Category Archives: General

Accept the Responsibilities of Participating in Public Health

By James Giordano PhD, Professor, Departments of Neurology and Biochemistry and Senior Scholar-in-Residence, Pellegrino Center for Clinical Bioethics

The SARS-CoV-2 virus is not taking the summer off.  Recent studies by Stephanhie Pfänder and colleagues at Ruhr University Bochum (GER) have shown that the virus remains viable for almost 18 hours at temperatures of 86 degrees Fahrenheit.

While many constraints on business openings and social gatherings have relaxed, COVID hasn’t cratered, and current efforts to regain socio-economic stability, while still being topics of contention in government, are in fact precariously balanced upon peoples’ participation in doing what it takes to sustain public health.

Public health is about us, but cannot happen without us; because we are that public. It is our health, individually and collectively, that is the goal, and as such we must be – and remain – committed to the process. Continue to maintain physical distancing when out in the community, and acknowledge and accept that being in public spaces requires your active role in public health.

So, when out and about, cover your nose and mouth:


Photo: St. Ignatius Masked at Loyola U Medical Center Maywood Illiniois. Photo courtesy Daniel Dillinger MD

Wearing Masks and Asserting Meaning: Insights from the Neurocognitive Science of Cool

By Will McCreadie and  James Giordano, PhD

Beginning this week, the nation as a whole will attempt relaxation of social restriction, re-engagement of public activities, and re-opening of certain businesses and venues. Four months ago, people wearing masks stood out. Now it’s those who don’t that often catch a sideways glance. Yet, despite the ongoing risk of infection amidst calls and efforts for relaxing social restrictions, some people are rebelling against wearing protective gear. Just this past weekend, when one maskless family was asked on the street about their lack of PPE, they responded, almost in unison “masks aren’t cool”. At the same time, A-list celebrities like Jennifer Lopez and Alex Rodriguez have been “corona-shamed” and labeled arrogant for not wearing masks. Why the discrepancy?

Research in neurocognitive science suggests that sentiments of “cool” are actually a complex combination of feelings of fear and aspiration. It combines the desire to be differentiated with the need to feel accepted. Studies indicate that deciding something is cool draws on two functional systems of the brain: the default mode network (DMN), and the salience network (SN). The DMN is linked to introspection and the determination of value – the rewards associated with being “cool”, while the SN plays a role in fear (often seeking to balance fears of both the behavior in question, and of being ostracized).

Such patterns of thought, emotion, and behavior are the focus of somewhat new disciplines of neuroeconomics and neuromarketing. The use of masks provides a perfect natural experiment to gauge how “cool” works, because they haven’t been common in our society since the 1918 flu pandemic, and have been now thrust into the social-spotlight.

When deciding if something is “cool,” our brains calculate the relative benefits and costs of that choice. We rarely need to ponder this judgement; we just “feel it”. The human brain takes less than 300 milliseconds to form an opinion, assessing events and consequences in our past, with the current situation, and making predictions about the near-term and future consequences of our decisions and actions. This is the phenomenon of automatic valuation.

Deciding whether something is cool, and worth the “investment” in terms of benefit, burden, and risk, comes down to figuring out what maximizes its – and your – utility. Our brains go through a rapid series of inquiry: Will this choice help me or hurt me? In the near term, or in the future? Is it the best of my available options? People aren’t perfectly rational, so we tend to base decisions and actions upon our beliefs and experience of what’s most useful.

In the case of masks, the obvious tradeoff is freedom versus safety; but considering “cool” in the equation demonstrates that other forces are also at work. What we find “cool” and feel good about depends on the image of ourselves we want to convey. We are strongly social creatures, who are sensitive to the ways we’re regarded. Whether or not you wear a mask conveys a signal (even if you don’t realize it). Social signaling plays a significant role in what we wear, and do.

This partly explains the divide in public stances on PPE. In neuroeconomic terms, masks are an identity good. People who wear masks (or dress up their Twitter profiles with mask pics) may hope to signal their virtue and intelligence, by highlighting the relative sacrifice of their comfort, both for the good of others (and for their own good – both to prevent infection, and to be perceived as socially responsible). People making unusual homemade masks may seek to highlight their resourcefulness and creativity. Those without masks are signaling something else: confidence, rebelliousness, bravery, or foolishness and selfishness — depending on your perspective.

There is also a status system in mask culture. Any recollection of middle school will surely bring to mind the in-group/out-group dynamic that plays a substantive part in determining what we find cool: with people on the “outside” aspiring to copy and outdo people on the “inside” to gain acceptance. Primate studies show this hierarchical behavior to be a side-effect of evolution. Status, and belonging to an in-group were valuable for our ancestors because the chances of survival were higher for a group member than an outcast. This primal need to conform may be a one of the factors in seeking to be “cool”. At the same time, no one wants to feel like a faceless member of the herd. To be cool, we strive for acceptance without homogeneity, and differentiation without alienation from the group.

Almost overnight COVID-19 has created a new in-group: people wearing masks. Like any major trend, there are subgroups within the mask-wearing set. The professional grade mask signals that you either are a “front-line” worker, that you have enough money to afford a scarce item, or that you’ve got good connections. People in different age groups also try to gain status by signaling different things. Teens, for example, may want branded masks (searches for designer masks increased 100-fold from mid-February to mid-April). Part of the reason why a teen covets a Supreme face mask ($450 online if you can get it), while their parents would never wear one, is that their peer groups value different things. Teens tend to want to be edgy and unique.

A significant element of cool in the age of COVID-19 is competitive – and reciprocal – altruism, which is another form of social signaling. Whether it’s the CEO of Flexport sending 3 million masks to Amsterdam, or the CEO of Twitter giving away almost a billion dollars and tracking it in a Google spreadsheet, people and companies are vying to be the most creative and effective responders to the virus. If selflessness wasn’t a valuable social signal, people would make these donations anonymously. Our research has shown that every altruistic act has an egoistic component. It’s “cool to be kind”, and as a result such acts of altruism make the actor feel good.

For many people, masks are an entirely new form of self-expression whose usefulness goes beyond their protective benefit. Simply put, as we strive to re-start our socio-economic engines for the benefit of both individuals and the population at large, masks are a currency of capability and cool. So, whether it’s making a statement of individualism, asserting acts of altruism, or evidencing a stance of responsibility, masks are a medium to represent ourselves in a commitment to each other.

Will McCreadie studies computer science and economics at Georgetown University, where he is a Baker Scholar and a Carroll Fellow.  His research in neuroeconomics examines the neurological underpinnings of decision-making.  Will’s current work explores the biological causes and economic implications of the human desire to be accepted.  He is on Twitter @McCreadieWill

James Giordano PhD is Professor in the Departments of Neurology and Biochemistry, Chief of the Neuroethics Studies Program, and Senior Scholar-in-Residence of the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center.

Navigating the COVID Crisis: A Call to Virtue, and Hope for Prudence


By James Giordano, PhD, MPhil

“Lead; follow; or get out of the way.”

Lee Iacocca


The COVID-19 crisis has impacted each and all in ways that range from inconvenience to inconsolable loss. Such times bring into stark relief the need – and ethical obligation – for an open society’s political establishment to exercise its purpose, process, and leadership to protect the polis it serves. This mandates comprehensive appraisal of all available information and establishment of facts – defined as “something known or proved to be true” – with recognition that facts can and often do change as a consequence of more detailed investigation and evolution of circumstance. Facts provide the basis for developing knowledge. This knowledge is important to effectively inform decision-making, develop planning, prepare necessary responses, and maintain public awareness, guidance, and trust.

A number of years ago, I was involved in a NATO modelling exercise that was intended to assess relative capabilities and weaknesses in United States’ biosecurity readiness and response. I had the interesting distinction of directing the “bad guy team” – to simulate development and implementation of a “biological agent” that would pose a potentially expansive threat to public health, safety, and stability. Interestingly, the exercise illustrated that the disruptive and ultimately destructive factor was not the biological agent itself, but rather the spread of misinformation, which heightened peoples’ uncertainties, preyed upon their relative lack of understanding of science, and manipulated the public need for sound, stable leadership.  In other words, it wasn’t the bug, but the bamboozling that fractured public trust, disrupted the capability of government, and created further opportunities for destructive effects in biomedical, socio-economic, and cultural domains and dimensions.

As the simulation played out, the “good guys” could not initially stem the tide of disruption that misinformation, miscommunication, and mistrust created.  To rebound and regain national stability required a concentrated, dedicated effort of establishing credible resources, providing accurate, appropriately communicated information, and fostering and sustaining cooperation and collaboration. Crucial to this enterprise was sound leadership, which served as a sail, rudder, and keel to “take the wind of change” – regardless of direction, intensity, and harshness – and harness it to steadily steer ahead a recuperative path. Such leadership requires trust, teamwork, and respect for and reliance upon those who are best qualified to navigate often treacherous courses, so as to “lead from the front of the boat.”

Sound leadership entails ethical stewardship of power. Ethical leadership responsibly assumes both the benefit and burden of command – in often self-effacing ways – so as to maximize the good of those being led, especially in times of uncertainty, insecurity, and need. The country – and world – is faced with a pandemic.  Professional forums and media of all sorts are rife with bellicose language about “fighting the war” on this “adversary,” the SARS-Cov-2 virus.

Such talk may be familiar to prior generations’ recall of mobilization of national resources during World War II, efforts of the space race, and in more recent memory, the aftermath of 9/11.  For a more biomedical example, we look back to the influenza pandemic of 1918, compare the morbidity and mortality it sustained to losses during the first world war, and frame the impact of the current COVID-crisis in terms of casualties of recent wars in the Middle East and Viet Nam. Perhaps such rhetoric is useful, as it drums up public spirit, poses a “grand challenge,” and harnesses “big science” to engage a common cause.

But if we use such language, and exemplify the triumphs of previous bellicose efforts, then we must also examine when, how, and why similar endeavors failed. History is rich with international and domestic instances of leaders who did not respect the wisdom and heed the counsel of expert field commanders, intelligence services, scientists and engineers. In so doing, those leaders fell prey to intellectual shortsightedness, egotism and/or narcissism, and as a result, acted impulsively and foolishly at least, and in ways gravely erroneous – and with dismal consequences – at worst. Let both the successes and failures of the past serve as lessons to be learned.

To be sure, the COVID crisis is humbling in many ways. It has brought to light our vulnerabilities and threatens much that we value. This is not the time for hubris, a lack of veracity, vindictiveness, or sarcasm. The public is anxious if not frightened. The present is wrought with burden and the future is uncertain. As a scientist, I call for confidence in, and reporting of facts – as they are known, and as they change. As an ethicist, I know all too well the importance of facts to decision-making and reasoned action, and I implore the need for responsible cooperation, collaboration, and communication. And as a citizen, I hope for an end to petty partisanry, and the sound shepherding of truth, intention, and commitment to assume a more prudent path through – and recovery from – this pandemic.

James Giordano PhD, MPhil, is Senior Scholar-in-Residence of the Pellegrino Center for Clinical Bioethics, and Professor in the Departments of Neurology and Biochemistry at Georgetown University Medical Center, Washington, DC.  For more of Dr. Giordano’s work on COVID-19, please visit our web site.

Dr. Edmund Pellegrino: Our Founder

Portrait by Jerry Crowley
Portrait by Jerry Crowley

Dr. Edmund D. Pellegrino was Professor Emeritus of Medicine and Medical Ethics at the Kennedy Institute of Ethics at Georgetown University and founding director of PCCB. He served as Chairman of the President’s Council on Bioethics in Washington, DC, John Carroll Professor of Medicine and Medical Ethics and as director of the Kennedy Institute of Ethics, and the Center for the Advanced Study of Ethics at Georgetown University. He received his BS degree from St. John’s University and his MD from New York University. He served residencies in medicine at Bellevue, Goldwater Memorial, and Homer Folks Tuberculosis Hospitals, following which he was a research fellow in renal medicine and physiology at New York University. During Dr. Pellegrino’s more than 65 years in medicine and university administration, he was a departmental chairman, dean, vice chancellor and president.

Dr. Pellegrino authored over 600 published items in medical science, philosophy, and ethics, and served as a member of numerous editorial boards. He was the author or co-author of twenty-three books, and the founding editor of the Journal of Medicine and Philosophy. Dr. Pellegrino was a Master of the American College of Physicians, Fellow of the American Association for the Advancement of Science, member of the Institute of Medicine of the National Academy of Sciences, and recipient of 52 honorary doctorates in addition to other honors and awards including the Benjamin Rush Award from the American Medical Association, the Abraham Flexner Award of the Association of American Medical Colleges, and the Laetare Award of the University of Notre Dame. Dr. Pellegrino’s research interests include the history and philosophy of medicine, professional ethics, and the physician-patient relationship.

For more from our founding director and the opportunity to have a virtual dialogue with him, check out our main webpage.


B&W Image of Dr. Pellegrino Source: Washington Post, Georgetown University