Atul Gawande, MD, Writer: What fascinated me from the start was how did my parents learn how to heal people?

How did ordinary people learn how to do extraordinary things?

Marcia Franklin, Host: Coming up, I talk with best-selling author and physician Atul Gawande about his writing and his career.

And Dr.

Gawande discusses the effects of defunding the U.S.

Agency for International Development, an organization he helped lead during the Biden administration.

That's next on "Conversations from the Sun Valley Writers' Conference.

Stay with us.

[MUSIC] (Announcer) Funding for this program is made possible by contributions to the Friends of Idaho Public Television from viewers like you.

Thank you.

Franklin: Hello and welcome.

I'm Marcia Franklin.

My guest today, Dr.

Atul Gawande, says he "said yes to everything" when he was first starting out his career.

That interest in many different fields has led him to a multifaceted life as both a respected physician and a bestselling writer.

In addition to being a cancer surgeon at Brigham and Women's Hospital in Boston, and a professor at the Harvard Medical School, Gawande has been a staff writer at the New Yorker magazine since 1998.

He's also the author of four books exploring issues in medicine, including: "Complications: A Surgeon's Notes on an Imperfect Science; " "Better: A Surgeon's Notes on Performance;" and "The Checklist Manifesto."

"Being Mortal," his exploration of the choices that humans make at the end of their lives -- or are prevented from making --- spent more than a year on the New York Times Bestseller list.

It was also adapted into a PBS "FRONTLINE" documentary.

From 2021 to 2025, Dr.

Gawande served as Assistant Administrator for Global Health at the U.S.

Agency for International Development.

USAID was eliminated by the second Trump administration in 2025, and Gawande has been writing about the effects of that decision, as well as making a documentary about it.

He and I spoke about that and other topics at the 2026 Sun Valley Writers' Conference.

Franklin: Well, welcome to Idaho.

I understand this is your first time here.

Gawande: I can't believe it.

Yes, I'm so delighted to be here.

Franklin: You have mentioned before that Hemingway has been an inspiration to you for your writing.

And then I assume you know that he lived here.

Gawande: Yeah.

Franklin: .died here.

And, um, do you think you might get a chance to go to the Hemingway house?

Gawande: I would like to.

Hemingway is interesting because -- to me -- because his father was a doctor, and like all parental doctors wanted his, wanted his son to become a doctor as well.

And Hemingway did not want to do that.

Didn't even head off to college, instead decided what he wanted to be was a writer and, and you know, disappointing the parents, headed off to be in Paris to become an expatriate writer.

And his concision and clarity is something, uh, I constantly feel like I'm striving for.

Franklin: Well, your parents were physicians and wanted you, I assume, to be a doctor, and you met their expectations in that respect.

But what was interesting to me was that not long really after you got your medical degree in the mid '90s, you also started writing.

What was it about writing that drew you so much that you knew from the very beginning you were going to have that along with the medical career?

Gawande: I didn't at all.

My parents were, indeed, you know, two Indian immigrant doctors.

I grew up in rural Ohio, and you know, there was pressure even without them saying it, "Will I become a doctor as well?"

And I spent some years avoiding it.

I worked in government for a while.

I did a degree in politics and philosophy.

I said yes to everything.

I tried all kinds of things.

I paid attention to the things that really energized me and the ones that didn't.

I mean, what fascinated me from the start was how did my parents learn how to heal people?

Like, you know, how did ordinary people learn how to do extraordinary things?

And that's been fascinating to me the whole time.

And between being in an operating room, which was like nothing I'd ever seen, um, working on public health policy and, and public health measures, and then it turned out writing were three things that drew me in, um.

Franklin: What about the writing?

What is it?

Gawande: Well, so it started out -- a friend started Slate Magazine, was on the team that started this internet magazine.

It was 1996 -- Netscape Navigator Days.

Google didn't exist.

And so no self-respecting journalists would actually write for this thing on the internet.

Who reads anything on the internet?

And, and so he asked his friends, "Would you write something?"

And in the beginning for me, it was, "Oh, this was great."

I'm in surgical residency at this point.

And I could write short pieces about policy issues of the day.

Um, and then it became a place that I could also write about what I was seeing in, and the problems I was often confused about in, in, in the people I was seeing day to day.

Whether it was, um, uh, people struggling with the cost of medicine, you know, "Why does medicine cost so much?"

Or a diagnosis that, um, uh, you know, was perplexing, that became a place for me to work it out on the page, get new ideas.

Um, and then it grew from there.

I started doing longer pieces for The New Yorker and within a year I'd joined them as a staff writer.

It just kept going from there.

Franklin: Do writing and surgery use the same side of the brain, complimentary sides of the brain?

Gawande: Very different.

And that was part of the attraction for me.

Um, surgery, you go in and you can solve a problem that day, but there's also a goal of doing nothing creative.

The whole point is not to invent something new every day.

You want every shot to have a 99% chance of going in the hoop.

Writing, you're trying to do something new every time.

As soon as it starts to seem like you're using a formula, you've failed.

Over time, it gets harder in some ways rather than easier, because you know, you've tried these tricks before and that doesn't work out the same way.

But in six months, I'd, you know, usually be able to finish a chapter of a book or a, or a long piece or an investigation or something like that and feel that I'd created something new in that time.

And that was incredibly gratifying.

Franklin: Does writing also help you when you're stuck or when you're down?

Gawande: It's especially when I'm stuck and confused.

Um, my, you know, motivations often come out of seeing a problem that I don't understand what is the answer to it and it's something that might bother me.

It might be, um, uh, as small as, "Why do people itch?"

prompted by a patient whose case report I read who had an itch so severe she scratched through her own skull and injured her brain.

Like, how does that happen?

What is that?

And it gave me an excuse to go around and talk to other people.

Let me sit with a geriatrician for a day.

And you know, you wouldn't get a colleague to do that except you said, "Well, I'm working on an article.

Can I, can I come sit and, sit and watch you see your patients today?"

And it was a great way of opening doors, seeing things anew, stepping back, um.

Franklin: Well, one of the results of that is "Being Mortal," which we have here on the table, which I'm wondering how much has changed in the 12, 14 years or so since -- this was, came out in 2014?

Gawande: 2014.

Franklin: But you were working on it prior to that.

So we're now talking, you know, well more than a decade.

Gawande: So the core thing that I had to learn in the, in the course of writing the book that sort of amazes me that it took writing a book to figure this out, but: people have goals in their life besides just living longer.

Those priorities that people have will change over time and also are very different from person to person.

When you don't understand people's priorities for their life, the result is a mismatch between the treatment and care you're providing, not only as a clinician, but even as a family member, and their, and what matters to them.

And that produces suffering.

And I was trying to unpack what happens when people have these conversations and what changes, what's worth living for.

Franklin: Right.

Gawande: What, what are, what's the minimum quality of life you would find acceptable?

What are you willing to endure?

And what are you not willing to endure for the sake of more time?

What are your fears and your hopes if your health worsens?"

Those give you answers that I found completely changed my practice and changed the way I interacted with my father, whose story I tell, as he ends up -- and he's a surgeon, my mother's a pediatrician; I'm a surgeon.

And we didn't know how to navigate his getting a brain tumor that would ultimately claim his life.

And we have gotten past the point that people were afraid of those conversations.

It's now almost, you know, it's "mom and apple pie" now that, that it is OK to have this conversation.

But people still fear it and don't feel equipped to have it.

The percentage of people who have a serious illness or an impairment that have this conversation is only about a quarter of the population.

And those people have, end up getting much better outcomes of care.

They, they have better quality of life because they're getting care that fits with it.

And it doesn't mean they're having a shorter life.

It often is a longer life as a consequence.

Franklin: So you feel that since this was published, more people are having the kind of conversations.

Gawande: Well.

Franklin: .that you wish they had had?

Um, are you seeing.?

Gawande: I do think we're seeing more interest and willingness to have it and there's some increase, but the vast majority of people still don't have it.

And part of it I think is we haven't reached a place where we think it's malpractice, it's a scandal that somebody facing a terminal condition or a really debilitating condition, um, has not had a chance to voice what their preferences and priorities are.

Franklin: Exactly a year ago -- exactly - um, the agency that you helped lead, USAID, was part of a major rescission package, which the Corporation for Public Broadcasting in full disclosure was also part of.

And the agency that you spent several years at in the Biden administration was decimated.

Talk about, first of all, what it was like in -- back in January, actually - 2025, when you realized that this was going to happen.

Gawande: Well, let me step back one step further and say alongside my life in surgery and writing has been, um, getting to do work developing health system interventions that can improve outcomes around the world, such as a checklist for surgery that cut the death rates by 50%.

Taking this kind of work, um, forward, I got asked to lead global health at USAID, uh, and it became the best job in medicine I've ever had.

I had 2,500 people in 65 countries and they were working around major public health goals -- eradicating HIV, tuberculosis, malaria, improving the safety of childbirth and uh, and, and, reducing child mortality, getting vaccine uptake increased for children around the world.

Over the last 20 years, um, 90 million lives were saved.

In the countries where USAD worked, the reduction in child mortality was 32%.

Remarkable, uh, work underway.

All with a budget that was less than half the budget of my hospital in Boston.

This is work that had been supported by both parties for 60 years.

The last thing I thought would be that we dismantled the most significant civilian capacity in the world for disaster assistance and international goals, such as reducing child mortality.

But within a few weeks, uh, it was being labeled a criminal enterprise, uh, a money-laundering operation and, uh, USAID was dismantled.

And the closure of USAID has now become the biggest threat to lives around the world.

Child mortality is now showing signs of rising for the first time in 60, in more than six decades.

Um, and so the main role I play right now is to just simply bear witness to the reality of what's happening -- whether it's in food aid and malnutrition, whether it's in vaccination and the way rollbacks are affecting our own health in the United States or abroad.

Um, we already see that it's been deeply unpopular for people across the political spectrum.

Uh, people are proud of the way the U.S.

has been a leader in the world in solving problems and being a force for good and a force for change.

It's also made us incredibly prosperous, because we've helped the development of economies around the world that now led to self-sufficiency.

And not only self-sufficiency; 13 of our 15 top trade partners in the world were at one time places that had received assistance to get on their feet from the United States.

We made an interesting choice after World War II that we as a country deployed the Marshall Plan, and said in the countries that were defeated, that were ravaged after World War II, we would not plunder and pillage.

We would do this very unusual thing.

We would actually invest in those countries.

We sent money and equipment and built back Germany and Japan and Italy and other places.

And that helped build prosperity, stability and peace and, and our own economic success.

So people are learning some about that history.

I've been writing it and as well as filming some of the effects.

Franklin: Yes.

You have a poignant short documentary that you're one of the executive producers on called "Rovina's Choice," which I recommend that people watch.

It's a "Sophie's Choice"-like scenario where a woman who's in a Kenyan refugee camp has to make the choice -- her child is starving -- would not have been starving had, had food aid been there.

And she's at the hospital, but she has a choice.

Her other children are hungry and are alone.

And so she has to leave the hospital and the child dies.

Gawande: We had managed during the last 20 years to dramatically reduce the mortality of, of acute malnutrition, starvation.

And then when the plug gets pulled, seeing a woman who has a child now who's got this severe acute malnutrition, and is looking for, trying to navigate her way through a broken system to find the treatment, is something that I think anybody ends up relating to once you are able to imagine yourself in her shoes.

I don't think it's a coincidence that at the same time that, you know, tens of billions of dollars was cut in U.S.

assistance to other countries, the, uh, we've ended up spending more than half a trillion dollars more on war and military efforts to deal with countries abroad.

And this is a debate that we have.

Is our approach to the world one of try, try to dominate, which ultimately becomes more expensive and less effective, or offer a helping hand?

Franklin: And some people would say, "We've done the helping hand.

It's enough already, and it's time for other countries to, to do their fair share."

Gawande: Countries absolutely need to do their fair share, and the U.S, has often led the way in bringing other countries to solve polio eradication, malnutrition and others.

We're not the only ones that are doing this work on the ground.

But we have often been the leaders that step up first and show the world that that is what we can do.

And we're not, and these have not proved to be forever kinds of things.

It's not a matter of that you can turn a country around in two years.

We were working with countries like South Korea and India for 25, 30 years before, um, uh, we were then able to step away as donors.

But the result is that almost all the world now has reached middle-income.

Africa is about half middle-income and our support to help places get to transition will be vital.

Franklin: What's your general demeanor about all this right now?

What are your emotions about it?

Gawande: In the beginning -- very angry.

The exaggerations, um, and lies about what was happening, what the work of the people I worked with every day and day out was infuriating.

The sadness, then, seeing the bomb blast and the effects that have gone through.

But I also have had faith if I and others can bear witness to what the reality of what has happened, I have great faith that over time -- I didn't know how long -- we would see that it would become unpopular and that this would not be the way we wanted to proceed.

I thought that might be many years.

In a space of a year, you're already seeing Democrats and Republicans both voted not to end USAID in the Congress and established a full budget for these kinds of foreign assistance programs.

So, it, uh, uh, my emotions have shifted over time as we see people coming together and now asking these correct next questions of, "How do we build back and build it back better?"

Franklin: And you're making a documentary as we speak, right, about what the cuts have meant?

Gawande: That's right.

We did "Rovina's Choice" last year.

We've continued to film and follow how has USAID been dismantled, what have been the programs and how they've been affected in, uh, around the world and what has that meant?

Franklin: Well, it's, it's related to now talk about your next book.

Your next book is going to be about how people change their minds, yes?

Gawande: It's true.

Yeah.

I still haven't worked out the title.

The working title is "How Minds Change."

And it's taking examples from medicine to -- and public health -- to unpack, "How have we managed to do anything (laugh) as a country?"

Franklin: Like getting rid of cigarette.

Gawande: Yeah.

So one example.

Franklin: .smoking in certain areas, in most areas now.

Gawande: Yeah.

The fact, you know, our generation grew up --I mean, my high school had a smoking patio.

Almost half of kids in the United States by the time they were in, out of high school smoked.

Franklin: I was on planes that had smoking and non-smoking sections.

Gawande: Every bar, every restaurant.

Franklin: Restaurants, bars.

Yeah.

When Ireland got rid of smoking in bars, I thought, "Wow, we're really going someplace."

Gawande: So how did we manage to do that?

You know, in some ways it is unbelievable.

Getting rid of cigarettes was inconceivable.

It was not imaginable in the 1980s, even into the 1990s.

And, and yet, it was turned around dramatically.

And it wasn't because someone had, you know, a great argument and, and won everybody over, overnight.

The pattern of it that I'm unpacking is that these, that change takes time.

It's a process.

It's a process of having to build credibility, having to build constituencies, having to often get many different kinds of people who have to see a win out of it coming along the way.

And then you get over and over again, whether it's seat belts, child safety seats, smoking, getting the navies to stock lemons so their sailors did not get scurvy.

There's been a repeated process of how we do manage to learn and we do manage to adopt things that are hard, require sacrifice now for ultimate gain later.

Um, what has made us successful as a human species is we are able to think ahead and sometimes take action for the sake of what might be further away than just our immediate gratification.

But it's hard.

Franklin: I'm sorry?

Gawande: But it's hard.

The culture change is always the hardest part.

Franklin: Yeah.

Gawande: It's shifting from the idea that your autonomy is the highest value, to one of humility, things can go wrong, discipline and teamwork, and believing that that's your way out.

Franklin: I wonder if AI will have a deleterious or a beneficial effect on people changing their minds.

You know, if a robot starts telling them certain things, they might change their mind.

Gawande: One of the interesting things is that getting your beliefs are partly about awareness of a new idea.

And that marketing, maybe an AI robot, you know, can do.

A good argument might move you from pre-contemplation to contemplation.

But getting you to action takes, "How do I prepare for the action?"

"How do I bear the costs that might be involved in learning something new?

That's a very social process.

That's people talking to people and it still is.

Franklin: Well, if the robot becomes your friend, though, and says, "You need to wash your hands now," or whatever it is, you need to... you know, maybe, maybe for certain people that don't have a group that.

Gawande: We'll have to see, because it depends on relationships over time and trust as you see other people around you try new things and then fear being left behind by them.

Franklin: Are you excited about AI and its application to medicine and all the various arenas in which you operate, literally and figuratively?

Gawande: I am, although it's not in these particular -- you know, I think the least important area it's going to have an effect is going to be in our relationships, um, and how we tackle hard problems together.

The power in AI of being able to solve problems where there's a clear goal, the data is available and you're able to turn to offloading those kinds of problems that are, can often be make-work, um, that is very exciting.

I'm involved in a number of projects in public health, both in the United States and abroad, about applying AI tools, developing AI tools as well.

Uh, and, you know, only part of it is having the right program or the right chatbot or platform.

Um, the rest is, "How do I actually make it so human beings can use them at the right time and the right place, embedding it into the system and the workflow that clinicians have and then, or getting it to support a patient to directly solve a problem and plug into a system?"

Those are the really big barriers that will take years for us to really capitalize.

Franklin: So, as we wrap up, what's your state of mind right now?

Are you generally an optimistic person?

Gawande: Yes.

Over the course of my life, I've gotten to see an extraordinary range of transformation, and I try as much as possible to not get caught in the, the waves of the current day.

I try to see, you know, not six months ahead or a year ahead, but am I working on things that will matter five, 10 years, 20 years down the road?

You know, I'm in health.

We've doubled the American lifespan in the course of the last century.

We are bringing what is now a 90-year average lifespan for the, you know, segment of our society that can access the capabilities of healthcare and of public health.

And we're trying to make that available to everybody across the country and ultimately around the world.

We've made extraordinary progress.

It's going to take an entire generation and likely longer to make that happen for everybody at scale.

Um, it's a example of the kind of human problems that we both have had incredible ambition and have been able to make progress against and will occupy us for a good long time to come.

Franklin: Well, your legacy in all of that is very secure.

Thank you for all you've done to bring these issues to the attention of humans worldwide.

So, I really appreciate your thoughtfulness on.

Gawande: Thank you.

Franklin: .on these topics and certainly have learned from you over the years.

So thank you for taking the time to talk with me.

Gawande: Pleasure.

Thank you.

Franklin: You've been listening to physician and writer Dr.

Atul Gawande.

Our conversation was taped at the 2026 Sun Valley Writers' Conference.

My thanks to conference organizers for inviting us back for our 19th season of interviews at the esteemed event.

If you'd like to watch any of the nearly 90 conversations we've taped at the conference since 2005, check out the Idaho Public Television website or YouTube channel.

Thanks for joining us.

and keep reading!

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