The Happiness Lab with Dr. Laurie Santos - Making the Grade

Episode Date: November 19, 2019

From school grades to fitness trackers, we're all being ranked and rated on a daily basis. This is having a huge impact on our happiness and preventing us from living our lives to the fullest. Can giving up on grades radically improve our wellbeing?For an even deeper dive into the research we talk about in the show visit happinesslab.fm Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

Pushkin. that one filled with show tunes. More of you finding Gemini is because you know you always like them. More of you dating with intention because you know what you want. And you know what? We love that for you. Someone else will too. Be more you this year and find them on Bumble.

I want you to think back to your school days for a second. What was the worst grade you ever got? How did it make you feel? And now think about the best grade. How was that? Grades. Even decades after graduation, we can still remember what those marks felt like.

And it makes sense that grades affect us so deeply. Because they're important. I mean, they're kind of synonymous with education. Aren't they? Well, it turns out, not really. In fact, grades are a relatively new invention. For almost seven centuries, schools got by without them. As a professor myself, I find that incomprehensible.

I mean, generation after generation of scholars completed their studies without anything akin to a grade point average. How could my predecessors tell students apart? How did they sort pupils who worked really, really hard from those who just phoned it in? Back in 1785, all that changed. So we have the stuff that Karen found for us today, yeah? I recently went on a pilgrimage to a special spot at Yale where I teach, the Beinecke Library, in order to see an important document, one that's kept alongside a copy of the Declaration of Independence and one of the oldest pieces of literature in the world.

I can just, I wash my hands, but I can just open it and it's like not going to break it. I was able to hold the Diary of Ezra Stiles, seventh president of Yale University. So cool. So the important part is right here. On April 5th, 1785, he recorded the details of an exam he'd conducted that spring Tuesday with 58 of his students.

My colleague Mike Morand pointed me to a short but revolutionary footnote. 20 Optimi, 16 Second Optimi, 12 Inferiores Boni, 10 Pajores. In the unlikely event that you're someone who doesn't speak Latin, let me translate for you. Stiles was splitting his students up into four different grades, from Optimae best to Pejoras worse. With this tiny footnote, just a few lines, it's argued that Stiles invented the 4.0 grading system we still use today. I mean, this is amazing. It's like a single line, his handwritten text, and the biggest thing in education that shaped our history. It's right there. In my hand, I got to hold the first ever grades. Nowadays, we don't just have GPAs.

We have SATs and GREs and advanced placement tests and everything in between. It's estimated that the average American child takes more than 100 standardized tests. But we don't just grade in education. We think ratings are a good incentive for all our behaviors. And that means we're constantly being evaluated. From the number of stars in our Uber driver rating, to our positivity percentages on eBay, to a performance review on the job.

We seem to love being measured. And when we get good grades, it feels great. All those A pluses, the gold stars, those little smartphone vibrations when we hit our goal. They encourage us to become better, more virtuous people. Or do they? Are chasing these incentives really as good for our happiness as we think? Our minds are constantly telling us what to do to be happy. But what if our minds are wrong? What if our minds are lying to us,

leading us away from what will really make us happy? The good news is that understanding the science of the mind can point us all back in the right direction. You're listening to The Happiness Lab with Dr. Laurie Santos. The first time I unboxed it, I felt kind of like a dweeb. This is Emma Lord. She writes for Bustle.com. Back in 2014, she broke her foot. I couldn't run for a little while while I was waiting for a fracture to heal. And that's kind of how the whole thing started was I was pretty much told not to run for like six weeks. And to me, that kind of seemed like a nightmare. Emma was worried she wouldn't be able to stay in shape while she was injured. So her mom bought her a new step tracking device, a Fitbit, hoping it would make

her feel better and keep moving while she healed. But I, you know, the first day I used it, it did that thing where it buzzed when I got to 10,000 steps. And I was like, ooh, like, this is such a nice feeling. I just got instant validation from it. And then I was just kind of hooked. Emma quickly experienced what science shows happens when we start grading our performance with incentives like a Fitbit buzz. We humans are like little lab rats when it comes to external rewards. Those buzzes and good grades and gold stars work really well. They change our behavior quickly, but often more quickly than

we expect. I guess after that first day, the baseline goal was to always hit the 10,000 steps. And then, you know, it started getting to this threshold where you're like, oh, if I can do 10,000, I can do 15. And that was when Emma started seeing the problem. External rewards like the buzz of a Fitbit are so powerful that they often work a little too well. I think the first moment I felt myself becoming a little bit addicted to it was when I realized I was suddenly getting on the metro two hours before work just so I could get in the 10,000 steps before work because I just like wanted that validation like really early in the day so it was going to be like off my conscience which is like such a weird thing to think about because like nobody was gonna the police weren't gonna come for me if I didn't hit 10,000 steps that day but I just like felt better after it had buzzed.

The scary thing was that the Fitbit wasn't just affecting Emma's happiness. It also started affecting Emma's relationships. When I got a new job once and there was a Fitbit like leaderboard to see who had the best steps and some guy in the office had like 30,000 and I went out that weekend and crushed it. And I like came in the next day and I was like, I got 35,000 and like nobody was pleased with me. That was like not the way to make friends. The level of competition Emma experienced with her Fitbit was reminiscent of another time in her life when she felt super competitive back in school. I came from one of the most competitive school districts in the country.

So it was like one of those things where it was like the Hunger Games in there. So I definitely do think that this is related to that in some ways. I definitely was one of those kids who was very, very manic about my grades. In 2015, Emma shared her experiences in an article on Bustle entitled, 19 Very Real Emotional Struggles of Having a Fitbit, or Does Your Fitbit Have You? I thought it would be, you know, relatable to other people who are kind of going through the motions on that too. And weirdly, I got more response from that article than maybe anything I've written on this entire site. Because, you know, it is such a relatable kind of mania, especially because, you know,

I think people are so confused about where that compulsion is coming from that it's almost a relief to be like, oh, I'm not the only crazy one. But despite her own experiences with Fitbit and the response to her piece, years later, Emma's still tracking. You know, even after the foot injury healed, I like found myself still counting even when I was running. And that was like something I'd never really felt the need to count before just to like have that number there and to like know exactly how many steps I had in a day. I mean it's been four years and I'm still doing it. Emma's experience shows that seemingly innocuous benchmarks can quickly change our behavior for the worse. But they're more insidious than we realize. Every external reward has the power to turn love into hate and virtue into vice. They can even relentlessly play

on our most primal fears. The Happiness Lab will be right back. We're so done with new year, new you. This year, it's more you on Bumble. More of you shamelessly sending playlists, especially that one filled with show tunes. More of you finding Gemini's because you know you always like them. More of you dating with intention because you know what you want. And you know what? We love that for you. Someone else will too. Be more you this year and find them on

Bumble. Where do you stand on Obamacare? It's one of the most bitterly divisive issues in U.S. politics today. I bet you have a pretty strong opinion about it, so what do you think it would take to shift that opinion significantly? Would you believe me if I said I could manipulate your view with some arbitrary incentive, like giving you a fake grade? Let me explain. Back in 1961, Robert Bostrom and his colleagues surveyed more than 200 students on a couple hot-button issues. They asked whether America should legalize gambling and if the nation should adopt socialized medicine.

A few weeks later, all of the participants were assigned to write essays about these issues. But, and this is crucial, they were asked to defend the very view they had staunchly opposed. People who viewed gambling as an evil had to write in support of casino owners. Those who saw socialized medicine as creeping communism were told to act as its cheerleaders. The scientists collected the essays, but didn't even bother reading them. Bostrom and colleagues knew that the simple act of writing about the opposite view was likely to soften everyone's opinions, changing their minds slightly. But what effect would smacking an arbitrary grade on those essays have?

The next day, the researchers handed them back, randomly giving a third of them an A, a third of them a D, and a third no grade at all. After seeing their marks, students took the original survey again. So what happened? Students who got no grade, or a bad grade, a D, changed their minds a bit. But something much more incredible happened to the group that got an A. Remember, the grades were given totally randomly. The A-graded essays weren't better or more thoroughly researched than the others. Nevertheless, students who got that fake A shifted their views more significantly

than those who got a bad grade. The simple act of getting that A caused students to change their core beliefs. Isn't that chilling? Views we hold dear can be swayed by the simple act of evaluation, even if that evaluation is totally bogus. Let's play a little game. It's called Unscramble the Letters. I'm going to give you a series of letters, and you need to turn them into an English word.

Here's an easy one. Just three letters. Ready? K-O-A. Time's up. Did you get it? The answer is oak. Here's a harder one. Five letters. Ready? C-L-P-A-E. Time's up. The answer? Place. And now an even harder one. It's got nine letters. Ready? O-N-V-O-T-U-I-L-E. Time's up. The answer?

Evolution. Think about how much you enjoyed playing this game. Unless you're a huge puzzle fiend, the last one with nine letters might have been a bit taxing. The first one with three letters probably wasn't that great either. It was a little too easy to be fun. I bet the one in the middle was just right. When playing a game like this, we prefer puzzles that are hard but doable. Those are

the ones we tend to enjoy the most. The same holds for little kids. Back in the 70s, child psychologist Susan Harder tested sixth graders on anagrams just like this. She gave them super easy ones with just three letters and ones with just three letters and ones with six letters that were pretty tough for children their age. What did she find? Overall, the kids were happiest when pushing the boundaries of their abilities. They even smiled almost twice as much when doing the harder puzzles. But what happens when you throw grades into the mix?

To test that, Harder told a different group of sixth graders that the puzzles were part of a school exercise and that they would be graded on their performance. The result? It's actually heartbreaking. Here's how Harder described it. Children working for grades chose significantly easier anagrams to perform. Not only did subjects respond below their optimal level, but they manifested less pleasure and verbalized more anxiety. When working for grades, the kids did worse, felt worse, and aimed lower. Grades can take experiences that our minds normally find really enjoyable and turn them into a source of dread. My earliest memory of this was actually when I was in seventh grade.

This is Tracy George. She spent her whole career advising students suffering from severe academic stress. She's seen firsthand how grades can become a dangerous obsession, how they rob students of joy, and even worse. I was going to a private middle school outside of Cleveland, Ohio, And even worse. I was going to a private middle school outside of Cleveland, Ohio, where I'm from. And one day, a girl I know was crying at her locker, right? It was in the middle of class. She kind of snuck out.

I left to go to the bathroom and she was there alone crying. And I asked her what was going on. And she said she had gotten her first B. And she was so worried she would not be able to get into the school she wanted to go to. And she had already picked whatever Ivy League she wanted to go to at that time at 11 or 12. And it was really hard to see that, that she was so distraught and so worried about and really terrified. I mean, she was crying and almost like shaking about what this would mean for her future. And it was the first time I realized I really wanted to help people and students, growing adults, learn what is important to them.

Today, Tracy is the founding director of the Good Life Center at Yale University. Tracy and I teamed up to develop this new resource on campus in order to improve student well-being. Note the irony here. The very college where GPAs were invented now employs Tracy, as well as a host of other staff members, to deal with the fallout of that 200-year-old system. At Yale, there's a long, long wait list to see a mental health counselor here. And that's really one of the purposes of the Good Life Center is to create a space for this overflow of where do students go when they need to learn how to manage this daily fear, this daily

stress, this daily anxiety. And this isn't just an Ivy League problem or a Yale problem. This is the thing that colleges are seeing nationwide, right? Right, absolutely. This is an American thing. This is our country and how we are approaching education. And it's really detrimental and is breaking students down. It's one thing to feel a little stressed about getting your first B or to get a bit neurotic about missing your Fitbit buzz. But that's not what we're talking about. College mental health centers aren't just dealing with a few obsessive, stressed-out students. We are facing a real epidemic. In a national survey, more than 40% of college students reported they're too depressed to function. More than half of current students

say they feel hopeless a lot of the time. More than 60% said they experienced overwhelming anxiety. And more than 1 in 10 say they've seriously considered suicide in the last year. And these are not numbers that we should be seeing in this young population. This is when their brains are continuing to form. They're starting to figure out who they are, what they want to do in the world. This isn't just a surface level amount of stress or worry. It's really this fear-based reaction, just like I had experienced in seventh grade, this fear about what it will mean for your future, really far down the line.

What's most disturbing about all this fear and stress isn't how it's making students feel. It's affecting students' physical health, the basic way their bodies function. And so this constant low-level stress has a trickle-down effect of physical effects like our higher blood pressure, higher heart rate, quicker breathing, which is the activation of our sympathetic nervous system that was designed to help us fight off an animal or flight, run away from an animal, in a very direct way with our evolution. Like a tiger is attacking us, basically. Right, right. There is a tiger in the bush and we need to respond. So our muscles tense as if

we're actually getting ready to hit something or run away. Our heart rate goes up. Our blood pressure goes up in order to get the blood to our muscles to activate those muscles. And a lot of functions decrease that we don't need for immediate survival. Like we don't need digestion, we don't need reproduction, we don't need a lot of major systems to survive in the moment. And there's a ton of research that shows regular fight or flight response causes chronic stress in the body and has a trickle down effect of health impacts. The problem is we see this system activated and students see these little lions and tigers and bears behind every bush in their daily modern lives. So it's not a lion, a tiger, or a bear. It's an exam or

a transcript or an application that's actually causing the same reaction. So when you talk to students and you ask about their stress responses, especially chronic stress responses, they often talk about headaches, muscle tension, digestive issues, even reproductive or sexual issues. And they don't realize until they're getting this process, this biological process explained that it's actually chronic stress causing this trickle down effect of physical issues. It's really problematic, especially because I see the most that students are wrapping up their sense of value and purpose as a human in their grades. They're not just being graded in their classrooms.

They're being graded with everything, you know, from their Instagram likes to what their Fitbit is telling them. Absolutely. I've heard some students just in the hallways going like, why didn't this picture get enough likes? Or why did this, like, I stopped getting likes after so many days or whatever. Or why did this, like, I stopped getting likes after so many days or whatever. You know, any app that is designed to support us in a certain activity, like a running app, and even meditation apps, right? So even that's become competitive. Even meditation apps are competitive now? Yeah, it's totally crazy.

I actually haven't opened a meditation app in a while because of this. I mean, even students who come back to my class, the mindfulness class that I teach here at Yale, are talking about themselves as being quote unquote bad meditators. Tracy and I have had lots of conversations about what we can do to fix things. But we both worry it's going to take more than a wellness center. It's going to take major structural changes to how we and our institutions think about external rewards. The culture, the system has to change as well, especially for the school that invented this four-point grading scale. We invented this process.

We're in a great position to try to untangle that a little bit and to give a new generation of students a fighting chance at being functional and happy and successful. But that kind of change is really hard. We might even need to abandon the ways we've educated students since the time of Ezra Stiles. All right, let's get started. Welcome, everybody, to Psychology and the Good Life. Today, what we're going to go through is just a quick introduction to the course. If you've been listening to the Happiness Lab for a while, you know I teach a class

at Yale called Psychology and the Good Life. An entire class devoted to teaching students how to be happier. Over a thousand students enrolled the first time I taught it. This gets back to the reason why I want to teach this class, which is that I actually want to help you. I also want you to find ways to overcome the stress because it's not healthy. But even an Ivy League class devoted to making students happier had to include the one thing that I knew would make my students the most miserable. These are the things, by the way, that you are graded on. We're going to talk about how grades are stupid and you shouldn't worry about them, but I have to give you one because Yale College won't let me teach this course if I didn't. And I wish I didn't have to grade you, but I do.

That's right. Despite everything I just told you, I still had to grade my students. And while showing them the research, that grades don't work the way we think, but I still tried to give them a way out. Like, yo, college wouldn't let me teach this class. It was like, what are they grading? I'm like, nothing, because they don't get any grades. And they're like, no, you have to grade them. But you have a mechanism to thwart this, because you can say, aha, Professor Stitos has to grade me on something,

but I'm going to take the class credit D. Credit D is the Yale version of pass-fail. You get a grade, but there are no A-minuses and B-plus. Just credit or no credit. But I still couldn't force students to give up their grades. They had to elect to take my class credit D, of their own accord. I did a lot to try to convince them. Why do I care? Because everything we're going to learn in the course suggests that grades are really dumb.

You learn less, you're more anxious, and you're less happy. It's basically everything this course is supposed to fight against, but I have to provide you with it. So, just take the class credit D. Like, seriously, I know it's... How many students actually took the class credit D? I don't know, because professors at Yale aren't allowed to know. It's still considered a stigma for a student to choose to take a class without a letter grade, so they get to keep it a secret. 200 years after Yale president Ezra Stiles created grades, this is how deep his beliefs go.

They're so entrenched, they're like a religion. I was starting to lose faith in this system, but to find a path forward, I had to talk to one of the few true heretics who are willing to raise their voices and fight. But if you're asking, should we just get rid of grades? Yes. I mean, grades poison everything they touch. The Happiness Lab will be back in a moment. We're so done with new year, new you. This year, it's more you on Bumble. More of you shamelessly sending playlists, especially that one filled with show tunes. More of you finding Gemini's because you know filled with show tunes. More of you finding Gemini

because you know you always like them. More of you dating with intention because you know what you want. And you know what? We love that for you. Someone else will too. Be more you this year

and find them on Bumble. Writer Alfie Kohn has been America's fiercest critic of our grading obsession for decades. This could be revolutionary. You have to change the way you think about parenting because how many of you out there have offered bribes to get your kids to stop crying? His stark warnings about the dangers of external rewards got him invited on Oprah twice in one year back in the 90s.

You think kids are being punished by the rewards in the long run. Right. But in the short run, it works. That's right. Alfie's classic book, Punished by Rewards, was just reprinted to mark its 25th anniversary. 25 years, longer than my college students have been alive. Alfie's been railing against the creed of Ezra Stiles for more than a quarter of a century. Grades are problematic because of a larger phenomenon of using extrinsic inducements,

doggy biscuits, carrots and sticks, choose your metaphor, to try to make students perform rather than authentically engaging students in dealing with questions, problems, and projects that they find interesting and worth their curiosity. And the three effects of grades overall are, one, they undermine students' interest in learning. To the best of my knowledge, every study that has ever compared students with and without grades in terms of their excitement about the learning has found a negative effect from grades. The second effect is that grades lead students to try to avoid challenging tasks. If they have an opportunity to do that, they will then pick the shortest book or the most familiar

topic for their project. That's not because they're lazy. It's not because they're snowflakes. It's because the system has led them to respond rationally to an irrational demand. I mean, if the point is to get an A, of course, you're more likely to do that if you're doing something easier. And then we turn around and blame the students for not being motivated when the grading system has elicited a very predictable response. And the third effect of grades is that it leads students to think in a shallower or more superficial way. They're less likely to really press to say, how do we know that's true? Or isn't that

contradictory to what we did last week? They're more likely to say, do we have to know this? Is this going to be on the test? And again, the problem is not with the students. It's with the fact of giving grades. Research finds that when you get rid of things like grades and indeed all rewards. Kids spontaneously pick harder things to do. So you can't improve the system by merely tweaking the way grades are done. You've got to get rid of it, which a number of schools have done, including some colleges and high schools and even more middle schools and elementary schools. When I first met Alfie at his home in Massachusetts, I took him a present, a photocopy of that Ezra Stiles diary entry I saw back at Yale, the first grades ever. I thought he might get a kick out of seeing it. I didn't realize how

strong his reaction would be. This is like showing me the first paddle that was used to hurt a kid. This is something I look at frowning. This is not something I treat as a cherished relic. As an educator, that's a tough thing to hear. Alfie is placing the grades I give my students on a spectrum that includes the horrifying practice of corporal punishment, beating my students. That's one thing I've learned from studying this topic for 30 years is that rewards like punishments are ultimately about power if if i if i threaten you with a punishment you do this or i'm going to make you suffer it's obvious i'm trying to control you but if i say if you jump through these hoops here's the goody i'll give you it It should be obvious, but it isn't always, that that's just as much about

control. Because it's treacly, you know, because it's dipped in sugar syrup, we often don't realize this is just as much about doing to rather than working with. Alfie argues that we tend to see motivation as a single entity, when in reality there are two distinct forces which drive us, one intrinsic, the other extrinsic. The first is a hero, but the second is somewhat of a villain. Intrinsic motivation in general just means you get a kick out of whatever it is you're doing. It means you enjoy doing something for its own sake. And that can be reading a book, solving a problem, writing code, painting a picture, helping someone who needs the help, anything. Extrinsic motivation means you do something that's for something

extrinsic to or outside of the task itself, such as getting a reward. And that reward could be money, a grade, a certificate. It could be praise. Good job. That's just a verbal doggy biscuit. Or fear of punishment, which is another kind of extrinsic motivation. So the question, I mean, because you could see someone who really wanted to motivate kids thinking, well, if they are already interested in learning, why don't I add an additional reward on top of that? You know, like two rewards should be better than one, right? Right. The problem is that, first of all, you can't motivate someone other than yourself. And the more you try, the more you paradoxically undermine the very thing you're trying to promote. So, for example, about a half dozen studies have found that children who are rewarded or praised

are less generous than their peers. When you say, good job, I really like how you shared your brownie with Diane. You're so generous. Good for you. That kid just became a little more selfish because you taught her that Diane's feelings are irrelevant. What matters is what you'll get from helping, in this case, a patronizing pat on the head. If you wanted to destroy a child's interest in reading, you should give the kid a prize for reading a book. A, that's manipulative and people don't like to be manipulated. B, it intrinsically devalues the thing for which you got the reward. Now the kid figures, well, reading must suck if it's something they have to bribe me to do. You have reframed it in the person's head.

That's why it's so remarkable to watch little kids who have not yet been graded and rated and ranked and so on, following their interests. You're looking at intrinsic motivation in its undiluted form, where little kids can't wait to figure out how to make sense of those squiggles on the restaurant menu. They want to know, as my daughter asked, are there bones in my tummy? They keep asking us until we give them doggy biscuits for successful answering the question. And then they start asking a different question, which is, do we have to know this? And we're continuing to treat our children, our students, our employees, and sometimes even ourselves in effect like lab animals. It's not just dehumanizing. The research shows it's counterproductive,

not merely ineffective. The students I teach at Yale are far removed from the innocent children Alfie describes. After years of A's and B's, they have internalized the pursuit of grades as the prime motivation for paying attention in class. I worry the idea that they should learn because it brings them pleasure and stimulation is long forgotten. They are way down a path leading them away from their own happiness. The question is not how much achievement do they have under their belts. It's what's happened to their souls. It's what's happened to the desire to figure stuff out that all human beings start with. Many of them are joyless. So we're in this situation where most educational systems are using grades. What's the solution? If you're an individual teacher, you do what you can in the long run by organizing and mobilizing

your peers to change the structure rather than treating grades as a fact of nature, like the weather that's just always going to be with us and we have to cope with. It is not. It's a political decision. And there are plenty of pilot projects and schools showing that you not only can do without grades, but that students do much better without them. As I talked to Alfie more and more, I started to believe it is possible to go back to a world without grades, to what education was like before Ezra Stiles started this new creed. Alfie understands that it's a long road ahead, but he believes the revolution is worth it.

He even thinks our fundamental values, goals like equality and intrinsic worth, depend on it. I think your primary goal should be to help everyone to succeed. If you had to use grades, then you would want everyone to get A's. The idea that there's a little normal distribution, a bell curve, sits in the head of a lot of instructors, even when they're not grading on a curve. Grading on a curve is immoral. There's no other word for it to say that no matter how well everyone does, some of you cannot get the best grade, suggest that it's a war of all against all. The more we tend to see life in adversarial terms where I can succeed only if you fail, the more all of us are dragged down to failure. Even the winners ultimately lose.

So what should you take away from this episode? First, the external rewards aren't all they're cracked up to be. Adding in a grade or a Fitbit buzz might change your performance in the short term, but it'll cost you dearly. Pursuing success on those terms can rob you of the joy you might experience in your studies, hobbies, or even career. And that means we need to find ways to return to our internal rewards. Run because you enjoy the sensation, not to beat some arbitrary number on an app. Take a class to satisfy your intellectual curiosity, not to get on the honor roll.

And make a podcast for the fun of it, not to top the charts. As people and as a society, we need to find ways to reduce these systems of external rewards that we've surrounded ourselves with. It's the only way to return to our childlike joy of learning, just for learning's sake, just because it's fun, just because we dig it. And if you want a completely grade-free way to learn about the other lies of your mind, then I really hope you'll come back for the next season of The Happiness Lab with me, Dr. Laurie Santos. The Happiness Lab is co-written and produced by Ryan Dilley. The show is mixed and mastered by Evan Viola and edited by Julia Barton.

Fact-checking by Joseph Fridman. And our original music was composed by Zachary Silver. Special thanks to Mia LaBelle, Carly Migliore, Heather Fane, Maggie Taylor, Maya Koenig, and Jacob Weisberg. The Happiness Lab is brought to you by Pushkin Industries and me, Dr. Laurie Santos.