautifully of his clinical and social observations. Importantly, Sacks expressed enormous gratitude for his life as a sentient and thinking person, who loved and was loved, and whose life was consequential. What more can one want? My friend Jordan was such an individual: sentient, smart, and funny; a man who lived a consequential and impactful life, who loved and was loved. His illness, however, was not one of going softly into the good night, as was depicted in the movie Love Story.6 Toward the end, my friend suffered with pain, balance problems, fractures from falls, shortness of breath, insomnia, and the like. But through it all, he presented, at least to me, an admirable grace and equanimity that gave us all hope that despite his suffering, there would be one more day, one more week, one more month. My wife and I went out to northern California last winter to visit Jordan and his wife, and although unsaid, to say good-bye. But now, more than a half year later, he died, just days short of their 50th wedding anniversary. We have stayed in close contact with Jordan's wife since his death. The funeral was private, but my wife and I attended a subsequent memorial service for Jordan at which family, friends, and colleagues remembered him and his consequential life and bid him a proper farewell. So, here we are. My good friend is gone, and his struggles have been hard to watch, even from a distance, but he has helped me see more clearly that this all does come to an end at some point. So how do I want to pursue this end game? Certainly, I want to stay engaged in my science-related activities. But I also want to use what time I have left while I am healthy to spend as much time as I can with my wife and family, to be with good friends as much as they will tolerate me, to continue to read, to go to theater and concerts, to travel, finding humor in life, and enjoying good wines and food—all the typical things that people do and say they want to do as they approach the end game. Indeed, I want to do as many of these things as possible, but with a renewed sense of wonderment and gratitude, gratitude in the way Oliver Sacks expressed it. My friend, Jordan, the academic, still has some lessons to offer, so I will try to follow his example to live as good a life as possible, and if I become infirm, I will try to remember how he approached the end: with grace, courage, and equanimity and reflect on all the good things I have had in this life, with a great sense of gratitude. Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, brought to you by ASCO podcasts, which covers a range of educational and scientific content, and offers enriching insight into the world of cancer care. You can find all ASCO shows, including this one at: podcasts.asco.org. I'm your host, Lidia Schapira, Associate Editor for Art of Oncology and Professor of Medicine at Stanford University. Today, we are joined by Dr. William Beck, a university distinguished Professor Emeritus, and Professor of Pharmacology and Molecular Genetics at the University of Illinois, at Chicago. In this episode, we will be discussing his Art of Oncology article, 'Preparing for the End Game.' At the time of this recording, our guest has no disclosures. Bill, welcome to our podcast. Thank you for joining us. Dr. William Beck: Thank you, Lidia. I appreciate the opportunity. I think this is a unique and valuable feature of JCO, and I hope I can do it justice. Dr. Lidia Schapira: It's terrific to have you. Tell our listeners a little bit about the motivation for writing about Jordan, and the effect that his illness and passing had on you. Dr. William Beck: Yes. Well, his illness and death made me think of my own mortality, and how if it were me, would I want to spend whatever remaining days I have, hopefully, many. But hopefully, in a way that would allow me to honor his life, and also do justice to my own situation. So, that was the nexus of the issue. I spoke to a writer friend, Eric Lax, he's written a number of books; one is, The Mold in Dr. Florey's Coat. If you haven't read it, I highly recommend it. It's about commercialization issues during World War II, and he's written some other books as well, a book with the hematologist Robert Peter Gale on radiation. And I asked him what he thought about this, and he was very positive. As you, I'm not accustomed to opening myself up in the scientific literature. I write scientific papers, and they're not emotional. One might get emotional about the reviewer's comments, but that's another story. And so, this was a difficult thing for me to write, but I felt if done correctly, it might be useful not only to help me articulate my own feelings, but it might be useful for others, especially oncologists with whom I've been around in my entire professional life, and who deal with these matters daily, as you do. But most likely, and of necessity, keep their thoughts and their own mortality locked away. And I sort of thought that this might be a way to help others think about ‘Preparing for the End Game'. Dr. Lidia Schapira: You bring up some interesting points because in order to write a piece that will resonate with others, you have to allow yourself to be vulnerable, and that is not something that we are taught to do in our academic and professional lives. Was that hard for you? Dr. William Beck: Very, yes. Dr. Lidia Schapira: And how did you work through that period of deciding to make yourself vulnerable and then share that with colleagues whom you may never know or meet? Dr. William Beck: Thank you for that question. I wanted to write somewhat of an homage for my friend, Jordan, and that made it a little easier to open myself up. And I might add, I shared this, after it was accepted, with Jordan's family - his wife, who is a friend, and his two adult children. And they all very, very much appreciated what I had done. So, I felt I was on the right path with that. So, it was in part for an homage to Jordan, and I had walked with him and his wife during his illness, and then with his death, and I wanted to mark the event in a way that I felt more than just giving money to a memorial fund. I felt I wanted to make it very personal, he was a good. I don't know if that answers your question, but that's why I started it. Dr. Lidia Schapira: In thinking about your essay and the way you chose to honor your friend and his memory, what do you think is the message for some of our young readers? Dr. William Beck: That's a good question. I put myself in the 40-year-old Bill Beck mindset, and back in those days, as I said in my essay, you know, everyone has to die, but in my case, I thought an exception would be made. Jordan's death, and those of others around my age have led me to understand that an exception will not be made, and I want to make the best of it, and if our young readers who know that this is an abstract that's very far away, but it becomes more and more of a reality as you approach the end, and I'm guessing that our younger readers who are oncologists can wall that off with difficulty, but can wall it off to a certain extent. But it's there. It's inescapable, and so, maybe preparing early, if it even makes you think about enjoying a little bit more time with your kids, enjoying a vacation for another day, or even putting a little bit more money away for your IRA for your retirement, that could be very useful for them. Dr. Lidia Schapira: On the flip side of that, Bill, you write in your essay that you have continued to remain involved in your science, and I imagine that's because you love your science. So, tell us a little bit more about how you're thinking now, as you are mature-- I won't use the word senior, or old, about continuing to remain involved in a career that is not just work, but something that you love. Dr. William Beck: I could not imagine retiring. What I enjoy about my retirement is that I basically do everything that I did before, except the administrative part - the running a department for so long. And I do it on my schedule, not somebody else's schedule, and that is liberating. I just came back from a two-hour lecture that I gave yesterday; I mentor young people, I review grant applications and manuscripts, I read the literature. So, I stay involved. I can't imagine not being involved. And as Oliver Sacks, whom I've cited in the essay, he went at it all the ways best he could all the way to the end, and I hope that I will have that opportunity to do so as well. Dr. Lidia Schapira: What advice would you have for some of our listeners who are themselves accompanying a friend who is ill, or perhaps a relative who is facing a chronic or terminal illness? Dr. William Beck: I'm loath to give advice, but I would suggest that they might want to be there as much as their friend wants them to be there for them. To be there, and for them to know that they're there. I was in a unique position because I knew a little bit about the cancer field, and I could help Jordan and his wife navigate the shoals of interacting with physicians, and understanding their drugs, and getting second opinions, actually, for them. So, I was in a fairly unique position, but I think that the key thing is to be there to the extent that the individual wants you to be there with them is important. That's what I've learned from my deep emotional involvement with Jordan, but with others as well. Dr. Lidia Schapira: As you know from reading the essays we've published in Art of Oncology, Grief is a common theme, and I ask many of our authors to recommend, perhaps, some books they've read, or works of art that have helped them in processing their own grief. So, let me ask you if you can recommend any books, or poems to our listeners. Dr. William Beck: I'm not much into poetry, but I did happen to see an amazing interpretation of Psalm 23 on the Jewish Broadcasting Network recently that was eye-opening to me as a non-religious person. That was very interesting. In terms of books, I think a good start is the beautiful essays of Gratitude by Oliver Sacks. I've started to peel into, and peer into a book on Morality, by Jonathan Sacks-- no relation, I don't think. He was the Chief Rabbi of the UK. And in terms of art, I can think of music - the ‘Pastoral', by Beethoven, and the ‘9th', by Beethoven, are the ones that just are so uplifting to me, that I think would be very important to calm one's soul. Also, if I might add, The Stones are pretty good too, for that. Dr. Lidia Schapira: So, let me conclude our interview by asking you a little bit more about the role of storytelling, and essays, and narrative, in helping us come together as a community of professionals who are actually dedicated to looking after patients who are seriously ill. How have you used stories in your approach to Medicine and Academia, and what do you see as the role of these narratives in the future education of oncologists and hematologists? Dr. William Beck: So, I think young people, especially, need to hear stories of how these things begin. They need to hear origin stories, and middle stories, and end stories. Joseph Campbell, is one who's delved into where we came from, and about storytelling, as being very important in development of societies and traditions. So, I've tried in my work, even though it's scientific work, and maybe some of my reviewer critics would say, "Well, it's all stories and fables," but I've tried to develop several lines of science storytelling for our colleagues. And I think in general, whether it's in science or this kind of essay, yes, it's very important that the young people get outside of the, "What do I need to know for the exam?" mentality, to look at the bigger picture; and I'm afraid that's getting lost in modern education. The guy who introduces me, when I give the general lecture to all the students who are first time, first day in the room, never to be in the room again, always says, "And Dr. Beck won't answer any questions about what's on the exam." Dr. Lidia Schapira: Well, I thank you for sharing some of your humanity with the readers of JCO, through the essay. I know, as you told us, during the review, that you're not used to writing these kinds of essays, and you're much more comfortable with scientific work. But I think we need to show the human side of our scientists. I think that Jordan's family is right in thanking you for the tribute you paid to him through this essay, and I'm very glad that you did write it, and decided to share it with us. Dr. William Beck: Thank you. Well, I'm really glad that you have this venue, and I'm honored to have my essay published in it. I thank you, and your colleagues. Dr. Lidia Schapira: Thank you, Bill. Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, wherever you listen. Be sure to subscribe, so you never miss an episode. JCO's Cancer Stories: The Art of Oncology is just one of ASCO's many podcasts. You can find all of the shows at: podcasts.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement. Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review.   Bio: Dr. William Beck is a university distinguished Professor Emeritus, and Professor of Pharmacology and Molecular Genetics at the University of Illinois, at Chicago.  

In this episode, we talk to Dr. Tanya Baker, the director of national programs at the National Writing Project. In this role, Dr. Baker builds and manages national programs that connect educators to work together on areas of interest and problems of practice.  We discuss current problems of practice and strategize ways to rejuvenate teachers and teaching. Dr. Baker also shares a number of resources for personal and professional growth. Referenced in this podcast: https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fread.amazon.com%2Fkp%2Fembed%3Fasin%3DB000QCSAB8%26preview%3Dnewtab%26linkCode%3Dkpe%26ref_%3Dcm_sw_r_kb_dp_R3K7301WKABZ82KH4WEM&data=05%7C01%7CRJackson%40govst.edu%7C8e75f965c4c740ff01c608da89dedf46%7Cb86dab28987f4cada951ce05b68601ab%7C0%7C0%7C637973887578125077%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=9NDTP3cnZJgw3Lp49HVDLuUhKUWYme1p%2BIty3a39aeI%3D&reserved=0 (Gawande, Atul (2008). Better: A Surgeon's Notes on Performance.) https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.amazon.com%2Fdp%2F032504919X%2Fref%3Dcm_sw_em_r_mt_dp_7P1BSCN1MBD69T7ZGPF4&data=05%7C01%7CRJackson%40govst.edu%7C8e75f965c4c740ff01c608da89dedf46%7Cb86dab28987f4cada951ce05b68601ab%7C0%7C0%7C637973887578125077%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=YQamOd%2BGtu%2Bs7SDI2AdA480we4gEWYBdtn%2Bdlk6sTdY%3D&reserved=0 (Rami, Meenoo (2014). Thrive: 5 Ways to (Re)Invigorate Your Teaching.) https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fread.amazon.com%2Fkp%2Fembed%3Fasin%3DB00YHM2H80%26preview%3Dnewtab%26linkCode%3Dkpe%26ref_%3Dcm_sw_r_kb_dp_SV2TP2XBHFCRR05DKXYC&data=05%7C01%7CRJackson%40govst.edu%7C8e75f965c4c740ff01c608da89dedf46%7Cb86dab28987f4cada951ce05b68601ab%7C0%7C0%7C637973887578125077%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=4HFsKJhTT0TrVY5ycbPucAK2CloEeIcymtzjN22v%2BWw%3D&reserved=0 (Baker-Doyle,) https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fread.amazon.com%2Fkp%2Fembed%3Fasin%3DB00YHM2H80%26preview%3Dnewtab%26linkCode%3Dkpe%26ref_%3Dcm_sw_r_kb_dp_SV2TP2XBHFCRR05DKXYC&data=05%7C01%7CRJackson%40govst.edu%7C8e75f965c4c740ff01c608da89dedf46%7Cb86dab28987f4cada951ce05b68601ab%7C0%7C0%7C637973887578125077%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=4HFsKJhTT0TrVY5ycbPucAK2CloEeIcymtzjN22v%2BWw%3D&reserved=0 ( Kira J., Wasley, Patricia A., Lieberman, Ann, McDonald, Joseph (2011). ) https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fread.amazon.com%2Fkp%2Fembed%3Fasin%3DB00YHM2H80%26preview%3Dnewtab%26linkCode%3Dkpe%26ref_%3Dcm_sw_r_kb_dp_SV2TP2XBHFCRR05DKXYC&data=05%7C01%7CRJackson%40govst.edu%7C8e75f965c4c740ff01c608da89dedf46%7Cb86dab28987f4cada951ce05b68601ab%7C0%7C0%7C637973887578125077%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=4HFsKJhTT0TrVY5ycbPucAK2CloEeIcymtzjN22v%2BWw%3D&reserved=0 (The Networked Teacher: How New Teachers Build Social Networks for ) https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fread.amazon.com%2Fkp%2Fembed%3Fasin%3DB00YHM2H80%26preview%3Dnewtab%26linkCode%3Dkpe%26ref_%3Dcm_sw_r_kb_dp_SV2TP2XBHFCRR05DKXYC&data=05%7C01%7CRJackson%40govst.edu%7C8e75f965c4c740ff01c608da89dedf46%7Cb86dab28987f4cada951ce05b68601ab%7C0%7C0%7C637973887578125077%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=4HFsKJhTT0TrVY5ycbPucAK2CloEeIcymtzjN22v%2BWw%3D&reserved=0 (Professional Support.)

Dr. Atul Gawande has had a varied, celebrated career in medicine. He's been a physician, a writer, and now he's the Global Health Assistant Administrator at USAID. Dr. Gawande has always said the task of sharing medical progress with every corner of the planet is “the most ambitious thing we've ever attempted.” From facing a global public health system weakened by COVID-19, to families seeking support caring for aging loved ones, Dr. Gawande is focused on “generational work” at USAID, and about how society can step up.    In this episode, Dr. Gawande and Ray Suarez discuss taking public health work to the global stage, and the immense challenges that lie ahead.   Support for this podcast episode was provided in part by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.   Guest(s):   Dr. Atul Gawande, writer, physician, and Assistant Administrator for Global Health for the U.S. Agency for International Development (USAID)    Host:     Ray Suarez   If you appreciate this episode and want to support the work we do, please consider making a donation to World Affairs. We cannot do this work without your help. Thank you.

In this episode, we hear from Megan and Mikhail, graduate students in Clinical Informatics and Patient-Centered Technologies and Archeology, respectively. In their discussion, we hear about utilizing multiple forms of communication, negotiating audiences, and the ongoing process of refining your approach. Listen in to learn more! Find out more about the material mentioned in this episode: The Pomodoro Technique – This time management strategy is summarized by Amrita Mandal in “The Pomodoro Technique: An Effective Time Management Tool.” Zotero – Zotero is a citation manager. Find links to Zotero and other similar apps in the UW Libraries' research guide on digital history tools under “Productivity." StatQuest with Josh Starmer – Find engaging digital content about statistics and mathematics from Josh Starmer on his YouTube page. Atul Gawande – Learn more about Gawande's work in writing, medicine, and public health on his website here. “To Save The Science Poster, Researchers Want To Kill It And Start Over” -- Nell Greenfieldboyce (NPR, 2019). “Why Doctors Hate Their Computers”– Atul Gawande (The New Yorker, 2018) Bitch Doctrine: Essays for Dissenting Adults – Laurie Penny (Bloomsbury, 2017)

Harry's guest Eric Daimler, a serial software entrepreneur and a former Presidential Innovation Fellow in the Obama Administration, has an interesting argument about math. If you're a young person today trying to decide which math course you're going to take—or maybe an old person who just wants to brush up—he says you shouldn't bother with trigonometry or calculus. Instead he says you should study category theory. An increasingly important in computer science, category theory is about the relationships between sets or structures. It can be used to prove that different structures are consistent or compatible with one another, and to prove that the relationships in a dataset are still intact even after the data has been transformed in some way. Together with two former MIT mathematicians, Daimler co-founded a company called Conexus that uses category theory to tackle the problem of data interoperability. Longtime listeners know that data interoperability in healthcare, or more often the lack of interoperability, is a repeating theme of the show. In fields from drug development to frontline medical care, we've got petabytes of data to work with, in the form of electronic medical records, genomic and proteomic data, and clinical trial data. That data could be the fuel for machine learning and other kinds of computation that could help us make develop drugs faster and make smarter decisions about care. The problem is, it's all stored in different databases and formats that can't be safely merged without a nightmarish amount of work. So when someone like Daimler says they have a way to use math to bring heterogeneous data together without compromising that data's integrity – well, it's time to pay attention. That's why on today's show, we're all going back to school for an introductory class in category theory.Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3. Scroll down to find the subhead titled "Ratings & Reviews."4. Under one of the highlighted reviews, select "Write a Review."5. Next, select a star rating at the top — you have the option of choosing between one and five stars. 6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7. Once you've finished, select "Send" or "Save" in the top-right corner. 8. If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9. After selecting a nickname, tap OK. Your review may not be immediately visible.That's it! Thanks so much.TranscriptHarry Glorikian: Hello. I'm Harry Glorikian, and this is The Harry Glorikian Show, where we explore how technology is changing everything we know about healthcare.My guest today is Eric Daimler, a serial software entrepreneur and a former Presidential Innovation Fellow in the Obama Administration.And he has an interesting argument about math. Daimler says if you're a young person today trying to decide which math course you're going to take, or maybe an old person who just wants to brush up, you shouldn't bother with trigonometry or calculus.Instead he says you should study category theory.That's a field that isn't even part of the curriculum at most high schools. But it's increasingly important in computer science.Category theory is about the relationships between sets or structures. It can be used to prove that different structures are consistent or compatible with one another, and to prove that the relationships in a dataset are still intact even after you've transformed that data in some way.Together with two former MIT mathematicians, Daimler co-founded a company called Conexus that uses category theory to tackle the problem of data interoperability.Now…longtime listeners of the show know that data interoperability in healthcare, or more often the lack of interoperability, is one of my biggest hobby horses. In fields from drug development to frontline medical care, we've got petabytes of data to work with, in the form of electronic medical records, genomic and proteomic data, and clinical trial data.That data could be the fuel for machine learning and other kinds of computation that could help us make develop drugs faster and make smarter decisions about care. The problem is, it's all stored in different databases and formats that can't be safely merged without a nightmarish amount of work.So when someone like Daimler says they have a way to use math to bring heterogeneous data together without compromising that data's integrity – well, I pay attention.So on today's show, we're all going back to school for an introductory class in category theory from Conexus CEO Eric Daimler.Harry Glorikian: Eric, welcome to the show.Eric Daimler: It's great to be here.Harry Glorikian: So I was reading your varied background. I mean, you've worked in so many different kinds of organizations. I'm not sure that there is a compact way or even an accurate way to describe you. So can you describe yourself? You know, what do you do and what are your main interest areas?Eric Daimler: Yeah, I mean, the easiest way to describe me might come from my mother. Well, where, you know, somebody asked her, is that the doctor? And she says, Well, yes, but he's not the type that helps people. So I you know, I've been doing research around artificial intelligence and I from a lot of different perspectives around my research in graph theory and machine learning and computational linguistics. I've been a venture capitalist on Sand Hill Road. I've done entrepreneurship, done entrepreneurship, and I started a couple of businesses which I'm doing now. And most notably I was doing policy in Washington, D.C. is part of the Obama administration for a time. So I am often known for that last part. But my background really is rare, if not unique, for having the exposure to AI from all of those angles, from business, academia and policy.Harry Glorikian: Yeah. I mean, I was looking at the obviously the like you said, the one thing that jumped out to me was the you were a Presidential Innovation Fellow in the Obama administration in 2016. Can you can you give listeners an idea of what is what is the Presidential Innovation Fellowship Program? You know, who are the types of people that are fellows and what kind of things do they do?Eric Daimler: Sure, it was I guess with that sort of question, it's helpful then to give a broader picture, even how it started. There was a a program started during the Nixon administration that's colloquially known as the Science Advisers to the President, you know, a bipartisan group to give science advice to the president that that's called the OSTP, Office of Science and Technology Policy. There are experts within that group that know know everything from space to cancer, to be super specific to, in my domain, computer security. And I was the authority that was the sole authority during my time in artificial intelligence. So there are other people with other expertise there. There are people in different capacities. You know, I had the particular capacity, I had the particular title that I had that was a one year term. The staffing for these things goes up and down, depending on the administration in ways that you might be able to predict and guess. The people with those titles also also find themselves in different parts of the the executive branch. So they will do a variety of things that are not predicted by the the title of the fellow. My particular role that I happened to be doing was in helping to coordinate on behalf of the President, humbly, on behalf of the President, their research agenda across the executive branch. There are some very able people with whom I had the good fortune of working during my time during my time there, some of which are now in the in the Biden administration. And again, it's to be a nonpartisan effort around artificial intelligence. Both sides should really be advocates for having our research agenda in government be most effective. But my role was coordinating such things as, really this is helpful, the definition of robotics, which you might be surprised by as a reflex but but quickly find to be useful when you're thinking that the Defense Department's definition and use, therefore, of robotics is really fundamentally different than that of health and human services use and a definition of robotics and the VA and Department of Energy and State and and so forth.Eric Daimler: So that is we find to be useful, to be coordinated by the Office of the President and experts speaking on behalf. It was started really this additional impulse was started after the effects of, I'll generously call them, of healthcare.gov and the trip-ups there where President Obama, to his great credit, realized that we needed to attract more technologists into government, that we had a lot of lawyers to be sure we had, we had a ton of academics, but we didn't have a lot of business people, practical technologists. So he created a way to get people like me motivated to come into government for short, short periods of time. The the idea was that you could sit around a cabinet, a cabinet meeting, and you could you would never be able to raise your hand saying, oh, I don't know anything about economics or I don't know anything about foreign policy, but you could raise your hand and say, Oh, I don't know anything about technology. That needs to be a thing of the past. President Obama saw that and created a program starting with Todd. Todd Park, the chief technologist, the second chief technology officer of the United States, is fantastic to to start to start some programs to bring in people like me.Harry Glorikian: Oh, yeah. And believe me, in health care, we need we need more technologists, which I always preach. I'm like, don't go to Facebook. Come here. You know, you can get double whammy. You can make money and you can affect people's lives. So I'm always preaching that to everybody. But so if I'm not mistaken, in early 2021, you wrote an open letter to the brand new Biden administration calling for sort of a big federal effort to improve national data infrastructure. Like, can you summarize for everybody the argument in that piece and. Do you see them doing any of the items that you're suggesting?Eric Daimler: Right. The the idea is that despite us making some real good efforts during the Obama administration with solidifying our, I'll say, our view on artificial intelligence across the executive, and this continuing actually into the Trump administration with the establishment of an AI office inside the OSTP. So credit where credit is due. That extended into the the Biden administration, where some very well-meaning people can be focusing on different parts of the the conundrum of AI expressions, having various distortions. You know, the popular one we will read about is this distortion of bias that can express itself in really ugly ways, as you know, as individuals, especially for underrepresented groups. The point of the article was to help others be reminded of of some of the easy, low hanging fruit that we can that we can work on around AI. So, you know, bias comes in a lot of different ways, the same way we all have cognitive distortions, you know, cognitive biases. There are some like 50 of them, right. You know, bias can happen around gender and ethnicity and age, sexual orientation and so forth. You know, it all can also can come from absence of data. There's a type of bias that's present just by being in a developed, rich country in collecting, for example, with Conexus's customers, my company Conexus's customers, where they are trying to report on their good efforts for economic and social good and around clean, renewable energies, they find that there's a bias in being able to collect data in rich countries versus developing countries.Eric Daimler: That's another type of bias. So that was that was the point of me writing that open letter, to prioritize, these letters. It's just to distinguish what the low hanging fruit was versus some of the hard problems. The, some of tthe low hanging fruit, I think is available, I can say, In three easy parts that people can remember. One is circuit breakers. So we we can have circuit breakers in a lot of different parts of these automated systems. You know, automated car rolling down a road is, is the easiest example where, you know, at some point a driver needs to take over control to determine to make a judgment about that shadow being a person or a tumbleweed on the crosswalk, that's a type of circuit breaker. We can have those circuit breakers in a lot of different automated systems. Another one is an audit. And the way I mean is audit is having people like me or just generally people that are experts in the craft being able to distinguish the data or the biases can become possible from the data model algorithms where biases also can become possible. Right. And we get a lot of efficiency from these automated systems, these learning algorithms. I think we can afford a little bit taken off to audit the degree to which these data models are doing what we intend.Eric Daimler: And an example of a data model is that Delta Airlines, you know, they know my age or my height, and I fly to San Francisco, to New York or some such thing. The data model would be their own proprietary algorithm to determine whether or not I am deserving of an upgrade to first class, for example. That's a data model. We can have other data models. A famous one that we all are part of is FICO scores, credit scores, and those don't have to be disclosed. None of us actually know what Experian or any of the credit agencies used to determine our credit scores. But they they use these type of things called zero knowledge proofs, where we just send through enough data, enough times that we can get to a sense of what those data models are. So that's an exposure of a data model. A declarative exposure would be maybe a next best thing, a next step, and that's a type of audit.Eric Daimler: And then the third low hanging fruit, I'd say, around regulation, and I think these are just coming towards eventualities, is demanding lineage or demanding provenance. You know, you'll see a lot of news reports, often on less credible sites, but sometimes on on shockingly credible sites where claims are made that you need to then search yourself and, you know, people in a hurry just won't do it, when these become very large systems and very large systems of information, alert systems of automation, I want to know: How were these conclusions given? So, you know, an example in health care would be if my clinician gave me a diagnosis of, let's say, some sort of cancer. And then to say, you know, here's a drug, by the way, and there's a five chance, 5 percent chance of there being some awful side effects. You know, that's a connection of causation or a connection of of conclusions that I'm really not comfortable with. You know, I want to know, like, every step is like, wait, wait. So, so what type of cancer? So what's the probability of my cancer? You know, where is it? And so what drug, you know, how did you make that decision? You know, I want to know every little step of the way. It's fine that they give me that conclusion, but I want to be able to back that up. You know, a similar example, just in everyday parlance for people would be if I did suddenly to say I want a house, and then houses are presented to me. I don't quite want that. Although that looks like good for a Hollywood narrative. Right? I want to say, oh, wait, what's my income? Or what's my cash? You know, how much? And then what's my credit? Like, how much can I afford? Oh, these are houses you can kind of afford. Like, I want those little steps or at least want to back out how those decisions were made available. That's a lineage. So those three things, circuit breaker, audit, lineage, those are three pieces of low hanging fruit that I think the European Union, the State of New York and other other government entities would be well served to prioritize.Harry Glorikian: I would love all of them, especially, you know, the health care example, although I'm not holding my breath because I might not come back to life by how long I'd have to hold my breath on that one. But we're hoping for the best and we talk about that on the show all the time. But you mentioned Conexus. You're one of three co founders, I believe. If I'm not mistaken, Conexus is the first ever commercial spin out from MIT's math department. The company is in the area of large scale data integration, building on insights that come out of the field of mathematics that's called category algebra, categorical algebra, or something called enterprise category theory. And to be quite honest, I did have to Wikipedia to sort of look that up, was not familiar with it. So can you explain category algebra in terms of a non mathematician and maybe give us an example that someone can wrap their mind around.Eric Daimler: Yeah. Yeah. And it's important to get into because even though what my company does is, Conexus does a software expression of categorical algebra, it's really beginning to permeate our world. You know, the the way I tell my my nieces and nephews is, what do quantum computers, smart contracts and Minecraft all have in common? And the answer is composability. You know, they are actually all composable. And what composable is, is it's kind of related to modularity, but it's modularity without regard to scale. So the the easy analogy is in trains where, yeah, you can swap out a boxcar in a train, but mostly trains can only get to be a couple of miles long. Swap in and out boxcars, but the train is really limited in scale. Whereas the train system, the system of a train can be infinitely large, infinitely complex. At every point in the track you can have another track. That is the difference between modularity and composability. So Minecraft is infinitely self referential where you have a whole 'nother universe that exists in and around Minecraft. In smart contracts is actually not enabled without the ability to prove the efficacy, which is then enabled by categorical algebra or its sister in math, type theory. They're kind of adjacent. And that's similar to quantum computing. So quantum computing is very sexy. It gets in the press quite frequently with forks and all, all that. If it you wouldn't be able to prove the efficacy of a quantum compiler, you wouldn't actually. Humans can't actually say whether it's true or not without type theory or categorical algebra.Eric Daimler: How you think of kind categorical algebra you can think of as a little bit related to graph theory. Graph theory is those things that you see, they look like spider webs. If you see the visualizations of graph theories are graphs. Category theory is a little bit related, you might say, to graph theory, but with more structure or more semantics or richness. So in each point, each node and each edge, in the vernacular, you can you can put an infinite amount of information. That's really what a categorical algebra allows. This, the discovery, this was invented to be translating math between different domains of math. The discovery in 2011 from one of my co-founders, who was faculty at MIT's Math Department, was that we could apply that to databases. And it's in that the whole world opens up. This solves the problem that that bedeviled the good folks trying to work on healthcare.gov. It allows for a good explanation of how we can prevent the next 737 Max disaster, where individual systems certainly can be formally verified. But the whole plane doesn't have a mechanism of being formally verified with classic approaches. And it also has application in drug discovery, where we have a way of bringing together hundreds of thousands of databases in a formal way without risk of data being misinterpreted, which is a big deal when you have a 10-year time horizon for FDA trials and you have multiple teams coming in and out of data sets and and human instinct to hoard data and a concern about it ever becoming corrupted. This math and the software expression built upon it opens up just a fantastically rich new world of opportunity for for drug discovery and for clinicians and for health care delivery. And the list is quite, quite deep.Harry Glorikian: So. What does Conexus provide its clients? Is it a service? Is it a technology? Is it both? Can you give us an example of it?Eric Daimler: Yeah. So Conexus is software. Conexus is enterprise software. It's an enterprise software platform that works generally with very large organizations that have generally very large complex data data infrastructures. You know the example, I can start in health care and then I can I can move to an even bigger one, was with a hospital group that we work with in New York City. I didn't even know health care groups could really have this problem. But it's endemic to really the world's data, where one group within the same hospital had a particular way that they represented diabetes. Now to a layman, layman in a health care sense, I would think, well, there's a definition of diabetes. I can just look it up in the Oxford English Dictionary. But this particular domain found diabetes to just be easily represented as yes, no. Do they have it? Do they not? Another group within the same hospital group thought that they would represent it as diabetes, ow are we treating it? A third group would be representing it as diabetes, how long ago. And then a fourth group had some well-meaning clinicians that would characterize it as, they had it and they have less now or, you know, type one, type two, you know, with a more more nuanced view.Eric Daimler: The traditional way of capturing that data, whether it's for drug discovery or whether it's for delivery, is to normalize it, which would then squash the fidelity of the data collected within those groups. Or they most likely to actually just wouldn't do it. They wouldn't collect the data, they wouldn't bring the data together because it's just too hard, it's too expensive. They would use these processes called ETL, extract, transform, load, that have been around for 30 years but are often slow, expensive, fragile. They could take six months to year, cost $1,000,000, deploy 50 to 100 people generally from Accenture or Deloitte or Tata or Wipro. You know, that's a burden. It's a burden, you know, so the data wasn't available and that would then impair the researchers and their ability to to share data. And it would impair clinicians in their view of patient care. And it also impaired the people in operations where they would work on billing. So we work with one company right now that that works on 1.4 trillion records a year. And they just have trouble with that volume and the number of databases and the heterogeneous data infrastructure, bringing together that data to give them one view that then can facilitate health care delivery. Eric Daimler: The big example is, we work with Uber where they they have a very smart team, as smart as one might think. They also have an effectively infinite balance sheet with which they could fund an ideal IT infrastructure. But despite that, you know, Uber grew up like every other organization optimizing for the delivery of their service or product and, and that doesn't entail optimizing for that infrastructure. So what they found, just like this hospital group with different definitions of diabetes, they found they happen to have grown up around service areas. So in this case cities, more or less. So when then the time came to do analysis -- we're just passing Super Bowl weekend, how will the Super Bowl affect the the supply of drivers or the demand from riders? They had to do it for the city of San Francisco, separate than the city of San Jose or the city of Oakland. They couldn't do the whole San Francisco Bay Area region, let alone the whole of the state or the whole of the country or what have you. And that repeated itself for every business question, every organizational question that they would want to have. This is the same in drug discovery. This is the same in patient care delivery or in billing. These operational questions are hard, shockingly hard.Eric Daimler: We had another one in logistics where we had a logistics company that had 100,000 employees. I didn't even know some of these companies could be so big, and they actually had a client with 100,000 employees. That client had 1000 ships, each one of which had 10,000 containers. And I didn't even know like how big these systems were really. I hadn't thought about it. But I mean, they're enormous. And the question was, hey, where's our personal protective equipment? Where is the PPE? And that's actually a hard question to ask. You know, we are thinking about maybe our FedEx tracking numbers from an Amazon order. But if you're looking at the PPE and where it is on a container or inside of a ship, you know, inside this large company, it's actually a hard question to ask. That's this question that all of these organizations have. Eric Daimler: In our case, Uber, where they they they had a friction in time and in money and in accuracy, asking every one of these business questions. They went then to find, how do I solve this problem? Do I use these old tools of ETL from the '80s? Do I use these more modern tools from the 2000s? They're called RDF or OWL? Or is there something else? They discovered that they needed a more foundational system, this categorical algebra that that's now expressing itself in smart contracts and quantum computers and other places. And they just then they found, oh, who are the leaders in the enterprise software expression of that math? And it's us. We happen to be 40 miles north of them. Which is fortunate. We worked with Uber to to solve that problem in bringing together their heterogeneous data infrastructure to solve their problems. And to have them tell it they save $10 million plus a year in in the efficiency and speed gains from the solution we helped provide for them.[musical interlude]Harry Glorikian: Let's pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that's leave a rating and a review for the show on Apple Podcasts.All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but you'll be doing a lot to help other listeners discover the show.And one more thing. If you like the interviews we do here on the show I know you'll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.It's a friendly and accessible tour of all the ways today's information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.The book is now available in print and ebook formats. Just go to Amazon or Barnes & Noble and search for The Future You by Harry Glorikian.And now, back to the show.[musical interlude]Harry Glorikian: So your website says that your software can map data sources to each other so that the perfect data model is discovered, not designed. And so what does that mean? I mean, does that imply that there's some machine learning or other form of artificial intelligence involved, sort of saying here are the right pieces to put together as opposed to let me design this just for you. I'm trying to piece it together.Eric Daimler: Yeah. You know, the way we might come at this is just reminding ourselves about the structure of artificial intelligence. You know, in the public discourse, we will often find news, I'm sure you can find it today, on deep learning. You know, whatever's going on in deep learning because it's sexy, it's fun. You know, DeepMind really made a name for themselves and got them acquired at a pretty valuation because of their their Hollywood-esque challenge to Go, and solving of that game. But that particular domain of AI, deep learning, deep neural nets is a itself just a subset of machine learning. I say just not not not to minimize it. It's a fantastically powerful algorithm. But but just to place it, it is a subset of machine learning. And then machine learning itself is a subset of artificial intelligence. That's a probabilistic subset. So we all know probabilities are, those are good and bad. Fine when the context is digital advertising, less fine when it's the safety of a commercial jet. There is another part of artificial intelligence called deterministic artificial intelligence. They often get expressed as expert systems. Those generally got a bad name with the the flops of the early '80s. Right. They flopped because of scale, by the way. And then the flops in the early 2000s and 2010s from IBM's ill fated Watson experiment, the promise did not meet the the reality.Eric Daimler: It's in that deterministic A.I. that that magic is to be found, especially when deployed in conjunction with the probabilistic AI. That's that's where really the future is. There's some people have a religious view of, oh, it's only going to be a probabilistic world but there's many people like myself and not to bring up fancy names, but Andrew Ng, who's a brilliant AI researcher and investor, who also also shares this view, that it's a mix of probabilistic and deterministic AI. What deterministic AI does is, to put it simply, it searches the landscape of all possible connections. Actually it's difference between bottoms up and tops down. So the traditional way of, well, say, integrating things is looking at, for example, that hospital network and saying, oh, wow, we have four definitions of diabetes. Let me go solve this problem and create the one that works for our hospital network. Well, then pretty soon you have five standards, right? That's the traditional way that that goes. That's what a top down looks that looks like.Eric Daimler: It's called a Golden Record often, and it rarely works because pretty soon what happens is the organizations will find again their own need for their own definition of diabetes. In most all cases, that's top down approach rarely works. The bottoms up approach says, Let's discover the connections between these and we'll discover the relationships. We don't discover it organically like we depend on people because it's deterministic. I, we, we discover it through a massive, you know, non intuitive in some cases, it's just kind of infeasible for us to explore a trillion connections. But what the AI does is it explores a factorial number actually is a technical, the technical equation for it, a factorial number of of possible paths that then determine the map of relationships between between entities. So imagine just discovering the US highway system. If you did that as a person, it's going to take a bit. If you had some infinitely fast crawlers that robot's discovering the highway system infinitely fast, remember, then that's a much more effective way of doing it that gives you some degree of power. That's the difference between bottoms up and tops down. That's the difference between deterministic, really, we might say, and probabilistic in some simple way.Harry Glorikian: Yeah, I'm a firm believer of the two coming together and again, I just look at them as like a box. I always tell people like, it's a box of tools. I need to know the problem, and then we can sort of reach in and pick out which set of tools that are going to come together to solve this issue, as opposed to this damn word called AI that everybody thinks is one thing that they're sort of throwing at the wall to solve a problem.Harry Glorikian: But you're trying to solve, I'm going to say, data interoperability. And on this show I've had a lot of people talk about interoperability in health care, which I actually believe is, you could break the system because things aren't working right or I can't see what I need to see across the two hospitals that I need information from. But you published an essay on Medium about Haven, the health care collaboration between Amazon, JPMorgan, Berkshire Hathaway. Their goal was to use big data to guide patients to the best performing clinicians and the most affordable medicines. They originally were going to serve these first three founding companies. I think knowing the people that started it, their vision was bigger than that. There was a huge, you know, to-do when it came out. Fireworks and everything. Launched in 2018. They hired Atul Gawande, famous author, surgeon. But then Gawande left in 2020. And, you know, the company was sort of quietly, you know, pushed off into the sunset. Your essay argued that Haven likely failed due to data interoperability challenges. I mean. How so? What what specific challenges do you imagine Haven ran into?Eric Daimler: You know, it's funny, I say in the article very gently that I imagine this is what happened. And it's because I hedge it that that the Harvard Business Review said, "Oh, well, you're just guessing." Actually, I wasn't guessing. No, I know. I know the people that were doing it. I know the challenges there. But but I'm not going to quote them and get them in trouble. And, you know, they're not authorized to speak on it. So I perhaps was a little too modest in my framing of the conclusion. So this actually is what happened. What happens is in the same way that we had the difficulty with healthcare.gov, in the same way that I described these banks having difficulty. Heterogeneous databases don't like to talk to one another. In a variety of different ways. You know, the diabetes example is true, but it's just one of many, many, many, many, many, many cases of data just being collected differently for their own use. It can be as prosaic as first name, last name or "F.last name." Right? It's just that simple, you know? And how do I bring those together? Well, those are those are called entity resolutions. Those are somewhat straightforward, but not often 100 percent solvable. You know, this is just a pain. It's a pain. And, you know, so what what Haven gets into is they're saying, well, we're massive. We got like Uber, we got an effectively infinite balance sheet. We got some very smart people. We'll solve this problem. And, you know, this is some of the problem with getting ahead of yourself. You know, I won't call it arrogance, but getting ahead of yourself, is that, you think, oh, I'll just be able to solve that problem.Eric Daimler: You know, credit where credit is due to Uber, you know, they looked both deeper saying, oh, this can't be solved at the level of computer science. And they looked outside, which is often a really hard organizational exercise. That just didn't happen at Haven. They thought they thought they could they could solve it themselves and they just didn't. The databases, not only could they have had, did have, their own structure, but they also were stored in different formats or by different vendors. So you have an SAP database, you have an Oracle database. That's another layer of complication. And when I say that these these take $1,000,000 to connect, that's not $1,000,000 one way. It's actually $2 million if you want to connect it both ways. Right. And then when you start adding five, let alone 50, you take 50 factorial. That's a very big number already. You multiply that times a million and 6 to 12 months for each and a hundred or two hundred people each. And you just pretty soon it's an infeasible budget. It doesn't work. You know, the budget for us solving solving Uber's problem in the traditional way was something on the order of $2 trillion. You know, you do that. You know, we had a bank in the U.S. and the budget for their vision was was a couple of billion. Like, it doesn't work. Right. That's that's what happened Haven. They'll get around to it, but but they're slow, like all organizations, big organizations are. They'll get around to solving this at a deeper level. We hope that we will remain leaders in database integration when they finally realize that the solution is at a deeper level than their than the existing tools.Harry Glorikian: So I mean, this is not I mean, there's a lot of people trying to solve this problem. It's one of those areas where if we don't solve it, I don't think we're going to get health care to the next level, to sort of manage the information and manage people and get them what they need more efficiently and drive down costs.Eric Daimler: Yeah.Harry Glorikian: And I do believe that EMRs are. I don't want to call them junk. Maybe I'm going too far, but I really think that they you know, if you had decided that you were going to design something to manage patients, that is not the software you would have written to start. Hands down. Which I worry about because these places won't, they spent so much putting them in that trying to get them to rip them out and put something in that actually works is challenging. You guys were actually doing something in COVID-19, too, if I'm not mistaken. Well, how is that project going? I don't know if it's over, but what are you learning about COVID-19 and the capabilities of your software, let's say?Eric Daimler: Yeah. You know, this is an important point that for anybody that's ever used Excel, we know what it means to get frustrated enough to secretly hard code a cell, you know, not keeping a formula in a cell. Yeah, that's what happened in a lot of these systems. So we will continue with electronic medical records to to bring these together, but they will end up being fragile, besides slow and expensive to construct. They will end up being fragile, because they were at some point hardcoded. And how that gets expressed is that the next time some other database standard appears inside of that organization's ecosystem from an acquisition or a divestiture or a different technical standard, even emerging, and then the whole process starts all over again. You know, we just experience this with a large company that that spent $100 million in about five years. And then they came to us and like, yeah, we know it works now, but we know like a year from now we're going to have to say we're going to go through it again. And, it's not like, oh, we'll just have a marginal difference. No, it's again, that factorial issue, that one database connected to the other 50 that already exist, creates this same problem all over again at a couple of orders of magnitude. So what we discover is these systems, these systems in the organization, they will continue to exist.Eric Daimler: These fragile systems will continue to exist. They'll continue to scale. They'll continue to grow in different parts of the life sciences domain, whether it's for clinicians, whether it's for operations, whether it's for drug discovery. Those will continue to exist. They'll continue to expand, and they will begin to approach the type of compositional systems that I'm describing from quantum computers or Minecraft or smart contracts, where you then need the the discovery and math that Conexus expresses in software for databases. When you need that is when you then need to prove the efficacy or otherwise demonstrate the lack of fragility or the integrity of the semantics. Conexus can with, it's a law of nature and it's in math, with 100 percent accuracy, prove the integrity of a database integration. And that matters in high consequence context when you're doing something as critical as drug side effects for different populations. We don't want your data to be misinterpreted. You can't afford lives to be lost or you can't, in regulation, you can't afford data to be leaking. That's where you'll ultimately need the categorical algebra. You'll need a provable compositional system. You can continue to construct these ones that will begin to approach compositionality, but when you need the math is when you need to prove it for either the high consequence context of lives, of money or related to that, of regulation.Harry Glorikian: Yeah, well, I keep telling my kids, make sure you're proficient in math because you're going to be using it for the rest of your life and finance. I always remind them about finance because I think both go together. But you've got a new book coming out. It's called "The Future is Formal" and not tuxedo like formal, but like you're, using the word formal. And I think you have a very specific meaning in mind. And I do want you to talk about, but I think what you're referring to is how we want automated systems to behave, meaning everything from advertising algorithms to self-driving trucks. And you can tell me if that my assumption is correct or not.Eric Daimler: Though it's a great segue, actually, from the math. You know, what I'm trying to do is bring in people that are not programmers or research technology, information technology researchers day to day into the conversation around automated digital systems. That's my motivation. And my motivation is, powered by the belief that we will bring out the best of the technology with more people engaged. And with more people engaged, we have a chance to embrace it and not resist it. You know, my greatest fear, I will say, selfishly, is that we come up with technology that people just reject, they just veto it because they don't understand it as a citizen. That also presents a danger because I think that companies' commercial expressions naturally will grow towards where their technology is needed. So this is actually to some extent a threat to Western security relative to Chinese competition, that we embrace the technology in the way that we want it to be expressed in our society. So trying to bring people into this conversation, even if they're not programmers, the connection to math is that there are 18 million computer programmers in the world. We don't need 18 million and one, you know. But what we do need is we do need people to be thinking, I say in a formal way, but also just be thinking about the values that are going to be represented in these digital infrastructures.Eric Daimler: You know, somewhere as a society, we will have to have a conversation with ourselves to determine the car driving to the crosswalk, braking or rolling or slowing or stopping completely. And then who's liable if it doesn't? Is it the driver or is it the manufacturer? Is it the the programmer that somehow put a bug in their code? You know, we're entering an age where we're going to start experiencing what some person calls double bugs. There's the bug in maybe one's expression in code. This often could be the semantics. Or in English. Like your English doesn't make sense. Right? Right. Or or was it actually an error in your thinking? You know, did you leave a gap in your thinking? This is often where where some of the bugs in Ethereum and smart contracts have been expressed where, you know, there's an old programming rule where you don't want to say something equals true. You always want to be saying true equals something. If you get if you do the former, not the latter, you can have to actually create bugs that can create security breaches.Eric Daimler: Just a small little error in thinking. That's not an error in semantics. That level of thinking, you don't need to know calculus for, or category theory for that matter. You just need to be thinking in a formal way. You know, often, often lawyers, accountants, engineers, you know, anybody with scientific training can, can more quickly get this idea, where those that are educated in liberal arts can contribute is in reminding themselves of the broader context that wants to be expressed, because often engineers can be overly reductionist. So there's really a there's a push and pull or, you know, an interplay between those two sensibilities that then we want to express in rules. Then that's ultimately what I mean by formal, formal rules. Tell me exactly what you mean. Tell me exactly how that is going to work. You know, physicians would understand this when they think about drug effects and drug side effects. They know exactly what it's going to be supposed to be doing, you know, with some degree of probability. But they can be very clear, very clear about it. It's that clear thinking that all of us will need to exercise as we think about the development and deployment of modern automated digital systems.Harry Glorikian: Yeah, you know, it's funny because that's the other thing I tell people, like when they say, What should my kid take? I'm like, have him take a, you know, basic programming, not because they're going to do it for a living, but they'll understand how this thing is structured and they can get wrap their mind around how it is. And, you know, I see how my nephew thinks who's from the computer science world and how I think, and sometimes, you know, it's funny watching him think. Or one of the CTOs of one of our companies how he looks at the world. And I'm like you. You got to back up a little bit and look at the bigger picture. Right. And so it's the two of us coming together that make more magic than one or the other by themselves.Harry Glorikian: So, you know, I want to jump back sort of to the different roles you've had in your career. Like like you said, you've been a technology investor, a serial startup founder, a university professor, an academic administrator, an entrepreneur, a management instructor, Presidential Innovation Fellow. I don't think I've missed anything, but I may have. You're also a speaker, a commentator, an author. Which one of those is most rewarding?Eric Daimler: Oh, that's an interesting question. Which one of those is most rewarding? I'm not sure. I find it to be rewarding with my friends and family. So it's rewarding to be with people. I find that to be rewarding in those particular expressions. My motivation is to be, you know, just bringing people in to have a conversation about what we want our world to look like, to the degree to which the technologies that I work with every day are closer to the dystopia of Hollywood narratives or closer to our hopes around the utopia that's possible, that where this is in that spectrum is up to us in our conversation around what these things want to look like. We have some glimpses of both extremes, but I'd like people, and I find it to be rewarding, to just be helping facilitate the helping catalyze that conversation. So the catalyst of that conversation and whatever form it takes is where I enjoy being.Harry Glorikian: Yeah, because I was thinking about like, you know, what can, what can you do as an individual that shapes the future. Does any of these roles stand out as more impactful than others, let's say?Eric Daimler: I think the future is in this notion of composability. I feel strongly about that and I want to enroll people into this paradigm as a framework from which to see many of the activities going around us. Why have NFTs come on the public, in the public media, so quickly? Why does crypto, cryptocurrency capture our imagination? Those And TikTok and the metaverse. And those are all expressions of this quick reconfiguration of patterns in different contexts that themselves are going to become easier and easier to express. The future is going to be owned by people that that take the special knowledge that they've acquired and then put it into short business expressions. I'm going to call them rules that then can be recontextualized and redeployed. This is my version of, or my abstraction of what people call the the future being just all TikTok. It's not literally that we're all going to be doing short dance videos. It's that TikTok is is an expression of people creating short bits of content and then having those be reconfigured and redistributed. That can be in medicine or clinical practice or in drugs, but it can be in any range of expertise, expertise or knowledge. And what's changed? What's changed and what is changing is the different technologies that are being brought to bear to capture that knowledge so that it can be scalable, so it can be compositional. Yeah, that's what's changing. That's what's going to be changing over the next 10 to 20 years. The more you study that, I think the better off we will be. And I'd say, you know, for my way of thinking about math, you might say the more math, the better. But if I were to choose for my children, I would say I would replace trig and geometry and even calculus, some people would be happy to know, with categorical algebra, category theory and with probability and statistics. So I would replace calculus, which I think is really the math of the 20th century, with something more appropriate to our digital age, which is categorical algebra.Harry Glorikian: I will tell my son because I'm sure he'll be very excited to to if I told him that not calculus, but he's not going to be happy when I say go to this other area, because I think he'd like to get out of it altogether.Eric Daimler: It's easier than calculus. Yeah.Harry Glorikian: So, you know, it was great having you on the show. I feel like we could talk for another hour on all these different aspects. You know, I'm hoping that your company is truly successful and that you help us solve this interoperability problem, which is, I've been I've been talking about it forever. It seems like I feel like, you know, the last 15 or 20 years. And I still worry if we're any closer to solving that problem, but I'm hopeful, and I wish you great success on the launch of your new book. It sounds exciting. I'm going to have to get myself a copy.Eric Daimler: Thank you very much. It's been fun. It's good to be with you.Harry Glorikian: Thank you.Harry Glorikian: That's it for this week's episode. You can find a full transcript of this episode as well as the full archive of episodes of The Harry Glorikian Show and MoneyBall Medicine at our website. Just go to glorikian.com and click on the tab Podcasts.I'd like to thank our listeners for boosting The Harry Glorikian Show into the top three percent of global podcasts.If you want to be sure to get every new episode of the show automatically, be sure to open Apple Podcasts or your favorite podcast player and hit follow or subscribe. Don't forget to leave us a rating and review on Apple Podcasts. And we always love to hear from listeners on Twitter, where you can find me at hglorikian.Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.

Atul Gawande is a renowned American surgeon, writer, and public health leader. He was a longtime staff writer for The New Yorker magazine and has written four New York Times best-selling books: The Checklist Manifesto, was Gawande's third book, released  in 2009. It discusses the importance of organization and preplanning (such as thorough checklists) in both medicine and the larger world. The Checklist Manifesto reached the New York Times hardcover nonfiction bestseller list in 2010.He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. ★ Support this podcast on Patreon ★

Today on “Post Reports,” the head of global health at the U.S. Agency for International Development, Atul Gawande, on the state of the pandemic and why global vaccination efforts are at risk. Read more:Today on the show, we hear from national health reporter Dan Diamond about his interview with Atul Gawande, who leads global health at USAID and co-chairs the Biden administration's covid-19 task force. He is also an endocrine surgeon, health-care researcher and writer. Gawande explains his efforts as a Biden administration official to slow the pandemic through global vaccination — and how funding for those efforts are at risk. “It isn't enough to just bring a bunch of vaccines on the tarmac and say, ‘Go,'” Gawande says. “We need to support their ability to maintain the cold chain, to have workers who can move out into the rural areas.” Gawande also talks about the state of public health abroad as the war in Ukraine continues.

PiXL's Leadership Bookclub returns for Series 3. In this episode, Rachel Johnson discusses 'The Checklist Manifesto' by Atul Gawande with senior leaders Miriam Sechere (Secondary and Sixth Form School Improvement Education Advisor, Croydon Council) and James D'Souza (Head of Psychology, Ewell Castle School). In truth, many see a checklist as basic, and oftentimes beneath them: 'my job is too complicated to be reduced to a checklist'. However, Gawande and our trio of school leaders make the case that checklists could provide a solid foundation, from which magic can happen – be it in the classroom or in leadership meetings. How can they be crafted intentionally to reduce cognitive load and, potentially, bring about better school cultures? PiXL is a partnership organisation of thousands of schools, colleges and alternative education providers spanning KS1-5. Find out more about how you could gain value from a PiXL subscription: https://www.pixl.org.uk/membership PiXL Leadership Bookclub is a We Are In Beta production. Subscribe now to download every episode directly to your phone automatically.  

On 'current history', or what might be going on out there. Subscribe at: paid.retraice.com Details: what's GOOT; current history; hypotheses [and some predictions]; What's next? Complete notes and video at: https://www.retraice.com/segments/re17 Air date: Monday, 7th Mar. 2022, 4 : 20 PM Eastern/US. 0:00:00 what's GOOT; 0:01:35 current history; 0:04:30 hypotheses [and some predictions]; 0:13:38 What's next? References: Allison, G. (2018). Destined for War: Can America and China Escape Thucydides's Trap? Mariner Books. ISBN: 978-1328915382. Searches: https://www.amazon.com/s?k=9781328915382 https://www.google.com/search?q=isbn+9781328915382 https://lccn.loc.gov/2017005351 Andrew, C. (2018). The Secret World: A History of Intelligence. Yale University Press. ISBN in paperback edition printed as "978-0-300-23844-0 (hardcover : alk. paper)". Searches: https://www.amazon.com/s?k=978-0300238440 https://www.google.com/search?q=isbn+978-0300238440 https://lccn.loc.gov/2018947154 Baumeister, R. F. (1999). Evil: Inside Human Violence and Cruelty. Holt Paperbacks, revised ed. ISBN: 978-0805071658. Searches: https://www.amazon.com/s?k=9780805071658 https://www.google.com/search?q=isbn+9780805071658 https://lccn.loc.gov/96041940 Bostrom, N. (2011). Information Hazards: A Typology of Potential Harms from Knowledge. Review of Contemporary Philosophy, 10, 44-79. Citations are from Bostrom's website copy: https://www.nickbostrom.com/information-hazards.pdf Retrieved 9th Sep. 2020. Bostrom, N. (2019). The vulnerable world hypothesis. Global Policy, 10(4), 455-476. Nov. 2019. https://nickbostrom.com/papers/vulnerable.pdf Retrieved 24th Mar. 2020. Bostrom, N., & Cirkovic, M. M. (Eds.) (2008). Global Catastrophic Risks. Oxford University Press. ISBN: 978-0199606504. Searches: https://www.amazon.com/s?k=978-0199606504 https://www.google.com/search?q=isbn+978-0199606504 https://lccn.loc.gov/2008006539 Brockman, J. (Ed.) (2015). What to Think About Machines That Think: Today's Leading Thinkers on the Age of Machine Intelligence. Harper Perennial. ISBN: 978-0062425652. Searches: https://www.amazon.com/s?k=978-0062425652 https://www.google.com/search?q=isbn+978-0062425652 https://lccn.loc.gov/2016303054 Chomsky, N. (1970). For Reasons of State. The New Press, revised ed. ISBN: 1565847946. Originally published 1970; this revised ed. 2003. Searches: https://www.amazon.com/s?k=1565847946 https://www.google.com/search?q=isbn+1565847946 https://catalog.loc.gov/vwebv/search?searchArg=1565847946 Chomsky, N. (2017). Requiem for the American Dream: The 10 Principles of Concentration of Wealth & Power. Seven Stories Press. ISBN: 978-1609807368. 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Searches: https://www.amazon.com/s?k=0393317552 https://www.google.com/search?q=isbn+0393317552 https://catalog.loc.gov/vwebv/search?searchArg=0393317552 Dolan, R. M. (2000). UFOs and the National Security State Vol. 1: An Unclassified History. Keyhole, 1st ed. ISBN: 0967799503. Searches: https://www.amazon.com/s?k=0967799503 https://www.google.com/search?q=isbn+0967799503 https://catalog.loc.gov/vwebv/search?searchArg=0967799503 Dolan, R. M. (2009). UFOs and the National Security State Vol. 2: The Cover-Up Exposed, 1973-1991. Keyhole. ISBN: 978-0967799513. Searches: https://www.amazon.com/s?k=978-0967799513 https://www.google.com/search?q=isbn+978-0967799513 Durant, W., & Durant, A. (1968). The Lessons of History. Simon and Schuster. No ISBN. Searches: https://www.amazon.com/s?k=lessons+of+history+durant https://www.google.com/search?q=lessons+of+history+durant https://lccn.loc.gov/68019949 Dyson, G. (2015). Analog, the revolution that dares not speak its name. (pp. 255-256). 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Link and searches: http://philipjonesgriffiths.org/photography/selected-work/vietnam-inc/ Retrieved 10 Mar. 2022. https://www.amazon.com/s?k=978-0714846033 https://www.google.com/search?q=isbn+978-0714846033 https://lccn.loc.gov/2006283959 Hamming, R. W. (2020). The Art of Doing Science and Engineering: Learning to Learn. Stripe Press. ISBN: 978-1732265172. Searches: https://www.amazon.com/s?k=9781732265172 https://www.google.com/search?q=isbn+9781732265172 Hawking, S. (2018). Brief Answers to the Big Questions. Bantam. ISBN: 978-1984819192. Searches: https://www.amazon.com/s?k=9781984819192 https://www.google.com/search?q=isbn+9781984819192 https://catalog.loc.gov/vwebv/search?searchArg=9781984819192 Herrnstein, R. J., & Murray, C. (1996). The Bell Curve: Intelligence and Class Structure in American Life. Free Press. ISBN: 978-0684824291. Searches: https://www.amazon.com/s?k=9780684824291 https://www.google.com/search?q=isbn+9780684824291 https://catalog.loc.gov/vwebv/search?searchArg=9780684824291 Johnson, S. (2014). How We Got to Now: Six Innovations That Made the Modern World. Riverhead Books. ISBN: 978-1594633935. Searches: https://www.amazon.com/s?k=9781594633935 https://www.google.com/search?q=isbn+9781594633935 https://lccn.loc.gov/2014018412 Kahneman, D. (2011). Thinking, Fast and Slow. Farrar, Straus and Giroux. ISBN: 978-0374533557. Searches: https://www.amazon.com/s?k=978-0374533557 https://www.google.com/search?q=isbn+978-0374533557 https://lccn.loc.gov/2012533187 Kaplan, F. (2016). Dark Territory: The Secret History of Cyber War. Simon & Schuster. ISBN: 978-1476763255. Searches: https://www.amazon.com/s?k=9781476763255 https://www.google.com/search?q=isbn+9781476763255 https://catalog.loc.gov/vwebv/search?searchArg=9781476763255 Kelleher, C. A., & Knapp, G. (2005). Hunt for the Skinwalker: Science Confronts the Unexplained at a Remote Ranch in Utah. Paraview Pocket Books. ISBN: 978-1416505211. Searches: https://www.amazon.com/s?k=978-1416505211 https://www.google.com/search?q=isbn+978-1416505211 https://lccn.loc.gov/2005053457 Keyhoe, D. (1950). The Flying Saucers Are Real. Forgotten Books. ISBN: 978-1605065472. Originally published 1950; this edition 2008. Searches: https://www.amazon.com/s?k=9781605065472 https://www.google.com/search?q=isbn+9781605065472 https://lccn.loc.gov/50004886 Kilcullen, D. (2020). The Dragons And The Snakes: How The Rest Learned To Fight The West. Oxford University Press. ISBN: 978-0190265687. Searches: https://www.amazon.com/s?k=9780190265687 https://www.google.com/search?q=isbn+9780190265687 https://catalog.loc.gov/vwebv/search?searchArg=9780190265687 Lazar, B. (2019). Dreamland: An Autobiography. Interstellar. ISBN: 978-0578437057. Searches: https://www.amazon.com/s?k=9780578437057 https://www.google.com/search?q=isbn+9780578437057 Lee, K.-F. (2018). AI Superpowers: China, Silicon Valley, and the New World Order. Houghton Mifflin Harcourt. ISBN: 978-1328546395. Searches: https://www.amazon.com/s?k=9781328546395 https://www.google.com/search?q=isbn+9781328546395 https://catalog.loc.gov/vwebv/search?searchArg=9781328546395 Mitter, R. (2008). Modern China: A Very Short Introduction. Oxford University Press, kindle ed. ISBN: 978-0199228027. Searches: https://www.amazon.com/s?k=9780199228027 https://www.google.com/search?q=isbn+9780199228027 https://catalog.loc.gov/vwebv/search?searchArg=9780199228027 Nouri, A., & Chyba, C. F. (2008). Biotechnology and biosecurity. (pp. 450-480). In Bostrom & Cirkovic (2008). O'Donnell, P. K. (2004). Operatives, Spies, and Saboteurs: The Unknown Story of the Men and Women of World War II's OSS. Free Press / Simon & Schuster. ISBN: 074323572X. Edition and searches: https://archive.org/details/operativesspiess00odon https://www.amazon.com/s?k=074323572X https://www.google.com/search?q=isbn+074323572X https://catalog.loc.gov/vwebv/search?searchArg=074323572X Ord, T. (2020). The Precipice: Existential Risk and the Future of Humanity. Hachette. ISBN: 978-0316484916. Searches: https://www.amazon.com/s?k=978-0316484916 https://www.google.com/search?q=isbn+978-0316484916 https://lccn.loc.gov/2019956459 Orlov, D. (2008). Reinventing Collapse: The Soviet Example and American Prospects. New Society. ISBN: 978-0865716063. Searches: https://www.amazon.com/s?k=9780865716063 https://www.google.com/search?q=isbn+9780865716063 https://catalog.loc.gov/vwebv/search?searchArg=9780865716063 Osnos, E. (2020/01/06). The Future of America's Contest with China. The New Yorker. https://www.newyorker.com/magazine/2020/01/13/the-future-of-americas-contest-with-china Retrieved 22 April, 2020. Perlroth, N. (2020). This Is How They Tell Me the World Ends: The Cyberweapons Arms Race. Bloomsbury. ISBN: 978-1635576054. Searches: https://www.amazon.com/s?k=978-1635576054 https://www.google.com/search?q=isbn+978-1635576054 https://lccn.loc.gov/2020950713 Phoenix, C., & Treder, M. (2008). Nanotechnology as global catastrophic risk. (pp. 481-503). In Bostrom & Cirkovic (2008). Pillsbury, M. (2015). The Hundred-Year Marathon: China's Secret Strategy to Replace America as the Global Superpower. St. Martin's Griffin. ISBN: 978-1250081346. Searches: https://www.amazon.com/s?k=9781250081346 https://www.google.com/search?q=isbn+9781250081346 https://lccn.loc.gov/2014012015 Pinker, S. (2011). The Better Angels of Our Nature: Why Violence Has Declined. Penguin Publishing Group. ISBN: 978-0143122012. Searches: https://www.amazon.com/s?k=978-0143122012 https://www.google.com/search?q=isbn+978-0143122012 https://lccn.loc.gov/2011015201 Pogue, D. (2021). How to Prepare for Climate Change: A Practical Guide to Surviving the Chaos. Simon & Schuster. ISBN: 978-1982134518. Searches: https://www.amazon.com/s?k=9781982134518 https://www.google.com/search?q=isbn+9781982134518 https://catalog.loc.gov/vwebv/search?searchArg=9781982134518 Putnam, R. D. (2015). Our Kids: The American Dream in Crisis. Simon & Schuster. ISBN: 978-1476769905. Searches: https://www.amazon.com/s?k=9781476769905 https://www.google.com/search?q=isbn+9781476769905 https://lccn.loc.gov/2015001534 Rees, M. (2003). Our Final Hour: A Scientist's Warning. Basic Books. ISBN: 0465068634. Searches: https://www.amazon.com/s?k=0465068634 https://www.google.com/search?q=isbn+0465068634 https://lccn.loc.gov/2004556001 Rees, M. (2008). Foreword to Bostrom & Cirkovic (2008). (pp. iii-vii). Reid, T. R. (2017). A Fine Mess: A Global Quest for a Simpler, Fairer, and More Efficient Tax System. Penguin Press. ISBN: 978-1594205514. 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ISBN: 978-0465071732. Searches: https://www.amazon.com/s?k=978-0465071739 https://www.google.com/search?q=isbn+978-0465071739 https://lccn.loc.gov/2002015846 Sanger, D. E. (2018). The Perfect Weapon: War, Sabotage, and Fear in the Cyber Age. Broadway Books. ISBN: 978-0451497901. Searches: https://www.amazon.com/s?k=9780451497901 https://www.google.com/search?q=isbn+9780451497901 https://catalog.loc.gov/vwebv/search?searchArg=9780451497901 Sapolsky, R. M. (2018). Behave: The Biology of Humans at Our Best and Worst. Penguin Books. ISBN: 978-0143110910. Searches: https://www.amazon.com/s?k=9780143110910 https://www.google.com/search?q=isbn+9780143110910 https://lccn.loc.gov/2016056755 Shirer, W. L. (1959). The Rise and Fall of the Third Reich: A History of Nazi Germany. Simon & Schuster, 50th anniv. ed. ISBN: 978-1451651683. Originally published 1959; this ed. 2011. 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Everybody Lies: Big Data, New Data, and What the Internet Can Tell Us About Who We Really Are. Dey Street Books. ISBN: 978-0062390868. Searches: https://www.amazon.com/s?k=9780062390868 https://www.google.com/search?q=isbn+9780062390868 https://lccn.loc.gov/2017297094 Sternberg, R. J. (Ed.) (2020). The Cambridge Handbook of Intelligence (Cambridge Handbooks in Psychology) (2 vols.). Cambridge University Press, 2nd ed. ISBN: 978-1108719193. Searches: https://www.amazon.com/s?k=9781108719193 https://www.google.com/search?q=isbn+9781108719193 https://lccn.loc.gov/2019019464 Vallee, J. (1979). Messengers of Deception: UFO Contacts and Cults. And/Or Press. ISBN: 0915904381. Different edition and searches: https://archive.org/details/MessengersOfDeceptionUFOContactsAndCultsJacquesValle1979/mode/2up https://www.amazon.com/s?k=0915904381 https://www.google.com/search?q=isbn+0915904381 https://catalog.loc.gov/vwebv/search?searchArg=0915904381 Walter, B. F. (2022). How Civil Wars Start. Crown. ISBN: 978-0593137789. Searches: https://www.amazon.com/s?k=978-0593137789 https://www.google.com/search?q=isbn+978-0593137789 https://lccn.loc.gov/2021040090 Walter, C. (2020). Immortality, Inc.: Renegade Science, Silicon Valley Billions, and the Quest to Live Forever. National Geographic. ISBN: 978-1426219801. Searches: https://www.amazon.com/s?k=9781426219801 https://www.google.com/search?q=isbn+9781426219801 https://catalog.loc.gov/vwebv/search?searchArg=9781426219801 Zubrin, R. (1996). The Case for Mars: The Plan to Settle the Red Planet and Why We Must. Free Press. First published in 1996. This 25th anniv. edition 2021. ISBN: 978-0684827575. Searches: https://www.amazon.com/s?k=978-0684827575 https://www.google.com/search?q=isbn+978-0684827575 https://lccn.loc.gov/2011005417 Zubrin, R. (2019). The Case for Space: How the Revolution in Spaceflight Opens Up a Future of Limitless Possibility. Prometheus Books. ISBN: 978-1633885349. Searches: https://www.amazon.com/s?k=978-1633885349 https://www.google.com/search?q=isbn+978-1633885349 https://lccn.loc.gov/2018061068 Copyright: 2022 Retraice, Inc. https://retraice.com

Practice makes perfect, but sometimes mistakes are inevitable, especially in medicine. Learning not to dwell on mistakes and instead, learning from them makes doctors and surgeons stronger in their fields, as Dr. Gawande talks from his personal experiences. Advancements in medicine have greatly aided doctors in treating patients, but medicine is still nowhere near perfect. This week, Elsa and Riya dive into the importance of M & M meetings, taking responsibility for one's actions, and the importance of treating patients as humans rather than statistics. Tune in to learn more!

The reason to use checklists. I first talked about checklists way back in episode 89 of Resourceful Designer. In it, I shared various types of checklists you can use for your business. I even shared my now outdated checklist for starting a new WordPress website. Today, I'm not going to share checklist ideas with you. Instead, I want to talk about the importance of using checklists. To emphasize their importance, I want to start by telling you a story. I heard this story while listening to an audiobook called My Best Mistake, Epic Fails and Silver Linings written by Terry O'Reilly. It's a great book of stories about failures that led to amazing things. Check it out if you have the chance. One of the stories O'Reilly tells in the book inspired is what inspired what you're reading here. It's estimated that the average American undergoes seven surgeries in a lifetime, and surgeons perform over 50 million surgeries annually. That's a lot of operations. In 2009, roughly 150,000 patients died immediately after surgery—3 times the number of fatalities from road accidents. What's scary about that number is that half of those deaths were completely avoidable. That number caught the attention of Doctor Atul Gawande, a Boston surgeon and professor at Harvard Medical School. It's the 21st century. How can all these complications happen despite the accumulated knowledge of professionals? Gawande wondered if there was a way to reduce the number of operating room errors that resulted in these deaths. To find an answer, Gawande looked at other fields for ideas. Back in 1935, The U.S. Army was looking for the next generation of long-range bombers. They held a competition between top airplane manufacturers to come up with a new design. Although the issued tender was fair for all involved. It was a known fact that Boeing's technology was miles ahead of their rivals Martin and Douglas. Boeing's new Model 299 could fly faster than any previous bomber, travel twice as far, and carry five times as many bombs as the Army requested. The Army was prepared to order sixty-five of the aircraft before the competition was even over. The big brass of the Army Air Corps gathered for the first test flight of the Model 299. The impressive machine took to the sky with its 103-foot wingspan and four gleaming engines (instead of the usual two found on most planes.) It was quite a sight to see. As the plane took flight, it climbed to three hundred feet, stalled, and crashed in a fiery ball of flames. Two of the crew died that day, including the pilot who was the Army Air Corps' chief of flight testing. The Army decided to award the contract to Douglas instead. And Boeing almost went bankrupt. However, The follow-up investigation revealed that there was nothing mechanically wrong with the plane. And it was determined that the crash was due to pilot error. But how could that be? How could the chief of flight testing, one of their most experienced pilots, make a mistake that would lead to the crash of such a sophisticated plane? As the investigation showed, the Model 299 required the pilot to monitor the four engines. Each one requiring its own oil-fuel mixture. He also had to attend to the landing gear and wing flaps, adjust the electric trim to maintain stability at different airspeeds and regulate the constant-speed propellers with hydraulic controls. And that was only a few of the things on which the pilot needed to concentrate. It turns out that while attending to all of these things, the pilot forgot to release a new locking mechanism on the elevator and rudder controls. It was a simple oversight that led to the crash. Boeing was ready to scrap the plane, but a group of pilots believed the Model 299 was flyable. So they got together to find a solution. When they later approached Boeing, they didn't request any mechanical changes to the plane. Nor did they think pilots needed to undergo extended training on how to fly it. Instead, they came up with a simple and ingenious solution. They created a pilot's checklist. They made a list that was short enough to fit on an index card. It covered all the mundane step-by-step tasks required for takeoff, flight, landing and taxiing. In other words, the checklist covered all the dumb stuff. With the new checklist, pilots flew the Model 299 over 1.8 million miles without one single accident. To distance themselves from the previous failure during the test flight, Boeing changed the name of their new plane to the B-17. The Army ordered 13,000 of them, which gave the Air Corps a decisive advantage in WWII. All because of a checklist. Since the 1960s, nurses have relied on charts, a form of a checklist, to know when to dispense medicine, dress wounds, check pulse, blood pressure, respiration, pain level, etc. And although doctors would look at these charts when visiting a patient, they viewed these checklists as “nurse stuff.” In the late 90s, a study determined the average hospital patient required 178 individual actions by medical staff per day. Any one of which could pose a risk. The researchers noted that doctors and nurses made errors in only 1% of these actions. But that still adds up to almost two errors per day, per patient. When you multiply that by every hospital worldwide, it means millions of people around the globe are potentially harmed by the very medical staff assigned to help them. In 2001, a doctor at Johns Hopkins designed a doctor's checklist for putting in a central line; a tube inserted in a large vein used to administer medication. It's a standard procedure that just about every doctor is familiar with. It was also a widespread cause of infection in patients. So this doctor devised a simple checklist listing the five steps involved in carrying out the procedure. He then asked the nurses to observe the doctors for one month and record how often they carried out each step. They found that in over 1/3 of all patients, doctors omitted at least one of the five steps. The following month, hospital administration instructed the nurses to insist doctors follow each of the steps. The doctors didn't like being told what to do by the nurses, but the nurses had the backing of hospital administration, so they grudgingly complied. When the new data was later tabulated, they thought maybe a mistake had been made. The infection rate for central lines dropped from 11 percent to zero. They continued the study for longer, to be sure, but the results were the same. It was estimated that a simple checklist had prevented 43 severe infections and possibly eight deaths in that one hospital, saving $2 million in costs. And yet, even with this evidence, many doctors refused to grasp the importance of this precaution. They were offended by the very suggestion that they needed a checklist. They already had so much to do that they didn't want one more sheet of paper to worry about. To prove his point, the doctor who wrote the checklist introduced it to other hospitals in Michigan. There was pushback, but in just three months, the rate of bloodstream infections dropped by 66 percent. Many of the test hospitals cut their quarterly infection rate to zero. A cost savings of nearly $200 million. All because of a simple little checklist. All checklists have an essential function. They act as a “mental net” to catch stupid mistakes. In 2005, the director of surgical administrator in a Columbus, Ohio hospital created a checklist for operating rooms. It contained simple things such as verifying they had the correct patient on the table and the right body area prepared for the surgery. This little addition improved surgical success rates by 89%. There's a lot more to this story. In his book, O'Reilly shares stories of how more and more hospitals started implementing checklists for various things, but I'm not going to bore you with them. Back to the original story. In 2008, after conducting his research, Atul Gawande devised a checklist to be tested by a group of pilot hospitals worldwide. Some operating rooms embraced it, while others protested it as a waste of time. During a knee replacement surgery to be performed by one of the checklist's most vocal critics, it was discovered while checking the boxes that the prosthesis on hand was the wrong size. If they had started the surgery, the patient might have lost his leg. That surgeon became an instant checklist evangelist. In all the hospitals using the checklists, surgical teams began working better together, and the surgical success rates soared. Complications fell by 36 percent, deaths by 47 percent and infections by 50 percent. And patients needing return visits to the operating room fell by 25 percent. What's amazing about using checklists is that they dramatically improved an outcome without increasing skill or expenditure. Instead of adding rigidity to their lives, checklists free people by getting the dumb stuff out of the way. Today, 90 percent of hospitals in North America and 70 percent worldwide use a checklist. And you want to hear something funny. When Gawande's original pilot project was completed, doctors were asked to fill out an anonymous survey. Seventy-eight percent said the checklist had prevented errors. But there was still 20 percent who didn't like the checklist saying it took too long to implement and didn't think it was worth it. However, when those 20 percents were asked if they had to undergo surgery, would they want the checklist to be used? Ninety-three percent of those who opposed the checklist said yes. I hope you found these facts as interesting as I did. Now you may be saying, sure, a checklist in a plane or an operating room makes sense. It can save lives, after all. But I run a graphic design business, so I'm good. I don't need checklists. I used to think that way as well. But remember, checklists are freeing because they help get the dumb stuff out of the way, which frees you up for the more important things you do. I remember a couple of years ago. I was doing routine maintenance on one of my websites I had launched a couple of years prior. While verifying and updating things, I noticed something that almost made my heart stop. The little checkbox next to “Discourage search engines from indexing this site.” was still checked. Meaning, for close to two years, my website was telling search engines, “I'm good. Don't pay any attention to me. Go look somewhere else.” That's a stupid mistake that I could have avoided with the use of a pre-launch checklist. Today, I have several checklists I use regularly. I now have a website pre-launch checklist. A WordPress install checklist. A first client contact checklist. A podcast client checklist. A Resourceful Designer podcast checklist. And many more. As I said earlier, these checklists help ensure the dumb stuff gets done so that you can concentrate on the more important things without worrying. If you are not already using checklists in your business, I suggest you start now. And if you think that your checklists are in your head, remember the story about doctors putting in a central line. There are only five steps involved, steps that every doctor knows. And yet, when observed, nurses noted that over 1/3 of all patients, doctors missed at least one of the five steps. Your memory is failable. A checklist is not.

For a few brief moments this summer, in places where the vaccination rate was high, we could imagine life after COVID-19: restaurants and theatres were filling up, gatherings of all kinds were taking place, and many businesses were planning to return to their offices after Labor Day. Then the story changed, as the highly contagious Delta variant began sweeping the nation. Atul Gawande, a professor of medicine and an internationally recognized expert on public health, tells David Remnick that the Delta surge has also caused a vaccination surge, which is promising. They discuss the idea of booster shots and the possibility of a future variant that would resist the vaccine and cause more severe breakthrough infections. The Lambda variant, Gawande says, has already reached the U.S., but little is known yet about how it responds to the vaccines in use here.    (Gawande has been nominated by President Biden to lead global health development, including COVID-19 efforts, for the United States Agency for International Development. The appointment awaits confirmation in the Senate.)

本期节目的嘉宾是我们的朋友晨鹭和璐珊。晨鹭是天津医科大学老年医学专业的硕士学生，研究方向是老年认知障碍、阿尔茨海默病的临床机制。璐珊是美国明尼苏达大学药剂学的在读博士学生，主要方向是阿尔茨海默病发病机制和靶向药物在体内的药代动力学作用。阿尔茨海默病常常被称为“老年痴呆”。但只有老年人才有患阿尔茨海默病的风险吗？阿尔茨海默病的症状是什么？对于阿尔茨海默病这种不可逆、无法被根治的疾病，我们如何进行早期筛查？随着病程的发展，阿尔茨海默病的临床表现是什么？阿尔茨海默病的前期诊断非常困难，目前也没有可靠的诊断指标。在这样的情况下，研究人员如何找到治疗疾病的靶点、研发药物？药物开发的过程又是什么样的？在老龄化日益加剧的社会中，我们如何照顾患有阿尔茨海默病的长辈？作为年轻人，什么样的生活方式可以帮助我们降低患阿尔茨海默病的风险？从阿尔茨海默病的机制讲起，晨鹭和璐珊和我们在这期节目中聊到了诊断、药物治疗、家庭护理、养老机构、衰老与疾病等话题。本期嘉宾璐珊、晨鹭内容提要+精彩预告02:54 关于阿尔茨海默病的简单科普“阿尔茨海默病是一种不可逆转的疾病，会慢慢破坏患者的记忆和思维能力，最终会使患者失去自理生活的能力。”04:54 阿尔茨海默病的主要治疗方式是什么样的？“目前市面上没有药物可以根本上治疗阿尔茨海默病。目前的治疗方式主要是根据患者的症状，以缓解症状的思路进行治疗。”“这些治疗方式的问题是治标不治本，只能期待缓解作用。”“目前前沿的研究主要针对导致患病的毒性蛋白。”07:32 关于阿尔茨海默病目前还没有可靠的诊断指标“临床上目前还没有针对阿尔茨海默病的可靠的诊断指标，也没有明确的发病机制。目前在临床上的诊断主要依靠临床资料或者患者精神状况的检查，比如针对认知功能障碍的量表。”“对药物研发的角度来说，前期确诊也很困难。目前百分之百确诊的方式只能通过尸检，检查脑部切片。”“一旦患者出现非常严重的认知功能障碍，病程大多已经进入中后期，药物干预也变得非常困难。”“早确诊可以方便我们提前进行药物干预，也能方便患者及家属做好心理准备。”10:08 临床上如何做到早期筛查？“通过询问患者或患者家属，比如近期有没有出现记忆里减退的情况？”“百分之六七十的老人都会出现记忆里减退的情况，但是会因为心理上的抗拒，不愿意进行进一步的检查。”11:17 药剂学的研究如何帮助我们早期筛查？“我们实验室(药剂学实验室)的研究会筛选潜在药物分子，找出有效并且方便人体吸收的药物，并研究药物如何在体内被分解的过程。”14:45 阿尔茨海默症是老年痴呆的一种，所以前期诊断对症下药很重要18:15 阿尔茨海默病药物的研发过程和癌症药物研发过程的对比19:47 正常的衰老过程和衰老疾病有什么关系？我们应该如何理解衰老？衰老是不是一种疾病？“可能对于‘什么样的状态算做疾病'，什么样的状态就只是正常现象，没有一个天然的定义。而不同的对于疾病的理解也影响了医学干预的目标。”“我们对于疾病的认知也是一部分由社会因素所构造的。”23:35 我们应该如何理解疾病的病耻感？“一些反对之前提到的把衰老看作是一种可以治疗的疾病这种说法的声音认为，如果将老年人贴上“有病”的标签，这将会额外增加他们的耻辱感。相似的，可能把认知功能障碍、记忆力衰退等症状定义为阿尔茨海默病，会使我们有病耻感。”“从临床的角度看，又好又不好。如果尽早确诊病症，可以帮助患者更加重视治疗过程，改善生活方式，调节情绪。从这个角度讲，尽早干预也是一件好事情。”25:40 阿尔茨海默病药物研发的过程“药物研发过程分为四步：确定治疗靶点，筛选生物制剂，确定药物剂型，观察人体对于药物的反应。”“药物推出前还需要三期的临床试验：临床药理及毒理作用实验，临床效果实验，小样本量临床评估实验，大量样本临床实验。”“大部分阿尔茨海默病的潜在药物都被卡在了临床试验的第二期或者第三期。”“药物在人体实验上的效果和在实验室小鼠上的效果有非常大的差距。”32:00 阿尔茨海默病药物研发上面临的困难34:50 药物研发上的困难对临床治疗的影响“阿尔茨海默病的患者家属非常辛苦。”“长时间住院护理需要很大的资金投入，所以很多患者选择在家护理。”39:00 养老所需要的隐性财力，时间及精力成本41:30 社会养老机构在老龄化的社会中能起到什么样的作用？“养老机构中也有比较明显的阶级分化。”44:40 社会需要认识到阿尔茨海默病对晚年生活质量的影响45:20 选择阿尔茨海默病作为研究方向的契机“国内由超过四千万失能或半失能的老年人。我们应该给予这些老年人更多的关注。”“关于阿尔茨海默病的研究还有很多空白点，很多挑战，但从社会的角度很必要。”“不管未来怎么样，我们仍然要努力的活好今天。”49:12 身边的长辈确诊阿尔茨海默病，我们应该做些什么？“给予患者足够的关爱。”“家属做好心理准备，对于阿尔茨海默病很多人了解不多，但他还是一个有较高风险的疾病，后期对于生活的影响会比较大。”“多和老人沟通，多鼓励老人参加社会活动。”“年轻人可以从保证充足睡眠，保持饮食平衡开始。”55: 30 总结“如何处理身体的衰老是我们需要学习的事情。”“在我们终将走向死亡的生命进程中，如何获得更高的生命质量。在医疗干预之外，我们如何尊重自己和身边正在衰老的生命？对于晚年的我们和身边的老年人来说，什么样的晚年生活是我们想要追求的？”参考资料Gawande, A. (2014). Being mortal: Medicine and what matters in the end. Metropolitan Books.黄一成. (2020). "衰老，其实是一种疾病？"PingWest品玩转载自公众号造就. 新浪科技. 检索自https://tech.sina.cn/2020-05-19/detail-iirczymk2410303.d.htmlAlzheimer's Association. (2020). Alzheimer's Disease Facts and Figures. Alzheimers Dement 2020;16(3):391+. Retrieved from https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdfFDA关于Biogen，Eisai的官方报告https://investors.biogen.com/news-releases/news-release-details/biogen-and-eisai-announce-fdas-3-month-extension-review-period*Biogen和Eisai在今年的1月29日宣布US.FDA将aducanumab 许可申请（BLA）的审核周期延至今年的6月7日。希望能在今年夏天听到他们好消息。片头片尾音乐《Sunrise at Seaside》by 王乾封面图片Illustration by Dani Maizhttps://www.behance.net/gallery/82649699/ALMA-Alzheimer-----------双重意识是一档「让我们认识到那些我们以为此时此刻与我们生活需求没有关联的东西其实和我们紧密相关」的播客节目。你可以在苹果播客, 喜马拉雅，网易云音乐，荔枝fm，小宇宙APP和Spotify搜索"双重意识DoubleConsciousness"找到我们，关注我们并收听我们的节目，给我们留言、提供反馈意见。希望加入听友群的朋友可以关注公众号，后台回复“听友群”扫描二维码来和我们一起聊天。

Can the United States vaccinate enough of its population to prevent hundreds of thousands of deaths before new and more contagious COVID-19 variants take hold? And will these vaccines even be effective against more adaptable mutations of the virus? Surgeon and public health expert Dr. Atul Gawande, most recently of the Biden/Harris COVID-19 Transition Task Force, joins the podcast to discuss the latest in the global effort to vaccinate our way out of this pandemic. He also explains why people should get the Johnson & Johnson vaccine if offered the chance, despite its lower overall efficacy rate compared to the mRNA-based vaccines from Pfizer and Moderna. Subscribe to the GZERO World with Ian Bremmer Podcast on Apple Podcasts, Spotify, or your preferred podcast platform, to receive new episodes as soon as they're published.

Healthcare professionals often have to have some of the hardest conversations with their patients.  We deliver news that nobody wants to hear, and we don't want to say. Doctors are no exception. Often physicians have to deliver test results that are devastating.  In the Frontline documentary “Being Mortal”, Dr. Atul Gawande shines a bright light on doctors and their ability to manage discussions on end of life. Lacking training and needing to maintain a professional demeanor often leave physicians feeling ill-prepared to say the hard things that sometimes need to be said. Everyone working in healthcare should watch “Being Mortal”. You can find it on the PBS website (https://www.pbs.org/wgbh/frontline/film/being-mortal/.  It's a great tool to share with your hospice or palliative care team.  You can find links to more resources for end of life professionals, along with self care support and information on advance care planning at theheartofhospice.com.  Connect with Jerry Fenter and Helen Bauer, the hosts of The Heart of Hospice podcast by sending an email to host@theheartofhospice.com.  Remember, you are The Heart of Hospice!  

Dr. Michael Fratkin founded ResolutionCare to insure capable and soulful care of everyone, everywhere as they approach the completion of life. Learn how telehealth applications are bringing a greater quality of living and dying to those in need. Contact ResolutionCare website Transcript Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text. We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print. Please note there is some content that is explicit in this episode. Dr. Bob: Dr. Michael Fratkin is the President and Founder of Resolution Care. Dr. Fratkin is a father, a husband, a brother, a son, a physician, and a very dear friend of mine. Dr. Fratkin is dedicated to the well-being of his community and the community of all human beings. Since completing his training, he's made his home and built his family in rural Northern California. He's served his community as a primary care physician in the community health system, as a medical director of the local hospice, as a leader in the community hospital medical staff, and has been a transformative voice for improving the experience for people facing the end of life. At a time of great demographic and cultural change in our society, Dr. Fratkin has created Resolution Care to ensure capable and soulful care of everyone, everywhere, as they approach the completion of their life. Resolution Care is leveraging partnerships with existing healthcare providers and payers to provide telehealth services that bring a greater quality of life and greater quality of dying. The palliative care team at Resolution Care openly shares their expertise and mentorship so that people can receive the care they need, where they live, and on their own terms. In this podcast interview, Dr. Fratkin shares his passion and his intimate experience as a provider of care. He's innovative; he's creative, he's dedicated beyond what I've experienced with just about anybody else who I've communicated with about palliative care and end-of-life care. I think you're gonna find this podcast to be incredibly informative and really interesting. Okay, Michael, thank you so much for taking time out of your day. I know you've got lots of irons in the fire and lots of people vying for your attention. So I really appreciate having time to connect with you. Yeah. You know, it's interesting. I always enjoy talking with you. We connect sporadically, not as much as either of us would probably want, but we have been pretty consistent in finding times to connect and catch each other up on what's happening with our lives and our different enterprises. And what's interesting is, after our conversations, I always think to myself, "I wish other people could have heard that. I wish other people had a chance to listen in and hear what we're developing, and sort of the passion that comes out in these conversations." They're so informative, for me, and I find it so inspiring to hear what you're doing and the service that you're providing and creating. So today we have that opportunity so that people are going to be able to listen in on our conversation. In the introduction, I shared a bit about what you're doing, who you are, but I'd like to have you just do a little synopsis of what Resolution Care is doing currently, where it started from its humble beginnings, and what your vision is for where this is heading. Dr. Fratkin: I'm a dad, I'm a husband, I'm a brother, I'm a son, I'm a whole lot of stuff. But I'm also what's called a palliative care doctor. And your group of listeners probably know a little bit about what that is, but the way that I describe it for people is that there are really three central elements. That number one, we don't take care of any patients. We support people as they find their way through serious illness. We support people with a team; we support their families. Our team includes nurses, doctors, social workers, chaplains, nurse practitioners, community health workers, and all the people that they don't necessarily see, but that are just as important to creating a container for our care, the back office, and operational people. So the first principle is, is that we are a person-centered, not a patient-centered, but a person-centered initiative. And that those persons, the reason I distinguish it ... It's not just the patients or their families, but the people providing the care that are centrally important to everything that we do. And then we build out from there. So the first thing is, we're a person-centered organization, using a team to accompany people with serious illness as they navigate it, right? Dr. Bob: I love it. Dr. Fratkin: So the second thing that we do is that we're really damn good at managing symptoms. Our team has quite a bag of tricks around the treatment of pain and nausea, breathlessness, and various other physical manifestations of illness. And we know how to use that bag of tricks. So symptom control is the second thing. And the third thing is, we help people and their families to navigate what is a completely dysfunctional, fucked up if you don't mind me saying so- Dr. Bob: Let's call that like it is. Dr. Fratkin: Of fragments and silos and conflicting interests, and stakes held. We help people navigate, somewhat, through the complications of their illness, but more so, we recognize that people are trying to make their way through a human experience, not a medical one. And so, we help them navigate through that, bringing the personhood that we are to accompany them with the wisdom, skills, and shortcuts and strategies that we know about navigating. So it's person-centered around the people we care for and us as well. We matter, too. It's impeccable symptom control, and it's navigational assistance. And really tough times of life in a really complicated health care system. So Resolution Care does that. And we use some technology tricks, video conferencing, all of our care is based in the home. And that's that. But I think I also wanna tell you about how I got here and why. Dr. Bob: Please do. Dr. Fratkin: So I came to far Northern California, Humboldt County, in 1996 and joined a community clinic environment as the only internist in a five-clinic system. And my job was to take on all the patient V patients and all the complicated conditions that provided kind of complex case management approach for the heavy hitters, the outliers, the hot spotters. They're called lots of things now, but they were just languishing without the attention they needed when I showed up in town. And for six years, I took the hardest cases in the system, and helped with diagnosis and treatment planning, and burned out rather quickly, because I didn't have a team. I then sort of shifted my attention to my deep connection with hospice work and became a hospice medical director, where I did have a team. But I also had a very constraining box around me, a structure of hospice defined by the Medicare benefit that was limiting our ability to do what made sense, rather than meeting all of the regulation and compliance that continues to accumulate in the hospice model of care. And I burned out again. And then, I did some hospital work. When I started, I was seeing 9-12 people in a day, and I really enjoyed being at the point of the sphere where people were sick enough to be hospitalized and to attend to them both with good medicine, as well as a respect, and frankly, love in the face of what they're going through. And that was great until they started to push me to see 15 or 18. And now, it's 22 patients in a 12-hour shift. And I burned out again. And all the while, paying attention to the rising credibility and relevance of the palliative care movement. So I became first certificated in 2000, and board-certified a few years after that, in palliative care. In 2007, I worked with the hospital to launch a guided care consultation service in the hospital. And as soon as I got started doing that, there was almost immediately, four or five times as many people as I could care for. And I wasn't able to scare up the resources in the hospital to build out a team. So for a period of years, I wrote business plans, I went to committee meetings, I tried to advocate for greater resources to do this good work correctly, and failed to do that. So in 2014, I had had it. Exasperated, fatigued, burned out, I guess for the fourth or fifth time. God knows I can't keep track. I was looking for a job. I figured I couldn't stay here in this beautiful community, because I couldn't figure out how to get a sustainable job with a team that builds capacity over time. And so, I looked for work. And as you know, Bob, a palliative care doctor these days doesn't have to go too far to get too many interviews. I had three interviews in three weeks in the Bay area, and on the way to the Bay area. And they offered me three jobs, quickly, were better resourced, better compensated, more controlled work hours, but none of them were where I lived, where I made my home, where my kids were born in my house. I live on this five-acre piece of redwood forest. My kids were born there. My dogs and cats are buried in the yard. And I didn't wanna leave. So come around spring of 2014, I started to think about maybe there's a way to build capacity, build a team, and share what I know to others so that they could make that work for the people they're caring for. And so, the three ideas were video conferencing, Project Echo, which we could talk about later, it's a telementoring structure that allows a specialist to share information to primary care providers, et cetera. We can talk about that later if you want. And then the third thing was crowdfunding. So in November 1st or 2nd in 2014, we launched an Indiegogo campaign and based on all of my relationships in the community and people's trust in my work, we were able to raise $140,000 in a little over a month. And in January 2015, myself and one other person walked into a donated office space and turned on the lights. Dr. Bob: What a great story, and a great confluence of ... And you being true to your vision, being true to yourself, to what you knew was the absolute right way to practice the ... And you took a risk, right? And you continue every day, taking a risk. I know it. We've had these conversations. I'm trying to remember when we first connected because I've watched this thing go from birth to flourishing. And flourishing may not mean the same thing to you that it does to me, because I know your vision is grander. Dr. Fratkin: Well I know where we met. We met around ... There's a group in San Diego of one old-timer, one mid-timer, but some folks that have been inspired for more comprehensive cancer care in the community for a long time. A fellow by the name of Dan Vicario and the dear, dear friend of mine. I call him my grand brother, Paul Brenner, a psychologist with a deep connection. A psychologist and physician with deep connections to really thoughtful and complete approach to people with serious illness. And it was through them that they connected me to you. Dr. Bob: Right. And I remember that part very clearly. And I've had the honor and the privilege of collaborating on patients with both of them. And it is really; it's magical to be part of that with all of their combined years of wisdom and their just beautiful energy. But I'm trying to remember the stage that you were at. It was probably early on, and- Dr. Fratkin: It was probably in 2015. And without getting too wonkish about enterprise development so that we can get to the topic at hand, 2015 was the year of getting rolling and getting the team. And we did that. By September, we had a nurse, a social worker, chaplain, and office staff, as well as a little bit of a head of steam, with a group of patients. 2016, we really started to grow. And 2017, we continued to grow and sort of learned how to be a business that was sustainable. And coming into 2018, I'll just tell you today, Resolution Care network is tending to about 164 people in their homes, from the Oregon border to the north, the Pacific Ocean to the west, all the way to the ... I guess it's the Idaho/Nevada border to the east, south, pretty much to the Bay area with a couple of other folks a little bit further south. We've got 29 employees. We have contracts with four health plans. And we're making an impact with this model of care that we're developing. Yeah. Dr. Bob: That's beautiful. And of those 164 current patients, how many of those are receiving physical ... Are you able to get to visit physically, versus doing it entirely through video conferencing? Dr. Fratkin: It's variable. The key element is, is we really do what makes sense. So if a person lives down the street, it makes sense just to drop in and see them and sit on their couch and eat their cookies and chat with them that way. If they live 150 miles away from HQ, we're much more likely to engage with them by video conference. And it's really ... That's kind of what we built into the model. It's a hybrid model, both boots-on-the-ground, face-to-face encounters, with teleconferencing or video conferencing. And we do that in a really nimble fashion so that there are some people who really can't wrap their head around it. And if they're close enough, we provide them with a more traditional home care model. We have people who are right down the street who are very comfortable, in fact, prefer not having somebody knock on the door and walk into their house, but prefer to control the framework of the encounter. And then, different specialties. For my fellow providers and me, we're probably in the 85-90% video conferencing channel. Our nurses are probably in the 50-60% of their direct encounters are done by video. Our community health workers, the other end of the polarity, do very little video conferencing, because that's kind of what their value proposition is, is to be right there in the home with time and engagement to suss out what's needed. Our community health workers extend the reach of our doctors, our nurses, our social workers, and our chaplains. And they're given a lot of room to figure out what makes sense for each person and their family. So it's a variable ratio of boots-on-the-ground to remote engagement. Dr. Bob: Right. And what's cool about it is each situation is unique, and it probably changes over time as well. And I think it's fascinating; the different disciplines have the option of doing it whichever way makes the most sense for the provider as well as for the patient and family. Dr. Fratkin: For sure. At an organizational level for organization people who might be listening, it makes such great sense to use the technologies to eliminate the inefficiencies of travel. What's interesting ... I think we've talked about this before, but when I started to do initial consultations with people, first encounters to carry the arc of ... Oh, there are 8 or 10 elements that I've gotten accustomed to, to feel complete within an initial encounter. When I did it in a clinic setting, or at home, it was a 90 to 120-minute encounter, easily, and really exhausting. But when I started doing those same initial encounters by video conferencing, over and over and over again, they came to a place of completion in about half the time. Dr. Bob: Why is that? Dr. Fratkin: I think it's because we are primates. I think that when you walk into a person's home, there's a whole lot of social primate behavior. There's a whole lot of framing that includes so much more than just the relational engagement, one-on-one, with another person. There's the environment; there's the space, there's how the person feels about inviting a person into their home. There's their level of attention to, let's say, housekeeping, or their level of anxiety about how much energy they have to do housekeeping. There are the dogs; there's the feeling like you're hosting a doctor in your home, or a social worker, whoever. There are the elements of ... If you're really, really sick, maybe you just didn't feel like taking a shower this morning, but the doctor's coming, so you have to put yourself through a whole preparation mode. All of those things are, frankly, in the way of a relationship of trust. They're complications. So I've come to accept that actually doing care virtually is better than real life. Dr. Bob: Fascinating. I find that fascinating, because I do some care, some visits remotely that way. The vast majority, 95+% of them are in patient's homes. So those social, primal, primate behaviors, to me, I find those really endearing. And I think it's almost like a friendship is developing at the same time as a doctor-patient relationship. But I'm not seeing the same volume as you, so I have the luxury of being able to do that at this stage of the game. Dr. Fratkin: I think that's true. I think there are some other things that are hidden in plain sight that relate to it. I'm sure you'll agree that one of the great challenges for hospice work, palliative care work, complex conditions, where people with huge loads of social challenges with sensitive, inspired, caring caregivers and healthcare professionals ... One of the greatest challenges to this work is learning about the nature of boundaries. It shows up in every hospice organization, every palliative care organization, in the hospital, where people get confused about where they begin and where the people that they're attending to begin, or where they begin and end. The I and Thou, to quote Martin Buber. That is very interesting and hard to teach. The way that most of us learn is that we screw it up. We get caught up with the other person's energies. We end up feeling we must keep them pleased. We don't necessarily ... Well, here's the teaching metaphor that I use. I'll see if I can create a visual of this for you and the listeners. Bob, do you remember way back when, in the dark ages, when you took Physics? Dr. Bob: Yes, vaguely. Dr. Fratkin: Vaguely. And do you remember studying the components of an electronic circuit? Dr. Bob: Even more vaguely. Dr. Fratkin: Okay. Things like resistors and transistors. Dr. Bob: Capacitors. Dr. Fratkin: Capacitors and stuff, right? Now, I bet you don't quite remember. Maybe you do. You're a smart guy. What a capacitor actually is. Do you remember what a capacitor is? Dr. Bob: In the interest of time, I'm gonna let you- Dr. Fratkin: That's good. Good call, Doc. A capacitor is this: it's two plates. Imagine tiny little squares. One of them's a positive, anode; the other is the cathode. I think that's right, a negative. And they sit inside of a circuit with a proximity to each other and a surface area. And the closer they are together, and the more surface area they have in association with each other, the higher the capacitance. Whatever the stuff of capacitance is that contributes to doing what's needed to an electronic circuit, which is way above my pay grade, is proportional to the surface area and the proximity. And I think that that's better than thinking about staying professionally or technically detached from the people we care for. What we've built is a system that constructs ... All I'm here to do is to give you the technically, medically best treatment. And I can't really allow myself to engage with the truth of what's going on for you as a human being, because that'll make my hands shake in the operating room. That'll make me not make the right choices on your behalf, or provide you with the right recommendations. And I think what that done is it's alienated healthcare professionals from the people that have medical challenges, right? Dr. Bob: Absolutely. Dr. Fratkin: Professional detachment is a 20th century, obsolete concept. My concept is that what we're called to do, especially for people who are feeling the threat to their very existence, is to open as much of ourselves as we can, create a greater surface area, and have the courage to maintain the closest proximity to their circumstances. To understand what's going on. But what happens with the capacitor ... If the two plates touch- Dr. Bob: Kaboom. Dr. Fratkin: Circuit's completed, and there's no capacitance. If you get caught up in people's shit, then you lose the ability to really create the magic that lives between those two plates in close proximity. In human encounters, I say that it's not capacitance that arises with proximity and willingness to be open. What arises is empathy. And empathy is the secret sauce of understanding how to be of service to another person. But if you're caught up in them, if their happiness or well-being becomes relevant to your own happiness or well-being, then you've completed the circuit, and you lose the capacity to have the perspective of being of service to them. It's a long and involved metaphor. Dr. Bob: Yeah, but it's a great one. It's a great one. I'm gonna- Dr. Fratkin: Here's an example. With your wife ... Or actually, with my wife, being with my wife, not you with my wife, but me with my wife ... We are intertwangled. And we sometimes struggle to have enough individuation to understand what each other needs. But we're necessarily, intimately one. One circuit, my family, right? And so I struggle with different kinds of things there than I do in work. It's not a matter of distance; it's a matter of entanglement. When I, for example, being asked to see a 56-year-old person with a brain tumor and two children, the distance I can get in proximity to him is greater than with an old woman who doesn't look anything like my own life. So I have a little bit more room. Others on my team may be able to step right into tending to that father. But for me, I have to create a little bit less proximity in order to make sure that I don't get entangled in the reality of what's going on for him because it so resonates with my own fears and worries about myself. So I can manage the proximity consciously, and by having a team that has a whole different set of concerns and triggers. There, we're intentionally talking about the distance we can tolerate. The best possible scenario is you're almost touching, but not quite. So we have to manage that consciously, and that is one of the ways that I train people around boundaries. This is a very circular way to talk about what I think one of the great advantages of video conferencing in a frame, is that it's literally a frame around the encounter, around the relationship and development. It's necessarily a division. It's necessarily a boundary. And while I can get very close and understand empathically what that person is having, I'm not sitting on their bed. I'm not reacting to their place on the political spectrum, which may be revealed by their red baseball caps or bookshelf. I'm not struggling with my own biases. They are in their most comfortable place as a person, not having had to prepare, go to a clinic, and deal with the waiting room and all the rest of it. They're just at home, as themselves. And I am similarly in a work environment that I've constructed, that I'm very comfortable with. And so, in some ways, the frame around which we ... within which we encounter and develop a relationship, has this necessarily built-in boundary. And so I think that's part of why, rather than two hours, it takes one hour to get to the same place. And that once people have the experience, it's much, much more comfortable for them than home invasions. Dr. Bob: Fascinating. What's interesting is, I'm assuming ... Correct me if I'm wrong, but I'm assuming that this has all just been learned as you built this. The rationale and the initial inspiration for doing video conferencing, I'm assuming, was efficiency and being able to connect with people who are in more remote areas. I'm sure that you had very little awareness or understanding about all these additional benefits and advantages that you've come to, that you're just describing. Dr. Fratkin: Yeah. Well, just like I don't have any idea what benefits and nuances and subtleties I'm yet to discover over the next few years. But yeah, you're right. I mean, I started because I noticed that I have had this amazing smartphone and that I'm using it to text and to call and to talk to people on the phone and all the rest. But I realized that it was worth exploring, whether or not a synchronous audiovisual experience with two people in two different places, working on the same thing together, whether that would work. Because I have this crazy, amazing supercomputer in my pocket called an iPhone. So a lot of it was curiosity. I didn't really quite get the efficiencies and the network development until I started playing around with it. The way that I discovered it was, a friend of mine who works at Google told me about a project that came and went over about 11 months, called "Helpouts." And Google had this project where they were setting up a platform that included video conferencing, the "Hangouts" app, a webpage that you could tell your story about what expertise you wanted to share with other people, a scheduling function, a wallet function, and a messaging function, all on one little webpage. And if you had Chinese cooking that you wanted to teach, you could put your page up there, invite people to take a look, and if they wanted to schedule you, they could. And you'd charge them $15 for a half hour or whatever you wanted to charge. If you wanted to help people with their business plans or filling out their tax forms or whatever other expertise you might wanna share, you were out on the sort of open market, and direct consumer engagement would allow you to do it. So he asked me, would I wanna do it for palliative care. And I said, "Yeah, sure." So I spent two hours throwing up a little thing, and within a month, I had five people reach out to me. And the first person that did was a woman who was in a hospital in the Bronx, in terrible pain, from a metastatic cancer problem. And she was miserable and interested in talking. So we connected, and about five minutes, five seconds, the technology itself disappeared, and there I was, doing my thing. And within 30 or 40 minutes, we're both kind of in tears about the big picture of things. And it was really clear that some basic fundamentals of managing her symptoms would make a big difference. So I got her permission to reach out to the hospitalist tending to her. He was willing to talk to me. I told him, "Do x, y, and z." And the following day, she was discharged from the hospital. And I connected again, and she was so grateful for that advocacy and the difference that it made in her life. And I knew that this could so work. Dr. Bob: Yeah. What a beautiful story to spearhead and show you the impact. Dr. Fratkin: So it was more about just curiosity of what can I do with this crazy iPhone in my pocket? I hadn't really put it together that I was gonna build a social enterprise called Resolution Care at that point. I was just trying to figure out why are we not using this tool? And so I started using it, and it worked. Dr. Bob: That's great. So hey, I have a question. You and I, we're both palliative care physicians. We both specialize and are passionate about bringing people the best possible and holistic support to deal with their struggles and their challenges. And we know what works, right? And anyone who's involved in palliative care understands the value, sees the value on so many levels. On the human level, the financial level, the social level. Why are we having ... Why do you think we're having such a hard time getting traction and seeing palliative care become what it needs to become? Because you're working within the system. You're working with insurers, and you're working with the whole Medicare and insurance billing component, as well as contracting. What's your take on it? What's going on? I know it's a big question. And it's not a simple answer, but I really wanna hear your thoughts on it. Dr. Fratkin: Yeah, no. I think I would probably disagree with you. And only because- Dr. Bob: That's good. I'm happy to hear that, too. Dr. Fratkin: Only because this morning I happened to have a little bit of perspective. I don't know why that is. It might be just; I hit the number of cups of coffee just right. But I think what I would say is it's happening at an almost spectacular pace. It's amazing what's occurred for our society as it relates to our mortality in the last few years. That there's a transformative change in the public conversation around death and dying. I just happen to be pretty well-timed to get up on my surfboard and ride that wave, while also contributing to that wave through having conversations like this one. But let's go back to 2014. In 2014 in October, the Institute of Medicines Dying in America study, the second version was published. It was, I think, 10 or 11 years after they did it the first time, where they did a very deep dive into how people in America finished their lives. And what they basically said in that report was it sucks, and it hasn't changed in 12 years. It talked about how much bias there was and how little capacity there was for palliative care in cancer patients. But they also talked about the aging population, the demographic shifts that are intensifying this sort of tsunami, silver tsunami of people with a greater burden of illness, and the cost of health care, and the absence of focused and targeted support structures for people as they completed their life. And they said, "Why hasn't it changed for 12 years?" A month later, Atul Gawande published "Being Mortal," a blowout success that surprised even him, about bringing this conversation to "How do we die in America?" To a more narrative discussion. And you and I, in our field, we've been talking about these issues for 20 years, maybe longer. And I ask myself ... Well, actually, when Atul Gawande presented to the American Economy of Hospice and Palliative Medicine in 2015, he was interviewed by the Philadelphia Inquirer. And before his presentation, he says, "Gosh, Dr. Gawande, you have this blowout New York Times bestseller. Everybody's reading your book. What are you gonna tell all these hospice and palliative care doctors when you talk to them tomorrow?" And he said, "Well, I'm gonna say thank you. And I'm gonna ask the question, 'Why haven't they been listening to you?" And I was disappointed the next day when he actually didn't ask that question. He [inaudible 00:40:34] from his prepared remarks. But I found myself, for the next few days, thinking about that question [inaudible 00:40:42]. Why haven't they been listening to those of us that have been doing hospice or working with death and dying, working with families very closely, learning what brings value to them? Why haven't they been listening to us? And I think the answer is that we were talking to ourselves, talking to each other, thinking in terms of big health care delivery systems and academic papers and elevating our own careers through the accumulation of initials and prestige and all the rest. The academy of hospice and palliative medicine was academic, an ivory tower, and not really directing its attention outward. And I told Gawande, his voice was completely outward-directed, and it wasn't because he was such a great doctor. It was because he was a son. And being mortal, he's a clueless ears, nose, and throat surgeon who was getting it wrong. Then he, as a son, experienced the challenges that his father faced. And that transformed his perspective as a physician. So his story of conversion was related not to his role as world-famous, world-renowned surgeon. It was related to his role as a son. And so he ... And he's such a brilliant communicator and journalist. Now fast-forward three years later. He is selected by Berkshire Hathaway, Amazon, and whoever the heck, to lead an organization as a symbol of what's possible by thinking out of the box. And as a symbol, that his orientation is grounded, his career has exploded so that he is the leading, most exciting CEO in health care. And he's completely grounded in an understanding of what person-centered care must turn out to be. Dr. Bob: Yeah. That is exciting. That's an exciting development. Dr. Fratkin: And then there's BJ Miller and the traction that he got telling his story as a TED Talk. And then there's Jessica Zitter with her book, called "Extreme Measures." And then there's Shoshana Ungerleider, working in the Bay area, kind of behind-the-scenes, producing powerful documentary films, one of which, "Extremis," was nominated for an Academy Award. But these powerful experiences taking the public into places that we've been populating for decades. The intensive care unit, or the hospital-based palliative care program. And bringing people into that, that wouldn't otherwise look. Not to mention, the millennial spirit of younger people is that they don't blink. They don't avert their gaze at what's difficult. They tend to be drawn towards things that represented shadows for the previous generations. So I think there's a lot happening, that's happening very fast. And in three-and-a-half years, we built this organization kind of on the strength of that, and with the advantage of being an outsider like you, Bob. Dr. Bob: Well, I appreciate that perspective. And hearing you speak, it's inspiring. And it's true. Things are happening. There is a groundswell. I guess my perspective, A) I'm just, in general, a very impatient person. And B) I'm out here in the community speaking. And my of the talks are really focused on older groups, and I still have rooms that are filled with people who just don't really know about palliative care. And when there is palliative care in the community outpatient setting discussed, a lot of times, people have felt that it couldn't fulfill their needs. Because there's A) not enough providers, B) the offerings are not complete enough. And a lot of that has to do with the payment, the reimbursement models. So on the one hand, I do see that we are moving in the right direction, and that's exciting. And at the same time, I'm frustrated because I still ... And as I know, you see this as well. We still see people who are day-in and day-out, struggling, because their needs are not getting met. And we know what they need, and it's just not available to enough people today. Dr. Fratkin: No. It's super true, Bob. I mean, I feel exactly the same way. And for my own psychic well-being, there was a long time ago that I had to make the choice that I wasn't gonna focus on the unmet need or demand as the target of my attention. I was gonna focus on building capacity. And that I was gonna not worry about the fact that I could have burned myself out again trying to deal with one out of four people that I could get to in the hospital. I could have stayed inside of that, like most of us do, just trying to push that boulder up the hill. But what I had to do was to take a risk and say, "For those three or four people I don't get to, in their interest, not the same people but the next three or four or five or six or 12 or 250, it's gonna take some strategic thinking to build capacity." And there are so many sad stories. And as soon as I hear their names or hear some element of their stories, my heart starts to break and be frustrated with them that they don't get the service or don't know that there's a service that would help them. But my focus is not so much on those people; as it is, I know there are so many of them out there that my best efforts are to build capacity to manage and to set the tone of what palliative care capacity building looks like. We believe that it's not just whatever you could cobble together with crappy resources from whoever your institutional home is. Palliative care is best provided by a team of individuals who are well-supported in sustainable, soulful workplaces, but include a nursing perspective, a chaplaincy perspective, a social work perspective, and provider perspective. We are committed to that. So what we provide is actually pretty expensive. And the good news is, is that what we provide delivers to our health plan partners, a three to five x return on investment. Every dollar they spend turns into three to five that they saved. And they can measure those dollars. So they're interested in program development and building capacity for us. We think in the state of California, less than .5% of people who would benefit from palliative care support are getting it. If I focus on that 99.5 % of people who are suffering terribly- Dr. Bob: You'll be paralyzed, right? Dr. Fratkin: It breaks me down. Dr. Bob: Yeah. Dr. Fratkin: But I'm trying to get from .5 to 1. And I'm trying to do it by providing soulful, sustainable, meaningful experiences for my treasured colleagues. Nurses and all these people who, 100 years ago or 500 years ago or 5,000 years ago, would still be doing the same thing. They wouldn't be called nurses; they would be called neighbors. They would be called aunties. They would be called "the ones you call for help when you need it." It's been a part of human society forever, and we are burning out those people in a terrible way. So I'm just as loyal to creating incredible work experiences for those folks, as I am to building capacity to tend to the needs of sick folks, too. Dr. Bob: Yeah. And that's a beautiful thing. And that's how this will grow, sustain itself, by nurturing those who are serving others. Because this work, it's difficult, it's challenging, it is emotionally trying, and as I think we both experienced this, it is such ... It also fills us up in a way that nothing else does. And we don't throw the word "love" around enough. We had a meeting with my team a couple days ago. And when you try to really identify the essence of what we do, and really what we do is we love people, and then we take our skills and our experience and our wisdom, and we apply those in the way that we express our love for them. Dr. Fratkin: For sure. I was talking to a Native American fellow who lives up in the hills. And I was exploring with him his relationship to tribe and culture. And I'm not sure how we got there, and I wish I could remember the pronunciation of the word, but I won't massacre it. But he was explaining to me that there's a word that's being used by the tribe and others that kind of means "thank you," but it's being used in the "thank you" way. In a very, sort of, superficial way. But he said that the word itself is very much more specific. It's the kind of thank you or gratitude that's offered to someone who showed up to meet a need you had. If you're old and someone brings you food, it's the thank you for that. If your roof is leaking, but you can't fix it or afford it, and the guys hop in the truck and start throwing shingles on your roof, it's the thank you for that. It's the thank you for showing up and meeting a need for someone in your community. It's not "Thanks." It's deeper than that. And the presence that we bring, the willingness to love while preserving boundary, the willingness to respect the otherness of these people that we care for. And the willingness to drink a lot of coffee and build out a system to create beautiful jobs and keep the vision as clean and clear as possible. It's the thank you I feel from the community, even if I don't hear it said. I'm so proud of what this team has done for so many people we've touched. 1100, 1200 people who wouldn't otherwise have gotten this care. And that means there are 5-10,000 people who we didn't touch. I'm sad about that, but I'm proud of the work that this incredible team has done over these last three years with very little resource and a ton of coffee. Dr. Bob: Yeah. And a ton of passion and a ton of- Dr. Fratkin: Love. Dr. Bob: Love and determination. And proud you should be, my friend. And I'm excited to continue to follow your progress and the progress of Resolution Care and the impact that you're having. And your model is a model that I'm sure many will want to learn and try to apply in their communities. So before we sign off, I would love for the listeners to go and check out your website. That's resolutioncare.com. And in addition, there's a foundation and an opportunity to help support this amazing, so, so needed care. So you have a 501C3, I understand. Dr. Fratkin: It's called Resolution Care Institute, and there's a page on our website. And if people have a few dollars, they wanna donate, that's absolutely welcome. Yeah. And also, I guess I would ask them, too ... We create maybe once or twice a month what I consider to be pretty high-valued content in a newsletter. And I would love to build the community, so on the website, all you have to do is put in your name and email address, and we'll send you stuff. And if you don't think it has value, you just unsubscribe to it. But I suspect you'll enjoy being a part of our community. We tend to ... We're trying to figure out how to tell stories about the impact of the work that we're doing while getting ourselves out of the way. Just letting people tell their own stories. So we've done that with some videos, and we've done that with some blog posts and other newsletters. And the response we get is favorable. So I'd really like to build that community out if people are inclined. Dr. Bob: Yeah. Awesome. Well, we'll fully try to support that, and to everyone's benefit. And we'll also have the links for Michael's site and the ways to connect with him on our website, integratedmdcare.com. Michael, thank you. You're so passionate, articulate. I could listen to you all day, describing your views and your excitement about what you're doing. And I would love to try to connect again. And I know that there are several things that we wanted to touch on that we didn't have time to, but hopefully- Dr. Fratkin: I'm happy to do this anytime, Bob. This is how we're making an impact, is by telling the truth and sharing that.    

A RAGE session featuring Karel Habig, Cliff Reid, and Chris Nickson: Introduction... kind of (starts 00:00 min) ‘What's bubbling up?' (starts 04:48 min) — an ED checklist for cognitive debiasing, are 'cold' platelets ready for primetime, the ART trial and the open lung approach to ventilation using recruitment manoeuvres ‘What's The Sats Target?' (starts 22:55 min) — the RAGE team discuss what SpO2 targets to aim for, in which patients and diseases, and the tricks and traps of real-world clinical practice. ‘A blast from the past' by Chris Nickson on ‘Rudolph Virchow' (starts  52:52 min) ‘Words of Wisdom' from Cliff Reid (starts  57:10 min)