Part 2: Why Malcolm Gladwell Says AI Will Actually Make Us More Human

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All right, welcome everybody to less than 1%. Um, I am a little embarrassed today because I have an amazing uh treat for for you all, but actually it's more

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a treat for me. So, uh, and that's uh Malcolm Gladwell, probably my favorite I would say my favorite author, but I I see you more as a philosopher in my mind. And so, uh, you've helped to guide my philosophies, uh, throughout throughout my life more than you even want to know.

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The 10,000 hours, like I forced my kids on a 10,000 hour, uh, you know, track to become uh, basketball players and then also uh, David and Goliath Cut Steep.

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But I I I So, thank you. Thank you for being on. Welcome.

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Um, not at all. My pleasure.

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I have a lot of questions for you. And the first one I thought of is so obviously I'm all in as you can tell from my wall. Um I'm all in on on

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reading your books and really diving in not just for the you know the aesthetic or sort of the pleasure of reading but really the philosophy behind it which is

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I think u the the reader that you want to get to but who who do you read like sort of when you're when you're like hey

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I want to be you know I want to be entertained or I want to be inspired. I want to see what what different people are doing. Who who's who's your go-to?

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Well, I uh my my favorite author is uh uh Janet

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Malcolm, who's a who uh writes she she just died, but she is really kind of the great non-fiction writer of my

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generation. and she wrote for the New Yorker and she would do these books that were they

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seemed incredibly esoteric and they were always about very intellectual subjects but then you read

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them and you realized that she was talking about something else there she's trying to she writes these books they're

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impossible to describe she wrote a book I'm I'm just rereading right now called about psychoanalysis called the impossible profession um which which she

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just describes in this incredibly accessible, beautiful and and and um

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complex way about what it means to go into a fraudian analysis and like what how that works and how it changes your

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brain. Anyway, she she was that she she and also another person who I I've learned an incredible amount from

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reading um Michael Lewis uh you know uh who's a also but here at Pushkin and

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other um but he because he writes very differently than I do but but I always

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wanted to be more like him. He he writes single stories that are very character-driven. And I I used to kind

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of go through his books and like underline passages and try and figure out how I could um I wanted to be much more of a storyteller like he was. And

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uh so that's something I've taken very seriously. Yeah. You we talked about this before.

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Um u by the way just so everybody knows um Malcolm Grace the partnership he was at our partnership meeting and was on

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stage and we spent a short time um recording uh a little bit of a a podcast afterwards and um one of the things that

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I thought was um very interesting um about you know just about the way you work is you do tell stories I mean you

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know telling stories is um is the way you teach us um what you're thinking And so that's been a very deliberate thing that you've done over your career.

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Yeah. Um but that's all you know I'm a I am by training and origin um a reporter.

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You know I that's I I got my start working for the Washington Post and spent 10 years I was actually covering healthcare. That was my first assignment

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at the Washington Post and it's why healthcare remains such a kind of love of mine. Um, and that's what your

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that's what you quickly understand that your role is, right? You're taking you're not just communicating facts or

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digging up things. You're telling stories. You get helping people kind of make sense of the world. Um, and you do

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that through character and narrative and all those kinds of things. And then when you move on and write books and magazine

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articles and do podcast episodes, those that storytelling function becomes even more important. There's no think about

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it. When you writing a book, you're asking someone to spend hours with you. Yeah.

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To make a commitment, right? Same thing with a podcast episode. Our podcasts are typically maybe 35 minutes. It's a lot of time. Yeah. asking someone to spend

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35 minutes of exclusively just listening to you and the only way there's only one way to do that and that's to tell a story. There's just no other, right? If you can't do that, they're not they're

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not going to they're just going to stop listening.

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You um you you're still refining your craft and so you know when you where when did you refine when did you know

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that I want to tell stories to impact the world? When I mean you're sort of writing the New Yorker when in your career did you realize that that was who

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you were going to be? I mean, I don't know if there's a a kind of moment when and I never really thought about it in

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those terms. I always thought about it very personally. What stories do I want to tell? And I still think of it that way. It's never I think if you start

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with the question, what stories does the world want to hear?

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Then that's a that leads you into a bad place because you're trying to put your mind you're trying to pretend you're somebody

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else. And also you're undercutting what the reason

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I want to see a Martin Scorsesi movie is because I'm interested in Martin Scorsesi. I don't want Martin Scoresi to think what does Malcolm want to

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right want to watch. I want him to do what he wants to do because I'm very interested in who he is. um you know the

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and I feel like to be any kind of um professional creative person is about

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asserting your taste, right? It's the minute you start tailoring your taste to what you imagine people want, you're in trouble. You need to have confidence

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that the things you're interested in will be of interest to, you know, other people out there. And that's always been my I've always just done stuff that I

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thought was uh we were just talking um I just did a uh we were we're doing a series right now on mistakes where we're

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having people professional people sit with us and uh tell the story of what they consider to be their biggest mistake.

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And that's brilliant.

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It's having and these are stories. They really are stories. They have beginning, middles, and ends, and then they reflect on the story. And we just had a I just

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this morning interviewed the guy who um was the co-founder of Blackberry.

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And there was a moment when Blackberry could have been saved and he failed to

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convince the board at Blackberry that his way was the right path. And uh he told the story, it was like a classic

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error. He didn't he thought that logic was all he needed basically and that as

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you know if that was the case you know we wouldn't need doctors right the doctor's role is to go beyond logic is

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to logic doesn't work on patients I mean some of the time but um and so those are you know there that

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that kind of um uh that's just an idea that that that um uh appeals to me, I

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want to hear those stories. And so I I have the and I have the confidence that other people want to hear them as well.

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Yeah, that's that's awesome. We talked last time about almost, you know, something I'm working on right now and and the idea of, you know, that that gap

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you talked about. I mean, it's one small thing um in this case that could be a mistake or could be, you know, a championship. Um and you know, you know,

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I'm sensitive to Blackberry, too, because as two Canadians, um I would have loved to see Blackberry.

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I know. Well, there I'm from I'm from Wateroo. So, I'm from the home the birthplace of Black. Yeah.

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Um, and the interview I did, the guy who was the co-founder of it was across the hall from me in my second year of university. Oh, wow.

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I've known him since he was a kid. Oh my goodness.

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Since I was a kid. So, it was it was a very It was a very fun interview. Wow.

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He actually It's interesting because it's a it's a relevance to your world.

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the fundamental issue that we settled on and I had to give me he did not come up with this. This was my having because I know this guy.

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He's incredibly smart. Smarter than almost anyone else I've ever met. And he has the problem that smart people have

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which is they assume because they can see a choice clearly or a decision clearly that everyone else can too. and

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he he had to he had to kind of adjust his perception and get inside the minds of in this case his board who were just

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not they're just not on his level. I mean he just was way ahead and he couldn't do that. He didn't understand that you it's you know and I feel like

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that's a relevant thing because this is a fundamental problem that people have in medicine as well is that you guys

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know so much more than we do that the at some point you have you have to be able to translate all that expertise and

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knowledge into the uh for a for a a not just an inexpert audience but an audience that has a million different

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reasons why they don't want to go along with what you're thing, right? To be resistant, to be, you know, um it's just like a really interesting that problem

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of being so far ahead of the people you're talking to is it is a it is the central problem of kind of highly

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cognitively demanding professions I and leadership I mean as you talk about I think of healthcare of course

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um and how with AI and knowledge being much more accessible that as a physician I'm I'm more of a friend, a facilitator,

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a support, a mentor, you know, as opposed to before where you just came to me for knowledge. And I think the same thing with I fashion myself as a

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disruptor. And when you disrupt, you're way out in left field all the time. But if you don't find a way to connect the people to that

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vision, um you end up just being out there by that that video, the crazy dancing guy, you're just out there by yourself.

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Yeah. Yeah. So, so um I I think you know you you read less than 1% and you know sort of my thing you know my story or at

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at least parts of my story which every time we talk I feel like I tell you too much like you know the lesson I'm telling you

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all about my burns and all that stuff uh just cuz I feel I feel connected in that way but if you so you you're where you are

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now um and if you were to say you know if you were under the guise of less than 1% as a story as you're coming

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up. Was there any ever a time where you felt like that where you felt that um you were underrated or you may not have

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um had the impact that you were wanting to have? Mhm.

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Were you were you always sort of fully confident that I'm going to tell stories. I'm going to shape the world through my voice and through my writing?

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No, I mean I'm not someone who's I don't uh I'm not I mean I feel like

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the I'm not very introspective which spares me a lot of those kinds of worries and

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anxieties. I'm very um I don't find myself at the end of the day that interesting. I find other people interesting. And if you take that perspective then life's a lot easier.

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you know, you don't you don't kind of um uh you don't kind of uh end up naval gazing or speculating. Um, I'm also I

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was also deeply aware of it always struck me that the element of

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of luck and and um circumstance in how well we make it is so large that it's

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kind of it's almost kind of fruitless to spend a lot of time worrying about whether you're you know because you don't first

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of all you just don't know what's going to happen and you can't plan in the way that you imagine you can plan like the the lesson

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of of of middle age is the lesson of like what a crapshoot life is. It's like

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a and you could taken a million different paths and things could have turned out dramatically different if this or that had happened and um and you

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you you begin to understand on a kind of fundamental level um how fortunate if you are someone who's succeeded how

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fortunate you are. It's really it's like it's good luck is at the core of so much of what we do. So I've always had that I

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my mom always communicated to me that um how lucky we were and how lucky I was. She was right. She's just like

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because her story, you know, she's a Jamaican girl from the middle of nowhere, right? like tiny little house

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and no electricity or running water in the middle of the the hills of central Jamaica like

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growing up during the Second World War when the whole world seemed to be ending. I was just on the phone with her yesterday and she was talking about like

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you know ah when you're my age you've seen so many of these things it's not that bad.

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Yeah. But like that perspective is that was a very useful perspective to have as a kid because it just means you relax.

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You're like you can't control everything and chances are you'll get lucky in some unanticipated way. And you can also the the other

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thing that this is a more kind of abstract notion, but my dad was a mathematician and

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one of the things I would sometimes, you know, if I was struggling with some bit of math homework as a kid, I would take it to my dad and he would give because

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he knew so much, he would give very unconventional advice to how to do my math homework. And one of the things

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that he would always point out is I would be struggling to answer a problem a certain way and he would be like, well, you know, there's five ways to answer that problem.

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And he would like show me the five different ways to solve the problem. And that idea that like there's not one path, there's multiple paths and if one

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is blocked to you, you just do you just take one of the other paths, right? Like I once you understand particularly for people like us who are in this position

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of incredible privilege in the 21st century in North America like we have multiple opportunities. Like if I told

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you you couldn't go to medical school, are you trying to tell me you would be selling shoes in a in a strip mall? No.

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You'd be running something else. You just would have done something else.

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Like because you would have a million opportunities, right? So, it's like is that that's an incredibly freeing I've always thought I could be doing something else.

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That's that's that's amazing. I think that's such a, you know, my my dad is, you know, the the Jamaicans now, now we can go into the Jamaica part, but my dad

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always says, you know, whatever I'm going through and I might be a little down. Um, you know, he says it may be long, but not forever,

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you know. And, uh, the other thing that I think is fascinating that I that they always say is like normal days are amazing days are normal days, right?

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like which is flipping it to what you're saying is that you know my mindset should be that every day I'm doing something it's the mo it's the best

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thing ever you know but speak speaking of Jamaica so I you know we have that that connection right the Jamaican Canadian

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you know m you know immigrated to America um which I keep telling people I'm immigrant and they say well you're from Canada and I'm like well okay you

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know immigrant um but I I am fascinated and And I wanted to talk to you about this. Um,

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I'm fascinated by Jamaica's impact. And, you know, I write about, you know, you write about it uh at the end of Outliers. I

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I probably write about it too much. It's all over my book.

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But I'm just looking at this island with, you know, two and a half million, maybe three million people that have had such a profound impact on the world through

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music, through you, you name it. What do you What do you think that's from?

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like what what is the what is the heart and soul of Jamaica that it makes it so powerful?

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I don't know. It's like it's it's this kind of exclusive club thing,

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you know, like and there's somebody once made this argument, not this argument, pointed out this thing to me that the

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world is full of these small groups that outperform the Armenians, the you know there are

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there are subopuls of India that in South India that are insanely successful, Jews, uh you know, we can go

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down the list of Jamaicans are on that list, right? Um, and a lot of it, you know, this this idea when I say the I

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may make the comment about an exclusive club is not a is half a joke, but it's half not a joke, but that idea that you belong to to a special culture.

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Yeah. and is is a really really really powerful one because it it it empowers

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you and you see examples all around you or you have a kind of cultural script that allows you to succeed. Um you know

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the you had Donovan Bailey on your podcast. If you're a kid in Jamaica and

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you're fast there it is it is completely plausible for you to dream of being a world-class sprinter. Yes.

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Why? Because you're surrounded by world class sprinters. You've seen that movie play over and over again. It's not a

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kind of It's not like you know that same kid in I don't know Taiwan or South India has no expectation of that.

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like you there's no there's no script where somebody becomes a world-class sprinter or I'm just using that example as a um similar if you look at you know

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the massive over representation of African-Americans in sport of basketball same thing if you go and play in one of those

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playgrounds in Harlem or you know southside of Chicago whatever they all have a they know someone who made it in the NBA not it's not to say that they're

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going to make it but like it's not implausible it's a kind of thing that you know that uh that has happened. Um

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and I think these kinds of what what these highly successful cultures do is they kind of they've found a way to

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spread that message of possibility to everybody.

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Um and uh and that's like that turns out to be hugely um you know a Jamaican immigrant coming

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to America has so much evidence that you can make it in this country, right? It's just like it's funny like when you describe it um

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you know the goosebumps at the end of outliers for me because you know you describe because I didn't you know and I think that's maybe why you did it. I

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mean I didn't fundamentally know that about you and so um and then you know I told you before that I was forced uh to

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write my last chapter in my book and what I noticed is that it's there's an emotional essence to for me and I don't

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know if you have this too. there's this emotional essence almost like to the point of where you it's like for me cuz I'm an emotional dude but you you almost

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like want to tear up um when I think about you know what Jamaica means to the way I act, the way I behave, the height

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I am, the the body build I have and just really just the work ethic. Um and and

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and also like how that generation my parents were amazing. uh both both Jamaican immigrants both immigrated separately to Canada where they met.

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Mhm.

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Um but they also had, you know, some things that were uniquely Jamaican that were good and bad um that that that were

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the fundamental qualities that that ended up raising me. So I I I'm always fascinated. I I like your description.

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Um but I but I do think that Jamaicans there's also a pride like I I also noticed that too. And maybe it comes

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from that same thing, too, that like like Jamaicans, even when they're not the fastest, you know, even when even when they're the slowest, they believe that they're the fastest, you know.

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Yeah. Yeah. Who what's his name? God, now I'm I'm I'm spacing on his name, the

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Jamaican singer, the huge Jamaican reggae artist of the moment. Oh man.

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Uh you Vibes, you talking Vibes Cartel? Yeah, Vibes Cartel. Yeah. Yeah.

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Um who like first of all he's so like kind of quintessentially Jamaican in so

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many ways but like the his productivity like was he written like 900 songs or

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some kind of crazy thing still going strong in his that's like there's a certain energy that it's a very there's a very Jamaican energy about

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that kind of creative productivity that this is there's there's there's some kind of um if I had to put my finger on

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what makes Jamaica special, each each of these cultures we've talked about has a different thing that sort of sets them apart.

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But in Jamaica, it seems to be this kind of um combination of energy and joy. Yeah.

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That makes an incredibly powerful combination for people who are trying to kind of try to succeed, you know.

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Yeah. Energy, joy. I mean, I would add there's sort of this weird part of Jamaica which is competition and you can see it like when you land and or you go

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to the you go to the market like there's this competition come to my shop, come to my shop that I think that's why I think track is so amazing

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because I think you you grow up competing to get into school and then to run at that school. So, I think that there's a competition component, too.

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Um, but it's, you know, I I don't have a choice, but I'm very glad to be of Jamaican descent, you know.

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Yeah. It's great. It's like a just it's just like a kind of awesome world to be a part of.

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Okay. I I want to put you on the spot, though, and you and I and and and you're you're such a humble individual. I don't know if you'll be able to answer this question.

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Do you have a superpower?

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Do you have something that I mean I I know I know you're going to scoff at a little bit, but I mean is there something that you know like hey I do

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you know this is something that's unique to me. I do really well. I I don't lose any energy when I do it.

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I have this is going to sound very nerdy, but I can

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suppose I was writing an article about you and I interviewed you for an hour and a half.

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At the end of that hour and a half, I go, you know, I make a transcript of the conversation. I can look at that. So, it would be what 20 pages transcript.

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Yeah. I can look at that transcript and know instantly how to transform it into,

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you know, a half an hour of great audio or 3,000word article. I I can just see it and it's just from doing it's a I've

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been doing it for so long now. Took me a long time to get there, but I can see in my head

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a story in a buried in the middle of a conversation. Yeah. Well, I was close.

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Very What's that?

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I was close. I I thought that I I was going to guess if I would guess that storytelling is your is your superpower.

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Yeah. It's But story remember storytelling you need raw material, right? True, true, true.

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It's you. I'm not coming up I'm not like a fiction writer coming up with a story out of whole cloth. I'm transforming

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things. And it's that so I'm very dependent on acquiring material um to tell my stories. That's why I spend, you

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know, when people think about what it means to be a writer or a non-fiction writer, most of my time is spent talking to people. It's not writing. Yeah.

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Writing is is a thing you do at the end of the and if you do your talking properly, the writing takes up a relatively short amount of time. Um, my

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job is is finding lining up and talking to interesting people. That's that is at its core what I do for a living.

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That's awesome. And you I I mean the other thing that I think you do in those conversations I'm sure and you did it with me but you you and maybe I don't

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now if you try to do this or you generate very quick connection um in a

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in a in a very um intriguing way like you know like you you know like you'll

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go to I don't know um I I'm not a social person. I'm I'm an introvert. I do not like social events,

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but you can imagine going to a social event and being stuck having to talk to people.

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Um those people like that can connect with people on sort of an extraversion sale, but you have an ability to connect

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deeper. Um or and maybe maybe you just did that with me. May, maybe.

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Well, I like I actually I mean that's that's a very simple explanation for that and that is that I just like um I really enjoy meeting strangers.

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Yeah. I'm not, which is not to say that I'm an extrovert, but if I like I was in, we're just in Florida and um we're

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rented this house in this little beach community and some guy and his wife came up to me and they had read my books and

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I ended up like chatting with them for like half an hour because three questions in I realized, oh, like this guy's super interesting.

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Yeah.

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I still don't know what he did for a living, but he was from Birming. He was like a white guy from Birmingham, Al Alabama, who's like very self-aware

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about Birmingham. And it just was like interesting like just to hear his and then I started asking him about Florida

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and about it just it the once you get past that third question then you're off

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to the races. Like when people just have to sense that you have more than a surface interest in who they are, what they're

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doing. And if once people pick that up um then I think you're it's it's quite easy after that but it is really hard I

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think I say third the third question I think I mean actually that specifically like how are you and where are you from

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are the kind of you go to the next level right like some thing that demonstrates that

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um your answer matters to me and is and is an invitation I'm making I'm giving you an invitation to more conversation. That's what I'm doing here.

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Yeah.

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And when people hear that invitation, then they're like it's like the it's

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like the world opens. Um it's funny because I not to bring this back to medical care all the time, but you know,

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I feel like, you know, at the core of what a lot of doctors do is the patient interview,

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right? And that's the key to the whole thing. You got to unlock them. They're not going to tell you what you need to

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know with a series of wrote questions. I I've not only have observed myself doing this in a doctor and I realize I leave

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the appointment and I realize I didn't actually tell them right what I should have told them. And it's like is that my fault? Is that their fault? Like what was I doing in there?

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Like why was I shy about you know what X or Y? Um, but then even more when you realize

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when there's a cultural distance between the patient and the and the provider, how much harder it gets.

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Um, uh, and like people's, you know, uh, how we misread cues in unfamiliar from

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unfamiliar cultures and, um, that, uh, yeah. Yeah. It's like a it's a it's a it's a topic of kind of endless interest for me.

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I think you I think you hit something on the head though um in respect to healthcare. Um I thought about this after our last conversation and I think

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um you know you try to evaluate you know am I am I you know I'm leading this I'm I'm

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a leader now. I'm a CEO now but at some point I made the decision to go into healthcare because I just want to help people. I just want to make them feel better. I think the best

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physicians do what you talked about as your superpower. You know, you don't really go in with the logical here are the 27

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things that I need to make sure that they that I find out from them so I can narrow down the eight things they may or may not have. It's just connecting, you

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know, it's just sitting with them and, you know, and asking them about, you know, what what worries them. And inevitably

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you find your way to, you know, you find your way to to what's going, you know, the problem.

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Yeah. This actually brings up something I've thought about with respect to your world and AI. I know we I think we

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touched on this a little bit when we had our last conversation, but if we think that by introducing AI into

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uh the the doctor patient relationship or into aspects of it what we're doing

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in the best version of that is we are transferring some of the responsibilities currently carried by

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the doctor to uh to a machine the software what have you um and the question is what do you

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do with that time that you freed up? Um, and I if we made a kind of formal commitment to say I'm just talking now

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about the standard patient doctor visit, right? The kind of entry with a personal with your primary

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provider probably. Um, if we made a commitment to let's see if we can get 10 more minutes of conversation between a

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doctor and a patient on on average across all of those primary care encounters. What would be I'd love

33:06

someone to figure out how much benefit would that bring to uh healthcare in this country if I gave

33:13

you all 10 minutes and can I use an extra 10 minutes and can I use AI to help us get to that extra 10 minutes and

33:20

my suspicion is that that extra 10 minutes would be of incalculable value.

33:27

Maybe not all measurable value, but just in kind of if we think of so many of the

33:34

problems with the provision of health care as essentially cultural in the sense that people who need to go to the doctor don't go to the doctor. People

33:42

who sometimes go don't get out of that visit what they need to get or the doctor fails in some way understanding what the problem is. So many of those problems are are solved by time.

33:55

Yeah.

33:55

Right. and like but and the idea of like reframing instead of having all this gloom and doom about AI just saying this is the function of this technology.

34:05

Yes, it's going to get me 10 more minutes.

34:08

Yeah, I I totally agree. I mean we talked about that last time. I think AI in healthcare and maybe not in other areas but in in AI AI and healthcare

34:16

will if used appropriately will make physicians more human. it actually make them more human because I think if you look at it

34:25

um I think my generation the sort of the the ex the ex doctors kind of grew up using technology like we

34:34

you know we don't the baby boomers were the ones like when the EMR came the the electronic medical record came they're like I'm quitting but you know I I mean

34:41

I can remember being in medical school going to the VA and putting the entire chart typing the entire chart and so new

34:48

technology in some ways is more adoptable and generations after me definitely love the new. But to your

34:55

point, if you don't make it more human, you have an opportunity to be more human or you have an opportunity to see more patients and depending on the motivations behind why you're doing it.

35:07

you you may actually be more productive and therefore make more money or maybe you know can pay back your student loans which is important but

35:15

you could have that opportunity to be more um I I tell you a little story that is 100% along those lines when I was

35:23

just got out of um residency I really just use knowledge I you know I like oh my gosh this person

35:32

can't breathe I innovate him and I met an older doc who was like hey just go talk to them like but they can't breathe. He's like go talk to them and

35:40

he was able to avoid innovation and really treat. So I think it's that to that point he was being more human. I was being very algorithmic. It's been

35:49

it's been really interesting for me to observe my mom who is now 94

35:56

and very doing very well to obser to listen to her talk about her relationship to the healthcare system in

36:03

Canada. um and how hap she's incredibly happy and I real and I ask her like you

36:10

know what what is it about your healthcare that makes you so happy and that and it's it's just that she has

36:17

been blessed with a series of doctors who will listen to her. It's not about the not about objectively the quality of

36:26

care because she's 94. Like what what does it matter? Like no heroic we're not interested in heroic medicine here, right?

36:33

She has some aches and pains and she wants someone to go and like give her a sympathetic ear and some understanding of what her values are, which is she

36:41

doesn't want to like take 20 pills a day. And she's fine with like she doesn't need heroic measures. She just wants to be taken seriously as a human

36:49

being. It's all she's ever wanted, right? like she just nothing. She probably would have said the same thing at 15. Just take me seriously.

36:57

I don't need you to like, you know, I don't need heroics. I just need the world to look at me as a black woman and understand that I am the equal of anyone. That's what she wants.

37:08

Yeah.

37:08

Right. And the system has given her that. For all of its flaws that people like to rail on about about the Canare system, they have given my mom her

37:16

humanity. And that's the most important thing of all. Yes.

37:21

So you you talk about so when we talked last time you said healthcare and crime are the things that f just fascinate you. Yeah.

37:28

Um and uh can we talk about the new book or is it is it I mean I know Yeah. Yeah. Yeah. I'm happy to talk about it but I do want I want to make one last healthcare point.

37:37

Yeah. We're doing this, we're hopeful of doing this project um uh which I won't get into the specifics

37:44

of it, but I have been for the longest time fascinated by the fact that uh people hate the pharmaceutical industry.

37:53

In fact, I was looking at these um you know, they do these rankings every year. They ask a cross-section of Americans, what industries do you trust

38:02

the most? Pharma ranks below the oil and gas industry. Yeah. Which is insane.

38:09

Insane. Insane. Insane.

38:11

Like an industry that is essentially devoted to helping us all live longer, happier lives. And you know

38:20

there is no more complicated hard task than that. And it happens to take a lot of money and give you a million political mindfields. But the idea that

38:28

you would somehow think that Exxon was more important was more worthy of your trust than like so like one of the that's one of the

38:36

little things we've been really interested in is I think on at base it's a storytelling problem and it's not confined to pharma but it's confined to

38:44

many aspects of the overall healthcare world is that you guys do a terrible job. Yes.

38:49

Of telling of telling your own story. A terrible job.

38:52

Yeah. No I remember Go ahead. the I can see on my riff when that terrible tragedy happened to the

38:59

United CEO, healthcare CEO and like this weird thing happened where people were like cheering his killer online and I

39:07

was like do you have any understanding of how hard it is to be a health care insurance a health insurance company like

39:15

you have to say no if you didn't say no nobody would have any health health insurance the whole point of insurance is supposed to distinguish between those

39:23

who h just like I was like what do you what is wrong with this industry that they cannot explain fundamentally what they're doing to the American public.

39:32

But that I mean that's a very uniquely Canadian view of of the healthcare that someone has to say no because we grow up you know we grew up with that

39:40

with that model. You know what's interesting? I I think um because now you got me you got me thinking about healthcare. um you know we you know co

39:49

was my first realization that I that health care is part of healthc care's problem right

39:56

um and I think co the covid vaccine was a great storytelling miss you know miss and you write about that you know in revenge at

40:04

the tipping point but here you know it's like hey here's this vaccine take it it will save your life and if you're black take it first sort of like

40:13

it was just this crazy were like you like you guys they needed to call you and say Malcolm what's the best way to tell this story.

40:24

Yeah. Yeah. I know. I know. I know.

40:26

But okay. I want to stay on healthcare a little bit and then we'll go to the new book. But when you really quick if you you know sort of short answer

40:34

if you could magically fix health care system what's the one thing you would change like if you could snap your fingers.

40:43

I mean, I think at the end of the day in the United States, and not sure this is true for every culture in the world, but I think there has to be way more market

40:52

discipline in medicine, uh, a price has got to we got to have real prices. We

40:59

got to know should be able to shop and compare the provision of basic services. It's

41:06

it's it's not a bad idea to have a really high deductible insurance and then the government provides people who need it with some kind of there's got to

41:16

be some people have to make their own choices have ways to make their own choices about what they want from the system. Um that's the only right now. I

41:25

just I just feel like the system is so chaotic and also I employer provided healthcare is just a bad idea. It just is. It's not

41:34

like what are we thinking here? like you shouldn't have to lay awake at night.

41:38

What happens to your family if you lose your job? Like that just seems to me um so that would

41:45

be I would just have to I would try and address there's no way at the same time I would say we have to be honest with ourselves

41:52

there's no perfect system every system is going to drive some people crazy.

41:56

We have to abandon this notion that there is this magic thing out there. No, it's like they all they all have their

42:03

pluses and their minuses and you're picking your poison basically. Um, but so that would be I would like a little

42:12

um I'd like a little the pricing thing is is nothing. You can't do anything in life unless you know what something costs. Yes.

42:20

Like can you please tell me what this costs? Yeah.

42:23

Like it's a bizarre it's a bizarre structure.

42:27

the the woman who takes care of our kids has got this in the middle this long complicated thing where

42:36

it's bottom line is she's been told that she owes some hospital $50,000 and she

42:43

doesn't owe them $50,000. Like that's not a real number, right? So like I don't even know how to help her. Like I it just I how do I explain to someone

42:51

who's not sort of sophisticated about American healthare system that this number that's terrifying you is not real. Um anyway that's a side thing.

43:00

Yeah I 100% agree with you.

43:02

Uh so I'm so curious American way of killing I I want to spend a few minutes on that. It uh is this book uh I'm almost done.

43:11

um comes out in the fall trying to to explain what is peculiar and distinctive about America and gun

43:19

violence. Why do we have this gun violence? And what's really interesting is like America does not have a higher crime

43:27

rate than other western countries. Our crime rates you've you're more likely to be mugged and have your house burgled in

43:35

London or Paris than you are in New York. Like crime is not the issue.

43:39

Violence is the issue in America. That's what's distinctive. And first, so we have to like separate crime and violence. They're separate things. The

43:47

the kind of person who robs you is not the kind of person who shoots you, right?

43:51

Those are the person who shoots you is probably someone you know who when you and that person are high or drunk. The

43:59

person who robs you is a separate category. Um and then I sort of try to walk through and describe

44:07

why do we how did we come to the point where we um have such a fundamentally

44:15

uh broken and dishonest conversation about gun violence. So starting with the Supreme Court.

44:21

Yeah. all the way down to I have a the chapter I was just been re revising on this morning actually is it's this really fun one where did I tell you

44:29

about this trauma surgeon from Howard University no the head of trauma surgery at Howard

44:37

it's kind of Eddie Cornwell yes I know the name yeah famous famous famous trauma has treated he told me over the course of

44:46

his life 3450 gunshot victims First, which by the way,

44:53

and I make this point in the book, there is no one, I'm going to guess in the world who has treated 300

45:02

400 3,450. Think about it. There's no other country in the world where you would possibly get that kind of patient volume.

45:08

He trained in LA County in the 80s, went to Baltimore, East Baltimore,

45:14

Hopkins, and then DC. Like, so my first point is like the no. So he's like one

45:21

of the America's most renowned gunshot surgeons experts that as a subsp specialty does not exist anywhere in the

45:29

United States. By virtue of how insane our gun violence problem is, we've created a category of expert that has

45:38

never existed anywhere in the world until this point. Right? He's like a um but but the point of one of the points I

45:45

make is that we can't have a real conversation about gun violence in this problem in this in this country because

45:53

people like Eddie Cornwell hide the problem from us. They've gotten so good at saving the lives of people who've

46:00

gotten shot that we think we see the murder rate going down and we think, "Oh, we're being less violent." No, no, no. Eddie's saving those people when

46:07

they come to the to the ER. And so it's a it's aggravated assault and not a homicide. We they forget the homicide

46:14

rate is violence minus the quality of health care. Yes.

46:19

And you guys have done such an an unsung insanely brilliant job of saving the

46:27

lives of young men who are like got five bullet holes in them that the rest of us can can can sit back and say, "Oh, we don't have a problem.

46:35

The homicide went down." Yeah.

46:36

No. No. It was It's Did you Aren't you an ER doc? I forgot. Yes, I'm ER doc. Yes, it's you. Yeah.

46:43

Well, it's you. You It's It's my fault. But you know what I'm talking about.

46:50

Like 100% 100%.

46:52

You walked into Yeah.

46:54

Between in the last 40 years, like the difference between what happens to you if you walk into a if you're carried into an ER with a three gunshot wounds, it's like light night and day.

47:04

Night and day. Yeah. Night and day.

47:06

Yeah. and just and and I think the response time too, the response time, but that's a it's such a I mean as as usual and of course I'm

47:16

biased because I'm a fan um of the stories you tell and I think it's a I think it's a brilliant brilliant brilliant idea. So I have just a couple more questions and uh Sure.

‍

47:24

So So one is so that's an amazing idea.

47:28

Have there been ideas that you've had for a story, a podcast, a book that you're just like, "That was not a very

47:36

good idea." You know, that's I you know, I I Oh. Uh well,

47:44

yes, but that doesn't mean you abandon them. That means you keep going.

47:49

To me, it's all about that's not a good idea yet. M so I honestly believe there's a good story

47:57

everywhere but you just have to be patient enough to find it um and to see

48:04

it's often buried and you just have to kind of take your time to and I I you know if you take your time with people

48:11

everyone is interesting it's just that some people it's harder to find what's interesting than others sometime if

48:18

you're you know if you're talking to a guy who just climbed Mount Everest It's just not that hard to get interesting story out of him. It's on it's in part of his resume. He climb on, you know, that's where you start.

48:28

But if if it's more comp, you know, if there something is if someone thinks they're not interesting, you got to work a little harder to find

48:36

out to find exactly why they're wrong about themselves. Yeah.

48:41

There's there's a there's an idea that I had the other day. It's not the other day. It's actually about two years ago and I I wanted to um I I wanted to

48:50

explore it and I think I still am after being prompted by that conversation. But the I think Uber and Lift drivers are fascinating. Like I think they're they're amazing fascinating stories.

49:01

Um because most of them aren't doing Uber and Lift as a career, right?

49:04

They're doing it for another reason. I sometimes I ask their stories and talk to them and every once in a while I'm

49:11

like, "Hey, can I record this?" cuz cuz I feel like they just there's some fascinating there are people who have been s like surgeons in other countries

49:19

and can't get their license in America and they're they're driving Uber. It's it's just fascinating.

49:26

Yeah, that's funny. Yeah. No, it's a good Well, it's a cross-section. Any kind of cross-section moments

49:32

are super interesting. I I was just reading about um cystic fibrosis. Um and what's really

49:41

interesting about a genetic disease, it never occurred to me until I was reading about it was a genetic disease is a cross-section. So in the patient

49:50

population or the in this case the parents of the patients population, you get everybody. You get like

49:57

billionaires, you get people who are like cleaning houses, you get so like when people with cystic fibrosis or the

50:06

parents of those with cystic fibrosis get together, it's it is society. Yeah.

50:11

It's not like you know other diseases are very specific in who they you know economic status or

50:18

Yes. Exactly. like this is not that this is like really and that's really really interesting and that changes the way the

50:25

disease is addressed right like when you look at the fight against cystic fibrosis there's a guy who was number 10 at

50:33

Microsoft who had a kid with cystic fibrosis they sign him up and he goes to Bill Gates and gets like a huge chunk of

50:40

money for the first trial of some of the like that's like that's what happens when you have a true

50:48

cross-sectional disease, right? A socially cross-sectional disease. And I it made me wonder like so many of the

50:55

problems we have difficulty addressing in society are difficult because they're not socially cross cross-sectional.

51:02

They're confined. Gun violence would be the classic example.

51:05

Yeah. If you And then you make judgments based on those cohorts rather than on the disease itself. Yeah. Yeah. Yeah. Wow.

51:12

Um Yeah. That that's that's that's profound. So if you um

51:20

so you you you were I was blessed for you to read less than 1%. And um you know it's funny because I have all my

51:29

presentations are basically I have a hundred slides of all these different stories that I like to tell and based on who I talk to I bring out certain um

51:38

certain aspects of of those. was like, I just talked to SNMA, which is a bunch of young black physicians, and you know, the DJ in me and the rapper in me came out and it was great.

51:47

Like, we were we're all over. We're dancing and rapping. Um, but if there is is there a story that you look at in less

51:55

than 1% that you felt um sort of sort of sounded like me, the m the mood that

52:02

you've known that you've learned about sound like you. Oh, that's different than I Or is there one you like? Is there a

52:10

story you like in Who is the figure skater? Uh, Seria Bonley. That story? Yeah.

52:16

I thought was mostly because I'm in I find that

52:23

um sport to be incredibly interesting and not well understood by people outside of it. And the kind of that was

52:31

that was my favorite um that was my favorite in the book. I wish there's still this thing where like,

52:41

you know, quote unquote female sports get far less. We just don't know. We just don't know about them or take them seriously in the same way. And I I just

52:50

love that. I thought that was a great ch, you know, uh it it I was I was so pleasantly surprised. I don't know. I was just like, "Oh, this is all new." That's awesome.

52:58

You know, like it had that feeling for me. But uh yeah, it really really it really with uh um Ilia uh Malanin, if I'm saying his

53:07

name correctly, she she cropped up again. So, a lot of people are super interested in that story. How did you get on that story? Say again.

53:14

How did you get on that story?

53:17

How did I get on that story? Long long- winded way or the short answer to me being on

53:23

that story is my sister. Uh so my sister was a figure skater. Um, and so we grew up,

53:31

I mean, she's five years younger than me. Um, but I grew up watching Serena Bonnelly. That's who I, you know, because again, you you go back to what

53:38

we talked about before. It's like, whoa, there's this short athletic, you know, we're all short athletic, you know, black young girl who,

53:46

and then I think even more so is when she started losing.

53:50

Um, which I think is also fascinating, right? the idea that she'd just, you know, she'd do amazing things and then just come ever so close and then you

53:57

feel all that, you know, all that rage and all that negative energy from being misunderstood and underrated and, you

54:05

know, underrepresented. So, so yeah, so I I blame my sister for it for um my most amazing story.

‍

54:15

So if if you know if you had viewers out there, you know, a lot of people that are watching this are saying less than 1% they've heard my story. You know, the reluctant uh sort of person that then got the opportunity to do amazing things. What would you tell them? Um you know, if they're out there and they're struggling through trying to have an impact greater than they think that they're being acknowledged for, what would you say to them?

54:23

They've heard my story. You know, the reluctant uh sort of person that then got the opportunity to do amazing things.

54:31

Um you know, if they're out there and they're struggling through trying to have an impact greater than they think that they're being acknowledged for, what would you say to them?

54:39

I would go back to what I said earlier in the conversation about that lesson from my dad that there's more than one way to solve a problem.

54:46

And I think that the the danger people have when we're trying to succeed in the world is to think that if we fail at that pathway to think that we've failed as opposed to oh no it's just because there's five pathways and you just have to try another one.

54:54

That idea that like there's more than one way to get at the right answer is really really really really important and powerful one.

55:01

And when you look at any field of high achievers what's really striking is how much variation there is in their stories.

55:09

You know just like I was reading this book about cystic fibrosis.

55:16

If you look at the people who tackled cystic fibrosis so successfully, nobody went to Harvard or Yale.

55:24

It was like all these different backgrounds—farm kids from Nebraska, University of Nebraska—and you realize there are multiple paths.

55:31

We get in our head sometimes like you’ve got to go here or there, otherwise you’re done.

55:37

This is one of the most extraordinary medical stories of the last hundred years, and the people who did it come from ordinary backgrounds.

55:45

And they found a path that worked. It’s not who you are, it’s the topic you choose to tackle.

55:52

What they had in common was the ability to see something meaningful in a difficult problem and stick with it.

56:00

And then realize it’s not quixotic—it’s actually solvable if you stay with it for 15 years.

56:08

Who knew that was a viable pathway to one of the biggest medical achievements of the last 50 years?

56:16

It turns out it is.

56:24

That’s what I would tell them.

56:32

That’s awesome.

56:34

That’s awesome. Well, I appreciate your time, your friendship.

56:42

I appreciate the time you spent with me because you’ve spent a lot of time with me.

56:50

No, thank you so much.

56:56

What’s that?

57:04

I want to say before we go, when I saw you last, you were talking about this kid who was a rookie in the NBA…

57:11

Cedric Coward.

57:18

Yeah, who’s he’s a great young player.

57:26

He could be an all-star down the road.

57:32

Yeah, it’s so exciting.

57:37

I was reading about rookies in the NBA and realized that’s the guy you were talking about.

57:45

I’m a point guard in my life—I can pass the rock to a lot of other people.

57:52

I could tell you about 10 other kids who maybe didn’t make the NBA but had incredible experiences.

57:55

All of these were Davids—none of them were Goliaths.

58:01

If I keep going I’ll start crying.

58:07

Before we get to that embarrassing thing, this has been so much fun.

58:12

Thank you so much, Malcolm.

58:21

If you want to be inspired, check out any one of his books.

58:28

Seriously, if you want stories that change the way you see life, read them.

58:35

I have my favorite, but he refused to say his.

58:43

Thank you so much, Malcolm.

58:49

Bye bye.

58:58

They thought you’d give up, but you proved them wrong.

59:07

And all along, you were the less than one person.

‍