December 5, 2023 • 9 mins
Dr. Sandro Galea, Dean of Boston University School of Public Health, discusses his book Within Reason: A Liberal Public Health for an Illiberal Time.
Hosts: Carol Massar and Tim Stenovec. Producer: Paul Brennan.
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Episode Transcript
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Speaker 1 (00:00):
This is Bloomberg Business Week with Carol Messer and Tim
Stenebeck on Bloomberg Radio.
Speaker 2 (00:06):
Regular viewers and listeners know our guests, our next guest Well.
He was a go to voice for us throughout the pandemic.
We turned to him for updates, advice, and so much more.
He's a physician and the dean of the Boston University
School of Public Health. He's also among the most widely
cited scholars when it comes to social sciences, with more
than nine hundred and fifty scientific journal articles published. He's
(00:27):
the author of a new book, Within Reason, a liberal
public Health for an illiberal time.
Speaker 1 (00:32):
We're very pleased to add back with doctor Sandro Gallea,
dean of the Boston University School of Public Health. He
joins us on Zoom from Boston. Doctor Gleia, it's good
to have you back with us. Congratulations on the book.
Speaker 3 (00:42):
How are you, Thank you well, and it's great to
be back here, and thank you for having me on.
Speaker 1 (00:47):
Hey, I wanted to know the moment that you realized
you needed to write this book. What happened in your
life that said, Okay, you know, we're coming out of
the pandemic and we need to really re examine the
way that people trust institutions.
Speaker 3 (01:03):
Yeah, I think I have been thinking about this book
since really the middle of the pandemic. You know, you
mentioned that I've been on your show several times in
the pandemic. I remember one of the conversations we had
was about trust, and I remember you were asking me,
you know, how do we get people to trust us?
This was there the time when we're having a hard
time getting people to get vaccinated, and you know, I
probably gave an answer along the lines of, well, you
(01:25):
don't get people to trust you during a pandemic. You
get people to trust you before a pandemic. During a pandemic,
it's almost too late. And I think at that time
I started thinking about what is it that we were doing,
and how are we doing it, and how should we
be doing it better?
Speaker 4 (01:39):
Now.
Speaker 3 (01:40):
I didn't want to write this book during the acute pandemic,
you know. I think there's a time to self reflect
and there's a time to act. And I think twenty twenty,
twenty twenty one, twenty twenty two were times to act.
And I think Public Health acted acted the in by
and large admirably and nobly, and that was the moment
to do that. Now, when we're xiting the acute phase
of pandemic, I think it's time to reflect. It's time
(02:03):
to look back and say, recognizing that we did a
lot of things well and recognizing there were a lot
of challenges that all of that said, but what is
it that we should learn from? What is it that
we should do better?
Speaker 1 (02:14):
Well?
Speaker 2 (02:14):
And I want to we want to ask you what
we should learn and move forward with and then do better.
But having said that, just one quick look back, and
in terms of the pandemic, what do you see as
the biggest failure of public health strategy or policy during
that time? What was the biggest success?
Speaker 3 (02:33):
Well, I think the biggest success let me start there
is Look, the COVID pandemic was hopefully the largest public
health crisis any of us are going to face in
our lifetime. More than a million American died, seven million
people died around the world. Those are probably underestimates. This
was a huge event, right. It resulted in a setback
in our life expectancy by about twenty years. So this
(02:55):
was a really big event. Now, that event would have
been worse were it not for the excellent work of
many in public health. Were it not for the rapid
development of vaccines, Were it not for the rapid distribution
of vaccines. So I think there's a lot that was
done well, and you know, anything I say has to
be taken with that context in mind. Now in terms
of what we did not do well, and I'm not
(03:16):
sure I can answer what is the one thing, but
several things come to mind. I think number one, we
learned that our approach to communication was limited and limiting.
You know, we learned that our we had an approach
to communication that presupposed that people wanted certainty, and when
we tried to do that, when we're trying to give
certainty given the rapid changes in the science, it backfired
(03:39):
in that we were saying X one data and why
the next and that rapid trust and that was that
came from a place where we were used to communicating
by saying to people, trust us, this is the answer,
and that clearly no longer works.
Speaker 1 (03:51):
That's what I wanted to talk to you about, because
I mean, I vividly remember times at the beginning of
the pandemic where we were advised by doctor Anthony Fauci, Okay,
don't don't wear masks because we need masks for or
in the surgeon general. I think it was yeah surge
in general at the time under the Trump administration we
don't wear masks, and then the guidance on that changed
wear a mask, so well, don't wear cloth masks anymore,
(04:13):
wear and ninety five masks. And I think there was
a sort of a collective exhaustion with changes and also misunderstanding.
And I don't think there was also a good understanding
of what the scientific method is and the lack of certainty,
So how do you rebuild trust after that?
Speaker 3 (04:31):
You know, there is science that shows that people can
handle uncertainty much more do we give people credit for.
And there's science actually showed in psychological literature that when
people are told by experts this is our best estimate.
But we don't really know people actually trust experts more
not less. So I think there is an approach to
greater transparency, greater honesty in our communication, which is different,
(04:54):
if you think about it, than how we had communicated.
And you know, I'm very careful in my book, very
careful of my writing. I'm not singling out any individual.
I think a lot of people did their very best
given what we knew under very difficult circumstances, and I
want to be very careful about that, but I do
think that we should learn from the moment. You know,
another thing that I point out in the book is
(05:15):
we became poor at articulating trade offs. You know, a
dealing with a pandemic is not a one size fits
all answer. It is not saying the only thing that
matters is the pandemic. Because we knew that the pandemic
really mattered, but we also knew that more and more
people were dying from drug overdose. There are tradeoffs in
our approaches, and those tradeoffs need to be things that
(05:38):
we surface and that we are clear in the public
conversation that we are choosing approach X, even though we
know it has negative consequence. Well balance within this the
right approach tactrically?
Speaker 2 (05:48):
How do we do that? When I look at some
of the macro trends that are kind of a big
overlay over healthcare and the medical world, I think about politics,
an abortion making us think what's next? You know, what
else is going to be kind of somehow get into
the political narrative with significant outcomes. I think about presidential candidates,
(06:10):
you know, rolling back Obamacare, money and healthcare, private equity,
buying up hospitals and medical practices. I mean, there's a
lot going on that I understand why people are questioning
the medical community and maybe health care policy at large.
So what is the smart debate, the right debate to
be having around public health and how do we move
(06:31):
it to a better position.
Speaker 3 (06:36):
Well, I suppose my answer is that's in part why
I wrote this book, and that's why we're having this
conversation because I think my assumption is that most people,
most of the time are trying very hard to find
the right space and to have the right conversation. And
the other thing that you're hinting at, Carol, is that
we're living in very divisive times, right, and there are
strong partisan forces that are driving that are driving absolutest
(07:00):
answers on very complex questions. And I you know, the
subtitle of the book is a bit of a non
nerdy subtitle about liberal public health for in a liberal time,
But it's it's nerdy by design because it says we
should embrace a plurality of perspectives, we should have the nuanced,
the wisdom, the sophistication to actually have reason debate about
(07:21):
really complex issues and not allow ourselves to be swayed
into absolutest black or white answers, yes or no answers.
Speaker 2 (07:29):
Well, you know what I mean. I would say, like,
I agree like the public narrative, but I also think
there's so many issues out there that really should be
between a patient and their medical provider that all of
a sudden become up for public debate, and I think
that that provides problems.
Speaker 3 (07:45):
Well, I think I think I think the very question
about which issues actually should be in a public sphere
or not is a question we should be discussing, and
I think we should be honest about that that we
should be discussing.
Speaker 1 (07:56):
So it's an interesting question because I think now I'm
asking questions to my doctor about vaccinations for my kids
that I would never be asking in the past, like yes,
just do it. Yeah, there's like a typical vaccination schedule,
and you know in the past, you know when it
when it came to all vaccines, and and now it's
(08:16):
like and it's and it seemed to get this from
other parents too, and you see it in the data,
like when it comes to the COVID vaccine, even though
it's recommended by the CDC. There is a very small
percentage of parents who are vaccinating their kids, so it
seems like there's a missed It seems like a lot
of people don't think that the authorities have the answer,
(08:37):
you know.
Speaker 4 (08:38):
I I opened the book with an anecdote about, you know,
a bakery close to where I live, which essentially had
a sign on the door after mask mandates had been
lifted that said, we know that health experts in mass
mandates should be lifted, but we still insist on masking
in our store.
Speaker 3 (08:54):
And I asked the question before COVID, could you ever
imagine a bakery that doesn't have its own medical advisory
board putting a sign up on the door saying the
health experts say X, but we say why right? And
that speaks a lack of trust, you know. Coming back
to vaccines, and in my direction, I also use this example,
Tim that you mentioned of vaccinating kids in this country.
We never had a conversation about the benefits and the
(09:16):
risks of vaccinating kids around COVID. In European countries, Western
European countries, those discussions were had, and they actually took
a very different approach to it. So you know, I
feel like this was a piece of our approach, which
was a very absolutist approach. I said, this is the
right answer. Trust us, it's going to be fine, and
that approach has long tail consequences, where now, as you said,
(09:40):
people are questioning things that they never questioned before.
Speaker 2 (09:42):
Doctor Glay, Let's continue this in the future because I
think it's a really important conversation, Diana, the Boston University
School of Public Health, Thank you so much. Check out
his new book, This Is Bloomberg.
This is Bloomberg Business Week with Carol Messer and Tim
Stenebeck on Bloomberg Radio.
Speaker 2 (00:06):
Regular viewers and listeners know our guests, our next guest Well.
He was a go to voice for us throughout the pandemic.
We turned to him for updates, advice, and so much more.
He's a physician and the dean of the Boston University
School of Public Health. He's also among the most widely
cited scholars when it comes to social sciences, with more
than nine hundred and fifty scientific journal articles published. He's
(00:27):
the author of a new book, Within Reason, a liberal
public Health for an illiberal time.
Speaker 1 (00:32):
We're very pleased to add back with doctor Sandro Gallea,
dean of the Boston University School of Public Health. He
joins us on Zoom from Boston. Doctor Gleia, it's good
to have you back with us. Congratulations on the book.
Speaker 3 (00:42):
How are you, Thank you well, and it's great to
be back here, and thank you for having me on.
Speaker 1 (00:47):
Hey, I wanted to know the moment that you realized
you needed to write this book. What happened in your
life that said, Okay, you know, we're coming out of
the pandemic and we need to really re examine the
way that people trust institutions.
Speaker 3 (01:03):
Yeah, I think I have been thinking about this book
since really the middle of the pandemic. You know, you
mentioned that I've been on your show several times in
the pandemic. I remember one of the conversations we had
was about trust, and I remember you were asking me,
you know, how do we get people to trust us?
This was there the time when we're having a hard
time getting people to get vaccinated, and you know, I
probably gave an answer along the lines of, well, you
(01:25):
don't get people to trust you during a pandemic. You
get people to trust you before a pandemic. During a pandemic,
it's almost too late. And I think at that time
I started thinking about what is it that we were doing,
and how are we doing it, and how should we
be doing it better?
Speaker 4 (01:39):
Now.
Speaker 3 (01:40):
I didn't want to write this book during the acute pandemic,
you know. I think there's a time to self reflect
and there's a time to act. And I think twenty twenty,
twenty twenty one, twenty twenty two were times to act.
And I think Public Health acted acted the in by
and large admirably and nobly, and that was the moment
to do that. Now, when we're xiting the acute phase
of pandemic, I think it's time to reflect. It's time
(02:03):
to look back and say, recognizing that we did a
lot of things well and recognizing there were a lot
of challenges that all of that said, but what is
it that we should learn from? What is it that
we should do better?
Speaker 1 (02:14):
Well?
Speaker 2 (02:14):
And I want to we want to ask you what
we should learn and move forward with and then do better.
But having said that, just one quick look back, and
in terms of the pandemic, what do you see as
the biggest failure of public health strategy or policy during
that time? What was the biggest success?
Speaker 3 (02:33):
Well, I think the biggest success let me start there
is Look, the COVID pandemic was hopefully the largest public
health crisis any of us are going to face in
our lifetime. More than a million American died, seven million
people died around the world. Those are probably underestimates. This
was a huge event, right. It resulted in a setback
in our life expectancy by about twenty years. So this
(02:55):
was a really big event. Now, that event would have
been worse were it not for the excellent work of
many in public health. Were it not for the rapid
development of vaccines, Were it not for the rapid distribution
of vaccines. So I think there's a lot that was
done well, and you know, anything I say has to
be taken with that context in mind. Now in terms
of what we did not do well, and I'm not
(03:16):
sure I can answer what is the one thing, but
several things come to mind. I think number one, we
learned that our approach to communication was limited and limiting.
You know, we learned that our we had an approach
to communication that presupposed that people wanted certainty, and when
we tried to do that, when we're trying to give
certainty given the rapid changes in the science, it backfired
(03:39):
in that we were saying X one data and why
the next and that rapid trust and that was that
came from a place where we were used to communicating
by saying to people, trust us, this is the answer,
and that clearly no longer works.
Speaker 1 (03:51):
That's what I wanted to talk to you about, because
I mean, I vividly remember times at the beginning of
the pandemic where we were advised by doctor Anthony Fauci, Okay,
don't don't wear masks because we need masks for or
in the surgeon general. I think it was yeah surge
in general at the time under the Trump administration we
don't wear masks, and then the guidance on that changed
wear a mask, so well, don't wear cloth masks anymore,
(04:13):
wear and ninety five masks. And I think there was
a sort of a collective exhaustion with changes and also misunderstanding.
And I don't think there was also a good understanding
of what the scientific method is and the lack of certainty,
So how do you rebuild trust after that?
Speaker 3 (04:31):
You know, there is science that shows that people can
handle uncertainty much more do we give people credit for.
And there's science actually showed in psychological literature that when
people are told by experts this is our best estimate.
But we don't really know people actually trust experts more
not less. So I think there is an approach to
greater transparency, greater honesty in our communication, which is different,
(04:54):
if you think about it, than how we had communicated.
And you know, I'm very careful in my book, very
careful of my writing. I'm not singling out any individual.
I think a lot of people did their very best
given what we knew under very difficult circumstances, and I
want to be very careful about that, but I do
think that we should learn from the moment. You know,
another thing that I point out in the book is
(05:15):
we became poor at articulating trade offs. You know, a
dealing with a pandemic is not a one size fits
all answer. It is not saying the only thing that
matters is the pandemic. Because we knew that the pandemic
really mattered, but we also knew that more and more
people were dying from drug overdose. There are tradeoffs in
our approaches, and those tradeoffs need to be things that
(05:38):
we surface and that we are clear in the public
conversation that we are choosing approach X, even though we
know it has negative consequence. Well balance within this the
right approach tactrically?
Speaker 2 (05:48):
How do we do that? When I look at some
of the macro trends that are kind of a big
overlay over healthcare and the medical world, I think about politics,
an abortion making us think what's next? You know, what
else is going to be kind of somehow get into
the political narrative with significant outcomes. I think about presidential candidates,
(06:10):
you know, rolling back Obamacare, money and healthcare, private equity,
buying up hospitals and medical practices. I mean, there's a
lot going on that I understand why people are questioning
the medical community and maybe health care policy at large.
So what is the smart debate, the right debate to
be having around public health and how do we move
(06:31):
it to a better position.
Speaker 3 (06:36):
Well, I suppose my answer is that's in part why
I wrote this book, and that's why we're having this
conversation because I think my assumption is that most people,
most of the time are trying very hard to find
the right space and to have the right conversation. And
the other thing that you're hinting at, Carol, is that
we're living in very divisive times, right, and there are
strong partisan forces that are driving that are driving absolutest
(07:00):
answers on very complex questions. And I you know, the
subtitle of the book is a bit of a non
nerdy subtitle about liberal public health for in a liberal time,
But it's it's nerdy by design because it says we
should embrace a plurality of perspectives, we should have the nuanced,
the wisdom, the sophistication to actually have reason debate about
(07:21):
really complex issues and not allow ourselves to be swayed
into absolutest black or white answers, yes or no answers.
Speaker 2 (07:29):
Well, you know what I mean. I would say, like,
I agree like the public narrative, but I also think
there's so many issues out there that really should be
between a patient and their medical provider that all of
a sudden become up for public debate, and I think
that that provides problems.
Speaker 3 (07:45):
Well, I think I think I think the very question
about which issues actually should be in a public sphere
or not is a question we should be discussing, and
I think we should be honest about that that we
should be discussing.
Speaker 1 (07:56):
So it's an interesting question because I think now I'm
asking questions to my doctor about vaccinations for my kids
that I would never be asking in the past, like yes,
just do it. Yeah, there's like a typical vaccination schedule,
and you know in the past, you know when it
when it came to all vaccines, and and now it's
(08:16):
like and it's and it seemed to get this from
other parents too, and you see it in the data,
like when it comes to the COVID vaccine, even though
it's recommended by the CDC. There is a very small
percentage of parents who are vaccinating their kids, so it
seems like there's a missed It seems like a lot
of people don't think that the authorities have the answer,
(08:37):
you know.
Speaker 4 (08:38):
I I opened the book with an anecdote about, you know,
a bakery close to where I live, which essentially had
a sign on the door after mask mandates had been
lifted that said, we know that health experts in mass
mandates should be lifted, but we still insist on masking
in our store.
Speaker 3 (08:54):
And I asked the question before COVID, could you ever
imagine a bakery that doesn't have its own medical advisory
board putting a sign up on the door saying the
health experts say X, but we say why right? And
that speaks a lack of trust, you know. Coming back
to vaccines, and in my direction, I also use this example,
Tim that you mentioned of vaccinating kids in this country.
We never had a conversation about the benefits and the
(09:16):
risks of vaccinating kids around COVID. In European countries, Western
European countries, those discussions were had, and they actually took
a very different approach to it. So you know, I
feel like this was a piece of our approach, which
was a very absolutist approach. I said, this is the
right answer. Trust us, it's going to be fine, and
that approach has long tail consequences, where now, as you said,
(09:40):
people are questioning things that they never questioned before.
Speaker 2 (09:42):
Doctor Glay, Let's continue this in the future because I
think it's a really important conversation, Diana, the Boston University
School of Public Health, Thank you so much. Check out
his new book, This Is Bloomberg.
Hosts And Creators
Tim Stenovec
Carol Massar
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