B (3:00)

Oh, which isn't true at all today. There's no vitriol. That's all in the rearview mirror. Before we, though, talk more about that. I do, given we're called that can't be true. Want to start with something that I just think can't, maybe shouldn't be true?

A (3:15)

All right, let's hear it.

B (3:16)

All right, so we're talking now. Almost two weeks into the government shutdown this past weekend, the federal government somehow managed to fire More than 1,000 scientists at the Centers for Disease Control and Prevention and then shortly thereafter said not all, but most were in error. So this is a clip from Face The Nation on CBS. Margaret Brennan is interviewing Vice President J.D. vance about how all this went down. CBS did confirm on Saturday that the Trump administration went and rescinded some of the layoffs of hundreds of CDC scientists who were mistakenly laid off on Friday and then told Saturday that's not the case. But some of them were involved with the federal measles response. Some of them were involved with the response on Ebola. How does a mistake like this happen? Did the White House even talk to the CDC?

A (4:11)

Well, so, so 22 responses to that Margaret first of all, I want to assure the American people that the frontline health care workers, the people who monitor measles, Ebola, and other infectious diseases, those people are still on the job. But the second point, Margaret, is the government shutdown inevitably leads to some chaos. We are figuring out how to take money from some areas and give it to other areas. That chaos is because Schumer and the far left Democrats shut down the government.

B (4:38)

Well, to be clear, Dr. Knock, I'm very grateful that the vice president said that he and the administration are committed to ensuring that our frontline healthcare workers, to quote him, the people who monitor measles, Ebola, and other infectious diseases will stay on the job. But this chaos just it can't be true, and yet we know it is. What were your reactions when you kind of were observing all that's happened in the last few days?

A (5:04)

There's two parts to it. The first is actually very similar to your takeaway just now, which is if you do make a mistake and you realize it was a mistake and you reverse that mistake, that's what I want to see happen. So if they fired some people and then they decided that was a tremendous error, which it was, I'm very happy that they rehired them and said, basically, you know, whoops, they may have shifted some of the blame in political language, which I kind of tried to avoid that part of the discussion. The second part is just the way it's done just makes everything seem totally uncertain. Certainly for people within the cdc, they're not sure whether they're going to be there tomorrow, let alone next week or next month. And even for people who aren't yet at the cdc, if we want to be attracting the best and the brightest people in the country to go serve public health of our nation, and there's hundreds and thousands of people who do want to do that as their career, they may be looking at the CDC saying, you know, gosh, all I want to do is go help reduce the burden of chronic disease that I've seen affect my family and my community. And the CDC is the place to do that at the federal level. But I'm not sure if I can. I'm not sure if I apply there, if I'm going to be able to pay my rent, or if they're going to fire me a month later, or if there's going to be even anyone to talk to in that division, or if the whole division is going to be eliminated a month later. And so that uncertainty casts this shadow on the CDC and on public health in the country more broadly. It's going to have a significant, lasting implication. Of course, there's also the very immediate effects of firing entire groups of people. One of the groups that they fired, for example, and then reinstated, as far as I know. It's called the mmwr, which is not a very catchy acronym. It's the Morbidity and Mortality Weekly Report, which is also not a very catchy full name. But that's kind of like the way that the CDC communicates its research and its findings, both to the public, but also to public health agencies domestically and abroad. And they were fired and then put back in place. So it's really disappointing because there's both direct immediate Downsides to public health and this long term power that's being cast across the institution.

B (7:03)

Yeah, I totally agree. I mean, I have found it not only indefensible, but actually reprehensible when some of my fellow Democrats have this posture, this attitude, this rhetoric of, oh well, if this is what people voted for, then they have to deal with measles outbreaks. I'm like, no, actually I don't want any child, regardless of who their parents voted for, to have to quote, unquote, deal with the measles outbreak. No, I want every child in our country to be protected from vaccine, preventable diseases. I want every kid in our country to be protected because thankfully we have these. Not all superheroes wear capes. Sometimes they wear lab coats. Disease detectives who help trace outbreaks to stop them from becoming epidemics or pandemics. I feel that so deeply and resonate so completely with what you just said. We've talked about kind of the present moment. I do want to take a step back though and talk about your background with kind of a PhD in pharmaceutical sciences. With now kind of your thankful, hopefully not thankless, but thankful task of being kind of a public health communicator. And I know you spend a lot of time in, of trying to educate people around kind of what is toxic and what is not and quote, unquote, natural products. Kind of that the idea that just because something is natural kind of found in nature that it would be safer. I think you even have a term for it, kind of nature's halo. Can you define that term for us and just give us some examples of kind of what you mean by that?

A (8:41)

Yeah, so this is a bias that we all have, myself included. It's this underlying guiding assumption that if it comes from nature, it is somehow safer compared to something that is artificial or something that is from a lab or something that is the product of.

B (8:58)

Science or something that has been treated.

A (9:00)

Or something that has been treated. Right. Something that was initially natural, but then they applied something to it. That is sometimes true. And this is where it gets tricky. Like certainly eating more whole foods is better for you than eating the scientifically engineered ultra processed foods. On the whole, however, it can definitely lead you astray. And so there's research even in kids as young as 5 to 10 years old. If you tell them, if you're comparing two apples, one of them was grown on a farm, one of them was grown in a research lab, and you ask these children which one is more likely rate the expected safety of the two apples and the expected deliciousness of the two apples. And even young children, they'll score the farm apples as better in all respects than the lab grown apples. Adults will do the same thing. And so when you're comparing for prevention versus treatment of a disease, in the prevention of a disease, we really, really strongly emphasize safety when it comes to treatment. We're more willing to take on risks. We're more willing to accept, you know, the artificial super powerful drug to treat once you're already sick with strep throat or whatever it might be, or cancer or, you know, it's in the prevention sphere that nature's halo really shows up. Time and again the people say, I don't know if I want to take, you know, that vaccine option. If I can just eat fruits and vegetables to support my immune system naturally instead, or take some elderberry or vitamin C. But no one, you know, if you're getting ready for surgery, you don't want to see your anesthesiologist rolling into the surgery room grinding up some leaves or some, you know, nuts or seeds instead of a vial of actual anesthetic. When it comes to like very high stakes medical decisions, you want the reproducibility of science and artificial medicine. This becomes problematic, obviously, because I mentioned briefly, but vaccines are preventative. You don't already have the disease. And that's exactly when this effect of preferring the safest, what we think is the safest option being the natural option. And vaccines just seem inherently unnatural in many respects, even though you can argue, and I would argue, that they are just replicating what would happen in a natural immune system in a much more controlled and precise and safe and repeatable way. So I say this because it's not always true that natural is better when it comes to medicine. Sometimes it is both safer and more effective. But all of us need to be aware that even when products in the grocery store are subtly advertised with, you know, they've got some leaves on the product, or they make vague claims about source from nature or nature equivalent or whatever it might be, what they're playing upon is this bias that we all carry and they're doing it to try to get us to purchase it, not because there's necessarily evidence saying that that natural component of the product is meaningfully better in some way, do you think.

B (11:50)

That kind of natural versus artificial has utility? Or do you think in the world we're living in now, are those categories kind of artificial and natural not really relevant?

A (12:03)

It's a good question. I err on the side of the I don't think they're too useful. I certainly don't use them when making decisions for my own products, for my family. Certainly you have to also, you know, be aware as everyone is, that eating more whole foods, like as we said earlier, is better for you than ultra processed foods. Those types of decisions, I think, are separate from what the marketing teams use, which is hijacking our heuristics, whether it's the appeal to nature fallacy, nature's halo, or other various logical fallacies to try to sell you as much of something as they can. Unfortunately, when we're evaluating products, I think the marketing spin is much stronger than the data spin when it comes to natural versus artificial. And certainly you can find examples of artificial products that are not as good for you as natural ones. But I don't put too much stock into that when I'm making decisions for myself or for my family.

B (13:00)

And I think, Dr. Knock, that's important in all these conversations, right. That we're kind of candid and humble about what we know and don't know and also forthright about how we make decisions for our family. I mean, certainly I make my children eat their fruits and vegetables and also give them Tylenol if they have a fever. I also know that you spend a lot of time kind of in a similar conversation around toxins. And we hear a lot about toxins. Toxins in sunscreen. Yes or no. Are there kind of toxins that have infiltrated our food supply? People who assert that there are, you know, toxins in not only vaccines, but our drinking water, our toothpaste. Why do you think that word has become so mainstreamed? And how do you kind of engage with the debate around kind of toxins and what is and isn't toxic in your work?

A (13:59)

Perhaps I should start by saying there are things that are definitely very toxic that can end up in foods, can end up in medicines, can end up in sunscreens. Those are the things that are carefully regulated and measured for in your foods and in your medicines and in your vaccines.

B (14:15)

Arsenic and rice cereal. Terribly toxic and horrific. And how thankful are we that we, at least thus far, you have regulatory architecture to be able to identify kind of those products that we're not giving our children those things.

A (14:30)

Yeah. So it's a little complicated. It's not a straight story because it is true that sometimes, for example, some sunscreens have chemical contaminants that aren't supposed to be in there that are potentially dangerous to your health. That's different, though, from what I think you're referencing on social media, which is kind of the vague term toxins, like, capital T toxins, where, you know.

B (14:53)

But the vague term, I think partly has oxygen because of the first part, right?

A (14:57)

I think that's exactly correct. It's like there is this real thing that happens, but then it takes on a life of its own. When people say you need to get rid of the unnamed toxins in your body by buying my course or buying my supplement or buying my specialty or whatever it might be, those types of things are almost uniformly not true. Those kind of the vague toxin claims and what to do about them when it comes to toxins in your foods. And this is actually kind of similar to the Tylenol thing. What I'm really cautious about is any story related to health that has a clearly defined villain, like, ah, we figured it out, it's the Tylenol that's causing autism. It isn't. It's a complex mixture of genetics and environmental exposures, which it's unclear whether acetaminophen actually increases risk for autism spectrum disorder. The data certainly don't clearly show it. But what's dangerous is really simplifying the story so that, oh, if your children are eating too much, too many beans. Oddly enough, I've heard people demonize beans on the Internet.

B (16:08)

Legumes. Legumes are the villain.

A (16:11)

Sometimes you can find any number of things to blame, but it's like, you know, if it's this one thing that your children are eating or it's this one pesticide, it can be any big villain. It's a simple story that you can hold in your head because you can point to is like, oh, that's the bad guy that's causing this tidal surge of chronic disease. It's kind of satisfying to be able to point to something. It's like Scooby Doo. You've, like, ripped the COVID off of the villain's head. It's not going to be any single ingredient or pesticide or vaccine or medicine. It's this entire ecosystem we live in, you know, the socioeconomic framework of our country that determines differences in access both to healthcare and nutrition and physical activity and all the things that really influence your health in the long term. And any individual salient scapegoat that you can point to is often nothing more than a rhetorical device. It's an outlet for frustration, I think, is what I end up seeing a lot of foreign.

B (17:17)

This episode is sponsored by Better Help. The small breakthroughs you can make in therapy can then have a big impact on your life, which then ripples out to the lives of the people around you. Therapy can help anyone show up better for your family, your friends, and your community. The right therapist can truly change everything, and BetterHelp has more than 12 years of experience finding your perfect match. If you're ready to give therapy a try or looking for someone new, fill out a short questionnaire and let BetterHelp be your guide. This World Mental Health Day, we're celebrating the therapists who've helped millions of people take a step forward. If you're ready to find the right therapist for you, BetterHelp can help you start that journey. Our listeners get 10% off their first month@betterhelp.com CantBeTrue that's BetterH Better H E L P.com Can'tBeTrue well, hi everybody.

C (18:15)

It's Julia Louis Dreyfus from the Wiser Than Me podcast. And I'm not gonna talk about food waste this time. I'm gonna talk about food resources. All that uneaten food rotting in the landfill. It could be enriching our soil or feeding our chickens because it's still food. And the easiest and frankly, way coolest way to put all its nutrients to work is with the mill food recycler. It looks like an art house garbage can. You can just toss your scraps in it like a garbage can. But it is definitely not a garbage can. I mean, it's true, I'm pretty obsessed with this thing. I even invested in this thing. But I'm not alone. Any mill owner just might corner you at a party and rhapsodize about how it's completely odorless and it's fully automated and how you can keep filling it for weeks. But the clincher is that you can depend on it for years. Mill is a serious machine. Think about a dishwasher, not a toaster. It's built by hand in North America and it's engineered by the guy who did your iPhone. But you have to kind of live with mill to understand all the love. That's why they offer a risk free trial. Go to mil.com wiser for an exclusive offer.

B (19:58)

There's something you very recently addressed with your audience that I hope we can talk about here. There's a recent new study out of South Korea that a lot of people have been posting about, writing about, talking about it supposedly found a link between COVID 19 vaccines and cancer. Tell us about the study and what your thoughts are.

A (20:19)

I'm glad you said supposedly, because there's not A link between the COVID 19 vaccines and cancer. But there is an important broader lesson to take from this study about what it actually showed and how that resulted in this super viral amplification of something that's not true. Which if you understand it, it's actually helpful to understand a lot of other topics in health that you'll see when you're browsing on Instagram reels. So briefly, what the study appeared to show was that I think it was six different types of cancer, appeared to be higher risk for those types of cancer in the period right after COVID 19 vaccination. In just one year after Covid vaccination. There's a couple of things that stood out to me as a scientist looking at that. First of all, it was a peer reviewed paper published in a Journal, indexed on PubMed. It has all the hallmarks of what you might point to as this is high quality science.

B (21:11)

And that's important if I can interject for a moment, because oftentimes none of that is true. Kind of as the quote unquote foundation for a viral claim. Often it is from not even a paper, much less one that's peer reviewed or one that would be indexed on PubMed, which is sort of like, you know, the nerdy shorthand for a real deep and broad library of papers that have been validated by the relevant scientific community.

A (21:41)

And that's the danger. By all surface level measures, this is science. It's published in a journal. The difference though, and this takes quite a bit of training, is how to critically interpret a study's methods and results. In science, we almost never make decisions based off the findings of one paper. You place it in the context of broader evidence. And if something doesn't fit with everything else you've read about a topic and dozens of other papers, you have to take a moment and say, well, why might this finding be a little bit different in that paper? Specifically, since I made a video about it, I happen to know their figures, one of their figures where they were showing this divergence in cancer rates between people who did and did not get vaccinated. If you look closely at that figure panel, it's almost immediately after vaccination, like within days, that you start to see those two lines separate, which implies that people are getting vaccinated and then like one day later developing a cancer so serious they recognize the symptoms, going to the doctor, getting an appointment one day later, and getting formally diagnosed on the order of days or weeks, which is implausible from a biological perspective. Even some of the Most serious carcinogens that you could be exposed to. The timelines are much longer than that. And so the question is, well, what could really be explaining this? What's going on behind the scenes that's linking. Appearing to link COVID 19 vaccines to cancer. And the answer is related. This is one of my favorite stories. It shares the exact same answer as what's going on here. It turns out if you look at people who drink coffee, people who drink.

B (23:10)

More coffee drinking coffee right now, well.

A (23:13)

You'Re not going to like what I'm about to say.

B (23:14)

Oh, dear. Dr. Knock. Okay, I'm ready.

A (23:17)

Appear to have higher rates of lung cancer, which is true. That association exists if you look at unadjusted data. However, it just so happens that people who smoke tend to drink more coffee than people who don't smoke. And if you look in the data set and you adjust for smoking status, the apparent association between coffee and lung cancer goes away completely. It was that confounding factor that you didn't measure for maybe initially that was actually driving the lung cancer. I think it's the same type of thing going on here with the COVID 19 vaccines and cancer diagnoses. The question is, what could that middle link be? It's hard to say because they didn't really measure many variables in the study. One thing that comes up time and time again, and this is the thing you'll see in other health discussions online, something called healthcare seeking bias, sometimes called surveillance bias, most simply understood as how often do you show up at the doctor? Because obviously the more often you show up at a doctor, the more chances to get diagnosed with whether it's cancer or autism spectrum disorder or whatever it might be. And so the key thing you have to adjust for is, is it true that the people who were choosing to get Covid vaccines were also choosing to get diagnostics for cancer more frequently than people who are not even the act of going to get a vaccine. You're seeing a healthcare provider, maybe they notice something. You say, oh, I've been feeling tired, I've been losing weight. And they say, oh, that sounds concerning. Go get a blood test. And then maybe that leads to a cancer diagnosis. Those are very plausible ways to start getting cancer diagnoses within days or weeks after a COVID vaccine. What's not very plausible is that the vaccine is actually giving you cancer one day later, getting diagnosed a week after that or something. So failing to adjust for this type of confounding, whether it's healthcare seeking bias or whatever else it may be really underpins a lot of claims online. RFK Jr has done this with vaccines and autism. It is true that if you don't adjust the data, children who get more vaccines appear to have higher diagnoses of autism spectrum disorder. It's also true that children who get more vaccines see their pediatrician more more opportunities for autism diagnoses. And once you adjust for that healthcare utilization, the effect goes away completely. And so you'll see this a bunch even in published papers. If the authors haven't done a really good job of trying to compare for how many of these different explanatory variables could be out there, you can come away from a peer reviewed study indexed on very official sites with a totally incorrect understanding of the situation.

B (25:41)

I have great bemusement whenever I read any kind of new claim that's being made about coffee because I do drink, no doubt way too much coffee, as my doctor tells me every year.

A (25:57)

But how many cups per day are we talking?

B (25:59)

Oh, Dr. Knock. Well I now try to drink less than four and I would say I make that most days. But there have been periods in my life where it has been much higher than that. I'm not proud of this. It's not like Starbucks venti size, it's like a coffee cup size of 4. Yet I know I need to do a better job. I don't though justify my coffee consumption by the myriad claims that are made periodically about how coffee is an antioxidant, which is true. It does have flavonoids, which is, which is true. And also, you know, may not be kind of the elixir that enables me to live forever. It does seem to me that there are quite a few kind of swirls of misinformation, misapprehension, assumption around cancer specifically. Certainly I think we'll sometimes see non specific claims like oh, there's a hidden cure for cancer that we're not being told about. We'll sometimes see very specific claims like rather infamously, when Mel Gibson was on Joe Rogan and said that three of his friends who had had stage four cancer now no longer do because they took ivermectin and other drugs. Two questions, Dr. Knock. Why do you think there is so much assumption and I would also argue hope, but kind of hope untethered to evidence in trying to explain both the causes of cancer and then secondly, what the hidden treatments or the miracle cures might be.

A (27:42)

Hmm, great question. I think hope is the right word because when you get diagnosed with cancer, it's obviously one of the most emotionally vulnerable times of your life. And against everything else, you want to believe that there's something that you can do. You want to believe that you haven't heard the full story. You're willing to at least hold the possibility that something you're seeing online might be true. Even if you never would have believed those things before your cancer diagnosis. Even if you know, 15 years prior, you would have heard a claim like that and be like, obviously that's not true. That's just social media grifting, they're trying to sell more supplements or whatever. It might be that same person. Fifteen years later, when you're diagnosed and you're told you've got two years, sorry, that's all Western medicine and science can do. Naturally you're going to say, I don't want that to be true. What else might be true instead? And so the unfortunate part is that these narratives really take advantage of people at the most emotionally vulnerable times of their life. Where you run into really serious trouble is when people start to believe, I just need to do a juice detox cleanse instead of actual evidence based treatment. The second part of the answer is, does a hidden cure exist? The answer is no. We've actually made incredibly good progress in cancer treatment in the past 30 years. I think it's since 1991, cancer mortality in the US has dropped by, I think it's 33%, 34% as a result of improvements in treatments, both natural and artificial. Science made treatments decreasing smoking better diagnoses and stuff. But basically the core idea is like cancer treatment has gotten radically better in the last 30 years for some specific cancers. And there's all these little bits of variability between different types of cancer, the end result of which is we're never going to have one thing that treats all cancer that could be kept hidden in a freezer. So we are making really, really good progress toward better treatments for cancers. Maybe not to the point of a cure for all cancers, but I mean, it's been really good progress.

B (30:00)

And we know more about what can help reduce our risk of getting cancer.

A (30:04)

Oh yeah, that's the other half of the equation. Unfortunately, it's a very boring list of things you can do. It's the list of things that help you with pretty much every other chronic disease you can think of.

B (30:15)

It's the list of things that my grandmother would have said to me, right, like eat a well balanced diet, get enough sleep, get fresh air when you can, wear sunscreen, don't smoke, exercise alcohol in moderation, try to avoid stress oh.

A (30:30)

Maybe one surprising thing on the list, in addition to everything else that everybody knows, and it's just like, I got to do it better, is actually infections can increase your risk for cancer. Hepatitis is one example, can cause liver cancer. Another one is hpv, human papillomavirus. It is, like, by far the dominant cause of cervical cancer. And fortunately enough, actually we have a vaccine for hpv, which now there's new data coming out to show that it's not just the people who get vaccinated. I don't know if you've seen these data that are protected from cervical cancer. There's these second and third order effects, like, because HPV is spreading less in the networks of communities around the people who are vaccinated, there appears to be actually a broader protection against cervical cancer that's happening as a result of the HPV vaccine. There's a lot of misinformation about the HPV vaccine, but the data are really clear that the benefits of getting it outweigh its risks. And I hate when people say that vaccines are safe and effective because obviously no vaccine is totally safe and totally effective. I think that's a criticism that's launched against HPV vaccine, for sure. Hepatitis vaccine, COVID vaccine, influenza vaccine, you name it. As long as the benefits outweigh the risks, though, which is that the way that these decisions are made in, you know, by the CDC and by medical associations, it can be worth getting. And that is definitely true for the HPV vaccine.

B (31:54)

I certainly agree. Doctor, I'm so grateful for your time. Before that we close, I want to kind of do one thing that we do on the show. It's a segment called Fact or Fiction. So I'm going to kind of rattle off statements or claims that are made on social media, and I hope you can tell me kind of whether they're fact or fiction or that maybe we don't know.

A (32:36)

I hope so, too. Let's find out.

B (32:37)

Let's find out. We hear often, you know, not only online, but I would say I hear this too, in conversations, particularly with other parents, that if we can't pronounce an ingredient that is on a food label, that ingredient therefore must be, to pick up on our earlier conversation, unnatural and harmful. Fact or fiction. If you can't pronounce it, is it bad for you?

A (33:05)

That's big time fiction. Although that plays into, I mean, the story's coming together. I don't know if you saw that clip of Trump trying to say acetaminophen while giving health advice to pregnant Women all across the country couldn't say the word. It's wrong. The ability to pronounce the chemical name of something is not predictive of its health effects.

B (33:24)

Secretary Kennedy said that he needed to fire the members of the Advisory Committee on Immunization Practices because they had too many financial conflicts of interest. I know you looked into this. So from your perspective, fact or fiction?

A (33:38)

That's just blatantly fiction. It turns out it's actually rigorously reported the financial conflicts of interest that they.

B (33:46)

Have over years, over decades.

A (33:50)

And what you see is a declining fraction of financial conflicts of interest. I Forget the exact percent. I think it was under 5 or 6% most recently. And many of those were that the people had received grants, research grants related to the topics being discussed. And so when you're trying to assemble experts about a certain type of vaccine, you kind of have to expect that some of them are going to be like leading researchers in the field getting research grants related to that topic. When you sub analyze the actual prevalence of financial conflicts of interest, probably that you and I would think of like getting consulting money from the pharmaceutical company, it's a vanishingly small fraction of the former committee members. So it was used as a unfortunately convenient and compelling narrative because people believe, you know, Big Pharma has this shady influence over medical decisions. And if that's your starting perspective on what is true, maybe you don't look into the fact that actually only 2%, 1% or something had true financial conflicts of interest. So he uses that as justification to wipe out all the actual experts and replace them with people who share his opinions. This is exactly how to undermine vaccine availability in the country is through changing these recommendations that now will be basically unilaterally made by people that RFK Jr appointed.

B (35:15)

Another thing that Secretary Kennedy has said recently is that circumcision doubles the risk of autism.

A (35:22)

Fiction. And man, good thing we prepared for this earlier because it's the same issue as when we were Talking about the COVID 19 vaccines in cancer, coffee and lung cancer, and now circumcisions. He said it's the Tylenol after the circumcisions that's causing the increase in autism spectrum disorder diagnoses. And he didn't actually cite a paper. He said there were two studies. I looked, I could only find one study. And the study that I found had some glaring statistical questions. One of them was that among the Muslim boys in the country, this was In Denmark, only 10%, 10 or 11% of them were noted as being circumcised which is dramatically low culturally for Muslim boys. And so what that tells you is that something is going wrong with their labeling in the study. And it turns out many circumcisions happen outside of the healthcare system, which is.

B (36:16)

Also true here in the United States. You know, in Judaism or Islam, I think some would be circumcised in hospital or clinical settings, and many are circumcised at home as part of religious traditions.

A (36:30)

Right. And so what they didn't control for, though, is, well, what could be the differences then, explaining why some people were circumcised in a hospital versus people who were at home? What are the differences between people who are at hospitals versus not at hospitals? And so what could very possibly be the case is that the children who were circumcised in hospitals were not representative of the children who stayed home. Maybe they did have greater medical attention and therefore greater opportunities for diagnoses compared to the children outside of the hospital. You can't say that that is definitely the reason why, because the data weren't collected and compared. But maybe the most critical part that I should have started with is that the study never measured Tylenol use whatsoever. That was sort of RFK Jr. S conjecture on the spot that because circumcision appeared to be related to an increased risk of autism in this relatively low quality study, maybe it was the fact that they were also giving Tylenol afterwards, but they didn't assess whether they were giving Tylenol afterwards in the study. So it's this weird next level version of the mechanistic argument. We were just making stuff up that happened after the study to support your previously held opinion.

B (37:38)

I wish I could say I was surprised. Artificial food dyes lead to hyperactivity in kids, exacerbate ADHD in kids, fact or.

A (37:50)

Fiction for the general public and even most people with adhd, that is not true. What is true, and this gets to the little bit of nuance and a little bit of truth, is that there appears to be a subset of children with ADHD who may have exacerbated symptoms in response to artificial colors. But to say that, you know, the whole population, or all children, for example, should avoid artificial colors because of that small group of people is not true based on their review of the evidence. And so this is a circumstance, obviously I'm not a pediatrician, I'm not a neurologist, but this is where you want to be listening to your pediatrician. They'll tell you what are the major factors that you can address to help manage symptoms, focus on those big ones, whatever they might be, and I don't know what they are, but sleep or screens or whatever it might be. And then they may advise you. Sure, if you think that for your child artificial colors are exacerbating the issue, you'll do a carefully controlled elimination and then put it back in. But the trouble is that if you try to apply that to all children across the country and you say nobody should eat artificial colors, given our current food environment, is you end up with an unnecessarily restrictive diet, potentially. And so now maybe you're avoiding this theoretical fear of artificial colors, but you may be creating a very real problem of nutritional deficiencies or macronutrient imbalances because you're afraid of this theoretical risk, and you run into a very real risk. That's the problem with elimination diets more broadly, certainly for children, though I would be very careful about going off on your own and starting these restrictive diets, unless it's under the guidance of your pediatrician.

B (39:40)

I certainly have deep resonance with concerns around showing my own bias here, Dr. Knock colors in a family diet or a kid's kind of proverbial or actual dinner plate that may look as if they only appear in a Crayola crayon box and not in a natural environment. And certainly we are rather strict around what our kids eat, except on Halloween and Easter when all bets are off. And so I really understand this on a kind of emotional level and also recognize that it's an enormous privilege to be able to live in a place and to have the resources where we have farmer's markets multiple times a week and where we live near multiple grocery stores, and that our reality is very different than many families in the country. And I think we have to be candid about that, too, when having these types of conversations or anything that might approach sort of a quote, unquote, like debate or deliberation.

A (40:56)

Right. And at the end of the day, I think you're obviously totally correct. Like, if you're comparing eating red flaming hot Cheetos against snacking on blueberries and, you know, plain yogurt or something that hasn't been colored, obviously the total health difference between those two types of foods is massive. And I would expect that, on average, the types of foods that are flagrantly and flamboyantly colored are probably not as healthy as the more dull and uninteresting colored foods that are probably the more whole foods. But those health differences, I think I'm not sure that they're from the colors, if that makes sense. I think that the colors are probably associated with the ultra processed things that we know have serious impact on health.

B (41:39)

And I would argue that we need to do a better job of we as a society, we as a country need to do a better job of ensuring that that healthier foods are more accessible and more affordable to more people in more places every day of the year. I just am so thankful for your time today. Thank you for all that you're doing in your day job and in your free time to help all of us make the right choices for ourselves and our family. Very grateful. Thank you.

A (42:05)

Well, thank you for the invitation and thank you for providing a space to have these discussions. That's part of the challenge is that sometimes these topics never see the light of day. So I appreciate the work that you're doing.

B (42:24)

You can learn more about Morgan McSweeney at Dr. Knock on TikTok and Instagram. He's also got a newsletter at drnock.substack.com thanks for listening. Talk to you next week. That Can't Be True is a production of Limonada Media and the Clinton Foundation. The show is produced by Kathryn Barnes, Mix in Sound design by Ivan Koraev. Kristin Lepore is Senior Director of New Content and Jackie Danziger is VP of Narrative and Production. Maggie Kralshore is our Managing Director of Partnerships. Executive producers are Jessica Cordova Kramer, Stephanie Whittles, Wax and me, Chelsea Clinton. Special thanks to Erika Goodmanson, Sarah Horowitz, Francesca Ernst Kahn, Caroline Lewis, Sage Falter, Barry, Lurie Westerberg, Emily Young, and the entire team at the Clinton Foundation. You can help others find our show by leaving us a rating and writing a review. And if you can think of someone who might benefit from today's episode, please go ahead and share it with them. There's more of that can't Be true with Lemonada. Premium subscribers get exclusive access to bonus content when you subscribe on Apple Podcasts. You can also listen ad free on Amazon Music with your prime membership. Thanks so much for listening and see you next week.