No Excuses: We Need Better Communication and Discernment Skills

In 2008, I listened to Dan Heath deliver the opening plenary keynote at the Safe States Annual Conference. Heath and his brother, Chip, had released their book, Made to Stick, a year earlier, and the Safe States Alliance had managed to secure Dan at a greatly reduced cost for our 2008 keynote. I recall Dan quoting Mark Twain who supposedly said, “A lie can get halfway around the world before the truth can even get its boots on.” Dan went on to explain that urban legends and conspiracy theories circulate effortlessly, while important information from public health professionals languish. The reason – public health doesn’t know how to create “sticky” messages.

To prove his point, Dan showed a slide from a commercial advertisement followed by a typical slide from a Centers for Disease Control and Prevention (CDC) presentation. The advertisement was flashy, bold, and memorable. The CDC slide was boring, chock full of data, percentages, and graphs. I remember silently scolding myself for not thinking of this earlier because I had received an undergraduate degree in journalism. I knew this stuff; why hadn’t I used my journalism knowledge when I entered the public health field? 

I left the conference emboldened to communicate my important messages more effectively. But once I was back at work surrounded by my hospital and public health colleagues, I fell into the same patterns, convinced that our data and graphs were compelling enough to convince the public to wear their seat belts, bicycle and motorcycle helmets, install smoke detectors in their houses, or increase any number of other safety measures.

At various times during the past 13 years, I’ve heard similar presentations by communications specialists at several other conferences, and yet I have struggled to get beyond the theoretical and put into practice what I had learned and implement effective messaging. Why? Possibly it is because I haven’t looked beyond my own public health mental models to understand that not everyone sees the world as a rational public health professional.

Recently, I re-watched the HBO documentary, The Inventor, about the rise and fall of Elizabeth Holmes and Theranos, the multibillion-dollar diagnostics company she founded at 19 years of age. For those who don’t know the story, it is worth reading John Carreyrou’s book, Bad Blood, and watching the HBO documentary. In summary, Holmes was a charismatic, intelligent young white woman who had proclaimed at the age of 7 years that she wanted to be a billionaire. By the time she was 19 years of age, she had a bold vision to develop a small machine that could perform the range of blood tests (200+) with a small finger prick of blood as opposed to the standard venous blood draw in the arm to obtain the necessary vials for standard blood tests. 

She ignored the expert advice of medical professionals who told her it was impossible. She obtained a patent and started the company, then she dropped out of Stanford University. She convinced several powerful white men from politics and the military such as George Schultz, former Secretary of State for Ronald Reagan; Henry Kissinger, former Secretary of State for Richard Nixon; William Perry, former Secretary of Defense for Bill Clinton; James Mattis, a retired U.S. Marine Corps general who went on to serve as Donald Trump's Secretary of Defense, among others to serve on her Board of Directors.

She ignored the concerns from the engineers she hired who tried desperately to bring her vision to fruition. She ignored the scientists doing the testing who tried to tell her the machines didn’t work. Instead, she convinced investors like the Walton family of Walmart, Rupert Murdoch, who owns the Wall Street Journal and Fox News, the family of former Secretary of Education for Donald Trump, Betsy DeVos, and others to each invest $100,000,000 or more in Theranos without them ever seeing the equipment or how it worked. Spoiler alert: The equipment didn’t work. After Carreryou’s investigative report exposed the Theranos fraud in the Wall Street Journal, Theranos was dissolved in 2018. Holmes’ trial on fraud charges is expected to begin soon.

One of the whistleblowers who worked at Theranos and reported the fraud is the grandson of George Schultz, yet the elder Schultz continued to believe Holmes over his grandson.

Because I’m trying hard to be in a curious mindset and not in a judgmental one, I’ve been wondering what I can learn from the Theranos story? And no, it’s not that men (aging or otherwise) have a tendency to think with an appendage that hangs below the belt. Instead, maybe it is the same thing I should have learned from Dan Heath in 2008 and the other communications experts in the years following. A compelling story wins the day over data.

Dan Ariely, a behavioral economist who has a doctorate in cognitive psychology and another in business administration, and is the author of Predictably Irrational, appeared in The Inventor. Listening to Airely reminded me that stories sell, and that stories that convey a vision are even more effective, regardless of if they are true or not. 

In the documentary Ariely said, “Data just doesn’t sit in our minds as much as stories do.” He went on to say, “Stories have emotions that data doesn’t. And emotions get people to do all kinds of things, good and bad. If you think about the people who invested in her with very little amount of data, it’s about emotional appeal and having trust and believing the story.” 

Ariely also said human brains are good at remembering general statements or ideas, but they are not so good at remembering where the information came from, or even if it is true. He said it’s a psychological concept called source monitoring. “When our brain gets a message, we don’t separate very well the statement and where it came from, and we can often get very confused … and not remember,” says Ariely. “It’s why fake news works so well.”

Using just her story, Holmes was able to convince many “strategically brilliant” people to buy into that story.

There’s no doubt that public health professionals need to learn better communication skills and what resonates and what doesn’t. We need to rethink how we communicate.

I recently listened to a video that Dr. Julie Sweetand, a sociolinguist and Senior Advisor at the FrameWorks Institute submitted to my organization, the Safe States Alliance. She said communication should be a core strategy for public health.

I concur. But we also need discernment skills. In addition to telling a good story, we need to be able to determine whether it is true. I’m realizing my own limitations in this as I try to navigate the scores of information about COVID-19 and the variants.

There’s no need to get defensive about our limitations. We’ve all made decisions based on our best available knowledge at the time. I often quote Maya Angelou, who said “Do the best you can until you know better, then when you know better, do better.”

We have all made mistakes. We need to ensure the generations that follow us are taught skills we weren’t and have access to learning opportunities not afforded to us. 

It’s time to do better No excuses.