This transcript has been edited for clarity.
Eric J. Topol, MD: Hello. This is Eric Topol for Medscape's Medicine and the Machine. We have an exciting podcast today with Dr Randy Olson. Randy was a marine biologist, with his PhD from Harvard, who then, almost 25 years ago, received a master of fine arts in cinematics and film at perhaps the best film school in the United States, University of Southern California (USC). Since then, he has become one of the great communicators in this country. We're going to be talking with him about the pandemic and science and medical communication. Welcome, Randy.
Randy Olson, PhD, MFA: Thanks, Eric. Great to be here.
Topol: I'm ashamed to say that I didn't know about you until just recently when you gave a lecture at Scripps on science communication. It was extraordinary because you took some of our postdocs' statements about what they do for their projects and you rewrote them, so they became a lot more exciting and interesting. I realized then that you are a master of science communication. Previously, I interacted a fair amount with Alan Alda in his efforts. What's different about your ABT template and what you know about the Alda communication effort?
Olson: Those guys are great; he's given a real gift to the world of science just by bringing his brand name to the improv training for science. That's a very important tool in communications. For 25 years I worked with the Groundlings improv comedy theater in Hollywood. As soon as I got out of film school, I connected with them and knew they were a major resource. In fact, I've cast about 25 of their actors in different short films, always searching for one who had a deeper, almost intellectual side, who was interested in what I was doing. I finally found that in Brian Palermo, who's one of their veterans. He's an actor and was part of Jay Leno's show and lots of other shows. I cast him in a film, and he came up and said, "Any chance we could go to lunch someday and you could tell me about this marine biology stuff that you did? I'm really interested in that." So I recruited him and he started working with me and doing the improv side of the communications training.
In 2013, along with a narrative instructor, Dorie Barton, we coauthored a book called Connection: Hollywood Storytelling Meets Critical Thinking . I've been working with Brian now for 12 years. He's part of my ABT framework program. He's one of the 15-20 people who help run these courses; we're in the 24th round of it. And that is what makes what I'm doing different: I have a model for narrative structure and narrative is at the core of how we communicate — not just in recent years, but going back thousands of years.
I came to Hollywood 27 years ago with this belief that Hollywood knows better than anywhere else how to communicate to the masses. I was searching for the one thing I could find at the core of it all, and I found it: the ABT template. And it turns out it's nothing that Hollywood came up with. It goes back to 300 or 400 years ago to the philosophers Kant and Hegel. It was called the Triad back then, and it's at the core of how we communicate. It's been obfuscated and obscured over the ages, and in the last century in particular. As we've generated so much information in our society, we've lost these simple core principles. That's a lot of what I'm preaching — it's time for us to get back to this element of simplicity at the core of communication.
There's a book that's come out recently titled Stolen Focus: Why You Can't Pay Attention, by Johann Hari; 10 years ago, there was The Shallows by Nicholas Carr, and books before that about what's been going on throughout my lifetime and yours, which has been the glutting of information and the consequence in terms of reduced attention span and focus. That's the real ailment we have now. ABT is at least a part of the solution.
Topol: Our medical audience, the Medscape biomedical healthcare professionals, need to know what "ABT" stands for. Maybe you could give a quick review on that.
Olson: The starting point is to understand that there are two ways to communicate: non-narrative and narrative. Non-narrative is simply spewing out information that is not built around any problem-solution. That's the default way to communicate. That's how most everybody starts their communication. With more effort, you can work that material into narrative communication, and that's where you build it around a problem-solution dynamic. At that point, there are three parts to it: the setup, the problem, and the actions or solutions that are being taken. That's what the ABT is; the three words — And, But, and Therefore — are just the most common words for putting that into action in our language. They embody the three forces of narrative, which are agreement, contradiction, and consequence. This is how we — everybody everywhere — communicate all day long. And this becomes the very simple template of ABT, easy to remember and put to use, and it applies to everything.
For example, in your laboratory you may have been studying a gene for 50 years, and you've learned this, this, and this, but the one aspect of that gene that nobody's ever really been able to figure out is this thing; therefore, you're now doing the following projects. Every single project falls into that template of ABT. That's what we do in the training now.
Topol: We know that storytelling is important, but what you're providing is a template to tell the story. That's so vital. Now let's shift to the pandemic. This has been a historic botch job in communication by the CDC and other public health agencies. Could you give us a critique of the poor communication and storytelling along the way?
Olson: You've already given me the gift of a head start on that in the podcast you did in mid-December. Anybody listening to this episode, I wish you could stop right now and go back and listen to that one before we go any further. It was your discussion with Andy Slavitt about the pandemic. Of all the things I've listened to in the past 2 years about the pandemic, that may be the very best discussion I've heard, with you, Abraham [Verghese], and Andy Slavitt.
First off, the tone was perfect. You were so somber and he was so honest. What a great guy. He didn't put up some facade about "we're really proud of the job we did." No, he was honest. He just said, we know we've blown it and close to a million people have now died and we've got to figure out some way to assess what's gone on here.
You and I are both buddies with Mike Osterholm, the head of the University of Minnesota's Center for Infectious Diseases. I got to know him in October 2020. He was on Meet the Press, and he's the only guy I've heard talk about this part of the problem, which is that we've done a poor job with communication. Of course, everybody pounced on CDC. But on that appearance on Meet the Press, he said we're failing to communicate with a single voice, which has been the problem all along, with all of these people contradicting each other. He also said we're failing to tap into the power of storytelling. I immediately made a beeline to him through my contacts at CDC and asked them to please contact him.
He ended up getting on the phone with me a couple of days later, which may turn out to be his worst nightmare. We became buddies and began tons and tons of phone calls and discussions. Sometimes we locked horns. He's still the very best. He's my hero in the whole pandemic, the one guy who pointed to the communication problem when nobody else was pointing to it. To cut back to the discussion you had with Andy Slavitt, the best thing you guys did in that whole great discussion was you ended by saying, what's the bottom line here? And he owned up to it. He said there are two things. First, there is the science side of what went on, and I give us an A or an A-minus. I completely agree with that. The scientists did heroic work, as we know. Michael Lewis was on 60 Minutes last year with his book The Premonition. And he hit the same note. He told seven heroic stories in that book. But he said it's not a time to celebrate. Despite all this hard work, we failed the public. And yet, the science definitely does deserve an A or A-minus.
But then Slavitt went on to the other element, which was — you guys referred to it as social science. I'd broaden it out and say the social dynamic. And you guys agreed on the grade of a D-minus to an F. And there you go. Why do you think it deserves a D-minus or an F?
Topol: This is important because there are so many factors here that contribute to failed communication. I don't know if I want to call it a strategy. It was just poorly coordinated. The one you touched on, Randy, was the infighting; so there were different narratives from the White House saying, we're going to give boosters to everyone, and then the CDC and the FDA went against it. They each were fighting about the White House response team and the NIH, and they were on one side and the CDC and FDA were on another. Then every few days, the booster plan changed; it went from, we're going to have everyone get a booster to, well, maybe not everybody, but maybe in 8 months and maybe even 5 months now, maybe 6 months. It was mass confusion and we never recovered from that. Around 20% have had boosters, where there are other countries that are at 65%. We know that's important both for Delta, Omicron, and the waning of immunity.
That's just one part of the contradictions and the confusion. The communication isn't clear. I'll give you another example. Recently, the CDC has been putting on their website, finally, after much prodding, the vaccine's effects on death and hospitalization by different age groups. Okay? With a booster, without a booster, no vaccination, two vaccination shots. And they communicate this in very strange ways.
Olson: That's not a good thing.
Topol: I wrote on Twitter: 99% reduction of death with vaccination and a booster; 96% reduction in death, hospitalization with a booster across all age groups. Simple. Anybody can get that. But CDC has 62 x this and that.
Olson: Let me jump in at this point. I have a few simple quotes here to share, and this is a fundamental one. In the ABT course we produced a book. I wrote the first book, called The Narrative Gym . There are 15-20 people who help me run this course and are from a number of other disciplines, because the ABT template applies everywhere, across all disciplines. There is a fellow from the business world, Park Howell, the longtime host of a podcast called The Business of Story. He came across the ABT 8 years ago and flipped over it, and is now using it day in, day out. So he looked at my Narrative Gym book and said, nice book — but unless it has "business" on the cover, my business people aren't going to buy it.
So we did a rewrite of the first and last chapters and made the Narrative Gym for Business. The same thing happened with the lawyer, Doug Passon, who works with us. He's a great lawyer and co-authored the law version of this with me. And then Dave Gold, veteran Democratic Party political strategist, did the same thing and co-authored the politics version with me. We start that book with this quote from Barack Obama, who is my favorite president in recent memory. At the beginning of his second term, he was asked this simple question: What would you say was the biggest shortcoming of your first term? And here's what he answered: The mistake of my first couple of years was thinking that this job was just about getting the policy right, and that's important. But the nature of this office is also to tell a story to the American people.
So if we take a look and dissect this out, what he's saying matches completely with your grades of an A for the science and an F for the implementation. In the beginning, he says, I thought this job was just about getting the policy right. That's the information side. That's what the science folks did, and they got the information right. They nailed it on the vaccines. He goes on to say, but the nature of this office is also to tell a story to the American people. That's where the whole COVID project fell apart. There wasn't that effort. There wasn't an understanding of how equally important it is that once you get the knowledge of the vaccine, to figure out how you're going to get the public to actually do this.
It became a big shock when they started to roll it out and found out that a third of the public said, we're not taking your vaccine. Poor Mike Osterholm had to put up with all these horrible phone calls from me, where I just kept calling him up and saying, what's going on? Because he was on that advisory council from the beginning, the 13 and eventually 16 mostly epidemiologists they assembled, who were superstars, and they did their job. But I kept asking him, when are they putting together the equal and opposite counsel for the communication side? And the answer was "never." They never did. And there's where it fell down. There's your F. There was not a concerted effort on that. Furthermore, I kept saying to him, I hope that when they do finally put together those 13-16 communication experts, that none of them have PhDs, that they all come from either Hollywood or from the advertising and marketing world where they have the intuition, the gut-level stuff to connect with the masses.
You may recall in that talk I gave to your group at Scripps that I talked about the two presidents who were the most impactful in my lifetime. The first, John Kennedy, represented the best and the brightest, that whole image of let's put all the greatest minds in our society together to lead our society. And I thought that was how government was supposed to work until the year this country elected the co-star of Bedtime for Bonzo, a B-grade actor named Ronald Reagan. I despised him through all those years. But as the years went on, he developed the nickname of the Great Communicator. What I came to realize was that he understood the power and importance of communication.
One of my friends from high school worked in the Reagan administration, and she said, yes, it was true — he knocked off work at 5 o'clock and he laughed at academics and called them eggheads. But every so often in the White House, you'd see a transcript of one of his speeches sitting there, and it would be covered with his handwritten comments. It showed you that he took that part of his job very seriously. He was a trained actor. He knew how important acting is. It is communication, one and the same, and he put all his effort into that, became the Great Communicator, and had an enormous impact on this country. Whether you like it or not, he changed our society. He understood that need and, you know, he didn't have a PhD. There's got to be a partnership between the PhDs and the people who understand the communication. They are different groups and they've got to work together. But that did not happen at all in the pandemic.
Topol: In your lecture, you cited Michael Crichton, another physician who was a great communicator, and like you, a filmmaker. I hadn't remembered that he had written a New England Journal of Medicine article about communicating in medicine. The themes here are very similar, whether it's public health agencies or community science, progress in medicine, and how to deal with people who aren't going to get a vaccine no matter what, and trying to mitigate that concern. But then there are people like Joe Rogan who has become established as a great podcaster, like number one in the world, a $200 million man. Our friend Mike Osterholm was on his podcast just last week. He was brought in to try to get things straight after all the pressure of having people like vaccine skeptics Robert Malone and Peter McCullough and others who were very much miscommunicating. I would even say it was discommunication. Did you listen to that two-and-a-half–hour podcast as I did? What can you say about that and how Mike and Joe interacted?
Olson: Mike is the bravest of communicators out there, but this stuff is warfare. When you go on anybody's show, you're going into their arena and it's almost impossible for you to control the narrative. That's what communication is about — controlling the narrative. And the ABT template gives you a whole analytical way to look at it. But once you go into their arena, they're in charge. During the first half hour of that discussion, Joe Rogan kept bringing up the Wuhan lab escape idea, and Mike kept saying, there's no evidence, no evidence. I wish he could have been more aggressive and just said, end of story. We're not going any further. But he didn't want to get into a spat. I respect that.
But this is where you need a spokesperson — where's the Jen Psaki for the NIH? Where's the trained spokesperson, the flack, to deal with that so that the scientists aren't having to do this? Why in the world is Anthony Fauci defending himself in public from these attacks by Robert Kennedy Jr. and Rand Paul? There ought to be spokespeople who have the training on how to control the narrative. There are people like that in Hollywood. I've worked with some of these publicists and they are animals; it is a vicious, aggressive arena. You must have the training to get in there because you've got to get the jump on it. You've got to control the narrative, you've got to get out ahead of stories, you've got to look out for narrative voids.
One of the rules that was mentioned in all of these Narrative Gym books is something I call Shirley's Law. Shirley Malcolm is my good buddy who's been the head of education at the American Association for the Advancement of Science (AAAS) for many, many years. She's awesome. She's a Black woman in her mid-70s, grew up in Birmingham, Alabama. She and I have been soul mates for the past 15 years. Early on she would say this to me: If you don't tell your own story, somebody else is going to tell it for you and you probably aren't going to like how they do it. That has gone on over and over again with the Democratic Party. It happened with Michael Dukakis with the Willie Horton commercial. It happened with John Kerry with the Swift Boat veterans, and it happened with Hillary Clinton, with Trump calling her Crooked Hillary over and over again. They failed to get out ahead and tell powerful stories on their own. They've let other people tell the stories.
As the Hollywood publicist would say, you're chasing the bus at that point. The bus is already out. They've got the narrative and once you're chasing the bus, you can't redirect it. You can't stop it. All you can do is try to come up with another narrative that might compete with it. But there's none of this discussion.
The single biggest message I had for the Biden administration and for Andy Slavitt and all of them is, you want to know where the golden chalice is? It's in chapter 2 of Robert McKee's 1997 book Story ; that is the gold standard for Hollywood storytelling.
Robert McKee is the big guru in Hollywood, and chapter 2 is his account of the eight fundamental principles of classical design of stories, and how they've been shaped for thousands of years. What's not going on in science communication is any understanding that you're dealing with communication dynamics that have been programed into the brains of the masses for thousands of years, going back to Gilgamesh and the first recorded stories. I don't hear any of that discussion going on with all these people in charge of communication. Until that happens, you're not going to get a handle on these things. It's lacking as a perspective.
Here's one tiny example of it. On Monday this week, Andy Slavitt had Rochelle Walensky, the director of CDC, on his podcast. Within about 3 or 4 minutes, they began talking about uncertainty. This comes up all the time, especially in the climate world. Well, if you read McKee's book, there in chapter 2, one of these eight characteristics of narrative is complete causality. The mass audiences want complete certainty. It's called the omniscient narrator in the world of literature. There's a whole body and tradition. When people read novels, they don't want to hear a narrator say, "I think this happened in Alaska. Or maybe it was Argentina. I don't really know where it happened." They disconnect at that point. They want complete confidence. That's the hole in the system that opens the door to all these conspiracy theories.
Have you ever heard anybody offer up a conspiracy theory with probabilities? No. It's what a con man does. The masses have this weakness toward confident voices because what they seek is complete confidence. The science world is not even aware of that as a constraint. But it all begins with understanding the landscape out there and that you've got to shape your communication dynamics around the way the masses think. You can't just yell, "Here's the facts!" It is an A vs an F. There's your marching orders, that F.
Topol: Besides being a filmmaker and a marine biologist, what you have done is understand the science of communication. A lot of the things you've just cited reflect that. What's amazing to me — whether it be the storytelling in ABT, whether it's getting ahead of the story, whether it's dealing with certainty and knowing what is going to resonate and not resonate, or lead to holes in stories that are going to be filled in by conspiracy theorists or whoever — I don't understand why the CDC, the FDA, and the White House response team have not called you in to help them.
Olson: Great question. First off, my first book, in 2009, was titled Don't Be Such a Scientist , which is a fairly aggressive title. And even before it came out, a lot of people on blogs said, this is so negative. But it came out and got solid reviews in Science and Nature. One of my biggest treats was in August of 2010, when a group of communications folks at the CDC invited me to come spend a lengthy day with them. It was the first of five visits I had with them, but that first day was monumental. The day began in the morning with me meeting with Tom Frieden, who was the director then. As I walked to his office, he was holding up my book and saying, "This is not the way to do it. This is too negative." It was supposed to be a 10-minute meeting but we spent half an hour locking horns.
From the outset, all the communications people at CDC had their doubts. I'll try to be polite about this. I had a conference call with them the week before and they said, you have the Harvard PhD, you are a postdoc, you have tenure and the big National Science Foundation (NSF) grant. Maybe they'll listen to you because they will not listen to anything we try to tell them on how this communication stuff is so important. That first day, they set me up for three meetings, each with 20-30 scientists in the room. One of these turned into pretty much of a shouting match. As I was telling them, you have to work with these communications people because if you don't, this growing anti-science movement will keep growing.
I made two movies about the attacks on evolution science and climate science. I saw it all amassing. There was an article in The New Yorker in May of 2005 called "Devolution," about this $5 million budget of the Discovery Institute, to fund efforts to try to get intelligent design — repackaging creationism — into science classrooms. Back when I was in graduate school doing my biology PhD, creationism was a laughable, marginal movement, but now it's moved on. In fact, a month ago, The Washington Post had an article about that big rally of the anti-vaccination folks. And in that article, they said, "Almost 2 years into the coronavirus pandemic, the movement to challenge vaccine safety and reject vaccine mandates has never been stronger. An ideology whose most notable adherents were once religious fundamentalists and minor celebrities is now firmly entrenched among tens of millions of Americans." The mobs are not just at the gate; they're pouring into the science establishment. They're rooting the palace. And when will the science world understand that it is under assault?
As you know, in 2010, the CDC was in its golden years in the Obama administration and that day, I remember so clearly, twice during that day, people said to me, every year a survey comes out about the most trusted institutions in the government. We're always number two because number one is Fort Knox, and we figure that's because it's got all the gold. But after Fort Knox, we're the most trusted institution. It's so sad to think back on that now because12 years later, it's just a shambles with the things that unfolded. It's too bad because there needs to be that single voice.
Going back to Michael Crichton, the science world is so literal-minded that they view anybody who leaves the ivory tower as irrelevant. So that's your answer to why I have not been brought into these things. It's an endless battle. I thought that by going the whole distance and getting tenure and the big NSF grant, that would show everybody. But no, as soon as you leave the ivory tower, you're just labeled; they say, oh, that person washed out for one reason or another. It was the same thing with Michael Crichton. He graduated from the Harvard Medical School, he was a postdoc at the Salk Institute, and then got pulled away to make hundreds of millions of dollars in Hollywood. For 25 years, he offered his knowledge. One of his last major gestures was a keynote address at the 1999 AAAS meeting, and that speech is still online. It's a blueprint for how to deal with the anti-science movement from 1999, and it is as current and relevant today as it was back then.
Here are a couple of short excerpts from it. One of the things he said was, "The information society will be dominated by groups of people who are most skilled at manipulating the media for their own ends." That was foretelling what happened with Trump and the idea of manipulating the media. And then he talked about the way to deal with these attacks on the credibility of the science world is to develop these single, authoritative voices for each discipline. And he said, "Over time, build a news bureau of experts and turn it into a kind of Good Housekeeping Seal." That's something from our generation that today's youth don't even know about. When we were growing up, the Good Housekeeping Seal of Approval was the singular voice of validation. That's what's been needed. But there was no plan.
When the pandemic broke out, there should have been a contingency plan. We should have had a plan for what we would do if we ever elected an anti-science president. Within days of coming into office, Trump took us out of the Paris Accords. How bigger a flare did you need to know that you've got an anti-science president? Never had a science adviser and scoffed at the whole science world.
When I did my film Flock of Dodos , I was involved with the people in Kansas who were trying to beat back this intelligent-design movement. In the summer of 2006, the Discovery Institute was pouring money into Kansas to support these people running for the school board who were openly, avowedly pro-intelligent design to undermine evolution. I kept writing emails to people at National Academy of Sciences and AAAS, specifically Bruce Alberts, then the head of the National Academy of Sciences. I said, why aren't you guys out here with your millions of dollars helping to defend science? And they just said, we don't do that. That's politics. We don't get into that; we're science organizations. We promote science.
Well, now the barbarians are flooding in through the gate and there hasn't been a plan and there still isn't a plan. And the last thing to say on how bad it is, just one symptom of it, is that as soon as the Biden team got going, they began holding these press conferences on TV. Look at the graphics from those things and what you see are three characters there. There's Anthony Fauci, Rochelle Walensky, and Andy Slavitt, and then Jeffrey Zients. You don't do that. Read The One Thing, a best-selling book from the business world about how people need the singular narrative. You have one spokesperson; you don't put three on the screen. You're confusing people from the outset. Mixed signals. Oh my goodness — such a fundamental lack of intuition.
The problem is too many PhDs in the kitchen. I'm sorry, but the PhDs have got to get out of the room when it comes to communication. It's the Hollywood people who do this, and it's laughable when you're in Hollywood. You know, they laugh at film school graduates and the highly educated. You can't do everything with an advanced education. There are some things in our society you can't do so well, and you've got to respect that.
Topol: You are a gem, Randy. I hope some of the people in our public health agencies who are still trying to manage this pandemic will hear this. You have a great impact on people to try to get the story, get ahead of it, get it right, get it so that people really listen to it. That's what this is about.
Olson: I have one last tidbit here for your cohost Abraham Verghese and his wonderful book, The Tennis Partner . The ABT template originates, as far as I can tell, with Frank Daniel, one of the great screenwriting instructors who was at USC when I got there. I took his script analysis course, and in 1986 he gave a speech that included two paragraphs that are the source for the ABT dynamic. In the first paragraph, he says very simply that monotony is a problem in first drafts. He's talking about screenwriting, but it applies to everything. There are several reasons for it. One is that the scenes follow in the forbidden pattern of and then..., and then..., and then.... That's how people start telling stories, and it's in the revisions that you start to get the buts and the therefores that turn it into a story.
I loved Abraham's book. I'm an avid tennis player myself, so I just ate it up. But on page 30, he tells this great anecdote. He came home one night and his two kids, ages 5 and 7, were telling him the whole story of the latest episode of Batman and Robin. The 7-year-old was telling the story, but every so often he would pause, and as Abraham said, the 5-year-old would jump in, and when he did, he would say "and then..., , and then ..., and then .... And that just shows you that at 5 years old, you're at that same place everyone is with first drafts. You begin with that, with all the information, and the ABT template is about moving it further. That's what comes with age. You develop this ability to shape things into the story, the very story Obama talked about — that his job as the president was to tell a story to the American public. It's about having that ABT structure to it. So that's how universal it is. Please tell him that I love The Tennis Partner.
Topol: I will, and I'm sorry he couldn't join us today. I know he's going to love hearing that, and I've loved hearing from you today. I will look forward to more of that in the future. Randy "ABT" Olson, we can all learn from you. Thanks so much for joining us today.
This podcast is intended for US healthcare professionals only.
Follow Medscape on Facebook, Twitter, Instagram, and YouTube
