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- [00:04]
Bianna Golodriga
Hello, everyone, and welcome to Amanpour. Here's what's coming up.
- [00:08]
Interviewer/Host or Panelist
The economy, as you saw, some incredible.
- [00:11]
Bianna Golodriga
Numbers came in, but the people feel differently. Trump's approval rating at a record low. Analysis on a bad month for the president.
- [00:20]
Susan Choi
Plus management of malnutrition. Is a system so fragile that one budget cut would make everything just fall apart.
- [00:31]
Bianna Golodriga
Hundreds of thousands of lives that could have been saved by usaid. The harrowing impact of Trump's cuts laid bare in a new documentary. Its director joins me alongside public health leader Atul Gawande about what they found on the ground in Kenya. Then flashlight. A family rocked by tragedy and a sinister time in Japanese Korean relations. Author Susan Choi joins me to discuss her Booker nominated novel.
- [01:01]
Interviewer/Host or Panelist
And there have always been drugs in America.
- [01:04]
Bianna Golodriga
As the administration targets drug cartels in Latin America, can they actually solve America's drug cris? Welcome to the program, everyone. I'm Bianna Golodriga in New York sitting in for Christiane Amanpour. Tough headlines for the president recently. A judge tossing out the cases against ex FBI boss James Comey and New York Attorney General Letitia James yesterday ruling that the prosecutor who brought the charges was unlawfully appointed Lindsay Halligan had been picked by the president to go after his political adversaries. Yet another loss for Donald Trump, hot on the heels of those wins for Democrats in elections earlier this month. Meanwhile, the release of the Epstein files loomed large, threatening to further fracture his MAGA base. And polls show people do not feel that the president is delivering on his promise to fix the economy. In fact, his approval rating is at a record low. Let's get into all of this now with correspondent Stephen Collinson, who joins me from Washington. Stephen, it is good to see you. And you wrote about the president's not so good, almost terrible. One could describe few weeks and months that he's had. And we'll get into the economy and the Epstein situation in a moment. But I do want to start with what we heard yesterday in this federal judge dismissing the cases against former FBI Director James Comey. New York Attorney General LETITIA JAMES because they ruled that the prosecutor, the judge ruled that the prosecutor had not been appointed legally and accurately. So what do you make of the situation that the president says, you know, he was the one who directed the attorney general to go after and prosecute. All about vindication and the courts have stepped in. Should this be viewed in a positive light, that the guardrails are holding up, or should we be worried about what's coming next? The DOJ says that they will appeal this ruling.
- [03:21]
Stephen Collinson
I think for supporters of democracy, it's always good to worry about what's coming next with this administration. But I would say that the guardrails are holding up partially. It's true that the judiciary has been the premium branch of government that has stood up to the Trump administration and the president's expansive claims of executive power. We've not just seen that in these cases, which failed for procedural reasons, but, for example, multiple judges have ruled that the president's use of troops in US Cities to enforce his crime and immigration crackdown was not legal and flouted the Constitution. So the judiciary is, I think, curtailing the Trump administration. We're still waiting for that big Supreme Court decision on whether his emergency use of tariff powers is constitutional. That'll be another one. But at the same time, a decision by the Supreme Court, even before Trump ever took office for the second time, arising from his criminal trials, that the president has substantial immunity for official acts in office. That has given the White House massive, a real permission structure, I think, to push the legal system to its limit. Look at, for example, the dismantling of U.S. aid. The courts were used to try and curtail that, but by the time any cases came to fruition, USAID had been wiped out. So I think the administration has worked out how to work around the courts to some extent. The other checks and balances from Congress, we've seen very little from that from the Republican Congress, apart from this decision last week to try to force the Trump administration to release the Epstein files.
- [05:09]
Bianna Golodriga
Yeah. And we'll get to the consequences of cutting USAID in our next segment. But I do want to ask you about the other development yesterday, and that's the Pentagon now announcing a probe and potential court martialing of a war hero. That's astronaut and Democratic Senator Mark Kelly. This after he and five other Democratic lawmakers released a video where they urged members of the military to not act on illegal orders and not follow illegal orders and to uphold the Constitution. The president and some of his supporters seem to have not heard or choose to not incorporate the word illegal and are now saying that they are acting unlawfully by saying or suggesting that members of the military should not follow orders. That's not what this video claims. This argument itself and the fact that the Pentagon is launching a probe, what does that tell you about the politicization of the Pentagon now? I mean, we've spent so much time focused on that question as it relates to the Justice Department. Do we now have to worry about that impacting The Pentagon and the Department of Defense.
- [06:22]
Stephen Collinson
Yeah. And it shows us that the administration will use every possible avenue that it can to expand presidential and executive power. You rightly talk about how the Justice Department has been weaponized to Trump's political goals, breaking down the wall of independence between the White House and the Justice Department. Well, this goes across an even more troubling line because if you think about it, Mark Kelly, former shuttle astronaut, a US War hero, flew carriers, flew jets off carriers in the first Gulf War. He's retired, and they're talking about bringing him back into uniform to court martial him over the use of his own free speech. After all he said was that members of the services should always obey the law. That doesn't seem to be such a heinous offense. And if this, for example, were to go to court martial and he was found guilty, theoretically that raises the possibility that anybody who is in the armed services, even if they're retired and they criticized a president, they could find themselves legally liable. So this is a huge crossing of a legal and military Rubicon, not least because it seems to be using the powers of the military against a civilian. You know, that's something we've never seen before in the modern United States.
- [07:51]
Bianna Golodriga
Yeah, and a decorated, you know, war hero and an astronaut as well. I mean, politically, I can't imagine this boding well for the White House. And this coming after we noted lower approval ratings stemming from more concern among voters, Republican and Democrat, over the economy, the direction that's headed, and the president really losing the battle with his own party over the release of the Epstein files, too. Stephen Collins says. Really appreciate the time. Thank you so much for breaking it down for us.
- [08:18]
Tom Jennings
Thanks.
- [08:20]
Bianna Golodriga
Well, 91 million lives saved. That is the extraordinary legacy of USAID across 20 years, according to the Lancet. And now some estimates say Trump's dismantling of the agency has already caused 600,000 deaths, two thirds of them children. Now, the administration refutes those figures, but those on the ground and the world's poorest nations are seeing it happen firsthand. Dr. Atul Gawande is a renowned surgeon who served at USAID between 2022 and 20. He recently traveled to Kenya with a documentary team to see the impact of the cuts. The short film is called Raveena's Choice, and here is a clip. And Dr. Gawande and the film's co director, Thomas Jennings, are joining me now. Welcome, both of you. I do have to say it was a very difficult film to watch. Equally important, though, in terms of anybody questioning where this money, where USAID funding, where it goes and who it helps, because you see the life or death decisions that parents like Raveena have to make on a daily basis. And I do want to start with you, Tom, as it relates to the film, because it shows what happens when aid goes. Why did you choose to center the story on Raveena?
- [10:19]
Tom Jennings
We chose to center the story on Raveena because her story epitomized what is happening across the world, around the globe to thousands of people. We did a lot of work trying to find stories, and we were given many, many opportunities to tell the stories of many people who were impacted as significantly as Ravenna was. Ravena's story, though, has as part of it a very dramatic element which has to do with a choice that she was forced to make, a choice that no mother should ever have to make. It had to do with a choice between a child, a single child, and many children, other children that she had at home. What would she do in a circumstance when there's tremendous food insecurity involved? Her story is a very powerful, powerful, you know, story of that tells us exactly what the problems are that have happened subsequent to the cutting of USAID.
- [11:23]
Bianna Golodriga
And Dr. Gawanda, you followed communities in Kenya, from advanced HIV wards in Nairobi to malnutrition centers in Columa refugee camp, where mortality from severe malnutrition had dropped below 1% with, what is that statistic in that figure today?
- [11:42]
Dr. Atul Gawande
So it's hard to say exactly where the statistic is now. What I can tell you is that over the last two decades, malnutrition, severe acute malnutrition in children had a 20% death rate. There have been discoveries and approaches that have reduced that death rate to less than 1%. As you said in Kakuma, the system that makes that work is being able to reach people at their own community with a community health worker who has a tape measure and a scale to check on young children, being able to give a fortified food therapy for those that are losing weight and severely malnourished and rescuing them. As a consequence, that system has been broken. And what I saw was the consequences for hundreds of thousands of people there, resulting in much higher levels of starvation and much sicker children coming into wards. And then on those wards not having the staff and not having the resources to be able to respond. And so you were seeing death rates that were elevated when I was there, well above last year's talk about staff.
- [12:57]
Bianna Golodriga
Cuts and the number of doctors and medical nurses there to assist the patients. What is that ratio now, Tom?
- [13:06]
Dr. Atul Gawande
Or Dr. Gawande, I'll jump in as an example. During that time, there were, for a community of 300,000 people, about one community health worker per thousand refugees. These were people coming from South Sudan, Somalia, across the border into Kenya. Kenya is a growing economy, an increasingly important part to the US and so we partnered with the government to establish refugee camps to keep peace, keep stability and attend to humanitarian needs. The community health workers that touch base at the homes for prenatal care, for immunizations and especially malnutrition were cut by 2/3, from roughly 301 per thousand to under 100 for the entire community and simply could not keep up with attending to the most at risk. And that is happening across the world.
- [14:04]
Bianna Golodriga
Yeah. And Tom, you highlight so effectively the courage of these doctors that are trying to do their job so bravely every single day. I want to play a clip from an interview with the chief medical Officer of Clinic 7.
- [14:20]
Susan Choi
Clinic 7 provides the highest level of care for all refugees. We started to see the impact of the funding cuts quite early. When we had the first wave of people being let go of, there was a lot of incredulity like, this can't be happening. This actually cannot be happening. It seemed unimaginable that the cuts would be as bad as they were and affect the sectors where life saving activities were ongoing.
- [14:57]
Bianna Golodriga
And Tom, you know, the film centers on a terrible choice no mother should have to make. And that is Raveena. But I'm just wondering from the time that you spent with these healthcare workers and these Doctors, doctors like Dr. Monthy, what you learned about the choice they are making by continuing with this job and the dedication to their patients despite all of these obstacles and new obstacles now with the cut of USAID, just.
- [15:27]
Tom Jennings
Such immense respect for Dr. Monte, Dr. Sheila Monte, she and Dr. Kefa, the other doctor in the film, have given their lives over to treating a population that nobody else will do. And it's an amazing. You know, Kakama is the northern part of Kenya, near the South Sudanese border. They have been there for years. Dr. Sila has been there for more than 10 years and has dedicated her life. I have to say that they are on three month contracts now, those doctors. It's because of the funding cuts that have hit. They still live essentially month to month as providers, dedicating their lives and their careers to helping these most needy people. So the amount of work and dedication to the work that they provide is astounding and needs to be supported.
- [16:24]
Bianna Golodriga
Dr. Gawande, the figures that we cited at the Introduction of this segment here, which the US Government has refuted but had been reported by the Lancet and the USAID dismantling, already causing some 600,000 deaths, two thirds of them children. We're seeing other countries follow suit as well. You've described this moment as a public man made death. I want to play sound for you from a few months ago where Marco Rubio was asked about Elon Musk's role in doge. We should note DOGE has now been dismantled as an organization, as has the USAID funding. We should note. But he said that no life would be lost with the cutting of usaid. Here's what he said. Let's play it for our viewers.
- [17:09]
Interviewer/Host or Panelist
Has anyone in the world died because of what Elon Musk did?
- [17:14]
Bianna Golodriga
Listen, yes or no?
- [17:15]
Interviewer/Host or Panelist
Reclaiming my time. If you won't answer, that's a loud.
- [17:18]
Dr. Atul Gawande
Answer no one has doubted because of usa.
- [17:23]
Bianna Golodriga
I don't know if you have a relationship with Senator Rubio, with former Senator Rubio at the time, given your work there and now Secretary of State, National Security Advisor, but what were your thoughts when you heard that from him?
- [17:35]
Dr. Atul Gawande
Well, he's repeated it multiple times and it is a shock. Senator Rubio understands very well what USAID delivered in the world. He was actually one of the agency's strongest defenders. It's had six decades of Republican and Democratic support. There are criticisms that are totally valid, that it could be more efficient. It could be it could use less international organizations and more local organizations. But none of the destruction of USAID was about solving those problems. And then to this day, Senator Rubio has refused requests from Congress to address the death toll, has denied that anybody has died, even though there is ample indication, ample documentation of the deaths. And we have reasons to believe that the 600,000 that are estimated so far is in fact smaller than the actual toll. This is what is estimatable from the existing data. That's possible.
- [18:43]
Bianna Golodriga
You said I'm looking at notes here in your final meeting at usaid, that you felt the agency's work was bipartisan and stable, as you noted from your work there with then Senator Rubio, now Secretary of State, and that you, quote, lacked imagination in anticipation what would come. Given everything that you have seen, both professionally in your work and politically, the fact that you lacked imagination about how bad things could get speaks volumes. What exactly did you miss here, in your view?
- [19:14]
Dr. Atul Gawande
I miss the willingness to disregard signs. You know, the President signed an executive order the day of his inauguration calling for a pause on foreign assistance funding. Marco Rubio Turned that into orders by that weekend. And then as letters hit, we saw places where midwives were pulled out of deliveries, where food and medicines on the shelf were not allowed to get delivered. And we had a chance to see, in settings across Kenya as an example, actual deaths that resulted from that. It was clear in the first couple weeks that hundreds of thousands of people would die in the first year. And I did not imagine that there would be people like Elon Musk and someone who'd been an advocate, like Marco Rubio, would turn on the agency, deny, have no curiosity about the harm being done, and shut it all down, purge the staff, terminate 86% of the programs, and impound the funds. The results are catastrophic. When you've saved 90 million lives over the last 20 years, it is arguably the highest impact per dollar of any agency in the US government. And it's been wiped away.
- [20:34]
Bianna Golodriga
When we look at the cost alone to U.S. taxpayers, roughly, USAID costs about $24 a person per year. And Dr. Gawande, I have heard after these cuts were first implemented, from a political standpoint, there were Democrats who were saying, listen, this is not the political hill to die on for Democrats. There are other challenges and other policies that we should focus on in combating and pushing back on for this administration, not usaid. This is not something that, you know, average Americans are thinking about every single day. And I wonder how you juxtapose that argument, because there are families that are struggling here in the United States as well with the video here and the documentary of where some of that money could go help, and that is cases like Raveena and her daughter Jane Sunday.
- [21:32]
Dr. Atul Gawande
Yeah, well, the first thing I'd say is exactly as you point out, out of $15,000 per American taxpayer per year, our budget in the global health that I ran was only $24 per person per American. With that, it reached hundreds of millions of people. But the second thing I would say is the indifference to suffering and loss of life from the dismantling of global public health is coming home. It's the same approach that is being used to dismantle our vaccine supply. The HIV program stopped abroad. Our now HIV prevention programs stopped here at home. We have stopped pursuing research of HIV vaccines or vaccines for MRNA vaccines to prevent the next pandemic. This is damage that is now occurring right here at home with the dismantling of research, dismantling of major public health operations. And the harm doesn't just stay abroad.
- [22:35]
Bianna Golodriga
Right, which is why so many have argued that aside from just benevolence that this was really a soft power use for the United States to help it geopolitically. And all those issues that Dr. Gwande just listed right there in terms of why it's beneficial to continue programs like this. I do want to end by asking you, Tom, just from what you were hearing from those on the ground and those you were interviewing, has their view towards the United States changed?
- [23:05]
Tom Jennings
Yeah, it has. What was astounding in our experience was how well in say, geopolitics, they understood exactly where the cuts were and who was making them. And I think generally speaking, the overarching sense is that America has lost its sheen, has lost its reputation. It's undependable. And as a journalist, as an American, it's hard to hear that. It's hard to hear it from the people who are most affected. I feel like Raveena's story is one of those stories that compels us to understand more, better what the real suffering is at hand. And I do hope people get a chance to watch it.
- [23:53]
Bianna Golodriga
I hope so as well. I highly recommend it. It's about 20 minutes, doesn't take long.
- [23:57]
Tom Jennings
But you really see on the new yorker.com if people like to look at it.
- [24:01]
Bianna Golodriga
Yes. New yorker.com you see the impact, the real life impacts and the devastating choices of cutting programs like usaid, what it has on families across the world. Atul Gawande, Tom Jennings, thank you so much for joining us. Really appreciate it.
- [24:16]
Tom Jennings
Thank you.
- [24:17]
Bianna Golodriga
And do stay with cnn. We'll be right back after the break.
- [24:26]
Interviewer/Host or Panelist
Tav, I got news for your ears. The podcast.
- [24:29]
Dr. Atul Gawande
I am your host, Michael Ian Black.
- [24:32]
Interviewer/Host or Panelist
Trump could have released these files at any moment.
- [24:34]
Bianna Golodriga
When he wants to do something, he does it.
- [24:37]
Interviewer/Host or Panelist
Yeah, basically he's been refusing to, but now he's saying let's do it. Well, then do it.
- [24:41]
Dr. Atul Gawande
Yeah, it's up to you.
- [24:42]
Bianna Golodriga
Took a wing off the White House.
- [24:44]
Interviewer/Host or Panelist
That's right.
- [24:44]
Bianna Golodriga
You do whatever you want. And he doesn't let you forget that. He does whatever he wants.
- [24:49]
Interviewer/Host or Panelist
Right.
- [24:49]
Bianna Golodriga
He'll remind you.
- [24:50]
Interviewer/Host or Panelist
Have I Got News for your Ears. Releases new episodes every Wednesday.
- [24:54]
Dr. Atul Gawande
Don't miss an episode.
- [24:56]
David Herzberg
Follow us wherever you get your podcasts.
- [25:03]
Bianna Golodriga
Well, if you're planning to relax and do some holidays, some reading this holiday weekend, I highly recommend my next guest novel. Susan Choi's Flashlight was shortlisted for this year's Booker Prize and long listed for the National Book Award. It centers on Louisa and the tragic disappearance of her father, which begins the unraveling of a family across generations from Korea to Japan to Indiana to the U.S. in the U.S. it's a story of secrets, loss and alienation, while also charting a dark period in Japanese Korean history. And Susan Choi now joins me from Houston, Texas. Susan, welcome to the program. Congratulations on all the accolades that this book has received. So let's start at the water's edge. The novel begins with that defining moment in Sirk and his young daughter Louisa. Taking a walk on the beach. Sirk enters a misty area and he never comes back. This began as a short story in the New Yorker that you wrote, I believe, in 2020. What made you want to revisit it? And not only revisit it, but expand it to a 450 page novel?
- [26:14]
Susan Choi
To be completely honest, I wasn't expanding or revisiting so much as already trying to write that novel in 2020. When the short story was published. I had the characters and the situation, but I could not find my way in. And, and that story was more of a kind of a carve out of material already there. And then I was able to structure it from there.
- [26:40]
Bianna Golodriga
And much of the book is about characters who don't fit in because of race, culture, heritage, language, among other things. Louisa is a white American mother. She has an Asian father and she feels like she doesn't believe or doesn't fit into life in either the United States or Japan. And you wrote so beautifully about this experience that she had throughout her life. Can you talk about or can you read a passage from the book that gives us a sense of what that experience was like?
- [27:14]
Susan Choi
Yes, and thank you. Thank you for saying that. After they got off the plane at the Tokyo airport, before they found their greeters or even their luggage, a little boy with black hair like a glossy black bowl pointed and gaped at Luisa Gaijin. He cried in thrilled horror. The boy was dragged off by his slim black haired Japanese mother who sternly hushed him and yet at the same time stared over her shoulder at Louisa. Why are they looking at me? Said Louisa with fury. Just like the Japanese mother, her own mother said, shh. But why? It's just they're not used to Americans. I don't look American. All her life she'd been asked what she was, where she came from. In the second grade Thanksgiving play, she'd been cast as the sole Indian. She'd expected the disadvantages of brown hair, brown eyes and brown skin, all imposed by her father to be clear advantages here. Wasn't this where he came from? It must be her mother's fault.
- [28:30]
Bianna Golodriga
And so much of your own life seems to mirror Louisa's as well. Your mother is an American Jewish woman. You have a Korean father. You were born. You grew up in the Midwest. You spent time in Japan. And you've actually written about this. You've said, I've grown up in the Midwest, and no one ever looked like me. Korean. And my mom isn't. So we went to Japan, and I was sort of expecting to, like, fit in brilliantly and, I don't know, be received with glory, you know, at last, here you are, a person who looks like us. And, of course, I didn't look like anybody there either. How much of your own life is in this book?
- [29:10]
Susan Choi
This book starts in my own life and then really develops into kind of a wild place that my life thankfully, never visited. I went to Japan with my parents when I was a little girl, the same age as Louisa. It was the late 70s. And a lot of those feelings of expecting to fit in and not fitting in are very much drawn from my own experience there. But my experience there was, in the end, very ordinary. It was the exciting culture shock of a young child who had never been outside of her own country or even, you know, really town. Very much the way that the book moves forward from there, from this journey into a series of events that are extremely extraordinary is, you know, I'm happy to say, completely not borrowed from my own life. But it's a way that I often write. I actually start from an experience that's comfortable to me, that's my own, but I end up somewhere very different, and that's where this book goes.
- [30:12]
Bianna Golodriga
You say comfortable to you, so you've come to accept being different and being the other. I mean, I can sort of relate as an immigrant to this country, growing up in the south as well. You know, as children, you want to fit in wherever you are, and it's obvious from day one that you won't be like everyone else. But you seem to have accepted that. So it's not as if this was a therapeutic experience or a cathartic experience for you, but a place that you're very comfortable and familiar with.
- [30:39]
Susan Choi
I think I had definitely come to accept myself and the way I look and the way I appear to other people. Growing up, especially in the United states through the 80s and 90s, was an experience of discovering that there were so many other kids who didn't fit into the simple categories that existed when I was little. And it's been an experience of really the collapse of categories or the proliferation of categories. I'm not sure which you prefer. So I think these issues of Louisa's not looking like the other children, not feeling like the other children. Those weren't things that I felt I needed to really work through anymore. The thing I really wanted to return to in this book was the Japan of the 70s that I visited so briefly and was always kind of haunted by.
- [31:29]
Bianna Golodriga
And why do you think you were? Why were you so haunted by Japan? Why did that stay with you for so long?
- [31:36]
Susan Choi
It was such a different place from the US Where I'd grown up, and I think such a different place from the Japan of today. I always had this sense, once I became an adult and started writing, that the Japan I remembered from 1978, 1979, isn't there anymore. And I wanted to return to it in some way because it had been a very powerful experience for me to be somewhere so utterly unlike the United States and so utterly unlike my life up to that point.
- [32:10]
Bianna Golodriga
And the title Flashlight, I have to ask, appears in important moments throughout the story. What does it represent?
- [32:19]
Susan Choi
Initially, the title represented the fact that there's a literal flashlight in that short story you mentioned. And I'm not great at titles. With the short story, I felt less pressure to have a profound title, and I thought, well, there's a flashlight. Short stories are best titled in a simple way. So it was called Flashlight as a Story. As the book grew and grew, unbeknownst to me, I think this idea of illuminating some parts of life and in the course of that, casting other parts into an even deeper darkness so that, you know, the harder you look at one thing, maybe the less well, you can see other parts of your life. I think this idea started to emerge in the book before I could see it. My agent, actually, who's a wonderful reader and a wonderful editor herself, said, oh, I love the metaphorical role of the flashlight. And I said, the what?
- [33:19]
Bianna Golodriga
Yeah, you're like, oh, that's. I hadn't noticed. That was the intent, right?
- [33:24]
Susan Choi
Oh, yes. I intended it all along. No, it's really good to have readers who can see more than you can. It's another example of the flashlight problem. I was looking hard at other things.
- [33:34]
Bianna Golodriga
Well, they pick up on it because it comes up in so many important moments in this book. Louisa's father is carrying one, and when he gets lost at the beach, and then she steals one herself from a therapist office. So there is sort of this metaphorical role that the flashlight plays here in this book. I do want to ask you just about literary fiction in the US and the controversy over book banning. Writers over the US are Working now under increased scrutiny. I don't have to tell you that last month, PEN America actually warned that book banning has become more rampant and more common. What is your view on that as a writer?
- [34:17]
Susan Choi
I'm appalled by it. Appalled, Horrified. Not really surprised, though I think that book banning, unfortunately, is. It's an easy way to wage culture war. It's an easy way to lash out at. If you are someone who believes that there are certain members of our society who don't belong, who aren't equally deserving, who aren't equally human, I think that book banning is an easy and cowardly way to lash out at those people, at their stories. And I look forward to a time that book banning is on the decline. But the truth is, it's always been with us. It's something that has been done to greater or lesser degree throughout history, and this happens to. To unfortunately be a time that it's on the rise.
- [35:14]
Bianna Golodriga
Well, something else that's on the decline is the amount of time spent reading. Not only Americans, I think, around the world, but there's a new study that shows that Americans who read for pleasure, the number has fallen by 40% this year, which is alarming, I would imagine, for you, especially as an authority. But I do want to encourage our viewers to continue reading. And so, no pressure on you, but what is next for you and what are you reading? In the meantime.
- [35:48]
Susan Choi
I'd like to join you in encouraging Rihanna. More reading. Reading is irreplaceable, and it's one of my favorite things to do. What I've been reading most recently are all of the incredible other five books on the Booker short list, each of which was amazing in its own way. I was so thrilled and honored to be on that list. And I have to say, it was such a treat to read each of the books by the other authors. What I'm working on now is finding the next thing to work on. I'm slow. It always takes me a little while after one thing is done to find my way into the next thing. But I'm hoping to write a little bit more about my father's family.
- [36:33]
Bianna Golodriga
Amazing. Well, we're looking forward to reading about that. And we were just discussing in our show meeting about the beauty of the camaraderie, especially among the Booker finalists, each supporting each other. So that is a wonderful thing to see as well.
- [36:47]
Susan Choi
We were so lucky to meet each other.
- [36:49]
Bianna Golodriga
Well, you're all winners in our book and we should be reading more books, so. Susan Choi, we appreciate this segment. We appreciate you. Thank you. So much.
- [36:58]
Susan Choi
Thank you so much for having me.
- [37:00]
Bianna Golodriga
We'll be right back after this short break.
- [37:05]
Susan Choi
Life on the Mars farm, it's anything but quiet for me and Dave. Every day is a lot of moving parts. Five kids do not go in the house, a working farm and a renovation business that never stops.
- [37:19]
Interviewer/Host or Panelist
We've been pushed to the limit. If you build it, they will come.
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Susan Choi
Oh my gosh, it's so beautiful.
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Bianna Golodriga
Just another day in this crazy, beautiful.
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Susan Choi
Life we call ours. Fixer to fabulous season premiered December 2nd at 8 on HGTV.
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Bianna Golodriga
While the US Battles a fentanyl crisis at home, the Trump administration is taking its fight against drugs to the Caribbean. Dozens have been killed since President Trump announced military operations against what the administration says are drug boats used by Venezuelan traffickers. The move is facing a lot of criticism over its legality and whether it's actually reducing the spread of drugs in the US Drug historian David Herzberg argues this strategy is falling short and he joins Hari Srinivasan to explain why.
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David Herzberg
Bianna, thanks. David Herzberg, thanks so much for joining us. You wrote an op ed in the New York Times recently that was titled I Am a Drug Historian. Trump is wrong about fentanyl in almost every way, I guess. What's the biggest way that the administration is wrong about this new kind of war on drugs that we seem to be prosecuting?
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Interviewer/Host or Panelist
Well, first, thanks for having me on to talk about this. And I guess the biggest way is the idea that there is a drug free America in the past that we can return to if we just stop this foreign supply of fentanyl. That's the story. The idea that these open borders have undermined America's traditional communities and that if we could just get back to that before state, everything could begin to recover and we could have that traditional America again. But as a drug historian, I can tell you that there have always been drugs in America. Even in suburbs and rural areas and small towns, there's always been quite a lot of drugs. In fact, it's not always been in crisis. But there isn't a drug free place we can return to if we just stop this.
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David Herzberg
David According to the CDC, there were 53,000 drug overdose deaths in 2024. That's down from 75,000 in 2023. And illegally made fentanyl were involved in 65.1% of those overdose deaths. Now, even though the numbers are down, you know, more than 50,000 deaths a year is still a staggering number. That sounds like a crisis. Doesn't the president have a point that this is a crisis.
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Interviewer/Host or Panelist
We should absolutely be taking more significant actions to try to stem this drug. The question is, we want those actions to work right. We want our goal to be less death, less harm. And if we aim our policies at a goal that is kind of a mirage or a fantasy, they can't succeed. What we want is policies that can actually achieve something that'll improve people's lives. And, you know, fentanyl is not a good, is not a good product for consumer use. It's very potent, it's hard to package for safe use. And so, you know, we saw a shift in illegal markets from heroin to fentanyl in the 2010s, and this was a shift that didn't occur because consumers were asking for it. They weren't saying, we want a more powerful opioid. It happened because of policy changes that change the incentives in supply chains away from providing heroin, which had its own problems, of course.
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David Herzberg
Right.
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Interviewer/Host or Panelist
It's not a perfect product either. But they shifted to fentanyl, and we can do that in reverse. We can shift away from the drugs that are killing so many people and reduce that harm.
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David Herzberg
Help us kind of put this in perspective for us. I think most people are familiar with kind of the opioid crisis that America had started to deal with and still deals with, especially in rural parts of the country. But how did we get from something that was, you know, pill mills over prescribing people getting addicted to painkillers through heroin to fentanyl.
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Interviewer/Host or Panelist
Now, the problem with fentanyl began in what I call white markets. White markets are those legal markets that sell psychoactive drugs that are the ones in your medicine cabinet, prescribed by doctors and sold by pharmacists. And when those markets, as they sometimes do, spiraled out of control in the opioid crisis, when author responded to try to fix that problem, they were. Their actions were in keeping with the pharmaceutical industry argument that it's. The problem is not with the products. The problem is with the abusers who are diverting them and misusing them. And so the steps they took to fix the problem were to exclude those buyers, people with addiction, exclude them from buying in white markets. Those are people very strongly committed to continuing to buy and use opioids. So they wanted to continue to do that. But there was a mismatch between supply and demand here because they did not live in the places where heroin was sold. Right. That heroin markets were like a 20th century thing. They involved farms, they went to central markets in major cities. And the opioid crisis as you mentioned, began in the suburban rural areas. So you had this mismatch. There were people who wanted to buy opioids, but there weren't enough people selling to them. And that meant somebody could make a lot of money. And so new suppliers stepped in. And these new suppliers were modernizers. They said, we don't need farms and farmers and goo coming from the SAP of flowers. This is all so complicated. We're in the 21st century. Let's have a synthetic product. It'll even be more powerful, so it's more profitable. And instead of sending it to just a few major markets in New York and Chicago and Los Angeles, let's send it to where the consumers are, just like every other product does in the 21st century.
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David Herzberg
If this is such a hard drug to handle and get correctly, why is it so prevalent? I mean, you also hear about fentanyl in other drugs or other drugs laced with fentanyl.
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Interviewer/Host or Panelist
So the trouble is that fentanyl is a bad product for consumers. Just objectively speaking, it's hard to make safe. It doesn't last very long, et cetera. But it's a great product for smuggling. I call these illegal markets prohibition markets, because we think about them as there to eliminate the supply, but they don't eliminate the supply. Right. Fentanyl is still there. They're just a different set of market incentives that we call prohibition. And those market incentives favor a very potent product because you need less of it to make the same amount of doses. So that can increase the chances for profit. And because fentanyl is such a good product for smuggling, it starts to outcompete other products. But also, prohibition markets don't incentivize safe production practices. You know, in white markets, pharmaceutical companies have to do all this expensive stuff to make sure that when you buy one of their products, it is exactly what it says it is on the label, and that's way safer. But in prohibition markets, it's just as illegal to sell fentanyl that is high quality, that is accurately labeled as it is to sell fentanyl that is poorly mixed and therefore quite dangerous, or to sell something that you claim as cocaine, but it's laced with fentanyl because people didn't clean the machines or what have you. So there's no incentive to do this expensive, careful production process in a prohibition market. The incentive is to avoid the cops. So fentanyl kind of spreads out through there because it's good for the people whose job it is to make money selling drugs.
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David Herzberg
I think there has Also been some questioning of whether or not the boats that we have targeted and attacked are these boats coming from Venezuela carrying fentanyl onto the shores of the United States.
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Interviewer/Host or Panelist
Nothing that I've seen suggests that they have fentanyl on board. The fentanyl supply chain doesn't involve Venezuela. As far as I'm aware, Venezuela is not a significant source of any drugs to the United States. I went to the 2024 United Nations Office of Drugs and Crime report and I searched for country names. You search China, comes up 130 times or what have you, you search Mexico lots of times, you search Venezuela and it literally comes up with zero. So I, there's no evidence that I have that suggests that they are carrying those drugs. And that's part of the problem with shooting first and asking questions later. These are essentially imposing the death penalty on people who, as far as I can tell, have never been even accused of a crime, much less convicted of one.
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David Herzberg
What's interesting about not just the op ed that you wrote, but really the books that you've written in the past is that you kind of have this much longer arc and you're looking at how the culture in the country, that is America, has had previous experience with drugs that we couldn't contain, that became socially acceptable, that might be legally questionable. I mean, we had, you know, President Nixon famously wanted to start this war on drugs. And we've had this kind of really difficult relationship back and forth on trying to figure this, this problem out.
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Interviewer/Host or Panelist
So while there has long been widespread drug use in America, starting with in the years after the revolution, historians call this the Alcoh Republic, drinking rates shot up to a level that has never been matched since, eventually triggering a century long crusade against alcohol that culminated in literally a constitutional amendment to criminalize the sale and transport of alcohol. So the problem has been there, but there have also been, there have been times when widespread drug use has led to public health crises, and there have been times when there's still widespread drug use, but there aren't public health crises. And this is something that we can learn from history and say, well, what's the difference difference between the two? And I've developed a little bit of a, of a rule of thumb in trying to think about this 150 year history. And public health crises usually come in a situation where certain communities or lots of communities are flooded with a dangerous drug, meaning that that drug is really, really easy to access. And I think about this in my own life. In the 1980s, when I was in high school, kids Knew how to get beer, they knew how to get cannabis out. Of all the illegal drugs that exist, those are the ones that kids in my high school used. Why? Because they were the ones that were easiest to get. So in a certain way there was an informal harm reduction going on. In theory, the kids were supposed to be using no drugs, but in reality, the ones they had access to were the ones that were relatively safer than, let's say, if I had been in high school in the 2000s and at every high school party there were a ton of opioid pills. So that flooding is really at the basis of a lot of the crises.
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David Herzberg
Do you see parallels like when 71, when Nixon starts this sort of war on drugs and then we've seen president after president in different ways, kind of quote that or come up with their own slogan, just say no, famously with Nancy Reagan. Right. And even now I wonder whether you're seeing the kind of rhetoric politically that comes out in trying to stop fentanyl. Are there parallels going back in American history?
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Interviewer/Host or Panelist
Yeah, there are, there are a lot of parallels. And it even goes before Nixon. The first federal anti drug laws with mandatory minimum prison sentences were in the 1950s in the so called Boggs Act. So this is, it's easy to understand this reaction. Addiction is frightening. I'm a parent of three children myself and it's terrifying to imagine the, this kind of harms befalling your children. And the idea of someone saying, I'm going to take a tough approach and really punish and scare the people who want to threaten your children. It's an emotionally satisfying approach. And as a parent, I fully understand it. Unfortunately, history shows it simply doesn't reduce the risk. It simply is ineffective. We don't have to debate whether it's better or moral or this or that. If you want kids to be less harmed by drugs, that's not the approach that you take. Because those prohibition markets, once again, they select for more dangerous drugs, they select for more danger to young people than less. And so if we are switching now, if we are shifting back towards that rhetoric, that harsh anti drug rhetoric trying to deal with drug problems through warlike actions like blowing up boats in the Caribbean, that suggests another period of lengthened crisis. Because those approaches don't work the way that approaches have been working to reduce the number of overdose deaths. You cited 50,000, there were over 100,000 recently and there was nobody blowing up both. When that happened, it was because of a set, a set of practical policies that had as their goal preventing deaths, preventing overdose deaths. So we're talking about fentanyl test strips so that people can tell what's in the drug they're about to use. Syringe exchange programs that reduce the transmission of disease between injection drug users, even safe injection sites, which kind of bring into prohibition markets a little bit of that white market safety. I have a medical professional there. And those kind of things help reduce death. So everyone should agree that people should stay alive. And that should be a central goal of drug policy.
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David Herzberg
When you kind of think of this sort of longer arc of how a country can tackle a problem like this, is there a country that's done it?
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Interviewer/Host or Panelist
Well, I think that there are those precedents in the United States. There are moments where the policies worked reasonably well. And I want to be clear. There is nowhere that has no drug problems. There's nowhere that has no drug harms. But what had been happening in the 1950s and 60s were twin catastrophes. White markets were selling barbiturates, amphetamine, quaalude, valium, hand and fist. As many as half of all Americans had used one of those products in the past year. And there was tons of addiction and harm in those white markets. So they were and about a control. Meanwhile, waves of heroin addiction were washing through American major cities. And so all elements of American drug policy were failing dramatically and catastrophically by the late 1960s. And initially, this war on drugs looked a lot different than what it eventually became. It initially involved tightening the screws on the pharmaceutical industry. In other words, regulating the sellers who are motivated by profit so they will respond to incentives. And then they reduced many penalties for drug consumers and sort of trained their sights on those big sellers. And at the same time, they invested massively in the kinds of services and supports that people who had developed an addiction might need. This was the era that methadone maintenance became really widespread. So if you think about this combination of regulating suppliers and they regulated in a smart way, the more dangerous drugs like amphetamine got restricted really strongly. And then less dangerous drugs, maybe like a codeine or in the sedative class, valium, they were less intensely regulated so that the market was steered towards products that were safer. And in the meantime, there was special recognition that, that people with addiction need different kind of response than everyone else.
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David Herzberg
Professor David Herzberg at the University of Buffalo, thanks so much for joining us.
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Interviewer/Host or Panelist
Thank you.
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Bianna Golodriga
All right, that is it for us for now. If you ever miss our show, you can find the latest episode shortly after it airs on our podcast. Remember, you can always catch us online on our website and all over social media. Thanks so much for watching and goodbye from New York.
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Susan Choi
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Bianna Golodriga
Com.