Dana L. Suskind
Appearances
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
There's obviously the implementation, everybody focusing on adherence, but there's also sort of the infrastructure delivery mechanism, which I think is an issue, whether it's government or healthcare, that they're just not set up for interventions, which are sort of like innovations. So you've got these researchers who think of themselves as, you know,
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
scientific entrepreneurs developing the next best thing, you know, thinking, you know, you build it and they will come. And then you've got organizations that are sort of built for efficiency rather than effectiveness that can't uptake it.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
What randomized control trials tell us about an intervention is what that actual intervention does in a particular population, in a particular context. It doesn't mean that it's generalizable.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
But you have to continue the science so you can understand how it's going to work in a different place, in a different context, in a different population, and have the same effect. And that's part of the scaling science.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
One of the most compelling examples is the issue of hypertension. About a third of all Americans have high blood pressure. First of all, the awareness rate is about only 80%. Of the total amount, only 50% actually are controlled. We have great drugs, right?
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
But you can see the cascade of issues when you have to disseminate, you have to adhere, et cetera, and the public health ramifications of that.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
When the researcher starts his or her experiment, the inclination is, I'm going to get the best tutors in the world, so I'm going to be able to show how effective my intervention is.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
You only needed 10 math tutors, and you happened to get the PhD students from the University of Chicago. And then what happens is you show this tremendous effect size, and in the scaling, all of a sudden, you need 100 or 1,000. And you no longer have that access to those individuals.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
And you go either down the supply chain with individuals who are not quite as well-trained, or you end up having to pay a whole lot more money to maintain the trained tutor program. And one way or the other, either the impacts of the intervention go down or your costs go up significantly.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
All of us, our lives get busy. We forget.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
And yet... When I put the internal device in, it stays there. But it actually requires an external portion as well, sort of like a hearing aid. And that is the part where you see issues related to adherence. Just because I put the internal part doesn't mean that an individual or a child will be wearing the external part.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
I mean, we have figured through randomized control trials to understand causation, real impact in the small scale. But the next step is understanding the science of how to use this science. Because, you know, how you do it on the small scale in perfect conditions is very different than the messy real world. And that is a very real issue.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
Usually when children are born deaf, they call it nerve deafness. But it's really not the actual nerve. It's little tiny hair cells in the cochlea.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
My job is to implant this incredible piece of technology which bypasses these defective hair cells and takes the sound from the environment, the acoustic sound, and transforms it into electrical energy, which then stimulates the nerve. And somebody who is severe to completely profoundly deaf after implantation can have normal levels of hearing. And it is pretty phenomenal.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
I guess you could say I'm a surgeon by day and social scientist by night. My clinical work is about taking care of one child at a time. My research really comes out of the fact that not all children do as well as others after surgery and trying to figure out the best ways to allow all my patients and really children born into low-income backgrounds to reach their educational potentials.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
I think that really the hard part is the night part. I love doing surgery. I adore my patients, but it's actually not as hard as many of the complex issues in this world.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
Yeah. It's not simply about hearing loss. It's because language is the food for the developing brain. Before surgery, they all looked like they'd have the same potential to, as you say, zoom up the educational ladder. After surgery, there were very different outcomes. And too often that difference fell along socioeconomic lines.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
That made me start searching outside the operating room for understanding why and what I could do about it. And it has taken me on a journey.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
I always joke that I was wooed with spreadsheets and hypotheses.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
Yes, yes. In fact, the reason I decided to marry him was because I wanted this area of scaling to be a robust area of research for him. Because it really is a major issue.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
We've actually moved away from the term 30 million words because it's such a hot-button issue.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
Well, no. I mean, some people say, look, it's a deficit mentality. You're talking about what's not there. And then the replication, somebody did another study that said, oh, it's only 4 million. And it really isn't actually legit. even the point, because it's not even about words. It's about the interaction. So I just made the decision.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
I'd rather be focusing on developing the research than fighting a naming battle.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
Well, that's what everybody gives me trouble for. It stands for 30 million words, but only I know that.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
With this idea that, you know, we need to take a public health or a population level approach during the early years to optimize early foundational brain development. Because the research is pretty clear that parent talk and interaction in the first three years of life are the catalyst for brain development. And so that's basically our work.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
Initially, we started with an intensive home visiting program, but understanding that to reach population-level impact, you need to develop programs both with an eye for scaling as well as an eye for understanding where parents go regularly. Because healthcare, unlike the education system, the first three years of life really don't have any infrastructure in which to disseminate programs.
Freakonomics Radio
Policymaking Is Not a Science — Yet (Update)
So we actually expanded our model. multifaceted program that reached parents where they were from maternity wards into pediatrics offices, into the homes, as well as group sessions. Those programs that are most vulnerable to the issues of scale are the complex sort of service delivery interventions. You know, anything that takes a human service delivery. Scaling isn't an end.