Pushing for Change
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Bad advice. That's what Jenny Ahlstrom feels like her brother-in-law David was getting after he was diagnosed with a type of aggressive blood cancer called acute myeloid leukemia in 2004. For example, when he was hospitalized with respiratory distress related to his illness, his family was told he had just hours to live. So you should just let him go. You're being cruel by keeping him alive.

Instead, Jenny and her husband went online, searched far and wide, and found an existing drug that could potentially help David. And they convinced his doctors to try it. And they gave it to David, and 72 hours later, he was riding a stationary bike and was able to get out of the hospital.

So he lived another six months after that. But Jenny and her family wondered, why did they have to intervene and find this treatment option? And as a family, we just thought, that's really crazy. Why didn't we have the data to understand this problem? Why didn't we have the data to understand this is a potential solution for him and for others?

None of his peers will ever know that that worked for him for an extended period of time. And that drug didn't get approved for another 14 years by the FDA. For that indication? Yeah, for that indication. So it just was a shocker. Like, why does this take so long?

And there was more bad advice. Jenny says her brother-in-law had also been told to start with chemotherapy to treat his cancer and to wait to try a stem cell transplant. But by the time he had gone through all of the chemo options, he was too sick for the transplant. David died just a year after getting his diagnosis.

After losing him, Jenny was stuck with all of these questions. Why don't we have these insights when we need them? Why aren't we using data to make personalized cancer treatment decisions? Jenny and her husband, Paul, felt motivated to change this. They started building a platform that could help patients navigate their diagnosis and find individualized, up-to-date resources and treatments. They named it HealthTree.

But life got busy and the website project stalled. Paul got a new job and the family moved from Utah to Mexico. There was so much going on. I was really, really tired, but we had six kids and our kids were ages two to about 15. Yeah.

And that's a lot of kids to try to manage. And so I just thought, well, who isn't tired moving to a foreign country? But I was so fatigued that I would have a personal tutor come over to teach me Spanish in the morning and I would fall asleep during my lesson. And eventually, Jenny realized her fatigue was a sign of something more.

something was wrong. In 2010, after a big checkup, she got her own very serious diagnosis. My diagnosis was multiple myeloma, which is another type of blood cancer. After having seen what her brother-in-law went through, she knew she had to be very active in researching her own treatment.

And in the course of that, she also got back to working on the HealthTree website. We're going to advocate for ourselves. We're going to advocate for others. We're going to get educated. We're going to do the research. In a nutshell, what is the most basic issue that you wanted HealthTree to tackle? I wanted to use data to drive my decisions. So I went to my first doctor and I said, show me the data.

for patients that look like me that are younger, that have a high risk feature, what do they get for treatment and how do they respond? If you show me the data, I'm going to pick the best path for me. Nobody could show me that. Nobody. And that didn't make sense to me as a patient.

People push for change or create it themselves for all different reasons. They care deeply about an issue. They want to help other people or improve their own lives. On this episode, what motivates people in their quest for change? ♪

Let's hear more of Jenny's story and how HealthTree became a reality. Jenny says when she asked her doctors for specific information regarding her cancer treatment and they didn't have it, it's because researchers don't have good data either. It's messy. It's missing. It's incomplete.

It's not representative of the whole patient experience. For example, if somebody gets treatments at different medical centers, only the patient has access to all of the records, all of the pieces to the puzzle. So Jenny wondered, what if patients uploaded their own data to her website, allowing it to be accessed by researchers to speed along progress and discovery?

Jenny successfully completed stem cell transplant treatment, her cancer went into remission, and she became the CEO of HealthTree, putting a lot of her time and effort into building this site. She took her idea on tour, visited 50 cities, and spoke to over 800 blood cancer patients.

And she asked them, would you share your data? They were 100% yes. Yes, of course, I will do that. The site now offers all kinds of information to blood cancer patients. It helps them look for clinical trials, treatment protocols, or brand new treatments. You also have on your site, patients can access something called a diagnosis twin. What is that and what is the purpose? Yes.

So we have something called the twin machine. And this is what I wanted at diagnosis. I had a specific genetic feature and I was a younger patient. So that's what I wanted to see. I wanted to see a list of all the patients that look like me. And then I can go into their profiles. So we do that. We say, okay, based on your genetics or based on the prior treatments you've had or based on whatever, show me my twins.

And then you can go in in a de-identified way so you can't see who they are. But you can see their past therapies, how long they remain in remission. You can see their genetic features. And if you want to reach out in an anonymous way, then you can send them a message and they can accept it or not accept it. Because you might have a question like, why did you decide to do this over this? Or, you know, you can look ahead at people who are very similar to you.

The site is also moving the needle for researchers who have free access to this information. They can help them use best-in-class treatment options and can drive towards cures. One patient recently told Jenny the site saved his life. Because I found a new treatment option that I could consider that my doctor would have never brought up to me.

Having created this change, you needed this to exist when you were diagnosed, but instead you created it. How does that feel, like looking back on that work? It makes me want to cry all the time. I love doing it. I love supporting patients. We just want faster cures. That's it.

Jenny Ostrom is the founder and CEO of the Health Tree Foundation. It's a site that provides support and information for blood cancer patients, and it makes information accessible to researchers. We're talking about pushing for change.

When Bill Osmunson was in high school, he took a trip to Europe. His classmates met with a bunch of European students, and they had a discussion about what was better or worse in each country. One of the European kids brought up a point that made Bill mad. You promote fluoride in the water. And I go, what? That helps teeth. That's fine. There's nothing wrong with that.

And she said, well, we disagree with that here in Europe. Bill thought that was crazy. He actually went on to become a dentist. But now he's part of a vocal movement pushing against adding fluoride to our drinking water. One of the big arguments is that fluoride lowers IQ in children.

The anti-fluoride movement has been marginalized for a long time, but more recently, it has gained steam for two reasons. They now have a powerful advocate in Robert Kennedy Jr., President Trump's pick for a Secretary of Health and Human Services. And just last year, a California judge ordered the Environmental Protection Agency to address potential risks of water fluoridation.

In response, many scientists and advocates are now stepping up their efforts to defend fluoride in drinking water. So there's a lot of push and pull here. Nicole Leonard looked into it. Before Bill Osmunson was a dentist, he got a master's degree in public health.

But something one of his professors said didn't sit well with him at all. I want you to remember that your job is to promote policy. Your job is not to give your own opinions, but you're to promote what you're told to promote. Bill bristled at this idea, being part of the establishment, without being able to think through issues on his own.

He ended up choosing dentistry as his profession, working in a town in Idaho where fluoride was added to the drinking water, which Bill liked for its power to reduce cavities by about 25%. I told my assistant, I'm going to tell you where these people live by looking in their mouths. And so the next patient came in and I'd look in their mouths and I would see good, strong, nice teeth.

And I'd say, this person lives in the city because they were getting fluoridation. They had good teeth. And then the next patient would come in and I'd look in there and they had lots of problems. And I'd go, oh, they live out in the country. And I was about 80, 90% correct in my guessing over the next 20, 30 patients. And what I was looking at helped convince me that fluoridation had benefits.

But over time, little by little, Bill started to question the safety of fluoride in the drinking water supply. For example, while looking at the label on a tube of fluoride toothpaste. It said, do not swallow. That's pretty simple. Do not swallow. And if you do, then contact the poison control center. Bill knew that with anything that's potentially poisonous, the dose is a key factor.

And that part started rubbing Bill the wrong way. That fluoride was added to the water by his municipality.

They're just shoving it down my throat, whether I like it or not, without any label, without FDA approval, without, I mean, come on. There's no dosage control. People drink different amounts of water. And in trying to look deeper into potential impacts on fluoride exposure, Bill says he discovered something else. The science on fluoride ingestion is not high quality science.

And so I promoted fluoridation for 25 years. Why? Because I never looked at the science. I just did what my profession recommended, and I followed what they recommended, and I didn't look at the science. Bill says when he reviewed the science, he found links between high levels of fluoride and damage to teeth, especially white spots on teeth. But

but far worse, potential links between fluoride and cancer and lowered IQs in children. To him, it was enough to speak up, especially for kids. Of course I'm going to try to defend their brains. Am I not going to speak up, knowing what I knew, and not speak up to try to help parents and children?

And that's what Bill continued to do. He retired a couple years ago after practicing for 46 years. He now lives in Washington state with his family and remains active in efforts to stop water fluoridation.

I can remember when the Public Health Service first suggested fluoridating drinking water in about 1962. And there were people who called it a communist plot. Linda Birnbaum is a toxicologist and microbiologist. She worked as a governmental scientist for 40 years and has been director at both the National Institute of Environmental Health Sciences and the National Toxicology Program.

Over her career, Linda oversaw colleagues as they researched the effects of fluoride and water fluoridation. To her, there's merit to studies that have shown that fluoride can be harmful to human health and development at certain levels. But there is far less data, if any, showing harm caused by the current levels of fluoride in American drinking water.

which is set at 0.7 milligrams per liter. You know, does fluoride, inorganic fluoride, have the potential to be developmentally neurotoxic? The answer is yes. The question of is 0.7, which is the current public health recommendation, can it be associated with IQ deficits? I think the answer is we're really not sure. To Linda, that uncertainty is important enough to warrant further explorations.

But she says other scientists and dental experts may be less willing to explore this issue. She blames years of teachings about water fluoridation. They've been told for the last 60 years that this is a good thing to do and it's important. It was a belief structure. And, you know, when you've been told that your whole professional career, it's hard to change a mindset.

But now that mindset may have to change with the decision by California District Court Judge Edward Chen last September. After looking at the IQ study, he determined there was enough evidence to rule that the Environmental Protection Agency must address potential risks of water fluoridation.

Attorney Michael Connett of firms Siri and Glimstad represented the plaintiffs and led arguments against the EPA in court. He specializes in litigation related to toxic substances. It was great to see the result. You know, there's no question about that, you know, and it's been a long time coming with a lot of hard work. Part of that hard work was to change the attitudes about people who are opposing water fluoridation. People who

People who've long been viewed as fringe, anti-science, or conspiracy theorists. The cultural baggage. A lot of people, when they hear about fluoride, they immediately think of Dr. Strangelove and the crazy Colonel Ripper. Here's the scene in question from the 1964 political satire film, where General Jack Ripper explains the dangers of water fluoridation to Captain Mandrake.

Have you ever heard of a thing called fluoridation? Fluoridation of water? Yes, I have heard of that, Jack, yes. Well, do you know what it is? No, no, I don't know what it is now. Do you realize that fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face? It's really hard for some people to...

But Michael has been familiar with this issue for a long time.

He first learned about it when he was attending St. Lawrence University in Canton, New York, and the town was considering removing fluoride from its drinking water in the early 2000s. I didn't know anything about it. My parents, you know, are very actively involved with environmental health issues. They had been working for decades on garbage incineration and the hazards of that. My dad's a chemist.

My mom was, you know, editing this newsletter on waste issues. They became interested in this fluoride issue, and through them, I learned about it. Michael says he continued to dig deeper into water fluoridation. He became involved in the early years of the Fluoride Action Network, an anti-fluoride advocacy organization.

The group hopes that its recent win against the EPA means the federal agency will have to take action. But lawyers for the EPA are now in the early process of filing an appeal, which means this could turn into a drawn-out fight on a topic that many scientists argue does not warrant investigation. A majority of dental experts and scientists maintain that water fluoridation is safe at the current levels and not harmful.

Researchers like Scott Tomar point to decades of studies and data showing that fluoride continues to prevent and protect against cavities, even though increased sugar consumption has cut into those successes. He says there's no valid evidence that water fluoridation at standard levels in the U.S. negatively impacts health or development.

Scott is a professor and associate dean for prevention and public health sciences at the University of Illinois' Chicago College of Dentistry. He previously worked as an oral health epidemiologist at the CDC.

And he's taken a critical look at studies like the latest ones linking fluoride and lower IQ, which were included in a meta-analysis or larger review of existing science on the issue. The levels that we're talking about in the United States, 0.7 milligrams per liter, is less than one half of...

the lowest level that they've even looked at. So the bottom line is there's no evidence from that systematic review that there's any association between the levels used

Scott echoes comments and criticisms made by other scientists and experts affiliated with major dental organizations and associations. They say many of these studies were poorly designed, contain errors, and were seriously flawed in ways that invalidate the findings.

But the studies and the subsequent headlines, like fluoride linked to lower IQ, have created doubt among the public, and not just limited to the fluoride in water.

I'm hearing from all of my colleagues in dentistry, you know, a not insignificant percentage of their patients, you know, no longer want topical fluorides on their child when they go in for their checkup visits. They're looking for non-fluoride toothpaste. He says it's becoming harder and harder to cut through the noise. It's so easy to sow fear and doubt in the public eye.

And so difficult to reassure people that, no, we've looked at the best available science. The best available science continues to support that this is safe and effective. Helen Hawkey is seeing the fallout in her daily work.

She's the executive director of the Pennsylvania Coalition for Oral Health, which supports communities in maintaining or starting water fluoridation. You know, it just takes, you know, one person to say, oh, I read that fluoride lowers IQ. And so we can't have fluoride in our water. So let's take it out.

Since 2010, the coalition has helped towns and cities that have struggled with the costs of fluoridation or had trouble locating a supplier for the minerals.

But Helen says the biggest issue is misinformation about water fluoridation, which can lead to a rollback or communities stopping fluoridating. You know, water boards, they're not scientists. They're not researchers. They're usually everyday folks from the community and they want to do what's right for their community. So we kind of view it as when there's a rollback, we've got to go. And our first step is always to find out what the reasoning is. Helen.

Helen says sometimes that involves acknowledging what people are reading and seeing in the news headlines and helping them put it into context. She and others who do oral public health work are used to dealing with criticism and challenges to data and research.

But in this moment, she says it feels more intense, especially with politicians interested in reducing or banning water fluoridation. Just in the last four months, you know, we had a community that was voting on a rollback. And the justification they gave in the newspaper was that, hey, the federal government's going to stop doing this anyway, so we may as well do it now. And we're like, wait a minute, wait a minute, wait a minute. Nothing even happened yet.

Change can be hard, especially when there's so much disagreement on if that change is actually needed. For anti-fluoridation advocate and retired dentist Bill Osmunson, this is an important moment, though, where this discussion could get more attention and could perhaps no longer be viewed as fringe.

taking the stance he has taken has not been easy. It comes with serious costs. And when you go out on a limb, you're out on a limb. He says he often underestimated the stress of fighting for this issue. I knew that this would be some pushback, that I knew it would become so intense on my part.

No, I don't think I would have the stomach problems, the acid problems in my stomach. I think I could sleep better if I was just retired. But Bill says he's not done fighting, even when there are no guarantees that anything will change regarding water fluoridation anytime soon. That story was reported by Nicole Lennert.

We're talking about pushing for change. Coming up, one way people push for change is through protests. But what kind of protest actually works? That's not the right way. You're going to alienate people. Why are you doing this? You're just making the movement unpopular. That's next on The Pulse.

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The most vocal and public way to push for change is to take to the streets and to protest, to make your discontent seen and heard. Pulse reporter Alan Yu has covered a lot of protests over the years, some of them massive and disruptive, like pro-democracy protests in Hong Kong a few years ago that took over major streets.

And in 2020, Allen covered a protest in Philadelphia following the murder of George Floyd. The mood turned from peaceful to violent after a protester threw a Molotov cocktail into a police car, setting it on fire. Allen got trapped in a police corral and people were being pushed against each other. Move back! Move back!

Over the past year, intense protests raged in the U.S. and across the world against the war between Israel and Hamas. Protesters disrupted university campuses and traffic. Police used tear gas and force. All of this made Allen question what makes for an effective protest? What have researchers learned about what actually works?

Last spring, when tensions over the Israel-Hamas war were raging globally, dozens of protesters broke into and occupied a building at Columbia University in New York. Some of them were students. The NYPD later ended the occupation and arrested protesters.

at Villanova University outside Philadelphia. Bailey Proctor, a student there, organized a peaceful demonstration calling for a ceasefire in Gaza. Free Palestine!

Bailey studies political science and sociology. She is part of her school's chapter of Students for Justice in Palestine. One of their demands was for the university to take a stand against the war. No justice, no peace!

Campus police stood by as the students and supportive faculty gathered, chanted slogans, and made their case to people walking by or sitting in front of a dining hall and a student center. We've met with a lot of administrative people and...

The response has always been like, we like what you're doing, but essentially don't push any further than this or don't do anything that would further, I guess, disrupt the status quo at this university. Bailey says the university wanted them to not disrupt the campus. Follow the rules, chant slogans, keep things peaceful.

Social and political psychologist Johanna Folhart at Clark University says that's what political commentators often point to when describing what protests should be like. There is this kind of gold standard of protest that is supposed to be a march, right? Like a nonviolent march where people are just marching peacefully and nothing else happens, right?

But when protesters take action that goes beyond that, like if they block traffic, interrupt college classes or events, destroy property or art, then public opinion starts to turn on them. That's where people often say, that's not the right way, you're going to alienate people, why are you doing this, you're just making the movement unpopular. The

The protests at Villanova stayed orderly, but they also did not have the desired results. The university did not take an official stance condemning the war, though it did send a message praying for those impacted by the violence in Israel and Gaza.

And that's the tension protesters sometimes face. How effective is protest when you limit yourself to marching, chanting slogans and holding up signs? Colin Leach, a social psychologist at Barnard College at Columbia University, has been studying what motivates people to protest for around 20 years.

Colin says the push and pull here is a little bit like this. Let's say you have dinner with the same friend regularly. When the bill comes, the friend always disappears. This annoys you. So this is unfair. And you think this person's never going to change. They're always going to do this. But how should you change this? So you only complain in the same old quiet way, like, oh, you know, you went to the bathroom again when the bill came.

That way of responding is very unlikely to do anything. Colin says a quiet and non-disruptive protest is like you meekly making your point about the bill, but showing up to dinner and paying for everything each time. Why protest?

if you're protesting in a way that's not really challenging, how things are. Colin says that's why protesters might want to demonstrate in a way that other people disapprove of. He says it's important to remember that usually protesters are either a minority or a disadvantaged group in society, or both. The status quo is not working for them.

And protesters have to protest in such a way to get other people to pay attention to their cause, whether the methods are popular or not. During the civil rights movement, Gallup polling showed that almost 60% of people surveyed thought that activists who organized sit-ins at lunch counters or rode buses to protest segregation would hurt the cause. History proved those people wrong.

But generally speaking, do disruptive forms of protest actually change people's minds? Psychologist Eric Schulman at New York University has looked at this exact question. He studies protest and social change.

In a study, he pitted peaceful demonstrations against violent protests against non-violent, non-normative protests. Think of strikes, sit-ins, boycotts, these kinds of tactics.

Aside from strikes or sit-ins or boycotts, this could also include blocking off roads. For his research, Eric looked at survey data on support for Black Lives Matter protests across U.S. counties in 2020. In counties where there was kind of a mix of both nonviolent normative tactics and more aggressive non-normative tactics, there was an increase in support for the

the policy goals of Black Lives Matter, particularly among conservatives. Conservatives became more supportive of the Black Lives Matter movement after seeing both peaceful marches and aggressive non-violent protests. Eric also ran experiments where he asked people to read about protests, where people used the three different ways of protesting: non-violent, disruptive but non-violent, and violent.

Those experiments found the same thing. Nonviolent, non-normative protests can convince people to become more sympathetic to a cause. The reason that this happened was because nonviolent, non-normative action was able to kind of balance two important psychological reactions to the protests.

this sense that the protests are kind of disrupting something fundamental in society and that we have to respond to the protests in some way. And then the second element is communicating constructive intentions. So this is communicating that the protesters

aren't trying to attack or harm their opponents, rather they're just trying to kind of achieve some positive change. But sometimes there is tension among the protesters themselves when it comes to how aggressive they want to be. Jeremy Gingas is a behavioral scientist with the London School of Economics. For instance, he says he has no issue with the Palestinian solidarity protests.

but does take issue with some of the things he saw. I don't regard the protests as being anti-Semitic, but they have been quite a few really disturbing instances of anti-Semitism. He cites an example from the New York subway that was captured on video last year by the YouTube channel Status Quo News.

In the video, you can see people in a crowded subway car, some of whom are wearing keffiyehs, a black and white scarf that's become a symbol of the Palestinian liberation movement. One person who is not wearing the scarf addresses everyone on the subway car. Raise your hands if you're a Zionist! This is your chance to get out!

Jeremy says this is complicated because it's not like there is a leadership structure that can tell protesters what to do and what not to do.

The question of what kind of protest is most effective is complicated. Protests that are disruptive and not peaceful can be effective, even if they are not popular at the time they are happening. It may take some time, even years, but public sentiment can come around to appreciate why protesters felt passionately enough about something to break up the pace of life as usual. ♪

That story was reported by Alan Yu.

You're listening to The Pulse. I'm Maiken Scott. You can find us wherever you get your podcasts. Also, subscribe to our newsletter to stay in touch with us and to find out what's happening on the show. Every week, I'm going to send you a recap of favorite moments and an exclusive preview of what's ahead. There will also be ways to participate in upcoming episodes. To sign up, go to whyy.org slash The Pulse Newsletter. ♪

Coming up, one man pushes for change in his own life and behavior. It was a perpetual guilt cycle. So I would make these big elaborate plans about everything I was going to try and accomplish for the week ahead. And invariably, it wouldn't work. That's next on The Pulse.

This is The Pulse. I'm Maiken Scott. We're talking about pushing for changes. So far, we've heard about big picture issues, things that affect lots of people. But what about pushing for changes within yourself? It can be incredibly hard to do and hard to stick with. That's been the experience of Pulse reporter Liz Tong. She struggled with procrastination her entire life and

and had given up hope of changing. But then she came across somebody who said they had discovered a solution. Here's Liz. I am a chronic procrastinator. I always have been. I have this memory of being eight or nine years old, sitting on the floor of my bedroom at like 11 p.m. with my mom as she, angrily, no doubt, was helping me finish some project I had either forgotten about or procrastinated on. ♪

It just got worse in high school. That's when I started staying up till 2, 3, and 4 in the morning, finishing essays and chem labs and math homework. By college, I was writing entire 15- to 20-page papers starting at 2 a.m. the night before they were due. And then, for some reason, I chose a career where my life revolves around deadlines—

At some point, I figured I must just like the excitement of panic-induced flurries of work. But the reality is, it is torture. Extended torture. Knowing I have to get something done, but somehow not being able to get started. Okay, so it is about 1230, and I really...

Should start working on my script. Fast forward to an hour and a half later. Okay, so I was planning on starting now, but I just remembered there is this other assignment that I probably should get the ball rolling on. I usually put off tasks that I know are going to be hard and fill my day with busy work until I absolutely 100% need to knuckle down. It's exhausting and stressful. I hate it.

I have tried and tried and failed to change. So I'd pretty much accepted that this is just the way I am. Change will never happen. There is no escape. Or is there? Honestly, it was kind of overnight. It was pretty much instantaneous. This is David Maloney. He's a psychologist who says about eight years ago, he managed to completely kick his chronic procrastination habit.

But first, he had to hit rock bottom. Grad school. Really, the interesting thing about it was it was a perpetual guilt cycle. So I would make these big elaborate plans about everything I was going to try and accomplish for the week ahead. And invariably, it wouldn't work.

Sounds familiar. For years at the start of every week or every month, I would craft these master life plans. Not only am I going to stop procrastinating, I am going to level up my entire life. I'm going to schedule each and every day down to the minute so I can fit in all this fantastic productivity that I'm right on the verge of. I actually refer to it as the good intentions plan because

Because it looks awesome. You know, it looks fantastic. It's really impressive. There's just one problem with good intention plans. They don't work. They're too big, too ambitious. And inevitably, they lead to feelings of failure. That voice inside your head that's going, of course you failed, just like always. It's this sort of internal bully we have that says you need to do it, you have to do it, you should have done it yesterday. And it's that kind of narrative that puts all this pressure on us.

And with that building pressure, it's harder to take the action. It was reflecting on this inner bully or inner dialogue, as David calls it, that led to his first big epiphany. This wasn't about time management for him. When he thought about all the guilt and shame and anxiety surrounding his procrastination, his psychological training clicked into place.

And he realized that both the causes and the effects of his procrastination went a lot deeper. This must be about self-esteem. Because if I'm doing things that are constantly making me feel guilty about myself,

Well, maybe there's a part of me that's acting this out in order to prove that there's something wrong with me. Now, that might seem a little overly dramatic. It's natural to put off something hard or unpleasant in favor of something fun. But David says the constant making and breaking of plans can have a really harmful effect because we're not only constantly beating ourselves up for failing, we're actually losing faith in our own word. David.

David compares it to canceling on a friend. You say you'll be there in 15 minutes, then 30, then an hour. Finally, you text them that you're not going to make it. You broke your promise. In fact, you broke multiple promises. And now your friend has lost trust in you. Not only that, they feel disrespected and devalued. But we make these promises to ourselves all the time.

And it's in breaking those promises repeatedly that we're kind of undermining our self-trust, our own self-esteem, our own authority. At this point, David would be feeling terrible and guilty, which in turn would just lead to more procrastination, as if he was punishing himself for having failed to get his work done the day before by procrastinating more.

David realized that his emotional response to this constant stream of have-tos and should-haves wasn't having the intended effect. Instead, it was actually making him less willing to get started on work. First of all, the power to me that really wants freedom and autonomy in my life is going to resist that. It's going to rebel against it. But the other problem with it is that if I go and do it from that sense of obligation and feeling I have to do it,

The real problem is then it doesn't do anything for my self-esteem. When you actively decide to do something and then you do it, ideally, you should get a little pulse of satisfaction. You've just demonstrated to yourself that you are trustworthy. You are that competent, reliable person who gets things done.

If, on the other hand, you put it off until you're absolutely forced to do it, it does not feel like a choice. There's no feeling of self-efficacy or pride or satisfaction, which means there's no validation.

David now knew that guilt and low self-esteem were the motor driving his procrastination, which meant his first priority needed to be changing his inner dialogue from one of guilt and bullying to one of security and empowerment.

One of the first big changes David made was to build in time for play and relaxation. At first, this felt totally counterintuitive to David. If you looked at me when I was chronically procrastinating, well, what would you find? You'd find someone watching TV. You'd find someone watching movies or playing video games or something. Which normally you would say, well, that guy's having fun there, right? He's doing fun things.

But the problem is, because of the procrastination, there's always this little voice in the back of your mind that's making you feel guilty about it. So one of the first steps David recommends to procrastinators trying to change their ways is to actually schedule play into their day, transforming it from a source of guilt into a sanctioned form of self-care.

And in doing so, to change that harmful inner dialogue of have-tos and should-haves into something more like this. I can choose to do this. I prioritize guilt-free play in my life. And my productivity is very easily achieved. I don't need to push myself. I can relax. The more I relax, the more productive I become. Part two of David's solution feels even more counterintuitive, at least to me.

Basically, it boils down to setting boundaries with yourself surrounding work. Instead of repeatedly making and breaking promises to get started, I'll do it at 7, no, I'll do it at 8, actually, I'll get started at 9. He recommends putting hard limits on your work time, as in, my workday ends at 7 p.m. and no work will be done after that point.

Even more shocking to my procrastinator's brain is this rule. Set firm work times and don't compromise. If you say you'll start working at 10 a.m. and you don't, then you have lost your chance to work for the day. I

I know this sounds crazy, and it only works if you have flexibility in your schedule or your deadline isn't the next day. But David says this is how you remove yourself from the procrastinator's hell of uncertainty and indecision and show yourself that there are consequences to procrastinating. It's how you train yourself to keep your word.

But what happens if you sit down to work and you just can't do it? One of the rules is that there is no such thing as an unproductive work session. Sometimes that little struggle is because it's complicated. Maybe it's creative work. It's not easy work. And it's sometimes maybe you just write something or you produce something and it's not high quality. You have to be willing to give yourself permission to

to have an unproductive, not great productivity session. It all might sound like a high-risk strategy, but for David, it's worked. Eight years in, he remains procrastination-free and more importantly, says his quality of life is way better. Much less pressure, much less anxiety. I find myself constantly being surprised about how much I'm able to do in a given day.

That story was reported by Liz Tang. David Maloney's book is called Procrastination Decoded. How to overcome procrastination by ending the guilt cycle, building self-respect and adopting the now or never philosophy. This is The Pulse. I'm Mike and Scott. We're talking about pushing for change. And our last story is about changing the landscape.

If you live in a city, green spaces and parks, big and small, provide much-needed respite from traffic, all of that concrete and asphalt. In the summer, it's a great way to escape the heat. People come to...

Especially these public squares near their homes because of the tall trees and the shade they provide and just being in a beautiful space. June Armstrong is the executive director of the Friends of Rittenhouse Square. It's a public park in Philadelphia. So it really gives you the sense that you're in a grand outdoor urban living room.

City dwellers love trees, but trees don't always love cities. The pollution, droughts, having to dig their roots into the underbelly of roads. It takes a special tree to be able to handle all of that. And that means often the same trees get planted over and over, like London plane trees. And if you look all the way down, you actually see one, two, three London plane trees growing

This small park actually has 50 London plane trees. They are one of the most common city trees all over the world because they are resistant to air pollution and pests. I'm sure you've seen them. They grow really tall. Their bark is scaly and sometimes peels off in layers. They have these spiky green balls on them.

London plane trees are non-native. They are hybrids believed to be a cross between an American sycamore and the Oriental plane. Sure, planting trees, no matter what kind, helps sequester carbon. But we also have a biodiversity crisis.

Doug Tallamy is an entomologist at the University of Delaware. He says when we rely only on a few super popular trees, like London Plain, that are not native, we're not thinking about the habitats that trees provide for other species. I consider these decorations that don't really support biodiversity as if they're statues. You don't have ecosystem function. That's what we're talking about here, reducing the number of statues.

He says you want to plant a tree that helps insects, birds, and other creatures thrive. And city planners need to change it up when it comes to planting trees. Right now, if you look at a typical city planning or suburban planning, it's about 82% non-native plants.

That's food web collapse. You know, we have lost 3 billion breeding birds in the last 50 years, and the vast majority of those are insectivores. You take the insects away, you're going to lose the birds, of course. These are important things. So, yes, plants are decorations, and we want to choose pretty ones, but they do a whole lot more than that, and we have to start considering those ecological roles in our plant choices as well. Does it have to be 100% native? No.

But can we shift the percentage a little bit? Yes, we can. That story was produced by Julianne Koch.

That's our show for this week. The Pulse is a production of WHYY in Philadelphia, made possible with support from our founding sponsor, the Sutherland Family, and the Commonwealth Fund. You can follow us wherever you get your podcasts. Our health and science reporters are Alan Yu and Liz Tong. Our intern is Christina Brown. Charlie Kyer is our engineer. Our producers are Nicole Curry and Lindsay Lazarski.

I'm Maiken Scott. Thank you for listening.

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