Latest / Health Ethics Podcast / Does science have a PR Problem? Information, Misinformation, and the Politics of Medicine

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Does science have a PR Problem? Information, Misinformation, and the Politics of Medicine · Health Ethics Podcast

0:08
Speaker 1: Welcome to Health Ethics, a series of conversations with leading
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Speaker 1: experts about ethical considerations associated with health and healthcare, both
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Speaker 1: locally and globally. I am Brian Pilkington, Professor of Bioethics
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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
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Speaker 1: on the COVID nineteen pandemic, relies on the idea that
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Speaker 1: challenging ethical issues are best addressed by folks from diverse
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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,
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Speaker 1: and the law. Thank you and enjoy the episode.
1:02
Speaker 2: In this episode, I speak with doctor Arthur Caplan about
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Speaker 2: bioethics and power and the politicization of health. Professor Kaplan
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Speaker 2: is the doctors William F. And Virginia Conley Midi Professor
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Speaker 2: and founding Head of the Division of Medical Ethics at
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Speaker 2: the NYU Grossman School of Medicines Department of Population Health
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Speaker 2: in New York City. Prior to taking on this post,
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Speaker 2: doctor Caplan was the Sydney D. Kaplan Professor of bioethics
1:27
Speaker 2: at the University of Pennsylvania Perilman School of Medicine in Philadelphia,
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Speaker 2: where he created the Center for Bioethics in the Department
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Speaker 2: of Medical Ethics. He has also taught at the University
1:37
Speaker 2: of Minnesota, at the University of Pittsburgh, and Columbia University,
1:41
Speaker 2: where he received his PhD. Doctor Caplan is the author
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Speaker 2: or editor of thirty five books and more than eight
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Speaker 2: hundred and eighty papers in peer reviewed journals. His books
1:51
Speaker 2: include Vaccination, Ethics and Policy and Getting to Good Research,
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Speaker 2: Integrity and Biomedicine. Doctor Kaplan has served on a number
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Speaker 2: of national and international committees. Is extremely prolific, as I
2:04
Speaker 2: just mentioned, and is very very well known within bioethics circles.
2:08
Speaker 2: It is a great pleasure to have doctor Kaplan on
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Speaker 2: the podcast today.
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Speaker 3: Welcome to the Health Ethics Podcast. I'm Brian Pilkington and
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Speaker 3: it's my great pleasure to be speaking with Professor Ert Kaplan.
2:18
Speaker 3: All right, thanks so much for joining me today.
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Speaker 4: Thanks very much for having me.
2:22
Speaker 3: So among the host of topics you've written on and
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Speaker 3: you're amazingly prolific, is the politicization of health and medicine.
2:30
Speaker 3: So I want to ask a few questions to help
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Speaker 3: our audience understand what that is, why it happens, and
2:35
Speaker 3: what means for the future. So let's start first with
2:38
Speaker 3: conceptions of expertise. What's the proper place for expertise in health?
2:44
Speaker 3: And I'll sort of push the political and social background
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Speaker 3: as we go, But what do you think the proper
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Speaker 3: place is for expertise in health?
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Speaker 4: Well, look, we have a society in America that has
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Speaker 4: always been very strong on the idea that each person
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Speaker 4: is their own best judge of everything, whatever it is,
3:04
Speaker 4: and health certainly falls in there. We have a long
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Speaker 4: tradition in bioethics of defending autonomy and saying the person
3:13
Speaker 4: who's the patient should get to choose what they want
3:17
Speaker 4: in terms of health care. If they're competent and informed,
3:20
Speaker 4: they can say no, they don't want it. They can
3:23
Speaker 4: die if they wish, or if use a blood transfusion,
3:25
Speaker 4: and so on. We also, in recent years have seen
3:31
Speaker 4: pharmaceutical companies take to the airwaves and direct advertise their
3:35
Speaker 4: products to people just sitting in their living rooms and saying,
3:41
Speaker 4: you know, here's what you need to ask your doctor
3:43
Speaker 4: about if you have advanced breast cancer or you're becoming
3:49
Speaker 4: afflicted with Alzheimer's. No other country does that. So we have,
3:54
Speaker 4: if you will, a situation where expertise and experts are
3:58
Speaker 4: not necessary given the respect or the deference that you
4:02
Speaker 4: see in other cultures, in other societies. That said, my
4:08
Speaker 4: own view is we give too much deference in matters
4:12
Speaker 4: of health to individuals. I don't think they can follow
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Speaker 4: many of the technical or scientific complex kinds of questions
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Speaker 4: without help. Do you have to ultimately do what the
4:29
Speaker 4: expert says in healthcare? No, but you need an expert.
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Speaker 4: So just for example, that direct to consumer advertising that's
4:38
Speaker 4: on TV for drugs, I hate it. I think it's ridiculous.
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Speaker 4: People don't even know where their genes are, much less
4:44
Speaker 4: start to talk about drugs that are personalized for particular
4:47
Speaker 4: gene lo SI, it's silly. The old idea was have
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Speaker 4: a learned intermediary, which meant a doctor help you. Similarly,
4:57
Speaker 4: get counseling if you want to get a test, a
4:59
Speaker 4: full body skin or genetic test, or they're going to
5:03
Speaker 4: have a physical or whatever. There's nothing inconsistent about listening
5:08
Speaker 4: to an expert and still having the right to choose.
5:12
Speaker 3: That's helpful, and I think it's the right assessment of
5:14
Speaker 3: what's going on in our current context. Sometimes you'll have
5:18
Speaker 3: bioethics folks say when they talk about expertise, things like, well,
5:23
Speaker 3: the patient or the person are experts in their own values, right,
5:27
Speaker 3: and they have the relevant lived experience, and then this
5:29
Speaker 3: is juxtapposed to the relevant sort of medical science or
5:32
Speaker 3: health expertise. Do you find that kind of approach helpful
5:36
Speaker 3: and do you think that framing might be a way
5:39
Speaker 3: to help understand how there's less sort of deference to
5:44
Speaker 3: experts or is that.
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Speaker 4: A bit a little bit, because at the end of
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Speaker 4: the day, people set goals for how they want to
5:51
Speaker 4: live and what they want to do. When you talk
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Speaker 4: to healthcare experts, their primary purpose is to keep you healthy.
6:00
Speaker 4: But that isn't always what people want. Some people like
6:02
Speaker 4: to ride without a helmet on their motorcycle, knowing they
6:05
Speaker 4: could become a vegetable, but they love the proverbial, you know, experience.
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Speaker 3: Of wind in the hair, that sort of thing.
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Speaker 4: Other people are going to choose to do unhealthy things
6:18
Speaker 4: or pursue lifestyles that are risky or dangerous hobbies, even
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Speaker 4: nuts who go skiing or clearly not putting their health first,
6:28
Speaker 4: right anything. Any recreational thing that has a clinic, an
6:33
Speaker 4: orthopedic clinic at the bottom of a hill, is probably
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Speaker 4: sending you a message that is not the world's best
6:38
Speaker 4: health habit. So yeah, I get that. On the other hand,
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Speaker 4: I don't like that division because it suggests that what
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Speaker 4: the expert brings is just facts and what the patient
6:51
Speaker 4: or the would be patient or the potential recipient of
6:54
Speaker 4: health information, they just bring values. That's not quite true.
6:58
Speaker 4: I mean, the expert still has a value spin or
7:01
Speaker 4: of values approach, and I think it's silly when we
7:06
Speaker 4: say they should be value neutral. They're not that. That
7:09
Speaker 4: isn't something that you know, you go to a genetic
7:13
Speaker 4: councilor they're testing for Down syndrome and tas acts, and
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Speaker 4: that's not a neutral choice. They pick those because they
7:20
Speaker 4: think they're bad. You can argue against it, you can
7:24
Speaker 4: say I don't agree, but you know, the science brings
7:27
Speaker 4: its values along with it, and I think oftentimes it's
7:31
Speaker 4: important in dealing with experts to tease those out. You
7:34
Speaker 4: want to know if your healthcare provider is comfortable with
7:38
Speaker 4: medical assistance in dying, or taking away feeding tubes or
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Speaker 4: doing an abortion or whatever, and that's got more as
7:48
Speaker 4: much to do with their values. And on the other end,
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Speaker 4: you bring certain facts, and you know your body, and
7:53
Speaker 4: you have an idea about what's been going on with
7:56
Speaker 4: your health, and these are very important things to and discuss.
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Speaker 4: It's not just a set of values. So I think
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Speaker 4: it's too bifurcated to say the experts get the facts
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Speaker 4: and we got the values. On the other hand, there
8:13
Speaker 4: is something about respecting certain kinds of values that only
8:17
Speaker 4: the patient can bring.
8:19
Speaker 3: I appreciate the nuance there. I mean, facts can be
8:22
Speaker 3: valulating in a variety of ways, and especially now with
8:25
Speaker 3: a great access to information that folks have, patients come
8:28
Speaker 3: often very well in a form.
8:31
Speaker 4: By the way, too, You know, this is even a
8:34
Speaker 4: little disease specific, because if you have a chronic disease,
8:37
Speaker 4: say you're on kidney dialysis and you're on it for years, well,
8:40
Speaker 4: you get to know a great deal from experience. It
8:44
Speaker 4: isn't just some social media googling or something. You know
8:48
Speaker 4: your disease. When people I meet who have migraines, diabetes,
8:54
Speaker 4: they often are very well informed about what worked for them,
8:57
Speaker 4: what didn't work for them. They've tried these drugs. They
9:00
Speaker 4: went through these injections, it didn't help. So you know,
9:03
Speaker 4: it isn't we tend to say, oh, it's just jumping
9:06
Speaker 4: over to the uh, what's on social media and doctor
9:09
Speaker 4: Google or something. Yeah, there's that, but there's also for
9:12
Speaker 4: many people firsthand knowledge. These three drugs didn't work for me.
9:18
Speaker 3: That's a great point. I mean, the lived experience is powerful,
9:20
Speaker 3: and as you mentioned, it reminds me. I mean, I
9:22
Speaker 3: think I expert might be a little strong, but I
9:24
Speaker 3: was pretty close to an expert in how monitors worked
9:27
Speaker 3: when my daughter was in the NIKKEI like I could
9:29
Speaker 3: differentiate the tiniest of it. So I hear that, and
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Speaker 3: I think that's right if we're thinking about value, either
9:36
Speaker 3: the valuated nature of medical science or just sort of
9:39
Speaker 3: the more murky situation unless bifurcated situation. These interactions, it
9:44
Speaker 3: leads me to ask about some claims that have been made,
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Speaker 3: both popularly, some professionally, some politically, which have led to
9:53
Speaker 3: the ignoring or dismantling of expertise. And I really want
9:56
Speaker 3: to try to understand how and why this happens. Chief
9:58
Speaker 3: among these concerns, well, there are a list or considerations.
10:02
Speaker 3: Is what's going on in HSS. Two questions. One, can
10:06
Speaker 3: you say more about me bee, why this is happening,
10:08
Speaker 3: and how politically some folks are making claims about values
10:12
Speaker 3: which almost seem to rely on the bifurcated argument, and
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Speaker 3: then they trump in some ways what appears to be
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Speaker 3: good science. And then I'll move into health and human services.
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Speaker 4: Well, we do see a direct assault on the I'm
10:27
Speaker 4: gonna call it maga end of the political spectrum on
10:31
Speaker 4: experts in many areas climate science, arguments about you know, pollution,
10:38
Speaker 4: ocean pollution, fights about whether or not chemtrails are dangerous
10:43
Speaker 4: and we have to do something about them from airplanes.
10:47
Speaker 4: There's quite a bit of rejection, if you will, of
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Speaker 4: the science, and I think that's fueled by a number
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Speaker 4: of factors and reflected in policies that are saying, you know,
10:59
Speaker 4: either we're not going to pay attention to quote unquote
11:02
Speaker 4: experts in those domains health, climate, weather, risks, whatever, and
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Speaker 4: pulling them out of policy. One is, look, let's face it,
11:14
Speaker 4: the US is a very religious country, and religion and
11:18
Speaker 4: science don't always get along. They could, and they sometimes do,
11:22
Speaker 4: but often people who are religious in people who are
11:26
Speaker 4: scientific don't think they do. They think ill of one another.
11:31
Speaker 4: The MAGA movement is heavily fueled by evangelicals and some
11:36
Speaker 4: pretty strong people with convictions about religion, the Orthodox Jewish communities.
11:42
Speaker 4: In that group, you see a lot of Catholics over
11:44
Speaker 4: in that group. They're not friendly to science. They see
11:48
Speaker 4: it as threatening what they believe. I don't think it
11:51
Speaker 4: has to be that way, but it is that way,
11:53
Speaker 4: and so to some extent, even though it's not always acknowledged,
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Speaker 4: some of the blowback against science and scientific expert where
12:00
Speaker 4: it's I think comes from religiously inspired views that want
12:06
Speaker 4: to take science out of the classroom, want to bring
12:09
Speaker 4: the Bible back into the classroom, that sort of thing.
12:13
Speaker 4: I also think the experts stink and explaining what it
12:18
Speaker 4: is that they do, they don't communicate, well, they don't
12:22
Speaker 4: always know what makes what they do science, you know,
12:25
Speaker 4: And I ask some of my residents at NYU, what's science?
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Speaker 4: What gives you warranted belief? They see things like, well
12:32
Speaker 4: it's in their England Journal of Medicine. Well, I mean
12:36
Speaker 4: that's a fine journal and it's nice, but that is
12:38
Speaker 4: what makes something science, that's what presumably they publish this
12:42
Speaker 4: science but not so understanding what a theory is, what
12:46
Speaker 4: evidence is falsification, In my opinion, the key importance of
12:52
Speaker 4: practical outcomes. I mean, for me, what makes something warranted
12:57
Speaker 4: is not just that you have a nice theory, but
12:59
Speaker 4: that you can predict something and then make something happen
13:03
Speaker 4: as a result in an engineering or translational sense. I
13:08
Speaker 4: think poor explanation of why you should trust me or
13:12
Speaker 4: my track record about being successful in predicting storms or
13:16
Speaker 4: telling you that temperatures are rising, or explaining that vaccines
13:21
Speaker 4: have stopped many deaths for many diseases over a long
13:25
Speaker 4: period of time. It's just bad, bad, bad in terms
13:30
Speaker 4: of them rising to the doubters, because the doubters sort
13:34
Speaker 4: of say, you know, there's an old philosophy distinction between
13:39
Speaker 4: people who believe things because they cohere have a coherence
13:42
Speaker 4: theory of truth. There's a lot of people in the
13:45
Speaker 4: migaside who have a coherence theory of truth. Science presumably
13:49
Speaker 4: has some sort of a testable or a notion of
13:55
Speaker 4: truth that relies on efforts to falsify, and they're not
14:00
Speaker 4: hitting the same themes again, and I think again, sadly,
14:06
Speaker 4: the scientific community just doesn't do a good job holding
14:10
Speaker 4: its ground, protecting its ground. In one other comment, science
14:15
Speaker 4: withdrew into the Ivory Tower. I mean, you go ask
14:19
Speaker 4: a person the last time they actually talked to a scientist.
14:23
Speaker 4: And I'm not talking about a guy at Walmart. I'm
14:25
Speaker 4: just talking about a relatively sophisticated person who might have
14:31
Speaker 4: a well paying job or something like that. Well the
14:33
Speaker 4: answer is probably they don't remember, or never, or I
14:37
Speaker 4: don't think so. I sort of called this how stupid
14:41
Speaker 4: is science? Because when they've had popularizers for old timers.
14:46
Speaker 4: Carl Sagan, the astronomer who used to appear on late
14:51
Speaker 4: night TV had its own shows, tried to explain in
14:55
Speaker 4: his case, cosmology astronomy to the average person. They rejected him.
15:02
Speaker 4: They basically said, you're not going to get into the
15:04
Speaker 4: National Academy of Sciences, your popularizer. This is not what
15:08
Speaker 4: science should do. How stupid is that? In trying to
15:14
Speaker 4: protect scientific turf, you want a thousand Carl Sagans instead.
15:20
Speaker 4: The idea has been we're over in the tower, we
15:23
Speaker 4: do our work, and we talked to one another and
15:28
Speaker 4: keep funding us. Well, there's a missing gap between the
15:31
Speaker 4: we're doing our work and we're talking to one another
15:34
Speaker 4: and they keep funding me.
15:36
Speaker 3: That's a great point, I mean, and we'll jump to
15:40
Speaker 3: research funding a little later on. But the not inability
15:45
Speaker 3: but science is sort of not correctly communicating or communicating
15:50
Speaker 3: well with the public to fully understand what's going on,
15:52
Speaker 3: I think is well, recently it was all over the
15:55
Speaker 3: place in COVID. Yeah, and that's a helpful analysis. So
15:59
Speaker 3: let's with that in mind, and I'll move to bioethicists
16:03
Speaker 3: in a bit two. How should students think about our students? Jesus,
16:08
Speaker 3: how should citizens? We can do medicines too, and really institutions.
16:13
Speaker 3: So with this background, right, we have HHS, We have
16:16
Speaker 3: Robert Kennedy Junior, who has made a variety of claims,
16:20
Speaker 3: all of which seem to not be true. I mean,
16:23
Speaker 3: I may be too naive, and so I'm not fully
16:26
Speaker 3: understanding this as a philosopher sits in the Department of
16:29
Speaker 3: Medical Sciences, in the scientific echo chamber. So this is
16:32
Speaker 3: this is helpful, But can you comment on HSS and
16:37
Speaker 3: then sort of in relation to how citizens right, because
16:40
Speaker 3: if we have this gap between scientists not explaining things
16:43
Speaker 3: well to citizens, if citizens, if the average per if
16:46
Speaker 3: there is an average person, if the public is looking
16:49
Speaker 3: for figures, and some of whom have this coherence theory
16:53
Speaker 3: of knowledge. I mean, if they have leading figures making
16:56
Speaker 3: claims about, for example, vaccines which just don't see to
17:00
Speaker 3: cohere with truth. I mean, now I'm rambling, but help
17:04
Speaker 3: us understand how the public, in viewing the work and
17:09
Speaker 3: pronouncements of very powerful institutions, is supposed to sort of
17:13
Speaker 3: move forward.
17:15
Speaker 4: Well, first, let's understand vaccines are almost their own special problem,
17:23
Speaker 4: because there's been anti vaccine sentiment since the beginning of
17:27
Speaker 4: the last century. When vaccines got introduced, they were immediately feared,
17:32
Speaker 4: partly because they didn't work that well, partly because they
17:36
Speaker 4: were a source of disease. You could catch the disease
17:40
Speaker 4: and and't know how to make vaccines all that. Well,
17:41
Speaker 4: it was better for smallpox to get vaccinated than not,
17:45
Speaker 4: but still you could get ill if you use those
17:49
Speaker 4: early vaccines, and many people way back then sort of
17:54
Speaker 4: said no, thanks, it's not safe or it's too risky.
17:58
Speaker 4: Other people had fear like we sometimes see today about
18:01
Speaker 4: genetic engineering. If you put foreign substances into me directly
18:06
Speaker 4: through a needle, it's going to change the essence of
18:10
Speaker 4: who I am. It's going to turn me. If you
18:12
Speaker 4: make vaccines from derivatives that use animals, I'll become more
18:17
Speaker 4: animal like. We see this in transplant today, we see
18:20
Speaker 4: it in worries about crisper and other things like that.
18:23
Speaker 4: These are deep seated fears about personal identity. So point being,
18:29
Speaker 4: we've had a long, long history of anti vaccine sentiment.
18:34
Speaker 4: Some linked up to things like it causes autism, some
18:38
Speaker 4: linked up to things like you get the disease, something
18:43
Speaker 4: linked up to things like this just don't work and
18:45
Speaker 4: on andonic goes right through COVID. I mean, you know,
18:48
Speaker 4: COVID was not special in one sense. It was the
18:52
Speaker 4: usual suspects bringing forward fears and doubts about vaccines that
18:56
Speaker 4: they'd had for decades, and the modern leader of that
19:00
Speaker 4: in his RFK Junior. So, I don't know why people
19:02
Speaker 4: are surprised to see that there's a lot of misinformation, stupidity,
19:07
Speaker 4: and bunk flying out of HHS. You make him the director.
19:12
Speaker 4: He's got a three decade history of nuttiness about vaccines.
19:17
Speaker 4: He is mister anti vaccine, So I am not looking
19:21
Speaker 4: for any wisdom to be coming from him. For a
19:26
Speaker 4: long time he was a proponent of the vaccine's cause
19:30
Speaker 4: autism thing, which has been debunked forever. He then has
19:34
Speaker 4: shifted recently to they've never been studied, which is also silliness.
19:40
Speaker 4: And by the way, I should say Brian, when he
19:42
Speaker 4: says they've never been studying, he means in a randomized
19:45
Speaker 4: trial against placebo. Well, it is true that they've been
19:48
Speaker 4: studied that way for a while, but it's also true
19:50
Speaker 4: that would be unefthical because you can't run a placibo
19:53
Speaker 4: arm when you know you've got a pretty effective vaccine
19:56
Speaker 4: and you're trying to make a better You can't not
19:59
Speaker 4: give somebody the partially effective one. But you could. It
20:03
Speaker 4: would just be a version of the Tuskegee study where
20:05
Speaker 4: they didn't give penicilline to PEOPLE'SSELFI was deliberately to study
20:13
Speaker 4: the impact of the disease. I mean, you can't, it's
20:15
Speaker 4: not ethical. And so but anyway, he's in that camp
20:20
Speaker 4: now that we don't have good studies, and also he's
20:23
Speaker 4: wrapped himself in an interesting banner to be anti vaccine,
20:27
Speaker 4: which is choice. And we did talk a little bit
20:30
Speaker 4: about choice already. But what the anti vacciners have found
20:35
Speaker 4: is that they get great traction by saying, oh, we're
20:38
Speaker 4: not anti vaccine, it's just up to you to choose.
20:41
Speaker 4: You want vaccines, you don't want vaccines. Two comments about that.
20:45
Speaker 4: That makes for crummy HHS policy because vaccines are not
20:49
Speaker 4: about the individuals, they're about the community. I can choose
20:54
Speaker 4: not to vaccinate, and maybe I can even survive the
20:56
Speaker 4: flu or covid or measles, but it doesn't mean my
21:00
Speaker 4: neighbor or my neighbor's kid or the nursing home residents can.
21:05
Speaker 4: So morally, you're sending a message out of HHS. Hey,
21:11
Speaker 4: you pick, and you know, weigh the information and listen
21:14
Speaker 4: to what said. And all we're doing is defending your
21:17
Speaker 4: right to choose. Well, you know what to defend your
21:19
Speaker 4: right to choose if you're going to kill vulnerable people
21:22
Speaker 4: who are your neighbors or people you see at the
21:25
Speaker 4: mall or at the airport or church or wherever you
21:27
Speaker 4: run into them, or especially vulnerable to infectious disease. And
21:33
Speaker 4: the other thing that Kennedy has done on a moral
21:37
Speaker 4: framework is this HHS policy. He's saying, you know what,
21:41
Speaker 4: I'm for a prevention, even though vaccines are probably the
21:44
Speaker 4: greatest preventive thing we've ever come up with but put
21:47
Speaker 4: that on the side. So he's worried about seed oils,
21:50
Speaker 4: and he's worried about red dye number two, and he's
21:53
Speaker 4: worried about kind of a food supply that's in trouble. Okay,
21:58
Speaker 4: I can't comment with great expertise about the dangers of
22:00
Speaker 4: seed oils, although they seem to be better than eating
22:03
Speaker 4: butter and lard, which is what our grandparents did and
22:06
Speaker 4: died of heart disease left and right. But maybe there
22:10
Speaker 4: are better things now. I don't know. I'll lead that
22:13
Speaker 4: to nutritionis in others. But what I want to make
22:17
Speaker 4: the point is this, he is saying, I'm gonna redo
22:21
Speaker 4: our science. I'm not gonna have a science establishment at
22:24
Speaker 4: the NIH, FDA, CDC, Department of Defense that focuses in
22:30
Speaker 4: on the needs of people today who are ill, or
22:34
Speaker 4: the needs of people today who are gonna become ill
22:37
Speaker 4: pretty soon. I'm gonna shift to prevention. Morally, what he's
22:41
Speaker 4: done then is said I'm gonna do I'm gonna follow
22:45
Speaker 4: policies I believe it right that are gonna deliver thirty
22:48
Speaker 4: years from now. The historical way of understanding what the
22:52
Speaker 4: NIA should do is find cures for diseases for people
22:55
Speaker 4: who are sick. Now. I got cancer, Alzheimer's. I have
23:01
Speaker 4: a baby born prematurely, and I got to come up
23:04
Speaker 4: with technology to help save him or soon to be sick.
23:09
Speaker 4: You know, my genetic profile is bad. I'm going to
23:12
Speaker 4: get this in a few years, or I'm starting to
23:15
Speaker 4: show signs of pre diabetes or something. And jump in.
23:19
Speaker 4: He is, and it hasn't been challenged, shifting the moral
23:24
Speaker 4: calculus to say that, forget all these people in the
23:27
Speaker 4: here and now, let's worry about people thirty years from now,
23:31
Speaker 4: because that's what prevention is all about. It's not going
23:33
Speaker 4: to be like we all start eating better tomorrow and
23:36
Speaker 4: then oh, all our cancer went away the next day.
23:39
Speaker 4: It doesn't work out way. So I think he has.
23:43
Speaker 4: He's showing his colors as an anti vaccine critic and
23:47
Speaker 4: driving HHS and federal policy that way. No surprise, you know,
23:53
Speaker 4: he commissioned to study by some nut to report in
23:56
Speaker 4: the fall about whether vaccines cause autism or what's causing autism.
24:01
Speaker 4: I should say more accurately. I think I know what
24:04
Speaker 4: the study will report. It'll be vaccines or somewhat to
24:09
Speaker 4: blame for autism. Still, but more to the point he's
24:13
Speaker 4: made fundamental shifts in because of his outlook in terms
24:18
Speaker 4: of focusing on future generations, future people far in the
24:24
Speaker 4: future to deliver results, and tearing down the NIH science
24:31
Speaker 4: structure focus different divisions which are all focused on trying
24:36
Speaker 4: to do something about diseases in the short run. We
24:39
Speaker 4: haven't had a real debate about that, and people haven't
24:41
Speaker 4: called him out on that. I mean, maybe it's a
24:44
Speaker 4: good thing, Maybe Americans want that.
24:46
Speaker 3: I doubt it, but it's a great point and sort
24:49
Speaker 3: of connects up with democratic considerations if Americans really are
24:53
Speaker 3: sort of saying we want this as opposed to that,
24:54
Speaker 3: and then institutions are following that view. And I take
24:59
Speaker 3: your point that there is something special about vaccines. So
25:03
Speaker 3: this has been a particular locus of argument, but the
25:07
Speaker 3: broad move seems the reframing of science, right. I mean,
25:10
Speaker 3: there's also been pushed back on the germ theory of disease.
25:13
Speaker 3: I'm not a scientist, right, I'm a philosopher, and I
25:16
Speaker 3: remember from intro medical ethics, like you know when you say,
25:19
Speaker 3: like how great science is in certain ways, the germ
25:22
Speaker 3: theory of disease nineteen oh four, nineteen oh five, I'm
25:24
Speaker 3: not a history like you can track when the average
25:27
Speaker 3: patient shows up to see the average physician and stuff
25:30
Speaker 3: goes better than not. And it's because people are washing
25:32
Speaker 3: their hands. We saw this in COVID too, right, A
25:34
Speaker 3: bunch of hospital common hospital illnesses just drop because maybe
25:38
Speaker 3: people weren't washing their hands as carefully as before. And
25:41
Speaker 3: so I take these points, I think you're you're right,
25:44
Speaker 3: and it's persuasive, And then I think back to what
25:46
Speaker 3: you had mentioned earlier in sort of laying out the
25:49
Speaker 3: socio political landscape and thinking about, you know, the kind
25:53
Speaker 3: of person or the exemplar who is trying to get
25:56
Speaker 3: their views to cohere. And a number of at least
26:00
Speaker 3: that I know, who have personal philosophic personal religious views
26:04
Speaker 3: often are interested in safeguarding the vulnerable. It's not always
26:08
Speaker 3: that language, right, and you can run sort of the
26:11
Speaker 3: rawlsy and stuff on this. You can run sort of
26:14
Speaker 3: different religious views on this, but you're looking out for
26:17
Speaker 3: the little person. In some ways, this seems to be
26:21
Speaker 3: not doing that. And you make a really nice point
26:23
Speaker 3: about the like we're just shifting it, or maybe it's
26:25
Speaker 3: being shifted to the future in thirties. That's also not
26:28
Speaker 3: what the institutions are for as you noted, and not common.
26:31
Speaker 3: So I mean, this is asking way to much.
26:34
Speaker 4: But I'm not even sure we know what we're doing
26:37
Speaker 4: in terms prevention that would return thirty years from now,
26:39
Speaker 4: even if that is what we all decided we would do.
26:44
Speaker 4: It's not like I mean, people do say experts that
26:48
Speaker 4: we should, you know, watch our diet and lose weight
26:51
Speaker 4: and exercise, and we're a helmet if you operate a
26:55
Speaker 4: bicycle or motorcycle or something and don't use drugs. These
27:01
Speaker 4: are simple tips. But the kind of stuff he's promoting
27:05
Speaker 4: in terms of change the diet fundamentally or do something
27:10
Speaker 4: that might involve taking supplements or special intervention, I don't
27:15
Speaker 4: know if those things deliver anything, and we won't know
27:17
Speaker 4: for thirty years.
27:18
Speaker 3: Yeah, I mean it's a good point. And you raised
27:20
Speaker 3: earlier sort of the interconnected nature of persons, right, So
27:24
Speaker 3: if I mean I have no balance, I'm not running
27:26
Speaker 3: a motorcycle no matter what. I also don't have hair.
27:28
Speaker 3: If I had hair and I had balance and I
27:30
Speaker 3: wanted to feel the wind blown through my hair, there's
27:32
Speaker 3: still some concern about others. If I, you know, crash,
27:37
Speaker 3: get a pelvic fracture that's a strand on the system.
27:39
Speaker 3: Maybe the motorcycle spins whatever, we can play this out
27:42
Speaker 3: arguing against vaccinations and promoting which what appears to be misinformation,
27:48
Speaker 3: disinformation about this reducing I mean, we've seen this with
27:51
Speaker 3: the measles outbreak and foot recently, and folks who listen
27:55
Speaker 3: to the podcast regularly we'll have heard doctor jeff Jeffrey
27:57
Speaker 3: boss Camp talk about measles and sort of the problem
28:00
Speaker 3: and sort of significant challenges for pediatric population. I mean, yeah,
28:04
Speaker 3: I'm just trying to put all this together, and maybe
28:05
Speaker 3: it doesn't go together, but how you have folks who
28:07
Speaker 3: are interested in protecting the vulnerable and also are pushing
28:11
Speaker 3: back on sort of well vetted vaccinations. I mean, I
28:16
Speaker 3: just maybe I'm.
28:17
Speaker 4: I'm gonna say something harsh. I'm not sure that the
28:21
Speaker 4: MAGA movement and Kennedy as a member of that inside
28:27
Speaker 4: AHHS and his many other appointees are committed to protecting
28:33
Speaker 4: the vulnerable. This sounds a little perhaps cruel to say,
28:37
Speaker 4: but I think it's true. You have a group that
28:41
Speaker 4: sometimes says, oh, well, the people in COVID who died
28:43
Speaker 4: they were elderly, and the hint is being like, okay,
28:46
Speaker 4: so we don't need them anymore, or you know, we
28:48
Speaker 4: get rid of them. Kennedy has said many times about
28:52
Speaker 4: autistic kids, they can't toilet, They're like completely useless. You
28:58
Speaker 4: get this language that starts to sound like useless eaters
29:01
Speaker 4: from say, the Nazi regimes of you know, seventy five
29:06
Speaker 4: years ago. What I'm saying is this, if you take
29:09
Speaker 4: this rugged individualism, the exaltation of the individual, which is
29:17
Speaker 4: in our culture. It's in the libertarian side, it's in
29:20
Speaker 4: the bro culture. When Musk talks about, you know, I
29:25
Speaker 4: got to have fourteen children because everybody else who's reproducing
29:28
Speaker 4: his inferior and many others are in his camp. When
29:33
Speaker 4: Trump says we need more white babies, he's not talking
29:36
Speaker 4: about babies. He's talking about the kind of babies he
29:40
Speaker 4: wants as desirable. They are pushing a worldview and an
29:45
Speaker 4: ethic that says, I'll call it similar to Ian Rand.
29:50
Speaker 4: It's kind of like I do my thing, and I
29:53
Speaker 4: make my choices, and I'm responsible for me, maybe a
29:56
Speaker 4: little bit for my kids, but my neighbor or people
30:00
Speaker 4: in Africa, I don't think so. So I think you've
30:03
Speaker 4: got one way to bring together what they're doing is
30:07
Speaker 4: they are rejecting a traditional ethic that says the weak,
30:11
Speaker 4: the vulnerable, the at risk deserve help. I don't see
30:17
Speaker 4: that strong in HHS RFK junior culture.
30:23
Speaker 3: That's helpful, that's helpful. And I mean, and well, we
30:25
Speaker 3: could do fun philosophy all day, with the devastating critiques
30:28
Speaker 3: of different versions of libertarian but libertarianism, but let's go practical.
30:34
Speaker 3: What should bioethicists do? So you've laid the landscape out? Well,
30:38
Speaker 3: I mean, there's more we talk about other than vaccines
30:40
Speaker 3: in germ theory, but I think you know, folks can extrapolate.
30:43
Speaker 3: Should bioethicists be advocating for particular positions in the public
30:48
Speaker 3: space more than they are already? I mean, so what
30:52
Speaker 3: sho bioethics bioethicists do in this landscape?
30:56
Speaker 4: Well, I'll say this as a bioethicis who tried to
31:01
Speaker 4: haul bioethics kicking and screaming into the public arena many
31:06
Speaker 4: decades ago, around the time of the birth of Louise Brown,
31:10
Speaker 4: the first Test two baby, the baby Fade Baboon Heart experiment,
31:14
Speaker 4: first uses of the artificial heart. We're talking early eighties.
31:18
Speaker 4: Basically Prior to that, bioethics was trying to establish as
31:22
Speaker 4: bona fides as an academic and legitimate intellectual enterprise. It
31:28
Speaker 4: wanted to publish in the right journals. The Hastings Center
31:31
Speaker 4: created a Bioethics journal precisely because it wanted academic recognition.
31:36
Speaker 4: It wanted other people in law, in medicine, in the sciences,
31:42
Speaker 4: in nursing to respect it and to accept it. And
31:46
Speaker 4: it did. I mean, it succeeded in becoming amazingly and
31:50
Speaker 4: by the way, a little side note, it's one of
31:52
Speaker 4: the few fields you can actually chart the entire development
31:55
Speaker 4: of the field from beginning to now. You don't get
31:58
Speaker 4: to do that with physics very often, or it's hard,
32:02
Speaker 4: let's put it that way. But here you've got this
32:04
Speaker 4: little discipline that grows and you can see it trying
32:08
Speaker 4: to do things like we have journals, we have an encyclopedia,
32:11
Speaker 4: we have an annual meeting, We do what academics want
32:15
Speaker 4: us to do. We publish in their journals, not just
32:18
Speaker 4: our journals. We give guidelines that are useful, blah blah blah.
32:23
Speaker 4: But that wasn't, in my view, ever sufficient because a
32:26
Speaker 4: lot of the decisions public policy decisions or we got
32:30
Speaker 4: to clone people. Do you want to have medical aid
32:33
Speaker 4: and dying? Do you want to eat genetically engineered food?
32:36
Speaker 4: Do you want animals to be experimented on? These are
32:39
Speaker 4: public policy questions and they demand public involvement, in my opinion,
32:45
Speaker 4: so I've always felt and always tried to do both
32:48
Speaker 4: have an academic side, but write opinion pieces, try to
32:53
Speaker 4: interest journalists in writing about the ethics issues of medicine
32:57
Speaker 4: and science over the years. So you've got somebody in
33:00
Speaker 4: answering that question about what should bioethics do who says
33:05
Speaker 4: go public, be public. Each bioethicist should try to some
33:11
Speaker 4: extent as a part of their career to communicate to
33:14
Speaker 4: broader audiences than their academic peers. That might mean just
33:19
Speaker 4: giving a talk at a high school or showing up
33:21
Speaker 4: at your synagogue or mosque and doing a presentation. Are
33:27
Speaker 4: there are many forums. Are writing an op ed not
33:29
Speaker 4: for the New York Times, I mean, that's fine, but
33:32
Speaker 4: you could write it for the Ridgefield Weekly Press in Connecticut.
33:37
Speaker 4: That's fine too, But make an effort reach out. These
33:42
Speaker 4: are decisions that aren't just going to be made by academics. Sometimes,
33:48
Speaker 4: as we've said, earlier academics think they're going to make
33:50
Speaker 4: these decisions alone, but they're getting a kind of abrupt
33:54
Speaker 4: lesson in the fact that that isn't how it works.
33:57
Speaker 4: So first, yes, I think we have a requirement to
34:01
Speaker 4: be public. Second, we have a requirement to warn people
34:05
Speaker 4: about issues that are coming down the road. So I
34:09
Speaker 4: always think that prophylactic bioethics is part of what you're doing.
34:13
Speaker 4: It's not just responding and saying, oh, look, we transplanted
34:17
Speaker 4: a pig heart into a human. What do you think
34:20
Speaker 4: it should be. Oh, we're going to plan to transplant
34:23
Speaker 4: a pig heart into a human, and what are the
34:25
Speaker 4: issues and let's talk about that. I see the bioethicist
34:28
Speaker 4: as having a prophetic role, like the profits of the Bible,
34:33
Speaker 4: to say this is coming, I might want to worry
34:36
Speaker 4: about this, look out for that, and people can do
34:40
Speaker 4: so or not as they wish. They ignored the profits
34:44
Speaker 4: and I think they poison Socrates, But okay, you know
34:47
Speaker 4: it's an occupational hazard of trying to warn folks that
34:51
Speaker 4: I always want to hear this stuff. Thirdly, in the
34:54
Speaker 4: current climate, there are certain values I think we have
34:57
Speaker 4: to stand up for. I think is correct it's valid.
35:04
Speaker 4: It's true. We should be inclusive, we should respect diversity,
35:09
Speaker 4: we should seek equity. I want to stand for those values.
35:12
Speaker 4: I don't want to see them wiped off the websites
35:15
Speaker 4: and blown away. In terms of the programs that exist,
35:19
Speaker 4: I'm not naive. I get it that people who manage
35:23
Speaker 4: institutions have to preserve them. And if they get threatened
35:27
Speaker 4: with no money and the breakdown of Harvard or Columbia
35:30
Speaker 4: or whoever, Indiana, then those places are gonna survive. And
35:38
Speaker 4: they're not always gonna smile at the bioethicists who continues
35:41
Speaker 4: to get them in trouble. But you're gonna make some
35:43
Speaker 4: trouble a little bit, a little bit. Sometimes you gotta
35:46
Speaker 4: be clever about how you say it or what you do.
35:50
Speaker 4: I tend to be a little more blunt than others,
35:52
Speaker 4: But then I'm close to retirement, so I'm not as
35:54
Speaker 4: worried as But the consequences is you might be. Let's say,
35:58
Speaker 4: but without going on and on about this, bioethics has
36:03
Speaker 4: an obligation to stand up for core values that it
36:07
Speaker 4: believes society should endorse. When it is dealing in the
36:13
Speaker 4: health sphere. It has an obligation to stand up for
36:16
Speaker 4: those who are voiceless, people overseas, who are poor, people
36:20
Speaker 4: don't have health care access here, people with disabilities, elderly
36:26
Speaker 4: institutionalize prisoners. There are groups that just can't get hurt
36:31
Speaker 4: unless someone tries to bring their needs for health care
36:35
Speaker 4: or mental health care into the public arena. And then
36:39
Speaker 4: I think, as I said, challenge false or incorrect views
36:45
Speaker 4: about value commitments that say, in this case, the administration
36:50
Speaker 4: is promoting that there's something wrong inherently with seeking justice
36:56
Speaker 4: in health care. They don't like equity. That's a pretty
37:01
Speaker 4: tough position to defend.
37:02
Speaker 3: A great and helpful response both for those of us
37:05
Speaker 3: who are sort of not as far along in our
37:09
Speaker 3: bioethics career, but more generally right, So, and I was
37:12
Speaker 3: gonna ask you some detailed questions about the duties to plan,
37:15
Speaker 3: which that you anticipated well, and bioethicists have an opportunity
37:19
Speaker 3: to say, when X comes out, well, here's whay ethically
37:22
Speaker 3: what might happen down the road, But also right to
37:26
Speaker 3: stand up for particular core values as you just mentioned
37:29
Speaker 3: of bioethics, and that connects up to the vulnerable, which
37:31
Speaker 3: we're talking about earlier it's not divided up by national boundaries, right,
37:36
Speaker 3: you connected us globally, right, And that's another big question.
37:39
Speaker 3: I mean jump in or just push me down the road.
37:41
Speaker 3: But I mean, given the aid reductions from the US,
37:46
Speaker 3: I mean, how are what should bioethicists be doing if
37:50
Speaker 3: you think that you owe something not just to your neighbor.
37:52
Speaker 3: And I know other folks might not think this, but
37:54
Speaker 3: to your neighbor that's a little further down the road
37:56
Speaker 3: or a little you know, further away. I mean, that's
38:00
Speaker 3: it's a big question.
38:02
Speaker 4: It's so again be a little provocative. One very popular bioethicist,
38:09
Speaker 4: very influential friend of mine, Peter Singer, has argued what
38:12
Speaker 4: they do is they almost do a kind of moral equivalence.
38:16
Speaker 4: You fight as hard for people far away as you
38:18
Speaker 4: do the people who are living in your house. And
38:22
Speaker 4: that's a kind of strict utilitarian outlook that says, you know,
38:25
Speaker 4: every life is valuable, whether they're in Chad or you know,
38:31
Speaker 4: living in Richfield, Connecticut, in my house as my spouse
38:37
Speaker 4: or my kids or something. Well, I don't think that's right.
38:41
Speaker 4: And I think by what they skits itself in trouble
38:44
Speaker 4: when it sells a message that says, yes, yes, national
38:48
Speaker 4: boundaries are not necessarily morally relevant for many questions, and
38:53
Speaker 4: yes we have duties to help others even far away.
38:58
Speaker 4: But I still believe this is an old critique of
39:01
Speaker 4: utilitarianism that people like wd ross Back made of John
39:06
Speaker 4: swort Mill. You have more obligations to those closer to
39:10
Speaker 4: you than you do those further away. And it isn't
39:13
Speaker 4: just I mean, it's partly because they have the bigger needs.
39:17
Speaker 4: You've got to spend time raising your kids and worrying
39:19
Speaker 4: about earning money for your food, and worrying about making
39:24
Speaker 4: sure that you provide an education for your kids in
39:29
Speaker 4: ways that makes them a bigger priority than a kid
39:34
Speaker 4: who is in big trouble in Ukraine or Gaza or
39:38
Speaker 4: starving in the Sudan. Do I ignore them, know? But
39:41
Speaker 4: I think there's a discount factor involved. And when we
39:44
Speaker 4: as bioet to say well, we're world citizens and we
39:48
Speaker 4: don't see any special priority for our community, our nation,
39:54
Speaker 4: or other intermediate levels of organization, I think we lose.
39:58
Speaker 4: People use somewhat common sense as to them. So if
40:03
Speaker 4: I'm gonna make breakfast tomorrow, it's a coin flip as
40:06
Speaker 4: to whether I send that breakfast to a port person
40:10
Speaker 4: that I never met downtown, or feed my kid. It
40:15
Speaker 4: just doesn't wash, and because I think in part it's wrong. So, yes,
40:20
Speaker 4: we do have to think about what goes on overseas.
40:23
Speaker 4: Often it's in our interest to do that, particularly with
40:27
Speaker 4: infectious diseases. It's not just keep them alive, it's like,
40:30
Speaker 4: don't infect me. That they go hand in hand when
40:33
Speaker 4: you ignore what's going on far away. But even if
40:37
Speaker 4: it's simply a matter of saying, look, I want to help,
40:40
Speaker 4: you have to decide. Am I going to spend ten
40:42
Speaker 4: percent of my income twenty percent of my time thinking
40:46
Speaker 4: about people far away? But it isn't gonna be one
40:49
Speaker 4: hundred and it's not going to be, in my view,
40:50
Speaker 4: morally equivalent.
40:53
Speaker 3: That's helpful, And it's always in this to have a
40:54
Speaker 3: conversation where someone mentions Ross and mill this is I
40:56
Speaker 3: don't get to have these chats every day.
41:00
Speaker 4: I knew them both personal. Yes, that totally.
41:04
Speaker 3: Well, the folks who listen to this podcast are a
41:08
Speaker 3: fortunate are all over the globe, and we got a
41:10
Speaker 3: bunch of people which is from different backgrounds, which is
41:12
Speaker 3: really nice. But we always pay special attention to the
41:15
Speaker 3: medical students, and I know you care about medical students.
41:17
Speaker 3: I care about medical students. We got a bunch of
41:19
Speaker 3: the Hackensack grinny in School of Medicine in Jersey who
41:22
Speaker 3: listen to this. So as a seasoned bioethicist for medical
41:27
Speaker 3: students who are interested in ethics or just who are
41:30
Speaker 3: going to be practicing for the next thirty forty fifty years,
41:34
Speaker 3: any advice for them, any direction, any thoughts.
41:38
Speaker 4: Yeah, One thing I think is important is to retain
41:41
Speaker 4: your empathy. Everything about medical school, often even into residency
41:49
Speaker 4: and fellowship, can really wear you out and burn you out.
41:53
Speaker 4: And people come in idealistic and wanting to help, and
41:58
Speaker 4: almost come with a calling frequently to go to med school.
42:02
Speaker 4: And you know, time and again you talk to them
42:04
Speaker 4: either at medical school, graduation or later in their training,
42:08
Speaker 4: and they're sort of like, you know, it's a job,
42:10
Speaker 4: and boy, I don't know if I really want to
42:13
Speaker 4: do this anymore. It's a very important and admirable career.
42:19
Speaker 4: And you got to hang on to what brought you
42:21
Speaker 4: there and appreciate the value of what you do. And
42:28
Speaker 4: I think also make time, you know, as people say,
42:31
Speaker 4: for yourself and to keep yourself from just getting burned
42:36
Speaker 4: out from work and all that pressure. I'm a terrible
42:41
Speaker 4: person to do this because I'm a workaholic. But you know,
42:44
Speaker 4: there are ways to at least I travel. I do that.
42:48
Speaker 4: I take vacations, you know, I try to watch sports.
42:52
Speaker 4: I have breaks from things that give me a little
42:56
Speaker 4: relief in terms of my work. I think that's important
43:00
Speaker 4: to do. Secondly, you pertain your professionalism. These days, medicine
43:06
Speaker 4: is more and more business. Private equity is here, people
43:09
Speaker 4: are working for somebody else, and you start to see
43:12
Speaker 4: business ethics seep into what used to be medical ethics
43:17
Speaker 4: as you and I know it, meaning which try harder
43:21
Speaker 4: in a play to save people or help people, even
43:25
Speaker 4: if it meant putting yourself at risk. Would you work
43:28
Speaker 4: at home at the hospital to prevent transmission of disease
43:32
Speaker 4: even if it meant having to use more daycare or
43:35
Speaker 4: burdening your spouse with more childcare duties. And I think
43:38
Speaker 4: the answer to those things still should be yes. I
43:41
Speaker 4: try to serve patients. That is what makes medical ethics
43:47
Speaker 4: different from what you know. A guy who's selling widgets
43:50
Speaker 4: is going to say about what they have to do
43:52
Speaker 4: or their duties. I see it under threat. Every day
43:56
Speaker 4: I see people being treated miserably. You have ten minutes
44:00
Speaker 4: with a patient, We're going to measure your productivity all
44:04
Speaker 4: day long. It's MBA driven medicine. You gotta fight it,
44:09
Speaker 4: you gotta resist it, gotta call it out, gotta say
44:12
Speaker 4: that isn't in the patient's best interest, even when companies
44:16
Speaker 4: are saying I want you on the phone for an
44:18
Speaker 4: hour trying to appeal decisions made by algorithms by a
44:23
Speaker 4: third party payer. What are we putting up with that
44:26
Speaker 4: system for. That's craziness, and it makes your life miserable.
44:30
Speaker 4: And and by the way, I don't know why your
44:33
Speaker 4: medical judgment should be second guests by let's say, a
44:38
Speaker 4: nurse in a different specialty who's in a different country,
44:41
Speaker 4: or worse, an AI bot, which some payers are doing.
44:47
Speaker 4: So you've got to be willing to take on the
44:49
Speaker 4: things that make practice bad, get your patients involved, get
44:53
Speaker 4: people angry about it, seek out allies, that sort of thing.
44:58
Speaker 4: Last bit of advice the medical student, I think there
45:02
Speaker 4: has been a kind of suggestion that we have to
45:08
Speaker 4: live with alternative medicine and wellness. I think that message
45:13
Speaker 4: is chiropractors, people who sell us vaginal eggs and goop,
45:21
Speaker 4: or even people who say I'm going to the SPA.
45:25
Speaker 4: They do have some tricks that we need to capture back.
45:28
Speaker 4: They listen, they try to take seriously complaints. They don't
45:34
Speaker 4: put down or dismiss somebody who says I have chronic
45:36
Speaker 4: pain or I have headaches or whatever. But we don't
45:41
Speaker 4: have to endorse those alternative interventions and remedies. So to me,
45:48
Speaker 4: there are many people seeking healthcare in a lot of
45:51
Speaker 4: places outside of medicine. But what we want to do
45:54
Speaker 4: is learn what they do well and then try to
45:59
Speaker 4: respond just say, oh, well, we live alongside Kooch's nuts
46:04
Speaker 4: and dissemblers.
46:06
Speaker 3: A great sort of triparthide set of recommendations for students.
46:11
Speaker 3: And I think the second one about professionalism, well, they're
46:14
Speaker 3: all salient, but we'll be especially salient, as you noted
46:16
Speaker 3: in the Age of AI and what the I mean
46:19
Speaker 3: without that's a whole nother I mean podcast in two books,
46:22
Speaker 3: but sort of the way in which medical practice, the
46:27
Speaker 3: daily practice that got these students interested in caring for
46:30
Speaker 3: others and their health, well, change, I think is also
46:33
Speaker 3: both promising but threatening. Last question, I'll get you out
46:36
Speaker 3: on this one. When we do this with everybody who
46:38
Speaker 3: hops on the podcast, what's next? New paper? I mean,
46:41
Speaker 3: you're so perlicent, new paper, new book? What are you
46:44
Speaker 3: most interested in? And what can the listeners check out
46:46
Speaker 3: in the future you're given a big talk. What's for
46:48
Speaker 3: folks who are interested? What's next?
46:51
Speaker 4: So I'm working on a little book on hundred of
46:54
Speaker 4: my most miserable cases, clinical casebook, just partly to show
47:01
Speaker 4: you don't always know what's right, and sometimes we're wrong,
47:04
Speaker 4: and sometimes you gotta learn. And you know, people sometimes
47:07
Speaker 4: say to me, have you ever changed your mind? Yes,
47:12
Speaker 4: Frequently new facts come in or you say do this
47:16
Speaker 4: and doesn't lead to a good outcome. You gotta learn.
47:19
Speaker 4: So I think trying to make people understand it's not
47:22
Speaker 4: just I'm right, and these are the ethical principles and
47:25
Speaker 4: follow what the quote unquote expert says. The expert is vulnerable,
47:30
Speaker 4: the expert can be flawed, and the expert can learn.
47:33
Speaker 4: And that's true even for the people medical students others
47:37
Speaker 4: who are trying to do medical ethics. When the ethicists
47:41
Speaker 4: so to speak, isn't available, isn't around, probably going to
47:46
Speaker 4: do something like a little memoir. You know, I'm one
47:49
Speaker 4: of the guys left who's a little bit like the
47:52
Speaker 4: Forest Gump of bioethics. I was there for this. I
47:56
Speaker 4: knew that guy. I was around when this happened. I
47:59
Speaker 4: saw this change and so on, and that one I've
48:03
Speaker 4: started to do. I don't want to call it an
48:05
Speaker 4: autobiography because it's more a witness to history kind of approach,
48:12
Speaker 4: and I'm working on that too. So those are the
48:15
Speaker 4: sort of fun book projects, but more immediately, keep fighting
48:19
Speaker 4: with RFK Junior, keep fighting with the administration. That's a
48:24
Speaker 4: day to day activity. At this point. It's like every
48:27
Speaker 4: morning I wake up to see what cuckoo thing they're
48:30
Speaker 4: doing at the FDA or the state of Montana has
48:33
Speaker 4: pasted a complete right to try law that makes no
48:36
Speaker 4: sense to me, and so on. So there, certainly, when
48:41
Speaker 4: you said what's next, it depends on whether you're talking
48:44
Speaker 4: about in the next twenty four hours or like this.
48:48
Speaker 3: Year gives our audience both sort of specific, helpful things
48:51
Speaker 3: to look forward to in the short term, and then
48:54
Speaker 3: I mean, when the books come out, we'll definitely stick
48:56
Speaker 3: the links on the podcast, because you know, I would dream,
49:00
Speaker 3: I'm sure everyone would. So I've been speaking everyone. Thanks
49:05
Speaker 3: for listening. I've been speaking with Art Kaplan about a
49:07
Speaker 3: host divisions and bioethics and a politicization which I keeps
49:10
Speaker 3: stumbling over of medicine and health. Art, thanks so much
49:14
Speaker 3: for being with me.
49:15
Speaker 4: Thank you for having me.
49:27
Speaker 1: This podcast series is a production of the Health Ethics Lab,
49:30
Speaker 1: and I am grateful to colleagues in the Department of
49:32
Speaker 1: Medical Sciences, the IHS Library, and the Hackensack Bady in
49:35
Speaker 1: the School of Medicine for making this collaboration possible. To
49:39
Speaker 1: learn more about our work or to engage with the
49:41
Speaker 1: series content, reach out to me Brian Pilkington at Brian
49:45
Speaker 1: dot Pilkington at hmh N dot org.