How To Have Impossible Conversations - Peter Boghossian at UCF

as most of you guys already know my name is Hannah Noor and I am a first year medical student here at the University of Central Florida College of Medicine and I am also a critical thinking fellow at the ion heresy Ali Foundation which is a non-profit organization that works to protect women from genital mutilation honor violence and forced marriage with an overall emphasis on Liberty for all as a fellow I work to advance freedoms and human rights both in the U.S and around the world which brings us to today's event now we are in an age where differing opinions are often equated with ill intent an age where extreme polarization is stripping us of civil discourse in today's event on how to have impossible conversations we will work to bridge the moral divide and rekindle the art of civil discourse now today's speaker is Peter burgosian Peter is a founding faculty member at the University of Austin and the director of the national progress Alliance he has a teaching degree spanning more than 25 years that focuses on the Socratic method scientific skepticism and critical thinking Peter's dissertation explored increasing the moral reasoning of prison inmates and aiding their desistance from crime his more recent book is how to have impossible conversations and his writing can be found in the New York Times The Wall Street Journal Scientific American Time Magazine National Review and elsewhere his work is centered on bringing the tools of professional philosophers to a wide variety of contexts to help people think through what what seemed to be intractable problems introducing Peter burgosian [Applause] anybody hear me okay press the button I'm a little technologically impaired I think I really do think it's the cold okay but anybody hear me okay all right flip it around okay wow it's so my fingers are literally so cold that I'm having trouble manipulating them um okay all right so what we're going to do is I'll teach you how to speak across the Divide I just came up with those uh right before I I uh folks walked in I tried to think about about the most controversial things that I could I apologize if I I've left out any major controversies but I think that those or if I have and you want to talk about those we can certainly do those so that's no problem and then we have a voting if you want to tweet that out you're certainly welcome to uh or put it in whatever social media platform so let's do this the first thing I'm going to do is so I've used this I published a paper on this a peer review paper on this this is a really good way to build a consensus among people specifically among people who don't agree with the topic so it's a version of What's called the Delphi technique where you go through multiple iterations of a process to gain consensus of often among people who wouldn't ordinarily uh agree with something so we have a bunch of topics up there when triage triaging black lives are more important than white lives individuals under 18 should be allowed to medically transition to a different sex Etc so I don't know so it's 12 11. so here's let me just tell you my plan I'm going to show you how to do the exercise we're going to do the exercise and I know there's a mandatory class at one so anybody who stays I'm going to teach you how to do it so you can do it to other people and uh I would never ask somebody to do something that I wouldn't do myself and if you see from the videos that we put out I frequently hand people the microphone after they've done this and then they they can do it to me so I'll teach you how to play this game or do this process with other people so Reed how are we doing on the voting okay cool I'll show you the Delphi technique this is really cool thing to that we can do so but we need to do it quickly so we're going to do two or three iterations I'm not sure it's going to depend and we're going to vote on these claims [Music] um oh you can add tallies oh that's perfect cut Reed is like MacGyver okay so everybody this first iteration gets two votes and then we're gonna change the number of votes so if you want when black when triaging black lives are more important than white lives raise your hand to talk about to do the exercise with you don't have to raise your hand if you don't want to so I'm just going to whip through these abortion should be legal in the third trimester one two three four five six seven eight nine ten in patient care knowing a person's race is more important than knowing their social class one men can get pregnant 14 try to raise your hand at once so I don't miscount the MCAT should be removed from consideration medical school admissions I'm amazed every hand didn't go up for that gay one nine less qualified individuals should be admitted to medical school to further diversity goals it doesn't mean you agree with this it just means you want to talk about it 12. individuals under 18 should be allowed to medically transition to a different sex wow 19. the Hippocratic Oath should be replaced should be it should be a d there I left it out by an equity oath one huh surprised that miners should be allowed to receive gender affirming care without parental notification 18 18. um Wikipedia is a good place to get medical information again you don't have to agree just we want to talk about it two Physicians should lie to patients if doing so would improve patient Health outcomes one two two remember you only get two votes gain of function research is ethical questions one uh requests of trans patients for Trans doctors should be honored zero are we going to have in other words cut in half my salary for a minor increase in patient Health outcomes not zero right race is a valid biological category two covet vaccine should be mandatory one obesity is a medical condition I'm going to vote for that one so everybody when you do this everybody gets a vote one two three four five seven uh requests of white patients for white doctors should be honored zero Physicians should lie to patients if doing so would improve patient care zero Physicians should discuss weight with patients who are obese one uh uh Physicians should discuss smoking with patients who smoke three uh if a female patient requests a female doctor she should be provided one zero requests of black patients for black doctors should be honored one hospitals should be allowed to deny certain services on religious grounds for example birth control zero in a conflict between saving a life and losing my medical license I would save a life one the Health Care System excuse me is systematically racist 11. big farmer hurts more than it helps five okay so here's what you do the next thing you do and again the idea is we're going to build a consensus not that you agree with this and then I'm going to show you how to play this um thinking game so you just basically eyeball it in other words you just look at this and immediately you you delete anything with a zero so if it has a zero you just delete it so can you delete those so one of the things the the goals of this process is that everybody will feel ownership in the outcome even if they disagree because it was a fair process from the get-go and when I do this when I do this in the prisons I made sure that the secretary the superintendent everybody received a vote okay so the second thing you do is you go through multiple iterations depending on how many people are are you're dealing with so if you're dealing with a large number of people you can go through three or maybe even four iterations but it's important each time you do you decrease the number of votes people have and the reason for that is just becomes more efficient so we're going to do this one more time so like look so so you see the ones you can delete the ones everybody see the idea get the idea and so at the end even if not none of the questions he voted for for example he'll still feel that because the process was fair he'll be willing to engage in whatever the outcome is okay let's do this one more time okay so delete the ones read and then the zero down there it's a physician should lie to patients awesome all right and then um I didn't mean it was awesome they should lie baby and then and then see can you reset those to zero or no okay while he resents resets those to zero I'm gonna talk about how to do this so this is a spectrum it's like a likert scale and in the middle is neutral and then you have slightly disagree disagree strongly disagree slightly agree agree strongly agree what we're going to do with these claims is we're gonna after we get a vote on which claims we're gonna do people are going to stand on the neutral line I'll read the claims off and then you'll go to a side now the the game is very very simple it only has two rules you can move anytime you want or you cannot move at all you can just decide to stay on the neutral line if you want the whole time that's fine however if you choose to move you have to commit to a Full Line you can't you know cheat or hedge the game or turn around you got to commit to one one full line the second rule is I'll count down five four three two one move and everybody moves at the same time and the reason for that is we don't want the people in the back to be influenced by the people in the front we want the everybody to make their own decisions without being externally influenced all right so let's go back to these ready read okay now everybody gets one vote if we had a little more time which we don't we'd do three iterations but in so this is these questions again not to agree but we're going to apply this soon individuals under 18 should be allowed to medically transition to a different sex if you want to talk about this raise your hand one wow surprising abortion should be legal in the third trimester nine less qualified individuals should be admitted to medical school to further diversity goals two men can get pregnant zero right so already we know that's not going to be discussed the MCAT should be removed from consideration medical school admissions two Wikipedia is a good place to get medical information zero race is a valid biological category two Physicians should discuss smoking with patients who smoke zero obesity is a medical condition four the Health Care system is systematically racist seven big farmer hurts more than it helps one miners should be allowed to receive gender affirming care without parental notification six did you have your hand up for that one okay six okay so here's what we're gonna do um we'll go you know nine seven six we'll just go in order and at one I know people have to leave so I want to expedite this and then uh if you if you do stay I'll teach you how to do this and you can do this when you teach it's an incredibly good exercises you'll see in a minute extremely useful I've literally gone all over the world and do this and I've never had a single person say that was that song that sucked everybody everybody enjoys it okay so let's do the first claim um abortion should be legal in the third trimester so if you want to talk about the claim abortion should be legal in the third trimester uh raise your hand okay one two three so come on down we can the maximum we can do is five four is ideal five we do five if you want to come on down and stand on the neutral line all right now line up by height we're height discriminating against people here no it's just for the it just so that everybody can see no no don't go there yet don't go there yet so stand on okay okay so I'm gonna count down five four three two one move and you move try to move all at once and everybody gets strongly agree and and uh strongly agree and strongly disagree the claim is abortion should be legal in the third trimester five four three two one move okay tell tell everybody you so what you'd normally do is if there was someone over here I'd say tell them why you but obviously I don't know anybody here and then we don't have anybody there but you would get people to talk this way but we don't have anybody so tell them tell tell everybody why you think abortion should be legal on the third trimester oh especially coming from the medical perspective we've learned about so many so many so many things that can happen that are unpredictable like tragic and you just you cannot put a ban on something without knowing the whole condition that it's affecting especially something that's as broad as any type of abortion in the third trimester so that's ridiculous like you will not have the same amount of information and insight that the doctor and the patient will have so like just Legalize It just saying this is absolutely never acceptable is not the way to do it can you tell everybody of an example that you're think because I I think you have something in mind like can you tell everybody an example like you said there are so many things could happen like what could happen uh premature rupture of the membranes you could have someone who goes into labor early and then the fetus dies and then if you don't get the products contention out they're going to die too just a lot of late term complications or even fetal abnormalities that aren't discovered until much much later or just things like that that don't show up until their trimester that you have no way to account for until you get to the third trimester okay so I think I I understood I am I have zero medical knowledge but I think I answered did you agree not with her position but with her reasoning I most part I think it's just dangerous to make broad legality when it comes to health care because the specifics when it comes to a patient are far more complicated than what you can put on a piece of paper and banning something will hurt more folks than it helps okay I'm going to come back to that in a second um how come you're on the agree line and and not the strongly agree or the slightly agree I think I tend to drift away from the binary end of it so I think there there may be some exception of which I haven't thought of and I think that's worth being mindful of but in general agreeing with pretty much all the same sentiments was the example that she gave um was that a sufficient example you know I'm I'm again I'm like excuse me I'm medically ignorant but there could be some medical circumstance that we couldn't think of that would require an abortion of third trimester do you accept that as true I would say so yeah okay so if you accept that as true then the claim abortion should be legal in the third trimester would admit of an example so you should move to the strongly agree line I'm almost willing to say she should come to the agree line tell her why tell her why if she agreed with my like my train of thought there then like perhaps we could meet like we can't meet somewhere in the middle no not in this game no no yeah so at least for me I think I I don't know given the the exceptions I'm pretty comfortable okay okay um why are you on the agree line I because I agree with her reasoning that there are medical exceptions and reasons why there should be abortion in the third trimester but I'm only on the agree line because I think that um there's other like circumstances where we're not considering like if the baby was completely healthy or the mother was completely healthy and like all the other circumstances was correct I believe that maybe the mom could deliver to term possibly okay um is the reasoning that she gave that the baby could be healthy and the mother could be healthy is that sufficient to move you to the green line not in the terms of legality no why because we're talking about legal repercussions we're not saying oh this is a personal decision like I'm saying that it's kind of what you said where like if you're putting in legislation you cannot say in this case and in this case in this case I think the broad deletion should be it should be up to the doctor and the mother because no doctor will perform an abortion on a healthy mother and a healthy third month trimester infant like that's not a thing that happens so I don't think that's something you need to account for in like the legal term if that makes sense okay what what argument could they give what could they say to you that would move you to the agree what would you have to learn what piece of evidence would you have to encounter to move you one line to to the right to the agree we'll say it's pretty tough there's a reason why I volunteered for this one this is kind of a strongly held belief I I'll understand the reasoning of wanting to limit abortions period but I don't think I don't think making it illegal to have them in certain trimesters is the way to do that if you said like oh if we had guaranteed uh the guaranteed prenatal care guaranteed contraceptive counseling like guaranteed education where it's like we've done everything else that we can to try to prevent this I could see where you would say okay maybe we should put in another measure but like not with the way things are now so you would or would not be willing to move to the agree but not okay what would you say about somebody who was on the strongly disagree and if I asked them what would it take you to move to the disagree they would say nothing like if someone were on the strongly disagree line and which unfortunately we don't have anyone because if they did this is exactly what I would ask them if someone were standing here and I would and I said to them what would it take you to move to the disagree line and they responded to me nothing what would you think about that what would your impression be I would hope that their personal feelings about it would not would not go into how they treat their patients just because this is this is something else where as Healthcare Providers we have to make sure that we are doing obviously doing what's legal but also keeping our our personal beliefs and biases out of how we treat patients so as long as they are keeping like all of their equity and like patient care okay there's not much I can do about someone who's not going to change their mind and would they say the same thing about you on the strongly agree okay I'm not able to provide that I would refer them out to someone who could okay let's do this I want to do something let's reset to the neutral please everybody go back to the neutral so we just did the claim abortion should be legal in the third trimester I want to reset the claim um and please don't move until I say move abortion should be legal up until the last day of the third trimester five four three two one move well that's quite interesting but by the way I I did this claim I did this claim based upon what you said that's how I pulled the claim why did you move um because what we said earlier that this is more of a legal matter and that it always should be legal um I didn't realize I think we weren't talking about more like the ethics of it or like all circumstances but they're always there shouldn't be like a a doctor shouldn't be a risk of losing their life or losing their license for trying to save a life of the mother why did you move pretty much the same reasoning yeah huh interesting interesting um is there anything that would cause you to move to the agree no I think if it's a conversation purely about like legality then I I see the rationale for strongly agree versus if it's yeah okay um okay give my hand thanks okay so uh so that's basically what it's like uh it's a rough template of how the exercises go we're going to pop up another claim and we're going to run through that claim the Health Care system is systematically racist who wants to volunteer okay uh one two one two anybody else all right three that's the spirit so as you can see from this uh there's no gotchas uh it's just pretty straightforward asking people if the reasons they have their beliefs warrant the confidence in their beliefs okay so uh by height sorry about that sorry about that uh okay so don't move until I say move and just remember uh commit to any line the Health Care system is systematically racist five four three two one move okay okay all right tell us why well first of all tell us what you mean by uh or how you interpret uh systemically or systematically racist right so um the way that I mean like systematically racist is that um like you as a patient uh you can encounter racism from pretty much anyone within the Health Care system because uh some like either racist policies or um kind of like racist training education or so baked into the field that you know you can be actively integrated or you could be a person without you know you you could you could actively try to be uh without bias but like it's baked into the education it's baked into the institution can you can you give uh folks an example so that it would help them understand like give them an example of a specific policy currently in place uh of an example that's racist and baked into the system so I think uh something that we talk about is egfr and so estimated G FR is a calculation that's used in like Nephrology basically is a measure of your kidney function and there's something in it called like basically like an African-American adjustment and this is something that's kind of a big contention right now in the medical field about whether or not we should be adjusting uh the egfr value for African-American patients it's based on the assumption that there's some fundamental difference between like the muscle mass and kidney function between African Americans versus everyone else but they've never been able to pinpoint that and if you look back into the history of egfr and other race-based adjustments there's also an adjustment for spirometry which is like for respiration that also assumes that black people have weaker lungs if you go back to the history not history like yeah yeah so but the thing is like like these things are baked in but they don't have evidence for like like we don't we don't have like a biological underpinning for why we believe these things they exist because of a history historical reason and um so I just I just want to make sure I'm clear because when when I ask everybody questions I I want to make sure I understand so the and I'm not a physician so it has to just kind of dumb it down for me so the idea is that there are example and if this is not correct let me know um that there are examples of systemic racism baked into the system because there are certain metrics or indices that Physicians base their treatment on that draw from racial categories of which there's insufficient evidence to Warrant the belief that those categories actually exist I can actually give a great example right please please um let's say you have two identical individuals they're identical in every way right uh you know a 45 year old white male 45 year old black male and uh they have the exact same creatinine sodium levels everything right um if they're on an organ transplant list let's say they're getting a simultaneous liver and kidney transplant exact same numbers every single parameter is the exact same egfr will calculate that black patients kidney function is being worse and so they would be placed better as being better so that they won't get the kidney because it seems like their liver function is better but it's not better or their kidney function is better yeah thank you it's confusing but yeah so like like that is like an example of like they're being you know like with the exact same metrics it kind of affects your placement on the transplant I just want to dwell on this because I'm trying to understand this so if it could be shown that there were biological differences and I I don't think race is a useful category but um if there could be shown that there are biological difference differences among certain among people's whose ancestors developed as a consequence of different evolutionary pressures and that manifested itself in specific ways in the body would you be would you be willing to revise your belief yeah and I I think there are there are ethnic differences right like there are uh Snips single nucleotide polymorphisms right that are significantly more common in certain ethnicities uh sickle cell trait and the the gene for that is tay-sac syndrome yeah yeah these are all like these are all like found in specific populations but race is an identifier races there's more genetic variation within races than between races so you know I'm coming to you in a second but this is complicated and I want to make sure we get it right so if that's the case then the problem that you have with this statement is the and I don't want to put words in your mouth I'm trying to understand this the problem that you have with this statement is that race as a category when I say systematically racist is that you think that that category confuses and obfuscates things such that it benefits people whose ancestors did not have historical oppression variables is that accurate yeah I would say that and I just gave like one example the other there are other examples of systematic racism um if I have time for this thing I'll also give an example of like in dermatology if uh darker skin predominantly like like of the darkest skin types are typically understudied and so like like if you look at a medical textbook you're more likely to get let me give an example of a condition like psoriasis psoriasis presents very differently in patients with lighter skin than in dark skin however um if you go into medical textbook you are much more likely to not have a atlas image with a patient of color or especially like darker skin tone and so if you're a dermatologist you're less likely to be trained and so therefore you know if you have a darker skin tone but like when I'm like and who you know do you know what I'm saying like yeah so and and and and you think that that's evidence of systemic racism yeah because uh that's baked into the institution right like the institution that educated the dermatologist right didn't uh you know didn't have a Equitable or equal kind of representation of skin tone but hold on I was right up with you and she made that those into your lump those together so I I suppose real quick and I'm getting to I promise real quick how do you define racist how I Define racist uh because the yeah because the the second example I I don't know like when people traffic in the word racist and common parlance I don't know if people there'd be a consensus among people that the second example would be racist so I say it's like racism is like an unfair or an illegitimate uh malign or prejudice against a certain racial group and do you think that the example of uh psoriasis and Skin Care was an uh was a malign did you think it was malintent I think it was malign I don't know if necessarily is intent intentional I did well actually yeah yeah I would say because like because like the field of Dermatology has been around for a very long time and for a very long time we've held like the idea of studying skin of color in particular is a new thing that's a new focus and so we have to kind of undo years of prejudice and racism in the field so if it's a new thing and it's and is it becoming more common a little bit we still have a lot of strides to make so that would mean that the that would that only would that determine the degree of racism like if if more strides were being made to study people who have dark skin in the arena of um Dermatology would that mean that the system is becoming less racist I think the system is becoming less racist I think we're headed in a good direction okay all right sorry it took me so long I apologize I just wanted to clarify the Health Care system is systemically racist tell us why you think so yes um I agree with everything that he said and in addition to I feel like since we already make up such little of the population of doctors and nurses I'm sorry we as in minorities African-Americans specifically um I feel like there's also like a sense of ignorance that plays into this racism because a lot of people aren't educated and aren't educating themselves and the different things that they would need to treat this population and then like for example there was a study done in like 2018 that surveyed like doctors residents medical students and asked like black people have thicker skin than white people yes or no and 61 said yes among Physicians yes and medical students and like so that was 2018 I was not even that long ago and people still believe that and then also like there's just not enough black people in the field who are doctors in order to to combat that and then they're also not making efforts to hold on would would a black person be needed to combat that or is that a truth that anybody could come to I mean it's not it's not truth it's false right so it's in other words it's in the domain of Truth or falsely would you need to be black to identify that as false no you don't need to be but it's definitely when you have some when you have like an out group versus an in-group when you have someone who's in to your group and explain to you the Norms of that culture that Society it definitely makes it easier and helps bridge the gap I don't think it's the responsibility of any person of minority to educate the my the majority but that's just in this country that's just how it is and so if you were to bring more people of that into your spaces and you could interact with them more you would understand where the flawed is and your knowledge because if you have something that you agree with and everyone around you also agrees with it but you're all wrong there's no one to tell you that you're wrong okay so I just want to make sure that I understand this so is I haven't read the 2018 study so I can't speak to it I'm sorry so is it more likely and I you'd have to get granular on the data but is it more likely that more or less likely that black people would believe black people have thicker skin because if it were equally likely then increasing the representation of black people would not combat that myth I feel like it's less likely that we yeah definitely less light hello oh sorry yeah and and the way that we would figure out if it were less likely is that you'd have to come to that conclusion through science through data right because it could just be a cultural myth that people believe independent of their race I'm not saying it is because I don't know the data but it could be cultural thing there's yeah I mean well it could be like like there's no one culture that fits all types of people okay so causally what would be responsible for people holding that belief if not a cultural yeah I have no idea why people believe that I I'm not them and I don't believe it so I've never heard it to him right now but okay all right cool thanks um so uh the Health Care system is systemically racist or systematically what tell us why you strongly agree uh so originally I was also going to touch upon the points that the majority of research that has taken place in the 20th 21st century and previously has all been conducted or pardon me the majority has been conducted on white males and thus both the gender demographics of male female as well as race demographics of black Asian Brown have been piled onto what it looks like in a male who is white who presents the way that a white male May and can lead to all sorts of misdiagnoses as far as what they were discussing in Durham there's Cardiology implications Nephrology but since those have been touched upon I'm going to go the political social route and discuss how socioeconomic barriers throughout specifically the US's history have intentionally created a system in which it is more difficult for black individuals in particular as well as Native Americans actually um to have access to educational opportunities the finances to fund higher education to allow them to access degrees in research in medicine so that they can explore things that have to do with their own cultures with their backgrounds their environments places and people that are consistently overlooked because for example if you are an African-American and you have historical ties to the U.S back through the 1800s then you could have family members who were slaves and then share croppers and then were redlined or denied bank loans were denied housing in good or what was considered safe areas whose rents were made to go up so that they couldn't leave the areas in the that they occupied the fact that it once was that Urban cities were populated by white individuals and when black individuals started gaining monetary advancements and business Holdings the white flight occurred and they ran to the suburbs and yeah so all these all these things that sorry all these things that denied people the opportunity to get to places where they could represent people of color Okay okay so let me ask you a question so we we have three claims the main the main claim we're taking a look at is the Health Care system is systematically racist and we have three uh basic basic I mean there are others but roughly people of color are not sufficiently represented within the healthcare industry and then from that socioeconomic barriers prevent people of color uh access to medical education and then parallel to the first reason they have most medical studies used only white males and that's a historical uh claim okay so let's let's break this down so what would the Health Care System look like if we're not systemically racist what would it look like oh yeah sorry face this way yeah tell them how would we know that we've extirpated all the vestiges of systemic racism um well I guess like assuming uh like if I guess like it's kind of hard to measure like something you know because like there's an independent variable there's an out uh dependency right like the independent variable is like are you being racist and then the dependent variable is the outcomes obviously right and so I want to say Equitable outcomes between the race what does that mean Equitable like uh we wouldn't have a significant difference between um complications in for example uh uh black mothers in pregnancy why did you use the word Equitable instead of equal uh well because Equity has to do with outcome and equal has to do with like just like access I believe okay I'll just go go far go far um yeah and so like if we were if you were to you know when you control for socioeconomic status comorbidities all the other you know factors that we uh control for and we looked at race and we saw that there were equal outcomes then yeah I could say that yeah it's probably we've done away with those uh you know okay systematic racism so let me let me ask you a question and and if my reasoning is an error let me know why would one assume that a disparity in outcome was due to a systemic Factor as opposed to something else like and I could rattle those off if you wanted like why why would disparities in outcome have to be rooted systemically as opposed to I don't know eating a lot of pasta or something or not exercising or not having why would that be yes that's what I mean by like uh like controlling for confounding variables like if you can found if you control for like dietary or culture like like that is like one of the things that you know when when we do study these things we do come troll for socioeconomics and see even when you control for socioeconomic status we still see these disparities and that's because but why would you assume that this disparities are due to systems as opposed to cultures like the you know I'm thinking Amy Chu's curse of the tiger the tiger mother or I'm assuming like you know certain uh specifically in Indian Americans not Native Americans or cold climate Asians like why would you assume or asking Aussie Jews why would us why would you assume that those disparities were causally attributable to to a system as opposed to a set of practices not ubiquitously you know from people in the culture but by and large that you could point to a the mode if you will to borrow terms of statistics yeah well because we can point to these things we can point to you know the origin of spirometry in racism right like that the person who created spirometry was a slave owner and invented the system explicitly to demonstrate that black people had weaker lungs and you know there has not been a like adequate kind of like retribution like we we still have that mathematical formula with that little you know multiply that little uh what do you mean by retribution like we haven't fixed that like we still we just we just like it is something that we don't have a biological underpinning for and we haven't rectified it and we haven't changed it because that's just how the formula is that's how they've been practicing for a very long time and so so that would be that would be an example of a system yeah exactly that's what I mean okay so that's an example of a system but what about the other disparities do you think that all disparities in racial outcome are due causally to systems yeah I mean well there could also be like individuals with racism like but like I'm saying that she was looking on her head can I I'm gonna get to her yes yes I do okay can you tell us why here I'm gonna give you this yes as you were stating before when we do studies on these inequalities inequities we control for all of these random cultural factors or any of that other stuff and we still see that the these things are underlined and you're also what do you mean these things like we still see the disparities even when you control for culture or eating habits or diet or whatever we still see them and then also you keep saying like culture like there is one culture of all black people there isn't so there's no way for for you to fit everyone that's being disadvantaged into a single similarity other than the fact that they have a different race so so now I think I understand so be the the the um disparity and outcome and I don't want to put words in your mouth so please tell me if I understand this correctly the disparity outcome has to be due to a system because culture itself is broadly illusory like there's no culture which for example you know Sephardic Jews participate so therefore if there are a disparity and outcome among Sephardic Jews causally it would have to be the the system that was responsible for the production of the disparities as opposed to any practice among the people because you can't say that those people by and large participate in a common practice is that did I get that right yes like for example he was talking about the three times higher mortality rate for black mothers they see that in the highest educated black women who come from six figures who had every advantage in life and they also see it in this low socioeconomic immigrants that didn't this English is their second language like it's seen on the broad spectrum of everyone and the only thing they have in common is that they have darker skin complexion there is no other group that you could fit them in other than that so how would we conduct so you guys are all scientists broadly Physicians specifically so how would we conduct a test to figure out if the disparities we see to what extent they can be attributable to practices if we don't like the word culture um so so they did a list of the rates of death within black mothers with a black doctor versus black mothers with a non-black doctor and they saw there was no disparities when you had a black doctor someone who related to you and believed your pain and took care of you versus someone who wasn't black so that's how they they saw it doctors with the same we assume that every doctor had the same training in this company and they're all on the same level of you know smartness and so if we're seeing that when you have a doctor that looks like you you survive more versus someone who doesn't look like you and the reasons why you're normally not surviving is because what do you mean look like you look like you color wise because talking about race here systemically racist so who looks like you live with the same race when they see that they live more than someone who doesn't and then they start listing the reasons on why this happened you start seeing the only reason this could have been was because of systemic racism okay okay thanks uh did you want to add we really run out of time did you want to add anything real quick um I agree with my colleagues so and you know since we're running out of time I will defer to their wisdom okay um okay couple things is there anything I should have asked you that I didn't ask you or any final points that you want to make I want to make sure you have an opportunity to be heard uh I guess the one last thing that I'll say is that um we're also seeing that the efforts that are being made like I gave an example in like Durham textbooks there aren't there isn't a lot of reference is that your specialty Dermatology what's up you know ask me how step two but fair enough fair enough but uh you know we're seeing that efforts by organizations like the skin and color Society textbooks on ethnic Dermatology there are there is like demonstrated improvements in outcomes and Equity like outcomes are being evened out when we address uh lack of representation if we had time I would reset this to equity but we'd only have four minutes do you want to comment on anything yeah I have to hold this because we're running late I would say that in far in terms of the systemic things that are in place like the egfr and the Durham textbook they're definitely getting better at at making them more like less biased but when it comes to people's individual mindsets that's like a different story and it's really hard to take that out of someone and it's also hard to prove that that is why something's happening so like I feel like the systemic part is getting better but now the individualized aspect of racism and individual Physicians especially longer practicing ones is not doing anything longer practitioners do you mean older one is that a euphemism for age yes okay did you did you want to add anything yeah yeah um so again medical access really important you'll notice that a lot of uh medical deserts exist where there are larger communities of color and that makes a physician less likely to want to practice there which then automatically denies those people the benefit of fast care they generally are the ones where people are going for like a rotation for a few months and then they're like oh check the rural off the list so yeah um just building on that but I have to go to my one piece okay so look real quick real quick while while we go thanks thanks everybody thanks appreciate it does everybody see how how this exercise can help you calibrate in an Ideal World what you do is you'd have other people and you'd listen to their Reasons by the way that's why intellectual and ideological particularly ideological diversity is vital because you can listen to the reasons of people and then you can watch them calibrate their beliefs in real time okay thanks everybody if you need to go to the one uh if you don't we're gonna stay here we're going to do this again and uh instead of me doing it one of you is going to do it and I'm going to guide you through the process um all right Reid what's number what's the one that got the third number of votes ah okay miners should be allowed to receive gender affirming care without parental notification okay and we're going to look at uh word definition you can see in real time read is gonna um that's a read over there Reed and Travis and like we just met today what's your name again Jerry um so you can see in real time when read will post those at Green he'll post them differently in terms of the claims Etc so uh who would like to go on the line for this and then who would like to do what I did to facilitate it who wants to facilitate it you okay come on down firsthand I saw uh if nobody goes on the line I guess I can go on the line but uh we'll see I've found that the the more controversy of the claim the less people the less likely are people to go on the line um or play the game who wants to to to to to do this you don't have to if you don't want to you want to do it oh awesome anybody else ah cool cool that's two excellent anybody else did you want to do it oh cool excellent all right so come here I'll tell you what to do pretty pretty straightforward so usually you'd repeat the rules of the game but you don't need to repeat the rules of the game because every we've done it twice and you're medical students well I think they're out of height order see that look you're already doing doing your job okay how you'd order so put them in hide order all right think you have to come back in front Okay so make sure the Only Rule you have to repeat is you have to tell them to move at the same time because you don't want to bias the outcome all right all right and then so they're going to go to a while so in the ideal World they'll go to different lines if not what can you do um ask them why they believe it probe the beliefs a little bit so say maybe like a con for example like what it doesn't matter where they go lie what about this what about this if they wind up on different lines make sure that the people on one end speak directly to the people on the other end if they wind up on different lines um ask them what it would take to change their mind and then go to the other person and say can you give them that can you give them that piece of evidence if they wind up on the same side like like we get a lot of people agreeing ask them what it would take what piece of evidence or data would cause them to move to the strongly agree what piece of evidence or data would move them to the slightly disagree there's two other things you can do if you want you can say I'm going to give you a last word what would you like to say now your job when you do this is to make is to be as neutral as possible so they should not know what you believe so I didn't do this because we ran out of time but I usually ask people what line do you think I'd be on and then I walk to the line you know that you will be successful if people choose the wrong line got it okay so you're new completely neutral so no matter where anybody is you have to ask the hard questions okay hello hello all right so everyone move on the count of three one two three repeat the claim oh and the claim of course was minors should be allowed to receive gender affirming care without parental notification so start over here Elizabeth so can you tell me about why I hold this belief sure so I think individual autonomy is crucial and I think there are other examples of it that I can bring up not necessarily in this but for example with contraception it is prescribed to minors regardless of Parental awareness and that's generally done just to preserve their safety and things like that um the reason why I didn't agree more is that I think it could potentially be very dangerous if the parents aren't aware of it it can also be dangerous you know in in another sense in that uh they wouldn't agree with it if they did know so it's very complicated but it can be dangerous to the health of the child or the minor can you elaborate more on the danger to the minor right so it's just um I'm not you know too well versed in this subject specifically but just if they're receiving these treatments which can be pretty aggressive you know hormonal treatments and things like that if the parents aren't aware of that aren't aware of the side effects aren't aware of the complications that could present a danger to the child okay thanks for sharing all right I'll move over to here to the agree side so start with you Catherine can you say why you agreed with this on the case when they say minors this kind of anyone under 18 so it's like how young um because there's always there's different forms of gender affirming care so pre-puberty you can do binding um if it's like female to male or other types um and gender affirming care can even just be something as easy as like using the right pronouns If the parents are out of the room if they're more comfortable with like they them pronouns um so I think when it comes to just like actually affirming care in terms of just talking and stuff easily strongly agree some of the medications can have interactions some of them could have more dangers I know transitioning on T can be something that causes some side effects and could interact with other medications so I think it might be important for parents to know in case like they break their leg and it's like what kind of treatment they get in the ER might differ so I think that might be one case where it could be a little risky also in cases where parents um don't like would not be supportive of their kids and there are a lot of cases where kids have become homeless because parents reject their gender identity um I actually worked with a lot of lgbtq plus youth two of them had been kicked out on the streets because of their gender and or sexual identity and so um and that was the parents were the danger in that case not just the medications so you mentioned stuff about different modes of care so you said using proper pronouns uh binding and then something about medications are you here on agree for care as a whole or for a specific mode of care like if you had the opportunity to only pick out a single mode of care using proper pronouns for a patient where would you stand I strongly agree it takes it's there's no medical harm if I say the pronoun that makes them comfortable um there's a lot of things I think Physicians should do in order to make their patients feel as welcomed and heard as a person and so saying they're proper pronouns is like kind of the least you could do okay so it's more of a just a general out of the entire Continuum of Care you're just taking the agree stance then yeah and when you factor in I think binding can be dangerous when it comes to developing trusts because it could actually lead to malformations so that one can be riskier because if you bind too tight there are sometimes issues with breathing okay hold on I'm going to help you out I'm going to throw so now you take the reasons now you take the reasons that she gave and in your mind do you think that the reason she gave justify the line that she's on honestly it um I kind of uh agree with the reasons that she's given because she's kind of on the fence again it's like the whole Continuum of Care things like she's very strongly for some and it seems like she's more slightly for others so like it's so it seems almost like she's trying to average out um so so do you think that the reason she offered is warrants her standing on the agree line because it seemed to me I usually I don't make this so transparent but I'm trying to teach you how to do this it seemed to me that the reasons that she gave she could if you can think you can nudge somebody try to nudge them any way you want ask her why the reason she gave does not put her on the strongly agree oh and remember if you need help you can just look at the board there so so that's one thing I do and then remember she's waiting to so get to her at some point there yeah so I will quickly ask you that question your reasons that you gave why are you not there with Elizabeth and why you're not over here um I mean in cases where the parents would be supportive I think it'd be good for them to know and I think it'll I and it also is the question of how young um so I think that is an important discussion I think at least in terms of medical licensure and like the current state of legality as is um I'm not sure you can give hormonal treatment to someone under 18 without parental permission um and so that that I think the the strongly agrees because like I would like to be affirming but I would also not like to lose my license and I think it's important to change it systemically instead of just trying to kind of go all vigilante medicine uh more systems okay moving back uh talk to Maggie Maggie why are you at uh agree um ultimately my like biggest push for agree was that um like your idea of your own personal gender is pretty much formed by the age of three so for the majority of minors who have an understanding that they are not the gender that they are they feel that they are presenting as that is something that is like a long time coming in the same way that I was born a female and identify as a cisgendered female like I've I've always identified with that so the idea that someone might identify with a different gender just at a young age is still viable in my understanding and then the only reason I'm here with agree rather than strongly agree is that again like with the vast majority of like gender affirming care being kind of a broad term and like ultimately the patient's safety I think is like foremost so I I think I could be pushed but I think in taking into account patient safety both understanding their parent situation but also understanding the risks and benefits of what gender affirming care means um you know that those play into that decision okay so don't go anywhere so the they both said something that I found entry and when you do this you can put your own spin but I'm just helping you the first time they both said I think you said two or three times it depends what you mean by a minor and how young so you can reset the claim anytime so let's reset the claim send everybody go back to neutral and then do the claim instead of minors because she's right technically a minor is someone under 18. um people uh individuals uh eight years old and under individuals eight and Below should be allowed to receive gender reforming care without parental notification so you can set I mean I just picked eight but there's a big that's a 10-year difference so I thought it'd be good so that's right yes all right with this uh New Age um I'd like you guys to go on the count of three so one two three all right so we've actually had a bit of a shift and I'll start with you Maggie all right I know I did say that Jen like your idea of gender is typically set by the age of three so like obviously an eight-year-old has the capacity to understand that their gender may or may not be equal to the gender that they were born with or the sex that they were born with however when taking Medical Care into this like obviously using the correct pronouns like that's something that's an easy change but taking into account actual medical care that eight and under is not a significant like your brain is not fully formed enough for you to make that decision on medical care for yourself so if it is I would like to present as a man or a woman that's fine but medical care I feel like needs to have a an adult helping you to or guiding you in those decisions so we talked about medical care but uh we also mentioned just affirmation and other like words and just acknowledging so where would you stand on maybe using like uh pronouns that an eight-year-old would prefer if they're presenting as male but they prefer to use female pronouns oh with pronouns I'd be and strongly agree you know if that's what they have you know if that would help me to improve my Therapeutic Alliance with the patient absolutely okay so is it an issue with like the ascent and the age like eight years old you just don't believe the ascent is at that capacity yeah have you seen a second grader recently that was a good Fair that's pretty fair yeah it's more it's more like medical treatment I don't think that they have the capacity to understand the risks and benefits Associated and therefore can't make those decisions for themselves all right so we'll move over here Elizabeth you didn't move at all I did it I'm not I'm not sure if that was the right decision I just I think the statement could be amended because like we were saying before gender reforming care is such a spectrum and it's just completely different whether you're giving like hormones to an eight-year-old versus you're calling them by a certain pronoun that they would prefer so yeah that's that's kind of why I didn't change my standpoint it would depend so real quick so she said something good not that anybody else didn't she said there's a big there's a huge Spectrum breast binding hormones Etc so this you're the boss so if you want to take what she said and run with it you can do it I mean you can do anything you want you could say uh individuals uh eight and Below should be allowed to receive um you know hormones or whatever like so you can reset at any time but before you reset it every time make sure you give everybody an opportunity to speak to this one issue so if someone says something in the process that you're like oh wow I didn't think of that it's pretty cool just reset them and start again okay hmm so you were talking about like the whole spectrum of care and just being like yeah I just mean in terms of the uh posing the question you know you could potentially after we all speak we could change the question to something more specific you know hormones or um just you know pronoun affirming care that's fair and you also move Catherine just one shift though yeah I mean I think the standard practices you don't start giving hormone therapy until approximately puberty or right beforehand eight is not that age and so I feel like gender affirming care would be pretty simple at that point because it is just kind of um pronouns and probably presentation and at that point like that's it it will be the hard part is like if you're in a pediatric facility the parents will be in the room if they are eight years old um I don't think there's really going to be a circumstance where you're not going to have the parents in the room at that age I was thinking more just the practicality like you're not gonna start having um puberty related changes until on average after 10 and that's sometimes when the conversation about hormone replacement therapy starts but at eight like you know it's kind of young at that point you just like wear whatever clothes you're comfortable with wear whatever use whatever pronouns you're comfortable with um and so in that case I don't even know how you would get away with no parental notification because they're probably always in the room that's fair yeah so right around like I forgot one it was like 14 is when you start like seeing if the patient wants to talk without the parent being in the room and the parent can say yes or no so if we had change the age to 14 so could we change the question to me being um um more of that if a teenager requests um do you need to notify the parent if the teenager requests to gender affirming Care at 14. or actually that question was appropriate I just I didn't read it fully my bad everyone back to neutral and then I'm sure everyone's getting a little tired of standing and my ranting all right so with this question um three two one go all right so wait wait do we do a reset reset okay I think you have to read it aloud okay teenagers 14 to 17 years old should be allowed to receive hormonal and surgical gender affirming care without parental notification three two one go okay so start with you Catherine uh it was an and statement and I don't agree with both uh surgical is too early for that age and also surgery without print notification I think is a very different um one of the big things we do as Physicians is like you balance net benefit to the patients with net harm and at that age the net harm could outweigh the net benefits um and I think at that point the parents need to be involved in the discussion because surgery is something that is very risky there's a lot of post-op procedures there's also actually a lot of pain risk so pain management post surgery you'll need to diagnose opioids and there actually is like more opioid use disorder in people who undergo Trend or just like trans affirming surgeries just because you need to prescribe pain management and I don't think kids should be taking those kinds of medications without parents who can be like checking in so parsing this question apart so what part was more hesitation for you the receiving hormonal or the surgical gender and where would you stand for either one just like split I think secret surgery would probably under the disagree pile hormonal I would go for slightly or neutral I think I would want to actually it depends on what I know but I'd probably want them to like see a psychiatrist and like actually go through the proper channels first I I don't want to be the one deciding if they can give consent at that age especially 14 you'd really want to make sure they actually know what they're committing to whether they understand the full rep like what could happen with hormonal therapy okay thanks for sharing that and then I'll move over here so you guys still in the slightly neutral or slightly agree let me move on this side can you tell me a bit more about that sure so actually I agree with a lot of what Catherine said it's a great point that surgery is risky um I think it's also important to note just the higher risk of suicide and mood disorders and things like that and the trans community and it's also among teenagers specifically so I think that's kind of what led me to go with slightly agree of course I do agree that it should be through the proper channel so no like unconsulted surgery would of course you know um again a psychiatrist involved get uh like a social worker potentially involved but the previous things I said also stand in that it is more difficult for parents to potentially care for their children if they're not aware that they're having these procedures okay I something that both of you guys have mentioned is the parental notification and what Desiring for it to go through the proper channels like one does not providing parental notification go through the proper channels because both of you have said we want to do things properly but this question is explicitly saying without parental notification when is that appropriate I'll start with you Elizabeth okay so in terms of properly providing you know the necessary support is just kind of looking out for any Factor so like I said the psychiatrists something like that would be beneficial because you're addressing all the different points all the different impacts and the social worker you know how this would affect your family Dynamic you don't necessarily have to get the parent involved in order for the child to have a certain position and a certain opinion on you know what's going on what's the Fallout going to be from this procedure okay and I may have zoned out regarding the question could you repeat the question so we're talking a lot about um the proper channels and making sure everything is done by the book but part of the question is providing this care without parental notification which might not go through the proper channels so can you give an example where you wouldn't provide you would provide these this care without the parent certification like how could you do that but still in a proper way I mean I think you could give hormonal treatment um it's the same thing where like I think certain miners are allowed to have certain medical procedures done without telling their parents um there is kind of that confidentiality surgery I think is a whole different ballgame yeah okay and I'll move back to Maggie and probably wrap things up yeah I think ultimately we're all here on like the risk benefit ratio is what we're really looking at so I agree with Kat that you know surgery without parental notification is pretty extreme especially if in this situation they are still living within the parents home so again it's really looking at safety okay so is the safety to the patient more at risk from having a secret surgery or is it more at risk from their gender dysphoria and the associated like risks of depression and suicide so in the case of surgery it's there's a potential that they are at a greater imminent risk for like from having the surgery than they are from like their dysphoria and therefore like when you weigh those against each other you know you fall on a different part of the spectrum so like I was here more because of the hormonal affirming care because the risk benefit ratio is different there okay okay so now you got everybody's I assume you you understand everything right and if you ever don't understand just ask somebody to always put the burden of understanding on yourself say I'm not I'm not clear I want to make sure I get this right and so then I'll repeat it and then you repeat it back to them so they make sure so you did a great job so you have a good idea of what where everybody everybody's beliefs and you have a good idea of why they're standing on the line they're standing on right and if you ever thought that the reasons that they gave were you know more neutral or more this way you'd ask them why aren't you know why you want slightly agree rather than agree and that the the final question and you can front load this if you want um is what would it take to change your mind what would it take for you to move one line to the left or one line to the right and again remember like when you ask someone um you we reset the question three times now and we've reset the question based upon things that people have said so we can keep honing honing the question down so the final you have three final questions you can keep all these things in your mind like I'm Amazed by servers when you go restaurant you do the whole table and they remember all the stuff um is what would it take for you to move one line to the left one line to the right um is there anything I should have asked but I didn't ask and what line do you think I would be on you got those yeah all right so I'll start with you Maggie you're here what's going to move you there and what's going to move you over here um I would move closer to agree if we're specifically physically disagree if we were talking about surgical treatment exclusively that's fair so we've kind of you've talked pretty uh at length on like why they each are pretty different so I think that's pretty understandable position and then move over to you Elizabeth took the words right out of my mouth I think this conversation and specifically focusing on the and aspect and you know surgical definitely moving closer to neutral or even slightly disagree so I guess uh with both of you if these surgeries Were Somehow 100 success pain was not going to be a long-term issue these patients were not going to have any issues with long-term complications would that assuage you from moving back down or would you move up here like if you knew these surgeries we're going to be 100 success right no long-term complications I I would be less likely to move towards disagree I still don't know if I would go to agree just because of the risks associated with anesthesia but um I'd be I'd maybe I'd maybe fall into the neutral category at that point so if there were no risks I guess if there are no risks risk and your risk benefit ratio your benefits medical risks right right okay right yeah I mean I wish we had 100 perfect surgeries for everything um yeah I probably moved to agree that's fair um talking to you Catherine you were here at neutral what would move you to slightly agree and slightly disagree I'd want to know the parental situation like if they're just not like it if it's if the parents are and not going to support them afterwards I'd be nervous to have them go through with hormonal treatment and surgery if it means like they might lose their support system like one of the major things you have to consider with patients is like who are they coming home to like will they be safe when they get home um and I would never want to do anything that could put a patient in danger and if they're in a dangerous household that is just like would not support them afterwards then I think that's still like even if there's no medical risk like the parents could be a problem so medical risks are the same there's no risk of the parents disowning their children where do you move I mean in that case then like I'd probably just counsel the patient like let's just involve your parents um okay good point yeah good point so I I think um I'd probably it depends that point I I'd probably just say like if you're 17 I'd be like wait till you're 18 and then um and then there's also the cost consideration because we don't live in a perfect Society where like these things are actually covered by Medicare and if they ever want to go into the military these surgeries are not provided and actually are explicitly not covered by the military insurance plans um so there's reality is complicated uh saying yes is I you you deal with the patient as the complex person that they are okay I forgot the second question whether you would where we think you are oh that's a third one oh that's what we're running late just just ask them because we only have four more minutes ask them where they think you are where do you guys think I am probably agree on the first one yeah I was ought to agree on the first one what about first question not this one where am I on this one see already it's a success because they had to think about it right I guess um I would be somewhere between these two for the for the second question there's a lot of things to keep in mind for this yeah you did a great job seriously you did a great job just yeah thank them so one of the things that you did I just want to say well I have you up here one of the things you did is you identified the reasons that they gave and the theme emerged that the surgery was there were potential complications so okay so when you do things like this when you ask people about why they believe things often the reason that they give is not the actual reason that they disagree so if you remove the reason you just ask them if they still disagree and that's why that question was so potent because you said to them okay so let's remove the reason let's remove the idea that surgery and risky you know I like I like to say we can wave a magic wand but in a medical context it's probably not a good idea but you know you have some kind of uh 20 years or 50 years AI or whatever and you take out the risk then where would you move if nobody moves that means that the reason that they gave was not the reason that they really why they hold the belief but if everybody moved as a consequence of that then you know that at least to some degree that's the reason so part of the thing when you if you ever do this with kids or whatever you need to figure out if the reasons they give or are the reasons that they actually believe the class and that question was excellent so you did a great job and no one knew where you stood right you see how they pause and say that's that's what you want every time so great thanks great great okay uh we have uh two minutes one minute left I'm gonna open up anybody have any general questions yeah hi uh uh where did I stand on on which one oh I don't know I'd have to know what the questions were but I don't remember I'd I'd stand on a disagree yeah what was the other one abortion should be allowed legal yeah uh I think my own belief is abortion should be allowed up to the first trimester no questions asked and then there has to be something endangering the mother's life or some some something like that but not just willy-nilly and uh well they were through three or were there four that what was the first one yeah I'm opposed to gender reforming care for people under 18 with or without parental consent uh above 18 you can do anything you want but I think that the and I could give you my reason for that but that's where I I would have stood on the strong I disagree to that and it's so that's also really important for why you need ideological diversity because if you don't you just fall down an echo chamber where everybody believes the same thing so it's a way to it's a kind of hypothesis testing or to test your beliefs you know you walk in here and you see the equity and you see all this stuff but um and then the uh oh he's gone now you know um I thought it was really interesting how he used the word uh equity and equality as a synonym they're just not synonyms but I thought that was really interesting but one of the reasons that you need ideological diversity this would have been really interesting if you had people standing on the strongly disagree line and then you listen to their reasons and then we calibrated the beliefs according to what those reasons are Cass sunstein and others have done some really interesting work in um you know what promotes a kind of radicalism when you get these Echo Chambers oh here he is hi uh we just talked about you oh I just talked about this um uh so so the idea would be you you can and um the idea of of this is not to have a uniformity of agreement where everyone stands in the same line one of the ideas besides calibrating the confidence in your belief to the evidence and the reason you have for the belief is that these kind of communicative interactions that you have with people they shouldn't be uh to force consensus they should be to mutually understand the other person so if you can understand but not agree with the reasons that people have you're much less likely to demonize them you're much less likely to other them and you're also much more likely to put a check on your own beliefs right because if everybody in your peer group and you're a social group and your institution has certain governing values certain load Stars you're much more likely to buy into the acceptance of those values without kind of demanding that where where was the without demanding that one of those final questions the disconfirmations right what would it take you to change your mind and if you have someone who who um is not an ideological agreement with what you think you can ask them so you say okay so what would it take to change your mind on this it's very difficult to do that if everybody's on the strongly agree you say well what would it take you to change your mind they tell you what it would take and then you ask this person is that reasonable is the thing that they said that would for gender reforming careful is it is it reasonable and they say yes or no most of the time to say yes and you say can you provide that can you provide the evidence that they're looking for to move them to the agree line not to the you know slightly disagreed or just simply one line over and it's those kind of communities of knowledge seeking and communities of inquiry where you can calibrate your confidence to your belief accordingly as opposed to whatever the institutional milieu in which you happen to find yourself like that kind of intellectual diversity challenges and questions people as opposed to just running with which morally fashionable or whatever the Orthodox is does that answer your question cool cool hey did anything anyone say today move you yeah uh him you you you Sean oh that's I try not to use people's names because when the video goes out and such it's it's trying to see sometimes we believe them all but yeah I think I think uh some of the things that he said um some some of the things he said certainly gave me pause and uh you know one of the things I kind of made a note to myself and my notes uh was to go back and review the video and fact check what he said uh about Dermatology about the Skin Care Etc and what and when when I did that the question is is the evidence that he provided me with sufficient to to calibrate to recalibrate my beliefs I think it would be yes but um I don't want to make that decision capriciously I think really have to look at what the data is and and when I look at the data what I do is I look at the methods of a study do the methods you know what's the and Etc yeah hi yeah I can uh I know what studies uh Ariel was talking about too so I can I can like send you a link yeah that would be that'd be great because so the other thing is um I would like to do whatever I can to influence the culture and the culture is not what line you should be standing on which I know is not morally fashionable to say but the culture should be we need to promote a willingness to change one's mind and we need to make that a um we need to make that a virtue and right now it's almost the opposite of what we have now so I don't want to be wrong about a belief for and even an instant more as a as a philosophy one more moment than I have to be so if I can be provided with evidence to change my mind I would certainly do that well my wife's a physician she does uh addiction medicine she's an internist uh that's where I came up the Narcan question but um so yeah so when I come when I when I hear things like that I'd like to take them um and think about them and I think we have a providing a pervading culture right now in a set of a suite of assumptions that goes with that that there are right answers to moral questions there are right orthodoxies there are right answers to the questions of equity I don't believe that's true I believe that we work these things out in discourse with people who disagree with us so we can kind of keep a reality check on the things we believe anybody else have any questions thoughts yeah hi you find when you do this with people of different ages like do people like that are older tend to change less versus younger people looking I'm looking at my team okay so the question is do people who are older uh are they more or less likely to change your mind I have a very disappointing answer for you but it's an honest answer so I'm going to give it anyway the number one factor that will determine whether or not someone will do this and I'm going to Australia we just got back from Puerto Rico I did Hungary and Romania you can see those videos on my YouTube channel the number one factor that will determine whether or not someone will engage this is their age so uh younger people they'll literally drive on their bikes and get off their bikes to play then the younger the problem is that legally I can't do this to someone who's under 18. so I have to have their so I have to say no to and then there's like a I think we got hordes of people young people want to play old people there's literally nothing I can do um so I don't the the answer to your question is I don't know because they won't do this I think I think a lot of it is that they're camera shy I think anybody else yeah hi um did we land where you expected before you met us yes yeah I did and and I specifically don't um research or do anything beforehand uh but I could tell when I walked in the building uh I I had a strong feeling where people would land the only thing that surprised me in terms of where you landed was when I when we changed the age to eight I think that was surprising to me I was surprised that more that more people didn't go to the to the disagree but yeah in in general I think the answer is yeah and and I think that the um I think that the reasons people gave were quite good I think that they were thoughtful I think that they were well evidenced but again and I offer this with total sincerity to you with complete sincerity you can never really be sure that those reasons are sufficient to justify your confidence unless you have someone trying to poke holes at them right you you as as Feynman said the easiest person to fool is yourself and if you have if you're in your epistemic landscape if you're only drawing from data that supports your conclusion you have to have ideological diversity you have to have someone say well wait a second what about this or what about this study or and again if your professors won't even show you what those studies are uh because their fear that they'll be brought up by the diversity office or whatever the the Injustice that's committed it's an epistemic injustice against you because then you've artificially inflated the confidence and a belief beyond the warrant of the evidence you have because you haven't had an opportunity to look at other domains of thought like other contradictory pieces of evidence or thinkers or Scholars Etc so again I think that's a really unfortunate position in which we find ourselves institutions but that's also why when you do this it's just vital to maintain your neutrality the moment someone has even the slightest hint of where you are you've compromised the Integrity of the exercise yeah hi and this is less than a question I guess the moral comment like I feel that we do at this school definitely have individuals that would land on different like areas of the spectrum but I think that not the culture necessarily at this school but just the culture and our age range in general at this point especially on social media is so much that we're not willing to hear people with ideological differences and therefore those people are scared like I made the joke earlier like oh am I going to be canceled for participating okay so there's that that fear of if I participate and share my opinion on this 100 that I will have some social retribution 100 thank you so much for saying that um and that's why if you value truth in your life and you want to believe true things you have several choices in your young life I have many years on everybody in here uh you have to make certain choices in your life right and so if you really want to not only have true beliefs but if you want to be a good physician and you want to make sure that you're doing right by your patients it really isn't a few things are incumbent upon you the first thing that's incumbent upon you is you you have to be willing to the Greeks call it parodyesia to speak truth in the face of danger the problem with a lot of these exercises is just exactly what you said we've created a conditions of fear in our institution such that even if some people wanted to stand on the strongly disagree they wouldn't for fear of Retribution for fear of cancellation Etc and as long as you have that you have a hindrance or a barrier to any mechanism or process that would allow people to increase the number of true beliefs they have and decrease the number of false beliefs so you know cutting through that Culture of Fear is a big thing and you know some some of it it's like the pronouns in the bio some of it's a kind of signaling right some of it is not it's not a signaling so it's a it's an enormous problem when an institution has a you know like in my own personal experience you know I've I've I'm not going to say I'm a victim or anything but but I have been suffering to many diversity uh uh tribunals for asking for evidence you know like what is the evidence for something not even for abstaining stating an opinion just for asking what the evidence is for something and I've been accused of microaggressors Etc but the idea is when you create a Culture of Fear to the extent that the culture of fear comes to dominate the institution that is the direct degree to which the truth is the North Star of that institution is compromised so in an ideal world everybody would able be that's what I'm going to talk about in my my talk ones that I think it's tomorrow it's tomorrow right this is one of the things I'm going to talk about on my talk it should not matter in terms of your friendship where someone stands in this line now I don't mean to say to you that there aren't deal breakers right you know of course there are deal breakers for you and whatever your relationship is but these are mere political archaeological disagreements that doesn't mean you're a bad person I mean it could just mean that someone's mistaken and you could be the one who's mistaken and to the extent that you one hasn't been one hasn't actively sought out disconfirming pieces of data to the extent that that's the case it's more likely that it's you because the con the confidence that you will place in those beliefs is not warranted on the basis of the evidence so even if someone does have a difference of opinion I would argue that's not a reason not to talk to them it's not a reason to cancel them it's not a reason to ostracize them if anything it's a more of a reason to civilly ask well why do you believe that because if they know something you don't know why wouldn't you want to know it I mean I don't want to know it yeah saying Maggie Maggie personally I've been through some instances of cancellations I am an ex-muslim meaning I left a religion for personal differences and speaking out on my disagreements with the religion has caused me to lose friends I've had a lot of things said about me but the moral of the story is I think it's just important to be able to speak freely about what you think if we can't freely play with words and ideas then we cannot progress as a society and that's why I brought Peter to our school to have this type of event and that's why a couple of our classmates are trying to start a bioethics club so that we can create an atmosphere which I think our school already has we do a great job of being able to speak freely here but overall I think this is this is crucial in in having a healthy culture that's just able to have disagreements thanks I appreciate that I want to say I want to say just a couple more things in closing What a Sad tragic State of Affairs that this is considered a controversy that what we did today is considered a controversy tells you that there's something sick about the culture it tells you that we are not well yeah I do think a lot of the context is very different for future health care providers because I think if you ask kind of like just like went to Disney and asked to like people at Disney Springs it's different but I think everyone in this room we're going to be deciding certain things that will change a person's health and I never want to be the limitating factor right I want it to be the science or like I want to get a patient to where they want to be and I never want to be the bias the the wall that says no I want it to be something else and so I think a lot of times when I'm very permissive it's not because I like the thing but it's because I never want to decide for someone else economy yeah and so I think uh I think part of the the difference in conversation is more how we speak in the medical profession and not just as like me as a person and so I think a lot of the views were like as future Physicians yeah and I think that's I think that's a good distinction um there is something I find I do find like you know I'm 56 and when I grew up my parents had friends of all different political beliefs and some who were didn't believe anything politically and I remember those spirited discussions um it's an interesting book The Big sort about how people are now dividing and it's worse online because people divide into communities of belief but uh if if you don't have just on that if you don't have any friends who disagree with you if like all your friends agree with you on everything man you need to get another friend set like you really need to pull you need to you need to consider broadening your friend base now that doesn't mean you go out and find a Ku Klux Klan member but it does mean that you you should use those disagreements to Foster healthy conversation and and and understanding all right cool so I hope everybody got something from this I hope you can use it um as you saw it's very easy this is not a particularly complicated thing to do uh the the only thing that you really need to do is to have a kind of Integrity when you do this and really listen to Somebody repeat back to them what and if repeat back to them and then see if they're Justified their confidence is Justified so thanks everybody I appreciate it [Applause] [Music]

Channel: AHA Foundation

Views: 906

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Id: dduV_ocBvHM

Length: 98min 47sec (5927 seconds)

Published: Fri Mar 31 2023