FHC #58: An unfiltered look at inauthenticity in medicine

“I wish I was more authentic, more transparent, more myself from the very beginning (rather) than trying to create a character or a persona,” said Dr. Zubin Damania (aka ZDoggMD) when asked about his social media regrets.

On this week’s show, Dr. Z joins cohosts Dr. Robert Pearl and Jeremy Corr to discuss the false personas that physicians assume as part of their medical training. They are taught, as doctors, to conceal emotions, remain objective and always keep patients at a professional distance.

“The culture of medicine,” added Dr. Damania, “is inauthentic by its own creation.”

Welcome to Unfiltered, a show that brings together iconic voices in healthcare for an unscripted, hard-hitting half hour of talk. A little show history: Prior to Unfiltered, Dr. Robert Pearl had twice appeared on The ZDoggMD Show (see: here and here) opposite Dr. Zubin Damania, who had twice appeared on the Fixing Healthcare podcast with Pearl, alongside cohost Jeremy Corr (see: here and here).

For more, press play or peruse the transcript below.

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.

UNFILTERED TRANSCRIPT

Jeremy Corr:

Welcome to Unfiltered, our newest program in our weekly Fixing Healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversations about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. I’ll then pose a question for the two of them as the patient based on what I’ve heard. Robbie, why don’t you kick it off?

Robert Pearl:

Hello, Zubin. I can’t tell you how much I look forward to this program each month.

Zubin Damania:

Oh, it is a lot of fun. I always learn something and then take it home and abuse that knowledge in some way and misuse it. So it’s very important to me.

Robert Pearl:

Excellent. Excellent. I’ve developed this habit. As people tell me various things each month on a variety of topics, I find myself wondering, what would Zubin say? Fortunately, I get to find out.

Zubin Damania:

And then how can I do the opposite of what he just said? It’s interesting. All joking aside, I feel the same way about you. I’m always thinking, how would Robbie interpret this? What would he do, given all his experience? So it’s fun to talk.

Robert Pearl:

All right. So let me start with a conversation we had on Fixing Healthcare with a physician who is very big in social media. This is Rod Rohrich. And I asked him a question about what did he regret having done on social media, and his response was interesting. He said, “There’s nothing much that I regret having done, but there’s much I regret not having done.” Is this your view about social media and yourself, or do you have regrets about social media that you wish you hadn’t done?

Zubin Damania:

Oh, it’s really interesting. I am more with him, actually on this. I wish I was more authentic, more transparent, more myself from the very beginning than trying to create a character or a persona living in this kind of fear that we are ingrained as physicians to make sure we’re always trying to be whatever vestige of professional we can. And I think people really on social media, where it really comes into its own is when there’s authenticity and also kind of a lack of concern about growing followers and growing influence and more like, here’s what I need to say and how I want to say it. And I think I have the authority say it for these reasons, and here I am. And the other regret, I think, if I’m thinking about regret, it’s more early recognizing the addictive quality of social media and how we can have these … There a term that my friend, Peter Limberg, has coined called second selfing. And it means when we put ourselves out as a digital facsimile, like out in the world of social media, say, we have our primary self, like what we do in work and home and all of that. And then we have our secondary self, which is out in the world. We really do fall prey to certain failure conditions that can be fulfilled, for example, the idea that we are actually addicts of the very platforms that we are out on. So we may become addicted to Facebook or Instagram or looking at our stats and that kind of thing. There’s a kind of internalized capitalism that happens where we’re always concerned about what are views and who’s sharing this and what are the comments, and getting those little hits of dopamine from those kind of things. There’s the strange parasocial projections that our audience project onto us thinking that they understand or know a lot about us because we’re out there, but those parasocial projections are often sort of distortions of what our actual reality is. So there’s a series of kind of interesting foibles. So my regret would be not understanding that earlier and then kind of adjusting for that and recognizing that. It took me a while to kind of fall into the flow of that.

Robert Pearl:

What he said that was fascinating to me or pointed out that was fascinating to me was that medicine is intrinsically a very conservative profession. And when you and I were in our training, we were told to have this false persona. Don’t show your emotion. Don’t connect with the patient. Keep a distance. Anything else distorts objective diagnosis and treatment. And so I’m not sure that there is an authenticity in the culture of medicine, and you’re pointing out that it takes the authenticity to engage in broad social media with thousands or hundreds of thousands of individuals.

Zubin Damania:

I think that’s an absolutely central point is that the culture itself is inauthentic by its own creation. And so to then tell a physician, “Oh, be authentic on social media,” that’s not going to happen because it’s antithetical to the training. When I started in 2010 doing social media, there was a kind of internal cognitive dissonance, like, can I really do this? This is absolutely contrary to everything I was trained. And my colleagues were telling me the same thing, like, “Oh, you’re going to get in trouble,” or Stanford’s going to be mad or Palo Alto is going to be mad, whatever it is. And so you’re always operating in this kind of climate of fear, which is very difficult to foster an authentic expression of connection with the audience in that case. You know?

Robert Pearl:

Like you, Zubin, I love asking questions for exactly the reason you said a few minutes ago. I always learn a lot, particularly when the people are expert or at least have unique perspectives. And I often realize how wrong my assumptions are. I thought of this a couple of weeks ago. I had dinner with a friend I hadn’t seen in eight years. And eight years ago, five of us had dinner in San Diego. And I was surprised when she told me that she often thought of the question I posed that evening. I couldn’t remember the details, so I had to ask her what had I said. And she responded that I had asked the whole table which was more important in friendship, truth or loyalty. What do you think?

Zubin Damania:

Oh, man. These are the existential questions. So this is what I think. I think the answer to that question depends entirely on our inborn and somewhat further conditioned personality types. So if we are a type that values relationships, commitments, loyalty, duty, responsibility … There are certain personality types that that’s very high scoring in. Then the answer would be loyalty. And actually, it’s funny, Robbie, because I actually fall into that inbred personality type. It’s kind of like the software that my personality runs on. And what’s interesting is I never take any of this personally anymore because I know that even that software is running in sort of a perfect open expression of awareness that’s running the software. So I don’t identify with my personality, so I can look at it a little more objectively. So for me, the answer would be loyalty and duty to each other, whereas there are many that, say a different personality type that values truth over loyalty. The answer is going to be quite different. And what is fascinating is that will manifest differently in behavior, say on social media. So betrayal might be the cardinal sin among friends questioning each other publicly or whatever, among one type. And among another, it might be just constantly trying to find truth, and any deviation from that would lead to a personal attack. So that’s just kind of my thinking on that.

Robert Pearl:

It was interesting because her answer was that at the time, she thought loyalty was. But now, almost a decade later, she’s come to recognize truth being more valuable. I thought that was an interesting evolution as she’s progressed along her professional career.

Zubin Damania:

Yeah. One might even say that progression to truth is more a question of seeing things clearly, regardless. Right? And loyalty can be folded into truth in that way, in some sense.

Robert Pearl:

I believe that at least with close friends, that loyalty demands truth.

Zubin Damania:

Oh yeah.

Robert Pearl:

Not judgment, but truth. I think that’s the evolution in my life. And when I have my close friends and I have a thought, I don’t try to protect them, but I try to engage them. I don’t judge them. I’m going to like them, whatever I tell them, whatever I perceive. But to me, truth becomes a derivative of that because if I can’t tell them the truth, then no one’s going to. And I’m a loyal friend of them.

Zubin Damania:

Yeah. And the interesting thing about truth is often we cannot see it in ourselves. We’re very good at self deception, especially in healthcare circles. And so having a friend who’s loyal enough to hold up the mirror of truth to you, I think is powerful.

Robert Pearl:

How about in medicine, particularly when it comes to telling patients difficult things and engaging in difficult conversations. Should we and do we tell them the truth, or do we protect them through some type of veil of loyalty?

Zubin Damania:

This is another wonderful question because sometimes, pure, unadulterated truth delivered in an indelicate way can destabilize the situation in a way that actually causes harm. And so because humans are so complex, truth, and even the definition of truth can vary from person to person. But the question is, I think we always have to be as honest with our patients as we can, but delivering that message must be done in a compassionate and thoughtful way, because how we deliver it is actually probably more important than the actual message we deliver for many people because how they receive it, it triggers a physiologic response, an emotional response, a mental response, a logistic response, what they’re going to do with it. So yes, honesty and truth is important, but the delivery vehicle is key as well.

Robert Pearl:

Yeah. My sense is that we often don’t tell the truth not to protect the other person or because they really can’t hear it, but because we don’t want to express it. It’s about us, not about them. And that’s where I think that loyalty and I think the doctor-patient relationship has to go past that, which you’re raising a very important part, that if you don’t have, I’ll say that in depth doctor-patient relationship, which should be one of bilateral loyalty and commitment, then you’re not able to provide the truth without creating harm. And that becomes the problem in medicine, as opposed to the fact itself, which says, yes, you have a disease, and no, there’s nothing I or any other doctor can do to correct it. I will be there with you in your most difficult times to the last moment. I will make sure that you’re not in pain. But you need to know, so that you can finalize your life, that you only have a certain amount of time. I can’t tell you exactly how long, but at the end of the time, you will be dying. And it will not be your hoped for longevity. It will be sometime most likely in the next year, or whatever the medical facts would say is the timeframe. And I think that’s so important so that there are no regrets, either obviously, for the person who died, who won’t have regrets after he or she’s dead, but also the people who are still alive.

Zubin Damania:

I think the key thing there is that you pointed out that contrary to popular belief, there are two human beings in the room when it’s a doctor and a patient in the room. And that physician human being, they have their own defenses and hangups around these conversations. And in many ways, like you say, we’re reluctant because it’s pointing a mirror at our own mortality, our own feelings of success or failure, or our own conditioned beliefs on what makes a good doctor, and giving hope or taking hope away, and all these concepts that we have around it. But in reality, I’ll never forget when I was a resident at Stanford, I had a clinic at the VA. And I had a youngish, like in his 50s, vet who I had diagnosed. We did a chest X-ray for some other reason and diagnosed a lung cancer. And he took me out to dinner along with my girlfriend, who became my wife, at the time. And I said, “Why are you doing this?” He said, “I really wanted to thank you for being able to show me what was going on. I know it’s going to be a tough thing, and I know I may not survive. But being able to know the truth and you delivering it very directly and compassionately was so important to me.” And I’ll never forget that. I’ll never forget the dinner. I’ll never forget him. And that’s what it was. There’s two human beings in the room. They’re connecting.

Robert Pearl:

If I can shift to another conversation, this one I had with a medical student who contacted me and wanted some career advice. He was trying to decide whether to get an MBA, whether to get a PhD. There were a variety of choices he had to make in his life. And he asked me a fascinating question. He said, “You’ve done so much in your career. You’ve achieved so much. Are you just a lucky person?” So let me ask you, Zubin. You’ve achieved so much. Are you just a lucky person?

Zubin Damania:

Oh, I’m the luckiest person on earth. All of it is a serendipitous, brilliant, interdependent connection. And to say that I had anything to do with it is to overstate it by an order of magnitude in that sense that yeah, I was lucky to be born to two physician parents who made me feel like there was struggle all the time and that there was scarcity. And so I fought for every little tooth and nail. And then I had mentors that were amazing and all that. But here’s another twist in that, is that we have the choice in any moment to make ourselves open to what my late friend, Tony Hsieh, calls return on luck, ROL. Are you open and available when luck strikes to actually do something, to be there, to actualize it? And that’s in your control. And so everybody has these vestiges of luck. It’s just how open are we to actually be there when it happens. And I think many people in medicine are so conditioned by inertia and fear that we close ourselves to return on these serendipitous gifts that life throws our way.

Robert Pearl:

There are clearly some people in this world who get born into tremendous poverty in Bangladesh and have bad luck, so let’s exclude that. But amongst most of the people around us in the United States, do some people have more luck than others? Or is it just that when the luck comes along, they’re better prepared, and they can take advantage of it in ways that others do not?

Zubin Damania:

It’s definitely a mix of things. If you can look at the kind of karmic background of people, what are the causes and effects that led to their current situation? And it’s intergenerational. It’s trans culture. These are things that are … It’s kind of a momentum that you’re born into. For example, if your life is like a wave, how big was that wave when it started? What was the nature of the currents and everything that led to it? And now here you are on this big wave coming towards the shore, versus somebody who was on a more subdued wave. And you look at the person in Bangladesh, who from our standpoint looks like they’re very unlucky, and you actually poll what’s their level of self-reported happiness. You may be surprised at how high it is because even though their wave was a little weird, they’re around people that are connected. There’s a sense of community, a sense of love, a sense of presence. And so their general level of happiness is high, even without all the material and health-wealth that we purport to have.

Robert Pearl:

You’re exactly right. It’s fascinating that I didn’t think about that when he asked me, because the studies on happiness have shown how much greater happiness exists in parts of the world that we would think would have misery. But people have family. They have relationships. They have to have enough food to survive and enough housing and protection against the elements. So there’s some basic pieces that if they don’t have it, then obviously, their life is in total crisis. But beyond that, there’s not very much. And as we said in our last podcast, the psychological literature even in the United States says that beyond a number that is at least among physicians, a level most of us pass, which is about $125,000 to $150,000 a year of income, beyond that there’s zero correlation with added happiness. And obviously, if people are having to make major compromises to generate a bigger number, there could be more dissatisfaction. And how distorted our minds are about what generates happiness in our lives.

Zubin Damania:

Yeah. It really gets back down to that central premise of a lot of the spiritual traditions, which is desire and aversion are the operating system of the mind, and it is also the root of all suffering. So once we reach a certain level of material comfort, if that desire machinery keeps going, you don’t get happier or more stable. You just get more anxious. So as they say, more money, more problems.

Robert Pearl:

So what’s the biggest piece of luck you’ve ever had in your life?

Zubin Damania:

Oh man. I would never be able to isolate it to one thing, but I would probably say just being born into the exact family I was born into led to pretty much everything after that. And then … Oh, sorry, Robbie. I would be remiss if I didn’t say this. The biggest piece of luck I ever had in my life was meeting my wife. They say in business, the best business decision you can ever make is who you marry. And I would say, yeah, that’s true. But it’s also your happiness, your stability, your mental health. All of that goes with how you’re partnering. And again, a lot of it is luck. I would say 99.9% of it is luck. So I just happened to get lucky to meet a person that was a very good fit. We’re very different, and we complement each other. And we’ve managed to make it work so far.

Robert Pearl:

Wow. Congratulations about that. Let me move into a little bit of a weirder area if it’s okay, because I was reading about this Google employee who was convinced that the AI application that existed was sentient and that had contacted an attorney. And he was the spokesperson for the AI application that was being deprived of the rights that it should have given its ability to perceive and feel things. But it made me think about a movie. Did you ever see the movie, Her, the 2013 movie with Joaquin Phoenix and the voice, at least, of Scarlet Johansson?

Zubin Damania:

I never saw it, and I heard I should see it.

Robert Pearl:

Yeah. So it focuses on Theodore, who is played by Joaquin Phoenix. He’s a sensitive and soulful man, and his job is to write personal letters for others. And he’s left heartbroken after his marriage ends in divorce. And he becomes fascinated by this computer operating system named Samantha, who is the voice of Scarlet Johansson. And her bright voice and playful personality lead to what he experiences as friendship, a date, ultimately love. I don’t want to spoil anymore of the movie, either for you or the listeners out there. But I’m fascinated by this line or lack of line or blurring of line between people and machines. I read that by 16 years from now, neural networks in AI will equal the number of neural networks in the human brain. The Turing Test will be easily passed by machines.

Robert Pearl:

What do you think? Will a time come when this line between machine and person will disappear? We can date machines. We can date people. We can have our doctor be machines, doctor people. Where do you think it’s going to go 50 years from now? You’re a visionary of the future. Where is it going to be, Zubin?

Zubin Damania:

Oh, the easy questions, always. Every podcast, you throw these softball questions. Yeah. It’s funny. I actually interviewed Federico Faggin. I may have mentioned in a previous podcast, he co-invented the world’s first commercial microprocessor. He’s kind of Silicon Valley royalty, worked with Andy Grove at Intel. And he studied AI for 30 years after, and also has had a series of little mini spiritual awakenings and has kind of studied consciousness. And he is quite convinced that machines, they can fool us. So in other words, you can get these complex neural networks that can behave for all intents and purposes like a human, and humans will be fooled. It’ll pass the Turing Test, all of that other stuff. But it’s really in essence, a zombie. The lights are not on inside. It’s just going through these prescribed motions that humans are conditioned to believe is actually sentience. So this person who’s saying, “Oh the Google AI is sentient,” is easily fooled by patterns, basically of behavior or action. And so why wouldn’t the AI actually have an internal life? Why would it not have a subjective experience? And that gets to the fundamental question of what is consciousness and what is our immediate experience. I will argue, and Federico argued the same thing, that organisms like us are unique in that the internal experience is so transcendent of what we think mechanical intelligence can do that it actually has a kind of inductive intelligence that you will never touch with computers. You can facsimile it, but it doesn’t have an internal state. And so if you want to fall in love with something that pretends to be a human, that’s great. That’s great for you. That’s wonderful. But if you’re telling yourself that it actually has an internal experience, that’s a tougher thing to wrap something around because it probably doesn’t and probably never will.

Robert Pearl:

So let me challenge you a little bit, which is if you are correct that there’s something truly unique about humans that doesn’t exist in other animals and to your point might not exist in a machine or a computer application, what is the evolutionary reason that it happened and persisted, because if it doesn’t have evolutionary value, then as we went from chimpanzee to human or from reptile to mammal, it would have not been a factor that would have persisted and now become ubiquitous. What is it about that you believe has tremendous advantages specific to survival?

Zubin Damania:

Okay. I should clarify a couple things. One is, I do think actually animals are sentient. It’s just I don’t think that something we create in terms of mechanical intelligence can be sentient in the way that we understand sentience. The second thing I’ll say is, so this idea of consciousness as an evolutionary sort of epiphenomenon that has evolved and may have advantages and disadvantages for reproduction, you can talk about that at length, but I actually think that we’re getting it backwards. I’m actually an adherent of what professor Donald Hoffman’s theory is and some others, which is instead of saying the material stuff is primary, and consciousness evolved somehow from it in a way that we can’t quite understand yet because maybe we’re not smart enough, or whatever, I actually take the stance that consciousness was primary, and the material world is what consciousness sees when it constructs a kind of interface. So there is an objective reality, but it’s all consciousness. And we’re sort of like consciousness in a vast sense, social network of consciousness, evolving and competing with other interfaces that see the world differently. And so in that sense, consciousness is evolving, not so much consciousness evolved. That’s my roundabout way of totally avoiding your question.

Robert Pearl:

Well, I’ll push again.

Zubin Damania:

Yes.

Robert Pearl:

Which is that so much of human survival, so much of human existence, is being able to read other people and respond back in ways that are empathetic, sympathetic, engaging. Why, when a machine does that using an AI application … Not now, but we’re talking about 16 years from now, when it’s a thousand times more powerful. Why is that different than the human interaction and experience?

Zubin Damania:

Ah, what a great question. I’ll just point us back at our own experience in the present moment. So if we think that we can make a computer and we can describe in parameters and terms and sequences how that computer can create the taste of chocolate or the internal state of love or something like that, I would then point us back to our immediate experience of any of those states without the conceptual overlays. So just experience what it looks like looking at your desk or your microphone, and really, really pay attention without labels. Look at that in a very mindful, present way. And what you will find as that experience unfolds is that it is indescribably vivid, intense, and without stability. It’s totally ephemeral. It’s radiating. And those words are not even coming close to doing it justice. So the actual conscious experience is unfathomably complex. And that’s why I think even if we were to use the microscope and the science of our own introspection, we would realize very quickly that it’s beyond our ability to create a facsimile of it mechanically. So that would be my take. And I’m probably wrong.

Robert Pearl:

The beauty about talking about 50 years from now is no one really has any idea. But I think it’s important because I actually do believe that there can be an evolution in machines beyond which we are capable of controlling. There was another movie around the same time. I think it was called Ex Machina.

Zubin Damania:

Oh, yeah.

Robert Pearl:

That was exactly about this theme and an AI application deciding that no longer did the AI application want to be under the direction of humans. And this is certainly the fear that people have talked about in AI getting out of control or computerized systems getting ahead of humans, not the ability to just memorize, but the ability to actually have more sophisticated neural connections than we do.

Zubin Damania:

Yeah. And what’s interesting is I don’t think consciousness is even required for that to be a threat. Even the mechanical intelligence that can happen can be a threat to humans because it will vastly outstrip any human intelligence in that way. But it may not have comprehension. It may not have an internal state. But does it need it to actually destroy us? Probably not. So, yeah. This is hours of fun, Robbie. Either one of us could be right, and yet civilization could end.

Robert Pearl:

Well, I feel like we owe it to our listeners to at least bring this back into reality. So one last observation that I learned about this week, which is that the business of psychological literature now is focused on an interesting phenomenon about people, which is that we always like to add and rarely subtract. And by that, I mean if you give people a problem, you give them a Lego structure with two towers, one that’s slightly higher than the other, and a ramp connecting the two sides, and you ask them to horizontalize, if there’s such a word, that ramp, 90% of people will add a block to the lower side, rather than just subtracting one from the elevated side. And they’ve pointed out how much in our lives we move to adding when we face a problem, rather than thinking about ways to subtract from it. And my sense in medicine is that’s what doctors and healthcare leaders do. We add a new policy when there’s a problem, rather than perceiving that maybe there is a policy that needs to be taken away. Or we add a new procedure or approach, rather than recognizing that maybe something we’re doing needs to be eliminated. What do you think? Do you think that this problem is real, and what can we do about it?

Zubin Damania:

Yeah. You have a great way of pointing out these things that people don’t think about. That’s exactly it. If you ask doctors, what’s the best day you’ve had in recent memory at work, they’ll always point to something where things were stripped away. There was less administrative stuff. There was less charting. There was more time with the patient. But that more time with the patient is almost like a presence or a silence. It’s almost subtractive in itself. It’s taking away all the garbage and just allowing this to be. And in medicine, it’s exactly that, especially in the West. It’s all about adding, adding, adding. Well, if these three click boxes weren’t enough, something isn’t working. Let’s just add another click box, instead of thinking, well, maybe the concept of all these click boxes is probably not the right way to approach this particular problem. Technology, same thing. Add more features, more of this. How about just make the technology more focused on what it is we actually need and strip away all the stuff you don’t need? And again, I always bring it back, because you see where my head is these days, to any kind of spiritual practice. It’s all about letting go and surrendering and letting things sort of regress back to almost childlike wonder. And we don’t do that in medicine at all. We generally do the opposite, as you said. It’s interesting that the psychological literature then kind of reifies that, that people just do that. Maybe it’s a function of human beings, or maybe it’s a function of how we’re conditioned in society.

Robert Pearl:

In my book Uncaring, I write about my aunt, who at the time was in her 90s. She ultimately died at 99. And I was visiting her, and she had this big garbage bag full of medications. I don’t know how many she was on, 8, 10, 12. Every doctor continued to have a drug they prescribed for her and then added more as she had an abnormal lab result or an abnormal finding. And I suggested she see a geriatric physician. And the first thing the doctor said is, “You only have one medication you need. I’d throw the rest of them away.” And she felt so much better. She didn’t have complications and lightheadedness. She was steadier in her gait. Now, this is not the right advice for everyone at every point in their life. But no one thought about saying, “Maybe you should stop some of those medications. You don’t need to lower your blood lipids. You’re 97 years old. How long are you going to live?”

Zubin Damania:

It’s a disease we have in healthcare that we’re conditioned to do that. At our clinic, Turntable Health, we have this thing because again, so much of it, as you all always point out, Robbie, is your incentives. So if you’re paid to do stuff to people, you’re going to do stuff to people. And what we were at our clinic in Turntable … And I know you were doing this at Permanente Medical Group. It was a capitated rate to take care of a population. And so what we would do is we had in our huddle room bags and bags and bags of medications that we’d taken patients off on a wall. And that was sort of our pride was like, look at all these medicines we’ve stopped on people. And they’re doing so much better. They’re so much happier, instead of just the knee jerk of wanting to add more stuff. And it all gets right back to your Lego analogy. We really need to learn that less is more in medicine more than anything, often.

Robert Pearl:

And in many ways, that’s what prevention is. It’s less disease. Not treating the disease and avoiding complications from disease, eliminating disease, figuring out ways to avoid hypertension, to avoid diabetes, to avoid chronic lung disease. And in medicine, we don’t value that highly enough. And again, I like to think about these unanswerable questions. I wonder how much of that is just the human mind, that we want to see ourselves as problem solvers, not as problem preventers.

Zubin Damania:

I think you have been one of the clearest voices in pointing out our own internal conflicts around this and in medicine, and I think that’s one of the central ones. That’s very brilliantly put.

Robert Pearl:

And you did it in Las Vegas.

Jeremy Corr:

So we just celebrated the 4th of July here in the United States, and this year it felt very bittersweet. I’m a firm believer that America’s the greatest nation in the world, in spite of some of the dark things in our past, such as slavery and the horrible treatment of indigenous people. That being said, America in my opinion was a great experiment in democracy, and largely it worked. It has worked for some people more than others though. You guys talked about luck earlier. And some people have obviously lucked into good situations or being born with wealthy parents or wealthier, more educated communities, et cetera. And I’ve seen many people on social media in the last couple of weeks, boycotting July 4th or having F the 4th of July parties, while others celebrate it like we’re some sort of flawless nation.

Jeremy Corr:

We even had a mass shooting again over the weekend in Illinois. And I don’t think at the time of this recording, his motivations are known yet. But what I have seen on social media is a lot of people claiming he was a right wing nut job and an equal number of people claiming he was a left wing nut job. One thing that was very clear though is that he was very, very mentally ill. How can we as a nation heal this divide, focus on helping those that are less fortunate, in less lucky situations, people that are mentally ill? And how can we focus on community and togetherness and healing instead of all this material and tribal things? And before I ask you your thoughts, I kind of want to close it with this Thomas Jefferson quote. He said, “Yes, we did produce a near perfect Republic, but will they keep it, or will they in the employment of plenty lose the memory of freedom? Material abundance without character is the surest way to destruction.” What are your thoughts?

Zubin Damania:

Back to the unanswerable. No, I think this is actually something that we can wrap our heads around. We know there have been multiple reasons for division and all of that in this country, and some of it’s social media. Some of it’s cable news. Some of it is our sort of general natural evolution as humans to differentiate apart from each other before we integrate to the next phase of development. And one of the things you pointed out were these F the 4th of July parties and this kind of reaction to celebrating in a patriotic way, US democracy and independence. I think that’s a form of nihilistic reaction to problems and excesses that we see in our country. And rather, I think, than focusing on the nihilism, or even focusing on the people who are behaving in a nihilistic way, we ought to focus on, okay, yes and. So, yes, our country is wonderful and it has problems. So what’s the next thing? What’s more inclusive? Yes, there are people at all different stages of luck, wealth, development, personal development, spiritual development, economic development, and intellectual development. How do we nudge everybody at their stage of development to the healthiest version of that stage that we can without judging, without condescending, and without rejecting? That’s the kind of focus that we need as a society to bring us back together. And some of that means we’ve kind of lost a sense of collective meaning, a collective purpose. There’s a kind of meaning crisis as we’ve secularized and everything. And so how do we bring back a sense of meaning? And these are the questions we ought to be really trying to process through rather than getting, I think too much into the weeds of, what do we do with this kind of division and that kind of division and this situation and that situation. It’s a bigger picture move forward that we ought to be seeking out.

Robert Pearl:

My thought aligns very closely with Zubin about the fact that we try to have an or, and we need to have an and. I heard a program this morning on the radio comparing the shooters in the most recent tragic events and whether we want to label them having mental health problems. I can’t imagine taking a high velocity rifle with a lot of ammo and shooting into the crowd and killing a lot of people, particularly killing a lot of children as in any way consistent with mental health. The other point that they all shared was social isolation, and we have a problematic society where people are excluded. And if we ignore that and we don’t figure out ways to increase community, we’re going to have more people for whom this seems to be the only way that they can address the pain that they have because they don’t go to get the care that they should receive personally. But even then they need to be able to build the relationships around them. And it’s not unexpected that all these shooters are sort of 18 to 21. They’ve left high school. They’re not in college. They find themselves really socially isolated from people, from friends, from family, and this is their means of addressing what’s going on. And that to me, Jeremy is the bigger problem that exists right now. You’re a historian. If you look at Hamilton versus Jefferson, Hamilton was an individual who very much elevated the elite, and Jefferson was an individual who created and viewed broad community as being vital to a healthy country. And we’re moving in the opposite direction right now. I think the recent Supreme Court decisions are really problematic. I think basing it upon a world that existed back in 1783 or the whatever year exactly the constitution was put into place, when you had a world with a life expectancy of 35 years, when you had women being seen not just as property, but as the possessions of their husbands, when you had the existence of slavery, all the pieces that existed at the time, and to believe that we could use that as the foundation of modern society, I think the crises that are about to come up are going to be even more problematic than the present. And we need to come to grips with this as a nation, or we’re going to see even more ongoing deaths, tragedies, ruined families, ruined communities, ruined relationships. So I’m a very optimistic person, but right now, I think I have as many concerns as hopes for the future.

Jeremy Corr:

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