« The Weeds

Is Google in an "ideological echo chamber"?

2017-08-09

Matt, Ezra, and Sarah talk about the now-infamous Google memo, the Democrats' plan for prescription drug pricing, and a study on opioid prescriptions and medical schools.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
I don't hear you guys is everything. Ok, yeah, it's close enough as long as somebody can below welcome to another episode of the weeds on the box, media, podcast network and Matthew Iglesias back from the wilds of of northern main drawn by as recline and Sarah Cliff, Sir. I think you did it. You did a great job add reads out my intro as ok, the intro. What you know the interests of its high five now but the ads it made me and made me want to buy like all the other guy, that's great. I get to continue this package as that and, if you buy other that, yes exactly everyone by things- ok, let's back ass, Ok. So we gotta go white Paper Goodbye Paper, a good policy
issue, but we want to talk first about us or a controversy. That's been up in the news, a sort of political, well a little less less policy oriented, but Google. Made waves first for this guy running a manifesto and then for firing, are any manifold, and this is a somewhat complex, his head story. I think I came to this late to end. It was one of these things were trying to trace back. What had happened was tricky. since only try to lay out what we're looking at here and then treads at which part of us who want to talk about so good has an internal message board system. They also something apparently that is it a meme posting interface. It is supposed to be in it or Google read it. So obviously It's gonna go to you, then they have to google wave alive and there is a further means, those in internal Google plus Google
the still live inside Google, what about wave, and so how can having read it inside Google ever led to anything bad, and I say that somebody who enjoys some read it but does not mix of company culture. I think in general or get so. They ve got this place where Google Earth are supposed to do oh and create discussions and talk about internal Google issues and what are not there. I don't know how the conversations normally go a guy named James Day, more de more on action to pronounce it. He wrote a piece called Google's ideological echo chamber, and it's a ten page issue manifesto that is trying to make the argument to try to make a lot of arguments actually and it is very familiar. I think if you read it, a lot of the all right or kind of semi rationalist blogosphere a ring follows. I got like a structure, and I think people you stupid Betty cradle
go because what it is doing is it is trying to make an argument that Google's leftist bias and its decision as a corpse mission to pursue diversity, and in this case, partly gender diversity, as as a major corporate value, is going to harm, the company and is obscuring the just fly reality, which, if and again I am abstaining, I think the member's view that if you just look at the evidence. Men and women are biologically genetically different in ways that just make it obvious that and are going to be heavily overrepresented in industries. Like and computer engineering at the top levels of large firms like Google, the executive class and women are going to be off doing other things that relate to care work, the relating to working with people more that have a better work, life balance and since
picture of the memo is that it sort of goes through what his thesis Google's biases and serve left, leaning and politically correct, which is probably true, then goes through. I think, a pretty weak discussion of so the science of personality differences men's higher dry for status on me, sort of. Does it very quickly? It's only a page yourselves After this memo and then sort of tries to argue that there are other ways to may be reduced the gender gap, but really the big danger is it in trying to reduce the gender gap. Google will get worse engineers or it will, he's not really super clear on how will putting Google, but but that it would be bad for Google if they have a politically motivated hiring agenda as opposed to one based in on a cordon quote: meritocracy. I'm a thing it sort of says throughout is that opinions like his are suppressed in Google, despite being recently widely held him. Sure, that's true
So then dismember gets written. It gets leaked too. I believe it was mother board advice, yes, vote, also got it. It had created a big stir in Google, then created stir in the wider world, Google's VP of First, he writes a rebuttal to the memo internally diskiver. creates I think, realising that he might be in trouble. He files a complete with the National Labour Relations Board. The Google is basically saying that his work rights are being violated by Google's counterattacking on this memo he's subsequently fired since then there. These sort of three, conversely, happening, probably more than that that the three conversations happening. What It is about this memo itself and is its arguments in any way. True another is whether this guy's free speech rights were violated bright, whether he weather
Google either violated the law or violated just basic ethics and and the way a major corporations should act in firing him and then the third is the sort of broader fight about what you can and can't say in sort of different spaces in american life, these could become a major disguise becoming major rolling Bob point, four for the alt right, which feels you know, even irrespective of what you believe that we should be able to adjust like a good old fashioned conversation about whether women are biologically less suited to computer engineering than men, and so take any level of this conversation, but it? But I thought I would after a pause there and see what people want to go with it I was struck most of all the native tee of this memo right, the premise of this man. How is that Google and its politically
correct leaders inhabit an ideological echo chamber in which they are trying really hard to increase the diversity of their engineering staff and, like that's just not true. read like if, before this happened, ass, you do like. What's the deal with diversity, Google I'd say Google, like a lot of companies, does a lot of pr around this, but like, a higher women engineers now did they have women top executives? Now, do I hear TAT things are moving to work there. Yes, all the time and then like this guy has to go ruin the party for himself. But my writing. This mama, that's like hey guys. Maybe we should just say what kind of sexist ass laws and then there are like the whole, like its marketing like how you know we used to have this slogan its I dont be evil, but, like we still do evil of stuff right like it's such a its such software, engineer reaction to just like take at face value company,
marketing material, and they like. We have this thing ideology so to me that's interesting, and then, of course, he gets fired because you can ask surely, if you dont, actually care perversity, but just have a kind of marketing pushed around. It then like this is a no brainer, rightly go be really hard to like fundamentally shift the workforce at Google and the internal company culture, but really easy to fires have one guy nobody's heard of like lots of people would like to work a Google ones listening to me, though, is the chief and there's a policy I got here right. I think there is a case. I don't think he's a very strong case, but there's an argument he could make to the hour, be that this violates. I forget, the the exact section of the code, but there are some protections for workers ability to just
on political issues. I think Google would argue well. He was using an internal company message. Board is not the same as just like saying something outside, but even Oh it's conservatives who were inclined to champion of this particular guy on this particular topic because they agree with him on the merits. Its there's no way. Trump Anna Lobby is gonna rule in his favour where's in Obama and I'll be like might of an Bernie Sanders and all our be like really really really might have, and it would be interesting for conservatives to like step outside their own sort of little like mental loop, around political correctness and about do. They want to sort of reduce employers, discretion to fire people, I think you know what they would say if this guy had said or done literally anything else were concerned
would say about. It is like look Google's a private company dignify, whoever they want, for whatever reason they want James do more if he doesn't like Google's ideological echo chamber. He should quit and go work at a different company. If he gets fired for publishing manifesto is Helga work. Someplace else congenial like there's a free market companies that cripple themselves with political correctness will fail in the marketplace and like who cares? What's the issue here, whereas its vocs dot com that a few weeks ago published an article about how employers are like little? Private tyranny is, and you know we should have liked strong sort of rights in the workplace. The particular presentation here kind of like flips people's biases, but that seems like to the extent of theirs let's see question like that would be the policy question to me as like is at will employment like bad an authoritarian? I want to go back to the actual argument makes here about this kind of biogas
biological centralism argument that there are just these fundamental things that are different, that cannot be changed in its interesting, he decides on computer science is the space he wants to focus and where you have so much evidence, flying in. face of this one of them. Surprising things when you look into the history of computer scientists, women have actually been a. the tv dominant group Spain is that you have people like Margaret Hamilton, you don't writing the the code for the APOLLO mission really up the nineteen eighty years or so, and Cuba of this surprisingly gets this in this memo. It is that you really of women is a very tough forests in computer science and there's a fascinating planet money episode about swear you get women and Rolling Peterson line. Medicine and the nineteen ease off sudden something changes, and I dont think it was something about the biology of women that changed in the nineteen eighties.
some of the research suggest what happened was personal computers happened and boys were a lot more likely to be given personal computers than women and they had an age when they were signing up for computer science class in college because they had this per computer in their bedroom. They'd been tinkering on for you whereas women always had more, showing up and felt quite behind and three level computer science and that when you try, through the history of computer science in recent years. It suggests a lot of external, fair hers in that it suggested completely possible affirmed, it feels silly to engaging with this, unlike such specific level, but is completely possible for women to be successful computer engineers. So on tat, of all the argument feels quite weak, that something different going on with the work that women do, the other, please you, about as women in executive positions, women and am-
in the leadership at Google. And on that I mean they're just so many other things going on that are kind of stomach to the wage gap. Generally. You know that madman, this is a challenge Google has. It does not like they were two men out of their executive, they believe they are currently under investigation by the and of labour average Henry for gender discrimination. and so it suggests that, like Google has not been all of sudden sudden men and I think some of that Are they released about? Thirty percent of Google employees are female? Twenty per cent of those in technical positions are female. It is not the case that all this sudden there's been this influx of em. Women. But when you look at women, the very top levels of companies, one or two things are seeing as a lot of those jobs a very inflexible hours. That makes it very difficult for someone who is take maternity leave, who you know, is having children to get to the very top level position, usually one
surprising things. I did along explain on the gender wage gap, last summer and you actually tend to see tat has a smaller tender wage gap because you know possess abject engineering positions tend to have more flexible hours there more self, directly you can kind of do the work when, when you do it it's not like, I'm, you know, being a business. Person where you have to have keep these certain hours or owning a store where you have to be open. Ninety five, you could do a lot of your. work on your own schedule, but a lotta that e disappears when you up to the sea sweet level where you do end up in a more traditional having to work certain hours having less of a flexible schedule, a lot of their research from Claudia gold? at Harvard he's one of the top researchers and the wage gap really suggestible what's driving is not the skills of the people
the structure of the jobs in the ways that jobs have typically been structured around the idea there is someone else at home, taking care of things taken care of kids, taking care of the House and that, as that, someone increasingly gone into the workforce. That is really challenge the destruction of jobs, but that is the limiting factor not a drive succeed or even, if some kind of biological difference. I think all I think the point you bring up your incredibly incredibly important report, because this memos this man was a very bad, representation of like a much more common form of of argument. I wanna things about the way this whole thing has been treated. I worry now I came back like, after being out of this conversation fer, you know when it began and the like read this man like with this. This is what everybody is talking about. It's a bad blog posts dismember I get you would read this and like it reads like a lot of I read and it just nobody would.
noticed right. It's ignited a good example the form and at their couple things that I just want to point out here, because I think that the? U you put our big London and I think it hits his conversational lot the structure of this memo, if you search zoom out from its argumentation first, we should note, because our people, mad a notice that it does the bullshit move that all these things do where it has one of the signs. Many Differences are small in their significant overlap between men and women. You can say anything about an individual, given these population apple distributions, so they here is this I think, lets me huge generalizations about women, as a group generalizations that we will then attached to company policy that treats people as a group, but obviously like don't think about this in any individual, which is just the most insanely naive like if you want to treat people's individuals. Treat them as individuals like gonna be like women in general, bad computer, programmers mechanism,
literally every woman? Oh, you mean we can give them a test or something maybe they can convince us so That's why I note that in there and also know that I don't buy it. So, though structure this argument is basically it works like this Google, have decided that diversity is important. So that's like premise, for one in premise. Number one is true, then, from number two. Is they ve decided this because as there is huge despair in this case, gender representation in these industries? It lets say Google for now. That's also true. Premise three, then, is that there are biologic go down Hence it between men and women that might be relevant to computer engineering and inheres? I think move the memo makes it and that a lot of these kinds of arguments make. If three is true, then one and two are mistaken but that the memo is trying to make the whole question here like. Is it the case that
there? It is like a thing orientation in female infants, but, like of we had our I'm sorry, people rotation in female adverts, but a thing orientation in male infants like, as you just said, the culture in which all this happens, the way companies restructured the way I'm careers are structured. The way Streets are structured. What we think of people, whether we give them computers, when the young? There are so many of these huge questions that over? only DR what ends up happening in people's life outcomes that to restrict these arguments, even if it were true, it's beside the point to a very large degree like differences. He's got this whole thing about, life balance right that being at the top of Google is gonna. Shitty work, life balance and we we're gonna want more work, life balance, and so we just shouldn't, have women do it for the most part, because
being a taboo. Was gonna shoot work, life balance, as you know there decisions made indifferent industry is about whether or not you can have more flexible hours, whether you can work at home forces working at the office are all kinds of these things that are decided and real we do a fact representation and nothing to do with genetic sets out by law. You it is choices we make and what we end of valuing in society. Human beings live sleep in America. Seventy five years, eighty years, unlike in that time and, unlike one person's life, We imagine that groups that are currently under our can do like how we talk about that like if you go back and look in nineteen, twenty or one thousand nine hundred and thirty, or one thousand nine hundred and forty about what, It was totally normal to say a word. could do a jewish person could do, and I person could do an african American. and can do human by all.
Is not changed very much over that period of time, but our understanding of what's going on has tremendously, and it should make us incredibly humble about offering these kinds of pronouncements. I mean this guy. I think, if you talk to him, he would say that he thinks he's a scientifically minded. Guy he's got a whole like little defence of science in areas like on the right people think earth was made six thousand years ago and that's wrong, but on the left, people think women can be programmers and the same rights as men and that's wrong. We have not run an experiment here. american society food? one hundred and two thousand and seventeen or whatever you note appear to want to choose is not Some lab experiment in what people can do and how different groups, gender, race, sexuality, etc, perform we ve not run it for my computer engineering with not structure the industry, a bunch of different ways to see which way would be the best I it's just like it.
So insane to look at this and say well, I looked at One study about boys reaching for trucks- and I got explains it when we built all this when it's all constructed by us. I just think it so bad building on this kind of this kind of essential ism, and it's so flies in the face of like our ancient history. But the last sixty years and american life when, as you say like, could Reprogramming was a heavily female job and that we change how computer programming worked and like we had all these people. changes, and it goes to mount something you're saying where I think these kinds of arguments end up all over running a lot of traditional left by boundaries, they can general something the right is often better out. Left is thinking about. The importance of culture is thinking about the importance of culture as a distinct thing from politics from the law from legality that there are things it you're, not just going to be able to. and for the regulation or a statute, because culture is a powerful force and
get into these debates and its culture discuss like totally thrown overboard like nope, it's old gent, it's all centralism, it's all biologically nothin weakened, about it. It just is what it is, and it's just weird, a massage is greatly, and only it helps you feel better. Eighty relieve stress, but you know a lot of us- don't really go and actually get them very often, and a big part of that is the commission's factor and to know zeal is going to solve that problem by letting you gotta massaging the comfort of your own home with no travel, no inconvenience, no difficulty booking such with zeal is all about you book, a five star, top quality massaged at a time that works for you in the most convenient place of all your very own hope So how does it work you just gotta zeal, dot com or use the Iphone or Android up their zeal? Z, eighty l, dot com sec from cop local licensed increase, green, massage therapists. He's your favorite technique. Your gender preference, The location of works for you to help me out getting sick
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a study showing that there's a fat or tail distribution of male performance. I math tests. He mentioned a study about kids Jim for trucks and he was like. So we should consider that one reason that all of our tenured sides faculty are man is that men are biologically superior. There was a huge firestorm, he got fired the position it became one of these weird things where I think the view of anti pc people is it. This was an example of the suppression of like bad, think, tat. Larry summers got fired, is present, Harvard University for summarizes critics. The fact that he went on two of the most powerful economic policy making job in a Democratic Party administration, the he hasn't like exactly been run out of town on rail. I covered as I got a student journalist and a key theme in that controversy- is that Even though summers was officially
he wasn't denying that there was any possibility of discrimination or anything that could be changed when the president of a university that has a major demographic disparities and its appointments in the legal field starts can amusing allowed or home. Maybe this is fixed genetic capacities it so to any reasonable person like what he is saying is is like actually we're not going to change anything we're not going to try anything swear to me again that that day you ve of of Jim Stead. Timor comes into play here. It would be interesting if we had an example of a prominent technology company that adopted a hard quota, hiring system. and then collapsed right, and then we were saying as a hypothesis as to like what had happened here. Perhaps they like went too far in the pursuit of equality.
But would it often seems like is really going on with these things- is that people are trying to say there is nothing to be redressed through through our art, of means it and modes and there's enough quite a few good studies that that show. You know that, regardless of who we just for trucks, That can't be right. I mean I rode over the July Fourth weekend about a study that employers and pull gamblers and Sophie Wang Dead, and they looked at venture capital firms who senior partners have daughters versus who men and they show that, when senior partners in a vc, firm, wind up having daughter- They start hiring more women as junior partners at their firm and that the firm that have more senior partners who have daughters and therefore more women hired to be junior partners, have better investment performance. Then the firms that don't wait and
the market and its wisdom is not like cashing out for this more diverse hiring. If you, if you hire more women, are your venture capital firm. You will get better investment returns, but venture capital firms dont higher more women unless sort of quays. I do doing you and there's a good study from the from business school and it shows gives a possible reason for reason. It shows that more diverse organizations make better decisions, but that they are also less happy. Why did like people prefer to be with a group of people who are similar to them to have their ideas not be challenged, and then they make worse decisions. You will be better off technically as an organisation having a more diverse group having more contentious things rethinking your premises and a more fundamental way, but people just don't like it. So if they have the opportunity to only hire people who are like themselves they choose to do it because they're not like strict sort of business maximizes and
You know it just seems to me that if you are taking these issues seriously, then you have to take findings like that seriously. You know that, like there are real biases and entrenched structures, they give us a good reason to think that, like organisers, would do better to make more diverse, hiring and that there's no. This like question of. What's in that light, limits of maybe I have a science thing, in a rise in any practical way in its it's just its fundamentally weird to me to be looking at this giant company, where the executives are almost all men with under pay. Discrimination. Resignation by the Labour Department were only twenty percent of the people and and during departments are women and to be like a ha. What is the stultifying culture of political correctness here rightly too, isn't actually want. and it, but I do think that is unfortunate, that the method I think Fortunately, the guy got fired. Breathing is unfortunate that the
palm result of him publishing this manifesto there being a firestorm at the manifesto him getting fired, there's been a fire shown by the firing, is get me to further entrenched this idea, that, like Google, is this hotbed of politically correct. Decision making when It's definitely kind of like how they position. Cells, particularly when o Bhamo as president, but it's not it's, I what they're doing right, like the reason you dont have any company is any big companies that have lots of women suffer engineers is that none of them are actually really really try right, like even on this guy's theory. It's not that there's, like Oh talented, woman software engineers, if any company was like genuinely out there, really trying to like, recruit and hire a diverse technical workforce like they would do it, but they are doing I was surprised you bring up the Larry Summers thing, how much traction this memo guy?
Larry summers amid sentence. If, as the President of Harvard this was like some if it works at Google, I was a little surprised that just sitting there was a meeting, something that wasn't new likely as there is like a due for a Google writing a shitty blog posts that like, if I had read on the internet, I would have been like and then just moved like that would have been the amount I would have engaged with that. But forward. I think you know what the things you could see as a what woman, wants to like work in this environment like. Why would you want to go? Be an engineer. Google knowing like this is what your colleagues thinking, That's one of you know when you think of like wire, they're, not feel engineers at Google, like maybe they didn't reach for a truck when there were six month old, but maybe they don't want to work and environment where their colleagues think that their mentally inferior to that and where they haven't been encouraged to think like. Yes, you are someone who belongs area. You are someone who is going to be justice
small sue you, you always see something like this perpetuating this guy's believe, because you say well, look: there's no talented female engineers here, like they're, not here, they're doing something else, SAM, you know, they're, probably doing some more person centred job. Are more biologically fit for, but it also just seems like something that really It makes it a very unappealing work environment too, to want to be somewhere like were you know? People are writing these ten page things about why why you're never going to be at the top? Why you don't really belong, and it seems an explanation that should like fly back at this guy you know why. Why There are many women and tackle because you're writing like memos. These lines? I want to merge things you all both said could having as having actually pretty important here so Did you ask a really good question? I think, which is why? Why did this mammal blow up the coup,
care this guy's, not even if he is not even a senior position at Google, Google's tens of thousands of people to huge workforce, So why does this blow up and- and I think the reason is it memo? Isn't it allows? besides have an argument they want to have. What I think is an interesting about the debate on this memo is actually not the same debate. What the sort of like the court unquotable left as argued about this memo is look at the diversity. Woman tack, as you just said, right, like look at what people in TAT our like. Of course, women want to go into the field, of course, people of colored at one alike. Like being engineer, Google, I could just six terrible, like you, gotta work next to the sky like. Why put yourself through it and then, on the other side, like people on the right one to say we're not even The savings like on an eternal company message more than you can even talk any more like it. What is into America, we can't even speak, and this goes to Mount. What you were saying about What is Google say? What is it believe? One of I think the
trends, dynamics of the Trump Administration of this area, and I think one of the that the tricky parts of his whole conversation is there, A quite large difference between what many people think and what sort of Particularly in more or less company cultures and in politics in the media, what is considered now, ok to say and a lot of people have opinions they don't feel are ok to say. Donald Trump holds a lot of opinions that, and I quote in Co. Polite society are not ok to say, you're, not supposed to run for president and walk neglect You know Mexico just sending us all these rapist, like all the time or you know, when star, they let you do whatever they want. You can grab them by the pussy right. Donald Trump, as a guy holds a lot of opinions about a lot of things that you're just not supposed to say. We should have. No people believe that stuff, but do you know, there's a lot of modes of politeness in society right like I am not supposed to walk up to people on the street in person.
and some things get ruled I came may be- should keep it to yourself and so on. Questions about their just about politeness in their versions of that, those that are more dangerous or more significant or more consequential right, depending on what opinion we're talking. I think something mad is getting out here is that I think you actually have called I google, where there is a pretty big difference between what they, how they self present, how they publicly present what the company leadership presents as and then what a lot of people but I think it's something your hearing internally, that there are a lot of people in the company who are privately like sending this guy words of support. That is certainly not a hundred per cent of Google is really what d more believes in. Maybe maybe it's not even twenty percent, but fifteen or two and even seven percent of companies a lot and if they offer, like they're, not even like, are allowed to say, hey like stop and by the way this comes on here
Donald Trump of there being report on the New York Times. That Trump is going to directive E Civil Rights Department, the Department of Justice to begin investigating colleges. there are discriminating against whites and and and possibly Asians, in awe the tab fit more historically oppressed minority groups, and so this is feeling right now and you see it now exhibited the highest levels of the government. But it's also within these tech companies that you know that effort to write a stroke wrongs is disadvantaging. You know people this guy, you know who maybe he feels he's pie, not that great of generic be higher up in Google, and maybe he looks Ronnie thinks people getting promoted over him because either they hold the right opinions or that he think somebody got promoted over him, whose a woman or a person code, not as good as him. But it's because are trying to get this representation here, and so you know any not even allowed to talk about it right and this. is this.
Created a lot of pressure in the system right, I think, of trumpets to some degree response to that pressure. I think of it outcry around this memo as the responses that pressure and it's hard, because I think people a little have not wanted to have the argument- which probably doesn't be discussed in more. We always, although I don't even exactly know, rife on all parts of it. Yes like there or like there are reasons people try to be start moving the conversation do these directions when you're dealing with groups who we have historically oppressed, who we have locked out of Willie, important professions who we have given worse educational opportunities to obey talking about women in stem who, from very early on in a lot of messages, computers are not for them. The math is not for them right. You like math, our Barbie back in the day that yeah like that The important too maybe get fuckin engineers who grew up in a complete who came up in a pretty sexist culture D.
wandering around saying, maybe There are more women engineers here because we just biologically not as suited for it as I am, and I think that one thing here is like you're, seeing eye people do believe s right and I'm even people dont want to believe it sometimes play. But I think you see that places like Google on. You are certainly people who say, they believe the opposite thing, don't always act like it, and It is a in that gap between where people the on where they are or were people feel like they can their publicly. to be in where they really are. There is a lot of ferment. American society ran I'll, probably always has been, but but is a lot right now and it's coming out. in weird ways: it's coming out in problematic ways and its come that I think ways that are allowing quite bad arguments to attain the sort of martyrdom status because, like other Inside the argument you shouldn't be making that argument and honey,
like that arguments it like that documents, bat like it's a bit shut up on the other side. It becomes nine really defence of the argument, but a defensive like free speech and like everyone he's just sort of like running past each other. In this conversation, I'm not sure I know better what I'm not sure. I know what the right conversation is to have I think the dynamics of this are we're. Seeing this repeated out a lot of I'm right now and and trumpet and like we are living in a country where the president of the United States has served this wave of discontent about the gap between what You know people feel like we should be able to say in what they feel they are able to say more. A joy They then than any one else in public life
The postal service is honestly like a practically miraculous kind of thing. You you ve, got a letter, you that a package of deliberate anywhere effort for very little money anywhere in the country and its really is cutting grave, but the one aspect of it that isn't that great necessarily is leading to go through the post office in order to get your postage they maintain limited. Ours is a limited sort of range of convenience and it's really just such a sort of AIDS, the least interesting thing what they do is like giving you a stamp and that's why stamps that come to such a great solution, so anything you could do at the post office. You can add your right from your debts were stamps. How come you? in print official. U S posted for any letter. A package is own computer printer any unlike the post office, it never closed its rights to which they are twenty. Four seven. You need a much postage right now. You got time right now, you tingled get it there on line super, can Lee, and so right now you can use our corrode weeds to get a village of a special offers, a four we trial than goods, postage and digital scale that you know how much post
unique he's got a standstill com and then, before you do anything else. Click on the radio microphone off the top of the homepage type and weakness that stamps dot com and enter reads: stamps dot com never go to the post office. Giving greater a few weeks ago, I came out with a better deal sort of policy agenda for the mid terms it. This has sort of like a bullet points with bullet points to it. But one particular point it. You know that was is wheezy uninteresting relates to prescription drugs pricing and this itself has sort of three elements to it. one is that Medicare part DE should call them, negotiate with form soon companies and basically make them, accept lower prices in exchange for the very large volume of purchases that that it accounts or I that's a sort of democratic idea that predates Medicare Party itself? This was a big part of the legislative controversy over over the programme,
first place potentially more interesting in some ways, although also potentially smaller bore is what they're talking about in terms of drug price increases in June or all, and they want to say that companies that want to do large price increases should have to submit to health and human services. A sort of written have described as a justification explaining why the prices up, so that I guess the idea that if the only reason your jacking up, the price is you're like Barton squarely and you just like figured, you could get away with it. You have actually right on paper like there's no reason for this. We just thought we could make more money this way and then you, you cannot look add and then relating to that they want to create a new sort of single purpose agency that would be able to investigate- and I guess, veto drastic
price increases, and this is something that drug policy expert not focused on? You know illicit drugs in public health type staff who is talking to recently about the opium crisis? He was actually advocating for this because he made the point that something can happen like we develop drugs that are effective encounter opium overdoses wide, which is something that happened years ago. There was a modest market for that kind of drug. It's not like that big of a deal, then ten. Fifteen years into the drugs lifespan, the quantity of ability to abuse goes way way way up. Suddenly, police departments all across the country want to get their hands on anti overdose medication, and so now the suppliers monitor Jack up prices to sort of meat that increase that's just a pure windfall right. There does
create any incentives to do are indeed your turn, my drugs that was developed long in the past, and he was saying you know the government should basically not let people do that by that. If you lucky into some kind of windfall like that, you shouldn't be allowed to jack up the the prices on things. If you Philip, something new with its extremely valuable. Maybe you can bring it to the market with a high price. So I know these are. interesting kind of on the one hand, does nothing that overwhelmingly knew about it. If you serve our a long time veteran but is also, I would say, the first sort of the clearest sign I've seen from my democratic the abolition of like wanting to do I've had a post Obama reboot. These we're, ideas that have been kind of like in democratic party circles for awhile, but a bomb
office. They made the decision not to do any of this kind of stuff to actually not really challenge pharmaceutical companies to use them as partners to help gonna sell the affordable care act here, you have the party leader saying no, you know now there were like in the opposition. We want to go back to the drawing board, come out with a message. That's you know much more statist, more populist harsher on these kind of corporate interests, and that country x on some good corporate tighten type villains rather than saying we're. We're gonna have an enormous peril tax increase to create a huge new government programme, This is the kind of populism that political consultants really like you know where you like you, take the bad guys, rather than saying like we're just gonna, have like you tax increases on everyone, but actually know like they're. Like you do
work on like the merits of this kind of thing like does this make any kind of Xenia it's interesting. To borrow some of this regulation, you saw around health insurance premiums and AC ay, so a Mamma care requires that any health insurance rate increase above ten percent be publicly. Instead, I think it's on healthcare knock over somewhere, but there somewhere You can go up and look up in the individual market, not in the employer market, but if you're, someone who buys through the affordable correct, You can see all these listings and insurance companies are required to justify will hears. Why we want to. Thirty saint increase this year. It's always a bit of a buck passing its inner. We want to thirty percent in Greece because the drug companies are increasing their prices, fifty percent, and we have to account for that one I'm curious about either relates to these the health insurance premiums is whether just making information available and bringing light to it. Actually,
dangerous behaviour they think there's a theory with this rate review. This idea that I have every double digit increase would gather publicly posted, that insurance companies might try and do a nine percent increase because I didn't want to go through. You know that process of being out in the local news, is the one who wants the double digit increase. I don't think there's been Good research, not as far as I am aware, am whether or not this is actually changed, how insurance companies act if they try and do a lower premium in says because of that threshold. But I am a little sceptical about this idea. Citing goes the second idea. You mentioned bad that companies have to have to kind of give this justification. Why there that moves the needle. What does things you ve seen over the past four years or some controversies around some really expensive patients, I'm the one that comes to mind me. As of all d, this pelvic cures
Hepatitis C mon take anything for about three or four months and was incredibly expensive and the reason is expensive when I talked to the real needs of all. Do they say what our competitors are expensive and we just priced competitively and we have a better product. It's not like the materials or the r and d like it's not like all we had to like employ ex people, or by this fancy ingredient is, We have very innovative medicine and we plan to charges should ton of money for that, because we have done something quite different, the lesson I think drugmakers took from Sovaldi was it it's got a ton of attention and like two thousand and fifteen, I was at conferences where people were protesting outside, but they were the storm, like they charge the money and they got a bunch of muddy ended. Well, and even with that very public focus on very high drug prices. It seems like that fine. The lesson I would take us a drug maker is just like keep your
down, I think, like don't be like a total asshole, like Martin check rally like dont, like flying to people on twitter that you're charging all this money. But if your professional drug company it's clear to me how much of am just transparency making drug companies talk a little bit more about their prices would actually think make them think currently about how they price, I think that's right, So all these are really good one to look after it was eighty thousand dollars. If I remember, I think, Eighty two hundred the offer horse of treatment when somebody cured Hepatitis c guess I mean- and so I think that is where there's something really interesting to talk about here. So it seems to me there are two key of policies in this release. One is a pretty straightforward: palsied allow Medicare, partied and negotiate drug prices which adjusts it's insane currently cannot. Medicare negotiates other kinds of medical services, and nobody thinks, like the medical system is collapsing. On top of that, also being able negotiator prices would make. A lot of sense is what you do in other countries,
and you get into very weird efforts to to do go around here. Bernie Sanders, I think, of Trump supports a, but Bernie Sanders has keeps putting forward a bill to allow importation of goods from Canada, which makes sense, because those drugs are fine and their lot cheaper, but they're the same drugs like instead of having the king. The government negotiate drug prices. I M going to buy them from Canada and sending them into the EU s. We should just have the american government negotiator ices by them in the? U S, it's a simpler way of doing of doing yes, and it just like the fact that anybody that weaving kept talking about re importation for so long, it's just that is like it shows how screwed up our system is, but then you, this other huh a question which it this other set of policies is trying to deal with, which is what happens. The drug company, creates a drug
genuinely as much much much better. The genuinely produces a huge social gain and selling price it much much much higher, because working with a product that people do almost anything began because the alternative may well be death or may be permanent disability or may be being on a dialysis forever. Whatever the cost, my baby- and you know you get into somewhat tough argue here, because there is real evidence that spending more on drugs does lead to innovation in their easy cases like the sword of post hawk windfall. right, you didn't you created a drug long ago. Then you jack prices fifteen years later, because was an opium crisis inquiry back in it. That's not leading to much innovation but you're, the somali thing where you know arguably the thoughtful manner we could create some cures. Hepsey could charge any amount of money on earth for it. So it's worth spending huge amount of money to try to find that the drug Israel. I think that you ve got to trade
find other answers in here and you don't Bernie Sanders. He he's had in the past that on August, reintroduce didn't in this Congress, but he's had an idea. I've always thought a pretty good one. The way we do drug price right now is based on patents. The reward for creating a drug is it you patent it, and then you get. I forget the length of exclusivity, but before other people can be in our versions of drug you get twelve years is at hand like that. I answer during that period the market is not working. You have a remit granted monopoly on this product do the only one who can sell it, and so you can charge basically any price cause. Nobody can come into the market under cut you in the way, like apple comes out with a cool new. Pod and something else. Just like the countless sell you apples, IP but they can make their own parliament. I gotta. Do it a little bit different, but but you know you do you're able to competition in these spaces and what centres argued and- and other people argued this to over the years- is it at the very least as a parallel system. It would be wise because it dry,
innovation is something we want to incentivize and the way we're doing. It is clearly very a fish and it also incentivize, is companies take me to drugs. They just allow them Baisley to renew their patent on something, but doesn't really work any better or just looks like something somebody else has done so loving bass, we're getting is just chasing these, these men op, he's with no with no real thought for what people actually need or where the innovation would be most useful. So he's argue that we should have a fund. I'm gonna have to be quite big, but that would allow for prize based dry. innovation. So you know the government would say if you are coming, that manages to create a pale, and I'm just completely using hypothetical example here, but there can be no up a pill they could be a massive improvement on current AIDS cocktail, regiments right or view can create an AIDS vaccine. Let's say you would get again, I'm picking an thin scenario, but five dollars, but as soon as that happens- and it does make a company can be university- could be a guy in your garage. You get this fibre
dollar check and then the formulas immediately generic, so anybody can make it and so can be avoided but very low cost to the public, and then government could say like ok like what are, we actually feel them strongly about getting innovation and, unlike you know, opiates might be real place right if you can create a treatment that is clearly an improvement on current and addictive pharmaceuticals, then you'd get this huge windfall and anybody would be able to make the treatment or, if you can, treatment that you know somehow relabel help the obesity crisis. You can get these huge, this huge amount of money, so that is one thing. One thing out: no Democrats are thinking about how to bring drug prices down, but they're, not thinking in a real way, by how to bring innovation up- and that's really what we really somehow need to do both is often presented, is a choice, but this can we have right now- is not one oriented towards innovation. It's one oriented towards profit, making with innovation being one side effect, but also a lot of waste being another side effect on a lot of you
not being able to put drugs being a third side effect, and I would like to see both like Democrats and Republicans thinking a bit harder on this can. I take on one thing that I think I'm we're things has helped me as I think there is actually the two different problems hide praises, get kind of like lumped together, like there's IBM had and civility, and Martin check rally in all of these are really expensive drugs. I think there are two separate he's going on that require two different sets of policy, one is just as profit seeking on generic drugs. Like the Martin check rally, you find this drug. No one else wants to make a new check up the price by if that doesn't percent, because you can because there's no price regulation, where you are not adding any innovation, I think that's a space where there's a lot of agreement and like we should not allow that to happen like there should be more readily and I think, there's one set of policies aimed at an empty pen- is another good example of this aid. where the ingredients are generic, but you have one dominant manually,
sure and all of a sudden the price keeps going up, and people who- need this strapped survive or kind of held hostage the their thing is actually innovative. Drugs drugs. That potatoes see that really change the game that am when for example, it is on the market about a decade or so ago, were a completely new, more effective contraceptive that also costs. five hundred dollars, you know per device, Making them out of reach for a lot of women- and I those are. You know we often put them together as the same problem, but I think they're pretty differently. how you handle generic profits, drugs and how you handle these. truly innovative drugs, because we want to encourage innovation and drugs we want to encourage more save all these unless Martin Shack rallies- and I think thinking of is two separate categories, would help develop. they better better scheme of actual turn price
elation, and that the problem is not the same with list of all What part unchecked rally nobody's gonna stand up for further: of. I actually feel like in terms of what were you guys, you're saying that the Tibetans, your proposal, the bike justification and the special You later is reason well suited to tackle the kind of squarely cases without impacting the body cases and I mean edges right, that's a of limited. Scope of the universal. We might also want to do more to encourage like groundbreaking cures, but I mean I think a good point about this. Is that, like you know, if you had to submit your literature data Jesse's of what the reasons are already caused? So much is that we think this is game. Changing technology that will drastically improve the lives of patients, You might look at that and say yeah, fair enough man, but like lots of things that happened, the drug market don't meet that test. You know, and it could be way
harder to get away with. You could just say well, look were creeping up the price of the pen, because we did our market analysis and we think that other people know that if you in make the fixed investment to enter this market, we can cut our prices again to drive you out. So we're not going to face competition even though the ingredients are generic. You look at that Paypal, or could you like? No man but we're not gonna? Let you do that and that's a sort of costs we way to make the lives of a lot of people who suffer from fear
we want all kind of medical issues like we need some Ebby pens around the house just sort of way better right, I'm a big fan of prizes. I already got buckshot Longitude about the prizes that were created by the british government because they wanted someone to invent a good way to tell where your boat was. It did not occur. I think the eighteenth century people to just have the patent system. The government was like this is an important Odin, which we want to encourage technical innovations that eight they got a big pot of money together for it you know, but this Ebby pen starve. These other kind of, like workaday chronic type treatments, people are just relying on month after month, year after year, issues we had it matters a lot to people and there's a least potentially some some gains, this idea is how I would I think, the better deal policies are there. I think they're well suited to deal with Ike depends and Martin check alleys. I dont know if they're well suited to deal with something
of all day with really expensive cure. That is like that. healthcare rationing problem, like a lion, People want it and we can't afford it for everyone enough. They can try and negotiate down the price, but typically you, I think everyone likes of Medicare negotiating drug prices. They like it less when viewed them Medicare will have to say no to some things like that is too expensive. We are not going to buy. It were only some medic, programmes, for example, or trying to manage their of all. These spending They said: ok, we're only going to gifts of all these people with end stage liver disease like that is how we are going to handle this, because our Medicaid budget, we cannot pay for this very and it led to a number of lawsuits from people with earlier stage, liver disease, who said will well that's not fair, like I could be cured and you're just denying me this drug, that's really going may I think you'll be there.
crap policies here they they help deal with these generic drugs. I dont know you know if they deal with severely. You come in and say well our justification as we cared hepatitis C. That's it not a bad thing to submit when you're asking for four pretty significant price, and as you see I mean some of these drugs are come out likes of all the because of the way partly Medicare restructured. Medicate is less this way, it's a lot more internal rationing in its benefit packages, but and and who gives benefits to men- care, I believe, the way it works. It basically has to cover any thing, but has clinical efficacy and so could have a this. It would like. If, if it was for a common element, it could decide Roy the federal, but I'm u take adieu. Tremendous tremendous died at the writing of Alzheimer's. If there's I yes, a border Alzheimer's
would you be great, would you would you events men and that it hard to grapple with, and that's what why I admit I didn't phrases very well, the first moments. Actually, why I push on the innovation side of this? I think that in politics we have a very robust conversation over the affair. the ability of existing medical treatments. I don't think we ve been policies, but I think we were a good conversation about We spent up an ongoing conversation about it. I think there is a lot of political pressure on the question of this treatment exists, but I can't afford it or this treatment exists, but people afford it. I think we have a lot more trouble with the value of things it dont yet exist and may or may not ever exist, but that I mean, if you look at what has been effective in the medical system in the past. However, many years forty years a lot of the real, big gains come from pharmaceutical innovation. I mean they really do for all kinds of different reasons. Now that's actually
go down a little bit, we're going through pharmaceutical innovations. Slow down part of my Medicare part B is coming under budget because there's just been fewer big blockbuster drugs and we're projected when the when the program was for. That's really bad reason for to becoming an under budget, and this is something I think the government can do, and so it is that I want to take away from the importance of trying to figure out how to make existing innovations affordable. But in terms of the way the medical system can make people's lives better. It's not just by able to afford care, but its by being able to actually make you healthy again. I'm in Alzheimer's, being a great example of that. Now there a lot of things like all timers, where it is clear that if you did come up with an all time as drug and effective autonomous drug, the profits- and that would be tremendous, and so I don't really think there is a dearth of market incentive to come up with it, but there are a lot of things where there are antibiotic structure, really good example of something where there's a dearth of of market reasons for a lot of complex reasons to come up with new kinds.
Biotechs. There are a lot of kinds of conditions that tend to be the tend to afflict poor people than that people, don't you know what to do as much as we wanted as much round then than this. A lot of energy that just goes into what will be sure fire. So you create drug acts and drug excess, fantastic retreating, allergies, and after a certain period of time you lose your patent on that. So you put in a bunch effort into sightly, changing the molecules you can be bring out like tat a guy named something very close to. Actually you keep the branding, but you also have a patent now as other that's of his problematic but issues The energy goes into me to drugs and goes into surefire drug innovation, whereas, and a lot less goes into things that are, for whatever reason, consider less profitable, even if our really dangerous. I mean a great example, this kind of thing something like Huntington's disease, which is
credibly devastating for the people who are afflicted by it. But it's also not that big of population, so the possible profits of like really working time to fix Huntington's disease. Would not be that big. So this is not to say that we should not have a drug affordability agenda. We clearly clearly should an interesting thing about. the ways adult abused to say. He believed in negotiating down drug prices than he had a meeting with. Monsieur de Gaulle executives and never so that it can. But it's worth noting that So in theory this even to some degree by partisan- but I just I all I think we need a drug innovation and in Genoa, gently medical innovation agenda and what pisses me off about it is medical and Haitian I find is like it's only invoked as a defensive mechanism. Against affordability, measures that can't be like. We can't be they the status whoa is like the only thing we can pause happiness cut. You like, I think we actually need to figure out what apparently things to happen, affordability, agenda and all. genuine innovation agenda because, like what we knew, what you're
post to be doing here is both creating healthcare system that can cure or treat as men elements as possible and then making those cures or treatment affordable for as many people as possible and just focusing on the ladder in politics, I think is missing. You know, lot of the long term benefits it. We could be getting out of a focus on the former looking good is great. It's important it to every body it is good to have nice tie was close shopping, though, can be kind of a pain in the ass. Not by likes it. Certainly I don't like it and the five for Club of rebel nice is the way you can get men's where so that you you're looking great without all the shopping with. Was they send you a curative box of two or three items its hand picked match the currencies in and your style They ve been helping them with virgin for fifteen years to shift over a hundred thousand men every month, so silly
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looking at the role of physician education in the opioid epidemic and what they find. It kind of big picture finding in this. That, I think, will engender a little bit of controversy. At least is that physicians, you train at higher rank to medical school as per prescribe significantly less opiates. It is true across specialities does not seem to be reflective of the patient populations. People train on it does not seem to reflect that certain programme in the medical school, what they find in his papers that there is a gradient cross, the rank of medical schools, and when you get to the lowest ranked medical schools they have, the highest rates of opium bribing and the thing they really are show in this paper. Is that this something possibly the school one of their tests. Is they look at physicians who had training after
article Squaw some pain, specific training, and I saw that that had an effect that if you we use that gradient go away when there are some pain, specific training outside of the matter school environment soon after having some reporting on the european crisis. It makes to me that, physician. Habits. Iron, opium aids are largely learned you to one of the people. I interviewed recently the president of the American Medical Association, Andrew German, who is a hand surgeon- and you know he told me. You know when he started practising as a hand surgeon. He would. I forget the nuts but you know he would give all his patients 45lb weight pills after surgery, because you know the person who taught him to be a hand. Surgeon gave his patients. Forty five hope you are. After surgery and that's how you end up by an you know situation either my husband and just in December, where you know we had surgery any has like thirty exe. pills that he has no need for eating, maybe two and then you, These left over
Christians and a lot of that is really learned behaviour that thing that surprised me in this paper and thing that will probably be the subject of more research. Is the correlation with the rank of medical research while I am suggesting that school, and Peter, maybe hiring schools you're, having better diffusion of knowledge on the opium crisis. More concern about it. I do so the part about the part about physician habits, thing, medical school that definitely made sense to me, the rank of medical. Pull a part was really surprising, an interesting to me. I guess I don't know, I mean not super control this, but I'm not sure why it would be set as arising that people went to better medical schools gives somewhat better treatment. I think
This shows that this is changing predictably opiate area, but is on how weak overall standards in the medical industry are. There hasn't been good. Evidence is up in good research on opiates. Will it all we just had a great piece of Julia blues. Looked at eighty, some studies are back pain and just found. The frosty opiates prescribe is actually no good studies showing that opium aids are more effective than other things for back pain, say true for most kind of surgery. By the way I just like the things we do and back pain, it's like big rumour and which could have to end its bad. It's really bad. If I'm surprised at any point that there is this difference, it's more because so little good research, I'm not sure what would be making the higher rank. Schools do a better job than that. You know in some kind of abstract way the best doctors are better than worse. Doctors, in that, where you went to medical school is to some degree correlated, although obviously, would not be a hundred per cent.
the doktor quality, I will know it just cause. I thought this was one of my initial questions about the paper and they elated. For me, one possible thing you be seeing there is it doctors from high rank medical schools end up with a less sick, patient population or somehow indifferent, and population, so one I think important control they ran in here they looked it. They looked devotion view medical school rank and propensity to describe opiates among specialists who attended different medical schools, but worked in the same clinic. Since I mean you have a clinic. Our some people went to pick your top school on. Some people went to pick your not tops and they looked at what happened in those populations and there is still a quite big difference. Even though you assume the patients coming into that clinics are on the same area, would have reasonably similar propensities and an end needs for pain treatment. Again me the stuff we're not seeing the other day. I wouldn't be shocked to find there is some amount of patient issue here, but But I wouldn't that that doesn't be to me to be a robust, controlled. Thus quick thing I'll, say: that's a lie
of the opium problem, not all of it, but at a fair amount of it does come from like really quite on ethical opiate prescription. Summing there's over this too much opiate biscuit just in general, and then there's some people just running pills. I just dream land, which is a fantastic bite on the our guide, real good and it wouldn't. rise me at all that the people running pills did not go to the next medical schools. He sort of goes through held the pillows actually pick up on doctors who You know nearly got disbarred, or how did you know like loss or job somewhere else, and so I think that in some of the places, where got really really bad, you do see the prom. Concentrated among certain doctors, and those doctors
I do wonder for skimming the results at all coming in a lurking beneath the surface of this paper, but that it is remind me of his that we treat medicine in a slightly oddly decentralized entrepreneurial kind of way. Act like doktor training level, even while other things like Medicare and Medicaid, and the affordable CARE act and health insurance regulation and the tax deductibility of. Works by an insurance and arrests are rules are like very top now write him in the wood. There's like marketing year approaches and more state to see approaches, but there's a general consensus that, like medicine, is a scientific field that there is a truth to it a right way and wrong way. The FDA just like says what drugs you can sell and what drugs you can't within doctors are being treated like straight out of eighteen. Seventy like going with like ability,
tracking of the medical school students right which, like as when it one questions reasonable. Why do you do it that way? Right so, like the guys were the best l, sad scores cluster and the same him full of law schools and they produce lawyers who go work for the same cluster of like big law firms, but that's because it's like a private business with no Like public interest objective but like, why do we want to train the nations core of doctors? In that way? Like should them marginal candidates being a school full of other marginal candidates being instructed by marginal instructors and then put out in the world to like, do not good job of treating people's illness. Is, and then we'll say like well, it's gonna fail in the market test, so it'll be poor. People who are treated by the poorly trained week like that, that doesn't sound like selling. You would articulate as like a goal of the medical education system.
And there's like a lot of different versions of that with like not requiring that address to update their their training in their practices. But it's like I think it would be an interesting exercise, some point four members of Congress involved to like you know, sit around a table with a White Board, unlike what are they trying to accomplish with medical training in America and then ask some people if the system in any way is like effective at a couple, sing those things, because whenever you look under the hood, it always seems like yeah. It's kind of obvious that, like the doctor's with the week or Mcat scores who get caught by the person, structures are going to do a worse job of treating on this effectively but like that seems really like. That's really unfortunate, like that's. That's bad people need like medically effective healthcare treatments, I think we could probably all agree on this reminded me a lot of. Am I told the long days he's in a new Yorker that heading it called the costs, conundrum this peace them they became.
famous during the healthcare debate in two thousand eight, where we went to Macao in Texas, where people get way more treatment no seeming reason and I think this is one small example of a much less Sure thing you see it of care, is just queued. You judge variation from doktor to doktor from place to place, in how doctors practice medicine where you have all these medical journal. You ve all this research, but its kind. Bit of a crapshoot of how its being represented to you as a patient when you walk into a doctor's office I've got an older and like shopped around for doktor is you can really seem to figure out how to treat a problem. Having becomes really apparent very quickly. How much variation there is between. I was seeing where the Peters my foot and one I was just like stuff on, while just take vitamin d every time, I'd God be like vitamin d again in Canada can take vitamin d, I did and it didn't fix the problem.
But you know each person I would see would have a totally you know they were all technically trained, as orthopedic would have a totally different idea of what exactly it was. I should be doing and with hope. You, though I do, the stakes are like a little bit higher than like this stress Bactra, I thought you know, vitamin d is not an addictive pill that I was taking with obviates. The stakes are much higher and how people are interpreting the research and how you know what treatments that they are getting. I was also gonna start up. My comment here within a tool the one day you indifferent to go on, they pull out. What are you have? As I was listening to and interview, I took one day with our common on Untilat podcast Andy. I think tar asked him. I don't remember the exact question, but but the answer that tool gave was it the biggest thing that physicians need update themselves on and recognize him and become more honest about is it medicine has now become, is so complex and fast moving. It can't be an art anymore.
Just be that you are experienced and smart to Emma, keep up with a medical journals. It's too big for that, and it a we're not at a point where, like Watts in Kansas, diagnose you its own, but we are really fast moving to a point where to not be having real sort of a I assisted diagnostic is insane because it's like, even if your trying really hard partake your general practitioners, your seeing a very wide range of things, just keeping up with like the latest evidence, much much much much much more than full time job, and you know I mean look like we all are humans. We can't do everything wanting that actually might be accounting for some of this is that a trait of the people by Gordon
medical schools ease of it. They study really really hard, and that might be a trade that persist after medical school, and so they are keeping up with evidence at a faster rate than people who go to to worse medical schools, and maybe don't have that in that doesn't mean the people go to the other. Medical schools are bad. I did not go to a great college. I mean I've. I like you, see Santa Cruz, but it was not the best college in the country, because I dont study while uncertainly didn't back then and and so like I've needed to come up with ways to think try to like deal with that deal with the fact that I have trouble concentrating on things like that The medicine has for a very long time. I didn't go. Go I d like to talk about them. Cowboys like it had the sort of cowboy mentality. Like you know, you go to the fifth Orthopedic then the like he's a guy with a mustache Nike does things his own way, but he knows what's really wrong with the only no legs, it's gotten too big. For that we don't. Nobody can know anything and we need to begin in a much more systematic way, creating
we ve already beginning to work on this, but creating assistance fur for doctors so that their not on their own out there, but with very depressing. Is that when you think about the incredibly so diffusion I simply electronic health records imagining moving doctors to day I assisted diagnostics. Is it very difficult to imagine it struck me. I mean it struck me how reluctant doctors often seem compared to other professionals to just like emitted there. Looking something up, because this happens to me all the time I, like I'm, a journalist while Bob you know it's like if, if someone's like. does like. You should do a piece about the Bolivar. Don't try to just like right off the top of my head about things because it using its unsound, but like ethical once in my life, I saw it gradually turn to her computer and like check something, and it turned out like the things you'd start, it's like she wishes
long, but would suck is fine, but I very rarely see them so. People just come in and they'll just like be like rattling off like odour of this simple that one we get this treatment, unlike if it works. I guess like good good for you. You should go in jeopardy you're something, but that's a weird waited do your job. It's like performance of vike competence and an end like mastery and like how you would want the like healer character in a movie to Julia ACT, two things but like that's, not how I do my job is our. How like attorneys that I know do their job in part, because you're not expected to do your job, like with the clients directly in front of you all the time, but it it doesn't make me wonder about seventy six, just a kind of like cultural norm against like checking back with, like what is the professional standard for this again
like I've, heard a lot of buzz about this opium oil problem. Like am I doing it right, it's a weird kind of field, because it's it's a scientific and technical enterprise, but is also very much like a human service enterprise where, like you're you're there in front of the patient and, like you, want them to like feel good about your interaction in a way that you don't expect like the chemists behind the drugs to like the empathetic have bedside manner. This is like real, like weird cunning duality to it. Any good, particularly imagine with over prescribing the things like really pushing in different directions. That, like being told by the doctor like now like those pills, did not really can help you, you might get addicted and colonial life like what you have to do is like
Fuck it up and do stretches more is like that. I don't want to hear that right leg, you want someone who's gonna tell you like, they ve got a magic fill that that's gonna, carry you and it seems very inherently difficult to me to sort of like the strike. The balance between the job of the doktor is too like deal with the human being in front of you in a way that the patient find satisfactory and then also you gonna do what's like technically scientifically and professionally, like what the sort of state of the art expects you to know what we should like those of their workers. Circa board, one that was talking, fair enough. Sorry, sorry for being so dull. I thank you to everyone all those years ago who always Still here aberrant bearing Witherspoon and listening and thanks to our are pretty unlike Sarah, Yes exactly, they went on a long time. He was alone with a lot. He was alone episode, but you know thank you, George, our producers, actually mine, Berger and and Peter Leonards, who have not been
an amateur quickly plug the essential this week. An interview with Centre, Michael Bennet, from Colorado about Hey Congress, is both so terrible and also failed to somebody says you pass, which was one of his points. It is one of the EAST bullshit filled the interviews, I've done with a member of Congress and is if you would like to get a sense of how working in a broken institution feels to somebody who is not completely lost sight of the fact that that what he is doing, I really recommended, I think, is one of the best and abuse we ve had on this while- and I think I'll be up a lot of interest to the Congress. Nerves of the and if you ve been lying awake at night, terrified of the latest north korean nuclear programme. The latest episode of worldly. Well,
Will you learn a lot you don't to an extent what you did. He is about a little better about the situation after listening to it. So you know you should you should check that out for a brief spate of with a from global terror, and we will see a private Eendracht right buddy,
Transcript generated on 2021-09-13.