Funding the Future: Research on COVID-19

In our divided world we face or avoid conflicts on a frequent basis. I turned to Bob Bordone and Joel Salinas to find out the best strategies to deal with these, including having them take on a mock conflict between each other on the merits of Covid research.

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Eric Topol (00:06):

Well, hello. It's Eric Topol with Ground Truths, and we're going to get into a new book called Conflict Resilience: Negotiating Disagreement Without Giving Up or Giving In, and we're lucky to have its two authors, Bob Bordone, who is a Senior Fellow at Harvard Law School, and Joel Salinas, who is a physician, neurologist, a clinician scientist at NYU. So welcome both Bob and Joel.

Bob Bordone and Joel Salinas (00:34):

Thank you for having us. Yeah, looking forward to the conversation.

Eric Topol (00:37):

Yeah. So first, how did you guys get together? This is a pretty diverse, you got law and medicine, usually they don't talk to each other very much.

Bob Bordone (00:46):

Well, we were very fortunate. I mean, we basically were friends, but part of that friendship, I think emerged from work that I do around conflict issues in the Mass General system and then just the larger, bigger Mass General, Harvard community. Yeah, so this began really as a friendship where we were each swimming in very different waters, but then as we would start to talk, we realized there was a lot of connection and maybe the possibility to bring two different disciplines together in a way that might be practically useful and make an impact. And even when we started writing this, which was during Covid, what seemed to be some pretty polarizing times that were unlikely to resolve by the time the book would come out.

Eric Topol (01:44):

Yeah, well you sure hit it with the divisiveness and the polarized world that we live in is perhaps worse than ever, certainly in all my years, and probably long before then as well. So this topic of resilience, it's a very interesting concept because some people might think of resilience as just being tough. So go into a conflict and just go heavy tough. That obviously is not what you're writing about. And I guess maybe we can start off, what was the goal here? Obviously, there's other books that have addressed this topic, I'm sure, but yours is somewhat unique in many respects because it brings in the science of it and many strategies perhaps that have never been developed. But when you got together, what was the mission that you set out to do?

Joel Salinas (02:38):

Yeah, well maybe I can start out and then you can add on. So my research has been all around understanding how social relationships influenced brain health, and one of the things that I was seeing was social isolation and loneliness had been steadily increasing. Want to figure out what kind of interventions or what are the factors that are involved here? And I think one of the things that has stood out is just the difficulty with being able to navigate conflict in different contexts. And so, the idea around conflict resilience is really, even though there's been lots of books on what to say and what specific tactics to use, I think that there was this skillset around just being able to sit with the discomfort of that disagreement, which will ultimately help make it much more useful to take on those tactics. One way to think about it, if it's like all these tactics are like learning how to cook with a set of recipes in the kitchen, what we're really proposing here is that you also need to be able to stand the heat of the kitchen to even be able to cook.

Eric Topol (03:47):

Okay. Go ahead, Bob.

Bob Bordone (03:49):

Yeah, and I would say I was starting to write about my first kind of piece on this topic where I use the word conflict resilience was in 2018, and it really came from an observed dynamic that I was seeing in my teaching of Harvard Law School students. I was on the admissions committee, I'd been on the admissions committee for many years. I knew that we worked very hard and were quite successful in fact, at bringing together a very diverse student body, including politically. And people sometimes maybe think of elite law schools as being very progressive. But Harvard Law School, the biggest student organization is actually the Federalists, which is the conservative students. And despite that effort, what I noticed in the classroom was a reduction in conversation, diversity of viewpoint across the board, interesting classrooms became boring. And even though I was teaching around conflict and negotiation and difficult conversations, I would read in students' journals things like, I want to avoid conflict or I don't want to get into it.

Bob Bordone (04:59):

And so, it occurred to me that quite a part, as Joel said, from any skills, if we don't develop this capacity to sit with disagreement, then we will never get to problem solving. I'm in favor of problem solving. But this paper on conflict resilience, its original title was called Against Problem Solving. Mostly because I thought that if we had opened the possibility of problem solving as a precondition for entering the room, then we might never enter the room, particularly if we've told the demonized and dehumanized story about them. And so, that somehow we had to make the case that sitting with the discomfort of the disagreement, even if it didn't mean problem solving, although we hope for that, even if we didn't mean that it was worthwhile and it was important. And so, part of what was really attractive to me about joining up with Joel is that he just brought all of this brain science aspect to it that I had this kind of teaching and kind of academic in the negotiation and dispute resolution research experience, but couldn't bring to bear the kind of brain science parts of, well, what is going on in our brain when we do want to run or when we get into that really unproductive battle.

Eric Topol (06:27):

Yeah, I agree that the unique part here is that whole scaffolding with the neuroscience, the behavioral science, and those five Fs that you mentioned. You alluded to fight, flight, freeze, fawn, or fester. Yeah, so avoidance of conflict has kind of been the default for many people now because we have political divides, we have anti-science versus pro-science divides and on and on. There's a quote in the book that I thought we'd start off with because it really lays the groundwork from you both. “The biggest hidden barrier to being conflict resilient stems from the inability or unwillingness to face and sit with our own internal conflicts - the negotiations between our divided and sometimes contradictory “selves.” Even more surprising is that although there are dozens of self-help books on negotiation and conflict resolution, almost none of them spend any meaningful time on this critical intrapersonal barrier to handing conflict.” So maybe Joel, maybe start you off here. I guess you were bullied as a kid, and maybe that gives you a little background here. Joel, tell us about that if you would.

Bob Bordone (07:46):

Hey, Eric. On our bad days sometimes I probably inadvertently bully Joel still today, but he's pretty resilient now.

Joel Salinas (07:53):

Yeah, I'm a Teflon. So I think I am generally conflict of what an individual, and I think a lot of listeners and viewers can relate with that experience. And I think that also kind of speaks to some of the neuroscience that comes into this, which is that our brain has really evolved to be a fortune telling machine. It takes all of our past experiences, turns them into memories, and then makes projections about what's going to happen. And this projection or prediction of what's going to happen might as well be reality for our brain's sake. And so, if we had really negative experiences with conflict in the past growing up, whether through our families or the schoolyard or others, there'll be likely a very negative charge of negative emotional charge that comes with that. And what that does is that it increases the chances that you'll trigger this system for salience and arousal, which then sets off the alarms essentially in your body that then creates these fight or flight type responses where you're more likely to fall back on these really reflexive behaviors to make the bad thing less bad.

Joel Salinas (09:08):

And when you do that, whether it's through avoiding or to blowing through conflict like a battering ram that then trains your brain to assign some kind of a reward using the orbital frontal cortex, a system that kind of keeps tabs over how much reward you get for a behavior, it makes it much more likely that you'll do it again. And so, we from a very young age, develop a propensity to either avoid conflict or tackle it. And it varies depending on the context and how you're feeling, but it just makes it much, much harder to be able to bring on a much more thoughtful and deliberative approach to conflict.

Eric Topol (09:49):

Yeah, I mean, I think one of the salient points is that avoiding the conflict can make things worse. And as you described that it's not, I would've thought that there are some people who are just innately gifted to being diplomatic and artful about having to deal with the conflict issue and others, there's just no hope. But in fact, it can be acquired. And you alluded to this kind of neuroplasticity, the brain and you advocate for chair work. Can you tell us about chair work, because that's something I wouldn't have thought would help in this manner.

Bob Bordone (10:30):

Sure. I mean, I'll say a little bit work about that. A big part of this chair work idea, frankly, is influenced by work in internal family systems. And I was very fortunate early in my career, even though I was at teaching at law school to start partnering with some folks who did IFS work, they call it peace work often. But the chair work is really identifying some of these conflicted sides of ourself, right? The side of ourself that maybe feels like it's important and okay to raise this issue because it's something that matters to me and maybe the side of ourself that feels like it's pointless and it will hurt the relationship and maybe the side of ourself that's fearful and to name each of them. And then to actually give each in preparation a physical chair where we sit in that chair and give voice to each of those sides.

Bob Bordone (11:32):

And I'm imagining that at least some people listening to this will say, this sounds very hokey, and does he really mean going to the chairs? And the answer is, yes, I do mean that because there is something about the physicality of it that forces you to give voice to something that is true and real in you. And the chair work is very helpful to set up what an opening might be into a hard conversation, meaning that all of the chairs are real and authentic and okay, they're worthy of getting some voice. So as someone who teaches in a law school, it's all about advocacy. And you would find students who would be very good at advocating on behalf of a client would be incredibly poor at advocating on behalf of themself. And so, separating out the side that maybe has a little bit of feeling, it's selfish, but actually giving it a legitimate voice, help them when they get to the table to be able to say, I'm worried about this, or I realize I may be wrong about this, or it might be upsetting. And also, it's important and deserves to be heard because one of the things around avoidance is we often do avoidance in service of preserving the relationship or not disrupting. And we do maybe preserve the relationship for the time being of the person across the table, except we go home and there's still the side of us that is not feeling good about it, and the person we're not preserving the relationship with is that side, then we just get to have a sleepless night. And so, that's really the kind of idea behind the chair work.

Eric Topol (13:22):

That's helpful, Bob. I guess managing conflict, of course, I think we know you don't get emotional. Okay, sure. But yeah, there's three parts of that, three components, self-awareness. We've been talking about that deep listening, which of course when you're engaging in a discussion that's potentially leading to escalation of a conflict or the amplification that is really important. And then effective assertion. Now, that's where it seems to me things fall apart. If you're making effective assertion, then everything kind of blows up. So tell us about how you can be assertive and still, you're not trying to win the argument. I get that, but how can you be assertive and still come out in a positive way?

Joel Salinas (14:16):

Maybe I can start, Bob.

Joel Salinas (14:19):

I think one of the things that really is a good predictor of how effective you'll be at effective assertion is how good you were at the deep listening part. So the more genuine you are and curious you are about the perspective of the other person, really understanding what are the set of facts, experiences, beliefs that eventually lead up to that headline of what their position is or what their interests are. The better you'll be able articulate your own perspective while still engaging in the conversation. And the other thing that's really important here is that in that listening piece, it's really essential to be able to bring in tenets of really great listening that includes eliminating distractions, both external and internal. It involves having a nonjudgmental position toward the other person and being able to reflect an understanding of what the other person is saying. But all of that does not mean that you are endorsing their point of view. And I think that's really essential. It's really about getting as clear as you can about where the other person is coming from. So that way when you have an opportunity to share your perspective, you're able to really speak to the concerns of the other person and your own.

Eric Topol (15:46):

Yeah. Well, in reading the book, it took me, interestingly to an evening discussion I had with a very close friend.

Eric Topol (15:56):

And he was saying, we do need a randomized trial of the measles vaccine, MMR for autism. And I said, what? And I started thinking about, well, I'm going to hear him out because there's so much evidence now that you would think this has been totally debunked. And his view is, well, it can't hurt. And I'm thinking, well, so in that discussion, a lot of these points that you've been raising help me to come not to a point where basically I was trying to put a bow on it, as you said, or trying to externalize or abstract it. But to have a happy ending with him about this saying, okay, well it's never going to get done, but if you want to get it, I'm supportive of that. We don't do enough of this. I had to listen to what he had to say. I had to deal with my own confirmation biases and not get emotional and all that stuff, right. Now, I'd like the two of you to role play on something like that if you would. And let me just give you an example. Maybe you can run with it. Let's go to Covid, okay?

Eric Topol (17:14):

So one of you will take the side that we shouldn't do any more Covid research because the pandemic is over and we need to be efficient and not use these funds for other things. Covid is over, Long Covid is a hoax, and the other person will take the side that, no, this is a really big deal because Covid has not gone away and there's still a endemic of the virus, Long Covid in millions of people. Who wants to take away the funds? Would that be you, Bob?

Bob Bordone (17:52):

As a lawyer, I am happy to take any side.

Eric Topol (17:55):

Okay. You are the one to be on that side. Okay. And Joel, you are going to be the pro science side, if you will. Can you start that argument?

Bob Bordone (18:05):

Eric, can I make a suggestion? Yeah, but I'm happy to. It might be fun if one of us tries to be a person who hasn't read the book and the other person maybe tries to actually model the skills. What do you think about that?

Eric Topol (18:18):

Sure. Yeah, that’s fine.

Joel Salinas (18:19):

Bob, I'll take on the unskilled position.

Bob Bordone (18:22):

Okay, fine.

Joel Salinas (18:25):

All right. So Bob, you know what? I keep hearing about people wanting to cut Covid funding and just really, I just can't believe it. It just makes me want to throw up because there's such an important need to do this research. It's just critical to understand the long-term effects of it, and Covid even gone yet. So I just can't believe that people would even want to cut this research at all.

Bob Bordone (18:50):

Well, first of all, it sounds like you're stunned and surprised by this. Am I right about that?

Joel Salinas (18:56):

Yeah, I'm beyond stunned. I'm revolted by it.

Bob Bordone (19:01):

So you're pretty angry about it. And I'm curious if I can ask you, you said that the disease is still going on, and of course Covid still exists. I am curious from your perspective, what do you think the benefits of spending lots and lots of money on the diseases at this point, since it's not at that level where it's killing a lot of people?

Joel Salinas (19:30):

Well, I think that it is killing a lot of people. Still, the disease hasn't gone away and it has a huge impact on health. I think we're still feeling the impacts on that. So I think that being able to understand what the impact does require funding to be able to do the research. And if we don't do that research, then we don't understand what interventions there can be.

Bob Bordone (19:51):

And what are the impacts? I mean, clearly there's impacts of the pandemic broadly in our society, but what are the kinds of health impacts from your perspective that research would be helpful to from a medical perspective?

Joel Salinas (20:05):

Well, for sure it impacts cognition. We have people talking about brain fog and Long Covid, and that has a real societal impact on productivity and people's ability to engage in life. It affects people's mood. And then you've got the people who have respiratory symptoms from Covid that have continued to gone on, and that decreases their ability to do their day-to-day things. It's a real societal impact.

Bob Bordone (20:28):

And how would you think about balancing whatever impact Covid has from all of the other funding choices that need to be made given a shrinking research pool for funds?

Joel Salinas (20:44):

I don't know. I mean, I think it's an important priority, and I know that there's a lot of other priorities. I think it needs to be weighed against a lot of other big programs that are out there. I just want to make sure that it doesn't go away because it needs to happen.

Bob Bordone (20:56):

Yeah. No, it's helpful to hear that. And if we had more time, I'd ask you some more questions. I mean, one thing that, as I think about this is given just the number of priorities out there, I worry that because Covid was in the press so much and is so politicized that we overweight the importance of money in that direction. And I would say that there's probably other things if we have a fixed set of money that kills a lot more people and has a lot more health impact. And so, I'd rather see the funds get placed there than just satisfy some kind of highly salient political issue.

Joel Salinas (21:40):

And I just want to make sure that the funding happens. I mean, it should be to a level that it makes sense to continue the funding so that we get good results from it, that it can be applied. But yeah, I guess you're right that it needs to be weighed against other research priorities. I mean, that's a whole other topic that gets me upset, but I think I just want to make sure that this funding doesn't go away.

Bob Bordone (22:03):

Yeah. So it sounds like for you, the concern is less about reduction and more about moving it to zero?

Joel Salinas (22:12):

I think so, yeah.

Bob Bordone (22:13):

And if it did move to zero, what is the thing you'd be most worried about?

Joel Salinas (22:18):

I think we would lose out on this really unique opportunity after all these people had been affected by this condition to understand the long-term effects. So that way, if there's another resurgence, we'll understand what can we do about it to mitigate those effects. I mean, we're still trying to figure out what the effects of a lockdown were on people. I think that's something that needs to be better understood.

Bob Bordone (22:40):

So for you, the research is very forward looking about future pandemics that might come up.

Joel Salinas (22:46):

Absolutely.

Bob Bordone (22:47):

And that might be something that I'd be more interested in than how can we prevent future pandemics than I would worrying about. I mean, it's very regrettable what has happened to this set of people who have Long Covid, of course. I just think that that has happened, and I would almost rather see the funds move in the direction of how do we prevent another pandemic than how do we worry about a relatively small set of people, although it's tragic on them, a relatively small set of people who may still suffer those benefits.

Joel Salinas (23:26):

Yeah, I think we do want to focus on the prevention, definitely. I still just don't want to lose sight of making sure that we're getting the research done that needs to happen.

Bob Bordone (23:38):

Should we cut?

Eric Topol (23:39):

That's helpful. These are two experts in conflict resilience here. I mean, the only thing I'd add is that Long Covid is affecting millions of Americans, perhaps as many as 60 million people around the world, and we have no treatment for it. So it's a big deal.

Bob Bordone (23:56):

I just want to say for the record, I was just being an actor there.

Eric Topol (24:03):

Yeah, that’s okay.

Bob Bordone (24:04):

I don't even know if my arguments on the other side were making sense, but I was trying.

Eric Topol (24:08):

I think you did a good job. I think both of you did a good job. I think the point here is that you were able to have a civil discussion, make your points, I forced you into it. You couldn't avoid it. You're in touch, obviously with your own innate issues. You kind of really emphasize that throughout the book, which is you got to be in touch with yourself, not just about your priors, but also your current, what you're feeling, your posture, your heart rate, all these other physical things. So you really got us queued into what's important when you're having a discussion that could lead to, it could exacerbate the conflict rather than help come to a happy mid stance or where both people feel that they've expressed themselves adequately. I really love the Frederick Douglass quote in your book, “if there is no struggle, there is no progress. Those who profess to favor freedom and yet depreciate agitation…want crops without plowing up the ground. They want rain without thunder and lightning. They want the ocean without the awful roar of its many waters.” I think that is so rich. And before we wrap up, I just want to get your overall thoughts. What haven't we touched on in our brief conversation about the topic, about the book that we should before we close today? Maybe start with you, Bob.

Bob Bordone (25:53):

Yeah, I mean, in some sense, I think it connects to exactly that quote, which is that without conflict, we are not going to get the kind of changes and dynamism we would want in our organizations, whether it's a medical center, a country, a family, but also without the conflict, we don't get the deeper connection that is possible because it's not until the first, no, that all of the yeses actually have the meaning that they should. And so, even though it seems scary to go into conflict, what I would say is it offers opportunities maybe for agreement, but if not for agreement, for a deeper kind of more authentic and real relationship. And I would just say for me, part of this is inviting people to reframe the way they think about what conflict can do in their lives.

Joel Salinas (26:58):

Yeah. I think if there's one thing that listeners or viewers take from this is awareness is more than half the battle. So just really taking the time to become more aware of how you react to different disagreements with different conflicts, how you're responding to it physically and mentally, and what specific patterns might emerge in terms of whether it's with colleagues, with people with authority, with family members. And I think that alone begins to get you to pay more attention about how you can be more deliberate in your responses. And ideally, you can try out some of the skills from the book with those disagreements that are a little less stressful for you. Just like when you go to the gym, you don't start out by lifting the heaviest weights. You start out by getting the reps down with the good form, and then you build that muscle. And similar with building the brain programming wiring around it is to start low and build up from there.

Eric Topol (27:57):

Yeah. Well, I think what you have put forth in the book will go down anchoring such an important problem. It's magnified now than more than ever. People are socially isolated, not just in the pandemic, but post pandemic and the divisiveness is profound. So hopefully the tips that you've provided, the science behind it, the practical ways to navigate and deal with this will help people as we go forward. So thank you both for the work you did in putting together the book, and hopefully some of our listeners or viewers will use these tools in the future and will have much better exchanges with others who have different views, different what might be considered adversarial perspective, whatever. So thank you very much for joining today.

Joel Salinas (28:58):

Well, thank you.

Bob Bordone (28:59):

Thank you for having us. It's been a delight.

********************************

As you can imagine, I’m excited to get my new book out on May 6th. It’s about extended our healthspan, and I introduce 2 of my patients (one below, Mrs. L.R.) as exemplars to learn from.

My op-ed preview of the book was published in The NY Times last week. Here’s a gift link. I did a podcast with Mel Robbins on the book here. Here’s my publisher ‘s (Simon and Schuster) site for the book. If you’re interested in the audio book, I am the reader (first time I have done this, quite an experience!)

Here’s the back cover to give you an idea of what some people had to say about it.

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