Monday, November 9, 2020

Biden Won – So Did Science

The most anti-science, science-denying president of our lifetime was defeated by, you guessed it, science. While the election was close, it still has to rank as one of the biggest ironies in history.

Even so, seeing how tens of millions of people voted against their own self-interest is one of the most baffling and infuriating phenomena I know. It helps to prove that a belief can overpower a fact, how a lie can (shall I say it?) trump the truth. 

The facts and allegations are painful to repeat but, briefly, Donald Trump failed to disclose taxes or foreign entanglements; destroyed immigrant families; encouraged white supremacists; belittled women; covered up ties to Russia; illegally used campaign funds; threatened allies; praised dictators; created economic hardship with a trade war; killed environmental protections; undermined funding for education and the arts; enriched himself and his family at taxpayer expense; threatened political adversaries; mocked disabled persons; disparaged soldiers; attacked the news media; rammed through lifetime appointments to the judiciary; advocated voter suppression and intimidation efforts, and lied to the public – according to fact checkers – approximately 25,000 times.

But put aside his long list of self-serving, amoral, unethical, and likely illegal activities for a moment. It was the COVID-19 issue that Donald Trump handed to Joe Biden. While Trump won in some of the states hit hardest by the virus, the pandemic cost him the election. He and tens of millions of others may have ignored the science, but a bug less than 0.000004 inches across tipped the scales to Biden. 

Trump cowed Republican leaders, tossed the Obama “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents” and all but disbanded the White House Coronavirus Task Force. He called Dr. Anthony Fauci, head of National Institute of Allergy and Infectious Diseases and one of the world’s top infectious disease specialists, a “disaster,” said scientists were “idiots,” and falsely claimed “doctors get more money if somebody dies from COVID.” 

Despite all of that and the desperate efforts to gaslight the public on the seriousness and deadly scope of COVID-19 – a White House press release claimed the president ended the pandemic – Trump could not alter the science of a viral infection. He couldn’t bully the virus away.  He couldn’t short-circuit the careful research and development process required for new vaccines and therapeutics. 

Joe Biden did push a few other campaign issues: Trump’s lack of character, morality, and empathy (“The Battle for the Soul of America”); the assaults on affordable healthcare and attempts to strip protections from those with preexisting conditions, and the diminished standing of the United Sates around the world. In fact, some reports had the economy and health care out-polling COVID-19 as key election drivers.

Yet the Biden team ended up displaying some remarkable consistency in messaging on the COVID crisis. Why? The economy and health care are complex issues. COVID-19 is not. It’s impossible to ignore. The virus is surging again and predictions are the worst is yet to come. Some will continue to claim it’s a hoax, that the numbers are inflated, and it’s not much worse than a bad cold. But the number of cases, positivity rates, hospital admissions, and deaths are hard to argue unless you’re locked into a belief system where no facts will ever penetrate. 

Trump couldn’t help but to respond, not with actions to protect the public health but with more derision. “With the fake news, everything is COVID, COVID, COVID, COVID,” Trump complained at a mostly maskless rally. It was painful to see how he politicized science and it used as a wedge, driving people further apart.

A platform based largely on science, medicine, and public health won this election – barely. We will win the battle against this coronavirus with the right leadership and resources; naming a new coronavirus task force on November 9 was the president-elect’s first major announcement. But the fight comes with a terrible, sometimes irretrievable cost, the result of missteps and misdeeds from a malign, incompetent Administration. 

Like hundreds of millions of others around the world, though, I’m hopeful that in the days and years ahead that facts will matter, and our scientific, political, educational, and journalistic institutions will again be held in the highest regard.

Between blog posts, I invite you to follow me @pauloestreicher.

Monday, August 10, 2020

Three Steps to Save the Presidential Debates

While the president was demanding a fourth debate with his challenger, an opinion piece in The New York Times suggested that debates be scrapped altogether. Yes, the debates have certainly devolved over the years but this is a classic “throw the baby out with the bathwater” reaction. Let’s fix them instead. Here are three changes to elevate the debates and increase their value to the public:


1. Ditch the audience. In her NYT piece, Elizabeth Drew wrote that debates were less about conveying a vision or a plan than they were about upstaging the opponent. “Points went to snappy comebacks and one-liners. Witty remarks drew laughs from the audience and got repeated for days and remembered for years,” she said. She’s not wrong, of course. But it’s the debate format that has helped to create the reality TV atmosphere. The candidates have been playing to the audience; they look for applause or a laugh. Let’s get serious and let’s remove the audience. The point might be made moot because of the pandemic this year but the editorial board of The Washington Post recently endorsed this idea, calling the debates “quip contests.” We’ll gain time, engagement, and potentially more substantive responses. 


2. Level the field. I mean this literally. The candidates should be seated, anchored to their chairs. The freewheeling Town Hall format, where the candidates roam the stage, should be banned. In 2016, candidate Trump tried to intimidate Secretary Clinton when he alternated between standing and pacing back-and-forth behind her. Clinton said he was breathing down her neck, which made her feel "incredibly uncomfortable." Politico magazine called it "the ugliest debate ever seen." Pressing a physical advantage – bullying – must not be allowed. And having the candidates seated will also help mitigate any height discrimination, or “heightism,” where taller people are perceived to be stronger, and better leaders.


3. Check the facts. A consequence of our glorious First Amendment is that political speech is highly protected – essentially any half-truth or lie may be told. While there are plenty of post-debate analyses, it’s too late. Many viewers tune-out after the practiced smiles and forced handshakes. And our brains tend to cling to misinformation even after it's been refuted. We need real time (or near real time) fact checking. If IBM's Watson computer can win at Jeopardy!, why can't we get an indication of veracity while the debate is still in progress? Let’s use technology to help the experts sift through speech transcripts and testimony; almanacs and atlases; laws, regulations and policy statements; credible survey data, and non-partisan news articles, journals, and research reports. Let’s help ensure the public gets the facts and not the flimflam.


While we’re more polarized than ever and fewer people are undecided, more information, more opportunity for side-by-side comparison, is still crucial to the democratic process. In a society that’s increasingly stressed by the health and economic consequences of COVID-19, systemic racism, and so many other issues, political discussion can be dispiriting, infuriating, and sometimes incendiary. But, as Ray Bradbury wrote in Fahrenheit 451, “If you don't want a man unhappy politically, don't give him two sides to a question to worry him; give him one. Better yet, give him none.”

Between blog posts, I invite you to follow me @pauloestreicher.

Thursday, May 28, 2020

My Time with Larry

Larry Kramer, the playwright and AIDS activist, died yesterday at age 84. He left his mark in two different worlds – the arts and health care. He changed me, too.

I was sad to read of his passing but this is not an obituary covering all the details of his dynamic life; it’s a brief reflection starting when we met in 1988. I was the chief representative to the HIV/AIDS and oncology patient communities at drug giant Hoffmann-La Roche and he was on the other side of a conference room table. His first comment to me was, “Bristol-Myers met us in a nicer hotel.”

The year before, I joined the company’s Public Affairs department from the R&D group. There was a need for someone with a technical background to help explain what was coming out of the labs to the general public. I landed in the role and immediately found myself in the middle of history. Roche was one of only three companies at the time that had a late-stage anti-HIV drug development program. Burroughs Wellcome (now part of Glaxo) had the first marketed product, Retrovir®/AZT. Bristol-Myers (now Bristol-Myers Squibb) and Roche had retroviral analogs in the pipeline.

Burroughs Wellcome was reviled by the AIDS community Larry helped to organize. Drug prices were high and communication from the company was absent. There were no best practices, no case studies on how to communicate with patients. It simply wasn’t done. Companies would inform the “learned intermediary” – the physician – and he or she would communicate with the patient.

Today, there’s at least one patient advocacy organization for any given disease. There were only a handful of AIDS groups in those days. Larry and others paved the way for all the rest.

Bristol-Myers decided to meet with the AIDS groups and I began my campaign to convince Roche management to do the same. I remember making a presentation to the Executive Committee and quoted Lincoln: “As our case is new, so we must think anew, and act anew.” It wasn’t the easiest sell. But people realized there were both ethical and business considerations at play – many of the activists were patients trying to save their own lives, and they were phenomenally organized and well informed. The potential benefits of hearing the patients’ point of view and adjusting our own plans were new and valuable concepts.

A letter from Larry’s organization, ACT UP (the AIDS Coalition to Unleash Power) was the catalyst for our first meeting. He once said, “If you write a calm letter and fax it to nobody, it sinks like a brick in the Hudson.” The demands in the letter were copied to a long list of top-tier news media, members of Congress, AIDS activists, and health care policy makers. I wrote back, explained our research initiative, agreed to meet, and copied back the entire list.

Then, my phone rang. “What are you doing writing back to all my constituents?,” he barked. I said, “They’re our constituents, too.”

That was a pivotal moment. Yes, I gained some respect by coming right back at him but the truly important piece was that first step we took into a common ground. Our constituency was their constituency and everyone wanted new, effective medications in the hands of patients as soon as possible. The two “sides” worked to expand access to experimental therapeutics, enroll patients into clinical trials, support NIH funding, and lobby for FDA reform to speed drug reviews and approvals.

The world was changing. The normal course of business – the normal course of life – was disrupted. But progress was made – advancements in understanding and equality, as well as advancements in medical science.

Larry was called a troublemaker and much worse. But at least there was talk back then and a respect for science. It’s worth noting that ACT UP’s slogan was Silence = Death. With COVID-19, I’m afraid Silence has been replaced by Division and Ignorance. Maybe a little Larry Kramer-style agitation wouldn’t be such a bad thing to get people think about the state of our society and the status of our health care system.

Between blog posts, I invite you to follow me @pauloestreicher

Tuesday, February 18, 2020

You Don’t Get It… and Don’t Know It

Like it or not, we don’t “get” a lot of things. Most importantly, we don’t get ourselves. 

The Harvard Business Review recently re-posted an article by Tasha Eurich where five years of research showed “95% of people think they’re self-aware, [while] only 10 to 15% actually are.” It’s a consequential finding, despite all that’s been written on cognitive dissonance and self-awareness. Think about how many and how deeply personal and professional relationships are affected by our lack of personal insight. 

A survey I conducted a few years ago on self-perceptions of meanness and niceness showed “respondents felt others are much meaner than they perceived themselves to be.” Twice as many people thought they were never mean versus those who said they were sometimes mean. In the workplace, “un-self-aware colleagues aren’t just frustrating; they can cut a team’s chances of success in half,” Eurich wrote. These individuals can spur “increased stress, decreased motivation, and a greater likelihood of leaving one’s job.” 

This is big. Unchecked, it’s life and career changing. 

It calls for intervention and the resolve to make it happen. No one likes conflict but it’s a necessary step. In Toxic Team Treatment I wrote, “Few go looking for a confrontation but it’s a critical part of working in teams, and supervising and leading others. Having the courage to take some action is not the same as “making waves.” Making waves connotes stirring up trouble and creating new problems. This is about airing and addressing the issues by asking questions, and seeking clarifications while showing respect for different views.” 

But productive dialogue requires mutual trust. “For someone to truly be open to critical feedback… they must fundamentally believe that we have their best interests at heart. When trust is present, the other person will feel more comfortable being vulnerable, a prerequisite to accept one’s unaware behavior,” Eurich said. 

If there’s a trusting relationship, go for it. If you don’t have it, find someone who does. Speed matters, just as it does in most situations though Eurich suggested, “If possible, wait until your colleague expresses feelings of frustration or dissatisfaction that (unbeknownst to them) are being caused by their unawareness.” 

Still, don’t allow an issue to become a crisis. Act. Follow up. And be empathic – understand that it’s not only about embracing the challenge to help yourself and others; others must be willing – or persuaded – to embrace the feedback.

Between blog posts, I invite you to follow me @pauloestreicher.