The Remarkable Value of Thinking Broadly: A COVID-19 Trifecta

; Zeynep Tufekci, PhD

Disclosures

October 28, 2020

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This transcript has been edited for clarity.

Eric J. Topol, MD: This is Eric Topol for Medicine and the Machine. It is a real privilege today to speak with Professor Zeynep Tufekci. I've only known Zeynep through her writings, but she has to be one of the most interesting people I've ever gotten to know through words. She is a professor at the University of North Carolina at Chapel Hill. She began her education in Istanbul and earned her PhD at the University of Texas at Austin. Her area of expertise is the intersection of digital artificial intelligence, society, and sociology. Welcome, Zeynep.

Zeynep Tufekci, PhD: Thank you for inviting me.

Topol: This is a real treat. You've been a leader and great thinker even before the pandemic, no less intra-pandemic. I'll start off with this quote from the recent profile about you in The New York Times at the end of August. It was a quote from epidemiologist Julia Marcus at Harvard. She said, "I've just been struck by how right she has been." You write for The New York Times, and you've been writing a series of amazing articles about the pandemic in The Atlantic. How do you get it right?

Tufekci: Now that you said it, I'm almost certain to get the next thing very, very wrong, by regression to the mean. I guess what I could say is that I was at the right intersection for the work I was doing. As you've noted, I'm a professor and that has given me a lot of flexibility in terms of my work. And I have a very eclectic training. I have a computer science background and a sociology background. I also have learned a lot about a lot of different things, partly because my home field, technology in society, wasn't even recognized as a field until recently. We have been trying to explain how these visual technologies are changing the way we live and interact in society.

I've had a broad interest in many disciplines over time, and I have some education along with my own learning about many relevant aspects of this pandemic. Also, I used to teach the sociology of pandemics as part of my introduction to sociology classes, because it's a very interesting way to get students to think about the globalized world. It's a little abstract, but with pandemics, you can talk about network theory, you can talk about globalization, you can talk about all sorts of things. What in the world is more interesting than viruses, right? They're fascinating little buggers.

Plus, I was doing research on social movements and the public sphere in Hong Kong last year. I'm interested in authoritarian governments and authoritarianism, partly as a result of my own research, and partly because I'm from the Middle East. When we started hearing at the very end of December about this mystery viral pneumonia, I started paying attention. I had read a lot about SARS and I had seen SARS as a "well, that was close" phenomenon. I think a lot of people translated that message to show that we can contain this. But I got the other message: I thought, This was really lucky. I thought we were within an inch of a major pandemic and we would be lucky to contain it. So in late December, I started watching it partly because I was hoping to go back to Hong Kong.

'By January 7th, I'd Ordered Masks'

There was very little news for a while, and then all this conflicting news. With authoritarian governments, there's a rule of thumb that you should look at what they do, not necessarily what they say. I think a lot of people misunderstand the nature of the Chinese government; they may be authoritarian, but they're far from stupid. They're very strategic in many ways, and they're not going to shut down a city of 11 million over something little. So when they shut down Wuhan, I thought, Okay, everything we've been told, like there was little human-to-human transmission, none of that must be true, because if it had been more like MERS, they wouldn't have shut down the whole city. So I knew it was a big thing.

That was my first moment. If you look at my Amazon orders, it's kind of funny. By January 7th, I'd ordered masks because early on, I thought, This is a big deal. Maybe something's happening. When Wuhan shut down, I started ordering hand sanitizer and started canceling trips.

When China finally started letting Chinese scientists publish, there was an article in The New England Journal of Medicine. It was small, but it was our first epidemiology out of Wuhan because there weren't that many cases yet. Strikingly, it said that some of the patients were showing atypical clinical signs. They weren't necessarily having fever. I knew that SARS came with fever, and that's how we were able to point temperature guns at people and identify them during the infectious phase. When I saw that COVID-infected people didn't necessarily have fever, that's when I said, "Okay, we're going to get hit." And I started tweeting about it, saying, "We will need millions of tests if this is the case, if we can't just detect them with a thermometer." That's where I was in January.

At that point, I still hadn't really thought of a role for myself. I was ordering my own supplies, canceling trips, kind of getting ready for something to happen, but I didn't see a role for myself. And then weeks kept passing. Papers kept coming out. To their credit, once they were allowed, Chinese scientists gave us excellent material to know what we could expect. But all around me, it was like everybody else was on a different planet. I was looking at newspapers and I was seeing op-eds that were telling us, "Don't panic," "It's okay," "Beware of the pandemic panic," "These travel bans are about Trump's racism." The discussion didn't seem to be about what we were about to get hit with. It seemed like we were dancing around the actual issue.

We had cases popping up all over the world. Then I started watching in my own sphere: people planning conferences, planning trips, planning all sorts of gatherings. At this point, it was the middle of February. Toward the end of February, asymptomatic or presymptomatic spread is being documented. People are spreading the infection without necessarily being very ill.

Cases are popping up around the world. And I'm thinking, What are we doing? Why aren't we getting ready for this? I was trying to convince people — "Let's not hold these big conferences, let's not do these things" — but I couldn't find articles to send to them.

I'm generally a big critic of Silicon Valley. I think they have a failure of imagination about their own products. I was writing about the misinformation potential of Facebook in 2012 and being laughed at. But the tech industry, partly because they have a stronger interface with China, started reacting. They started canceling conferences. But I saw a lot of people treat them like they were paranoid.

The survivalist preppers were all-in on this. But they're always prepping for the next end of the world, so there was this sense by others that taking it seriously was overreaction. That's when I thought to myself, I have to write something. Child kidnapping is every parent's nightmare, but it's rare and not something you should be thinking about all the time. Doomsday is an exaggerated risk. But pandemics are a recurring feature of human history. Preparing for them is not crazy doomsday prepping.

'Fatality Rate and R0 Are Not Fixed Numbers'

I owed Scientific American a blog post. I normally write about tech and society. But I asked if I could write about this, and my editor agreed. And they published it. That piece was basically about things that are not surprising to anyone anymore. But, as far as I know, it was the first mainstream piece trying to explain the idea of flattening the curve, which is well known to any epidemiologist.

I felt like no one was explaining that if we got slammed with cases, the hospitals would suffer and that would be terrible. I tried to explain that things like the case fatality rate and R0 are not fixed numbers; they depend on how we get ready. I tried to say that this is not something that only doomsday preppers do. And then I included very practical suggestions. For example, try to stay home for a couple of weeks, because at this point, we're not completely sure about transmission routes. Buy a couple of weeks' worth of food, don't go on that trip if you can avoid it — not just for yourself, but let's not have a hospital overload. It got a lot of attention. Hillary Clinton retweeted it and it went viral. That was my first step into writing about it.

The First of Three Was a Tipping Point

Topol: That foreshadowed several great things to come. I'd like to break this down to three areas you have written about. Next, you led the charge on the mask story. You sent out an incredible tweet storm on March 1st. It was a hyperalert: Hey, you know what might help here? Masks. Then you put it together subsequently in an op-ed for The New York Times. You changed the CDC's view; even people there called it a tipping point. What were you thinking? I mean, it's a respiratory virus, and now it looks obvious, but you were ahead of that curve.

Tufekci: Thank you. When I wrote that, masks were already almost sold out. I had said in my Scientific American piece, "If you can't get a mask, don't worry about it; wash your hands." That's what we knew at the time. But then a lot of people got mad at me because I linked to a list of strategies that included wearing masks. I also got an enormous amount of communication from epidemiologists and health communication specialists saying, "Don't tell people to use masks; masks are harmful." And I remember thinking, Say what? I remember getting this enormous pushback from the public health community saying, "Masks don't help; they harm." And I started thinking, What is the argument here? I tried to understand this. I can understand the argument that we don't know enough; that's a potential we could discuss. But the idea that masks could be harmful was the first one that got my antennas up because I didn't realize how widespread their harmful message was.

I tried to ask all these professionals with PhDs and MDs, "How are masks harmful? I don't want to harm people. What am I missing? What am I not understanding about this harm?" I heard two basic arguments. The first was that masks would provide a false sense of security, that people would wear masks and not wash their hands. That assumes that handwashing is more relevant, which doesn't seem to be the case. But let's leave that for a second. A false sense of security is more my domain and an attractive intellectual argument. It gets the contrarian in me thinking, Oh, unexpected result. But it's been researched to death and debunked for many previous safety devices, from seat belts to helmets.

Whenever there's a new safety device, someone says, "What about a false sense of security?" Then we do research and we find that even if this applies to some individuals, the first-order effect always overwhelms this little tail thing — false sense of security. Plus, even when it is relevant, it involves things like recreational skiing or something where thrill-seeking is the business. From everything we know about humans and sociology, the mask should increase compliance with everything else because you're signaling that something is wrong. If people are trying to avoid the deadly disease, they're not going to only wear a mask and not do everything else; they're going to do a lot more.

Since then, we have a lot of research that shows that mask-wearing increases compliance with everything else. So I immediately said that the false sense of security and risk-compensation argument doesn't make sense. It doesn't apply to this. If anything, we would expect the opposite.

The other thing I heard was, "What if the outside of your mask is contaminated?" I'm thinking, That sounds like success to me. If the outside of my mask is contaminated, I didn't breathe in all that contamination. I want the outside of my mask, rather than my nose, to be contaminated.

Then there were all these arguments about how people can't figure out how to wear them, which also didn't make sense, because when people don't wash their hands long enough, we have education campaigns. Plus, if people wear them a little less than perfectly, that's still better than zero masks. So that didn't make sense either. And, of course, masks for source control cannot be measured with randomized controlled trials because you're not measuring an individual's trajectory.

I finally realized that people were in a groupthink. The real thing that was going on was a fear of the mask shortage and people hoarding. We had talked ourselves into a corner. We could have said, "Look, masks are probably useful but we don't yet know how useful. It makes sense to use masks for a respiratory disease. There's no downside to them." But we were afraid of the shortage. We should have talked about the hoarding and shortage — something that treats the public as a partner.

I saw this hostility to the public and it had cornered itself into a groupthink among the public health community, too. Instead of saying, "Don't hoard masks," we were saying, "They'll harm you." I thought, This is terrible, because we're going to have to change this policy. And when we change the policy, people won't believe us because a pandemic is a communication emergency. Be right. Be first. Be credible. We're going to have to switch messaging at some point and then we're not going to be credible.

Taking a Stand — and a Risk

My tweets start from March 1st. I waited, though. I didn't just go in swinging because I kept thinking, There will be some doctor or public health professional who will come and write the definitive article saying, "Let's come to our senses." And I waited until mid-March. And then, thinking like a sociologist, I thought groupthink sometimes can't be broken by the group. It might be harder for the doctors and the public health professionals to go against the CDC or the WHO, because what needs to be said is, "The CDC is wrong, the WHO is wrong." That's a terrible message in some way. They're not wrong in the sense that they're terrible organizations; but in this particular thing, they happen to be wrong.

So I said to myself that I will do this. I believed it would probably end my career. I never in my life thought I would be writing a piece saying the CDC and the WHO are wrong on a medical topic. But I figured I could take this risk. If I get canceled, I'll be branded in a way similar to an antivaccination person. That's what I'll sound like to lots of people. But it needs to be said because we have a pandemic and people are still traveling. Also, because of my Hong Kong connections, I had been watching the infectious disease specialists in South Korea, Hong Kong, and Taiwan. They have top-notch people there who'd been through SARS and they were making a very good case for mask-wearing. The science was there.

I just thought, All right, I'm going to publish this, and if we're going to go out with a bang, so be it. I had access to The New York Times and I thought I might as well end my career in The New York Times. I submitted the piece and I got lucky with an editor who didn't want me to hem and haw. I said, "Just think through this. It's not something that requires an advanced degree. It's a respiratory disease. We have the CDC and the WHO saying wear a mask if you're sick. Now we have tons of papers saying that there's pre- or asymptomatic spread. So on face value, you don't even know when you're sick and spreading it, so there should be no debate about this. I understand the mask shortage, but that's something we can talk about. Trust the public. Let's talk about the shortage and how to deal with it."

I wrote that thinking it would probably be my last public piece. I would go back to my tech and sociology life.

Instead of ending my career, it opened the floodgates to the debate. I'm honored to have played that role. It is amazing that it opened that debate because it was a low bar. The arguments against masks made no sense. And the groupthink simply blinded many people to the fact that they really made no sense. We were gaslighting the public, so to speak. A lot of people started saying, "Yeah, this makes sense." And then I started hearing from doctors and epidemiologists and public health people saying, "I was thinking this too."

Topol: You started a new groupthink, actually.

It's Safer Outside

Tufekci: Right. That's how we got into all the rest of it. Parks, ventilation, dispersion. By that time I had probably read every paper about all of this. I may not be a virologist, but because I am an academic, I can sit and read and try to understand the statistics and the claims and all of that. By mid-March we had a lot of papers, but it was still a manageable number.

Next, I started seeing parks being closed and we started getting the superspreading reports. This interacts with sociology. We know from HIV and other research that if you don't let people have essential things, if they don't have a way to do essential things in a safe way, and you are overly restrictive, they'll just do it out of your sight. If you close parks, this just increases the odds of indoor gatherings. At that point, we already had people arguing that there was aerosol transmission and there was increasing evidence for it.

At that point, we had many reports of superspreading events that were all indoors. There was enough epidemiology. Plus, we had all of these previous pandemics and the simple physics of it: The virus will be diluted outdoors compared with indoors, with sunlight and the effects of UV. It would simply be better to be outdoors than indoors. I started writing these pieces saying, "Don't close parks. If you need to have congestion, try to manage the congestion. Try to have spacing in the parks and outdoor areas."

Topol: You called out the crowded beaches; why were people using that as their callout to the problem of the pandemic?

Then you got into ventilation. This is a bit simplistic and reductionist, but this was the second of your three big hits. First was the masks. Then you figured out the issue of ventilation and how we'd have a serious problem if we're going to be indoors. That is where the superspreader events are. And you autodidactically became an expert in ventilation filter aerosol. Tell us about that.

Droplets Don't Make Sense

Tufekci: Writing about parks and the outdoors and the beach pictures led me down the path to all the research about transmission methods. There were an increasing number of events that simply could not be related to droplet transmission. You had the restaurant with the air conditioner study. You had the choir in Seattle. You had the bus. The result is very interesting shoe-leather epidemiology. I started sort of looking at it and thinking, How? The WHO had this ballistic droplet image of transmission. You know: You spit it out somehow and it kind of lands on the other person. I'm looking at the epidemiology and thinking, There's no way this is droplets. You could potentially argue fomites and contact, but you have to twist yourself into a pretzel. Take the person in the choir. What did they do? You have the South Korea megachurch. If it was droplets, you shouldn't see this much outdoor/indoor difference. This idea of droplets was not making sense.

I started reading up on that and as I read, I encountered the aerosol engineers who normally study indoor air quality and things like that. They were tearing their hair out because, as we have since learned and they have since successfully convinced a lot of people, the WHO had an incorrect understanding of microbe sizes and the physiology and physics of droplets. I started reading all of these papers and I'm thinking, Wow, these people are right. And once again, there is a sociology to it.

I used to teach about the John Snow pump and cholera studies, because it's a very good way of thinking about how to eliminate alternative hypotheses. I knew about all of that and about the miasma theory. The public health community had successfully fought against theories that were wrong, like the miasma theory that assumed that dirty air brought the diseases. Instead, they developed the germ theory. They made a successful argument that these little things that you don't see in this beautiful, clear glass of water are killing you, whereas this filthy air that you're breathing is harmless. This was counterintuitive, right? But they were right and the public was wrong.

So here we are, 6 months into a respiratory pandemic, and I thought, This is nuts. I am still smelling bleach everywhere, but nobody is opening doors or windows. I am getting these emails from the airlines — Delta, United — saying, "We clean all of those seats and everything in between." And no one is telling me something that is actually to their advantage: They do air exchange and filtration 10 times an hour. I was thinking, I don't want to breathe your bleach. That's not good. I don't want all of those disinfectants when we have almost no cases from fomites.

It was just driving me nuts that we were not opening windows and improving ventilation. We're going to try to open schools and colleges. People are going to get quarantine fatigue. And some of the ventilation precautions that people can do are as simple as opening a window or meeting on the porch instead of in the living room. But we're not telling people that. We need to be thinking about ventilation.

I decided to dive into this very deeply. I went to my editor at The Atlantic and said, "I'm going to write about aerosols and ventilation." And he agreed to look at the draft. I turned in 5000 words on a topic that seemed kind of obscure at the time. This is July. At this point, I've thrown caution to the wind because I'm upset that we're not opening windows, we're not going outside enough. And they published it.

I was so paranoid about getting it right that I hired someone and said, "Go at it like I'm your worst enemy and try to see if I got anything wrong." I must have read at least 100 papers, because that's the thing I can do.

What happened next was amazing too. A lot of people read it. Some people sent it to Dr Fauci and said, "What are we doing on this?" And apparently he sent it to, among others, the CDC task force. Scientists were already lobbying him and others on this.

There was a letter about this to the WHO that was signed by, I think, [239] top scientists. But that was directed toward the scientific community. I had written something long that was directed at the general public who wanted to understand what was going on. I just explained as much as I could, not necessarily assuming that they knew a lot of background. I'm told that the article put pressure on various health agencies to think about what they could do about ventilation.

Explaining Superspreader Events

Topol: That was a great contribution. It rebooted the importance of aerosol transmission, and not to be so hard on people about being outdoors, and to actually use the UV light and the outdoor environment to our advantage. That is liberating and it's good for mental health. It was a great contribution.

But my favorite of all your writings was the most recent one about superspreader events. This was amazing. Kai Kupferschmidt in Science wrote a really good piece. Adam Kucharski at the London School of Hygiene & Tropical Medicine has written several articles. But you took it to another level. You got granular. What propelled you to write this? Obviously, it interacts with the masks and the aerosol, right?

Tufekci: I had gotten very deep into the science of aerosols. And part of the argument for aerosol transmission was the superspreading events. At this point, I was reading old papers, effectively all of the papers.

One thing that is my longtime interest is complex systems thinking and how the probability distribution really matters. When we teach methods, this is something we try to teach. We're more used to thinking of Gaussian distribution, where the average is representative. If you look at something like height, most people are neither tall nor short. This is the intuitive way of thinking about things. But many things, like wealth, have skewed distributions with fat tails: Some people have a lot of money right now. These kinds of things behave differently, and you have to think about them differently.

At this point, it had become clear that there were enough papers showing that this was a superspreading kind of pathogen. As you've noted, there was the Science article by Kai Kupferschmidt. It was a great article, but people didn't take it and say, "Well, then, what do we do?" There was another article in Bloomberg at the same time, and once again, they were making the point very well. But there wasn't an effort to understand what this means. How do we think about it? That's something you normally have the WHO and the CDC do for you. They look at the epidemiology and they say, "You know what, this is a superspreading disease; therefore, you have to do this, this, and this, compared with flu, which is less of a superspreading disease." That wasn't happening.

I thought, Okay, I got away with ventilation, so maybe I can write one more thing about the overdispersion — the way it's concentrated. I read and read and thought and thought and talked to tons of people. There are all of these experts who are working on aspects of the implications of superspreading. But there wasn't a piece that said to the public, "Here's how it all comes together." So I said, "Let me do it" and my editor at The Atlantic said, "All right, let's do this." Another 5000-word piece because I think people want the information. They want to be empowered. They want to be treated as partners. Again, in an ideal world, this is what the CDC and the WHO would be doing for us. And fascinating luck for me, it was published 2 days before the White House superspreader event. Why would that happen?

Topol: Your piece was the warm-up for the Rose Garden event.

Tufekci: Also, the day it was published, another paper came out from India with data from more than 80,000 patients that found the same thing — that about 8% of the cases were responsible for 60% or 70% of secondary infections. And immediately thereafter, there was another big event in which lots of people got infected, but it happened at the White House and we don't have contact tracing.

Just-so Stories

Tufekci: There are all of these mysteries to this disease that I think we were kind of papering over. For example, why, in Italy, was Lombardy hit hard but not Rome? I kept hearing these explanations: the weather, the vitamin D, they have this and they have that. And I kept looking at the data and thinking, This is what in evolutionary biology you call a just-so story: Something happens to have evolved, and you go back and think exactly what might have worked, but you're actually making up a story. It doesn't really explain what happened. It seems like a good story, but it doesn't exclude other explanations.

Why Lombardy but not Rome? Or why not? If it's the weather, why not the area of Switzerland bordering Italy? Yes, I can explain why big cities get hit. I can explain why the age gradation matters. But there are so many similar places with different outcomes. There were places in Ecuador with bodies in the street, but not in Colombia. It just wasn't making sense. We were, I think, sweeping all of these puzzle pieces under the rug. We had a story for each of them, but they didn't hold together. What about all of the places, like Japan, that were supposed to have catastrophic outbreaks but did not? Or South Korea, which had multiple major outbreaks. South Korea had terrible luck with that megachurch superspreading event very early on, when the world wasn't ready at all. How did they manage? There also were all of these sustained success stories that weren't being explained.

So when I went back and tried to make sense of it, which involved, of course, understanding ventilation, it turned out that aerosol transmission begins to fit things together. Now, I'm not saying that's the end of the story. It's very humbling. I love reading the history of pandemics. One of my favorites is yellow fever because it's quite puzzling until you know what exactly is happening, which is that it's spread by mosquitoes plus particular incubation periods. If you don't know this, it looks like the weirdest thing. Somebody sick comes into the city, but nobody in their household gets sick. But everyone five houses down gets sick 3 weeks later. People in prison don't get sick at all. What's going on?

It looks so weird until you understand that it's the mosquitoes. The prison is protected because it has high walls that the mosquitoes don't fly over it. The people in the household don't get infected because the person's not transmitting. But five houses down, they just happen to have standing water in the yard. So in retrospect, it makes perfect sense. If you read the contemporaneous accounts of people trying to puzzle through yellow fever, they weren't stupid at all. They thought hard about the evidence. It was just very hard to put together until they did. And once you see it in hindsight, it looks obvious.

Topol: That's the theme here. You keep doing that. In the case of the superspreaders, some articles used various tools like genomics to show that 70%-90% of the event's transmission chains were through superspreader events. Most transmissions weren't even occurring outside a superspreader event. It's extraordinary because here, again — just as you did with Twitter and Facebook pre-pandemic, you were all over the potential downsides of social media and the election before others saw a problem. If I look up "prescient" in the dictionary, I think I might see your picture.

Tufekci: That's very kind.

'It's a Generalist's Way of Thinking'

Topol: I think it's true. My take is that you have the data, you read assiduously, you review all the evidence, and you think mathematically and logically. You stick with it. You don't get modulated or diluted in terms of your thinking. What's the next piece you're working on?

Tufekci: I don't know. If you do these "big think" attempts, as with yellow fever, it's humbling. All these smart people can get it wrong because they don't have the missing puzzle piece. There's no doubt that I'll get stuff wrong eventually. That's just going to happen. But I have stumbled onto a couple of things. Because my original fields are technology and sociology, I didn't have the disciplinary constraints. I'm used to thinking about the way technology interacts with society. I'm used to thinking about everything from how machine learning works to how human psychology interacts with social media. There's no way to think only one of those things. It's a generalist's way of thinking. But it's not without empirical grounding in whatever it is you're working in, because otherwise you can just become a contrarian. That's the nightmare. It could be really easy to go from being a generalist and having all of these ideas to being a contrarian and saying, "I know this so now I'm going to opine about everything." You have to be supercautious about that.

In programing and computer science, there's this idea of the full-stack developer, where you go into every level of a thing. What we do with things like masks or ventilation, superspreading, or technology in society is that people tend to specialize in looking at one aspect of it. The tech people know the code. The sociologists might look at society. Psychologists might look at human behavior. But it doesn't occur in any one of those fields. So everybody's looking for the keys within their own particular light.

We tend to train people that way too. We have a very beautiful tradition in the United States, the liberal arts education, which is amazing. You get to be the sort of broad thinker. Then we take people to grad school and we narrow them down, which is fine. But then you have to pull them out again. I have no problem with people diving deep into one particular aspect, because without that, you're superficial. With ventilation, you need the people who are going to figure out exactly what is wrong with the physics of droplets. But you also need people who can remain empirically grounded in that. You're not making up your own facts. You are doing scientific thinking and analysis, but then bringing it together with everything else it interacts with.

It is a kind of systems thinking. I kind of stumbled onto it, partly because I have an eclectic educational background. I went from field to field. I don't come from an elite background; most of my schooling has been pretty terrible, so I didn't get beaten into the disciplinary mold. I'm not saying the disciplinary mold is terrible in and of itself, but there are a lot of problems, especially these complicated problems, for which you need the full-stack, across-the-spectrum kind of thinking.

Plus, as an academic, I have the privilege of reading 100 papers and then writing 5000 words about them. But I believe I should make the strongest case I can for what I think is correct. If it turns out I'm wrong, I should be first to say, "Someone showed me I was wrong." That's a very important thing. But I shouldn't be timid. I should say, "This is what I think is happening. Here's the best case for it."

Topol: That's one of the great lessons we can learn from you: to stand behind the work. You could retire now and feel really good about your career. What do you think is next?

Tufekci: I really don't know. But I want to keep saying this: The value here is in trying to do this kind of thinking rather than just taking these big swings. You're going to miss. There's no doubt that everyone who takes a lot of big swings is going to miss something. But the swings are still worth trying to take and think through. I want to go back to what I jokingly call my hobby of technology in society because we have all of these Twitter and Facebook things going on. I definitely want to write a lot more about technology and society, because it's pretty clear that we are going through a major historic transition and we need to tame these things.

Deep Research and Writing for The Atlantic

Topol: You were there years before anyone else; you had foreseen the downsides. For example, you explained how the 2016 election could be manipulated through social media, through interference and, of course, Twitter.

But what is striking here is that this is a pattern that we see: It's kind of like the deep neural network of Tufekci here. The great thing is that a lot of people think, Oh, I can't write for The Atlantic. You have to be a journalist and be great with metaphors and have flowery language. Well, you know what? You can write beautiful work in The Atlantic, which has had some of the best contributions in the whole pandemic and beyond. But what you're doing is deep research and formulation of conclusions. And, as you say, you're not mealy-mouthed about it. I want to congratulate you.

Tufekci: One of the things I want to tell people is that I'm actually not a good writer. And this is not false humility; I'm the woman who just said, "All right, I'm going to get canceled" and wrote about the CDC and WHO being wrong. So I'm not being humble. But I swear I am not a good writer. I'm an idea person. I am a thinker. And I have learned how to write better through many years; English isn't even my first language. But the thing here that's carrying the work is the ideas. So I just want to tell people that it's not about writing. I'm never going to write the great American novel because it would be terrible. I'm never going to write like the kind of literary stuff that I adore and I read. But that's not what I do. This kind of thinking — looking across multiple domains, trying to do synthesis, trying to kind of argue with yourself but also come to a conclusion — these are not things that require degrees. These are things that require work, for sure, but they're not things that require literary talent.

Topol: Well, you do it and we're learning from you. You've become what I would say is like an oracle for a lot of us. So, Zeynep, I want to thank you. This has been really fun. We'll be following you on your next chapter with great interest. I know that some people are going to root for you to be wrong, but I don't know — it's pretty unlikely.

Tufekci: It'll happen. And that's the nature of taking swings. I'm not afraid of being wrong. I just want to make sure that I made my best intellectual effort. And that's all I can do.

Topol: Thanks so much for joining us. And thanks to everybody for joining us on Medicine and the Machine for a fascinating conversation with Professor Tufekci.

Eric J. Topol, MD, is one of the top 10 most cited researchers in medicine and frequently writes about technology in healthcare, including in his latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.

Zeynep Tufekci, PhD, is a sociologist and regular contributor to The Atlantic who also regularly writes for The New York Times and Wired. Prior to the pandemic, her work focused on the social effects of technology. She published her first book, Twitter and Teargas: The Ecstatic, Fragile Politics of Networked Protest in the 21st Century, in 2018.

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