FDA’s Dr. Makary on Women’s Health & Warren Buffett’s Update 11/11/25

Summary

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Squawk Pod (11/11/2025) Summary

Episode Title: FDA’s Dr. Makary on Women’s Health & Warren Buffett’s Update
Hosts: Becky Quick, Joe Kernen, Andrew Ross Sorkin
Guests: Dr. Marty Makary (FDA Commissioner), Chris Hughes (Facebook Co-founder), Warren Buffett (topic only)
Main Theme:
This episode centers on the fallout of the historic government shutdown, the FDA’s reversal on hormone replacement therapy warnings, a critical look at Trump administration industrial policy, and a major philanthropic update from Warren Buffett.

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Government Shutdown: Senate Passes Bill, Fallout Continues

Key Discussion Points:

• Senate passes a bill (60-40) to reopen the government after the longest shutdown in US history.
  • All Republicans (minus Rand Paul), seven Democrats, and one Independent vote in favor.
  • Bill must still pass the House; subsidies for Obamacare remain a point of negotiation.
• Ongoing issues for federal workers:
  • Many have not been paid since October 1 and face missing further paychecks despite bill passage.
  • Air traffic controllers set to miss paychecks amid critical shortages and mounting delays.
  • Airlines forced to cut flights—a 6% reduction now, expected to reach 10% soon.
• Trump’s controversial remarks on air traffic controllers:
  • Urged them to return to work, threatened pay docking for those absent, dangled $10,000 bonuses for those who stayed.

Notable Quotes:

• "Just because they passed the vote doesn't mean that they automatically get paid. You have to wait for the next pay set." – Becky Quick, [04:14]
• "Tell that to your landlord. Tell that when you can't put food on the table..." – Becky Quick, [07:01]
• "Most of them are the primary breadwinners for their family in air traffic control... I don't think you're not a patriot if you don't show up because of the sacrifices that you may be making." – Becky Quick, [07:30]

Timestamps:

• Shutdown bill vote and details: [02:48]–[04:35]
• Worker hardships, air travel impacts: [04:35]–[08:13]
• Comments on controller pay/bonuses: [06:43]–[07:20]

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Tech & Tariffs – Chris Hughes Critiques Trump’s “Rule by Deal” Industrial Policy

Key Discussion Points:

• Chris Hughes argues Trump’s industrial strategy is a “rule by deal” system:
  • Criticizes the case-by-case, opaque allocation of federal resources to companies with political access.
  • Compares this “dealmaking” to criticisms levied at the previous administration, and warns of lack of transparency and accountability.
• Need for a consistent, institutional national industrial strategy:
  • Support for intervention in rare earths/semiconductors, but advocates for clear criteria and missions— not one-off deals.
• Chips Act and challenges:
  • Slowness in executing funds for semiconductor fabs.
• On government support for AI/data centers:
  • Hughes believes with so much private capital, public investment is not needed—risks of a bubble.
• Tariffs and the US car market:
  • Discussion on rising protectionism, Hughes warns broad tariffs make the US less competitive.
  • Targeted tariffs may be justified for national security, but blanket tariffs will hurt consumers.

Notable Quotes:

• “This is rule by deal, and it’s not going very well.” – Chris Hughes, [12:30]
• “We need a comprehensive institutional approach... no transparency, and so far, very little accountability.” – Chris Hughes, [13:12], [14:23]
• "The idea of tariffing so aggressively and so across the board... I think would be a bad thing for consumers." – Chris Hughes, [18:47]
• "People are tired of paying higher and higher prices and the tariffs are only accelerating the price hikes." – Chris Hughes, [19:35]

Timestamps:

• Hughes on Trump’s policies: [11:49]–[14:23]
• Industrial policy and chips: [14:23]–[16:38]
• Govt role in AI/data centers: [16:38]–[18:00]
• Tariffs and auto industry: [18:00]–[19:57]

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Women's Health Revolution – Dr. Marty Makary on Hormone Replacement Therapy

Key Discussion Points:

• FDA removing black box warnings from hormone replacement therapy (HRT) for menopause.
  • Dr. Makary frames past warnings as a "real American tragedy."
  • Argues 2002 WHI study that prompted warnings was flawed:
    • Studied older women, already at higher heart risk, and used now-outdated hormone formulations.
  • Subsequent trials found no increase in breast cancer mortality with HRT.
• Profound benefits of HRT when started within 10 years of menopause:
  • Dramatic reductions in heart disease, heart attack deaths, cognitive decline, Alzheimer’s risk, and bone fractures.
• Urges a more nuanced and individual doctor-patient conversation.
• Notes history of neglecting women’s health in medical research and education.

Notable Quotes:

• "No subsequent clinical trial has ever found that hormone replacement therapy increases breast cancer mortality..." – Dr. Marty Makary, [22:44]
• "Arguably, with the exception of antibiotics and vaccines, there may be no medication that can improve the health outcomes of women on a population level more than hormone replacement therapy." – Dr. Marty Makary, [25:39]
• "We're elevating issues of women's health that have been underappreciated, under recognized and underfunded." – Dr. Marty Makary, [26:27]
• "We want women to have the right information... not the fear machine." – Dr. Marty Makary, [27:25]

Timestamps:

• Dr. Makary on historic studies/fears: [21:39]–[24:54]
• Benefits of modern HRT, population health: [24:54]–[26:27]
• Access and removing stigma: [26:27]–[28:06]
• Guidelines, individual risk factors: [28:06]–[30:57]

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Warren Buffett Update: Estate Giving and Legacy

Key Discussion Points:

• Buffett, 95, will accelerate disbursing his Berkshire Hathaway shares to his children’s foundations.
  • Purpose: Ensure heirs can manage and give away the estate before needing alternative trustees due to age.
  • Plans to keep A shares until new CEO Greg Abel is well settled.
• Buffett’s emotional Thanksgiving letter:
  • Reflects on valuing kindness and the Golden Rule above all.
  • Says he is prouder of the second half of his life than the first; encourages others to keep learning and growing.

Notable Quotes:

• "Kindness costs you nothing, but it's also priceless. It's the most important thing..." – Warren Buffett (quoted by Becky Quick), [32:00]
• "He’s prouder of the second half of his life than the first half..." – Becky Quick, [32:40]

Timestamps:

• Becky Quick summarizes Buffett’s letter and legacy: [31:10]–[33:32]

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Memorable Moments & Tone

• The show balances sharp criticism (Hughes on policy, Dr. Makary on medical dogma) with empathy for real-world impact (federal workers, women’s health).
• Several moments of levity (birthday jokes, pasta tariffs drama), grounding the heavy topics in engaging, everyday language.
• Direct, accessible, and at times, passionate discussion—especially around healthcare access and fairness.

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For Listeners:

• This episode delivers deep dives into industrial policy, women's health, and economic fairness, marrying policy critique with personal impact.
• If you want more, check Becky Quick’s recommendation to visit the Berkshire Hathaway site for Warren Buffett’s full letter.

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Transcript

[Chris Hughes]

Hey there, it's Dr. Sanjay Gupta with.

[Becky Quick]

Some exciting news to share.

[Dr. Marty Makary]

CNN is now streaming.

[Chris Hughes]

That means you can read, watch and stream everything in one subscription. You can watch News Live 24.

[Dr. Marty Makary]

7.

[Chris Hughes]

You can also explore catch up videos and explainer videos.

[Dr. Marty Makary]

And you can also watch the library.

[Chris Hughes]

Of CNN's originals, including my latest documentary.

[Dr. Marty Makary]

It doesn't have to hurt, just go to cnn.

[Schwab/Ameritrade Announcer]

Trading at Schwab is powered by Ameritrade. Unlocking the power of thinkorswim. The award winning trading platforms loaded with features that let you dive deeper into the market. You can visualize your trades in a new light on thinkorswim desktop with robust charting and analysis tools all while you uncover new opportunities with up to the minute market news and insights. ThinkOrSwim is available on desktop, web and mobile to meet you where you are so you never miss a thing. It's built by the trading obsessed to help you trade brilliantly. Learn [e-mail] trading bring in show music please.

[Squawk Pod Narrator]

Hi, I'm CNBC producer Katie Kramer. Today on Squawk Pod, Rule by Deal, the provocative take Facebook co founder Chris Hughes has on the Trump 2.0 strategies toward tariffs, revenue and business investment.

[Chris Hughes]

The point I'm making in the piece isn't that industrial policy is bad in and of itself. It's rather that we need to have a comprehensive institutional approach.

[Squawk Pod Narrator]

A landmark change from the FDA removing a long time and chilling warning for women in menopause considering hormone replacement therapy. Commissioner Marty McCauri we're going to be.

[Dr. Marty Makary]

Removing those black box warnings. We want women to have the right information.

[Squawk Pod Narrator]

A radical shift in directives that some critics say may be short on evidence. We'll get into it.

[Dr. Marty Makary]

Arguably, with the exception of antibiotics and vaccines, there may be no medication that can improve the health outcomes of women on a population level more than hormone.

[Becky Quick]

Replacement therapy plus pasta prices.

[Squawk Pod Narrator]

Warren Buffett says he's going quiet, sort of. And the government shutdown on the way to reopening. But not without some painful consequences due to the longest shutdown in history.

[Joe Kernen]

Someone's got to be there.

[Becky Quick]

Someone's got to be there. Sure, but we should also pay them. How about we have government function for a change.

[Squawk Pod Narrator]

It's Tuesday, November 11, 2025. Squawk Pod begins right now.

[Andrew Ross Sorkin]

Stand Becky by in three, two, one.

[Schwab/Ameritrade Announcer]

Cue please.

[Becky Quick]

Good morning, everybody. Welcome to Squawk Box right here on cnbc. We're live from the NASDAQ Marketsite in Times Square. I'm Becky Quick along with Joe Kernan and Andrew Ross. Sorkin and here we go on this Tuesday morning.

[Dr. Marty Makary]

On this vote, the ayes are 60, the nays are 40.

[Andrew Ross Sorkin]

The bill, as amended, is passed under the previous order.

[Dr. Marty Makary]

The motion to reconsider is considered made and laid upon the table.

[Becky Quick]

Mr. President, senator from Maine. Mr. President, I just want to reiterate my gratitude for my colleagues, our staff, staff who have worked night and day, literally, and all of those who have brought us to this point.

[Andrew Ross Sorkin]

The Senate passing a bill to fund the federal government through January and end the longest government shutdown in US history. The bill passing 60 to 40 with seven Democratic senators and one independent voting in favor, along with all Republicans, minus Kentucky's Rand Paul. The bill still needs to pass the House and President Trump needs to sign it to end that shutdown. The president said he supports the deal, but House Speaker Mike Johnson has not committed to allowing his chamber to hold a separate vote on extending Obamacare health subsidies. That was a key part of the Senate deal. So we still have some work to be done, probably done by tomorrow, you think?

[Joe Kernen]

Yeah, I think, I think it's probably.

[Andrew Ross Sorkin]

How is that piece of it going to get resolved?

[Joe Kernen]

I don't know what, whether Speaker Johnson has actually said that he's not going to do it or not. Maybe we just don't know. But holding, you know, holding a vote doesn't mean anything.

[Becky Quick]

No, it doesn't. But in the meantime, these guys are going to miss paychecks again.

[Joe Kernen]

Yeah.

[Becky Quick]

They have not been paid since October 1st. Expecting people to volunteer, particularly if you don't have, if you're living paycheck to paycheck or every couple of paychecks, maybe you can miss a couple of paychecks. But they haven't been paid since October 1st. They're about to miss another one. And just because they passed the vote doesn't mean that they automatically get paid. You have to wait for the next pay set.

[Joe Kernen]

The dynamic in the Democratic Party is where everybody's mad at Chuck Schumer and he voted no. But a lot of people think that guys like Ro Khanna or others that are just fuming need to thank the seven that took the flak for that. Because you don't want to be sitting there doing. You just pointed out how bad it is. It's terrible. Exactly. So they get to. The government gets to reopen. So they don't. They're no longer going to be blamed for what's happening. So I'd be thanking the ones that gave me cover to pretend that I was still a no. But that's not Today's. It doesn't portend good things for what we're looking at between now and 2026 in the election. Things are ugly and getting uglier without an end. Official end the shutdown. Air traffic controllers are still not getting paid. Air Force are still facing some heavy delays. Controllers are set to miss their second paycheck. Airlines are supposed to cut 6% of the flight starting today, up from 4% last week and going, I think, 10% soon. Flight Aware, there's a new one you like now. We don't like Flight Flighty.

[Andrew Ross Sorkin]

Flighty.

[Joe Kernen]

Flighty, yeah, that's what the funny name.

[Andrew Ross Sorkin]

I've been. I've been. I've heard of Flighty for a long time and didn't want to go all.

[Becky Quick]

In, but you have to pay for it because of.

[Andrew Ross Sorkin]

Because of the charge. But I'm told now it's worth it, so. And given what's happening out there, maybe it is.

[Joe Kernen]

What's the charge? How much?

[Andrew Ross Sorkin]

A couple dollars a month.

[Joe Kernen]

You don't want those adding up.

[Andrew Ross Sorkin]

Well, you know me.

[Joe Kernen]

Then it gets to. Then it gets to dozens of dollars, which, you know. Flight Aware says close to 3,000 US flights were canceled yesterday. 1,400 have been cut so far today. Yesterday on Truth Social, before the Senate bill passed its funding, President Trump told air traffic controllers to get back to work immediately, saying anyone who didn't would have their pay docked. And he said for those that did nothing but complain and took time off, even though everyone knew they'd be paid in full shortly after, in the future, I'm not happy with you. But then he said he'd be recommending a $10,000 bonus for any controllers who haven't taken time off.

[Becky Quick]

This ticked me off, too. The idea that, you know, you're not here, you should be doing this for us. Easy to say when you don't have bills to pay that you can't pay.

[Joe Kernen]

Exactly where you got to get a second job.

[Becky Quick]

Right.

[Joe Kernen]

But they really do need to.

[Becky Quick]

They do need to come in, but you don't pay them.

[Joe Kernen]

But you're going to get back pay. You're going to get back pay.

[Becky Quick]

Sure. But tell that to your landlord. Tell that when you can't put food on the table for any of these things.

[Joe Kernen]

Well, so you're not giving any credit to the people that did show up?

[Becky Quick]

No, I am. I'm giving complete credit to them and they still get a $10,000 bonus. But the idea, if you didn't show up, I think that's understandable. If you were asked to volunteer for two months at a time. You didn't have enough money in the bank to cover it. I get it. Take a second job.

[Joe Kernen]

Not like us, where no one would miss us. I mean, it does matter. I might feel compelled to go in.

[Becky Quick]

And it does matter. But if you have take a second job because you can't pay the bills.

[Joe Kernen]

Well, if they're going to cut, you.

[Becky Quick]

Know, I mean, listen to Sean Duffy, the transportation secretary, who has talked about how most of them are the primary breadwinners for their family in air traffic control. Most of them are already working. He wants them to be there. But I don't think you're not a patriot if you don't show up because of the sacrifices that you may be making along.

[Joe Kernen]

And they know that if you cut back on, you know, go 6, 10, whatever it is, 10%, that hopefully there's enough.

[Becky Quick]

But we were already dealing with an air traffic controller shortage of 4000 people. 4000 air traffic controllers that we were already short. So these people have already been overworked. They're already asked to work six days a week before you even got to this chaos. Then when you have people who are calling in sick and you're expected to pick up for your colleagues on top of that and you're not getting paid.

[Joe Kernen]

Someone'S got to be there.

[Becky Quick]

In a volunteer situation, someone's got to be there, sure, but we should also pay them. How about we have government function for a change?

[Joe Kernen]

We wanted a pan. Trump wants to pay it.

[Becky Quick]

We should.

[Joe Kernen]

Italy's biggest pasta importers are preparing to pull out of US Stores as soon as January. They say tariffs and anti dumping duties totaling 107% will make doing business in America just too costly. The tariff On Italy is 15% for most products. But the Commerce Department announced a 92% anti dumping duty on pasta made by 13 Italian companies. The commerce department cited a long running probe into pricing practices and complaints that accused Italian producers of selling pasta in the US at below market prices. Apparently, the producer of this hour is just beside himself. And to make matters worse, it's Cantino's birthday. So happy birthday.

[Chris Hughes]

How do you do?

[Andrew Ross Sorkin]

Happy birthday, Rob.

[Joe Kernen]

How do you do? Slap in the face. Yeah, how do you do? So that's your birthday present, Rob, no. Pasta could be a blessing in dis. Could be a blessing in disguise. We want you to live a long time, Rob. You're welcome.

[Andrew Ross Sorkin]

Okay, we gotta go. He's telling us T's next.

[Chris Hughes]

Teas will be next.

[Squawk Pod Narrator]

Coming up, tech and tariffs. Facebook's co founder Chris Hughes has a critique of the Trump administration's policy policies when it comes to international duties.

[Chris Hughes]

Is it economic nationalism? Is it industrial policy? Greg Yip in the Wall Street Journal calls it state capitalism. I see a group of dealmakers, the president himself, but also the commerce secretary and the treasury secretary going one by one, picking winners and losers.

[Squawk Pod Narrator]

Squawk Pod will be right back.

[Audie Cornish]

Hey friends, this is Audie Cornish, host of CNN this Morning and the Assignment. And guess what? Every story you care about, every angle you want unpacked is now streaming on cnn. That means you can catch my show or other CNN programming whenever you want on your favorite device. And a subscription also gets you access to exclusive video series and unlimited articles. So subscribe to [e-mail] subscription Our state has changed a lot in the last 140 years. We know because Multicare has been here guided by a single making our communities.

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[Squawk Pod Narrator]

We're back.

[Chris Hughes]

This is Squawk Pop up and Andrew Q.

[Andrew Ross Sorkin]

You're watching Squawk Box on cnbc. I'm Andrew Ozarkin along with Joe Kernan and Becky Quick on a Tuesday morning.

[Becky Quick]

Joining us right now on the economy, big tech and much more is Economic Security Project co chair Chris Hughes, who is also the co founder of Facebook. His new piece in the American Prospect, Rule by Deal is a criticism of the Trump administration's industrial and tariff policies. And Chris, welcome. Thank you for joining us today.

[Chris Hughes]

Thanks for having me.

[Becky Quick]

Let's start with the piece first. The way you've laid this out, you make a lot of pretty deep and important points. You're looking at the deals that the Trump administration has cut when it comes to semiconductors, when it comes to rare earths, but when it comes to lots of other things, too. And your point is that this is not new economic nationalism, and it's not state capitalism. What do you think it is?

[Chris Hughes]

Yeah, exactly. I think we've got to take a step back. This is rule by deal, and it's not going very well, and I'll tell you why. So a lot of people are trying to figure out what all these private deals are. You know, two weeks ago it's nuclear power. Before that it was MP Materials, before that it was intel. Nvidia. We know the sequence of them. And people are trying to figure out, is it economic nationalism, is it industrial policy? Greg Yip in the Wall Street Journal calls it state capitalism. And I see something a lot more basic. I see a group of dealmakers, the President himself, but also the Commerce Secretary and the Treasury Secretary going one by one picking winners and losers. And that is exactly the criticism that so many leveled at the Biden administration. And what's actually happening here is that there are particular companies that can find their way to the White House. They find their way through the negotiations, and then they can get really meaningful public investment. And the private capital crowds in without any thorough consideration of competitors. Industrial landscape, no transparency, and so far, very little accountability to follow up on it. So this is exactly how one doesn't want to do.

[Becky Quick]

Yeah, I see your point. When it comes to picking winners and losers and doing a deal by deal basis, I'm not a huge fan of that. But I will say there are some arenas that the Trump administration has pushed into that could require a government intervention. Because these are national security issues.

[Chris Hughes]

Absolutely.

[Becky Quick]

Specifically, if you look at rare earths, if you look at semiconductors, if you look at a lot of these areas, we're in a much more complicated position because of the dominance that China has in some of those areas, whether it's rare earths. And they say we're not going to sell them to you anymore after they drove us out of the business, from a capitalistic point of view 20 years ago to what happens if they decide to try and take over Taiwan and the semiconductor business there.

[Chris Hughes]

Yeah, And I think that's why we have to get this right. So the point I'm making in the piece isn't that industrial policy is bad in and of itself. It's rather that we need to have a comprehensive institutional approach. So we'll take critical Minerals, because I'm 100% with you. We have got to use the public sector to get those industries moving. So we need a clear mission. Are we producing the critical minerals in the United States. Are we okay doing that with our partners and friends like Canada and elsewhere? Then we need an institutional capacity. Who's charged with putting that mission into place? I think the Development Finance Corporation, which is actually a Trump one invention, would be a great place to put it. And then we need a process to say, hey, if you are either mining, extracting, or doing any kind of innovative work around these minerals, you need to come to the government and say you're doing it and we will invest in you. We, we have the template for this. With the chips program, $40 billion was put forward.

[Becky Quick]

Don't love the chips program either.

[Chris Hughes]

Five of the largest semiconductor manufacturers in the world open up fabs. And we did it in a thorough and fair way.

[Becky Quick]

We did it in a thorough and fair and really slow way. And that's part of the problem with this. In fact, we had Intel's former CEO, who was just with us a couple of weeks ago, who said it was years that they were waiting for the Commerce Department under the Biden administration to hand out those funds. And in the meantime, things collapsed with something like rare earths.

[Chris Hughes]

And totally.

[Becky Quick]

It's probably going to take us five to seven years, even if we start today, to be in a position where we are not reliant on China.

[Chris Hughes]

Yeah, well, I mean, the chips package was passed in the summer of 2021, and then by the end of the Biden administration, $34 billion had been committed. So that's three years. I'm with you. It should have been half that. Totally agreed. But the only way to do that is to work with. To give an institution a clear mission and then work with Congress to streamline that rather than just doing one deal here or there because your buddy called you up and you know somebody. And so here's $80 billion for Westinghouse, or here's a suspension of export controls for Nvidia, or, you know, we're going to take this one equity stake in intel because we had a special conversation. There's no coherency. And I think that runs the risk of enriching certain private market actors and misallocating, you know, private capital, which is the big fear that so many have had about industrial policy for so long.

[Andrew Ross Sorkin]

Can I ask a separate question? OpenAI recently put out a statement around the way the government should think about potentially investing in data centers.

[Chris Hughes]

Yeah.

[Andrew Ross Sorkin]

In the country.

[Chris Hughes]

Yeah.

[Andrew Ross Sorkin]

And I'm. And they effectively were trying to, I think, tried to argue to some degree that, you know, it shouldn't be a situation where the government spending money and then private sectors on top of it. But it was sort of hard to. Yeah, exactly where, where they were going with this. But long term, do you see the government playing a big role in data centers?

[Chris Hughes]

Yeah, I saw the news that you're talking about. I thought that was pretty rich, particularly coming a few days after this accidental disclosure of a desire for a government backstop for open. I. I mean, there is so much private capital moving into, not just open air, but the AI ecosystem. I mean, the CapEx numbers are. You guys talk about them all the time. Well, pushing close to half a trillion dollars this year. When you see an industry with that much private capital rushing in, that's the exact moment where public capital should lean back. We don't need any additional funds. If anything, I worry about a bubble in that space with so much money. So, I mean, the government should be monitoring that, thinking about that, analyzing its, its implications on national security concerns. But if I, you know, had the magic wand around what industrial policy to pursue, I'd be thinking a lot more about things like critical minerals than I.

[Andrew Ross Sorkin]

Would I, and then stepping on tariffs. You know, I was talking to a CEO of a automobile maker, US Automobile maker, recently, and they were basically making the argument that 10 years from now we will just have a domestic car market, given the way, and that parts of the rest of the market will be this way as well, where we will have cars that costs more money, that are less competitive, that, you know, don't have the same features that you can get in China or elsewhere. And whether you think that that's a good thing, a feature, a bug, it's a bug. And if it's a bug, therefore, what should happen? Because the truth is, and you've heard Elon Musk make this comment, if we didn't have tariffs on automobiles, it is not clear we would have an automobile industry at all in this country. And whether we should just say we want to be a services industry and that's. That's cool too. I don't know the answer.

[Chris Hughes]

Yeah, listen, I think tariffs can be used tactically to accomplish certain public policy goals. But the kinds of tariffs that I don't think make any sense sense are these kind of sweeping tariffs across all imports or across, you know, all kinds of industries. It's automobiles, avocados, Rolex watches, you name it. Everything is tariff. I think that's a bad thing for trade. I think that'll lower economic growth and makes little sense. I can see, you know, the Trump administration early on believed that making domestic automobiles was important. And so work that into the renegotiation of nafta. Biden did something similar with electronic vehicles from China, putting targeted tariffs on those. I think those kinds of policies can at times make sense. But the idea of tariffing so aggressively and so across the board that the entirety of automobile production would be domestic rather than international, I think would be a bad thing for consumers. And people are tired of paying higher and higher prices and the tariffs are only accelerating the price hikes. And I think that is going to increasingly become a problem for this administration and for the Republicans in Congress.

[Becky Quick]

Chris, want to thank you for joining us today. It's good to see you.

[Chris Hughes]

Thanks for having me.

[Squawk Pod Narrator]

Next on Squawkpot, FDA Commissioner Dr. Marty Makari is defending the agency's decision to remove black box warnings from hormone replacement therapy for menopause.

[Dr. Marty Makary]

No subscription clinical trial has ever found that hormone replacement therapy increases breast cancer mortality and the cardiovascular complications are a function of when you start hormone replacement therapy.

[Squawk Pod Narrator]

His perspective on women's health right after this.

[Audie Cornish]

Hey, friends, this is Audie Cornish, host of CNN THIS MORNING and the assignment. And guess what? Every story you care about, every angle you want unpacked is now streaming on cnn. That means you can catch my show or other CNN programming whenever you want on your favorite device. And a subscription also gets you access to exclusive video series and unlimited articles. So subscribe to [e-mail] subscription.

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This episode is brought to you by Schwab Market Update, an original podcast from Charles Schwab. Join host Keith Lansford for this information packed daily market Preview delivered in 10 minutes or less, including projected stock updates, monetary policy decisions and key results and statistics that may impact your trading. Download the latest episode and [e-mail] MarketUpdatePodcast or find Schwab Market Update wherever you get your podcasts.

[Squawk Pod Narrator]

You're listening to Squawk Pod from cnbc. Here's Becky.

[Becky Quick]

Quick questions around the use of female hormone replacement therapy for years have kept women on the fence about these treatments. But in a new Wall street journal opinion piece, FDA Commissioner Dr. Marty Makary says that it is time for drug manufacturers to remove black box warnings from these products because they've inappropriately scared women off. FDA Commissioner Dr. Marty Makary joins us this morning to go more in depth on this. And Commissioner, thank you for being here today. This is a really big deal and something that probably is not talked about often enough, but there was a Women's Health Initiative study back in 2002 that proclaimed that women who use these Therapies, estrogen and progesterone have a much higher risk of things like heart disease, breast cancer, associated other problems. And when the study came out, it cut the use of hormone replacement therapy by almost 50%. What happened? What are you looking at that makes you think we need to rethink all of this?

[Dr. Marty Makary]

Well, that's right, Becky. That was a real American tragedy. The fear machine that started in 2002 with that headline took on a life of its own. And tragically, 50 million women in the United States since then have been denied, not offered or convinced to not take hormone replacement therapy when they go through menopause. And what happened back in 2002 was that the study went to the media, the authors took it to the media and they broadcast scary headlines about it causing breast cancer, an increase in cardiovascular disease complications. When in reality, no subsequent clinical trial has ever found that hormone replacement therapy increases breast cancer mortality. And the cardiovascular complications are a function of when you start hormone replacement therapy. When it started more than 10 years after the onset of menopause, then, yes, the cardiovascular complications invert the risk benefit ratio to make it unfavorable, that is that there are cardiovascular complications. It needs to be started within 10 years, the onset of menopause. And when it is done that way, it dramatically reduces heart disease. In One study, a 30 to 50% reduction in heart disease. And in another study that just came out two years ago, a 48% reduction in heart attack deaths. Well, heart attacks are the number one cause of death in women. And that's just one of the profound long term benefits of hormone replacement therapy. On top of alleviating the symptoms of menopause, the hot flashes, night sweats, mood swings, weight gains, there are 50 plus different symptoms of menopause. 80% of women experience them. It is not like I was taught in medical school where, oh, some women go through those symptoms, but they usually last a few years and they're mild. No, they can be severe. 80% of women experience them and they last on average eight years. And when you look at the long term benefits alone in reducing cognitive decline by up to 64%, reducing Alzheimer's by 35% in some studies, and reducing the rate of bone fractures, those long term health benefits are profound.

[Becky Quick]

Yeah, I mean, that's a pretty compelling argument for why this should at least be considered and discussed between women and their doctors. Dr. Makary, there was a Yale medicine write up about some of the flaws, the critical flaws. They said with that 2002 study by the women's Health initiative. Just for starters, they exclusively studied women who were on average 10 years post menopause with an average age of 63, which is a demographic that's already vulnerable to cardiovascular disease. And secondly, they only evaluated one delivery method, a daily pill that combined both estrogen and progesterone. And I believe the delivery methods have gotten a lot better since then.

[Dr. Marty Makary]

That's right. Now there are more identical forms to the intrinsic form of estrogen that a woman's body produces. The slight increase in breast cancer observed, I.e. breast cancer diagnosed in that original study was attributed to the type of progesterone use called mpa. It is no longer a type of progesterone commonly used for hormone replacement therapy. Again, it did not translate into an increase in breast cancer mortality. If you look holistically, arguably, with the exception of antibiotics and vaccines, there may be no medication that can improve the health outcomes of women on a population level more than hormone replacement therapy. And so this is a message we want people to know. Unfortunately, around that time in 2003, the FDA slapped black box warnings. It was part of a group think it was a pile on. It was not scientific or rational. And so we want, we announced yesterday we're going to be removing those black box warnings. We want women to have the right information. All these issues of women's health have not received the attention they deserve in a historically paternalistic male culture dominated medical establishment. So in the Trump administration, we're elevating issues of women's health that have been underappreciated, under recognized and underfunded. You saw our announcement on IVF a few weeks ago. And so this is, I think, one of the bigger ones that impacts every single woman in the United States.

[Becky Quick]

Yeah, I mean, we don't want to swing in the opposite direction. I'm guessing you're not necessarily suggesting that every woman should be on this, but it should be a conversation women are having with their doctors and that there is a much more kind of open and educated discussion that's taking place.

[Dr. Marty Makary]

That's right. There are some contraindications, like an underlying predisposing risk to blood clots, somebody with active breast cancer, somebody who may have had breast cancer in the past, and their doctor has a concern. But those contraindications are rare. And the vast majority of women who go through menopause, which is 2 million of women each year, are great candidates for hormone replacement therapy. It is a conversation with your doctor. We're not promoting a product here, but we are getting away from the fear machine whereby women would pick up these products, they bring them home, and they see this very scary black box warning that is not nuanced as it should be, and they decide not to take it.

[Becky Quick]

Is it simply women who have experienced breast cancer who should be more concerned about this, or women who have had any type of cancer? Because I've spoken with women who've had uterine cancer, who have had bone cancer, other issues, who've thought I shouldn't do this because I've had cancer.

[Dr. Marty Makary]

Yeah. So there are a few types of cancer, and it's the types of cancers with estrogen receptors. Now, every cell in the body has an estrogen receptor, which is why it's in somebody without cancer. There's sort of brain health benefits to taking hormone replacement therapy, but when a doctor sees a condition where there's an upregulated estrogen receptor that could interact directly with the cancer, they're going to recommend against it. And that's a well accepted practice. And there are a couple of those well accepted practices. Doctors generally don't prescribe hormone therapy if you're over age 60 or more than 10 years after the onset. So that's why it's important for people to have the information when they go through perimenopause early on. You know, 50 million women are really a lost generation who have not experienced the benefits. And for many of those women, they're angry and they have a right to be angry.

[Becky Quick]

Yeah, I hear that. I feel that perimenopause sets in at what age typically?

[Dr. Marty Makary]

Perimenopause is typically one to three years before menopause itself, which happens roughly between the ages of 45 and 55. And that's when the estrogen levels intrinsically go down. And it's interesting you go back to the Mayo Clinic studies in the 1920s. What they noticed is that young women in their 20s who had their ovaries removed for reasons like cancer or part of a hysterectomy, they went on to have severe heart disease in their 30s and 40s. Well, what's going on there? It suggests a profound, powerful cardio protective effect of estrogen. And that is why the studies now have caught up and showing us that it is probably one of the most powerful medications a woman can take to reduce cardiovascular disease. By comparison, statins reduce cardiovascular risk by 35%, and estrogen reduces cardiovascular risk in postmenopausal women by 30 to 50%. So this is something that needs to be a part of conversations. Unfortunately, menopause was not taught in medical schools because there was a feeling that, oh, well, the only treatment out there causes cancer and therefore there's no point in teaching about menopause. And so tragically, we had about two minutes in menopause education in medical school. It's something every woman experiences. And as a result of this kind of mismatch, a woman is more likely to be prescribed an antidepressant for a mood swing of menopause than they are estrogen.

[Joe Kernen]

Wow.

[Becky Quick]

Dr. Makary, thank you for leading up this charge. Thank you for joining us today, and I hope a lot of people are listening.

[Dr. Marty Makary]

Thanks so much, Becky.

[Becky Quick]

Berkshire Hathaway CEO Warren Buffet laying out a plan to step up the pace of giving away his estate. In his Thanksgiving letter, the 95 year old Mr. Buffett said that he needs to accelerate the disbursement of his Berkshire stock to his three children's foundations because of their own advanced ages, and that by doing so it will improve the probability that, in his words, they will dispose of what will essentially be my entire estate before alternative trustees replace them. Buffett also said that he wants to keep a significant amount of Berkshire's A shares until investors get more comfortable with incoming CEO Greg Abel. He did this in his Thanksgiving letter. At the time, he said he'd be going quiet, sort of. He's not going to be writing the annual letter to shareholders anymore that he's always done in the past. That is going to be going to incoming CEO Greg Abel, who will be fully taking over the reins come January 1st. But he did say that this Thanksgiving letter is one that he will continue to use to communicate with shareholders and everyone else because he likes doing it. He talked an awful lot in the letter about how money isn't everything, had some incredible words. And if you want to see it yourself, you can go to the Berkshire Hathaway website to check it out. But he has some incredible words about how kindness costs you nothing, but it's also priceless. It's the most important thing that you can do to anybody. He said to live by the golden rule, that those are the best words he can come up with and that you should remember everybody along the way is equally important. Just said that those are the lessons he has taken away. He also said that he's prouder of the second half of his life than the first half of his life and kind of challenged everyone else to do that, too. If you ever listen to him, he basically says you should learn things along the first half of your life that you put into play. Give yourself some grace when it comes to making mistakes, but always strive to be better. And they were pretty great words if you get the chance to check it out. I think you should.

[Joe Kernen]

So it's pointed out the Buffett premium's kind of gone out of Berkshire at this point.

[Becky Quick]

Yeah, I think that's been the case. Underperformed the S&P 500 this year. But last week when you saw the big pressure that came in on the AI stocks and technology stocks, it outperformed the market over the course of last week and it cut the underperformance pretty significantly, I think. What is it, maybe 12%? Berkshire Hathaway shares are up for the year if you look at a year to date versus the S&P 500. Yeah.

[Squawk Pod Narrator]

And that is the pod for today. Thanks for listening. Squawkbox is hosted by Joe Kernan, Becky Quick and Andrew Ross Sorkin. Tune in weekday mornings on CNBC at 6 Eastern to get the smartest takes and analysis from our TV show right into your ears. Follow Squawkpod wherever you get your podcasts and please let us know what you think. If you'd be so kind to rate Squawkpod or even write a brief review on Apple Podcasts, that would be great. It would help other listeners find us as well.

[Audie Cornish]

That's it.

[Squawk Pod Narrator]

We'll meet you right back here tomorrow.

[Chris Hughes]

We are clear.

[Andrew Ross Sorkin]

Thanks guys.

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