December 2021/January 2022
Welcome to the December/January issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
This edition is a bit different from the previous one (and it’s a long one, so brace yourself!), because it’s focused on ONE big topic, which is: what do we ‘attend’ (pay attention) to? I’ve written briefly about this before, after reading a book I often recommend: Attending by Ronald Epstein.
This photo will make sense shortly.
so will this!
While I was in London for 6 weeks recently, for personal and professional reasons, I met a lot of fascinating people (maybe there was something in the air…besides the obvious SARS-CoV-2?), but one person, whom I’ll dub for dispositional reasons “Mr Darcy“, stood out for one reason: he paid attention to to the *right* things.
Mr Darcy is unique for many reasons: an academic surgeon but someone who grew up with a strong literary background, being diasporic but born in the UK, and having several unusual obsessions outside of work, all of which has allowed his mind to adapt and see connections between disparate things and experience the world differently. This same tendency has undoubtedly also led him to pursue the right questions in his research (think: senior authorship on several Nature papers, even though he’s technically an early career physician and researcher) and numerous professional opportunities.
Mr Darcy also happens to be an excellent cook, namely because he’s a bit of an obsessive. Once he made squid ink breadsticks (with a complicated dip recipe) for a party we attended, because at some point he realized regular breadsticks were not good enough. The extra few minutes to add squid ink paid off for the guests, mostly in ‘awe’ and joy, and even though the dish itself was tasty — that tiny tweak moved it from good to “extraordinary.”
But all of these things aside, Mr Darcy also left an impression on me personally because he paid attention to the *right* things. To be sure, it wasn’t an *excess* of attention — but an investment and calibration towards the things that matter.
It’s quite easy, when we think about it, to give anyone or anything a *lot* of generic attention: spend more money to impress someone, spend more time on one thing (this grit/slogging isn’t always ideal) or person to show ‘effort’ or ‘commitment.’ But the impact tends to be low, over time especially, if that’s the only dimension we focus on. Investing in the correct things, things that lead to the biggest payoff, is often a better, or at least complementary, strategy.
This idea led me to think about how often I pay a *lot* of attention, when I should really be spending the *right* type of specific attention. One big area is cooking.
I’m a relatively good cook: I’ve been cooking for many years. Overall, when I cook for loved ones, they enjoy the meal. But am I a great cook? Definitely not, if we define ‘great’ as ‘exceptional’ or ‘extraordinary’ — I can’t recall one time when a loved one brought up a meal I’ve made as specifically memorable, which is a good marker for ‘extraordinary.’ We know this because we often remember the moments that stand out as well above average — specific meals at restaurants are a big one.
So, for 2 weeks, mid November to December 1st, effectively just as I returned from London, I challenged myself to apply the principle of ‘paying the right attention,’ towards becoming closer to ‘extraordinary’ with cooking. My goal wasn’t to cosplay as a professional chef, in as much as a layperson can’t just put a white coat on and be a doctor, but I wanted to refine my thinking and approach enough to get closer to ‘extraordinary’ — to change up my ‘process’, and iterate to lead to a better outcome and experience.
I decided to experiment with a new dinner dish, or refine one I’d made before, daily, as this seemed the most efficient way to establish a habit, and enter into a learning curve where I could build upon skills each day (so total immersion!).
Instead of focusing solely on one sense (taste), I wanted to explore the other senses as well: aroma (the feeling that hits you just before you take a bite, or when a plate arrives), visual (how are things plated/the art element to the presentation), sound and texture (how do elements pair together and ‘sound’ e.g. a crunch). Flavor/taste was also important, but I wanted to dive into pairing things that we don’t typically see together, or explore ingredients I haven’t used before.
The way I cook is probably how I approach many things, including my writing: I begin with an idea, and build around it. With cooking, I’ve always followed the taste principle of balancing at least four of: sweet/sour/bitter/salt/fat in some way. If I wanted to make one element the center — a cut of fish or meat, tofu, grain, or vegetable — I’d begin there, and then see how the other puzzle pieces fit together, according to the framework of flavor, visual, texture, etc. What worked best was creating a list of several potential dishes, and moving elements around over time.
The biggest gap was around technique: where I asked myself ‘if my goal is X, what cooking technique would be best?’ And in those instances, a quick google search or Youtube video sufficed to fill in that gap. This is all to say that I didn’t follow any preset recipes for most dishes (Dishoom’s black dal being one big exception!), and don’t tend to write out my recipes, because I simply don’t see cooking as prescriptive: and reversing my exact steps seemed cumbersome.
Adventure was also key: having ‘beginners mind‘ conversations with people at niche grocery stores and asking for advice or ingredient recommendations, for instance.
Part of intentionally gaining any new skill is accepting that failure and risk are part of it. As such, I set an ‘error rate’ of 10%, meaning that if 10% of my dishes ended up inedible, I’d be ok with it. Setting this meant I was free to explore weird combinations, or plate things without the expectation of perfection.
I also wanted to ensure that, unlike when I typically cook, I wouldn’t multitask. This meant that music was fine, but no podcasts/audiobooks or phone calls — I wanted to cultivate a flow state and focus my attention to each step of the ‘cooking experiment.’ It thus became a form of ‘mindfulness’ in action, and allowed for ‘deep work.’
Last: I wanted to set a few boundaries — namely time (the daily experiments had an end date so I wouldn’t totally fall into a rabbit hole but could also spend the time cultivating this new skill; also that most dishes should take about an hour, even if prep involved a few minutes overnight) and ‘gadgets‘: often when we get excited about a new hobby we can be impulsive with getting all the gear, even before we know whether we actually need it. I did change my mind on a sous vide machine: I settled on a basic one that saved a lot of time and effort after I understood the manual investment (because I made the manual investment for one dish!), and because my perspective changed on Black Friday! But I didn’t purchase a blowtorch (which would have allowed me to cook pieces of fish directly on a plate).
Overall, the process was enjoyable, and a fun self-directed learning activity that allowed me to follow my curiosity, take risks, and improve in a tangible way. Now I’m inspired to offer this skill to loved ones as a way to change up the typical ‘ordering takeout’ or cooking something basic. Cooking for someone is, indeed, an under-appreciated love language and expression of care — why not make it extraordinary then?
It also made me realize that, when we often discuss ‘wellness’ strategies and approaches, we focus heavily on things like nutrition, sleep, connection, mindfulness (all things I’ve written about, are described on my website) but we pay less attention to the human need to explore and discover, and the unique benefit it poses to well-being that most other ‘self improvement’/wellness/self-help things don’t. For instance: when is the last time you took a ‘field trip’ to learn about something (eg an industry) that you’ve been curious about, without a professional payoff (eg as part of a job)? And why are adult field trips not more common?
So, as a small step up from Instagram, I’ve added a tab to my website as a nudge to inspire us all to do more curiosity-led experiments in the future, even if it isn’t daily (or even weekly), as part of our wellness. Why ‘peaceful pescetarian’? That was a [now defunct] food blog I had several years ago to document seafood-y things I ate (and a few things I made). Needless to say it didn’t last, but I love the name (though if I could rename it, it would be ‘the peaceful pescetarian and the vegetarian hedonist’ 🙂 ).
We’re nearing the end of this rather long, hopefully not *too rambling*, letter but my hope is to inspire you to consider adding something to your wellness repertoire this holiday season, that perhaps you might carry forward into 2022, that goes beyond what we typically associated with ‘wellness;’ something that challenges you to learn something/get better at something you’ve perhaps been curious about for a long while; something that doesn’t necessarily need to be tied to your professional goals, but has the potential to expand your sense of joy and well-being. Part of this may involve exploring where you might have been paying *excess* attention, and where instead, you might get a better outcome from paying the *right* attention instead. Consider it an experiment that provides meaningful data to help you make better decisions, and re-evaluate how/where/when you spend your energy and time.
In other words, we can all benefit from Mr Darcy’s insight, especially as our well-being may be further challenged this winter due to the new variant: a reminder that we’re in a pandemic marathon, one that’s approaching almost two years, where it might be helpful to expand our toolbox of things that keep us calibrated towards more joy, peace, and wonder during these uncertain and troubling times. And if you *do* try something new, shoot me an email or tweet it to me!
Have a healthy, joyful, and safe Holiday season,
Amitha Kalaichandran, M.D., M.H.S.
ps and on an unrelated note, I’m re-sharing the link to a very worthwhile fund to consider during this season of ‘giving’. I’ll have more to say in the next newsletter.
October 2021
Welcome to the October issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
Wiltshire, UK, Oct 2021
Some things that had me wondering this month:
1. COVID and…
The kids are alright: from The Washington Post, a story about a young boy not wanting to take his mask off for his school photo, and his sweet reason why!
A Canadian physician’s essay on caring for patients: and reflections on managing those who remain unvaccinated.
A great way to frame the pandemic trajectory ahead (without forecasting): From The Atlantic, 6 rules to help provide context ahead of the Fall/Winter.
2. Podcasts (& shows/books) worth listening to/watching
I loved this interview between psychiatrist Paul Conti and Tim Ferris on understanding trauma, the brain, and behavior.
And, in about 2 weeks in the US, Anil Seth’s book, Being You, will be released (it’s already out in the UK, a Sunday Times bestseller, and fascinating). I recently [and serendipitously] met Anil and had some of the most interesting chats in recent memory. His popular TedTalk is also worth a watch.
3.On…#Metoo, Consent, Desire, and so much more
By Philosophy Professor, Amia Srinivasan — her piece in the NYT was probably the most shared essay in my network last month. Her book of essays, The Right to Sex is also an excellent read.
4.Sound (and wise) reflections
And as part of the OpEd project, I coached Suparna Dutta and this is her first piece, on the butterfly effect impacting hospital transfers
5.Miscellany
If Canadian journalist, Sydney Page, who regularly writes for the “Inspired Life” column of the Washington Post, is not yet on your weekly reading list, she should be. This will make you cry (and hopefully smile too).
6.Best tweets of the month goes to…
Sahil Bloom, on what the Chinese bamboo can teach us about growth
Tareq Hadhad on the Canadian election
Elaine Welteroth, quoting part of Michaela Coel’s Emmy speech
Adam Grant, on reframing ‘self-worth’
Ted Lasso (which I just started watching!), on grief
7.Products/Services that have made a meaningful difference during the pandemic:
As mentioned last month, I’m trying something new. This newsletter is not sponsored, but I love sharing products/services (including books, workshops) that have made a meaningful difference in my day-to-day, i.e. things I’d share with my friends. So I thought I’d share one with you each month.
This month, I’m sharing this small device — the Zulay frother. I love it for matcha, chai, coffee lattes for ambrosia-like froth, even for milk alternatives like oat or soy. It just makes the colder mornings (and frantic Sunday afternoons) a little more enjoyable.
Here it helped me create a fluffy chai (a ‘chuffy’?)
Chuffy!
In My Own Words…
For Elemental, I wrote about a topic I’ve been a bit obsessed with since February 2021: the sharing of opinions by ‘experts’ while a pandemic is underway. Poynter, which is a journalistic resource, ran a slightly different version as well. Writing wise, I just submitted my second round of book edits, and got assigned a really interesting magazine story, which brings me to London for a few weeks. The last ‘truly’ longform story I worked on was this one, so I’m eager to dig in.
Fly-fishing in West Chisenbury
I also caught my first ever fish (wild trout!), during my first ever fishing trip (in Wiltshire), with a very patient teacher (thanks RC!). It’s not trout season, so we put it back. But…’teach a woman to fish and she’ll smile for a lifetime?’ might be a great quote adaptation for these times. As well: I didn’t realize how meditative and relaxing fly fishing is…though…
If you have time this month, please consider donating to St Michael’s hospital foundation. A dear mentor (and a much-loved teacher of medical students and residents) from medical school, Dr Robert Sargeant, was diagnosed with an incurable form of brain cancer just over a year ago. I know that I still remain hopeful. Arguably Dr Sargeant was among the first people who turned me onto writing about medicine, with an essay he suggested we (our clerkship rotation group in general internal medicine) read: Letting Go by Atul Gawande.
It takes on special significance at this time.
Have a healthy, joyful, and safe October,
Amitha Kalaichandran, M.D., M.H.S.
June/July 2021
Welcome to the June/July issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
A forest playground, near Chattahoochee Hills, Georgia, May 2021
Some things that had me wondering this month:
1. COVID and…
Pediatric Multinflammatory multisystem syndrome: In the Lancet, some good news: the sequelae (long lasting effects) of the initial symptoms may not persist past 6 months.
On masks: When and where to wear them, by a pubic health expert, in Slate and…could they be here to stay for cold/flu season (I think so), in the New York Times.
Vaccine Hesitancy: Among healthcare workers in the New York Times.
and….
How the pandemic ends, by the indomitable Helen Branswell, in STATNews.
2. Podcasts (and shows) worth listening to/watching
The best series I’ve watched in a long time is “The Me you Can’t See,” a series on mental health and wellbeing, produced by Oprah and Prince Harry. I especially loved the last episode, which placed a solutions-lens on mental health as well where this issue intersects with other contemporary challenges, such as policing. Make the time to watch!
3.On…reconciling with Canada’s challenging past with residential schools
In the CBC, the discovery of the bodies of 215 Indigenous children, some as young as three, rippled throughout the country. It’s likely there are many similar mass graves across the nation. First comes ‘truth’ and understanding the true scope of this tragic legacy, and then reconciliation. I sense that we’re only beginning to get to the truth bit.
4.Sound (and wise) reflections
~In NiemanLab, why Darnella Frazier, now 18, should win a Pulitzer for her bravery in capturing the tragic death of George Floyd, which had a ripple effect on how we understand systemic racism in policing and more broadly in our society.
~Billy Porter, on sharing his truth as a man living with HIV, in the Hollywood Reporter
~On the Cicadas who are re-emerging after years, in the New York Times.
5.Miscellany
~I developed a tree pollen allergy last year, and have been sneezing nonstop seemingly this month. Finally, I have my answer, from CTV.
~On brain implants that could translate thoughts into text, in Wired
~For subscribers to STAT+, the investment in healthcare teams, by tech companies.
~From Yahoo, the tragic death of Michael Lewis’ daughter, Dixie (along with her boyfriend, Ross Schultz), in a car accident last week reverberated throughout the literary community. Lewis is one of the most talented narrative nonfiction writers, and I just started his latest: The Premonition, about the pandemic. His podcast, with Pushkin Industries, Against the Rules, is one of my favorites, and last season he described being coached for singing, drawing parallels with Dixie’s experience with her softball coach. May Dixie and Ross rest in peace.
6.Best tweets of the month goes to…
Adam Grant, on a mantra we need to finally do away with:
“We’ve always done it that way” is not a valid reason for anything. Don’t follow traditions because the status quo is comfortable and change makes you uncomfortable. Question whether past routines are serving you well in the present and guiding you toward a better future.
Rebecca Herbert, on attachment (or…”inosculation”, in the plant world) which continues to be a theme I think about often:
The thinner tree was cut years ago and the big one has been holding and feeding it since then. They “wake up” together in the spring and “go to sleep” together in the autumn.
An excellent thread by Marie Beecham on cancel culture as a form of intellectualism.
This sums up a lot of the past 18 months with the pandemic: Mike DiCenzo: (a former writer for Jimmy Fallon, the Onion, etc):
Nobody really knows anything. Everyone’s just saying things. But some people say things more confidently than others.
NYC, enlivened, as the storm clouds (of COVID) appears to be clearing! May 2021
In My Own Words…
For Elemental, I wrote about the “re-emergence” effect we may all be experiencing. And for Wired, I wrote about medical reversals, and what they mean in the broader context of our post-COVID world.
This was also a month with additional ‘in person’ reporting in and around New York with sources I couldn’t meet in person a year ago, given the lockdowns. We also cemented the title (On Healing will be the final!) and the subtitle (this was a toss up between two — so stay tuned!) and hopefully I’ll be able to share the cover in the next newsletter.
And a brand new book to be sure to get your hands on, by my friend Barrett Swanson (I’ve linked to his essays in previous newsletter): Lost in Summerland. This interview, in LitHub, is a great as well.
Have a healthy, joyful, and safe June and July!
Amitha Kalaichandran, M.D., M.H.S.
May 2021
Welcome to the May issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
Some things that had me wondering this month:
1. COVID and…
India: The situation in India is devastating, to say the least. I’ve written about the role of large companies in helping us address the pandemic in North America (I wrote about some ideas in Fast Company last March, and for Medium). After an initial block on raw materials, the US lifted the ban, which was wonderful news. Companies like Salesforce and Apple have also stepped up to help, and the diaspora has spoken out as well (Toronto Star)
Brazil: The plight of COVID children was meticulously described in NBC News — what might explain this pattern in Brazil, but not North America? And, in the Globe and Mail, the tragic story of Emily Victoria Viegas, a 13 year old who died In Brampton Ontario
Vaccine Hesitancy: Some ideas on how to re-think it, in the New York Times. Two years ago I tackled the challenge more generally in the LATimes — it’s not about knowledge as much as it’s about understanding, the influence of our peers/social network, and our personal experiences intersecting with our values.
The Color Line: I’ve been waiting for someone to take a deep dive into the disproportionate element of race during this pandemic. Ibram Kendi did just that, in The Atlantic, and it’s worth a read.
To Mask or Not to Mask (and risks): Nikole Hannah Jones’ Tweet suggests that masking may be a social good in more ways than one. For the Globe and Mail, Andre Picard places the salience of risk assessment, as it relates to the vaccines, in perspective.
Organized Chaos: In Canada, a big batch of vaccines from Johnson and Johnson was held back for inspection (note they arrived from the same US factory that was problematic), the National Advisory Council on Immunizations provided mixed messaging regarding two tiers of vaccines, meanwhile the US is looking to expand vaccine eligibility for the Pfizer vaccine to 12-15 year olds (though herd immunity is looking more unlikely). That said, the W.H.O. had *finally* deemed COVID airborne (GREAT news) just weeks after an urgent an op-ed by the head of the W.H.O. that was timely and important.
2. Podcasts to listen to:
On her Dare to Lead Podcast, Brene Brown’s interview with Michael Bungay Stanier was brilliant. One big take-home (and there were many) was how to handle requests for giving advice, in a way that places the onus on the asker. It made me think a *lot* about motivational interviewing: the aim being to help clarify the person’s goals, and reminding them of their own agency. Another interview, on the same podcast, with Angela Duckworth was also a worthwhile listen, especially near the end, when both Brown and Duckworth share experiences with envy and how best to channel that sentiment productively.
This Tim Ferris podcast episode, with Balaji Srinivasan, was from the end of March, but I listened to it in early April (late to the party). It’s well worth the 3.5 hour listen (in chunks!). Some highlights: how autonomy can help offset cancel culture, the future of cryptocurrency, and what work/purpose may eventually look like for each of us. I also appreciated Srinivasan’s orientation towards legacy building, and ‘giving back’ after his success.
While not a podcast, an incredible Audiobook to make time for is: What Happened to You, by Oprah and Bruce Perry (a psychiatrist) which takes a deep dive into trauma. Over the last year I’ve realized how much is secondary to trauma — how we respond to things and how others respond for instance. These traumatic events, as Gabor Mate shared during a chat earlier this year, can seem minor at the time but they all lead to patterns that underlie how we understand the world and how we interact with others and respond to others. It has deepened my understanding of others and myself. The book wraps up with Oprah doubling down on post-traumatic ‘wisdom’ with some words around making ‘trauma your power.’
3.On…re-examining medical culture (from 2017)
In the American Academy of Family Physicians — a nice framework for shifting medical culture, both as a leader and someone who is being ‘led.’
4.Sound (and wise) reflections
~On languishing, by Adam Grant in the NYT (who humbly shared a counterpoint by Austin Kleon)
~Newark police reform seems to have worked, in NJ.com.
~Why the dental ‘system’ is so broken, in Canada at least, via The Walrus. It’s a great title too.
5.Miscellany
~From STATNews: while diversity and inclusion efforts have expanded in most industries, medical education/medical schools is not one. And, in Time, how medical journals remain resistant to writing about systemic racism
~Cancel culture x Shame, by Ezra Klein in the NYT. I’d love to see/hear Brene Brown’s take on this topic.
~The history of the Rubik’s cube — I’ll have more to share in due time (it’s briefly in my book)!
6.Best tweets of the month goes to…
Via Tim Ferris:
“Let me never fall into the vulgar mistake of dreaming that I am persecuted whenever I am contradicted.” — Ralph Waldo Emerson
By @ProductHunt — your brain on Zoom (without breaks)
A lovely cartoon by one of my favorite children’s book illustrators, Debbie Ridpath Ohi on ignoring writing competition, and focusing on your own journey and pace
Viral viral thread on imaginary New Yorker covers — this one made me cry (a perfect depiction of grief).
And by @JamaalBowmanNY
Addiction requires love — not jail.
And last: @EzraKlein, on anxiety
And then came the pandemic. Reality was objectively terrifying, and many of us were trapped inside, severed from social connection and routine, with acres of time to fret. It was a bad mix. I know a lot of people who didn’t have an anxiety problem before, but do now.
In My Own Words…
For the last year, I’ve been perplexed by the role of medical expert witnesses in the criminal justice system. I didn’t have a reason to explore it until the Chauvin/George Floyd trial, and came across an excellent law review paper by David Faigman (Chancellor of UC Hastings School of Law) which got me thinking. It was truly a page turner!!
I shared my thoughts in an opinion/analysis piece for Scientific American here.
This was a month with lots of *editing* of my first book draft; I completed the second draft in early May. One of the best books I’ve read over the last few months was by Ashley Bristowe, My Own Blood, which explores how, as a mother of a child with a rare health condition, she was able to navigate both the medical world and the personal world. I highly recommend it — we rarely get insight into these struggles from the ‘patient’ side of things.
It’s promising to see that in some places–parts of the US, things are opening up and vaccine rates are high. Canada still has issues with the vaccine supply, and places like India do as well. I had COVID last year and tested positive for antibodies before receiving the first dose of Pfizer — surprisingly I didn’t become ill but will have to see what the second shot will show. I’m feeling more optimistic than I have in over a year that things will start to open up in the Fall in most places in North America. Hopefully the whole world will be in a position to see the end of this terrible pandemic very soon as well — there’s no ‘them,’ just us, and if there was ever a time for vaccine diplomacy and general regard for global health, this is it.
Have a healthy, joyful, and safe month,
Amitha Kalaichandran, M.D., M.H.S.
April 2021
Welcome to the April issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
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Some things that had me wondering this month:
1. COVID and…
~Vaccine hesitancy. In December I wrote about a hypothesis on scarcity and social proof about potentially overcoming vaccine hesitancy. Recently the WSJ published data on vaccine hesitancy, which appears to be going down on several states — could it be secondary to scarcity and social proof? And what *might* it mean for vaccine hesitancy in general?
~The politics behind pandemics. This, from the New Yorker is an excellent review of Baylor Medicine’s Dr. Peter Hoetz latest book, Preventing the Next Pandemic, and a great reflection on a remarkable career in infectious diseases/global health.
~Design. COVID has impacted the design world in unique way, in the New York Times .
2. Podcasts to listen to:
The On Being podcast is a favorite. Recently host Krista Tippett interviewed psychologist Christine Ryntab about how our mental health has been affected by the pandemic.
Part 1 (covers mastery vs success) and Part 2 (covers a beautiful term called “aesthetic force”) where Brene Brown, for her Daring Leadership podast, interviews Harvard’s Dr Sarah Lewis. It might be the best set of interviews I’ve listened to in years. It will nourish you and inspire you (and i’m currently listening to Lewis’ gorgeous book The Rise, on audiobook).
I’ve been listening to poet and musician Morgan Harper Nichols daily for the last 2 weeks. Her 3-12 min episodes are beautiful reflections which leave you with a question. Nichols’ voice alone is incredible, and her instagram account covers her artwork as well. She’s a rising star to watch.
Some of my recent favorites have been on trusting despite the uncertainty, on our purpose (with lovely) a river analogy, and 7 phrases to help with future worries.
3.On…forecasting and expertise
This is from the archives of the Atlantic, by the incredible David Epstein (his book Range is a must-read). Here, citing Philip Tetlock’s work, he calls into question ‘expertise’ — indeed it must be a balance. We need experts to guide us, but non-experts help us identify blind-spots. This is a topic I’ve been thinking about a LOT with the pandemic. I’m now left thinking it’s more of an ‘amplification problem.’ Perhaps, with COVID, given the amount of uncertainty and the fast-moving nature of science, the media tends to rely on experts to self-identify. This then leads to many ‘non-experts’ (confident but incompetent, at least as it relates to medicine and public health), who *should* be part of the discussion, but shouldn’t be amplified, get amplified the media.
Recently an economist at Brown received immense criticism (here, here , here, and here, but really — there were lots of important points made) for an article about childhood COVID transmission. It was inaccurate and simply unwise, as many physicians and epidemiologists identified, but it likely wasn’t intentionally so. The simplest explanation: economists and epidemiologists look at data and value various factors *differently.* As an economist, her views could add to the discussion — it may just be that they should not have been amplified in that fashion, as it drowned out the current recommendations and expert forecasts. It was quickly debunked but the harm cannot be underestimated. Reporters, and others without expertise but who write about a subject, are expected to incorporate expertise into their pieces, in order to report out an issue fairly and accurately. It’s possible that this economist may have avoided the controversy by interviewing epidemiologists in a “reported op-ed” (one that isn’t solely her opinion), as opposed to writing an op-ed from her point of view as, effectively, a non-expert in public health. Perhaps an article on the economic impacts of COVID or how an economist may *think* through the challenge of lockdowns would have been more appropriate.
We must amplify experts who are truly able to comment on the pandemic and make recommendations, and not simply allow the loudest voices (in the room or on Twitter) to prevail. This, ultimately, causes harm to public understanding, and influences behavior in a way that ultimately negatively impacts how the pandemic is handled. Editors and producers, therefore, must also be equally discerning when commissioning op-eds from academics, and ensure their expertise lines up with the subject matter.
4.Sound (and wise) reflections
~A former incarcerated man reflects on solitary confinement — which he suffered through for 18 years — in NYTOpinion
~The challenge of bullying in healthcare, in the Financial Post
~The role of trauma in gun violence, in the NYTOpinion
~There were many great pieces about anti-asian violence. This Q+A in the New Yorker and this op-ed by National Book Award winner, Charles Yu, in the LATimes are worth a read
5.Miscellany
~From the LATimes, the things migrants carried and dropped on their trek across the border for a better life
~The incomparable Dr Eric Topol, for the WSJ, on how science accelerated over the last 13 months
~The plight of child caregivers, in the LATimes
~In the NYT, the incredible life of one of my favorite writers as a child — Beverley Cleary
~One of the best personal essays I’ve read in months, in the Washington Post, about medical error, second opinions, and the limits of medical ‘expertise’
6.Best tweet of the month goes to…
A Three-WAY tie:
This thread is inspiring (it’s worth reading in its entirety).
@JouLee:
We think strength is self-sufficiency— achievement without reliance on others. We think that if someone else gains, we lose. But intertwined, we all go further. This is the secret of Silicon Valley. Help others, ask for help, and collective strength multiplies.
@gradydoctor:
Reflecting on these statements from 2 good friends in academic medicine this week: 1. “There HAS to be a consequence between nothing and professional death.” 2. “Healing HAS to include restorative justice–which begins with accountability.” Yeah. That part.
In My Own Words…
This was a month with lots of writing, and the next few weeks will be dedicated to my book revisions (due in 3 wks!). For Medium‘s Coronavirus vertical, I wrote a primer about the AstraZeneca vaccine, clots, and concerns about causality. For Elemental, I examined the role of prayer in healing, inspired by the story of Molly (that many of us were inspired by in February). Last, for Wired I tackled an issue that has been on my mind for many weeks: the puzzle of pandemic prognostication (and why some see things through an optimistic lens, whereas others are more concerned) — I make mention of epistemic trust and the issue I discuss above (point #3).
Also, a personal one from the archive (2017), about my grandfather, who has been on my mind late, in Hektoen International.
My time in Vancouver is soon coming to an end (as, sadly, variants are taking hold). It has been such an incredible place, with so much natural beauty, to spend time in over the last 8 months.
Have a healthy, joyful, month,
Amitha Kalaichandran, M.D., M.H.S.
March 2021
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Welcome to the March issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being
“Two days, Two seasons” (Kitsilano, Vancouver BC, February 14th vs February 13th, 2021)
Some things that had me wondering this month:
1. COVID and…
~A new vaccine. The Johnson & Johnson COVID vaccine is now available in the US (hopefully in Canada soon). How does it stack up against Moderna and Pfizer (and AstraZeneca)? This might be the wrong question when scarcity is at play: take what you get, as this NYT op-ed advises. Remember: the vaccine is intended to prevent severe disease, i.e. disease that would require a hospitalization/ICU visit or worse: death. It may not be perfectly effective at preventing infection. The flu vaccine is similar, though often has much lower effectiveness. But in general, those vaccinated with the flu vaccine are at a much lower risk of severe disease, even if they do have mild flu symptoms.
~Vaccine diplomacy. This will continue to be a topic to watch closely, and one I’ve been pondering since the Summer when I received a press release about an Indian manufacturer planning to ramp up production of a vaccine (which ended up being the Astra Zeneca vaccine). India specifically has played a major role over the last 15 years in terms of drug manufacturing: especially as it relates to anti-retroviral drugs, and facilitating a price drop which improved global access. India has manufactured vaccines for global health (e.g. polio) as distributed by organizations like GAVI, WHO, UNICEF, etc. But this is the first time to my knowledge that India is playing a role in manufacturing vaccines for the ‘developed’ world. So not only is Jamaica receiving shipments, but so is Canada. The editors of the NYT Opinion section penned an excellent op-ed on the theme here. My question: will India then be able to leverage other interests (e.g. politically, trade/economic) with recipient countries? And what are the potential pitfalls and opportunities? A handy comparison: the role China played in providing PPE to affected countries, and the potential downside regarding accountability as it relates to investigations into the virus origins in the country.
~On reopening schools. It remains a tricky debate. I like Dr Leana Wen’s take in the Washington Post. Side note: I spent my 32nd birthday in Charleston, and Dr Wen happened to be there (story for another time, but she’s fabulous!)
~ Screening for health conditions. There’s no doubt that there are several externalities secondary to the pandemic. One big one that doesn’t get discussed enough: the negative impact on screening. This piece, in the NYT, tackles it head on.
~Children. A well presented and reported piece on the youngest victims of the pandemic in the Post — even if children rarely suffer from severe disease, they are impacted in other long-lasting ways.
~The best essay I’ve read (about COVID since the pandemic began), by none other than Dr. Siddhartha Mukherjee. This one is about the mystery behind the low death rate in India in the New Yorker (followup with my favourite New Yorker piece period, from 2017, Cancer’s Invasion Equation, also by Dr. Mukherjee)
2. Podcasts to listen to:
This episode of Brene Brown’s podcast features one of my favorite thinkers, Adam Grant.
Here they interview each other in a sense, and Grant gets into the topic of his latest book, “Think Again,” while also sharing a variety of anecdotes about his career and life decisions.
And because she’s utterly delightful, Fran Lebowitz interviewed by Kara Swisher on Sway is well worth the laughs and incredulity, if only for her line comparing herself to Helen Keller.
3.On…systemic racism in the 1950s and 2021
~Harry Jerome is a Canadian that I, and many others, never learned about in school. As a Black man attending a mostly all-white school in Vancouver in the 1950s, he had rocks hurled at him. His story of that time is captured here, in the CBC. A track star that went on to set several world records, Jerome sadly died in 1982. Now Vancouver is finding a way to honor him.
~This is an important read from StatNews‘ Theresa Gaffey, about a big story that was trending on Twitter earlier in February. A program director, who happened to be a Black woman, was dismissed from her position after flagging issues of systemic racism. This topic in general is a sad and very real issue in academic medicine, affecting residents, but also, clearly, staff as well. Of note, Gaffey is a multimedia producer but I hope she stays on this beat (medical education) as this article was so well reported, covering the nuances particularly well.
~And for GQ, the incomparable Wesley Lowery on how one police department, in Ithaca, New York is attempting reform. It may be a model for others.
4.Sound (and wise) reflections
~From NYTMag, this profile of Kazuo Ishiguro is simply sublime. What a brilliant mind
~The type of love that makes you happiest, in the Atlantic
~From ESPN, on injury and resilience, through the story of basketball player Azzi Fudd
~One of the most harmful questions you can ask children, by Adam Grant for CNBC
5.Miscellany
~From NYTOpinion about nurses, and what the pandemic means for the future of nursing. We rarely hear from other frontline workers (other than physicians), so this was illuminating for me. That said, someone on Twitter, who happens to be a nurse, flagged to me that that article was not inclusive, and my sharing of it failed to amplify this issue. And, well, I agree (I have my own blindspots). That opinion piece did not include the fact that in many cities most hard hit, nurses of color (mostly women) have disproportionately been affected. So I also share this article, in CNN: about the toll on Filipino nurses in particular, though the same may be said of Caribbean-American nurses, Latin-American nurses, and so forth. It also reminded me of why I mentor with the Op-Ed project, to help ensure that under-represented voices get heard.
~The tragic story of Joe Ligon, which broke my heart and I *still* can’t wrap my head around: to be captive for THAT many years, and now released. Unimaginable.
~The death of groundbreaking cancer researcher, Dr. Emil Freireich hits hard for anyone in pediatric medicine. He was a trailblazer to say the least, and highly disagreeable in his approach as a pediatric oncologist and researcher. He didn’t care much for the status quo: his focus was on finding a treatment for childhood leukemia, which he did. His obituary in the NYT is a must read.
6.Best tweet of the month goes to…
A compelling speech by Ryan Leaf, about the NFL’s failure to acknowledge mental health issues. As I write this another former player, Louis Nix, has died (though the cause has not been confirmed).
I don’t know who needs to hear this, or if I just needed to say it, but I will not continue to stand by and watch my brothers disappear because the multi billion $$$ corporation won’t do the right thing.
@nfl @NFLPA do something!! #igoturback #nflbrotherhood
And a thread by the incredible writer and musician Morgan Harper Nichols, about her recent diagnosis of autism, as a reminder of how women are often diagnosed late, or misdiagnosed:
Last Saturday, after a very long journey, I was officially diagnosed with autism and I just want to share my experiences here for anyone else out there whom it could help (a lengthy thread)
In My Own Words…
My lockdown obsession: colorful heritage hen eggs by Black Rooster Farms, Langley BC
January 2021 (these aren’t painted by the way– the colors are REAL!)
This month, I had the pleasure of being interviewed by influencer Camille Styles, on finding our purpose. I also participated in the “SoMeDocs writers conference” which was really fun (some great questions).
Other than that, I’m knee deep in book edits, with revisions due in April, and polishing off a textbook chapter I’m co-writing with a friend and colleague, Dr. Daniel Lakoff (emergency medicine physician with NYP Hospitals). I will have a piece out next week, which I’ll include in next month’s newsletter.
To end I’d like to highlight Andre Picard’s book on elder care arrived this week, and is timely and important. For my American readers: Picard is a must follow, as arguably the most prominent health journalist in Canada, and longstanding columnist for the Globe and Mail. He shares his commentary thoughtfully and wisely.
Have a healthy, joyful, month,
Amitha Kalaichandran, M.D., M.H.S.