Unintended Consequences

We all create a wake: the downstream turbulence of us. Treat unintended consequences as welcomed guests. Catalog & learn from them. Brief episode with Health Hats

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Episode Notes

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Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here

Contents with Time-Stamped Headings

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The downstream turbulence of us 00:53. 1

Unintended consequences. That’s COVID life. 02:41. 1

Disasters and public health 04:45. 1

Various unintended consequences 05:58. 2

Reflection 08:12. 2

Please comments and ask questions


Music by permission from Joey van Leeuwen, Boston Drummer, Composer, Arranger

Thanks to these fine people who inspired me for this episode: Jane Sarasohn-Kahn, Robert Doherty, Dorothy Cuccinelli, Dick Argys, Caryl Carpenter, Suzanne Feeney


Jane Sarasohn-Kahn, Health Populi (amazing, day-in and day-out), The She-Cession – a Financially Toxic Side-Effect of the Coronavirus Pandemic.

Moving to Flood Plains The Unintended Consequences of the National Flood Insurance Program on Population Flows

Mark Twain and the Paige Typesetter

Brent Goldfarb and David Kirsch, Bubbles and Crashes

Edward Tenner’s TED Talk, Unintended Consequences

How to start a movement

Related podcasts and blogs

Make a Ruckus Podcasting


More: Journal for Best Health

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. We will listen and learn about what it takes to adjust to life’s realities in the awesome circus of healthcare. Let’s make some sense of all this.

To subscribe go to https://health-hats.com/

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The Show

The downstream turbulence of us

We all create a wake – the downstream turbulence of us, think a boat or a duck. Many people don’t realize they leave a wake behind them.  Those that do rely on family, friends, co-workers, and coaches to let them know about that wake so they can mitigate (lessen) the impact of these unintended consequences of being. In the ’90s at Value Behavioral Health in Troy, NY, Jim Bulger, my mentor and best boss ever, often spoke to me about my wake. Another great boss and mentor, Bob Doherty, at St. Peter’s Addiction Recovery Center told me, with love, that I was an acquired taste. I learned that I needed a boss with self-confidence to value me and my wake.  My 9-year-old grandson, the writer, read to me from a book he wrote about wizards using wands. I asked him how using a wand affected the wizard. He said, ‘sometimes powers can come back up the wand to the user or using the wand can exhaust the wizard’ – unintended consequences. As a pathologically optimistic, apocalyptic person, I appreciate the yin and yang of unintended consequences – the gift and the danger. It’s everywhere – it’s life.

Unintended consequences. That’s COVID life.

These past few months, I’ve noticed several examples of unintended consequences in COVID-19 world: Wearing masks may lessen physical distancing. Some people think that if they wear a mask, they can get as close as they want. I think keeping the distance trumps the mask—something like a pedestrian hit by a car in a crosswalk with the legal right of way. The confidence in the mask and crosswalk decreased alertness to other risks.

One of my favorite bloggers is Jane Sarasohn-Kahn of Health Populi fame. She wrote about The She-Cession – a Financially Toxic Side-Effect of the Coronavirus Pandemic. Along with the life-threatening impact of the coronavirus on physical health, and the accompanying mental health distress activated by self-distancing comes a third unintended consequence with the pandemic: a hard hit on women’s personal economies. The recession of the pandemic is considered by many economists as a “She-Cession,” a downturn in the economy that’s negatively impacting women more acutely than men. This is markedly different than the Great Recession of 2008, the last major financial crisis: that financial decline was coined a “Man-Cession,” taking a more significant toll out of more typically men’s jobs like construction and manufacturing where fewer women worked.

Disasters and public health

Easing the effects of disasters can create their own disasters. Look at the many floods this season: Beta in Texas, Sally in Alabama and Florida, Hanna on the Texas coast.  In previous years people rebuilt homes six feet higher in flood plains cashing in their National Flood Insurance claims rather than move to higher ground. Then reflooding occurred. Read Moving to Flood Plains The Unintended Consequences of the National Flood Insurance Program on Population Flows. Our findings show that population increases in flood-prone areas as a direct response to community enrollment into the NFIP. This program provides highly subsidized flood insurance, securing households against expensive damages from future floods. Thus, our findings suggest that the private benefit households receive in the form of a reduction in potential risks far exceed insurance rates, thereby altering location incentives.

Various unintended consequences

Mark Twain, my favorite author, demonstrates a different kind of unintended consequence. Mark Twain invested in the Paige Typesetter and went bankrupt. He toured the world to pay off his debts, and he went viral.

Brent Goldfarb and David Kirsch wrote a book, Bubbles and Crashes, noting that the most significant number of innovations occurred during the Great Depression.

Edward Tenner’s TED Talk, Unintended Consequences: Every new invention changes the world — in ways both intentional and unexpected. He tells stories that illustrate the under-appreciated gap between our ability to innovate and our ability to foresee the consequences.

Pandora’s Box is an unintended consequence. So is the Adam and Eve story.

Environmental justice: As people of privilege increase the use of electric cars and solar panels, natural gas price goes up for those without those means and opportunities. Fixed infrastructure costs remain as less gas is used; hence price increases

Now a word about our sponsor, ABRIDGE.

Use Abridge to record your doctor visit. Push the big pink button and record the conversation. Read the transcript or listen to clips when you get home. Check out the app at abridge.com or download it on the Apple App Store or Google Play Store. Record your health care conversations. Let me know how it went!”


I’ve never wanted the superpower to predict or see the future. As my grandson would say, that would be a curse. As a pathologically optimistic apocalyptic Emergency/ICU Nurse/paramedic, I believe in calculated risks with sensible preparations. My wife and I realized a few weeks after we got married that we needed to live below our means, hold minimal debt, and pay off every credit card every month for us to survive me. In that early moment of our marriage, I had to quit a decent paying job after one day when we were pregnant, broke, and living in a new state. I’ll tell the rest of the story another time. But that realization and subsequent habit allowed us to weather some unexpected storms. Embracing unintended consequences as unintended guests reduces baseline stress so you have more gas in the tank to deal with mishaps and tragedy and allows for the possibility of joy in the unexpected.

In healthcare, we call unintended consequences side effects. I like unintended because they are usually known effects, just not the intended ones. Almost nothing is good for everyone, all the time. Many well-intentioned actions, chemicals, policies hurt someone. Unintended, better with open eyes.


Danny van Leeuwen

Danny van Leeuwen

Patient/Caregiver activist: learn on the journey toward best health


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