Latest / Health Ethics Podcast / First, Organize: Physicians, Public Health, and the Power of Collective Action

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First, Organize: Physicians, Public Health, and the Power of Collective Action · Health Ethics Podcast

• 0:09
  Speaker 1: Welcome to Health Ethics, a series of conversations with leading
• 0:13
  Speaker 1: experts about ethical considerations associated with health and healthcare, both
• 0:17
  Speaker 1: locally and globally. I am Brian Pilkington, Professor of Bioethics
• 0:21
  Speaker 1: in the Department of Medical Sciences at the Hackensack Meridan
• 0:24
  Speaker 1: School of Medicine. This series, like its predecessor, which focused
• 0:29
  Speaker 1: on the COVID nineteen pandemic, relies on the idea that
• 0:32
  Speaker 1: challenging ethical issues are best addressed by folks from diverse
• 0:36
  Speaker 1: backgrounds practically reasoning together, and complements the Health Ethics series
• 0:41
  Speaker 1: with its panel of leading experts from medicine, nursing, politics, economics, philosophy,
• 0:47
  Speaker 1: and the law. Thank you and enjoy the episode.
• 0:58
  Speaker 2: It is my great pleasure today to welcome John Schaeffer,
• 1:01
  Speaker 2: Assistant Professor of Sociology at the University of Vermont. Professor
• 1:06
  Speaker 2: Schaeffer specializes in global health disparities, non governmental organizations, and
• 1:10
  Speaker 2: translant national sociology. He is Assistant professor in the Department
• 1:15
  Speaker 2: of Sociology at the University of Vermont, where his academic
• 1:19
  Speaker 2: interests focus on the intersection of global health, human rights, science,
• 1:22
  Speaker 2: technology studies, and social movements. And so it should be
• 1:25
  Speaker 2: no surprise why we've invited him to chat today. His
• 1:30
  Speaker 2: dissertation work studies modeled demonstration processes both in the global
• 1:35
  Speaker 2: North and the global South. And in addition to his
• 1:38
  Speaker 2: academic work which spans global health, ethics and sociology. As
• 1:42
  Speaker 2: I've just mentioned, Professor Schaeffer founded and led Right to
• 1:47
  Speaker 2: Health Action PIH, Engage and Globe med. He is passionate
• 1:51
  Speaker 2: about building people powered campaigns and organizations that fight for
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  Speaker 2: the right to health. He's served as the hect LEVI
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  Speaker 2: fell at Johns, Hopkins and Oxford and well, I will
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  Speaker 2: not read the rest of the CV because it's quite
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  Speaker 2: impressive and quite long.
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  Speaker 3: John, thanks so much for being here with me today.
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  Speaker 4: Yeah, it's great to be here. Thanks so much for
• 2:12
  Speaker 4: the invitation.
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  Speaker 3: Of course, of course, and so, I mean, you've done
• 2:16
  Speaker 3: a ton of work that's been super interesting. The paper
• 2:19
  Speaker 3: that caught my recently was one that came out earlier
• 2:21
  Speaker 3: this year Were You and Gavin Yimmi pend a thoughtful
• 2:25
  Speaker 3: piece on physicians and public health. And I want to
• 2:29
  Speaker 3: get into a few of the sort of relationships connections
• 2:31
  Speaker 3: between medicine, public health and politics. But let's take one
• 2:35
  Speaker 3: step back to start, just to kind of frame things.
• 2:38
  Speaker 3: What got you interested in ethics and public health and
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  Speaker 3: these kinds of questions and maybe how did how had
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  Speaker 3: sociology been useful to you as a lens in this
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  Speaker 3: sort of work.
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  Speaker 4: Yeah, thanks so much Brian for this question and chance
• 2:54
  Speaker 4: to go back a little bit. You know, I went
• 2:57
  Speaker 4: to college, or I entered college, I went to Northwestern
• 3:00
  Speaker 4: started college back in two thousand and five, which feels
• 3:02
  Speaker 4: like a different, different universe, but you know, wanted to
• 3:08
  Speaker 4: study medicine, wanted to be a doctor, and decided to
• 3:12
  Speaker 4: the way to do that was to study biomedical engineering.
• 3:16
  Speaker 4: So I was I was really committed to kind of
• 3:19
  Speaker 4: a technocratic vision. Oh, if we just had the right diagnostics,
• 3:24
  Speaker 4: if we just had the right therapeutics, if we had
• 3:26
  Speaker 4: the right technology, boy, maybe some of these inequalities that
• 3:30
  Speaker 4: we observe around health and outcomes would be be be solved.
• 3:36
  Speaker 4: And obviously naive idea, but part of my attention to
• 3:41
  Speaker 4: kind of questions of health inequality came and part of
• 3:44
  Speaker 4: my interest in medicine more broadly came from my own
• 3:46
  Speaker 4: sort of health experience. So as a child, I had
• 3:49
  Speaker 4: a very like serious congenital kidney problem that required surgical intervention,
• 3:54
  Speaker 4: and it put me in the hospital for many months
• 3:57
  Speaker 4: in those first couple of years of my life which
• 3:59
  Speaker 4: I was they don't really have memories of, but my
• 4:02
  Speaker 4: parents would recount when I was growing up about how
• 4:05
  Speaker 4: difficult that was for them, taking on medical debt, you know,
• 4:09
  Speaker 4: dropping out of a grad program for my dad, and
• 4:13
  Speaker 4: and spending a lot of time in hospitals. And I
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  Speaker 4: think that those stories and the way that our community
• 4:21
  Speaker 4: supported my parents and the ways that they would recount
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  Speaker 4: those things made me curious about, well, who gets care,
• 4:28
  Speaker 4: who doesn't get care, And the fact that I've been
• 4:30
  Speaker 4: able to get the care that I needed and live
• 4:34
  Speaker 4: a mostly healthy life since that time, you know, sort
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  Speaker 4: of impressed upon me like these are questions that are
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  Speaker 4: meant to be wrestled with and thought through. And so,
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  Speaker 4: you know, I was in college, like doing this biomedical
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  Speaker 4: engineering thing, and also had a chance to go travel
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  Speaker 4: abroad and spend some time in West Africa. I did
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  Speaker 4: some work with a small community health organization working outside
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  Speaker 4: of ACRA in Ghana, and came back to Northwestern and
• 5:02
  Speaker 4: got connected with a group of students who were really
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  Speaker 4: serious about global health and thinking about global health and
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  Speaker 4: wrestling with you know, what role should undergraduate students who
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  Speaker 4: are not experts, who are not clinicians, but who are
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  Speaker 4: in positions of real privilege and in institutions that have
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  Speaker 4: power and resources. What role could we play? And that
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  Speaker 4: was sort of a mind blowing thought. I was like, oh,
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  Speaker 4: you know, this isn't just about studying. Maybe we have
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  Speaker 4: some other kinds of obligations beyond just self serving sort
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  Speaker 4: of self improvement or whatever. And we developed a student
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  Speaker 4: organization we organized on campus. We built a student organization
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  Speaker 4: called Globe Meed, which you know, was a good idea,
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  Speaker 4: was about students building long term partnerships with small, community
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  Speaker 4: based health organizations in ways that could move resources but
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  Speaker 4: also could be a powerful setting for learning about what
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  Speaker 4: these and equalities are, what types of transnational things produced them.
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  Speaker 4: And that was mind blowing. It was mind blowing to
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  Speaker 4: learn about those things and to be involved in that,
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  Speaker 4: but was also really mind blowing to see that groups
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  Speaker 4: of individuals could organize in some kind of collective way
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  Speaker 4: and could create new kinds of program especially for a
• 6:21
  Speaker 4: twenty year old to think through what we could do
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  Speaker 4: together and to try to build the organization that could
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  Speaker 4: could drive that, and so that was a big part
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  Speaker 4: of my life during college. Yeah, it led me down
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  Speaker 4: this sort of path of community organizing. Partners in Health
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  Speaker 4: was a major sort of inspiring force for many of us.
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  Speaker 4: Paul Farmer, Joy and Mukherjee and others people who we
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  Speaker 4: saw as as and see as real luminaries and moral
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  Speaker 4: standard bearers and also great intellects that we could learn
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  Speaker 4: a lot from. So they sort of took us under
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  Speaker 4: their wing and supported us, and I had a chance
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  Speaker 4: to then go to Partners in Health and work to
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  Speaker 4: do community organizing there, to develop a program called pih Engage,
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  Speaker 4: which has built a network of activists across the country,
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  Speaker 4: mostly young people, to you know, fight for politically and
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  Speaker 4: through policy advocacy work, you know, the health justice vision
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  Speaker 4: that Partners in Health has been been fighting for for
• 7:23
  Speaker 4: a long time. So anyway, all this is to say,
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  Speaker 4: I never ended up going to medical school. I never
• 7:28
  Speaker 4: ended up you know, you know, working in any way clinically,
• 7:33
  Speaker 4: but have been really interested in how we look at
• 7:40
  Speaker 4: the kinds of material and social structures that drive unequal
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  Speaker 4: outcomes in health and trying to think about how we
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  Speaker 4: you know, effectively not just performatively but effectively fight these
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  Speaker 4: kinds of political fights, which you know, you know, I
• 7:58
  Speaker 4: have to say we're losing, you know, which is frustrating,
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  Speaker 4: and so I don't want to seem like this is
• 8:05
  Speaker 4: you know, that have been successful, but it I think
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  Speaker 4: it's been a really interesting journey and I feel like
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  Speaker 4: I've learned a lot.
• 8:12
  Speaker 3: The background's really really helpful. I mean, folks who listen
• 8:14
  Speaker 3: to the podcast, we have folks from all over the
• 8:17
  Speaker 3: globe and all walks of life, but we do have
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  Speaker 3: a chunk of students really interested in medicine, and so
• 8:22
  Speaker 3: that I think will be especially helpful for our medical
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  Speaker 3: students who now are in an interesting time in thinking
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  Speaker 3: about the future of medicine and what it is that
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  Speaker 3: they're doing.
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  Speaker 2: Right.
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  Speaker 3: There's a ton of clinical stuff. They know that, but
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  Speaker 3: more and more conversations that I've had these are the
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  Speaker 3: anecdotal with students. They're thinking about advocacy, and they're thinking
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  Speaker 3: about given work on the determinants of health, social, political
• 8:46
  Speaker 3: and all that. If they're aim as to care for
• 8:49
  Speaker 3: their patient, what does that mean? And there's a diverse
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  Speaker 3: There are new routes that weren't thought of as much
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  Speaker 3: in medical education five ten, twenty fifty years ago, and
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  Speaker 3: the kind of organized and we've talked about it. I mean,
• 9:01
  Speaker 3: that's really helpful. And so we'll jump into the article
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  Speaker 3: and then we just going to sort of pull back
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  Speaker 3: different pieces of your experience that and form some of
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  Speaker 3: that sort of organizing and sociological perspective. You note, the
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  Speaker 3: one thing medicals that always say right is they know, first,
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  Speaker 3: do no harm. Everybody's got it right, And you pick
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  Speaker 3: up on those really really well, and so you ask,
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  Speaker 3: or so you highlight the importance of not harming, which
• 9:25
  Speaker 3: leads me to ask, what do you think the obligations
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  Speaker 3: of members of the medical profession are regarding support for
• 9:32
  Speaker 3: controversial maybe I don't know the right categories here, or
• 9:36
  Speaker 3: just simply incorrect, especially if it's potentially harmful scientific medical
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  Speaker 3: and public health claims and big question, right, and those
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  Speaker 3: maybe three different categories if you want to parse out science, medicine,
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  Speaker 3: and public health. But what I'm really thinking about is
• 9:51
  Speaker 3: when you bump into someone who may not have the
• 9:54
  Speaker 3: time or space that either you or I have to
• 9:56
  Speaker 3: engage certain pieces of information or news more critic and
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  Speaker 3: you just find out that HHS put out X or
• 10:05
  Speaker 3: leading a fairly well known physician has made the following claims,
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  Speaker 3: even if it's only a handful. You know, So, what
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  Speaker 3: do you think the obligations of medical medical professionals are
• 10:17
  Speaker 3: in light of misinformation, disinformation and just sort of bad science.
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  Speaker 4: Yeah, yeah, it's a it's a really great question, you know.
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  Speaker 4: And there are two parts there. I mean, one I
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  Speaker 4: think is kind of like this is sort of the
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  Speaker 4: sociologist in me, which is like, there's an empirical question,
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  Speaker 4: like what are those boundaries and how are those boundaries enforced?
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  Speaker 4: How does the profession demarcate them?
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  Speaker 3: What are the.
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  Speaker 4: Forces structures, you know, interests and strategies that inform the
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  Speaker 4: kinds of boundary making practices that professions engage in. And
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  Speaker 4: then there's like a normative question, which is the one
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  Speaker 4: that you just asked, what should they should they be?
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  Speaker 4: So I'll start there because I think that a good way,
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  Speaker 4: you know, And this is, you know, again, one of
• 11:07
  Speaker 4: the roles that ethicists, specifically bioethicists play is making strong
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  Speaker 4: normative arguments about how things ought ought to work and
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  Speaker 4: working those things out. One of the things I've been
• 11:21
  Speaker 4: playing with I was briefly for about a year a
• 11:24
  Speaker 4: postdoctoral fellow at the Berman Center Burman Institute at Johns
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  Speaker 4: Hopkins University, which is a bioethics research center, and that
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  Speaker 4: was really interesting as a freshly minted PhD in sociology
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  Speaker 4: to be plopped into, you know, a really bustling medical
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  Speaker 4: center and a group of philosophers and clinicians and social
• 11:45
  Speaker 4: scientists all kind of bumping up against each other with
• 11:48
  Speaker 4: their own frameworks, their own ideas about the world, and
• 11:51
  Speaker 4: their own really their own ways of asking normative questions
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  Speaker 4: about these institutions that they were both employed by andmbedded in.
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  Speaker 4: And one of the things that struck me as surprising.
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  Speaker 4: I don't know if it should have been surprising, but
• 12:07
  Speaker 4: it was was. And again this is me coming from
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  Speaker 4: a PhD in sociology. Karl Marx was nowhere to be found,
• 12:17
  Speaker 4: which is interesting or very very like. It wasn't in
• 12:21
  Speaker 4: my field division, or at least it wasn't in the
• 12:22
  Speaker 4: conversations that I was taking part in. And you know, again,
• 12:26
  Speaker 4: I don't have some big empirical study to sort of
• 12:28
  Speaker 4: back this up, but I do think if you look
• 12:31
  Speaker 4: through sort of mainline bioethical research, there is a sort
• 12:36
  Speaker 4: of tendency towards a kind of liberal ideal theory that
• 12:42
  Speaker 4: grounds you know, much of mainline standard if not bioethical
• 12:49
  Speaker 4: scholarship and research, at least the practice of it as
• 12:52
  Speaker 4: it works through clinical bioethical committees or other kind of
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  Speaker 4: structures that are sort of the practice of bioethics in
• 13:02
  Speaker 4: the context of medical centers. And so I was like curious, like, well,
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  Speaker 4: what would so if instead of starting with Emmanuel cont
• 13:09
  Speaker 4: or something, you started with Karl Marx? Like where would
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  Speaker 4: that take you ethically in an analysis of of you know,
• 13:19
  Speaker 4: of these kinds of questions about normative boundaries for what
• 13:24
  Speaker 4: professions should be about. And you know, I think that,
• 13:30
  Speaker 4: but starting with with Marx allows you to to think
• 13:34
  Speaker 4: about ethics in a slightly different way. It allows us
• 13:38
  Speaker 4: to kind of go from kind of moving from kind
• 13:41
  Speaker 4: of is to ought and allows us to think about,
• 13:45
  Speaker 4: you know, a kind of materialist social bioethical approach. So
• 13:50
  Speaker 4: so we could you know, so we could think about
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  Speaker 4: sort of moving from the standard kind of principlist script
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  Speaker 4: right the ideal the kind of approach that rooted in idealism,
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  Speaker 4: and move from you know, a focus on autonomy, which
• 14:07
  Speaker 4: is sort of an individual level characteristic, a focus on beneficence,
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  Speaker 4: a focus on non moleficence and justice. And imagine moving
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  Speaker 4: from those kinds of abstracted idealistic principles to aspire to
• 14:25
  Speaker 4: and get far more you know, kind of empirically concrete
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  Speaker 4: to by focusing you know, ethics attention on concrete violations
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  Speaker 4: that require redress or social reform. So we could imagine
• 14:40
  Speaker 4: sort of this idealism moving into a kind of materialism, right,
• 14:44
  Speaker 4: sort of starting with a question of material resources, labor control,
• 14:49
  Speaker 4: et cetera. Moving from sort of a kind of autonomy
• 14:54
  Speaker 4: to a kind of heteronomy. So thinking about the ways
• 14:59
  Speaker 4: in which which people are controlled and actually have autonomy violated,
• 15:06
  Speaker 4: and thinking about the material and labor structures that create
• 15:10
  Speaker 4: that dependence or dependency. Think about moving from kind of
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  Speaker 4: again an abstract and a good one value of beneficence
• 15:19
  Speaker 4: and and and you know the importance of having interventions
• 15:24
  Speaker 4: be effective to thinking about ways in which our systems
• 15:28
  Speaker 4: are often exploitative, and thinking about the way exploitation, particularly
• 15:33
  Speaker 4: labor exploitation, are are often central to our institutions, and
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  Speaker 4: thinking about sort of non moleficence to real experiences of maleficence.
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  Speaker 4: You know, actual direct harm that our systems make and
• 15:48
  Speaker 4: finally moving from kind of a kind of descriptive justice
• 15:50
  Speaker 4: to a kind of implicated justice, meaning that we're actually
• 15:54
  Speaker 4: working to fight for these things. So, you know, going
• 15:57
  Speaker 4: back to your kind of original question about out professional
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  Speaker 4: norms and you know, how physicians, particularly medical doctors, and
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  Speaker 4: the profession of medicine should draw these boundaries about what
• 16:14
  Speaker 4: is harmful or not. It requires us to think about,
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  Speaker 4: I think, the way that professions exist within a political economy.
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  Speaker 4: Professions exist within a set of competing structural constraints. And
• 16:31
  Speaker 4: in our you know, hyper capitalist biomedical world, the profession
• 16:36
  Speaker 4: of medicine is no longer fully autonomous. They no longer
• 16:40
  Speaker 4: have the ability to have a monopoly on the control over,
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  Speaker 4: you know, the means of scientific production in ways that
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  Speaker 4: in previous generations they had had. They no longer control
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  Speaker 4: the means of their own compensation right through payment structure
• 17:00
  Speaker 4: and fee structures. They are dependent on, you know, often
• 17:03
  Speaker 4: private equity owned hospital systems or clinical systems and insurance reimbursement,
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  Speaker 4: and no longer control exclusively the regulatory systems that shape
• 17:16
  Speaker 4: or give them the kinds of authority that they had
• 17:20
  Speaker 4: had previously. Now now, I'm not trying to idealize necessarily the
• 17:25
  Speaker 4: profession of medicine. In the fifties or sixties. There were
• 17:28
  Speaker 4: a different set of norms and values and obviously inequalities
• 17:33
  Speaker 4: produced by them that were problematic. But what I'm saying
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  Speaker 4: is that the kinds of normative boundaries about even what's
• 17:42
  Speaker 4: harmful or what might be considered sort of controversial, those
• 17:46
  Speaker 4: things are subject to the political and economic field that
• 17:51
  Speaker 4: the profession is operating in, and I think without that
• 17:54
  Speaker 4: kind of socio material ethical analysis hard to really make
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  Speaker 4: clear sense of this. So, you know, going back to
• 18:04
  Speaker 4: the piece that I wrote that you know, Gavin and
• 18:07
  Speaker 4: I wrote the opinion piece, you know, I think what
• 18:11
  Speaker 4: we see right now is an attempt in a very
• 18:16
  Speaker 4: specific political economic conjuncture, in this moment in which we
• 18:20
  Speaker 4: have a Trump administration that is certainly attempting to drive
• 18:28
  Speaker 4: forward an authoritarian grab, and more than that, are empowering
• 18:35
  Speaker 4: through that kind of competitive authoritarianism, an opportunity for people
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  Speaker 4: associated with the administration the ability to essentially coerce and
• 18:47
  Speaker 4: erode some of the normative standards that had been previously
• 18:52
  Speaker 4: backstopped by the state. And so that shifts the kinds
• 18:57
  Speaker 4: of norms and standards that I think are likely to
• 19:02
  Speaker 4: given sort of no sort of popular intervention, or we'll
• 19:06
  Speaker 4: talk more about it, I think political or sort of
• 19:08
  Speaker 4: organized intervention. What will happen are you know, powerful actors
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  Speaker 4: backed by large capital will be able to sort of
• 19:17
  Speaker 4: capture some of the organs of sort of normative production,
• 19:21
  Speaker 4: policy making, boundary making around professional standards that had exist.
• 19:27
  Speaker 4: And I think we see that in certainly the HHS
• 19:33
  Speaker 4: Secretary and the kinds of very harmful kinds of policies
• 19:37
  Speaker 4: that he is advancing, whether it be deeply anti vaccine policies,
• 19:43
  Speaker 4: cuts to you know, federal spending on you know, scientific research,
• 19:49
  Speaker 4: the recent Office of Management and Budget rule that will
• 19:54
  Speaker 4: put grant making, federal grant making in the hands of
• 19:56
  Speaker 4: political appointees and away from the kind of reviewed, standard,
• 20:01
  Speaker 4: normative science funding that had exist previously. You know, we
• 20:06
  Speaker 4: go down the list of particular policies, but all of
• 20:09
  Speaker 4: it seems to be a concentration of capital and sort
• 20:13
  Speaker 4: of along with it the kinds of normative standards that
• 20:17
  Speaker 4: come with it. And unless there is a popular and
• 20:22
  Speaker 4: politically effective mass response to that within the profession and
• 20:28
  Speaker 4: beyond it, they could be successful with that, and that
• 20:32
  Speaker 4: would be be really harmful. So the first do no harm.
• 20:36
  Speaker 4: So anyway, I think the obligations that members have of
• 20:40
  Speaker 4: the medical profession is to organize. I don't think we
• 20:42
  Speaker 4: can do it individually. You know, writing op eds is
• 20:45
  Speaker 4: really good, which you know we've done, but you know,
• 20:48
  Speaker 4: completely insufficient to meet the kind of political power at
• 20:53
  Speaker 4: the center of the kinds of transformation that Trump Trump
• 20:56
  Speaker 4: administration is seeking to impose. So anyway, this is a
• 20:59
  Speaker 4: little bit of a answered.
• 21:00
  Speaker 3: But no, no, that's super no. I mean this is
• 21:02
  Speaker 3: like a tour to force and lecture for sort of
• 21:05
  Speaker 3: think about task spaces and what it is bioethicists do
• 21:08
  Speaker 3: and the boundaries and then thinking about that for medicine.
• 21:11
  Speaker 3: And I gave you an utterly unwieldy question, so an
• 21:14
  Speaker 3: unwieldy response is good. And I should say we should
• 21:18
  Speaker 3: have like a third person here who's a pro principles
• 21:20
  Speaker 3: I mean, I'm not the best advocate for the standard
• 21:23
  Speaker 3: for principles gadda YadA, YadA, and the cards on the
• 21:27
  Speaker 3: table more of a virtue and a character guy. And
• 21:30
  Speaker 3: they give out physicians and professional formation all this, But
• 21:33
  Speaker 3: I like the move of starting with Marx and thinking
• 21:36
  Speaker 3: through how you do it that way, and that's really
• 21:38
  Speaker 3: really helped, and I appreciate you taking the time to
• 21:39
  Speaker 3: do it because that's helpful in getting to your answer,
• 21:42
  Speaker 3: which is organized, right, and we need that background for
• 21:45
  Speaker 3: what should physicians do because historically there seem to be
• 21:49
  Speaker 3: obstacles to physician organizing which maybe didn't exist for other folks.
• 21:54
  Speaker 3: Right when we think about unionization in the US and
• 21:56
  Speaker 3: a few other kinds of things, I think physicians are
• 21:59
  Speaker 3: less like like we don't walk out on an emergency room, right,
• 22:02
  Speaker 3: someone's going to be covering care, whether it's just because
• 22:06
  Speaker 3: of antalla or some sort of more deeply held view.
• 22:09
  Speaker 3: And so if organized is the right response and at
• 22:12
  Speaker 3: very well maybe, and you and other folks have sort
• 22:14
  Speaker 3: of sort of pushed for this. Helping physicians along this
• 22:18
  Speaker 3: path is I think will be usedula. So that makes
• 22:22
  Speaker 3: a lot of sense. Organizing is the way that physicians
• 22:25
  Speaker 3: are able to satisfy certain kinds of obligations that they
• 22:28
  Speaker 3: might have as professionals in favor of the public health
• 22:33
  Speaker 3: and the health of their patients. Because they're not they're
• 22:35
  Speaker 3: going to be challenges to combating what the sort of
• 22:39
  Speaker 3: just incorrect scientific information that gets pushed out elsewhere, especially
• 22:43
  Speaker 3: from the highest levels of government in the US. So
• 22:47
  Speaker 3: that's good, And you started to get to before I
• 22:49
  Speaker 3: jumped in, unpack the organization piece a bit, and you're
• 22:53
  Speaker 3: sort of the autobiographical claims early on are super helpful
• 22:56
  Speaker 3: for the kinds of organization that you've done. But are
• 22:59
  Speaker 3: you thinking that positions are required to be advocates just
• 23:02
  Speaker 3: to get to get I mean, so sorry, say more
• 23:05
  Speaker 3: about physician organization and maybe even how that organization can
• 23:09
  Speaker 3: be directed towards better health situations for patients.
• 23:13
  Speaker 4: Just I mean, these are heady things, and you know,
• 23:15
  Speaker 4: I have a perspective which is no, by no means
• 23:18
  Speaker 4: like sufficient. But I think that if these values matter
• 23:23
  Speaker 4: to the profession collectively and to individual clinicians, I don't
• 23:28
  Speaker 4: know that there's much of a choice than to find
• 23:31
  Speaker 4: ways of collectively organizing and imposing some people power, some costs,
• 23:39
  Speaker 4: political costs on the political actors making decisions that are
• 23:43
  Speaker 4: contrary to the professional norms and values that that individuals
• 23:48
  Speaker 4: and groups hold. So and we're seeing this, right, we
• 23:51
  Speaker 4: see we see the professional, the clinic, different professional clinical
• 23:56
  Speaker 4: societies sort of making statements. We see, you know, in
• 24:01
  Speaker 4: different ways, clinicians participating in social movements. We see you know,
• 24:06
  Speaker 4: increased rates of resident physicians unionizing and how staff unionizing.
• 24:12
  Speaker 4: So these things are starting to happen. But you mentioned
• 24:15
  Speaker 4: at the beginning of this question the significant professional barriers
• 24:23
  Speaker 4: that exist amongst clinical workers, particularly doctors less so nurses.
• 24:29
  Speaker 4: Nurses know how to organize that often are are big hurdles,
• 24:34
  Speaker 4: and so that's an interesting question and I've been doing
• 24:36
  Speaker 4: some work on that. We have a I have a
• 24:38
  Speaker 4: paper in Social Science and Medicine with colleagues at Cambridge
• 24:42
  Speaker 4: Health Alliance called Training Clinicians to be Organizers, and it's
• 24:48
  Speaker 4: based on the first year of a fellowship program called
• 24:53
  Speaker 4: the Climate Health Organizing Fellowship Program, and it's a it's
• 25:00
  Speaker 4: been going for four years. We just finished the fourth
• 25:03
  Speaker 4: cohort and each cohort had interdisciplinary teams of health workers
• 25:08
  Speaker 4: who apply as a team, and we had thirteen about
• 25:12
  Speaker 4: thirteen teams per cohort over those four years. And each
• 25:17
  Speaker 4: team basically has an idea for a climate health related
• 25:23
  Speaker 4: social change campaign project that they want to see done
• 25:26
  Speaker 4: in their local institution, in their local neighborhood, etc. And
• 25:29
  Speaker 4: then they go through a year long of training on
• 25:33
  Speaker 4: community organizing. They're paired with a coach who works with
• 25:36
  Speaker 4: them every month to help coach them on the kinds
• 25:41
  Speaker 4: of barriers that you were alluding to and helps them
• 25:44
  Speaker 4: design and then enact an actual campaign that they do
• 25:49
  Speaker 4: in parallel with one another over the course of the
• 25:51
  Speaker 4: entire year. And what's been interesting, I mean one is
• 25:57
  Speaker 4: very interesting to see these clinicians wrestle with these tensions
• 26:00
  Speaker 4: and challenges in their own professional identities, their own professional workplaces,
• 26:06
  Speaker 4: the fears, the anxieties, the emotional barriers that prevent them
• 26:11
  Speaker 4: from active and also overcoming them and learning growing the
• 26:14
  Speaker 4: muscles to overcome those things, both for themselves and for
• 26:17
  Speaker 4: their colleagues, and actually often having success, you know, getting
• 26:22
  Speaker 4: their hospital to commit to major decarbonization goals, or getting
• 26:27
  Speaker 4: their hospital to reduce fairly straightforward amounts of unnecessary wasted
• 26:34
  Speaker 4: medical products, or pushing state or town city councils to
• 26:42
  Speaker 4: invest in you know, electric buses for their municipal buses,
• 26:46
  Speaker 4: things like that. These are things that these teams have
• 26:49
  Speaker 4: actually won through their campaigns. So I was in this
• 26:52
  Speaker 4: team as a sociologist trying to understand well, how you know,
• 26:56
  Speaker 4: so as an ethnographer witnessing and watching these clinicians kind
• 27:00
  Speaker 4: of go through this process and struggle with it, learn it,
• 27:05
  Speaker 4: try it on, or not sometimes refuse because it got hard,
• 27:09
  Speaker 4: or it got stressful, or they got overwhelmed with their
• 27:12
  Speaker 4: professional commitments, all the things that are certainly present, but
• 27:16
  Speaker 4: also trying to understand how do we think about this
• 27:20
  Speaker 4: kind of sociologically, what are the kinds of professional and
• 27:24
  Speaker 4: institutional barriers to this kind of relational, organizational and power
• 27:30
  Speaker 4: building work right, which you know, I think, you know,
• 27:33
  Speaker 4: just thinking about it off the top of our head
• 27:35
  Speaker 4: seems contrary to the practice of clinical biomedicine in certain ways,
• 27:39
  Speaker 4: and we talk in more detail in the paper about
• 27:41
  Speaker 4: kind of what those tensions or kind of places of
• 27:47
  Speaker 4: perpendicularity are. But what we come to is that part
• 27:52
  Speaker 4: of what this training did was it created an opportunity
• 27:57
  Speaker 4: for these clinicians to actually refer form their professional identity
• 28:01
  Speaker 4: in some important ways and allowed them to what we
• 28:04
  Speaker 4: call in source a new kind of expertise, which is
• 28:08
  Speaker 4: a kind of expertise around involving volunteers in shared work,
• 28:14
  Speaker 4: around social change. That this was something that that these
• 28:17
  Speaker 4: clinicians could learn. Uh, it wasn't uniform. You know, some
• 28:21
  Speaker 4: of the teams you know, you know, disbanded or just
• 28:24
  Speaker 4: ended after the fellowship, but many of these have actually built.
• 28:27
  Speaker 4: One in particular in Wisconsin. Healthy Climate Wisconsin has launched
• 28:31
  Speaker 4: a statewide climate health movement and they're they're racking up victories.
• 28:36
  Speaker 4: I've been out to Wisconsin every year for the last
• 28:39
  Speaker 4: three years to go to their national or their statewide
• 28:43
  Speaker 4: training conference, and so they're they're doing incredible work to
• 28:47
  Speaker 4: actually fight for and win statewide you know, climate health legislation.
• 28:53
  Speaker 4: So anyway, it's it's been a really interesting interesting thing
• 28:58
  Speaker 4: to engage in and and but I want to think
• 29:01
  Speaker 4: more about, very pragmatically, what do clinicians need to do
• 29:07
  Speaker 4: and and and you know, and and what kinds of
• 29:10
  Speaker 4: campaigns would be effective. I think sometimes it's like, oh, well,
• 29:14
  Speaker 4: clinicians aren't going to walk off the job site. But
• 29:17
  Speaker 4: that's that's one kind of tactic, you know, the idea
• 29:19
  Speaker 4: of a strike kind of tactic. We have a much
• 29:22
  Speaker 4: wider repertoire right of things that clinicians could do. Clinicians
• 29:27
  Speaker 4: have are a powerful constituency, they have, they're well resourced,
• 29:31
  Speaker 4: they have all sorts of you know, cultural authority and
• 29:37
  Speaker 4: uh and scientific authority and moral authority. And I think
• 29:43
  Speaker 4: thinking about the kinds of campaigns and organizational structures that
• 29:48
  Speaker 4: could facilitate the clinicians flexing that in the interests of
• 29:54
  Speaker 4: patients is a really interesting thing. Now, clinicians are also
• 29:58
  Speaker 4: you know, you know again go back to our you know,
• 30:01
  Speaker 4: me being a fan of Marx. You know, they're a
• 30:03
  Speaker 4: bourgeois class. You know, at the end of the day, right,
• 30:06
  Speaker 4: I mean, although proletarianized in many ways, right in that
• 30:09
  Speaker 4: they are now wage laborers in many cases and not
• 30:12
  Speaker 4: so much like the owners of small businesses or something
• 30:15
  Speaker 4: of the sort. There are ways, and there's all sorts
• 30:17
  Speaker 4: of evidence about this, about the AMA being the most
• 30:21
  Speaker 4: potent force against universal health coverage in this country or
• 30:25
  Speaker 4: you know, some kind of single payer program. So, you know,
• 30:28
  Speaker 4: clinicians have had tendencies to kinds of reactionary and somewhat
• 30:35
  Speaker 4: sort of self interested political mobilization in the past, but
• 30:39
  Speaker 4: in this moment there's actually, I think an opportunity in
• 30:42
  Speaker 4: which they have a class interest also in making common
• 30:47
  Speaker 4: cause with the rest of us who feel embattled by
• 30:52
  Speaker 4: the kinds of extreme class politics of the Trump administration.
• 30:56
  Speaker 4: So anyway, it's a really it's an interesting question. I
• 30:59
  Speaker 4: want to think think more about what are the pragmatic
• 31:03
  Speaker 4: ways that clinicians can learn how to take this stuff on,
• 31:06
  Speaker 4: because I do think it's really crucial.
• 31:09
  Speaker 3: Yeah, no, that's that's really really helpful. And to point
• 31:14
  Speaker 3: to the array of you know, pragmatic possibilities is good, right,
• 31:18
  Speaker 3: because the strike point is just an easy one and
• 31:20
  Speaker 3: it highlights at tension. I think that might exist between
• 31:23
  Speaker 3: how at least some of us think of physicians or
• 31:26
  Speaker 3: clinic healthcare, you know, folks of all stripes, and that
• 31:30
  Speaker 3: there's something altruism is not the best word. That's sort
• 31:32
  Speaker 3: of the concept that gets around, but like the work
• 31:35
  Speaker 3: is sort of inherently for others. You're caring for others.
• 31:39
  Speaker 3: And here's a nice contrast, Well you're not going to leave,
• 31:41
  Speaker 3: but then how do you know? Organisms? And in this case,
• 31:44
  Speaker 3: it's less about the finish physicians organizing for themselves, right,
• 31:49
  Speaker 3: it's organizing ways that would benefit patients, which would be
• 31:52
  Speaker 3: in line and the benefit the community and yees. So
• 31:54
  Speaker 3: that's how And the point about moral authority, I think
• 31:56
  Speaker 3: the last and sort of what being well resourced and
• 31:59
  Speaker 3: all this. I think the last study I saw physicians
• 32:03
  Speaker 3: and healthcare folks are still well trusted persons, right, who's
• 32:07
  Speaker 3: the most fused and so maybe there's something there. But
• 32:11
  Speaker 3: then you point to the AMA, right, and sort of
• 32:13
  Speaker 3: this one history of the medical profession that is in
• 32:16
  Speaker 3: the back of my mind when I ask questions. But
• 32:19
  Speaker 3: there are a variety of ways you can tell the history,
• 32:22
  Speaker 3: and it's not and maybe not right. Maybe this is
• 32:24
  Speaker 3: sort of like one of the most interesting you said
• 32:27
  Speaker 3: a ton of great stuff, but one of the most
• 32:28
  Speaker 3: interesting things to think about is sort of a pushback
• 32:31
  Speaker 3: on private practice. And eventually, now we've got a bunch
• 32:34
  Speaker 3: of or the many physicians are employed physicians, are there
• 32:39
  Speaker 3: now opportunities for collective responses that are seen because it's
• 32:43
  Speaker 3: no longer well I'm also a small business person hopping
• 32:46
  Speaker 3: on reading star again, right, opting for an autobile meal
• 32:51
  Speaker 3: over the horse because I can make two extra like
• 32:53
  Speaker 3: this is yeah, no, that's a that's a really really
• 32:55
  Speaker 3: nice point.
• 32:56
  Speaker 4: Yeah, I mean, just maybe to to share one other thought.
• 32:59
  Speaker 4: I mean, and you know, in certain ways, like organizers,
• 33:05
  Speaker 4: at least the organizers I've worked with, and I should say,
• 33:08
  Speaker 4: maybe my orientation to community organizing comes from a specific
• 33:12
  Speaker 4: kind of tradition. There are many, but it comes through
• 33:16
  Speaker 4: the work of Marshall Gands, who is a community organizer,
• 33:19
  Speaker 4: worked with a farm workers movement in the sixties and
• 33:21
  Speaker 4: civil rights movement before that, and he teaches at the
• 33:27
  Speaker 4: Harvard Kennedy School. Now. But you know, thinking about constituencies
• 33:32
  Speaker 4: as not fixed, you know, professions not fixed either, right,
• 33:36
  Speaker 4: and organizing in many ways is about the art of
• 33:40
  Speaker 4: constructing constituencies that can stand together in ways that change
• 33:46
  Speaker 4: balances of power or calculuses, or can impose new costs
• 33:52
  Speaker 4: on powerful actors in ways that didn't previously exist, you know,
• 33:57
  Speaker 4: And you reference Starr, you know, he tells his powerful
• 34:01
  Speaker 4: story right of the transformation of American medicine and the
• 34:04
  Speaker 4: production that really uniquely American production of this wildly autonomous
• 34:13
  Speaker 4: field and profession of the MD because there was a
• 34:18
  Speaker 4: monopoly of control of the scientific work and the all
• 34:24
  Speaker 4: of the boundaries of what was considered normative and acceptable
• 34:28
  Speaker 4: and scientifically accurate, a control of the feast structure and
• 34:35
  Speaker 4: the compensation right the material base of the profession, and
• 34:39
  Speaker 4: had great a great deal of control over the legislative
• 34:45
  Speaker 4: and had a huge amount of control and power over
• 34:49
  Speaker 4: the way that they were regulated through credentially, you know,
• 34:53
  Speaker 4: and the construction of the MD as this very kind
• 34:56
  Speaker 4: of sacred credential that allowed people with MD to do
• 35:00
  Speaker 4: things to other human beings that you know, the rest
• 35:03
  Speaker 4: of us mere mortals, cannot do, And so this gave
• 35:06
  Speaker 4: a tremendous amount of power. Those have all been chiseled away,
• 35:11
  Speaker 4: you know, since the seventies and eighties, you know, have
• 35:15
  Speaker 4: been chiseled away and have left the profession of medicine
• 35:18
  Speaker 4: far less powerful structurally as a profession. But they still hold,
• 35:23
  Speaker 4: as you mentioned, the kinds of cultural authority that you raised.
• 35:27
  Speaker 4: But this creates an opportunity, right, so organizers think about
• 35:30
  Speaker 4: when thinking about how what kinds of constituencies could be organized,
• 35:34
  Speaker 4: we think about three things interests, values, and resources. And
• 35:42
  Speaker 4: I think that there are new opportunities to articulate and
• 35:46
  Speaker 4: narrate far more shared interest and far more shared values
• 35:52
  Speaker 4: between the profession of medicine and the rest of us,
• 35:56
  Speaker 4: or at least patient communities who have been excluded, you know,
• 36:00
  Speaker 4: from access to medicine or you know, excluded from being
• 36:03
  Speaker 4: able to be insured or feel harmed by the train
• 36:07
  Speaker 4: there's there's an opportunity, I think in ways that the interest,
• 36:10
  Speaker 4: values and resources of the sort of professional movement of
• 36:16
  Speaker 4: medicine that Paul Star traces, they've been rearranged, and so
• 36:22
  Speaker 4: that gives I think an opportunity one for democratic actors,
• 36:26
  Speaker 4: populist actors, the rest of us a chance to work
• 36:30
  Speaker 4: in common cause with physicians in a way that maybe
• 36:33
  Speaker 4: previously wasn't quite the case, and also a chance to
• 36:39
  Speaker 4: build the kind of social movement that could perhaps unlock,
• 36:45
  Speaker 4: you know, things that United States is so far behind
• 36:48
  Speaker 4: on in terms of universal health care coverage. You know,
• 36:52
  Speaker 4: I do think that, you know, again, maybe I'm wrong
• 36:56
  Speaker 4: about this and we'll descend into fascism. I hope not,
• 36:59
  Speaker 4: But you know, I think that I do think that
• 37:02
  Speaker 4: the Trump administration is overplaying its hand in almost every direction,
• 37:06
  Speaker 4: and that it's opening new kinds of political possibilities and
• 37:11
  Speaker 4: coalitions and constituencies to stand together in ways that previously
• 37:15
  Speaker 4: we had been sort of segmented into our own self
• 37:18
  Speaker 4: much more delineated self interested camps, including physicians. So that's
• 37:23
  Speaker 4: kind of where there's hope, and I think, but we
• 37:26
  Speaker 4: need organizing structures. There's maybe one other sort of sociological
• 37:31
  Speaker 4: kind of theory. Thing that might be useful to listeners
• 37:33
  Speaker 4: is the work of Doug mccatam. Doug McCadam was or
• 37:37
  Speaker 4: is a social movement scholar of sociologists of social movements
• 37:42
  Speaker 4: and wrote a great book about the civil rights movement
• 37:45
  Speaker 4: called The Development of Black Insurgency from nineteen thirty to
• 37:49
  Speaker 4: nineteen seventy and it's a book about the civil rights
• 37:53
  Speaker 4: movement as a social movement. And he develops this idea
• 37:56
  Speaker 4: of the political process model of social movement emergence. And
• 38:03
  Speaker 4: you know, one of the things that's essential are is
• 38:06
  Speaker 4: some kind of institutional organizational structure expanding kinds of socioeconomic opportunities.
• 38:13
  Speaker 4: But really crucial he uses this term called cognitive liberation,
• 38:17
  Speaker 4: this idea that we could imagine actually and narrate a
• 38:21
  Speaker 4: different alternative than the one that we're embedded in. And
• 38:23
  Speaker 4: I think a combination of being able to articulate how
• 38:29
  Speaker 4: we could work together and having the sort of relational
• 38:33
  Speaker 4: organizational structures, the real teams, the real organizations, the place
• 38:37
  Speaker 4: to go to if you want to organize. Both those
• 38:40
  Speaker 4: things are really necessary if we're going to kind of
• 38:42
  Speaker 4: seize this kind of window put potential window of opportunity
• 38:46
  Speaker 4: that that maybe some of the overreach of the Trump
• 38:49
  Speaker 4: administration presents.
• 38:50
  Speaker 3: That's great. It's a really helpful analysis in thinking that
• 38:53
  Speaker 3: there are certain drivers that you know, levers and push
• 38:56
  Speaker 3: in certain ways that might get the right folks together.
• 39:00
  Speaker 3: And I was talking to somebody about Trusted Medicine earlier
• 39:03
  Speaker 3: and reflecting on given our sort of shared bioethics interests,
• 39:07
  Speaker 3: that old book by Paul Ramsey Patients Person and somewhere
• 39:10
  Speaker 3: right in nineteen seventy Research Ethics, he kind of stuff
• 39:13
  Speaker 3: Birth of Bioethics, sorts of things, and somewhere Ramy's talking
• 39:16
  Speaker 3: about physician researchers and participants and says that when that relationship,
• 39:21
  Speaker 3: when things go well and you have the relationship in place,
• 39:24
  Speaker 3: both parties can say, truthfully, I cure. And I thought
• 39:29
  Speaker 3: that just really interesting. I mean, the the rest is
• 39:31
  Speaker 3: a clinician, but to have the kind of trusting relationship
• 39:36
  Speaker 3: where you're engaged in the same endeavor and then of
• 39:38
  Speaker 3: course for the good of the patient, because the physicians
• 39:40
  Speaker 3: not being not being cured. But you know, political social
• 39:44
  Speaker 3: structures hands overplayed. How whatever it is the case, what
• 39:49
  Speaker 3: physicians ain't at least with the medical students. I spend
• 39:51
  Speaker 3: most of my days with aim for is making other
• 39:54
  Speaker 3: people well and helping them out, and what patients want
• 39:57
  Speaker 3: us to be made right. So, and we have various
• 39:59
  Speaker 3: conceptions of hell and values, but maybe this is a
• 40:02
  Speaker 3: time and a space where folks can come together and
• 40:04
  Speaker 3: then the right kinds of organizing features. Maybe instead of
• 40:09
  Speaker 3: like certain kinds of paths down advocacy and medicine, it
• 40:13
  Speaker 3: should really be more focused on organized. So this is
• 40:16
  Speaker 3: super helpful. I mean, this conversation is both sociologically interesting.
• 40:20
  Speaker 3: I'm a philosopher. I don't know much sociology, but it's
• 40:23
  Speaker 3: terrifically interesting to think about not just individuals and what
• 40:27
  Speaker 3: they should or should not be doing, but to think
• 40:29
  Speaker 3: about groups. And for folks who have listened to the podcast,
• 40:33
  Speaker 3: of course, we'll remember Fred Hafferty. I think read Me
• 40:36
  Speaker 3: the Riot act around these kinds of thinkings in an
• 40:38
  Speaker 3: old episode. So this is a nod to the previous show.
• 40:42
  Speaker 3: Go back and listen to it. But John, this is
• 40:44
  Speaker 3: really really helpful. I see we're running out of time,
• 40:47
  Speaker 3: but I want to one more question. How would you?
• 40:52
  Speaker 3: And I'm thinking and maybe the answer is or maybe
• 40:54
  Speaker 3: the subset is wider, But I'm thinking mainly about the
• 40:57
  Speaker 3: medical students that I spend my Is we any advice
• 41:02
  Speaker 3: along these organizing lines for advocating not just for their patients,
• 41:07
  Speaker 3: but for populations more broadly, or and sort of how
• 41:10
  Speaker 3: whatever that means, if it's engaging in political spheres in
• 41:14
  Speaker 3: a different kind of way, if it's building some of
• 41:16
  Speaker 3: these organizations. If a medical student hears this on two
• 41:19
  Speaker 3: time speed driving to class, what sort of a takeaway
• 41:24
  Speaker 3: positive message? Here's something concrete I could do that might
• 41:28
  Speaker 3: move my aim forward, because I need another avenue to make,
• 41:33
  Speaker 3: you know, to help folks get better.
• 41:35
  Speaker 4: Yeah, I think I think the biggest thing is to
• 41:38
  Speaker 4: build a little team and do it together. I think
• 41:43
  Speaker 4: that there is a tendency to, especially in the health sector,
• 41:49
  Speaker 4: to do individual advocacy. Right, I wrote my op ed,
• 41:54
  Speaker 4: or I sent my letter to Congress, or I tweeted
• 41:59
  Speaker 4: a snarky tweet or whatever the thing is, you know,
• 42:04
  Speaker 4: and that's good. There's nothing wrong with that, and I
• 42:06
  Speaker 4: think that is important. Right. We are individuals and we
• 42:10
  Speaker 4: each hold some responsibility. I just think it it is
• 42:14
  Speaker 4: sharply limiting. And I think, you know, part of what
• 42:18
  Speaker 4: we've learned in this organizing training of clinicians is that
• 42:23
  Speaker 4: there is like a civic muscle that atrophies in seeing
• 42:28
  Speaker 4: our professional roles solely as individual and that there is
• 42:35
  Speaker 4: so much expertise required in making a team functional, setting
• 42:42
  Speaker 4: a goal, holding the team together, holding accountability within the team,
• 42:48
  Speaker 4: developing a shared strategy, and then creating some roles and
• 42:51
  Speaker 4: some norms within the team, and then allowing that team
• 42:55
  Speaker 4: to grow and bring more people in. Now, I'm not
• 42:58
  Speaker 4: saying everyone needs to be an organizer. I don't think
• 43:01
  Speaker 4: that's reasonable, and I don't think that's the way it
• 43:04
  Speaker 4: should be, but I think that, you know, I mean,
• 43:08
  Speaker 4: this is also kind of old old stuff, But you know,
• 43:11
  Speaker 4: the bowling alone thing that we have a dearth of
• 43:16
  Speaker 4: spaces in which we learn the kind of interstitial relational
• 43:24
  Speaker 4: capacities to effectively work together, and we offload that onto
• 43:31
  Speaker 4: the kinds of routinized institutional interactions which are far more
• 43:35
  Speaker 4: transactional than we need. So, you know, it takes a
• 43:39
  Speaker 4: little bit of time, but it also can be super nourishing.
• 43:42
  Speaker 2: Right.
• 43:42
  Speaker 4: We hear all the time about moral injury, the extraordinary
• 43:46
  Speaker 4: burnout that capitalist biomedicine places on all of us. And
• 43:50
  Speaker 4: I think that getting with colleagues and friends around issues
• 43:54
  Speaker 4: that matter a great deal to us, like morally and
• 43:58
  Speaker 4: plotting modest but real ways that we could do work
• 44:02
  Speaker 4: on that together, not to solve it, but to work
• 44:04
  Speaker 4: on it together can be not just more work, but
• 44:07
  Speaker 4: really like nourishing. And so I would just say, like,
• 44:09
  Speaker 4: try to build like a little team of five to
• 44:11
  Speaker 4: seven of your of your friends and yeah, I mean
• 44:14
  Speaker 4: watch whatever you know World Cup or you know, some
• 44:18
  Speaker 4: bad reality TV to unwine, but also like take something
• 44:22
  Speaker 4: on that you could work on together. And I think
• 44:25
  Speaker 4: that that could be really meaningful and it might also
• 44:27
  Speaker 4: create the foundations for some of this organizing work that
• 44:30
  Speaker 4: we've been talking about.
• 44:32
  Speaker 3: That that's great and yeah, I mean it. So I
• 44:36
  Speaker 3: have my daughter, as all good people, is a big
• 44:39
  Speaker 3: Mets fan. Both of them are, I mean as far
• 44:41
  Speaker 3: as little kids can have real sensibilities, and so oh yeah,
• 44:45
  Speaker 3: I saw that. I saw. We won't go back through.
• 44:48
  Speaker 3: But we can never find the right title for these episodes.
• 44:51
  Speaker 3: And I hear she sings the like nineteen eighty six
• 44:53
  Speaker 3: promotional video from the Mets after they won, and it's
• 44:58
  Speaker 3: teamwork makes a dream work to go mets, I mean
• 45:01
  Speaker 3: constantly right, so like maybe that's the title this episode,
• 45:03
  Speaker 3: teamwork makes a Dream Work and yeah, I mean it's
• 45:05
  Speaker 3: or yeah, yeah that's John. Well, we run out of time.
• 45:09
  Speaker 3: Thank you so much. I really appreciate it. This has
• 45:11
  Speaker 3: been super helpful, and we'll put the article that we
• 45:15
  Speaker 3: started with and a bunch of other work in our
• 45:17
  Speaker 3: show notes page for folks who are listening. And yeah,
• 45:19
  Speaker 3: I just I really enjoyed the conversation, so thank you
• 45:22
  Speaker 3: for joining me.
• 45:23
  Speaker 4: Yeah, thank you very much, Brian. Great, great to be
• 45:25
  Speaker 4: with you, and hope to continue the conversation.
• 45:28
  Speaker 1: Series is a production of the Health Ethics Lab, and
• 45:31
  Speaker 1: I am grateful to colleagues in the Department of Medical Sciences,
• 45:34
  Speaker 1: the IHS Library, and the Hackensack I'm ready in the
• 45:36
  Speaker 1: School of Medicine for making this collaboration possible. To learn
• 45:40
  Speaker 1: more about our work or to engage with the series content,
• 45:43
  Speaker 1: reach out to me Brian Pilkington at Brian dot Pilkington
• 45:47
  Speaker 1: at HMHM dot org.