In this episode, we talk with writer Dustin Grinnell. He takes us behind the scenes on his ideas for his books, his research process, and how he brings medical stories to life. We also delve into the realm of speculative fiction, and how that intersects with medicine, technology, and ethical dilemmas.

Dustin Grinnell is a writer.

He shares his story and discusses his book, The Empathy Academy.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Dustin Grinnell. He is a writer, and he’s the author of the book The Empathy Academy. Dustin, welcome to the show.

Dustin Grinnell: Thanks for having me.

Kevin Pho: So we’ll talk about your book in a little bit, but first off, can you just share your story and journey to where you are today?

Dustin Grinnell: Yeah, of course. So I am a Boston-based writer. I write nonfiction and fiction. In nonfiction, I write personal essays and narrative journalism. In fiction, I write short stories and novels. I’ve written three novels now: The Genius Dilemma, Without Limits, and my new book, The Empathy Academy. And I’ve written a dozen or so short stories, and some of those have been published.

Kevin Pho: So tell me about the intersection between medicine and the stories that you write.

Dustin Grinnell: Yeah. So my background is a bit unique for a writer of fiction. I have a bachelor’s in psychobiology. I was also a pre-med major, and then I also went to graduate school to get a master’s degree in physiology at Penn State. And so that represents a lifelong fascination I’ve had with science and medicine and technology.

I grew up reading books just like that, too. My idol was Michael Crichton, who, I’m sure you know, was a Harvard-trained medical doctor who then started writing medical thrillers, and that led him out to California and kept his career going as a writer of technology thrillers. So I grew up on those. I grew up reading cautionary tales about technological advances, whether it was Kurt Vonnegut, or Ray Bradbury and his book Fahrenheit 451, or the book 1984 by Orwell. So it’s always been really natural for me to base fictional stories in science and in medicine, and to then explore the ethical complexities of those fictional technologies or fictional medical or scientific contexts.

Kevin Pho: So tell me the process of incorporating medicine, technology, and some ethical dilemmas into your stories. Do you start with specific medical advances and dilemmas first and then base a story around that, or do you start with a story first and incorporate these dilemmas and medical advances and technology into the story? So tell me about the process of how you incorporate medicine into your stories.

Dustin Grinnell: Yeah. So I wouldn’t call myself a literary writer by any stretch of the imagination. I’m sort of a high-concept, idea-driven commercial writer. So, much like Michael Crichton’s work, my stories are really more about the ideas, and the plot and the character development are kind of secondary to those “big ideas,” if you will.

So what I do is I write speculative fiction. The subgenre of speculative fiction is like sci-fi or fantasy. So any speculative fiction writer is always asking that “what if” question. So I think all of my stories start from a “what if,” right? What if this happened? What if the technology existed? And if so, how would humans deal with it, and how would it affect our society? And so I’m often dealing with this big what-if question, much like every Black Mirror episode starts. What if we could remember everything? What if we could bring back the dead through an android and place the consciousness of a loved one into a robot? What would that do to society, to our relationships? What are the interpersonal ramifications of technology?

So in my first book, I was dealing with the idea of smart drugs. What if we exponentially increased our intelligence, and what would be the ethical implications of that? The second book, Without Limits, is using nanotechnology to vastly increase our biological capacity in the physical sense.

And then my third book is The Empathy Academy. Over the years, I’ve really been drawn to, or darkly fascinated by, scandals and scams and cons. And particularly, I think it started with Lance Armstrong and his scandal, and then it went to the 2008 financial crisis and the unethical behavior that led to that, and the Bernie Madoff scandal, and then most recently Elizabeth Holmes and her fraudulent blood-testing technology and her company, Theranos. And I asked this kind of what-if question: What if we could identify future wrongdoing before it happened? What if we saw it coming, and what if it was related to one’s genes, a complex cluster of genes that drive certain behavior?

And so the book really revolves around this ability to predict future behavior. What is the relationship between how our genes affect who we are and what our behavior is, versus our environment? It’s the nature-versus-nurture discussion. So the book tries to dramatize that nature-versus-nurture discussion.

Kevin Pho: Before starting off and writing a speculative fiction story, how much research do you do before going about writing it?

Dustin Grinnell: A pretty significant amount, I would say. If I get captured by an idea, I’ll start to read around it. For example, with The Empathy Academy, because I was so captured by the idea of scandals, and why did Bernie Madoff do what he did, and then the Elizabeth Holmes scandal happened, I really did a lot of research around the science of ethics and morality. So why do otherwise good, well-intentioned people cross ethical and moral lines, right? So a lot of the research was around, what are those cognitive biases we have that get us into trouble? What are the psychological and organizational pressures that force us, that make us bend the rules, break the rules? And so I really dove into all that research.

And I think there’s always the question: Do you get caught in research, and you’re stuck there, and you don’t do any writing? And that’s a real possibility. So for me, I always do enough to get the story started, and then as I’m writing, I’m continually reading new books, talking to new people, seeing documentaries, and reading the literature that informs the story. So you kind of have to be open as you’re composing, and you even have to be open to new research when you’re in the editing phase, in your later drafts.

The Empathy Academy uses CRISPR technology to change the genes of adolescents in order to turn on these fictional empathy genes. And I had started outlining the book and writing the book before CRISPR really even came on the scene, so I didn’t know how I was going to “change” people’s genes effectively in fiction, because my fiction is very hyperrealistic. I need to actually do what Michael Crichton did in Jurassic Park. He substantiated the possibility of bringing old dinosaur genes to life. So I needed to do that too. So when CRISPR came on, I knew immediately I had something to hang my hat on. It’s just always being open to new developments that can help drive your story.

Kevin Pho: We’re talking to Dustin Grinnell. He’s a writer, and his latest book is called The Empathy Academy. So, Dustin, you’ve been talking about your latest book during this conversation. What are some of the other key messages that you want readers to come away with after reading it?

Dustin Grinnell: I think one of the things that is important, that I learned through writing the book, is that we should all be aware of the psychological and organizational forces that are at play in our work and in our personal lives, and be kind of aware that we’re all not too far away from crossing moral lines, if given the right forces at play. Like I said, the book was really inspired by Bernie Madoff, and for me, it was really, how does someone like him engineer that? He started off as this kind of master of the universe, very well respected by his family and by people in his industry, and then he sort of just started cooking the books, right? And why did that happen? And I think educating ourselves about the science of ethics is very helpful for us to not fall into similar traps.

In the case of Madoff, I think his behavior can be partially explained by what’s called loss aversion. And I encourage people to go to a website called Ethics Unwrapped. It’s a really good place to learn more about the science of morality and ethics. Loss aversion is this idea that we dislike losses about twice as much as we enjoy gains. And really what that means is that we’ll take much greater risks in order to avoid loss than we would to actually get something.

So in the case of Madoff, it may very well have been that when the economy turned and his business was in dire straits, he had trouble just admitting failure and just saying, “Potentially, I’m going to have to suffer major losses here.” And instead, he started taking major risks to avoid loss, through the process of loss aversion. And I think that’s probably where he started fudging numbers and cooking the books and creating a massive operation to shore up his losses, and then it just became a runaway train.

So I hesitate to call anyone “evil,” because I think it’s just much more complicated than we know. Sometimes there are unconscious and conscious things happening. There are very strong organizational and psychological forces at play. And I think just educating ourselves about those can help us all color in between the lines, so to speak.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Dustin Grinnell: One of the reasons why it’s such a pleasure to come on your show is I enjoy writing by physicians and health providers, and books like When Breath Becomes Air, books by Atul Gawande, and a book like Mountains Beyond Mountains, about Paul Farmer. These books are really compelling to me, and I would just love to read more. If your audience is interested in writing about their personal experiences as clinicians, in memoir or fictionalizing it, I would love to read it. I have an appetite for that type of writing. And I think, yeah, I just want to inspire people to tell their stories, because you have an audience here, at least.

Kevin Pho: Dustin, thank you so much for sharing your time and insight, and thanks again for being on the show.

Dustin Grinnell: Thank you.