The Prof G Pod with Scott Galloway - Pandemic Learnings with Dr. Abdul El-Sayed

Episode Date: December 31, 2020

Dr. Abdul El-Sayed, a physician, epidemiologist, educator, and progressive activist, joins Scott for our final episode of 2020. They discuss the intersection between public health, public policy, and politics as well as what a Biden-Harris administration can do differently on COVID-19. Abdul is the author of "Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic," the podcast host of America Dissected, and a Political Contributor at CNN.  Follow Abdul on Twitter, @AbdulElSayed Learn more about your ad choices. Visit podcastchoices.com/adchoices

Episode 42, the atomic number of molybdenum. In Star Wars, the rise of Skywalker, the festival of the ancestors on planet Pasaana is held every 42 years. My ex-wife used to say I was obsessed with Star Wars, and I'd say, well, may divorce be with you. Go, go, go! Go! Welcome to the 42nd episode of The Prop G Show and the final episode of 2020.

I hate to see 2020 go. Oh my gosh, get the fuck out of here. Anyways, in today's episode, we speak with Dr. Abdul El-Sayed, a physician, epidemiologist, educator, and progressive activist. He's also the author of Healing Politics, A Doctor's Journey into the Heart of Our Political Epidemic. That rolls right off the tongue. The podcast host of America Dissected and a political contributor at CNN. We discuss the intersection between public health, public policy, and politics, as well as what a Biden-Harris administration can do differently on COVID-19. We hope you enjoy our interview, and we'll be back with our regularly scheduled programming, office hours and all, on January 14th. Coming up next week on The Prop

G Show, we take a look back on the 2020 predictions we got right and the ones we got wrong and bust into what's in store for the new year. That's right. Our predictions for 2021. What a thrill. Anyway, we'll be right back after this break for our conversation with physician and epidemiologist, Dr. Abdul El-Sayed. Support for this show comes from Constant Contact. You know what's not easy? Marketing. And when you're starting your small business, while you're so focused on the day-to-day, the personnel, and the finances, marketing is the last thing on your mind. But if customers don't know about you, the rest of it doesn't really matter. Luckily, there's Constant Contact. Constant Contact's award-winning marketing platform can help your businesses stand out,

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ConstantContact.ca and start your free trial today. Go to ConstantContact.ca for your free trial. ConstantContact.ca Dr. El-Sayed, where does this podcast find you? I am in Ann Arbor, Michigan. So you think a lot about the intersection of healthcare and society. What, in your view, what has the pandemic revealed about social and economic inequality and insecurity in our country? Yeah, it's a really important question.

And I want to preface my comments here by saying two things. Number one, viruses are naturally occurring, but pandemics are a function of human decisions. And then the second is that- Or indecision, right? Indecision, that's right. Or wrong decision. And the second is that so much of public health is about how you are prepared or ill-prepared for a circumstance. And the part that we keep ignoring, right? I mean, the name of the pandemic is the coronavirus pandemic, but it's not as much just about a particular pathogen, though this one is uniquely well-suited to travel quickly and

take many lives. It's also about the nature and the circumstances of the host and the circumstances of the environment in which all three of these things interact. And I think what we need to understand is that we were a society that was set up to be impacted deeply by this particular virus. I mean, we account for nearly one in five of all global recorded pandemic related deaths. And yet we are the richest, most powerful country in the world. And I think the circumstances of our inequity, the fact that we've seen corporate capture in critical industries that offer or ought to provide public goods like housing and in particular

healthcare, and the fact that too many people were stuck choosing between protecting their lives or protecting their livelihoods in a society that does not believe that we should be able to provide for people in extenuating circumstances, all led to the kind of rapid transmission and ultimately the volume of deaths that we've experienced in our society. And all of that was, I hate to say it, preyed upon by a demagogue who leveraged this pandemic as he has leveraged all of the structural inequity in our society to divide people and to undercut any of the institutions of trust that we should have been able to rely upon to give us good, accurate information and to empower us to protect ourselves and our loved ones.

So it's fairly clear at this point, we had a lot of comorbidities as a nation, if you will, that made us especially vulnerable. What would you say are the two or three biggest comorbidities as a nation, if you will, that made us especially vulnerable, what would you say are the two or three biggest comorbidities that have made, that have resulted in over-indexing in terms of death and infection relative to the rest of the world? I'd say the first one is massive inequity, whether it's racial inequity or socioeconomic inequity. The second, I would say, is corporate capture of critical institutions, whether it's our political system, our housing, our healthcare, our economy across a number of different sectors, and the kind of, you know, monopsonistic behavior that allows those corporations in those sectors to practice. And then the last is I'd say just profound polarization and the capacity for misinformation to flow because of that polarization, because of the mistrust that it breeds in our public institutions, and because of the nature of our communication on social media that is primed, to get back to the second point, to sell us stuff by capturing

more and more of our attention. The inequality or inequity, I mean, there are other nations with greater inequality and greater inequity that haven't botched us as badly as us. Say more because I agree with you that our most vulnerable, it feels like we've outsourced, just as we've kind of slowly but surely outsourced war to military families, it feels as if we kind of outsourced the pandemic to people of color and frontline workers, and quite frankly, people that just didn't have as many options or people who are in a business, healthcare, who are naturally on the front lines and I don't need to diminish their efforts. But there are other nations that have

even greater income inequality that haven't fared as poorly as us. Isn't a lot of it just, didn't we just come into this thinking we were just exceptional? Wasn't that kind of the comorbidity here that we thought that our exceptionalism would somehow be some sort of immunity from this thing? I think that is definitely part of it. But what I will say is that, you know, inequality in our society is so much more multifactorial than it is in other societies. So it's not just income inequity, but it's also geographic inequity, and it's also certainly racial and ethnic inequity. And I think the combination of those three for so long in our country, considering the fact that there's been 401 years since the first enslaved people were brought to our country, that it has undercut the capacity to fully and deeply invest in public goods. And I think those public goods are so critical to explaining what happened here and why.

And I think that's yielded sort of an exceptionalism. We have an extremely high income society, the richest, most powerful country in the world. But we haven't appreciated that the social forces, I think, have decayed so much of our ability to provide some basic things to our people, whether it be healthcare or housing or a stable job that pays a fair wage, that puts a good roof over your head and clean air in your lungs and clean water in your cup. So I think those things together, right, in the way that they've sort of moved together are really what created the circumstances where the pandemic hit us and hit us so hard. So you served as the health commissioner of Detroit, Michigan. Talk to us about the impact

of COVID-19 on Detroit relative to other major metros. Yeah. Detroit, especially in the first three months of the pandemic, was hit exceptionally hard. It really is an example of the points that I was making. And so far as my job back in 2015 was to rebuild a department that had shut down its public health department when it went through bankruptcy in 2012. Now, we're having this whole conversation about defunding. The city of Detroit defunded its public health department. And my job was to rebuild it. And that means that Detroit is functionally facing down this pandemic with a health department that's about five years old. And then beyond that, right, Detroit is the poorest major city in America. There are as many McDonald's in Detroit as there are grocery stores. And it is a place where because of the nature of a concentrated and chronic poverty, a lot of the basic services that a lot of communities take for granted, Detroit is just now being able to bring it back online. I mean, one of them,

for example, is water shutoffs, which the mayor just declared an end to water shutoffs. But before that, Detroit was shutting off water on thousands of people every single year. And so, you know, of course, when the pandemic hits the city of Detroit, it hits it exceedingly hard and it hits black folks substantially harder than it hits everyone else. And the numbers told the story. The good news here is that since that early wave, Detroit has fared relatively well in terms of overall transmission and death. But still, that is after the deaths of too many people to count and economic devastation, the consequences of which we're just starting to fully understand. And if we could go back in time and you were

advising, that sounds unlikely, but you were advising the Trump administration and they would actually listen. What two or three things could we have done differently to have much better outcomes? Number one, you need to vastly increase your investment in the CDC and other public health agencies across the country. You need to make sure that your pandemic preparedness unit and your pandemic playbook are up to date and that we have the resources in terms of PPE and ventilators stockpiled in the way that we may need them. And you need to do everything you can to fight this pandemic in Wuhan before it spreads. I mean, that really is the most important thing. The thing about a pandemic is that, you know, it's kind of like a house fire that takes down the entire house. Every house fire starts small. It's rare that the entire house just catches a blaze. It's usually the case that you have like a fire in a toaster or a fire that, you know, escapes the fireplace and then burns a rug and then it takes down the house after some time. And, you know, the fire in a toaster equivalent was when the pandemic was still small and still containable in Wuhan. Now, it's not to say or take anything away from the fact that the Chinese government

have not been good faith actors and did everything they could to silence the circumstances coming out of their country. But, you know, it is a measure of our politics where we are able to sideline, you know, the kinds of conflicts that keep us from being able to offer support in another country to take on that pandemic. And, you know, you think about the Ebola pandemic or epidemic in West Africa and the capacity that our country had to fight it where it was. And despite the fact that it took way too many lives, tens of thousands of lives in West Africa, it never really spread meaningfully from there. That didn't happen with coronavirus, partly because of the nature of the virus itself. It's far more infectious than Ebola was, but also because we were structurally incapable of being able to keep it contained where it was,

and then it spread all over the world. And once it spread all over the world, fighting it and taking it back down was going to be a far bigger lift than it would have to keep it contained in the first place. And what would your advice be for the next, looking for for the next six months? Yeah, a few things. Number one, we've got to address the way that the virus has been polarized and politicized in a way that, you know, has turned wearing a small piece of cloth on your mouth to protect yourself and other people from a highly infectious and deadly virus into a referendum on your belief in liberty, that has to go away.

And I think part of that is just leadership, is that a constant steady drumbeat of reassurance and talking about why we're doing this? The second is that we've got to get the vaccine deployment right. There have already been a couple of bumps in the logistical piece. And to be clear, deploying a vaccine is a three-step thing, right? It's not just the scientific lift to create a safe and effective vaccine, which we've done. It's also the logistical deployment, and it's also the communications work of reaching deep into

communities to talk to them and be transparent about what we know and what we don't, and about the nature of the vaccine. And I think there's still a lot more work to be done there. So getting that piece right is critical. The third is being able to think through the economic consequences, right? Because if people are struggling to be able to secure their livelihoods, they're not necessarily going to do all the things that you ask them to do to protect their lives. And people should not have to think about what happens to prevent the next one, right? Just because the coronavirus hit us and it's been, you know, a hundred years since the last major pandemic does not mean that there's not another virus sitting there in a bat reservoir somewhere waiting to spring. And so we've got to get right all of these structural challenges that created such a difficult pandemic. And I would say that that starts with real serious healthcare reform, I believe deeply in single-payer healthcare, a national health insurance program, Medicare for all. I also believe that that means really, really asking big picture questions about

the ways that major corporations have leveraged this moment to suck up the capital that exists and obliterate their competitors and what that means for the job market moving forward. We'll be right back. Hey, it's Scott Galloway. And on our podcast, Pivot, we are bringing you a special series about the basics of artificial intelligence. We're answering all your questions. What should you use it for? What tools are right for you? And what privacy issues should you ultimately watch out for? And to help us out, we are joined by Kylie Robison, the senior AI reporter for The Verge, to give you a primer on how to integrate AI into your life. So tune into AI Basics, How and When to Use AI, a special series from Pivot sponsored by AWS, wherever you get your podcasts. So no doubt, structural change is needed, whether it's, I love the term corporate capture or inequality that manifests itself in healthcare that's wildly variant based on your income and your zip code and your ethnicity. But just over the next six months, so for example,

do you think we should pay people to get the vaccine or withhold certain benefits? How do we get to herd immunity as quickly as possible? Amongst my cohort, who I considered a very privileged, educated cohort, I'm hearing this bullshit narrative of, I'm going to wait. I'm going to wait to see if there's any short-term. And I think to myself, my God, this isn't about you. My fear, doctor, and tell me if you think there's any validity to this fear, is that we have a long line right now, frontline workers and seniors. And I worry that all of a sudden we're going to wake up sooner than we think. And there's going to be no one in line because a bunch of people who don't feel personal risk are going to decide to wait. Should companies

be mandating this? Should we be offering incentives? What are your thoughts? Well, I'll tell you this. I think there's a lot that we can do with honest, consistent, evidence-driven public communication. And you're already starting to see polls move in terms of overall support for getting vaccinated. I also think that, you know, recognizing the realities of getting vaccinated for your own ability to, you know, move about your daily life without having to ask whether or not you may contract this virus is a pretty steep incentive. And I also think that the more people who get this vaccine, who people know and trust, uh, the better. And, you know, I, I do think it, you know,

it's a function of the way that we deployed the vaccine that people's doctors are going to get vaccinated before they do. And that's a good thing, right? Because the, the, still the most trusted person that people go to, uh, is their own personal physician. If their physician said, look, you know, my shoulder has already been vaccinated twice and I think yours should be too. It really says something. Cause I'll tell you as, you know, as, as, as someone who's a physician who doesn't practice, right. I remember in med school, the first question everybody would ask is what would you do? Right. And and when doctors can say, well, I already did it. It really does matter. I do think you're right that there are going to be some folks who are going to hold out and who are going to wait. But I wouldn't discount what we can do by just sheer consistency and transparency. What I

will say is that obviously different workplaces are going to have different regulations, just given the fact that the nature of different workplaces is different in terms of risk. But I also think that compelling people to take the vaccine tends to have a unhelpful consequence in terms of ramping up the same kind of conspiracy fears that tend to drive the hesitancy in the first place. And so, you know, I'm not a fan of forcing people or compelling people, at least not now, you know, in the short term. And I'm not a fan of withholding certain benefits for people who don't get vaccinated, because I do think that that tends to drive up a lot of the fear. I think over the long term, right, if coronavirus stays with us

over time in the same way that, you know, people have to get their children vaccinated for mumps, measles, and rubella, that it may be the case that a coronavirus vaccine is part of that package. But for right now, with the kind of added attention that we have on this and the kind of fear that I hear, I just think being deeply transparent, honest, and relentlessly optimistic about what we know about this virus, which is entirely substantiated by the evidence, I think will get us most of the way there. So a question about the politicization of the pandemic. So on the far right, we have a lot of governors and a president who played down the severity, who talked up the solution, essentially didn't rally the troops, kept

giving V-Day speeches when they should have been giving D-Day speeches. I think that's been well-documented, or I think, at least in the media I watch, I hear about it every day. Do you think there's any blame that should be assigned to the far left that either university chancellors inviting people back to colleges in the midst of the pandemic, or even I would look at certain counties in California where they institute a statewide lockdown when there are certain communities where there is a disproportionate number of immigrant workers who are living in closer quarters and infections are running more rampant,

but the governor is less likely to impose, I don't know, variable restrictions because he doesn't want to come across as racist. Is there a certain woke ideology that's also been damaging in terms of inhibiting the spread? Well, I'll tell you, I think that what we need to do, right, and what I'm worried about largely, big picture, is that there has been a certain erosion of trust in institutions and in science and an unwillingness to be led by what the science suggests to us. And at the same time, right, I am somebody who believes that public health is inherently political, right? And, you. And what I'm asking for is not a politics of ideology. What I'm asking for is a politics that is led by the science and that seeks to leverage the resources that we have to do the things that the science tells us are going to improve, extend, and improve the equity of access to long, healthy lives over

the long term. So, you know, I worry about, you know, any strain of ideology that tells us that government is part of the problem and cannot be a part of the solution. And that tells us that we cannot do basic things or know basic things about how to help ourselves. And obviously, given Trump and Trumpism, that has been extremely dangerous on the right, where you've had, in effect, the Republican Party just completely run against the science on this. But also, you've seen strains of that kind of thinking on the left as well. And I think we do have to call out anything that we see that tells us that what we're hearing is not real, or that this is a hoax, or that government is in on it. And I think that's a really, really important

thing to keep in the back of our minds. That said, you know, sometimes we're going to get it wrong. And, you know, that's the nature of making public health policy in the short term. And just getting it wrong while you're trying to balance out perfectly fair ideals, right, around equity, I don't think is sort of a misplaced strain in our politics. I think it's just misjudgment. And given how hard it is to make smart policy in the short term and in real time, I think we've got to give our policymakers a wide berth, but also hold them accountable. You can make a mistake once, but you've got to correct

quickly and you've got to not make that same mistake again. So the CDC, there's just no doubt about it. If you keep cutting the funding, I think we spend $700 billion in the military. We spend, depending on who you talk to, $7 to $12 billion on the CDC. And it doesn't appear that we're being invaded from Canada or Mexico, yet this thing invaded us with lightning speed. It feels as if our priorities are all screwed up, or at least our capital allocation. But didn't the CDC sort of shoot itself in the foot, both with some of the recommendations around or saying that masks don't work or screwing up early testing? Haven't they? I mean, quite frankly, didn't the CDC, at least early on, kind of botch this?

Definitely when it came to the testing, there were some mistakes made at the CDC that were terrible. And when it came to the masking policy, this was actually something that is one of those mistakes that happens when you're dealing with a virus that's only ever been in humanity at that point for a couple of months. And the thinking was that this coronavirus, this is a strain of coronavirus, and we've dealt with coronaviruses in the past. SARS was a coronavirus. MERS was a coronavirus. And neither of those viruses were transmissible in asymptomatic people. And we had thought that given that there were limited numbers of masks at the time and doctors scrambling to get basic personal protective equipment, that telling folks to wear masks wasn't scientifically cogent because we had thought that this was spread only among symptomatic people and that we should keep the masks, therefore, for people who are dealing with symptomatic people who are, you know, the frontline healthcare workers and that a run on masks would mean that there weren't going to be enough masks for them. Obviously, we got that wrong. And when we learned that this virus was

spreading, in fact, most intensely, pre-symptomatically and sometimes asymptomatically, that people should be masked all the time, the mistakes that were made around masking, you can understand that in the absence of information, you use the best analogy, which is other coronaviruses, and that may lead you astray and you reverse course. What also has happened with the CDC, and this is something that I think over the longterm, we really need to protect the CDC from, is that it was politicized. Basically, the Trump administration used the likeness of the CDC without using the essence and the evidence base that the CDC brings to bear. And the CDC got, in effect, railroaded off and the name of the CDC was put on a bunch of things that were really purely political. That should never happen again. And part of that is that, you know, it's plausible that we rethink the governance of the CDC so that it's not, you know not so overtly potentially open to political interference, kind of like we do with the Federal Reserve.

But that was something that we really need to fix. So some of it is just frank mistakes that are inexcusable. Some of it was politicization, and some of it was the mistakes that you make when you're dealing with a new virus and the science isn't quite there. So I'm a glass half empty kind of guy, but that doesn't mean I'm wrong. And I look at this new strain or this, that the fact that the virus appears to be evolving, specifically some of the reports coming out of the UK, which is exceptionally more contagious. I look at the cold comfort or that the imminent or the arrival of the vaccine creates an environment where we're

less stringent or less disciplined about our behavior. And then the politicization of the vaccine where people seem to want to ignore data and ignore science and maybe put it off or not take it. And I see the potential for just disaster the next three months. Where do I have that wrong? Isn't this about to be the worst three months of the pandemic? And I hate saying that. You're not wrong. And I think it is those things. It is also the fact that it has been a long year and people need and want comfort from other people. And that's hard to get when you're still physically distanced and the virus is spreading like wildfire. You know, the thing that gives me hope is that this is all within our own control, right? You know, social forces, the ones that you discussed are what they are. But people I see all the time making great decisions and foregoing things that

otherwise they would do to protect themselves and their loved ones. And it's going to be those decisions that decide just how deadly the next several months are going to be. The other part of this, you know, to get back to a previous piece of the conversation that we shared, is that this virus is evolving. And it's plausible that if we are unable to get enough people vaccinated quickly enough to be able to quelch the virus's ability to evolve itself out of being prevented by this vaccine, that we could be in a really dire situation. And so this moment really calls on all of us to do basic collective action, right? To be able to trust in the science that created this right? To be able to trust in the science

that created this vaccine, to be able to trust in one another to do the right things and to do them ourselves and to be able to do the things that we need to do to collectively to take this virus down. But you're right, right? Your glass half empty view of this moment is not wrong,

but it is preventable. And my hope is that we can do what we need to do to prevent it. Yeah, the world isn't what it is. It's what we make of it, right? So I'd like to turn to Dr. Abdul El-Sayed. You've had a pretty remarkable professional career so far. I believe you were the youngest person to be the director or the first person to head a health department of a major city. And you also ran for governor. So you're obviously an ambitious young man. What advice would you give to a 25-year-old young man or young woman as you look at

the world of healthcare, you look at the nation, what advice would you have for somebody who's thinking about what career do I want to be in? What should my approach to politics be? You're in a room with 25-year-olds, blank slates, looking to build economic security for themselves, looking to be good citizens. Yeah. I mean, I'd say, number one, all of us are going to be good citizens? Yeah. I mean, I'd say number one, all of us are going to be a part of institutions. And the choice we have is about whether or not we choose to work within an institution or we choose to lead an institution. In leadership, I think of, you know, in physics, acceleration is either moving something forward faster or slower or changing its direction. And I think that real leaders often will work to change the direction of an institution

to ask it to meet the ideals that it says it serves. And I think so many of the institutions that we live and we learn and we work in, they have a stated set of aims and then they have a revealed their stated aims. And sometimes that means working against the directionality of the institutions in which you work and working for the people that the institution is set to serve. And as someone who started his career in healthcare and still works on issues related to healthcare, I think healthcare is emblematic of that change of direction that is needed, right? Every healthcare institution, every hospital says it's there to serve its patients. Every hospital is also there to serve its bottom line. And oftentimes those two things are mutually exclusive. And so I think we have to ask ourselves whether or not we want to be validated within institutions for allowing them

to move in the direction they're already moving, or if we want to be people who reshape those institutions to move in the direction that they ought to be moving. The other thing I'd say is that life is short, but it's also quite long. And I think there is a sense that we have to solve all the problems right now. And as much as we need to be grounded in the fact that when institutions fail their stated aims, people get hurt by them. We also have to recognize that, um, there are so many levels at which to work and so many ways in which to work, uh, that we've got to find the way that we think we're, we're optimized to work into work, uh, focused on the people that we're serving. And the last thing I'd say is that building a, a set of relationships for people who

remind you who you are and keep you whole and that give you true joy and balance in the world is really quite important. I think sometimes we forget just how important those sustaining relationships really are. And then the last, last thing I would say is my grandmother, wisest, most intelligent person I've ever met in my life. She never got to go to school. And I'd spent a lot of my summers in Egypt with her. And, you know, as that groundedness and that appreciation for the privilege that we have in the spaces that we get to occupy, I think shows you exactly what they're worth and allows you to remember that in the end, right, the value of privilege is that you can either use it to make other people more, people who have privilege, more privileged

or people who don't have that privilege, more privileged. And the choice is yours. And I think we've got to always be on the side of those who don't have and be willing to burn our privilege at the altar of serving people who may not have the very things that we have. Dr. Abdul El-Sayed is a physician, epidemiologist, progressive activist, educator, and podcast host. He's also a political contributor at CNN and the author of Healing Politics, A Doctor's Journey into the Heart of Our Political Epidemic. He joins us from his home in Ann Arbor, Michigan. Doctor, stay safe. Thank you, too. That's all for this episode. Stay safe and happy new year. The holidays are a difficult time for

many of us. We hope that you take stock of your blessings. And if it's been a very difficult year, I believe in regression to the mean and the good news about having a bad year is usually that means you're due for a better year. So let's hope that if it's a great year, your good fortune continues to bless you. And if it's been a bad year, that you recognize that nothing is permanent, nothing lasts forever, and all emotions pass. Our producers are Caroline Shagrin and Drew Burrows. If you like what you heard, please follow, download, and subscribe. Thank you for listening. We will catch you next week with another episode of The Prof G Show from Section 4 and the Westwood One Podcast Network.

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