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October Newsletter!

October 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

The future of work is here.

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.

Can Prayer Heal?

Does spirituality play a role in health outcomes?

Credit: RawPixel

On the last day of January, my Twitter feed lit up with a curious and heartfelt call: “Please. Please. Please. Everyone PRAY for my daughter Molly. She has been in an accident and suffered a brain trauma. She’s unconscious in the ICU. Please RT and PRAY.”

The tweet came from a woman named Kaye, a lawyer and mother of three in Los Angeles. Her daughter Molly was in a pediatric intensive care unit after suffering a brain injury. I, along with thousands of others, heeded her call, sharing a private prayer that Molly would recover. Soon Kaye began tweeting live as to Molly’s status — she regressed with brain swelling, needing surgical intervention. She was then stable for another day before her blood pressure and the pressure in her brain (intracranial pressure) fluctuated, needing another brain scan and another surgery to reduce the intracranial pressure.

By sharing what was happening for Molly, Kaye brought thousands of us into that small ICU room over several days, highlighting the hard work and efforts by Molly’s doctors and requesting that followers (the number amassed to more than 60,000 within the span of just a few days) do one thing: pray.

The research on intercessory prayer—the formal name for praying to a higher being or force, for ourselves or for others—paints a conflicting picture. In 2020, a published case report caught my eye: A patient’s blindness “resolved” after the patient received intercessory prayer. But the case happened in 1972; surely the details may have become muddled in the retelling over several decades. The same researchers reported on other cases, like prayer for gastroparesis (when the stomach becomes unable to function) in a 16-year-old. Other research suggests prayer may be helpful as an adjunct for pain management among patients who might describe themselves as religious.

In 2006, researchers from the Mind-Body Medical Institute at Harvard Medical School reported on the Study of the Therapeutic Effects of Intercessory Prayer (STEP). This trial involved cardiac bypass patients across six hospitals in the United States. Each participant was in one of three groups: One-third received prayer from others after not being told if they would or not, another third didn’t receive prayer after being told they may or may not receive it, and the last third were told they would receive prayer. In the end there was no significant difference in death rates (mortality) between the groups.

Perhaps most prominently, a Cochrane review from 2009 that reviewed 10 studies and more than 7,500 participants compared intercessory prayer plus standard care with standard care alone and found that the results were equivocal — in other words, prayer didn’t make a difference to the patient’s outcome. That review was then criticized as failing to “live up to the high standards required of Cochrane reviews,” and other researchers have criticized the study more generally.

Yet, spirituality may effectively be a way to create meaning out of the experience. It can also help patients create meaning from their experiences.

Jonah Geffen, a 44-year-old rabbi in Manhattan, echoed some of these same sentiments. His path into spiritual work involved a stint at law school, after earning a master’s in conflict analysis and resolution. Now he works primarily in the community but on occasion gets called into hospitals or people’s homes specifically for healing purposes.

“[As a] rabbi… generally, no matter where you are, what you’re doing, there’s always an element of care involved in it… very often someone looking to heal something,” Geffen told me.

Over the years, Geffen has become prepared to run to someone’s side in the hospital or at home when crisis hits. He adds that the biggest challenge he sees, among those who are chaplains in hospitals, is that much of the time they might be asked to pray for someone outside their faith.

“It’s a challenge with some of the rabbis I know who might be asked to pray for someone. In our tradition, prayers are quite scripted, so the challenge is for them to step out of that and find another way to connect with that person and to God,” he says.

Christina Puchalski, MD, a physician based in Washington, D.C., became interested in spirituality at an early age. “There wasn’t one specific thing that got me interested in orienting myself towards the spiritual needs of my patients. I suppose it was years of knowing my connection to the sacred and that so much of the suffering we see in our patients is of the spiritual kind,” Puchalski told me.

In 1996, Puchalski developed the FICA (faith/belief/meaning; importance/influence; community; address/action of care) spiritual assessment tool for health professionals to help them integrate spiritual views into a patient’s clinical history. Puchalski has worked with everyone from the Vatican to the World Health Organization (WHO). With the WHO, she has advocated to include “spirit” within the definition of health, specifically in the realm of palliative care.

Currently, Puchalski leads the George Washington Institute for Spirituality and Health, dubbed GWish. Established in 2001, the institute has the primary role of raising awareness about the spiritual aspect of patient well-being. It’s the biggest center of its kind in the United States.

In her book Making Health Care Whole, Puchalski defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” She goes on to emphasize that spirituality helps us find meaning and purpose “even in the midst of failed jobs, relationships, accomplishments, and unattained successes, especially at the end of life… The inability to find meaning and purpose can lead to depression and anxiety.”

According to Puchalski, the triggers for potential spiritual growth can include serious illness, aging, loss of a loved one, stress, life change, social events, and tragedies.

So perhaps what Geffen and Puchalski are both alluding to is that asking whether prayer “works”—as in whether it hastens recovery—is not the right question, even if it’s important from a research and evidence-based point of view. Instead, perhaps it’s important to define the outcome more holistically: as a measure of healing for both the patient and their family, one that transcends merely “curing” or “recovery.” As well, perhaps the word “prayer” is unnecessarily constraining. We could instead reframe it as “compassionate and caring presence” for another person, where we genuinely hold their well-being in our thoughts.

On February 15, Kaye shared an update that Molly had passed away and that her family was grateful that the request for prayer, regardless of one’s faith, was heard and met many times over in the form of an outpouring of compassion from a community of friends and strangers. She said it brought comfort and a sense of being witnessed during the family’s time of immense need. Perhaps this same sort of compassionate presence has the potential to heal and assist those suffering with an unimaginable reality and subsequent uncertainty, even if, in the end, we’re met with the limits medicine itself places on the ability to cure.

**Originally published in Elemental, March 2021**

June/July Newsletter!

 

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.

We Must Rethink the Role of Medical Expert Witnesses

The Derek Chauvin trial highlighted a potential way physicians could better serve the criminal justice system

Credit: Getty Images

In the aftermath of the guilty verdict in the trial of Minnesota police officer Derek Chauvin for the murder of George Floyd, a consistent element of many criminal trials came into sharp focus: the role of medical expert witnesses, and the influence they wield in the courtroom, particularly as it relates to determining the cause of death. Within the span of the ensuing weeks, one juror said that the medical expert testimony was particularly influential, and a petition to investigate another medical expert witness’s track record of assessing cases for potential bias, garnered over 400 signatures from concerned physicians. Clearly, it’s worth asking this question: If the broader goal is to improve justice, can the system of using medical expert witnesses be re-imagined? This question can be examined by highlighting three main challenges.

First, the term “expert” is tricky in medicine, as medical science evolves rapidly (COVID is a prime example). Yesterday’s expert could be out of touch with their field of expertise today. Further, the prosecution and defense choose the expert most appropriate for supporting their respective legal strategies, which runs the risk of confirmation bias. At its best, medicine is a group sport; in hospitals, particularly for challenging cases, physicians share their knowledge; debate and discuss a case; and formulate plans in consultation with each other. And when it comes to the determination of death, the standard for group involvement is often higher. For brain death, for instance, two different physicians’ assessments may improve the likelihood of an accurate assessment.

The second issue is that the standard used by the courts to assess whether an expert witness’s scientific testimony can be included differs by state. Several states (including Minnesota) use the Frye Rule, established in 1923, which asks whether the expert’s assessment is generally accepted by the scientific community that specializes in this narrow field of expertise. Federally, and in several other states, the Daubert Standard of 1993 is used, which dictates the expert show their scientific reasoning (so the determination of validity is left to the courts), though acceptance within the scientific community is still a factor. Each standard has its drawbacks. For instance, in Frye, the expert’s community could be narrowly drawn by the legal team in a way that helps bolster the expert’s outdated or rare perspective, and the Daubert standard presumes that the judge and jury have an understanding of the science in order to independently assess scientific validity. Some states also strictly apply the standard, whereas others are more flexible. (The Canadian approach is derived from the case R v. Mohan, which states the expert be qualified and their testimony be relevant, but the test for “reliability” is left to the courts).

Third, when it comes to assessments of cause of death specifically, understanding the distinction between necessary and sufficient is important. Juries can have a hard time teasing out the difference. In the Chauvin trial, the medical expert witnesses testifying on behalf of the prosecution were aligned in their assessment of what killed Floyd: the sustained pressure of the officer’s knee on Floyd’s neck (note that asphyxia is a common cause of cardiac arrest). However, David Fowler, the medical expert witness for the defense, suggested the asphyxia was secondary to heart disease and drug intoxication as meaningful contributors to his death.

An example of a cause being sufficient on its own might be a person who is pushed out of a plane, at 10,000 feet without a parachute. In a case like that, having a preexisting condition is inconsequential to their certain death. An example of a cause being necessary but not sufficient might be an individual with a compromised immune system who is infected with the influenza virus; neither condition alone would typically be lethal, but the combination might well be. With the Chauvin case, the disagreement between the medical expert witnesses was effectively over whether the force used was sufficient to cause Floyd’s death, irrespective of preexisting conditions (akin to the example of being dropped out of a plane) or whether it was only deadly in combination with another condition such as trace amounts of drugs (i.e., more similar to a person with preexisting conditions dying from influenza).

If we had the opportunity to re-imagine how medical expert witnesses might be used more effectively, how would we approach it?

In a 2010 Canadian paper, two scholars made several recommendations, including that these experts share only opinions (based on facts and reasoning, ideally supported by the medical literature) from their area of expertise, make clear where elements may be controversial in the scientific community, avoid confusing jargon during their testimony, and be informed that their primary role is to assist the court by providing testimony that is impartial, as in free from bias.

Arguments to improve how medical expert witnesses serve the justice system have been made by prominent legal scholars such as David Faigman, the Chancellor and Dean and John F Digardi Distinguished Professor of Law at the University of California Hastings School of Law. However, Faigman shared that it remains a challenge to convince the courts to re-imagine this system.

One potential improvement involves vetting medical expert witnesses for potential biases, such as those based on gender or race before they take the stand (Fowler, the medical expert on Chauvin’s defense team, was involved in another similar case, involving the death of a young Black man, which raised concerns, which is leading to a review of his other cases after an open letter signed by over 400 physicians). According to Faigman, currently only good cross-examination may help elucidate these biases during a trial. As well, biases related to compensation could potentially be avoided by instituting a common pool of funding, with a standard rate, though in practice, this would be challenging to put in place.

Another improvement could involve ensuring that courts institute a more stringent application and selection process, in which medical expert witnesses would be required to demonstrate their clinical and research competence related to the specific issues in a case, and where their abilities are recognized by their professional group. For example, the American College of Cardiology could endorse a cardiologist as a leader in a relevant subspecialty—a similar approach has been suggested as a way to reform medical expert witness testimony by emergency physicians. One drawback, according to Faigman, is that courts would be unlikely to fully abdicate their role in evaluating expertise.

Last, instead of medical experts working for both sides, the courts could appoint a panel of medical experts who are required to explain their assessments (which would be part of the record) independently of each other and the opposing legal teams, but also have the panel work together and deliberate on a final assessment. Faigman shared that while this would offer an ideal solution, the courts would still need to decide how best to appoint and compensate this panel.

In any case, borrowing from how medicine works at its best in hospitals, to improve the current model in court may help us better reach our common goal of justice.

Since the time of Chiron, doctors have been viewed as godlike. More recently, and particularly during the pandemic, we realize that physicians have limits to their knowledge. Perhaps no other physician described the fallibility of doctors more profoundly than Roger I. Lee, who served as the president of the American Medical Association. In an essay aptly titled “Are Doctors People?” published in the New England Journal of Medicine in 1944, he wrote:

“We must accept the fact that the community, from the days of folklore and the

medicine man to the present, conceives the medicine man and the doctor as someone apart

from the rest of the tribe or the rest of the community…[but] Doctors are human beings.”

Lee was ahead of his time in his recognition that doctors also have a role to play in ameliorating social ills. Systemic racism is perhaps the most profound of these ills. The Chauvin trial has only furthered the salience and limits of physician expertise and judgement in the criminal justice system. While the verdict was ultimately aligned with the majority of medical expert witnesses, and those physicians who assessed Floyd at the time, it’s on us to make the system better.

**Originally published in Scientific American, May 2021**

April Newsletter!

 

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. 

**to access all hyperlinks, please subscribe**

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 newsletter!

March 2021
**To access all of the hyperlinks, please subscribe**

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.

February Newsletter!

February 2021
**To access hyperlinks, please subscribe**

Welcome to the February 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.

“Thin Places.” Wreck Beach, Vancouver BC, credit: Amitha Kalaichandran.

This is jam-packed with many things that had me wondering this month:

1. COVID and…
~Vaccine distribution. Logistics remains a big issue. Now we’re looking at optimizing vials and syringes. I enjoyed this piece in the NYT, which suggests ramping up the speed of vaccination, and focusing on priority groups

~How the most marginalized will almost always bear the larger brunt of the burden when it comes to most health concerns, in this case a global pandemic. This is a very sad story about a teen, who happened to be a Syrian refugee, who died from COVID after likely being exposed during his work in a longterm care home.

~A beautiful brief reflection (part of a newsletter) on how a journalist treked across the U.S. to ensure his mother got the vaccine roadtrip

~The WashPo published this, a deep reflection with Dr. Stanley Plotkin, who happens to be a LEGEND in public health and vaccinology — his name appeared most frequently (to my recollection) during our vaccinology modules at Johns Hopkins Bloomberg School of Public Health.

~February is Black History Month, and a colleague and friend Dr. Uche Blackstock, along with her twin sister, described the inequities around vaccine rates, also in the WashPo.

~Jay Caspian Kang on why San Francisco may have been better equipped and prepared than other cities, in the New Yorker.

2. Podcast to listen to:
This episode from the Tara Brach podcast is excellent. I read Brach’s book “Radical Acceptance” last year, and just finished “Radical Compassion” which is even better.

As well, Kara Swisher has been hitting it out of the park lately, on Sway. Her episode with a Parler cofounder was slightly shocking (in an illuminating way) but her interview with Isabel Wilkerson was particularly excellent.

3.On…how to disagree better
This is a topic I’ve been thinking about for years and its more crucial during these divisive ties. In 2017 I wrote about the topic for the Walrus. Now the great Adam Grant has a new book out call Think Again (link to purchase here). His article in the New York Times serves as a wonderful appetizer. Another book to add to the list, on this topic, is Buster Benson’s Why are We Yelling? which was the best book I read in 2020.

4.Sound (and wise) reflections
~From the New Yorker, an interview between Isaac Chotiner and two experts from Turkey about how developing countries are navigating access to the COVID vaccine, and how more economically stable countries should lift their weight. I always enjoy Isaac’s interviews because he doesn’t hold back, and asks the questions most of us *want* to ask but might not.

~In the New Yorker again, a deeply vulnerable piece about opioid addiction and its toll on young people and families, from the journalist, Masha Gessen, herself.

~In the Atlantic, how your well-being is linked to where you choose to live — Arthur Brooks’ columns have been insightful and deeply relevant for these times

5.Miscellany
~For Black history month, this article on the experience of a black female interventional cardiologist, published by Canada’s CTV news is a must-read, especially as it gets to the ‘double burden’ of being a person of color and a woman in medicine, and the systemic challenges (e.g. microaggressions) she and many others have faced. Couple this with an excellent editorial in the CMAJ about why anti-racism should be a professional competence.

~The link between workplace culture and well-being is crucial to understand, and it’s a link I’m particularly interested in (if we can improve culture we will make major leaps as it relates to thriving — we spend most of our time at work!). This article, in the CBC was a powerful investigative piece into how this issue played out in one of Canada’s most important institutions — and underscored that women in power can *also* perpetuate harassment and abuse, a point that is too often ignored or overlooked. Undoubtedly, while Pyette has now resigned, she has done so only after leaving a trail of likely traumatized victims — in government, policing (those tasked to protect her were also allegedly abused), and employees at the Montreal Science Centre among others — behind, victims who may never see real justice. This piece, which is part of a series by CBC, also speaks to the power of journalism to push for accountability, specifically as it relates to workplace culture.

~Michael Lewis is one of the best storytellers of our time. There will be many “pandemic” books published in the coming year(s) but if I were to bet, his might be the best one, and this article about his track record of bringing us gripping stories is excellent.

~The result of the Capitol Hill riots in early January will bear out for years. We are seeing the ripple effects now. The suicide of a police officer days later for instance, and AOC recently shared the impact on her as well. Collective trauma is an under-discussed issue, as a recent tweet clearly illustrated to me recently.

~A year ago on January 26 2020 Kobe Bryant, his daughter Gigi, and six others died in a helicopter crash. Last week this article, by Mirin Fader, in The Ringer elucidates his legacy.

~Are you easily frustrated during the pandemic? Well this short video (as with most of his short videos) by Daniel Pink might provide some tips.

6.Best tweet of the month goes to…
A three-way tie!

A mother and lawyer who asked for prayers for her daughter Molly over Twitter:

Please. Please. Please. Everyone PRAY for my daughter Molly. She has been in an accident and suffered a brain trauma. She’s unconscious in ICU. Please RT and PRAY 🙏

Collective prayer, known as intercessory prayer has been studied extensively (the evidence isn’t great, as expected), but it was unique to see social media being used for this purpose. Would Molly have been ok otherwise? Possibly. But it was a nice moment to see a tweet like this go viral. I’m staying tuned on her progress and hope she has a swift recovery.

This tweet {hyperlinked} and {hyperlinked} encapsulate a big challenge for many writers: navigating community and the experience of envy and competition. These went viral for a reason! What I know for sure is that we live in an abundant world, and one person’s success doesn’t preclude your own. I’m grateful for the community of writers I hold dear, who inspire and motivate me.

And another, by Adam Grant, on curiosity:
The hallmark of curiosity is a thirst for knowledge that has no obvious utility. Being a lifelong learner is taking joy in exploration regardless of whether the discovery has immediate relevance. The goal is to understand for the sake of understanding.

In My Own Words…
This month, I had the pleasure of interviewing two companies for my blog on the intersection between tech and well-being. Joy Ventures invests and incubates primarily in tech companies that are committed to health and wellbeing. LongWalks is an app that connects people around a common daily prompt, while encouraging guided reflections which can then be shared with the community (or kept private).

As well, as part of my work as a mentor-editor with the OpEdProject, I edited this excellent article by a palliative care physician from Columbia University and the director of the Center for Bioethics and Health Law at the University of Pittsburgh, for the Hastings Center on vaccine distribution

I can also finally share that in December I was approached by Twitter to consult on a really interesting initiative to improve the health of the platform. We’ve seen so much strife happen on social media, but these platforms, if designed a bit differently, can also be a tool we can use to connect and empathize, perhaps more so during a pandemic. It’s an honour to be part of these efforts.

Have a healthy, joyful, month,

Amitha Kalaichandran, M.D., M.H.S.

Well-Tech Series: Melody Mortazavi & Trishla Jain

A series of interviews with pioneers bringing the world of wellness and technology to make meaningful change.

 

From her work on the initial Sephora team to her experiences in manufacturing, consulting, and brand strategy for companies like Gap Inc., Cisco, and Landor, Melody Mortazavi has been passionate about creating brands her entire career. Mortazavi is an entrepreneur who believes in the power of connection, and she founded UME in Menlo Park with that vision in mind. After UME was acquired, Mortazavi continued to pursue her love of brands and human connection by co-founding Longwalks with Trishla Jain.

Trishla Jain is an author, artist, and entrepreneur. Throughout her career, Trishla’s work has focused on helping people communicate and connect mindfully. She is an author of a mindful children’s book series and an accomplished artist with exhibitions exploring the intersection of joy, gratitude, and minimalism. Trishla sought to build a better way to spark meaningful conversations and deepen personal relationships online, co-founding Longwalks with Melody Mortazavi.

 

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Amitha: So I downloaded Longwalks back in December, and I can’t remember where I had first heard about it – it might have been through Oprah magazine or a tweet she posted? It’s so well designed, and I love the concept. What got you motivated to create it? And what spurred the interest in well-being and self-care?

Melody: I think that we approached this in a very personal way to start with. We (Trishla and I) met quite serendipitously, and she had invited me to a conversation, sort of a Jeffersonian type dinner, at her home, where she had crafted a really beautiful conversation for the evening. The conversation was designed to bring 10 women together who had never met before in the most optimal way possible. And yes, that's very “Silicon Valley,” but like everywhere else in the world we're all quite pressed for time and so she wanted to create the perfect environment for us to really get to know each other. And that meant getting to know each other outside of what we do or what our significant others do or where our children go to school, which are the typical things you generally hear from each other when you first get to know someone. There was a question that was posed about a poem that grounded the conversation, and each person just shared, one at a time, as we went around the table, about a story that that poem reminded them of. It was a very new way to have a conversation because you actually got to sit there and really listen to what the other person was saying. And then when it was your turn, you could speak essentially your truth. And so, this form of uninterrupted one-direction type of sharing was really beautiful. It was really transformative for me, and I had never been in a conversation with someone else or a group of people where I didn't actually have to work very hard to keep the conversation going. And this was just a really beautiful way of connecting with other people at the table, and after the third or fourth time we had done this, I started thinking about the ways people are connecting with each other now digitally. So we started thinking about how to deliver this same sort of experience to others. I think, when social media was designed and developed, people didn't really think about the negative impact on mental health. They didn't think about the impact on people's relationships or attention spans, and all the things that you very well know. So we embarked on this very ambitious mission of creating a truly supportive and kind social platform where people can share their stories in a way that I was alluding to, to really tell the things about themselves that really matter to them and make up who they are: like the really the good juicy stuff of who you are. And so I think what we did really beautifully was really utilize psychology, Eastern philosophy and a lot of really mindful meditation practices to create a platform that not only provides the content that's that really helps people connect, but also create this really beautiful safe space which we hear about time and time again.

Trishla: I mean your question was really why we started Longwalks, and in essence I think the quality of our human relationships, the depth and intimacy of them is one of the primary indicators of lifelong long-lasting happiness and kind of what the Harvard Study of Adult Development says.
When you look back, a fulfilled life is one with beautiful deep relationships. So that's really kind of the vector where we wanted to focus. It all came together in this beautiful way. And the way Longwalks is really different is that in some sense it's not open-ended, unlike every other social platform where you can kind of share whatever it is you want to share, using various formats. We've really created a little bit of a cocoon around the user using our prompt. So, we provide one single piece of content, which is a fill-in-the blank question every day. And that's it. It's very simple. It's very equalizing pretty much being a human. I've had a lot families say that they do it with their kids. They do it on their phone with adults and then at night they use it at the dinner table, and they make all their little kids like six year old, seven year old, kids fill it out. So it’s kind of just like a moment where you get to share something and then we anchor we map out the whole year. In 365 days we kind of cover a large aspect of what the human experience. And it's beautiful because you don't really have to think about what you're sharing and get yet if you're doing this with people on the platform. You get to experience humanity and living together.

I think that I've been practicing this formula of sort of asking a question and then making everyone answer it in the fill-in-the-blank model for a very long time, since high school, so it's just kind of my modus operandi. This was the first time I had kind of done this in Silicon Valley and Melody happened to be there, and then with serendipity, one thing led to the other and in 2017 Melody started to think of this as like a full-fledged business rather than just a private kind of experience with friends, but by then we must have had over, 250 of such dinners like that. And the digital format kind of coincided with COVID, even though it started way before COVID it just, there's so there's a lot of serendipity in our journey.

Melody: What matters is that the question has to be supportive enough for people to want to access that as a nugget to share it with somebody else, so 2017 was a year of focus grouping, really, essentially, and then figuring out how we want to how we want to deliver this what it would look like, as a feeling to bottle up. I think one of the beautiful parts of the digital platform is that you can have that feeling with someone, all the way across the world, who has like a completely different socio economic background is of a different race and gender and every everything is different about them, but you can actually have that exchange of that feeling with that person. And that's what's happened to me a lot -- I've randomly met probably 20 or 30 people who are now my friends on Longwalks, that I share with, and I don't even know where they live!

Amitha: That's amazing. I was just talking to someone about on most apps or social media there aren’t really incentives to be civil. And I’ve likened it to a dinner party, where if you aren’t civil, even if you have opposing views, you won’t get invited again. But there’s this feeling where it's almost invigorating when you have a really interesting discussion or debate, or you know that feeling of being connected. So you're, totally right – it’s super hard to get that online with a lot of the apps that are out there right now that are being used.

Trishla: I read that you're also Yogi and you love yoga. And I think with Longwalks it’s that synchronicity that sometimes gets missed. Like when you're in a yoga class, the entire class is participating in a series of motions, everybody's on the same page and moving together. And that creates a very harmonious flow. It's not like everybody's doing their own thing. One of the most unique things about our platform is that everybody's doing the same ‘pose’ as in answering the same prompt. So you feel you're not alone, like you're just all different rays of the same sun.

Amitha: I love that analogy. So the actual digital element was that rolled out in 2020 then you're saying just around the pandemic?

Melody: The first version of the app was launched in August of 2018. We had been working towards a solution for a couple years before the pandemic hit.. What we've done really mindfully is that we are building this app for our users, and we have a big cohort of users who really love this app. And so we build and we iterate based on their needs, that you know of course are aligned with, with the mission. So we have taken quite a few updates and changes to the app in order to best align with our with our users, and when COVID happened and we all went into lockdown in March, had just launched our best MVP (minimum viable product) to date. And so we saw this really beautiful alignment of user with product. And that's when we had a significant uptake in users, and we have really great App Store reviews that are all organic and just people's real experiences. So, the alignment was really great, during a time where it was so uncertain for everybody. We were providing a tool that was helping people feel better. That was helping people feel connected to each other not as far apart, was giving them something to anchor their daily practices so that they could answer something with the people in their lives. And it was really helping them stay close to the people they couldn't be close to. And so that really gave us a whole big lift in order to kind of keep going and keep building and keep doing what we're doing

Amitha: Why the name Longwalks?

Trishla: Many reasons. Some of them are practical, you know, in the sense of wanting to have a name that's unique and all of that, but really Melody and I are just nature lovers who love to walk and we think of human relationships as kind of like walking hand in hand. And we think that sometimes the best conversations you can have is when you're on a long walk with a friend. Because the conversation just organically flows, and you're enjoying the earth, so there's many different kind of connotations. I don't know -- Melody what does the name mean exactly?

Melody: I will just embellish a little bit more in that I think that the experience we try to mimic on Longwalks, is really that kind of those special moments that you have during a long walk, you know those really those heartfelt conversations that you really get to know people that's essentially I think what we hope toreplicate.

Amitha: How do you feel like, like how is the uptake been so you obviously launched in 2018, you were saying, um, have you seen an uptake. I mean, as I mentioned, I've heard about it. I think through either Oprah Magazine or something, some something over related.

Melody: She gave us a shout out! Oprah’s a gifted conversationalist and gifted person at making anybody feel important and worth listening to. And I think we've always just reached out to her along the way when we've needed guidance or calibration or just talking to someone whose life's work has been about helping people connect meaningfully.The shout out was definitely a big surprise to us- we had no idea it was coming. And I think I was on a long walk at the time because I hike a lot on the weekends, and our biggest concern was ‘oh my God are the server's gonna crash?’ Luckily they didn't and our tech team, they're all just incredible. So, it was a great shout out from her that kind of validated the experience that all the users were having. They were really grateful for Longwalks during a time where there wasn't a lot to be grateful for.

Amitha: Definitely. So have you found during this pandemic that uptake has increased like? Because apps are tough in terms of getting people to stay on them. But I think that what you're offering is unique, so I would hope that there's more people are more incentivized to like stick to it.

Melody: I mean I think that's where we started the conversation is ‘How do you have social wellness’ and ‘what does that even look like’ as in having a healthy relationship with this phone and the things we do on it. And I think that one thing we try to do as we definitely don't hold ourselves accountable to the same vanity metrics that other social companies, hold themselves accountable to. So for us time spent on app is measured a little bit differently for us, because it's important to have a depth of relationship. We don't make it about Facebook likes or friend counts or friends lists and things like that because it's just, it's a different platform it's a more niche platform and I think our goal is to empower the depth of relationships and authentic connections, and helping people find like-minded people on Longwalks. When we are looking at acquiring users we unfortunately have to use the same mediums that other people use, and do your standard performance marketing things but the way I sleep at night is to think that I am leveraging these other social media platforms to bring people to Longwalks. It’s a healthier and better way to communicate with the people that they want to communicate with.We don't expect to take over. So the time that you spend on Instagram or Facebook we just hope to kind of counterbalance it with things that fill your bucket and make you feel really good about the people that you're talking to.

Amitha: I'm sure you both watch The Social Dilemma. I'm sure it's not a surprise, in terms of what they presented, but do you have any thoughts on sort of how Longwalks fits in? I guess you've sort of answered that question as it being a buffer or counterbalance?

Trishla: Tristan is one of the early attendees to dinners. And at the end of the dinner he shared a very profound experience about his mother and said ‘I challenge you to bring this to tech as I've never seen it.’ And at the end of The Social Dilemma they pose a question, you know, as in ‘what is the solution?’ They don't offer solutions. So we really feel like Longwalks is very sustainable, because it only takes a few minutes maybe 5-10 minutes a day. It's a very sustainable solution to create social wellness in your life, using your phone.

Melody: I think it's just a really actionable solution. So that's how we think of it as well, in relation to The Social Dilemma, and Longwalks is literally designed as an antithesis to all of the problems of social media. So, it's designed to not feel like a popularity contest -- we don't display any kind of counts. We don't publicly display how many people have liked your post. We don't let you know how many friends people have or any kind of numerical things like that. The way that our commenting works is that it's pre-scripted to be extremely supportive and kind. So it really eliminates that culture of bullying or negative commenting that occurs in other platforms. It's very unified like I said and has synchronicity because everybody's on the same page and answering the same questions. You don't get a lot of distortion or distraction there's no ads. There, nobody's trying to sell you anything. So a lot of the problems associated with social media just don't happen on our Longwalks: we've created a situation where they won't happen. But we always have our eyes open, just to see if things are creeping into that territory.

Amitha: Do you feel you're also sort of self-selecting as well for people that are not going to be that way maybe?

Trishla: We have the very committed and sticky users who use both regular social media and Longwalks, and then there are of course the people who doing a detox off other social media, so only doing Longwalks. So we find that it works really for anyone who wants to have a kind of new social wellness habit in their day.

Amitha: Got it. And then so you were mentioning I mean it sounds like when you, when you mentioned like Tristan Harris, for example, it sounds like you're pretty plugged into the Silicon Valley community so I'm curious to know like what your, what both of your backgrounds are in in tech, like a different form of tech before you could work for, you know, big tech before this like without a motivator. Tell me a little bit about that.

Melody: I actually come from a retail background and brand strategy background but during the latest part of my career I worked for Cisco and I did Internet Business Solutions consulting so I do come from a slight tech background but my specialty is really optimizing retail solutions for consumers. And then after I got pregnant with my first child I didn't want to consult anymore. I was not going to get on a plane every week, and so I decided I came up with this idea for a children's play space, and this was at the time where there were no other really placed bases around, so we raised a seed round and opened a 15,000 square foot children's indoor play space in Menlo Park called U-Me, so that I could work, and do something with my brain but also bring my kids to work. And so I did that for about seven or eight years and then that was acquired. Then I decided to go back into the corporate world.

Amitha: I'm just trying to imagine what it would look like in Silicon Valley like a big play space I imagine all of the, all of the activities are planned intentional and…

Trishla: Very. It was so beautiful I mean she has an unbelievable eye for design, they have this kind of minimal Scandinavian aesthetic where everything had a purpose, there wasn't any like random stuff and it was really the child was at the center of the experience and the child could direct it to play very well so, and she used a lot of that learning. I can see how she applies that user experience design in Longwalks.

Amitha: What about you Trishla?

Trishla: I grew up in India, and my family runs the Times of India group. So I kind of grew up
enmeshed in those walls. And then I went to an American school and then I came to the U.S. for college (Stanford) during college and fell in love with English literature, so I had a circuitous path where [I then attended Columbia University to do graduate work in education then] worked in brand marketing in New York. And after that, I went back to India and just worked at times in different capacities, learning about print. And then also learning a lot about how to embark into the digital world. I did that, and then I became a full-time artist, which is kind of my deeper love, where I had three solo exhibitions in India while having children.

Amitha: What sort of art?

Trishla: Painting. But during that time, I would say my main real job is being a full time Yogi. I did so many maybe 50 silent retreats like Vipassana. Yeah. Even a few 60-day ones where I left my husband with my parents. And I think that was just a time of profound growth intellectually, emotionally, physically and every way. And then we both moved here to America about four years ago. But we were thinking of it as coming back to Stanford, where me and my husband met. He runs the digital business of Times of India. Tristan is really more of a Stanford connection than a Silicon Valley connection.

Amitha: Got it. It sounds like you've had some really interesting experiences, both in India as well as in the US, and that blending of Eastern and Western practices in the sense?

Trishla: When you have profound meditation, it's almost like you just want to give back to the world in whatever way you can and then I found Melody.

Amitha: Yes, serendipitously! I'm such a fan of serendipity and have noticed that in my life as well. So obviously you both women of color – Melody you have Persian (Iranian) heritage, and Trishla you were born in India. How does that sort of affect or impact your experience in Silicon Valley as founders, anything that you want to share about that, like, in terms of opportunities or barriers?

Melody: So I think that if I had to talk for a moment about whenever I feel inadequate or when I feel that maybe I am not. I am not on par with the audience that I'm keeping has not necessarily been ever because I'm a woman, I think, for me it has always been a feeling that because I don't come from that so called White, tech, engineer, or a certain pedigree, I think that feels very heavy for women. I think that there's a certain level of...I think Trishla and I just don’t let it get to us, otherwise it becomes very demoralizing. So I think we do a very good job of tuning those things out and really making it about the product that we're building, and the solution where it could do with the solution we're giving to people. And because we are in a space of wellness, it makes it a little bit more comfortable, but for sure I would say it's very hard to maintain your confidence and not feel adequate being in the Valley and being women who are not from a pure tech background.

Trishla: I think one of the things my dad always taught me is that you have to turn your disadvantages into your greatest advantages. So in some ways, I like to think of it as this idea that we're fresh blood, like we never think of a solution on the product the way a veteran Facebook person or someone who spent 10 years at Google. And I think being mothers what matters is we care so much about building a future for our children. So we both have two young children, each and Melody's kids are older and she sees them already interacting with social media, and she wants to create a new alternative, kind of like a different way for her daughter to portray herself in the world. One option is for her to take a beautiful picture glowing skin and maybe comment on how sunny and beautiful it is in California on Instagram, and the other is to talk about maybe something totally different, something meaningful or something she's focusing on or, which is more Longwalks’ aim.

Melody: And people gravitate towards Longwalks generally are pretty open minded.

Amitha: One the things I’ve noticed when about individuals that are trying to make a difference in healthcare, almost all of them are described themselves as like outsiders. So people that early in life might have felt like they needed to fit in for one reason or another, because of their background or their way of thinking or whatever but over time they realize that those differences were actually an asset, and that was what sort of fueled them to think differently and make changes because as you can appreciate health care and the health system which is a very antiquated system. But the people that are actually making change are the ones that can actually see the solutions because they have an outsider sort of perspective. And I think, you know, it's our perspective and I also think it's a bit of grit as well like if you're someone that's used to adapting but you're also sort of like you're maybe a little bit grittier as well. I think that that's super interesting that you both seem to identify with that as well. Was there anything that I didn't ask you that you think is really important.

Ok my last question! Because I have an epidemiology I'm always interested in research. Have you thought about looking at the data in terms of assessing how people are feeling using the app? Could it be an intervention or studied in some way in terms of short and long-term impacts on mental and emotional health? Or do you have a sense of this already?

Trishla: I would say intuitively, qualitatively, the feedback indicates a resounding yes, that people see a kind of marked uplift in their emotional states, reduction in depression, reduction in anxiety, and loneliness. However, it would be a dream come true I think for Melody and I to have that documented in a way that's actually scientific with rigor.

Melody: We're looking at a way actually to incorporate these questions into the user journey to get a sense of how it has impacted them and the main reason we wanted to do that was just so we can make sure that we are staying true to their needs and really able to satisfy kind of those things so we are looking into it right now. I think given the pandemic and everything that's happening, I just feel a little uneasy asking users to fill in those questions. But definitely I think going down the line, it’s something we will be doing.

November Newsletter!

November Newsletter!

November 2020

Welcome to the November 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.
***Please note that to access hyperlinks please subscribe**

CREDIT: Olivia Van Dyke

CREDIT: Olivia Van Dyke/Tofino British Columbia/ October 2020

Some things that had me wondering this month:

1. COVID and…hidden patterns
Some rapid-fire wonderings:
~Published in the BMJ: a new hypothesis on face masks might be associated in falls in the elderly (and note, it’s well known that a hip fracture in an older person is significantly associated with mortality risk during the following year). There’s no doubt face masks are crucial, but how do we avoid the externalities such as falls?
~From the NYT: how schools that are open to in-person instruction are shifting via allowing teaching to occur outdoors. Related to this: Richard Louv’s classic book “Last Child in the Woods,” is an excellent foray into the issue of ‘nature deprivation’ — outdoor teaching helps lower COVID transmission risk while also changing the setting for learning (it would be interesting to know if this helps with attention)
~A great, short discussion of Dr Akiko Iwasaki’s work and recent award, in Science. There are many unsung heroes, namely researchers and physician leaders, who are finally being recognized for their work this year, during COVID. There is also a Canadian/UofToronto connection here, as she did some of her training at the University of Toronto. That aside, especially as a woman of colour in research/medicine, it’s wonderful to see her gain influence.
~Few more choice pieces from the NYT: by the great Carl Zimmer on vaccine safety as it relates to research trials, Ashley Fetters (whose articles in the Atlantic were among the best in my view) on loneliness as it relates to working from home, and this great one on COVID long-haulers in pediatrics.

2. Two incredible podcast episodes to listen to:
Tim Ferris with Seth Godin: a long-time listener to Tim’s podcast, in 2020 his empathy and curiosity with his interview subjects is even more clear. He asks the questions most interviewers don’t, and really gets into the nuts and bolts of “process” and “habits”. This interview with Godin is excellent because 90% of the time they cover the writing process and what Godin advises. Godin’s thoughts on writers block alone are golden.

The GOOP podcast with Rebecca Traister: a somewhat divisive journalist, Traister isn’t afraid to ask tough questions and here she really interrogates traditional ideas of feminism, and specifically the role that white women have taken in oppressing women of colour as well as men of colour. We all intersect with various identities and it is sometimes the case where learning into power “over” an oppressed group is confused with self-empowerment. On my wish-list for 2021 is for Traister to have her own podcast: I’d really just love to hear more of her takes on provocative issues, and she seems like she’d be a thoughtful but brave interviewer.

3.Tiny piece on friendship and connection
Maria Popova’s hugely popular newsletter is hands down my favourite weekly email. This one is from last year, but it rings true during this time as well.

4.Sound (and wise) reflections
~From Knowable magazine — what lies ahead for “Black Lives Matter” from a political scientist and sociologist.

~Water on the moon!! But even better — a millennial discovered it, from the New Yorker
“‘For the first nine hours and forty minutes,Casey Honniball, a 27 yr old planetary scientist, didn’t have much to do. She took a nap, ate a PBJ sandwich, & used her laptop to work on research proposals.”

So what was that about millennials being lazy and entitled again? 🙂

~And an obituary from a very interesting psychologist– one who questioned the status quo, and the elements of psychiatry & psychology that have become, rightly or wrongly, dogma. The squeaky wheels in medicine/psychology are the ones that often make these fields better.

5.Miscellany (politics edition)
~AOC in Vanity Fair: her journey, and earnestness, has been incredible to watch

~Racial politics and Kamala Harris, in the New Yorker: how does a possible future Vice President navigate the harmful stereotypes on anger?

~Why this year really does feel different, from Politico.

6.Best tweet of the month goes to…
ANOTHER TIE between

Posthumous Richard Feynman:
One of the signs of intelligence is to be able to accept the facts without being offended.

and editor Jenee Desmond-Harris, mostly because I couldn’t agree more:
The beach really fixes everything. Except home pandemic haircuts.

In My Own Words…
This month, I’ll share an archival piece about Halloween (one of the first pieces I ever published) and trends related to allergy — the Toronto Sun is Toronto’s answer to the NYPost (!); I’m just glad they liked it enough to publish it. And another archival one on election stress, and how it can affect voter turnout, published in Ozy, also from 2016. The month was busy writing wise but because I was invited to contribute a textbook chapter, for a textbook on physician well-being, to be released in late 2021. I’m fortunate to work on it with two mentors I greatly respect and enjoy working with, and the chapter focuses on physician mental health. Academic writing is much much different compared to say magazine or news or op-ed writing (obviously) but it was still fun. I’ve excerpted the last paragraph of our [draft] introduction here [for subscribers only]

This is a BIG week ahead for my American readers (but really, who are we kidding — it matters for all of us). If you can vote, please do. I know I’ll be feeling a bit anxious for the results.

Have a wondrous & well (and healthy, and safe!) month,

Amitha Kalaichandran, M.D., M.H.S.

August Newsletter!

August 2020

Welcome to the August 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.

So…it’s been awhile! I took a few months off to focus on the first deadline for my book…yes book! Details at the end. Oh, and I broke my wrist (ironic, given the title of my book). Let’s say that the experience was eye-opening, as I had a first-hand glimpse into the American healthcare system! I also left beautiful New York City, a place that I got to know well, & fell deeply in love with, in sickness and in health. As mentioned in my last newsletter, we are living in very strange times currently, so the newsletter has pivoted slightly to include the same themes, but with a COVID19 lens.

Some things that had me wondering this month:

1. Can pandemic boredom be…Good?
Perhaps. At least according to a piece in the New Yorker and another in the New York Times Opinion Section. Perhaps some of our anxieties involve having to sit in deep contemplation — whether we like it or not. But what possibilities might this afford us? I loved this quote from the NYT Op-ed:

“This suggests that self-reflection can be intrinsically aversive…Sure, boredom is a signal that we’re underaroused, but if we sit long enough with our uncomfortable thoughts and feelings, boredom could provide us with an opportunity to rethink whether we are spending our lives in a way that is rewarding and meaningful to us. What things might we change to make life — and ourselves — more interesting?”

2.Election things and Current events
A big month in the U.S., as Kamala Harris was chosen as the Vice Presidential candidate, marking the first time a South Asian American and Black American was chosen for the role. This is a great article on what it means for many women who identify with parts of her heritage — myself included!

We also marked the passing of actor Chadwick Boseman from colon cancer, at the age of 43. This is a form of cancer that has seen an uptick among young (20s-50) people, and it’s a disturbing trend that serves as a reminder to take the signs and symptoms seriously, and to get screened. It’s also a reminder that we never really know what strangers, and sometimes even our loved ones, are facing privately — so kindness is key. There were lots of tributes over the weekend: this one from the New Yorker is especially good, as is this essay by Marvel director Ryan Coogler. What’s clear is that Boseman was motivated to use his platform and his work to advance social change, particularly as it applies to racial justice. His work speaks for itself, and he left a legacy — both in his work and all of those he impacted (the consistent theme is his humility, grace, and kindness) — which may inspire us all. This quote below, from the New Yorker article, sticks out as it reflects how often the industries we find ourselves in reward the conformists over the trailblazer. Personally, I’d much rather blaze a trail.

It is, perhaps, this very sense of history, of responsibility, of implicit but intensely personal political commitment, that also inhibited the acclaim, while Boseman lived and worked, from his timid and stumbling Hollywood milieu.

3.Are Doctors People?
I dug deep into the archive for this one, reflecting on burnout and the struggles many doctors are facing during his pandemic. Roger I Lee was an incredibly accomplished physician leader who also served in WWI. He also had a little mischief and sarcastic streak, which makes him even more interesting. This short essay is worth the read. His books are hard to find as they’re out of print — this one is next on my list, and sitting patiently on my nightstand.

4.Our memories and our attachments and….a contrariwise state
The theme of “attachments” has preoccupied me since January, for many reasons. I just gave a talk framing this idea within the context of the Biblical Book of Job, and William Blake’s rendering of it. This season finale episode of Malcolm Gladwell’s podcast, Revisionist History, builds on this theme in a slightly different way, and it will move you to tears. It’s well worth a listen, especially as we mourn many loved ones this year. After you listen, read this, from the Globe and Mail — a beautiful reflection on how we might mourn our old [pre-COVID] lives.

Sometimes the biggest attachments we have are to our opinions — so the challenge then becomes understanding how these opinions form (the best understanding I have is that it’s a confluence of information and our values), and what it might take to change our minds. I’m in the process of changing my mind about something quite significant (I’d share but am still cocooning it), and so this essay, on Medium, which touches on Heraclitus and Jung and the idea of “contrariwise” — that eventually we gravitate towards our opposite mind-state, is fascinating.

5.A book I’ve been enjoying
On my pandemic wish-list, since around March, was that someone, somewhere, might write an anthology — short stories and essays and images — about this ‘time of COVID.’ A written and visual “time capsule” of this moment, in other words. Well, Bill Hayes has done just that with “How We Live Now,” just released this month. Hayes is an amazing writer, whose subjects generally focus on medical nonfiction (everything from an exploration into the man behind “Gray’s Anatomy” i.e. the textbook not the show! And his own struggle with insomnia). He is also the partner of the late, great, Oliver Sacks (and this lovely piece describes their love story). I’ve been enjoying his latest book as a way to integrate my own reflections of this time, some of which will make their way into the last chapter of my own book. It’s worth the read.

6.Best tweet of the month goes to...
Adam Grant — with his tweet on which opinions we decide to share. It might especially be relevant for forums like Twitter.

“Not every opinion needs to be voiced. Not every emotion needs to be expressed. A key question: does what you’re about to share align with your values? It’s good to be true to your thoughts and feelings in the moment. It’s better to be true to your guiding principles in life.”

In My Own Words…
This month I gave a talk to the National Partnership for Hospice Innovation, on grief and attachments during COVID. I’ll link to the video next month. I also moderated an important discussion for Ellevate, on mental health, with a focus on this challenging period. Last, I’m pleased to share my formal book announcement — it’s slated for publication in 2022. Thank you for joining me on this journey!

Have a wondrous & well (and healthy, and safe!) month,

Amitha Kalaichandran, M.D., M.H.S.