Anthony Fauci on Science Communication in a Crisis

*This transcript was corrected with Claude AI. The human version is coming soon.

Bob Welcome to Top of Their Game, the show where we speak with the people, making communications clearer, fairer, and just plain better. I'm your host, Bob Milstein, a lawyer and plain language trainer, practitioner and advocate. It's a bit of a cliche in podcast land to say that our next guest is a household name, but our next guest really is a household name. And in just about every house on the planet. Anthony Fauci, M.D., former director of the National Institute of Allergy and Infectious Diseases, served the American and through it, the global public for over five decades. A doctor, scientist, and infectious diseases expert. He is one of the most recognized and influential figures in public health and policy in modern times. His fifty year career in public service was bookended by the HIV/AIDS and COVID-19 pandemics. Throughout his career, Doctor Fauci has maintained an unwavering devotion to science and empathy for those suffering from disease. In today's interview, we explore with Doctor Fauci the art of science communication. We'll explore within the challenges of communicating in the midst of a global health crisis and at a time of fear, uncertainty and immense societal disharmony. And we'll also look at what he did to get the attention of no less than seven presidents of the United States of America. And now Doctor Anthony Fauci. Doctor Fauci, thank you so much for joining us today.

Anthony Thank you. It's my pleasure to be with you.

Bob Wonderful. Before you became a global household name, you started off your professional life as an infectious diseases physician. What attracted you to that field?

Anthony Well, I was interested in all aspects of internal medicine. The thing about infectious disease, when I decided now, back in nineteen sixty eight, to do a combined fellowship in infectious diseases and immunology at the National Institutes of Health, after my residency training in internal medicine at the New York hospital, there were two reasons why I chose infectious disease, the discipline itself, with the idea that you can have an etiologic agent, that you can identify that it's serious enough that it could kill you. So you're not dealing with a trivial disease. You're dealing with a disease that has some impact, but you could also prevent it and treat it and in many cases, cure it. So the definitive nature of that discipline was attractive to me. The other element at the time was the sort of incipient years of truly understanding the complexities of the human immune system, and I got fascinated by that. And since the human immune system is the major mechanism to protect one against infection, I just felt a discipline and a study that would combine the excitement of the clinical field of infectious disease with the fundamental discovery of the complexities of the immune system, was just very attractive to me. So that was the reason why, when I had a choice of my fellowship, I chose one that combined both the clinical excitement of infectious disease and the real interesting mysteries of the human immune system.

Bob Those mysteries were no doubt the reason you ultimately subspecialized as an immunologist for the benefit of our audience, many of whom will not be scientists, some of whom will be. Can you please tease out for me for the record, immunology. Virology. Epidemiology.

Anthony Okay, so immunology is the science and the discipline of understanding. One of the organ systems of the body, the immune system is really a bona fide organ system. It evolved over millions of years from animals to humans, to be the mechanism whereby the body protects themselves against invasion from foreign invaders, in the case of pathogenic microbes, be they viruses, bacteria or parasites, but also about invaders from within. For example, when you get a transplantation, you've got to suppress the body's immune response, which naturally tries to reject that. The immune system also can go awry. And by going awry, it means it starts to inappropriately mount responses against its own tissue. And that's where you get the subspecialty of immunology, which is autoimmunity. With diseases like rheumatoid arthritis and lupus and a variety of other diseases, as well as allergies, where you inappropriately respond to environmental antigens in a way that ultimately is deleterious to the body. So that's the discipline of immunology. Virology is the study of one of the subgroups of potentially pathogenic organisms such as viruses. So there are millions of viruses. But there's a certain restricted group that have historically been pathogenic to mankind. You know, we're aware of the somewhat trivial viruses that give you rather self-contained upper respiratory infections. There are viruses that can cause serious disease like rabies and polio. And of course, the experience we've had now over more than forty years with HIV AIDS, which is an extraordinary virus that we just became aware of in the very early nineteen eighties. Epidemiology is a discipline of public health and infectious disease, where you study the patterns, the evolution, and the manifestations of a variety of diseases, how rapidly they spread, what their causes are. That falls under the auspices of epidemiology.

Bob I asked that question because I'm conscious that between two thousand and twenty twenty three, every person and their dogs seem to have a favorite epidemiologist and a least favorite epidemiologist. Even though that person was not an epidemiologist.

Anthony Right. Yes, people have been falsely classified, but. That's understandable, I guess.

Bob Sure, sure. Um, you trained as a physician and a scientist, but not as a communicator. When did you realize that communication itself was going to have to become central to your work?

Anthony Well, I realized that on a smaller scale early on in my career, even before I assumed a more visible, globally recognized role. I'm talking about way back when I was a scientist in a small lab with myself and a technician and maybe a postdoctoral fellow or two. And when we began to do experiments with results that we wanted to make sure that the scientific community and perhaps in some cases, the general public would understand what we were doing, why we were doing it, and what our results were. And it became very clear to me that in order to do that, you have to communicate clearly and succinctly and in a way that people can understand. I mean, that fundamental core principle I was aware of very, very early on in my career. It only became an extremely important part of what I did when I assumed the role as director of the National Institute of Allergy and Infectious Diseases, when in addition to being responsible for the conduct and the support through our grants and contracts of a substantial proportion of the infectious disease and immunology research that was conducted throughout our own country and even throughout the world, it became even more clear to me the importance of crisp, clear communication so that people could understand what you were doing and why you were doing it, and when you got results, for them to understand what the potential for and the limitation of those results are. So it started off very early and it just became more and more compelling that good communication was extremely important.

Bob Going back to the early days of your career and your sense of the importance of communicating with and to the public. Can I ask a rather basic question? Why was that a desirable thing to do? Why was it important from the perspective of you and your lab?

Anthony Well, for a number of reasons, because if you want to get support for the interesting, exciting things that you want to do in the arena of science, particularly the biomedical research arena, then it just makes sense that if you want support, and in the case of my own support working for the United States federal government, you were dealing with taxpayers money. So you had to really have a good articulation of what you were doing and why it was important, and why it is worthy of the support of the people that you're trying to serve.

Bob Early in your career, what, if anything, did you misunderstand about how hard it is to explain science to non-experts.

Anthony Well, I learned from watching other people do it the wrong way. It kind of gave me a heads up about don't do it that way. I mean, one of the problems that scientists have, and when I try to mentor the younger people that I've had the privilege of working with over so many years, you point out that if you drop back and watch people try and communicate and do it in a way that is not really clear, it in some respects does more harm than good because people not only don't understand what you're doing, but they might misinterpret and you might be inadvertently misrepresenting what you're doing. And you know, I make mistakes too. Nobody's perfect. But I made it a point to be very, very careful to not repeat the mistakes that you became clear that others were making, as well as to not make the same mistake that you've made twice. There are a couple of core principles of communication that I have tried to teach my mentees. You know, one of them is that when you're speaking about science and that can be sometimes complex and complicated, you've got to know your audience and direct your discussion to the level of the audience. Sometimes people go in and start talking. They have no idea who they're talking to. It's important to understand, is your audience a group of college students, high school students, or members of the Royal Society or the National Academy of Sciences? I think that's important. The other thing is don't try to give too many messages when you're giving a speech or a discussion. Sometimes scientists in their zest to be complete, give four or five or six or more messages in the same discussion, which almost invariably winds up confusing people. So try and be precise and give maybe one or two messages per discussion that you're giving so people don't get confused about what you're talking about. Another thing I often tell my mentees is that sometimes scientists fall into the problem of essentially feeling they need to show their audience how much they know and how smart they are. The the purpose of communicating is not to have your audience feel that you're really, really smart is to have them understand what the heck you're talking about. So that's another of the guardrails or principles that I do when I communicate.

Bob That does seem to be a recurring, seductive temptation among a whole range of professionally trained communicators.

Anthony Yeah.

Bob Your comments about clarity of message remind me of something you said recently in an article where you're interviewed about your great mentor, Sheldon Wolf. You said, I like clarity of thought. There are some people who are really good scientists, but you never know what they're talking about. You never know where they're going. You never know what the big picture is. And that's a problem for them. It's a problem for whoever they're communicating to.

Anthony That is correct. That is correct.

Bob Um, was the AIDS crisis the moment when communication stopped being secondary and became essential for you?

Anthony Yeah, I it was a historic outbreak of monumental proportions that was unfolding before us. There was a lot of concern, fear, particularly among the risk groups. And it just became essential that as the information was unfolding, because it was really a moving target. When you're dealing with the evolution of a brand new disease, you learn new things every day, every week, every month. So when that happens, there's always a lot of fear and concern because it was a mysterious disease back then to some respects. Even so today in some people's minds. But it became absolutely essential, as you alluded to in your question, that communication became an essential tool in the broad armamentarium of how we as scientists were approaching HIV AIDS.

Bob It was a very steep learning curve. So did you get important things wrong early in terms of your communications?

Anthony Uh, yeah. For me to say I got nothing wrong would be presumptuous and incorrect. I'm not perfect. I'm sure there were things that I could have done better. I don't see any obvious major blunder, but I am sure that there are things that I could have done better.

Bob Was it Larry Kramer with whom you had some conflict that was ultimately resolved very happily between the two of you?

Anthony Oh, yeah. I mean, Larry Kramer, for those who don't know, was an icon in the field of activism. But even before then, a much honored author, playwright, person who really created the AIDS movement in New York City, he was the founder of Gay Men's Health Crisis. He was the founder of Act Up New York, and he was very much of a firebrand who was very confrontational, and I think appropriately so, because he wanted the general public, but even the scientific community to appreciate why more effort should have been put into the study of HIV. But all important, he and his younger colleagues wanted a seat at the table in discussing the kinds of clinical trials that should be done, to discussing what was user friendly or not, why the FDA was very slow, at least in their mind, and to some extent they were correct in doing the work that needs to be done to approve new interventions. And also, what the scientific community didn't appreciate was when you're dealing with people who, once they get clinically ill, their life expectancy is measured in twelve to fifteen months from the time they get significantly ill, which brings them to the attention of the health care system that there was such rigidity in entry and exclusion criteria in clinical trials. The activist community wanted to have a seat at the table to talk about getting their input into the things that the scientific community did. Now, the problem was that the scientific community, understandably, but ultimately retrospectively, inappropriately kept on feeling we know what's best for you. We've done it well for so many years. We'll do it this way. That's when they became very provocative, disruptive, theatrical, because they felt the scientific community was not listening to them. And it was in that context that I got into what was at first a confrontational relationship. I wasn't being confrontational. Larry was with me because he wanted to gain my attention. But I say, and I wrote this very clearly in my memoir, that one of the best things I have done in my professional career was to very early on, when most of the scientific community was running away from the activists because they were being so disruptive and were just not listening to them, I was really the first person, at least to my knowledge, who actually really started listening to what they were saying. And when I was listening to what they were saying, it became clear to me that what they were saying was making absolutely perfect sense. And I came to the conclusion that if I were in their shoes, I would be doing exactly what they were doing. So that's when I embraced them. I invited them in. I brought them into our meetings. I brought them into our councils. And over a period of years, what started off as a confrontational relationship wound up, as I've written about extensively, a very cordial and productive and mutually beneficial relationship, including with Larry Kramer, who was the most iconoclastic of the activists.

Bob And that patient led response became the template for so many other public health and health challenges.

Anthony It was the paradigm. This all happened over a period now of forty five years. Because remember, this first started in nineteen eighty one, and over that period of time, I have been asked multiple times by people who represent other disease advocacy organizations. How did you get to where you were with your advocacy group? And it served as a really very effective model, which people have used over the years.

Bob So clearly, the patient population had a big influence on how you go about trying to solve problems. Who else influenced you in how you learned to explain things? I mentioned Sheldon Wolf, but mentors, teachers, writers, other clinicians. Did anyone have a particular impact on you?

Anthony You know, I think Shelly Wolf, yes, probably the second person is my wife, who is also in the field of science. She's a bioethicist. She started off as a nurse, and then she got her PhD in bioethicist. And she is also a real stickler on clarity. And whenever I try to explain something, she has no problem in interrupting me and saying, wait a minute, what exactly do you mean by that?

Bob Our spouses are excellent for that.

Anthony Yeah. Very good. Yes. So I would think the combination of my original mentor, Shelley Wolfe, and the continual fine tuning, if you want to call it that, that I got from my wife over the more than forty years that we've been married was, I think, very important for me.

Bob Did she have any particular offenses that she would highlight for you?

Anthony Well, she always wanted me appropriately when you're explaining something, particularly something that other people might be skeptical to, to refer to the data upon which you're making your statement. Like she'll always correct you and say, well, what is the basis for your saying that? Which is a very good reminder.

Bob Were there any other communications habits, either with or without the input of your wife that you found you had to unlearn over time.

Anthony Well, when you got into things that there was a considerable amount of misunderstanding, such as what happened to a lesser extent in the early years of HIV. But what happened to a great extent during the early years of COVID is that when you are making a statement that you know, has a degree of ambiguity to it, or lack of precision to it, by very nature, you've got to be very explicit in that. What you're saying now holds for the data that we are aware of at this time. However, information can change and you've got to be prepared to adjust your evaluation of things depending upon the changing information. That became really an important component of communication. For example, some of the things that was said early on when we knew very little about the disease, COVID as it was evolving, the press would ask you, well, what do you think about this? And you would say, well, based on the knowledge that we have now, this is what our thoughts are. And then you would always say semi-colon. However, comma, this could change if we get further information. Very often people who are trying to confuse things would forget that you said. However, this could change and people would say, well, you said this six months ago and now the situation is different. Are you flip flopping? So the painful lesson you learned is that when there is a caveat to what you're saying, repeat and emphasize that caveat multiple times because people tend to forget it after you finish saying what you're saying.

Bob I guess there's always the risk that regardless of your efforts, you'll be edited in a way that removes those things.

Anthony Absolutely. And that has happened multiple times over the years.

Bob You mentioned earlier that some of the messages you give to your mentees are about changing your communications approach to reflect your different audiences. And I imagine those audiences might be patients, policymakers, journalists, or the general public apart from making that general admonition to them. Do you give them any specific suggestions of how they ought to think about doing that, slicing and dicing for those different audiences?

Anthony Um, the answer is yes. You don't want to spend too much time trying to outguess who your audience is, but you've got to be really careful. I mean, as a physician, when you're talking to a patient, you've got to be really, really careful that the point you're making is not misinterpreted. Because when patients are frightened about a disease they might have, you've got to make sure that they totally understand what you're talking about. Because very often when patients are in understandably stressful situations, sometimes frightening situations, they often hear what they want to hear and they don't really hear what you're saying. So you have to be very careful, meticulously careful, and sometimes to the point of having to be repeating it multiple times and coming back and making sure they understand. Because you're dealing with a person's life with a person's emotions under a very stressful situation. That's really different than when you're up in front of a classroom talking to a bunch of students, when you know they're really concerned about what they're going to get on their exam as opposed to, you know, what it is you're saying. So there's a lot of differences in audiences when you're talking, for example, to the Congress. You've got to realize that there's a lot of political stuff going on with them, and they're going to be asking questions that are more in a political tone than in a basic scientific tone. So you've got to understand where they're coming from. So there is a lot of variability in adjusting yourself to the environment you're in when you're communicating.

Bob And I imagine that over the decades in which you've been involved in caring for patients, you've seen that their access to information, I won't say knowledge, I'll just say information has has radically transformed from perhaps a time when all they had was what they got from you and your colleagues to Doctor Google to doctor AI.

Anthony Yeah. That's true. That is a real challenge. Yeah.

Bob Curse.

Anthony Well, I don't know if it's a curse. I think you'd like to have patients who are well informed. But often you have to go and tell them what is really clearly documented to be true and what has gotten into the information flow that doesn't necessarily have the data backup that they would think it has.

Bob I want to talk about doctors and scientists as communicators. Do you believe that good communication is mostly instinct, or is it something that can be learned?

Anthony It's both. It's both. I think there are some people, and I've seen them, that as much as they try, they just don't actually get to the level, which I would consider optimum for the situation that they're in. So I think there's instinct about it. But there's a lot that you could learn too. You know, I think I had a very good instinct for communication, but I've also learned a lot over the years. Again, as I mentioned before, one of the best ways of learning is to watching the missteps of others and say, I better be careful not to fall into that rabbit hole, because obviously this person is now confusing their audience.

Bob Mhm. Mhm. Um. Before this interview, we had an email exchange in which I briefly referred to an international resource called the International Plain Language standard and its soon to be released supplement. On the topic of science writing broadly, it's a resource that at its end provides a series of aids, including a checklist for scientists to commit to clarity in writing. Ticking the boxes of the international definition of plain language, which is using their words, their sentences, and the design and structure of the document in a way that makes it as easy as possible for the target reader to easily find what they need to find, understand what they've found, and use it. So my question without notice, because I know you've not looked at this, is do you see value in that kind of resource?

Anthony Well, listening to what you were saying, Bob, I was saying to myself, right on. So yeah, absolutely. I mean, I'm sure there's enormous value in that and would be very helpful to people, particularly in the early stages of your career, because when you learn things early on, ultimately you incorporate that into your modus operandi. So yeah, I think it's extraordinarily beneficial.

Bob The resource is currently labeled science writing, which is specifically distinguished from what they call scientific writing. The former is expert to non-expert. The latter is peer to peer written communication. Do you have a view about whether these clarity principles perhaps also have a role, even in that more so-called elevated peer to peer environment?

Anthony No, I think so. I mean, what you're saying relates to what I said a little bit ago. You can always fine tune how you communicate with people. Again, I'm not familiar with the program you're talking about, but at least from your brief description now, it appears to me that it would really be very much value added for scientists to understand the differences that you're talking about.

Bob You talked earlier briefly about the evolving nature of science, the lack of certainty that accompanies that. People often confuse clarity with certainty. How do you communicate one without promising the other?

Anthony Uh, I think it gets to a statement I made a little bit ago about clarity of expression, of what you want to say together with the insertion of the caveats when they're appropriate. You know, there are very few things that are absolutely certain. And then there's a gradation of certainty in medicine and science that you got to make sure you walk the right line and not give the people that you're communicating with the idea that you're absolutely certain about something. You know, we are absolutely certain that smoking is deleterious to your health. And you could say that with a great deal of certainty. But there are a number of other things in medicine about what you're not one hundred percent certain, and you should communicate clearly, but don't necessarily communicate definitively.

Bob What do people misunderstand most about scientific uncertainty?

Anthony You know, I think what they misunderstand, and I have actually been lecturing a bit and writing about this lately, is not understanding that science is a process that collects information, data and evidence upon which some people may make decisions, others may make guidelines or recommendations. And one of the things that people I think don't understand, and that's reasonable, that they may not understand it, is that the information changes, but the process of science doesn't. It is really immutable. But what is not immutable is the information as it evolves and as new information comes. So if you want to be true to the science, the science will be self-correcting, because the very nature of the process of science forces you to evaluate new information as it comes along, and that new information that you gathered by the scientific process might actually differ from the information that that same scientific process allowed you to gather a month ago or a year ago. And I think a shorter answer to your question is the lack of understanding that the process of science stays the same. It's the information that changes that science helps you to gather and understand that changing information.

Bob When the pandemic was taking hold of the planet, I do wonder how the world would have responded to coronavirus if this had happened in the pre-internet days and before the opportunity to balkanize a range of views and disseminate them so powerfully and destructively. Any thoughts?

Anthony It is really unfortunate that social media has allowed the dissemination of fabricated and misguided information as effectively as fact and evidence based information and what we have in our era. And I'm going to use this terminology because I introduced it in a number of commencement addresses over the years during the early and mid years of COVID, is what I refer to as the normalization of untruths, where people can say things that are patently untrue. And once it gets into the amplifying effect of social media and is said often enough, then it becomes true to a substantial proportion of people. And you know, that could be annoying or what have you. But when you're dealing with information that relates Lakes directly to the health and lives of people. That dissemination of disinformation and misinformation results in lives that are lost. And I think that's what happened during COVID. And as I'm sure you're probably aware, there have been modeling studies to show that at least in the United States, there are a couple of hundred thousand people who likely lost their lives because of disinformation, telling them that don't get vaccinated because vaccines are bad for you in a disease in which you have a vaccine that probably was more widely tested than any other vaccine prior to this. Yeah. You're right. Uh, the era of disinformation has been detrimental to the health of the people of this globe.

Bob Is there a fundamental educational issue at play here about what people aren't getting educated about when it comes to, for example, concepts of risk, of scientific knowledge, of scientific progress.

Anthony You know, Bob, I look at it in a way that if there's anything that we should be focusing on, on our younger people is to instill in them the importance of critical thinking. Uh, we do not accept something merely because it's on Instagram, TikTok, or someone's YouTube account. There is so much of an acceptance without a critical evaluation. To me, that is dangerous in every element of life, but could be deadly when it comes to health. And when you're in the middle of a catastrophic situation like a pandemic, which in the United States, as you well know, has killed more than one point two million people. So disinformation and believing things that have no basis in fact is very dangerous.

Bob I'm going to come back to communicating in a crisis, but I wanted to turn to your role as an advisor to presidents, how many presidents were you advising over the course of your career?

Anthony A total of seven, starting with Ronald Reagan and ending with Joe Biden.

Bob So I have to confess to you that I do have a rather hollywoodized version of what that actually looks like. I have this idea that the hotline rings in the Fauci office. And then Anthony Fauci, played, of course, by Brad Pitt, strolls into the Oval Office and declaims authoritatively and solves the world's problems. I gather it doesn't quite happen like that.

Anthony Well, it doesn't happen that way, I can absolutely assure you.

Bob I am really fascinated, and perhaps so might our listeners, to understand how that particular sausage is made. Do you have regular catch ups or is it only crisis triggered catch ups with the president?

Anthony Good question. And first of all, the reason I had the privilege and the opportunity over a period. You know, I was at the NIH for fifty four years before I stepped down at the end of December in twenty twenty two, and I was the director of an institute that was in the eye of the hurricane of every important outbreak, you know, going from HIV to pandemic, flu to Zika to Ebola to COVID to bird flu. So it just so happened that since I was there for so long, I was appointed to my position when Ronald Reagan was president, and I had the opportunity to brief him and try to encourage him to be more out there and proactive in using the bully pulpit of the presidency to warn people about HIV and then every subsequent president. Uh, it really was a reactionary thing. It wasn't like the president's have more important things to do than to say, why don't we just sit down with Tony Fauci every month and see how he's doing? It doesn't happen that way. It's really crisis driven. During the crisis of HIV AIDS, I was in the White House, in the Oval Office multiple times, briefing different presidents because the HIV crisis spanned multiple presidencies. And then there was pandemic flu, and then there was Zika, and then there was Ebola. So it really is depending upon the crisis. And unfortunately, over a period of the almost forty years that I was director of NIAID, there were enough crises in each administration that I had the opportunity to advise the different presidents, anywhere from a few times to dozens and dozens of times, as I did during COVID, but particularly in HIV AIDS during Ebola, when there was a concern about the spread in this country, which is, I think, an ill founded concern. I mean, I was in the White House dozens and dozens of times.

Bob And when you prepare the meeting, do you or does your team have to communicate with presidential aides and advisers. Do you have to prepare a dossier for them or do you just go in?

Anthony No. Um, sometimes they would ask for something on paper of a position, but that was less often than just going in and giving a briefing. You know, there was an important thing that I emphasized in my memoir, and it is fundamental to the proper and honest response to your question of what was it like to be the person that, on matters of health and public health crises that I had the privilege of advising seven presidents. And it really relates to a fundamental principle that I mentioned when I described it in the memoir, that the first time that I was scheduled to go into the White House and brief Ronald Reagan, a mentor of mine who had the position during the Nixon administration of being in the White House in a national security role for about six years. And then he came into the Department of Health and Human Services. And we became very good friends. And when I was getting ready to go in, he advised me of something that I would have hoped that I would have come to that conclusion anyway. But he advised me of it. And he said, whenever you go into the White House to advise either the president or his or her advisers, and you walk under that awning in the lower level of the West Wing, going into the West Wing of the White House, you should whisper into your own ear that this might be the last time that I'm going to walk into this building, because I might have to tell the president and his advisers an inconvenient truth that they may not want to hear. And there is an instinctual feeling, and I know what it is, because I've been in the White House hundreds and hundreds of times. There's an instinctive feeling that the White House is such an awesome place that you really want to get asked back. Huh? So you don't want to fall into the trap of even subconsciously telling the president something that he wants to hear, other than what the actual real truth is, for fear that you might be the messenger, they get shot and that doesn't get asked back. So I lived by that principle for literally almost forty years. And sometimes I had to tell presidents inconvenient truths that they didn't want to hear, that things weren't going so well. And fortunately, I developed over the period of those almost forty years, the reputation that I was a straight shooter, that I would tell you something that had no political motivations at all, but that just was based on my experience and my instinct as a scientist, a physician, and a public health official. And that worked extremely well. Most of the time, just going in there and not being afraid to say what the truth is and not worry about. If they say, well, you disappointed me, I don't want to see you anymore. So that was the fundamental principle that drove my interactions with the White House.

Bob Seven different presidents, presumably seven different personalities and styles, including preferences for the way they receive and take in information if indeed they take in information on that basis. Did you see that you needed to shift to accommodate that, and how did it become apparent to you that you'd need to shift in a particular direction?

Anthony Well, the one thing you don't want to shift is the fundamental principles that I mentioned to you a moment ago. Sure, sure of truthfulness and honesty and transparency. But people have different characters. You know, some people used to like to just chat about things and do as little small talk about it. And there were others that wanted to get right down to the point, no fooling around. You know, we have a limited amount of time. And in order to be effective, you needed to be able to read their style and fit your interaction with them with that style. And yes, there are seven different individuals, multiple differences in ideologies, but multiple differences in styles.

Bob I know you said your role is to tell it as it is and to advise fearlessly and frankly, but I'm guessing that when you walk into the room, you have a view as to the best way to approach a particular problem. So I imagine there's a bit of a persuasive exercise that also is taking place. Do you try to lobby for positions?

Anthony Um, I don't like to use the word lobbying. It has a negative.

Bob Not in the American political sense, but no.

Anthony Yeah. Yeah. No. I mean, there were some presidents who, because of the nature of the persistence of the problem, that you get to see them a lot and you really get to know them very, very well. and the level of relaxation in the discussion is much easier than someone in which you don't have that degree of familiarity with. And that's really important.

Bob Were you scared the first time?

Anthony I wouldn't say scared. I certainly was a little nervous about making sure that I got my point across. I mean, the first time I did it, it was difficult because I tried to tell something to Ronald Reagan that he didn't want to hear, that he really needed to be out there more talking about HIV. You know, he had already in his second term, and he had never even mentioned the word AIDS until the second year of his second term.

Bob He did seem to have a bit of a hearing issue with that word.

Anthony Yeah. Yeah.

Bob You felt more confident in second and third visit, or was there always a bit of.

Anthony Well, no, actually, the second president that I spent a lot of time with, I first interacted with him when he was vice president. And that's President George H. W Bush. And among all the presidents, I've had very good relationships with all of them, but different levels of relationship. But President George H.W. Bush and I developed a very, very warm relationship because when he was getting ready to run for president, when he was vice president, unlike President Reagan, he really felt that the situation with HIV was something that as president of the United States, he would have to get his arms around. He would have to be much more involved in that. So he embraced me to be the person to essentially educate him about what was really going on with HIV. So I became pretty good friends with him at a time when he was vice president, and then when he became president, I was in a very positive position because he would invite me to the White House all the time to White House functions. He would call me up and ask me my advice on what was going on. And that was the second president I was involved with. But it was a very warm, cordial, easy relationship.

Bob Turning into something a lot less easy. Can I talk about our last global pandemic? It's a really interesting article I read the other day in The New Yorker in which they make this observation. Doubt is a cardinal virtue in the sciences, which advanced through skeptics willingness to question the experts. But it can be disastrous in public health, which depend on people's willingness to trust those same experts. Would you care to comment on that?

Anthony No. That's true. One of the real problems is, and we're in the midst of it now, even more so than when I was still in the government of the idea of what is an expert, and do you trust experts and what constitutes an expert And what happens when your own ideas, although you might be credentialed, you're not an expert. How does that contrast with someone who really is an expert? So it gets confusing.

Bob Experts need to have ongoing dialogue, though, and respectful disagreement in the setting of a pandemic, where the public is hanging on to every syllable and possibly misinterpreting every second one. How should that dialogue take place where there really is a need for experts to thrash things out?

Anthony Yeah, no. Experts need to thrash things out. The only thing we've got to be careful of, Bob. And that was one of the real difficulties during the height of COVID. And even to this day that we're dealing with, particularly with the idea of vaccines and the importance of vaccines and what the risk benefit ratio of vaccines are. It is okay to have back and forth and disagreements provided. People are dealing with the same set of facts And what the problem is, is that people were making up their own alternative facts. And that's when things get dicey. When you have someone who is acting like an expert, who is making statements based on absolutely no facts and fact statements in which facts contradict with what they're saying. And we ran into that during some of the early years of COVID, and that caused a lot of confusion among people.

Bob It's almost quaint to look back at the aphorism of Daniel Patrick Moynihan back in the seventies, when he said, everyone is entitled to their own opinion, but no one's entitled to their own facts. But that doesn't seem to be the world we're in at the moment.

Anthony No, no. And in fact, we had the privilege of getting to know Daniel Moynihan when he was in government. And, uh, boy, if he's in heaven looking down on us right now, he's scratching his head and saying, wow, I told you so. Really?

Bob Wow. So, uh, here's an easy question for you. What went wrong?

Anthony It depends on what you mean by went wrong. I think it was a series of circumstances in COVID in which the worst time you ever could have an outbreak of the real and potential proportions that happen with COVID would be when you're dealing with a society in which there's a profound degree of divisiveness. And that's what we had in this country. I mean, we had people's decisions about how they would approach a deadly outbreak that was driven by ideology. You know, wear a mask, don't wear a mask, get vaccinated, don't get vaccinated. You are probably aware that in this country, the red states or Republican states were much less prone to getting vaccinated. And the hospitalization and death rate in that group was significantly greater than in the blue states, which were much more amenable to wearing masks and getting vaccinated. You know, as a scientist and a completely apolitical, I'm not a political person. I don't have one ideology versus another. It's very painful for me to see people suffer and ultimately die because of a decision that was based on political ideology. That is really unfortunate.

Bob If we tweaked the chronology and made the pandemic happening in the nineteen sixties, say, or the seventies, do you sense that it would have played out differently in terms of community buy in?

Anthony I think so. I mean, there's always been political differences, but as you are aware in this country, it's not just political differences, it's profound divisiveness. I mean, back in the nineteen sixties and nineteen seventies, people with political differences liked each other. They used to go and be friends and maybe differ in discussions on the floor of the House or Senate, and then go out to a bar and have a drink together and talk about how we can work things out. Now, that's not the case at all.

Bob I remember listening to a podcast just before Obama's second election victory, where they were just reflecting on how incredibly divided American society is. Those were the salad days compared to what's going on in the last few years. It's it's it's remarkable and sad to watch.

Anthony Yes it is. Unfortunately, it's sad to watch in every element of society. It's tragic when it interferes with people's health. I look at it from the lane of a physician, a scientist, and a public health person. You know, you have differences in ideology that have economic implications. I'm not an economist. I look at it with interest. I shrug my shoulders. But when you look at it from a public health standpoint, it really is avoidable and tragic that people suffer in lives are lost because of that divisiveness.

Bob So when the next one happens, whenever it happens, how should we deal differently with it?

Anthony Well, you know, I look at it in two separate buckets in a scientific bucket on a public health bucket. From a scientific bucket, we need to continue to invest in the fundamental, basic and clinical research that has allowed us so rapidly to develop a vaccine in eleven months, from the time the COVID SARS-CoV-2 virus was identified and put into a public database. We've got to keep up that strength in our scientific approach. But the thing we've got to do much better, and I think we've been alluding to it in our discussions over the past couple of minutes, is that we've got to unify as a society to do the best public health responses at the local level and at the government level, which didn't happen. It was a really discordance of responses, depending upon what state you were in, what city you were in, what region of the country you were in. And that really needs to be corrected if we want to do better in the next outbreak.

Bob You mentioned the public health perspective. Is it correct that proper and responsible public health decision making does not turn exclusively on the scientific data, although that's important, but a range of other societal economic factors that are at play.

Anthony Yeah, I mean, it isn't a unidimensional problem. It's a very complicated issue when you're dealing with a public health crisis.

Bob So one of the great pressure point in Australia during the COVID was closing of schools, for instance. There are so many more.

Anthony Yes, indeed. That was also in the United States.

Bob I want to move away from that unhappy period. And in the few minutes left to us, perhaps reflect on a couple of lighter topics, if you don't mind, Tony.

Anthony Okay. Sure.

Bob Writers. Are there any writers, scientific or non, who have shaped how you think about clarity of writing, but also clarity of communication generally?

Anthony You know, I think probably the writer that influenced me in the sense of clarity and brevity of expression, was when I was younger in school and I continued to read Ernest Hemingway. You know, if you look at Ernest Hemingway's style, it's very precise and concise and terse and to the point. So I've always liked very much that type of approach. I went to a series of Jesuit schools in high school and in college, and there were certain mantras of the Jesuits, and one of them that I took away with is precision of thought and economy of expression, and namely, be precise in your thinking and say what you have to say in as few words as possible.

Bob Well, I have to say that's extraordinarily noticeable in your media performances. You are deliberate and deliberative and articulate and measured, and you never stumble. It's quite something. I've observed videos over the decades. Your pace has slowed down compared to what it used to be.

Anthony Yeah. You've noticed.

Bob Well, but that's a good thing.

Anthony Um, yeah.

Bob Are there books or essays you've returned to over the years?

Anthony Um, yes and no. Unfortunately, my life has not allowed me to do the kind of enjoyable reading outside of my own field I like.

Bob I'm a little busy.

Anthony A little busy. So when I read, I kind of alternate between a mystery spy detective book alternating mostly with things like biographies and historical analyses of things.

Bob Tips for young scientists. What should they read if they want to become better communicators?

Anthony You know, I don't think I have any recommendations of books and things that they should read. I would even say, when you're going to meetings where people are making presentations, listen to their style and critique it. Because as I mentioned to you, I've learned a lot about how to be a better communicator by being a listener of a communicator and observing some of the things that they could have done much better to make what they were saying more clear to me. And I learned by avoiding those kinds of mistakes.

Bob On that note, my wife works in a similar area to yours, and she has long celebrated the quality of the PowerPoint presentations that she's seen you present at conferences. She's always told me, I don't know what makes them so, but she's told me they are the absolute gold standard. How does that work? Is that your sweat and toil? Do you work with the team? Do you have final cut?

Anthony No. I actually put together my own talks. I have a very good person who is very good at putting together the slide that I say. I want it to look this way, but I'm a very active person in what my slides look like. And I have learned, again, interesting that you brought it up, because it goes back to one of the things that Shelley Wolfe taught me is that too much information on a slide is worse than no information on a slide. So the one thing I've learned is there should be a limited amount of information on a slide in a very crisp and clear way. And don't ever put just word slides more than two in a row. And you should have word slides followed by an image slide followed by a photograph slide. Getting back to word slides. If you have a talk that's all bulleted word slides, you're going to lose your audience very quickly, no matter how interesting it is.

Bob Amen. We've been spending our time today talking about communication. Should communication training be a formal part of scientific education?

Anthony You know, I think so. I used to say no, but I think now the importance of communication and the importance of the public really understanding all of these complexities of science, I've come around and saying that I really think it should be an important part.

Bob Was it the pandemic that was the turnaround time?

Anthony Uh, you know, I thought about that a little bit before the pandemic, but I think the pandemic really nailed it for me.

Bob And what would the core curriculum look like? What is it that they need to get their heads around conciseness, engagement, persuasion?

Anthony I think some of the things I've already spoken to you about know your audience. Don't try to make too many points. At the same time, don't overwhelm them. Don't try to show them how smart you are. Work on getting them to understand what you're talking about. I think that should be the first lesson, and then maybe some lessons into what you were talking about and what your wife alluded to. Make slides that are really crisp and clear and capture the attention of your audience. People should not have to struggle to see what's on your slide once they're struggling. They're going to get tired. And by the time they get a third of the way through the talk, they're going to phase out.

Bob MM mm. Couple of rapid fire questions, if you don't mind. If you could time travel to where would you go?

Anthony Time travel.

Bob Time travel.

Anthony Oh my goodness. I took a classics curriculum in high school and college. I took four years of Greek and three years of Latin in high school, and two years of Greek and two years of Latin in college. I would love to time travel back to the days of the Roman Empire and the Greeks and Socrates and Aristotle and people like that. I'd love to be a sort of a person on the side, listening to their conversations.

Bob So long as it's not a slave.

Anthony That's right.

Bob If you could own any artwork in the world. Any thoughts as to what it would be?

Anthony You know, would be some of Picasso's work, like when Erica and some of those things. Also Klimt I like very much so. I like the the color patterns on his paintings.

Bob Yeah. Wonderful. If you could have dinner with any writer, living or dead. Maybe this is another Hemingway answer. Who would it be?

Anthony Oh, it absolutely would be Ernest Hemingway. Absolutely. Yeah.

Bob He gets a lot of love from the people I interview. Very much an influence on them all. Coffee or tea while you write? Or perhaps something a little stronger?

Anthony No. Always coffee. Yeah. Not tea at all.

Bob Dog or cat person.

Anthony Dog all the way.

Bob Well done. Uh, pen and paper or keyboard?

Anthony Keyboard all the way.

Bob When did you start?

Anthony Oh, I started keyboarding. Uh, I think when the first word processors came out many decades ago. Yeah.

Bob What word or phrase do you most overuse, either in writing or in speech.

Anthony However.

Bob Aha! And what is your greatest linguistic extravagance?

Anthony I'm not sure what you mean by linguistic extravagance, Bob.

Bob I guess if there's a go to word or phrase that's a little on the elevated or technical or pompous side that you kind of use as a crutch, I guess.

Anthony Yeah. With regard to.

Bob Oh, yeah. Okay.

Anthony And it's interesting because every time I write with regard to the word correction crosses it out and says regarding. Yeah.

Bob Okay. Some closing reflections before we end our time together. Um, Tony, when you think about your career now, how would you like to be remembered. I'm not asking about specific decisions you've made or outcomes you've achieved, but for how you approached your role.

Anthony You're right. I mean, I could go through the different phases of my career and talk about the things I'd like to be remembered for. But the common denominator of that, I'd like to be remembered to somebody who literally left it out all on the field. You know, I let it all go and I didn't play the game and leave some energy behind. I left that out on the court or left that out on the field. I gave it everything I had, and you could judge my accomplishments the way you want. I'll let others judge that. But the one thing that was true is that I gave it everything one hundred percent.

Bob Just on leaving it all out on the field. A typical workday for Doctor Anthony Fauci in the eighties and 90s and the aughts. Very, very, very long days. Or did it vary?

Anthony No, it was very long days. I have always worked, you know, fourteen, fifteen hour days when we were in crises. Sometimes it became unimaginable. It was seventeen eighteen. Getting four hours sleep during the early years of HIV and during the early years of COVID, during the anthrax attacks, when we thought we were getting attacked by bioterror from al Qaeda. That was really terrible. Yeah, it's always been long days, but sometimes ridiculously long.

Bob So given that very demanding workload, did you have any strategies to keep yourself intact in body and in mind over that period?

Anthony Yeah. Physical things. I'm a runner. I've run marathons. I've run a lot of ten KS. And I think just exercise has been the thing that has been stress reduces for me. I also am fortunate to have an incredible partner and my wife, who really understands how to stress, reduce and kind of is able to every once in a while say, okay, you gotta stop, that's enough. Go to sleep, drink some water, you know, something like that.

Bob Oh that's great. Final question. If someone remembered one thing about how you communicated during crises, be it your tone, your honesty, your restraint, what would you hope it was?

Anthony Calmness under pressure?

Bob Well, I think you can be absolutely secure in the hope and expectation that that's the way the world look upon you. Tony, it's been an absolute privilege and pleasure to spend this time with you. Thank you for putting it in. Thank you, more importantly, for the enormous effort and contribution you've made to the health of the planet over these many decades.

Anthony Thank you very much, Bob. It's a real pleasure being with you. Thanks an awful lot for having me. Take care.

Bob Thank you so much. Bye bye.

Anthony All right. Bye.

Bob Precision of thought and economy of expression. When the Jesuits were teaching young Anthony Fauci about these principles. I suspect they never dreamed how expertly he would spend decades using these disciplines for the betterment of his fellow human being. What an outstanding person and what an outstanding communicator. And I have to say, I was particularly excited to hear Doctor Fauci's very positive response to the release of the International Plain Language standard on science writing. As soon as he said, right on. I had a flashback to the early seventies. Top of their game has been brought to you by In-Game Learning, the most fun you'll ever learn. Visit ingamelearning.com and see just how much fun online plain language training could be. If you enjoyed today's episode, share it with a colleague. Leave us a review. Or better yet, rewrite something terrible and send it to us. We will love you forever, and so might your target readers. I'm Bob Milstein, and until next time, go forth and clarify.

Anthony Yeah.

Bob Curse.

*This transcript was corrected with Claude AI. The human version is coming soon.

Anthony Yeah.

Bob Curse.

Anthony Fauci on Science Communication in a Crisis

Episode 7: Anthony Fauci