• A Conversation With Malcolm Gladwell

    In Sunday’s Closing Session (Spo6V), Ophthalmology® Editor-in-Chief Stephen D. McLeod, MD, and writer Malcolm Gladwell—who happen to be cousins—sat down for a probing and insightful conversation that tackled such diverse topics as COVID-19 and golf courses. Some highlights:

    Then versus now. Dr. McLeod asked, “As we look at our own questionable responses [to COVID-19] in various areas, what can we learn in comparing what happened [with the 1918-1919 pandemic] and what we’re seeing now?”

    In 1918, Mr. Gladwell responded, “all we really had available was a public health and political response.” In contrast, he said, “we now have a scientific response and a reasonable expectation that medicine can make inroads against this disease—which is a huge difference in people’s attitudes. Weirdly, it is harder [now] to convince people to do things like social distancing and wearing a mask if they know a vaccine is four or five months away.”

    The second issue, he said, is that the risk profiles of 1918 and 2020 are quite different. In 1918, the flu “disproportionately affected the young. This disproportionately affects the old. But more than that, what’s disturbing about COVID-19 is that ... it disproportionately affects the vulnerable.” He added, the virus “has exposed the holes in our safety net ... [and has] ripped the lid off of all the things we’ve been doing badly,” including initiatives to address obesity and diabetes and provision of health care to underserved populations.

    Slow down, you move too fast. In discussing issues of governance and politics and the impact of social media on public discourse, Dr. McLeod asked Mr. Gladwell about his most recent book, Talking to Strangers. “If you had to distill a core message into advice for people about talking to people in their daily life, what would that be?”

    “Slow down,” Mr. Gladwell responded, “and be willing to revisit your initial assumptions about others.” He said, “I think it’s a matter of recognizing the error rates in our assessments”—and then added, “It’s not that the error rates in our assessments are high, it’s that when we are wrong, it can have catastrophic consequences.” The key, then, is to reintroduce “some element of caution and humility” into interactions and conversations.

    Sis boom bah! At the end of their conversation, the cousins circled back to medicine and public health. The speed of COVID vaccine research is “mind-boggling,” Mr. Gladwell said, and it proves that medicine is capable of abruptly pivoting and rising to the occasion when needed—and when funds are directed to meet those needs. “It’s a reminder that very thoughtful, creative people in the sciences are as responsive to psychological encouragement as anyone else.”

    He explained, “You go to the stadium and you cheer your basketball team; they perform better when they play at home [because of fan support] . . . it’s no different when you work in a lab. We cheered the vaccine guys, and the vaccine guys said, ‘All right, here’s a solution, and it’s [coming to you] five years faster than I’ve ever given you a solution before.’”

    Thus, one of the take-home messages of the pandemic, he said, is that “one of the functions of government is to be a cheerleader.” Another take-home point: “The single easiest, cheapest thing we could do to improve the quality of life and the economy in the United States would be to double the NIH budget.” —Jean Shaw

    Financial disclosures. Dr. McLeod: None.

    Watch the Closing Session. If you are registered for AAO 2020 Virtual, you have access to the archived presentations on the virtual meeting platform until Feb. 15, 2021. Log in to the virtual meeting platform: Next, from the Lobby screen, select “Sessions” from the top navigation; click “Agenda” from the drop-down menu; select the “Sunday” tab; and either enter “Spo6V” into the filter or else scroll down to “Spo6V: Closing General Session.”

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