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- [00:01]
A
Hi, everyone. Chelsea. Here we have something really special dropping in your feed today. A never before published episode from one of my favorite health podcasts, the checkup with Dr. Mike. I was lucky to have Dr. Mike on as a guest recently, and he's also just an excellent host. In this episode, he sits down with Dr. Jeremy Faust, an emergency medicine physician in Boston, a public health researcher and the author of the substack column Inside Medicine. Together they talk about the current state of healthcare and scientific research under President Trump, their biggest fears around future outbreaks, and just a lot else that I think is really worth listening to. If you haven't already subscribed to the checkup with Dr. Mike, I hope you'll do yourself a favor and find it wherever you listen or watch podcasts. But first, enjoy this one. We'll be back next week with a new episode of that Can't Be True.
- [00:57]
B
You've been quite vocal about this administration and how they've had a terrible impact on healthcare, not just the United States, but globally as well. And you've been documenting that across several platforms. Why did you feel that that was necessary? When did you see the tide turning into something not making America healthy again, but perhaps making us unhealthy about the
- [01:22]
C
first week of the administration really just instantly came in. Yeah, my intention had been, okay, let me put my head down and do some work that I've been meaning to do. Write a book about sepsis maybe, or do some research that I've been wanting to get to. And within a couple of days of Trump's inauguration, it reminded me of the early days of 2020, where I felt, oh, someone needs to be tracking all of this because bad things were happening. So it was the first week they said, we're not going to be in the WHO anymore. And then we started to have censorship at the CDC and we started to hear all kinds of things that were happening. And it was so rapid fire that it was hard to keep up. So I just felt for me, I needed to document this as much as I could. I needed to say why it mattered. And a lot of it was coming out of conversations I was having with my friends and colleagues in these agencies, at the cdc, at fda, and people were really scared about the future of American healthcare and American science. Things that matter.
- [02:28]
B
What? Like, let's take each one of those instances point by point. WHO pulling out of the who. Why is that problematic?
- [02:35]
C
The World Health Organization does a lot of great work that we want to be a part of. They help figure out what should be in vaccines that we do seasonally. Flu vaccines, Covid vaccines. When there's an outbreak, the WHO frequently has people on the ground, WHO they already have relationships with to keep those outbreaks from becoming pandemics. It's the best we've got in terms of that. It's when the WHO is working, you don't hear about it, which is a lot of the time. There's some problems with the who. I'm not an expert on their ins and outs and there are reasonable criticisms. But when I saw Donald Trump have this Sharpie out there and they said, oh, this next executive order is to take us out of the who, and he looked like a kid opening a Christmas present. And he gets a Sharpie and he signs it, ooh, a big one. And I'm thinking, oh, man, I really hope that that doesn't cause an Ebola outbreak. I really hope that that doesn't cause a Marburg outbreak. I hope that this doesn't mean that we are now going to retreat from our dominance as a global health leader. And he was kind of excited about it. And that gave me pause. It's one thing to say, hey, let's tweak this, let's figure out how to make this better. But there was kind of a joy in those early days of the administration, both from the president, from the Doge people, and as a physician. I just felt that that was really kind of appalling.
- [04:07]
B
Well, it was very non medical, the approach, because when you're treating someone, you're always talking about risks, benefits, maximizing benefits, limiting risks. You're trying to figure out what works best for the individual that's sitting directly in front of you. You're never just coming out and saying, we're taking all of this off, we're completely discontinuing this drug. I mean, if we just wanted to villainize acetaminophen, all we have to show are that it causes. But then we're gonna end up with a lot of headaches in this country, a lot of lost productivity. And you don't realize what can happen if you just ban things or remove things in totality. So I try to put myself in other people's shoes, other leaders shoes, and say, okay, there are certainly problems who, we do have leverage because we're one of the biggest players in who. Perhaps we can use the threat of leaving WHO in order to make radical change, to make improvements to the agency, to perhaps make it be more America first in their priorities, whatever that would mean to someone. But we're not even doing that. So it's not even that we're leveraging America's power, financial success, in order to create better outcomes. We're just doing it to show force. I don't see the logic in it of why leaving who would even be a net positive. Do you see that?
- [05:25]
C
I don't, but I think that there are some grievances from the previous administration and how the pandemic was sort of how it was discovered and how it was thought about. And I think that a lot of what we see is grievances. And those grievances, again, they might have some truth to them, but when you look at the ledger of how many lives are going to be caused by some of these policies, it's horrifying. Look, if I said to you, mike, I'm going to give you a piece of paper, and if you sign here, a million lives will be saved, you'd be like, yeah, let me do that. How many people have had that opportunity? It's so extraordinary when people are given that opportunity, and surprisingly few people do have that opportunity. And I'll just like, name one who people don't always think of, which is Deborah Birx, Debbie Birx, the scarf lady in the Trump administration. You know, Debbie Birx saved a lot of lives because she convinced the president that we needed to do something to slow down this novel threat. And I give her enormous credit for that. But on the other side, if I said, hey, Mike, here's a piece of paper, you can Sign here, and 14 million people will die by the end of the decade because we're going to save a few bucks on global aid, I don't think you'd want to be that person. So it's. Do they not believe that the program saved those lives, even though they clearly do? Do they not care? That's what drew me into this, was I want to understand the stakes. I want people to understand the stakes. Why it matters to them. Why should they care as, like, our patients. I'm an ER doctor, but I'm also someone who has patients in my platforms, meaning the people who read what I say or they watch or listen to what I. What I talk about. I want to explain to them, like, why this matters to you because it's not immediately apparent. So that's what drew me in, was this sense of, we need to document it, we need to understand it. We need to. We need to make the case that this is who we are. I'm not like someone who sits around thinking about patriotism all the Time. But, like, I'm kind of lucky and proud to be from here, and I think we should all feel that way. I think a lot of people feel that way. I'm proud of American scientists. I'm proud of the fact that this insane number of Nobel Prizes came out of our work in the past 100 years. That's what makes us who we are. And on top of that, we do this global work, like pepfar, this thing. The President's Emergency Plan for AIDS Relief, a project that was developed by George W. Bush that was so ambitious and so good that when he proposed it, the liberal elites and public health did a triple take. They were like, no, this cannot be. And they looked under the hood and it was so real. That saved 25 million lives. And we started to hear in January, we're going to put this on pause right now, and we're going to put it through the wood chipper was what Musk said. And I just sort of felt like in Star wars when Obi Wan Kenobi says, I feel like I just heard a million voices cry out in terror before they were suddenly silenced. I was just like. That was like. It was a moment in my life where I just. People just died. It's kind of like when I first understood Covid, too. It was like, oh, it's a respiratory virus that spreads asymptomatically. There's going to be millions of deaths. So when I track what I care about, how I spend my time, I think there are these moments that radicalize us, that bring us to our mission. And this was in January and February, this moment where I realized, oh, shit, people are going to die. The people who are going to die are going to be so remote from most Americans that most Americans won't feel it. They won't care. And then by the time the dismantling of this system starts to affect us, it will be way too late. And I don't think the average person who thinks about this has a sense of the stakes that this has on American science. Imagine you've got kids, I've got two, and they want to be scientists. Wow. Wouldn't that be so cool if, like, your kid said, someday, dad, I want to be a scientist. That up until six months ago, I would have said, in this country, they want to be a scientist, they can be a scientist. I'm not sure they're going to win a Nobel Prize. I'm not sure what they're going to do, but there's going to be a system that if they, you know, if they get decent grades, they do the things they're supposed to do, they can do science. And we have a wonderful system of training grants that gets people up and running. Look, 20% of the grants that were cut in the early days of this administration were training grants. Like what message is that sending? Well, I'll tell you the message it's sending. It's saying this is not a place where we really support science. So we start to see the beginnings of a brain drain. The opposite of what happened in the 20th century where all the best and brightest came here. Now we're seeing the idea that people are going to flee in other countries. They are psyched.
- [10:20]
B
Yeah, I actually have seen it with one of our former podcast guests. He just messaged me yesterday saying that he's offered a job in an institution well regarded, one in the United States and, and one abroad. And even though the other one abroad is gonna be much more difficult on his life, not where he wants to live, he has to take it. Cuz he's fearful that our institutions are gonna be absolutely devastated by these funding cuts as well as just in principle, what they're allowed to study. This level of censorship, which again it goes against to what the talking points are, where the talking points are supposed to be about freeing people from censorship, focusing on lifestyle and nutrition, but then yet nutrition research budgets are being cut, nutrition researchers are being laid off. Some of our best and brightest. So it doesn't make sense to me. And the reason why I'm backing off of my Elon Musk criticism is that people won't drop a bomb if they want to fix something and destroy everything unless they think that's absolutely necessary. So you need to go into someone's mind much how like a jury would try and think about a self defense argument. They will say, well, does that person really fear for their life? And there could be some evidence pointing to it. My evidence that Elon Musk really believed this deficit would kill us all unless he fixes it, is watching him continuously drop bombs even now that he's out of doge on his own relationship with President Trump. Make accusations related to this Epstein list and he won't stop because he believes that we really need to fix this deficit. So I actually believe he believes in it and I see the evidence behind that.
- [11:58]
C
Yeah. But I also think that there is this thing about where to make these savings cuts, where should we go? Like why should we attack the things that make America so successful? 356 drugs were approved in the 2010s by the FDA. 354 of them had NIH funding in some way. That is 99.4%. You want to know why people are losing weight? Because GLP's work, we did some of that work. We didn't do as much of it as we could have. It's a great example. So I think that the average person has no idea the stake of these science experiments that happen. They hear these stories, oh, there's trans mice. Or they hear these stories, why are we spending millions of dollars to study worms and what they do with their hands, MRNA. And they just go, oh, well, look at this government bloat. And they don't see the through line to the fact that if your relative or you are diagnosed with cancer, here's a drug that will keep you alive. And I think that that's a case that we really have. I never thought we'd have to make that case so vehemently, but we do because that's what's at stake. So we're seeing cuts that in the early days of the administration, it was all executive stuff. Right. And the legality of that is really dicey. I'm not a lawyer, but the lawsuits have been playing out. But with the budget that Congress is currently. Well, there's the budget that they pass and then there's appropriations coming. These proposals we're seeing will legally take the NIH and cut funding by 30, 40, 45%. And no one will feel it immediately except in these university towns. Oh, someone lost a job or maybe in a year or two they won't get accepted to a PhD science program. But no one's going to really remember. Oh, that's because Congress cut that program at the University of Wisconsin or whatever it was, or University of Alabama. It's everywhere. So I really am fearful that they've chosen an area where we kind of rock, we're kind of amazing and that they don't. The average person doesn't see why they should support that stuff. And there's a lot of other areas. Look, I'm biased. I'm a physician, I'm a person who believes in science, I do research, so I'm biased. But I think there are probably other areas where if you really believed in the long term importance of our fiscal house, taking hhs, the Health and Human Services department of the federal government and reducing the workforce from 80,000 to 60,000, it's not the thing. And going from 47 billion at the NIH to 27 billion. 20 billion, that's a lot of money for you and me. But that's not what's going to keep us alive in terms of this country's ability to do everything that these people think that America should be doing. So it's just what I would say to people is watch how they do things. What choices are they making and what sacrifice does that have on the future? Innovation, the future health that we expect. We expect progress, we expect high quality care.
- [15:12]
B
Sure. Everyone believes that whenever they come into my office that I'm going to have a miracle cure for them. But that's not always the case. And I think. Interesting. I'm writing a scripted TV show with a really great writer, Peter Noah, and he said a line that sticks with me. He says that at any given moment, most people are not sick, but everyone gets sick. And everyone's gonna have a moment of reckoning, of realizing when they go see their doctor and there is medication shortages, there is less innovation. Their disease doesn't have a treatment for it, their elderly parent doesn't have coverage. They're gonna have a moment where they go, oh, man, now I've woken up and realized what all those cuts were about and what all those nerds were talking about, because that's how they view the conversation. They think this is inside baseball. That's not gonna impact them. And in this moment it won't. But ultimately it will affect everyone.
- [16:14]
C
Yeah.
- [16:16]
B
What I want people to highlight from what you just said, because they'll say, well, the working people won't be unhealthy. Why would they look at, I want to live like a natural caveman. They didn't have medications back then. Look how healthy they were. There's this, like, notion that people have associating how it used to be, how nature must be always great. And this fallacy that exists in people's minds is so twisted when if they were to look at what healthcare was back then, or the lack of healthcare did to people back then, or how people lived such truncated lives and then how powerless they were, had a virus, a fungi, came about, versus to where we are now, the capacity to create a vaccine, to create a treatment, to run research trials. How blessed we are to be here and how we're trying to go back to how terrible it was back then, where the working age public, yeah, they're not at risk of having heart attacks and strokes or cancers at such a high rate, but they are at risk of tuberculosis, hiv, novel illnesses with tropical climates changing. That's the scary part for a working age public. And that's the budget. That's Being cut the most, which is where that's the biggest threat for us. We're suddenly not gonna start losing 30 year olds. Cause they're eating too much high fructose corn syrup and switching it to cane sugar and saving their lives. But those people can absolutely be at risk if through temperature change there's some kind of adaptation from a fungi or a virus where now they are very much at risk. And that's the funding we're cutting. How is that where we are?
- [17:57]
C
Well, nostalgia ain't what it used to be. It's like there's this comic that I'm sure you've seen. The cavemen are sitting there and they're saying, boy, everything I eat is locally sourced, it's organic. But everyone dies at 30. Something's not adding up, right? And I think that there's this idea like make America healthy again. Make the kids healthy again. And there's something that's very true about that, but there's a lot that is very false about that again. Can we please tell me the year that we'd like to go back to? What year? If you want to go back to the early 20th century, then you're accepting a pediatric mortality rate of 50%. And how did we get through that? Well, sanitation, vaccines, other innovations, pediatric cancer that are rare didn't bend the curve there. But I'm proud of it that certain pediatric cancers went from fatal to survivable. So I wouldn't choose the early 20th century then. You've got a period in the middle of the century where we make a lot of progress, but it's not even. And so if you have means, then you might live a longer life. But when has life expectancy ever really been better? And the answer is a few years ago. But what has bent that for young people in particular, It's firearms, and then for young adults, it's drugs. It's the things that this administration doesn't want to talk about. I mean, there is this Make America Healthy Again report for kids talking about how to make the kids healthy again and omit the leading killer for a lot of kids, which is firearms. If you go from 1 to 17 or 1 to 18 or 1 to 19, firearms is the leading killer. Then people say, oh, no, no, you're just baking it in because it's mostly teens. Okay, true. It starts to be in the top three in like late middle school. And it starts to be number one. Late middle school, high school, 13, 14 year olds. Okay, you want to get kids life expectancy back on par with Our pure nations. I'd say firearms are the way to go.
- [19:59]
B
Yeah. I was doing a debate against folks who are vaccine skeptical or anti vaxx. I was surrounded by 20 of them and one started grilling me, pimping me on medical stats and said, do you know what the number one cause of death in pediatrics was? Pre pandemic or something. And I said, guns? He said, no accidents. And I'm like, what do you think is the source of those accidents?
- [20:21]
C
Well, actually, it's quite interesting. Well, actually, to this point, it used to be motor vehicle collisions. At the beginning of the century, it's fallen dramatically. Why has that happened? Well, because we enforced safety standards, so seat belts and airbags and so the pediatric and adult motor vehicle collision mortality has fallen dramatically since the beginning of the century. And before that. And then for young adults, we had opioids come on. And then for kids we had this firearm crisis, which my team studied. And we see it's really, it's everywhere, but it's really isolated to places that have adopted much more permissive laws. And I will just say, when someone says accidents are the number one cause of death, I have many reactions to that as a scientist and a physician. Number one, that's a gift. That means we're doing something interestingly well. Do you want to go back to when it was measles? We could do that. We could do that if you'd like. I don't want to do that. So when people are dying of accident, that usually tells you that society is fairly healthy and yet we're trying to make everything healthy again. That's number one. The other piece I'll just say is accidents are a big part of it. But in the pediatric gun thing, homicide and suicides are the leading causes. So I would just say we can do better. But that's again, watch what they do if they really are interested. You said you sort of made this comment about high fructose corn syrup and you said it kind of, kind of glibly. But you mean it because there's this idea of distraction that over here they're saying we're going to get rid of the high fructose corn syrup and that's going to make our kids healthier again. And then nowhere in their documents are they interested in firearm prevention in a way that, by the way, can be completely legal for, for gun ownership and not infringe on rights. And they're completely undermining vaccines, a thing that took the 20th century pediatric experience and turned it from a 50, 50 shot to we all expect our kids to survive childhood. And that is the exception. Perry Klass, a pediatrician and wonderful writer, wrote a book that actually had to be retitled called A Good Time to Be Born, and it was published in 2020. And she documented what happened last century to kids in this country. It's amazing. And I don't want to go back to before.
- [22:39]
B
Yeah. And it feels like we slowly are with the measles outbreak we're having right now, highest number in the last 30 years. We have the head of HHS, Secretary Kennedy, who's constantly bringing up talking points from the anti vaccine community that have been disproven. He, last I checked, currently has a tweet up that says the Gardasil vaccine, HPV vaccine has led to more deaths than cancers it saved or deaths it prevented. And that's who's in charge of our healthcare organizations, the largest ones in the nation. So what does the average doctor do? You're an ER doc, I'm a family med doc. We're at primary care frontlines. The way that I make recommendations to patients is from the major agencies guiding me from great research being done. The research that's currently being done by the administration is being whipped up by AI with hallucinations in it, made up reports, completely fake. And then the guidance that's being put forth, like what's on Secretary Kennedy's Twitter page, just blatantly lies. How do I know what the right thing is to do? How do I train my residents what the right thing is to do? Who should they look to for guidance now? Because this is scary, right?
- [24:03]
C
Absolutely. And I think that there are resources that you and I, as physicians can refer to. I'm not worried about us getting it right. There are projects that have sprung up to say, okay, if CDC is not going to be reliable on their assessment of risks and benefits for these vaccines, we'll do that work fine. That's probably going to be sustainable with small, modest financial investment here and there. And I hope that they're successful. The problem is that we've got a legal system that says that what the CDC's vaccine committee says goes for insurance companies. Right. So like under the Affordable Care act, if the CDC's vaccine advisory committee votes that a certain population should receive a certain vaccine by law, not only Medicare and Medicaid and public insurance must cover that, but the private insurers have to also. So that's a really important part. Preventative care. Preventive care. The thing that they're talking about. Let's prevent Chronic diseases. Fantastic. What's a great way to do that? Vaccines. Because vaccine preventable illnesses, we are learning, are probably responsible for more or contributing to chronic illness in ways we didn't really understand before. It's an area of active research. So you and I could look at the American Academy of Pediatrics if they do something, or this Vaccine Integrity Project, or we could look overseas to places that haven't politicized this to the extent that we are doing currently. And you and I could figure out something as clinicians. But then when they go to try to get those vaccines, they go to their doctor, it may not be covered because by law, they're not forced. Medicare and Medicaid will not be able to. Right. Because that's where the votes come from. That's where the decisions come from. And the private insurers have a choice. They have to do the minimum of what those committees say. And I hope they do the right thing.
- [26:00]
B
Well, I'm curious if they're gonna do the right thing by ethical means, but also by. Isn't it in the insurer's best interest to keep children out of the hospital by giving them vaccines?
- [26:10]
C
Yeah. So there's this idea of return on investment. So the fda, by the way, the Food and Drug Administration, they're not involved in that question historically, although now they seem to think that they are, which we can talk about. The FDA is simply there to say, is this medication safe and is it effective? Safe and effective. And then other groups have to look at other questions like is it reasonable? Is it necessary? Should we. So there's a concept of return on investment, or in the health economic space, the willingness to pay thresholds. Everyone gets this. If I say, hey, I've got a drug that cures cancer, it costs a trillion dollars per dose. If one gets. We'd love to have it, but. Sorry, no, but what's fascinating is when you drill down on a lot of these vaccines or a lot of these screenings or other things that we do in primary and preventive care, it's close. They're close calls. So I think, for example, there is a real misunderstanding on these thresholds with different groups of people. And on top of that, vaccines are a victim of their own success. Meaning that when there's a high enough uptake of vaccines, aren't there. There aren't that many cases. So it takes so many doses to prevent one disease because the disease is so rare. Then you, you see what happens when vaccine uptake comes down. All of a sudden, these start to look a lot Better. So an insurance company could look at a bunch of different questions and they could say is it worth it to us right now? And they actually economically, just truly economically could be, they could be correct to say maybe not, but in two years it will be.
- [27:49]
B
Yeah, exactly.
- [27:50]
C
So let's not do that. So what I'm hoping that they'll do is to see the longer picture, not what's right in front of them. But I'm not confident because I think that people think about quarterly reports, they think about investor portfolio, shareholder responsibility.
- [28:01]
B
Yeah.
- [28:02]
C
And then they also think about like, and then there's a question of what should the threshold be. I was actually having a really, actually just genuine debate with a colleague of mine in Australia, this guy Gideon Meyerowitz Katz, super smart epidemiologist. And he and I were debating whether or not the primary series for for kids, for Covid is meets most willingness to pay thresholds. Now I will just say right now it probably is not there for a 10 year old kid who has seen the virus before, who's been infected and maybe even for a 10 year old who somehow never got infected. Although if they can find that kid, let me know. But for like infants where the rates are high, it's actually kind of on the safe and effective part, like it's to me very slam dunk. Like these are safe, these are effective. The primary series is important for infants who, whose airways aren't done getting big. But on the willingness to pay threshold, on the economics of it, it's dicey, it's close to which my argument would be kids, it's kids. Can we just have a little. If the willingness to pay threshold is there, fantastic, I won the argument. But if it's not, or if it's close, my sort of phone a friend is all right. But for kids, could we flex a little bit because they don't have a say and if one dies, they lose not five months of life, they lose 80 years of life. A huge percentage of kids who get hospitalized and die of flu and Covid actually don't have diagnosed pre existing conditions. So the insurance companies could do this analysis correctly or incorrectly depending on what question they ask. And I think that's something that probably your listeners and my readers don't think about, which is the way we ask a scientific question can totally change everything.
- [29:46]
B
Yeah. Like to sum it up, asking the question, is this vaccine financially responsible? Like will giving the vaccine prevent enough hospitalizations where paying for all these vaccines will be in our financial best interest and maybe in the short term it won't be because the illnesses aren't there because the vaccines were so successful, but once illnesses come back, then it might be worthwhile. So we need them to not think about the short term. We need them to think big picture.
- [30:09]
C
Correct.
- [30:09]
B
But very tough to get them to think about big picture because they're not thinking about their profits in five years, they're thinking about their quarter this time.
- [30:16]
C
Yeah. So I don't know what they're going to do, but legally they at least have to do the minimum. And that's why when RFK completely vacated the CDC's vaccine advisory committee a couple of months ago, it was horrifying because that is an independent group, experts from outside the government who come together to make, in my view, really important decisions.
- [30:38]
B
He said that he was doing it so because he wanted to reset the status quo and they had too many conflicts of financial interest. Do you believe that to be the case? And if not, why?
- [30:50]
C
I don't think that that's an accurate representation of what that committee was. That there's always a. What is true is that there's always a balance to be found with people who have been in the space long enough to have worked with a variety of partners. So some people, they've only worked in academia. And then you could say, oh, they're just eggheads who don't know the real world. And then there's some people who've worked with pharmaceutical companies and drug companies and you could say, oh, well, they're in the real world, but they are shills. And then there's people who have done a little bit of both or none. It's really, it's a spectrum. And what I think is important to acknowledge is that the committee that was vacated, everyone had announced everything. It was all out there. And when I read down the list, nothing really concerned me. Right. And people do recuse themselves on occasion. They say, I can't be a part of this vote and I did not have any real concerns. Then he brings in his new committee and these people have horrifically relevant conflicts of interest. Taking millions of dollars to be lawyers and to be expert witnesses against vaccines, to say nothing of the fact that they're propagating misinformation about those things, but just the conflicts. Horrifying. So, and then, and then straight, straight up, just lying. Like Paul Offit, who you've had on this on your show rfk, just out there on tv, lying about Paul Offit, saying that he made votes when he was on CDC's, on the CDC's committee about his own vaccine.
- [32:21]
B
But it was before the.
- [32:22]
C
Paul wasn't on the committee at that time. So I always say, like, why do they have to lie to make their point? That's a big red flag for me.
- [32:32]
B
Before we get into the CDC style of communication of how they used to do things, I want to debunk without using any. I want to debunk this RFK notion of thimerosal and the wellness industry as a whole to the audience without really talking about science or statistics, maybe a little bit of statistics, but the most basic ones. Rfk. Secretary Kennedy published his book Thimerosal. He blamed thimerosal as the ingredient driving autism rates to be higher in the United States. I don't remember if it was in exactly the year 2000, but around the year 2000, CDC said, we're trying to eliminate, just to be safe thimerosal from all vaccines for children with the exception of the multi dose flu vials. And autism rates kept going up. So by definition, his theory is already debunked.
- [33:30]
C
I would say so.
- [33:31]
B
I mean, I mean, if you say ingredient A is causing these rates to go up, you remove ingredient A and the rates keep going up, that means, you know, it's not ingredient A. Yeah,
- [33:40]
C
it doesn't really match the. We call Koch's postulates. That's a 19th century idea that if you give an animal a pathogen and it gets sick, and then you then take that animal's blood and infect another and that one gets sick, you've kind of gone pretty far away in causation and proving that that's the agent. Right. I think that's fair. But I actually think that's even something more insidious and dangerous than what you just described, which is that bad policy begets bad policy. And I think that the CDC and a group called the Institute of Medicine made a huge mistake 25 years ago when they said, look, we don't really have any evidence that thimerosal is causing any problem, but we are worried about vaccine hesitancy. So we're just going to say let's just get rid of it just to appease the concern the masses. And that seems like good game theory, like that seems like good strategy. But that does two things that are bad. One is it gives the imprimatur that actually there's scientific validity to that, which opens the floodgates to more garbage. And two, it's a fantasy to imagine that something like that would appease people who have already decided that vaccines are harmful. I Agree with you. So then years later, people like RFK say, hey, look, the Institute of Medicine, the Institute of Medicine, these are smart people. The American Academy of Pediatrics, the cdc, they said, let's just be careful. Yeah, precautionary principle. That's precautionary principle. That sounds good, but it leads to the degradation of science and we should say no to that.
- [35:16]
B
Yeah, I agree with you on that. I believe that there was a similar incident when we were talking about the polio vaccine, when there was the Qatar labs incident where it was one of our biggest vaccine snafus as a nation. We actually ended up giving children polio because one lab did not formulate the vaccine correctly. And as a result, this vaccine ended up causing illness. And we agreed that happened. This lab messed up. It was one of the labs that was hired to make the vaccine. And because there was so much public outcry surrounding the vaccine, we swapped vaccines. And when we swapped to the oral polio vaccine, that actually did have some chance of giving people non wild type polio, it ended up actually giving kids polio. Until I believe it was in the Bill Clinton administration that we ended up going back and saying, oh man, we way overcorrected because of public outcry, public concern, trying to appease people who were naysayers, instead of putting our heels down and saying, this is the truth. Whether or not you like it to be the truth, it doesn't matter, but this is the truth and we need to stick to it. So I think this is it playing out all over again with the thimerosal conversation.
- [36:30]
C
Yeah, and it's also, if you wanted to get really deep into it, it's a question about risks and benefits that change with the prevalence of a disease.
- [36:38]
B
Right, right.
- [36:38]
C
So it might make sense at some point to give a vaccine that has a small chance of giving the virus, if that's your only option and if the how common that disease is in the population warrants it. But if you essentially have a disease that does not exist out there, the giving them something that could cause one in a million kids to get it is unethical. So it makes sense, actually, if you ask me, say, okay, it's the year 2050, should we give the oral polio vaccine or the injectable form? Which one should we give? My answer would 100% be, I don't know, what's the. I would say, yeah, what's the current situation? And so it's okay.
- [37:16]
B
And how can you store those vaccines? Like, because in remote areas, injectable is not an option.
- [37:22]
C
Right.
- [37:23]
B
So a lot of questions need to be answered before we start making mass recommendations, and that's not happening. So that's number one. I was going to say, as a way to debunk the thimerosal conversation, even at the outset, that it's not true because we stopped using thimerozole and nothing changed. The second thing is one of the big talking points from the Maha movement is that our lack of focus on wellness is leading to historical chronic health disease issues. And I could see why some people will say that. They'll say, oh, we're not exercising as much, we're not talking about physical activity or nutrition, and that's what's leading all these chronic health diseases to go up. Then all it takes is to look at wellness spending over the last two, three decades and see how much wellness spending is absolutely through the roof on supplements and all these products. And so are chronic health diseases. So clearly the wellness spending isn't working either.
- [38:19]
C
I mean, you can always make the argument that they would make. They would say, well, just imagine if we weren't spending that money, it'd be even worse. They always like to make the argument.
- [38:27]
B
But then what's the fix? You're doing the thing that I'm saying,
- [38:30]
C
what they would say, yeah, sure, yeah. I think that the idea that we have more chronic conditions, there's a lot of measurement bias there, but a lot of it's real too. Certainly obesity has gone up. There's no question of that. That's something that we didn't just start measuring. For decades people have been tracking this question. And I agree. I think that we do a disservice to our kids when we cancel physical education in schools, when we put crappy food in front of them. And so my solution to that would say, okay, I don't think you're going to bend the curve here on red dye. I think that where you're going to bend the curve is on making sure that the foods that kids eat aren't addictive. So that Instead of having 100 calories of snack, they have 500 calories of snack. And that's what we're dealing with. What's happened in our lifetimes, maybe a little bit beyond, is that food has become a lot more addictive. And that's the success of a certain kind of science.
- [39:35]
B
Yeah, well, it's addictive and non satiating. You know, you're continuing to be hungry and you just eat more. And part of all of that is also lack of movement People are spending a lot of times on screens, and as a result, you're burning less and consuming more. And when you have that equation play out at scale, you have rates of obesity going up. It's not based on dyes Colorado.
- [39:59]
C
Right. And I would take the movement much more seriously if they would say that. If they would say, hey, look, there is something about the caloric intake that's happened to our kids. They are just going through bags of chips and they aren't learning how to swim. I would take them more seriously. But the minute you start to talk about that or things that might even fix this later, like these miracle GLP1 drugs like wegovy and Ozempic and Mounjaro and others like it, they start to downplay that as a solution, saying, oh, that's just the band aid and the problem. And I'm thinking, you know, what if someone's bleeding out? Yeah, I'm going to put a tourniquet on there and ask questions later. But, yeah, it's hard to take them seriously when they're focused on things that, in my view are rounding errors and that the science supporting it is really weak. This actually is a form of public health theater. Remember when everyone was wiping down surfaces and the naysayers said, oh, this is just theater. It's just virtue signaling it's not doing anything? Well, I would say the same thing right now, and that's not my idea. Some of my colleagues have made this point who are nutritionists and other scientists. We should not be giving credit for public health theater in the absence of actual public health.
- [41:11]
B
Yeah, because they're not doing anything to make kids eat less calories. They're not doing anything to encourage exercise. He hasn't piloted a kid's movement program. There's been zero of that. I see videos of him sitting at Steak N Shake complimenting them on changing the oil that they're using or the sugar that's in their soft drinks, but not minimizing the amount of soft drinks that are consuming, which is the actual problem.
- [41:33]
C
Absolutely.
- [41:34]
B
So it's like he's solving an issue that wasn't a problem and taking credit as if he's solving the problem, but it's not going to fix anything.
- [41:40]
C
And I think what it does is it's sort of, why is it working? You and I were talking about this, like, why is it working? And I think it's that people feel heard and seen. They, deep down, do have some sort of phobia of the synthetic, which I think is on some understandable things, sure. But lots of things are natural that are harmful. Lots of things that are synthetic are healthy. It's really, that's not really the connection. So I think that parents, they hear this, oh, they see the color of Cheetos and they think that can't be good. And so it resonates. And so they say, oh, well, you hear this so much. RFK and his movement, they're right about some things and they're right about things that no one has been talking about. And I'm just like, they are right about nothing that is new. Again, I would take them more seriously if RFK went up there and said, boy, Michelle Obama was really onto something when she was talking about getting kids to eat healthy. Boy, Arnold Schwarzenegger was great when he was in the White House with the first Bush administration doing push ups in the White House and telling kids to get active. This is not novel. And by the way, the American Heart association has been saying diet and exercise since forever. One of my least favorite things you see is here's what doctors don't want you to know. And then they tell you how to live a healthier life. And the response is, we want you to know that we've always wanted you to know that we've been dying for you to know that.
- [43:06]
B
It's people that are disconnected from the industry because at one point they're not sick, so they're not familiar with what's happening. The same way. I just had a hospice nurse on and she was saying that people have this misbelief that hospice tries to kill you sooner to make money when she goes to hospice, wanted to make more money. They try and keep you alive as long as possible because every time you reapply for hospice, they make more money. So they get no more money by you dying an earlier death. And yet that's what people believe. So you want to believe that hospice providers are killing people earlier incorrectly because you just think that they're evil. Fine. At least there's some logic to it. But here, in this sense, you're saying they're doing it for financial reasons, but they're not. Those are financial reasons are not even true.
- [43:53]
C
No, like they're backwards. All the healthcare spending is tightly packed into the last year of life. It's like something like a quarter. So if we can make that less expensive, that'd be great. But hospice has. I'm not gonna sit here and defend hospice for a half hour, but I could they actually extend life with fewer resources.
- [44:17]
B
It's the perfect thing and comfort.
- [44:19]
C
And comfort. Right.
- [44:20]
B
Which we all want.
- [44:21]
C
It's everything you'd like to see. Yeah.
- [44:23]
B
Because one of her most powerful points in our podcast conversation was that I said, is death not the worst thing? She goes, absolutely not. I said, what is it? She goes, suffering while dying. That's absolutely why we're all afraid of death, is partially the unknown and partially the fear of suffering. So if we can eliminate that with the help of hospice. It's amazing when it comes to the CDC messaging, you talked about that there was radical transparency in the acip, in. In all these committees, there would be presentations done by CDC scientists. I view that as the failure of CDC over the last 20 years, throughout my medical career and education, I'll explain why. When I was a med student, I would go into a patient encounter, I would talk to them, create a rapport. Then the expert would come in, the subspecialist, make the correct diagnosis, give the correct treatment options, would recommend the right first treatment option, and I would be in awe. Wow, this is a great physician. Look how much they know. Then the second they would walk out, the patient will look at me as the med student say, what did they say? And I realized that to be a good clinician, a good physician, a good doctor meant not just knowing how to make the diagnosis, it meant how to get the information from the person in a way where you're getting accurate information, not just forcing the diagnosis that you believe that's going on, giving the right treatment options, the right treatment options that are accessible for the person that's there and then transferring that information over to them so they're in charge and empowered to take control of their health and agree with what your treatment is. And they were failing on the communication aspect. So often what I then have seen play out, that's like the micro scale. What I've seen play out on the macro scale and is the CDC took this notion of we're going to do the best research in the world. And they did. We're going to be the best at publishing in academic journals. And they were. But what they always failed to do was communicate en masse. I remember I was just coming out of my residency and I was writing for the American Academy of Family Physicians website and I wrote that the evidence of quality evidence based physicians on social media is creating a gray area for bad actors to take hold and become successful. Three years later, we have the pandemic. There's no voices from the CDC that are doing a great job. They were making misstep over misstep trying to take shortcuts to trying to take the paternalistic view of, oh, if we send them a mixed message of the truth, they might not get the vaccine. So let's just hammer home this booster. And it created distrust. It created a situation where I would look at the CDC Instagram page and see three likes on a post. They didn't believe in social media communication. When I tried to reach out to work with them, they weren't interested. And then it was left up to me, a few other doctors on YouTube, literally at the height of the pandemic, to make content. Whereas it should have been the cdc. They are the ones that should have been the expert in this type of communication, and yet they weren't there. So I ask you this. Do you think the failure of these big agencies in becoming great research institutions, but not great communication institutions has created this hole where we find ourselves in?
- [47:39]
C
Yes, but it's also really difficult.
- [47:41]
B
Sure.
- [47:42]
C
So I try not to be too like, well, I certainly disagreed with some of the things that the CDC has said. And they sometimes don't always see the harm. They, they think that they've got a view, okay, this is what we think and this is the way it's going to. We're going to do it. And that's the safe thing. And they don't necessarily know that that's incorrect. So I think that there's a couple things that sort of tie the CDC's hands and I'm not sure the way out of this. One of them is that if the CDC is going to put something out, they are so afraid to be wrong. If you and I put something out and we get something wrong, it's pretty easy. You just go, oh, sorry, I got that wrong. I've done that recently. I said something and I mischaracterized something and it was. Oh, it was. What was the quorum on the CDC's vaccine panel. I got that wrong, so I just fixed that. But they live in fear that if they get something wrong, their credibility is shot for generations to come. And so as a result of that, there was in place this infrastructure at the CDC where an expert would say something and they wanted to put it out. So then they have to ask their boss, and then their boss has to ask their boss. And ultimately everything takes forever. And one of the big things that's driving them, in addition to this concern about we can't possibly be wrong, the other one is they are absolutely obsessed with not appearing political. So that things that you and I wouldn't even think were political. They think are political.
- [49:18]
B
Like what, for example?
- [49:20]
C
Let's see here, what's a good example? The CDC has great epidemiologists. They get data coming in from all the states and jurisdictions, and they put that together and they make their summary statistics. So every year or every year, if not every year or two, they put out an infant mortality report that says, here's what's happening. And that report has to basically look the same year after year. And it's allowed to have what's going on in each state. It's allowed to do by race, ethnicity, it's allowed to do by certain other things. But under no circumstances would a CDC scientist ever be able to do that study and say, oh, by the way. And here's what happened in places where they changed abortion access because infant mortality went up, right? Because a lot of infants were born with conditions that are not compatible with living for more than a few days or a few weeks. And so in places like Texas, where women can't get an abortion and they can't get to a place where they can get an abortion a lot, there's a. There was a huge increase after they passed their abortion changes in babies who were born with these congenital conditions that just can't survive. So the CDC would never be allowed to say, oh, we looked at these states where they changed the access, because that would be considered political. They're not allowed. Like, I did a study with my colleagues looking at firearm violence, mortality in children, and they are allowed to say what's going on in every state, but they're not allowed politically by any means to say, oh, by the way. And here are the states that have really loose laws on the Second Amendment. Here are the ones that are stricter, that will be seen as too political. So there's two things driving this mic. Number one is they're so afraid to be wrong. Number two is they're afraid to be political because they feel like that's just like, not their purview. And then there are these levels of bureaucracy that you and I don't face. So given that, how can they respond in real time? It's really hard for them. So how do we undo that? I think that's a question that they would like to face now. I don't think they're facing it at this particular moment, but it's really hard. How do they face that? I ran into this once with them. There was an article written about me in the Wall Street Journal by Jay Bhattacharya, who's now the Director of the nih. And Jay said things that were false. And I asked the CDC if they would like to join me in refuting that in a letter. And I will just say that the CDC scientists said, sure. And by the way, Jay Bonachary was just a Stanford professor at this time. He wasn't a political person. And so I sent some draft language and they said, oh, this looks good. This looks okay. And it went back and forth for a week, and then it got to some level and they said, we're not doing it. It's too political. So I wrote the letter and I said, Look, Dr. Bhattacharya is entitled to his opinion, but not his facts. The facts are these. And that was fine. But, yeah, I've run into this where they want to do the right thing, but they are. They are completely tied up in their traditions.
- [52:44]
B
Yeah, Like, I've even heard from some staffers in certain parties offices where they have tried to think outside the box, reach a new demographic, try and reach people on dating apps, on video games, with public health messaging. And people viewed it as political, where the message they were sending was not political in nature at all. It was simply public health focused in terms of either raising awareness, increasing education value. And yet the CDC didn't like it. The political parties don't like it. And I don't quite understand what we're trying to be in agreement of, because if the agreement here is to make people healthy, we should want to educate and we should want to put out accurate info. And yet that's not happening on both sides of that equation. And I don't know, thinking back to how the CDC handled its messaging, I see a through line in some of the same conversations I had in, let's say, 2018, 2019. My YouTube page was doing pretty well during that time, so I started meeting network execs. They were like, nah, this social media thing won't take. We're going to be fine. LINEAR is awesome. Television's the greatest. They've been in power for 20 years. So they didn't see the value in social media the same way that when the pandemic hit, people who were in charge of the CDC said, oh, you don't want to send out a garbled message that's going to confuse people. You got to just tell them one thing, even if it's not fully accurate. I feel like that's the same mindset, that older mindset, that why do we need transparency? Social media is too transparent. This message with vaccine hesitancy is too Transparent. The CDC used to have a, a guideline where they wouldn't fact check misinformation. Like they used to say, oh, we're not gonna talk about the autism stuff because it's beneath us. But if that's what's on people's minds, if that's what people wanna hear about, you're just allowing someone else to come in there and deliver the message. And with the power of social media as a tool, that person will have all the power because they've been doing it so well for so long that now these agencies that were trying to do the right thing are just incredibly behind in their ability to use the platforms.
- [54:58]
C
And they're trying, I think they have hired in the past people to try to help them get their messaging a little more modern. I don't know how successful that's been. But another thing that's happened is that you see the scientists there and they have their mission driven. They are so passionate. There's this idea of the public health federal official as this caricature. Punch in, punch out, lazy, don't care. These, these are such passionate, mission driven people. I admire them greatly. But there's an occasional group think that happens and they don't think about what the downside might be. And I'm gonna give a really clear example of this. Back in the 2000 teens or so, they would say, every year about 50 to 60,000 people die of flu every year. That was what they said. But when you looked at their actual statistics, it was more like 5 to 10,000. Okay, so what were they saying? What they were saying was, well, there's some degree of incomplete diagnostic capture. That's a fancy way of saying we don't find every flu case.
- [56:02]
B
Yep.
- [56:03]
C
So people die of flu. We didn't exactly know that. And so let's add a little modifier, let's add 10% back or something. And then there's this whole other thing of, oh, in the six weeks after they got the flu, there is an increase in deaths due to excess mortality. Yeah. There's an increase in deaths due to heart disease or due to diabetes. And so those count. So then they get these, they show the math, they show how they get from the number of counted deaths to the number of 50,000 a year transparently showing their work. And I remember looking at it and thinking, I don't think that's still accurate. That's a very like 2005 mentality where we didn't have a lot of PCR testing, which is the nasal swabs to get the vaccine that it just seemed kind of wrong. And so their whole thing was, oh that's okay, it'll encourage people to get vaccinated. If we cite a higher number that we can justify. The problem then was you had in 2020, you had 50,000 people die in a relatively short period of time. And people said that's just a flu season. And so now decades of a policy that said we're going to use this higher number came back to bite because people said, oh, this Covid thing is no worse than flu. And the funny thing is this conversation about 50,000 people dying of flu every year, essentially it's a of versus with the CDC was saying, look, as far as we know, 15,000 or 10,000 people die like primarily of flu that we know. But there's up to 50 or 60,000 where this morbidity of disease can be a contributor and we're going to call it as related. Well that's fine. You can do that with any disease. And when you did that with COVID by the way, the numbers get really big too.
- [58:04]
B
Yeah.
- [58:05]
C
Now it happened to be the case that you had early in the pandemic. You had straightforward everyone was dying, was dying of COVID Later on, I wouldn't necessarily say it's as much with as people say. This is an area where I actually disagree with Paul Offit just a bit. Where we agree on most things, including booster policy that later on it's not that people were that their Covid illness was a complete non sequitur. It was completely unrelated to why they died. An example of that would be you die in a car accident and you test positive for Covid. That does not count.
- [58:40]
B
Irrelevant.
- [58:40]
C
That's a very small number. But what we were seeing and what we do see is that people die of something else. They die congestive heart failure, congestive heart failure or diabetes or emphysema that was triggered by their Covid illness and that might have been vaccine modified. And so the excess mortality, meaning the all cause death is actually a lot higher than it should be even now. And so but you could sort of say, okay, if we're going to compare flu and Covid, like let's at least make sure that we're talking about direct mortality versus the sort of combined, combined burden of disease that's caused by other things, downstream harms. And that's an article that I wrote in 2020 and I said the reason that there's a confusion on this is that the CDC has for a long time put this message out. And. And that at this moment, is causing confusion about how bad things are. And so when I was talking to the CDC about their flu stats back in the day, I was trying to make them imagine a world in which it would be unwise to have chosen the way they did things. And they couldn't see it. They just could not see it.
- [59:46]
B
Yeah, well, that shortsightedness is costing all of us. And I feel like now the other side has just adopted the shortsightedness for their mindset.
- [59:54]
C
Oh, and much worse.
- [59:55]
B
Yeah.
- [59:56]
C
Like censorship.
- [59:59]
B
Sure.
- [60:00]
C
There's this guy named Jeffrey Flyer. I don't know if you've heard of him. He at one point was the dean of the Harvard Medical School, and he very much was in this sort of, kind of medical contrarian circle where he felt, for example, that there was a lot of censorship happening from the left and that in order to make it in Harvard Medical School and other academic centers, you had to say these sort of woke things that he didn't acknowledge and that he really pushed back on this idea that doctors could be racist and all that kind of stuff. And to his great credit, I interviewed him a few months ago and I said, how's censorship looking these days? And Jeff said, oh, it's far worse than I ever expected. I had no idea that my side or the people who I was working with would jump the shark and start banning people's research based on keyword searches. So to Jeffrey Flyer's great credit, he was anti censorship when it was coming from one side. And then when it came to closer to his side, he didn't try to explain it away. He just said, no, it's horrifying. I wish that they wouldn't do that. And that's the kind of honesty that I think people want to hear. I think it's much better to say I got it wrong. I. And. Or at least I was. I didn't realize what would happen. And I think that's much more authentic than trying to double down and say, oh, no, what they're doing is they're just correcting science and take us through
- [61:32]
B
what are they doing with these keywords? Because I've heard you say it in
- [61:35]
C
other places, but like, yeah, so the National Institutes of Health funds science. They. They fund universities to do science, they fund other groups. And to get a National Institute of Health grant, you have to apply. And it's really competitive. It's a long process, and it's a prestigious one to get a grant. So there are grants that are out there that expressed what they wanted to see. That's a call for research or call for applications. And a lot of times people read those calls and they apply and they tweak their science, they tweak their goals, try to align with the federal government's stated intention, their interests, what they're up to. And so you have all these grants that are live, and people are just going along doing their research, trying to learn about whatever condition they're studying, whether it's cancer, hiv, heart disease. And then earlier this year, the administration just started to cancel grants out of the blue from Doge, just in a kind of draconian way. And then letters started to go out telling them why. And they would say things like, we are trying to fight against woke science. And your project falls into that category and there's nothing that you could ever do to tell us they said this. There's nothing that you could ever do to tell us that your study is justifiable. And therefore, effective immediately, your grant is not paused for review, because there's that process, it has terminated permanently. And I just remember reading one of those letters that a colleague received, and they were working on Alzheimer's with respect to risk and dementia, dementia and Alzheimer's with respect to LGBTQ and I think transgender individuals as well. And that was what their study was about. And I remember just thinking, well, when you study a subgroup, you're still learning about everybody. So even if you have a sort of very narrow ideology about these issues, which this administration does, it doesn't take a lot of work to say, okay, well, look, this may not be the study that we would have funded, but they're going to learn, what are the risk factors for dementia and Alzheimer's. What can we learn from this group? Is it applicable to other groups? Very frequently it is. And so for them to go through and just sort of say, this has no value, we're cutting your science, we're cutting your funding off immediately. Not only is it just cruel, it tells you that they don't really care to get into it. We later, of course, learned that this was all coming from people who had no scientific background. They were just out there just slashing stuff. And it also, again, it undermines this idea that we have in America, which is that if you want to study science, your government, should you be fortunate enough to get that grant, you come to an agreement. At that point, when they come to the agreement, it's not charity, it's a contract. It's saying, you, the government, we, the American people, are interested in learning About Alzheimer's, University of Pennsylvania, Harvard, unlv, whatever it's going to be, they are the contractor to do that work for us as a people. And I totally think it's reasonable to say like, okay, our priorities change for next time, but to have people just lose their funding overnight. And what's happened is there's been. There was at one point up to $3 billion in funding cuts. It's now about 2 billion because some of, some of it has been reinstated for pretty random reasons. It seems like there were at one point in the high 70,000 as the number of grants that were active, active, it's now 70,000. One of those studies could have the answers that we're looking for on something. So I think that's really, really important that the way this was, the way this has been going out has been really, really. It's been terrifying for the scientists and it hasn't affected my work, but I'm terrified for us as a people. So like, what are we not learning? So that's what's happened again. 20% of the grants that were cut were training grants.
- [65:40]
B
So what was there a situation where they were making these cuts based on keyword searches and finding the word diversity in research where, where it had nothing to do with actual diversity of races or sexual identities? Is that true?
- [65:54]
C
Yeah, it certainly seems like that. There's a website called Grant Watch which has been documenting this really wonderfully and they're heroes for doing it. And they have flagged all of the grants that were cut and some of them will just shock you because we want to know what causes this kind of deafness or this kind of cancer. And they don't necessarily always know why, but they have these keywords. So things like diversity would be one that they see a really big increase. But then just the five letters trans, a lot of things were getting cut, but it turned out that neurotransmitters were getting strays. So that people were actually another one that got cut was, oh, we've been following this cohort of doctors for prostate cancer for decades. This is a decade long project that says how are physicians? Are they better protected against prostate cancer? Because maybe we are more involved in our healthcare or this could be an argument for screening, although I'm skeptical of that sometimes. But whatever. The point is they're watching doctors prostate cancer. And the, the grant that got canceled was flagged, had the five letters of trans and it's because they wanted to transfer the data to the cloud. Now we don't know for sure if that's why. But there's nothing else about these grants that particularly would go against ideology. Again, I'm not in favor of cutting grants on ideological basis. That was already approved by scientists in response to a specific government call for proposals. But if you want to say next time we're not going to do that, fine. Elections have consequences, okay. But the things that were cut were just devoid of any kind of rationale that should really shock us. And it sets such a bad precedent. This is why people are looking overseas. It's so bad. We have this great record of all the Nobel prizes that we've won here. I think that's really in jeopardy.
- [68:04]
B
What do you think the FDA is doing right now? I know you have an existing relationship with the commissioner. Are you hopeful for their work? Are you feeling them as a potential bright spot in this administration or are you skeptical?
- [68:19]
C
I'm a little worried about the FDA right now. My relationship with Commissioner Mercary is. It's not like we're best of friends, but during the pandemic I got to know him a little bit and we met in person and had a really nice long lunch and a few zooms and that kind of a thing. And I believe that. And Marty and I always had a really, I think a very healthy kind of respect, saying I've got emails to show it. We don't always come down in the same way on these issues, but I think we both acknowledge that there's like a seriousness and a career that I would see from him. And what I'm worried now is that he's getting further away from that, that he's wrapped that he's more that the kinds of thought processes that he had before, which may not have always been accurate and in some cases just like really wrong, but that it was essentially high level science that we disagreed on. Now I'm worried that he sort of in this RFK orbit and that he's sort of morphing into that sphere so that he's out there saying things about the COVID vaccine that aren't evidence based, talking about anecdotes when he's always actually been a big data guy. So I'm really worried about that. I think that the FDA has such an awesome responsibility. They tell us whether it's safe and effective to use medical products and drugs, vaccines. And we are seeing their scientists, their work groups who spend all their time on these questions being ignored. Now on several occasions it's public, it's that the vaccine czar there is now saying, you know, What? I don't really agree with the FDA scientists, but then not really saying, we're not getting a full readout of that. We're getting, here's the bad stuff they didn't tell you, but we actually haven't had the transparency to see the good stuff. So we're seeing one side of an argument. I'm really worried that the process by which we've all relied on has been undermined. There was also this idea that the reductions in FDA staff was just bloat and that it was only administrative bloat. And I think that there's probably some truth to that. There was probably a lot of stuff that could be modernized, but there's also a lot of things that weren't being done that we could redeploy people, Right? If someone had said, look, we've got 20,000 FDA employees, 5,000 of them were really useful 10 years ago. Turns out that with technology, we don't need those 5,000. But by the way, here are some areas where we are super excited to make progress. So we're going to either like redeploy these people to those projects or if they're the wrong people, cycle in new people. But that's not what happened. They just cut, cut, cut, cut, cut. And then Marty's out there saying that no scientist was fired, which is just not true. They had to rehire people and because they made mistakes and because it was done so quickly and so thoughtlessly. So I don't like when people advance a viewpoint by saying something other than the facts. And that's what I'm, I'm seeing a pattern there. And I don't like it because I think that, you know, I think the Commissioner McCary is the kind of person who's, who's again, not always 100% right on some issues, but he's been better than that in the past. And I'm, I'm seeing a little bit of slippage there.
- [71:33]
B
Do you think our Secretary Kennedy is essentially just tricking all of us into making the general public feel like he's making them healthy when he's really not?
- [71:44]
C
I think that he is distracting people from the degradation of our system. He's saying, look over here, we're dealing with red dye. Look over here, we're going to deal with high fructose corn syrup. Look over here, we're getting wokeism out of medicine. And then they're undermining vaccines, and then they are writing documents about our kids health that omit the leading killers of kids. Are they Serious. So I think that's what's happening. And it's hard to know. You and I were talking about this. Why do you think they're doing this? Are they believers? Are they trying to. Is it financial? Probably not for rfk, right?
- [72:27]
B
I don't think so. I think his family's financially well off. That being said, power adoration, those are moving forces for someone with a last name as powerful as his, especially when you want to live up to. Or live past, perhaps. So I could see incentives being there, but it's almost like too hard to guess why they're doing it, because it almost seems arbitrary and random at times when. Where certain pieces of focus don't seem aligned with general principles that he espouses. At other moments in media, like, he'll talk about how fast food is so bad for us, but then talk about how McDonald's was at one point so healthy, the oil that they were using, or that, you know, soda is terrible for us, but then his co host on camera is drinking soda very happily and saying that if it's with cane sugar, it's better. So it just doesn't align. I always seek to understand people, even when I disagree with them. I always like to see where they're coming from, why they have the beliefs that they do. Because I'm a firm believer that we're all capable of having biases and blind spots. And the first doctor that was looked upon who recommended that we wash our hands because there's invisible microbes that are actually killing us was viewed as someone with a mental health disorder. So I'm aware that that could happen. So I try to understand everyone's viewpoint, but. But every time I sit down to try and understand Secretary Kennedy's, it's like one of those where they try and piece together a serial killer, and it's like just pins all across the board in different directions, full of contradictions. So if you're gonna talk about people making people healthier again, you can't write off the first three things, as you said, that are creating deaths. You can't create science that has been disproven to be true just because you said it is. And you can't write off funding for the research that you are saying is so incredibly valuable. Like it's. It just. I can't put it together. And I'm always trying in these conversations to find that common ground. There is no common ground. Secretary Kennedy should resign. I think our medical community has done a disservice by staying silent and thinking, oh, this the pendulum will, will flip the other way. People will realize it. When they will, I think it'll be too late. I look at leaders like Dr. Sanjay Gupta, leading voice in healthcare, who I think actually has stayed true to talking about real science despite having tremendous success in media. And I look back at his articles. All you have to do is go into Google and search Dr. Sanjay Gupta, Secretary Kennedy, or RFK Jr. And you see in November 2024, he was warning people about RFK Jr. Becoming head of HHS. He listed all the issues. Since then, silence almost a year. Where's Dr. Gupta? Where are trusted healthcare voices? Why are we not all signing petitions? When is it going to be that we realize that this is going too far? What issue needs to be had? And I don't know what the answer to that is because I view this as someone who's on social media and is sort of an expert at gaining a lot of people to pay attention. I have no support from medical institutions. I have no support from pharmaceutical companies. I have no support from even academic institutions. When are we all gonna come together at some point and say we need Secretary Kennedy to step down?
- [75:50]
C
Well, I agree with you. I think that it couldn't get any worse. And as bad as we were worried it might be, it is worse. In Sanjay's defense, I think that he doesn't have the airtime that he needs. If he would need a lot of airtime to make those points. I know he cares deeply about this issue. I know that because I talked to him. I believe it. Like during, like in the, during the transition period between the election and inauguration day. I absolutely spoke to Sanjay on several occasions saying, how are you all going to cover this? Because it's now going to be, as you say, the foxes are going to be in the henhouse. The science is going to be coming from an HHS that's may be run by rfk. How. What, what's your plan, dude? And he was worried. He was really worried. And to his great credit, he upped that to CNN executives who, when you talk to them, they're worried. They want to know how to do it. And I will say I'm not paid by cnn. I'm not on, on staff. But they reach out, they ask for fact checking. They say, does this look right? Does this not look right? Could you help us come do a segment? Would you be quoted in this article? So I feel like that they care, but they, they have not gone full on this. And I think it's probably a matter of just of resources like, they're. They're 99 out of 100 minutes on CNN is going to be discussing Donald Trump's latest tweet or whatever he puts on Truth Social or whatever.
- [77:13]
B
Sure.
- [77:14]
C
And so they. Why would they pay for their medical analysts and their writers to do this work when it's going to be a second of time on the air for them? The example of COVID was the time when people did care about these kinds of questions, and they gave a lot of airtime. They really did. And I'll never forget this. I mean, there was a moment when Sanjay was on the air talking about something about COVID and I'll never forget it for as long as I live, because he was explaining to the American people what error bars were. This was a graph that had a certain estimate of how effective something was. It said, I don't remember what it was, but it was. It's 80% effective. And those little line, the vertical lines, are called error bars. That means that we're 95% sure that the real number is between 75% and 85%, but our guess is 80%. And then he said, oh, if you notice that the error bars in the next graph, they overlap, and therefore we can't say that those numbers are actually different. And I was like, I actually, I texted him. I'm not that close with Sanjay, but, like, I have the ability to text or email him. And I was like, for as long as I live, I will love you for that. But I don't think that there is an opportunity to do that on a mass scale enough because it takes so much work. And the attention span that it takes to get through that is long. And that's part of the grift, by the way, is there's something called Gish Gallop. Gish gallop. Gish gallop is you're debating someone and they say 10 things that are completely wrong, and therefore, you have to spend all of your time trying to debunk maybe two of them, if you're lucky, and then the eight get left out for debunking. And I think that that's an inherent asymmetry in what we're doing when we're pushing forward the best science, the best knowledge we have. It's complicated. It's so easy just to say that's bullshit. And here's one study that shows that and not worry about the fact that study is not good.
- [79:23]
B
Yeah, I want to be optimistic and charitable in my thinking, but I think lack of resources is too easy of a cutout just because. Cop out just because. Again, not one article that I can pull up from CNN.com about RFK Jr. And Sanjay Gupta in the same title. Like, I feel like there's a fear there, and I don't know what that fear is, but it just. It's not clear to me why we're not seeing it. And I would love to just see more. I'm not putting this all on Dr. Gupta's shoulders here. I want all of us in the medical community to sort of stop complaining about RFK Jr and start putting some action behind it. Start getting the ama, aoa, AAFP all together. Let's get everyone in the same room and just uniformly show how much disagreement there is from one individual. And I think with enough political pressure, I mean, social media campaigns have gotten people out of office. Let's do this with a unified front. And I feel like we're so fractured and that that's what the CDC is missing with their communication, mass communication strategy. The ability to make impact using community is huge. And that's missing. And they've leveraged it so well from the Secretary Kennedy side of things. I think we should, too. And I look forward to the day where I think it ultimately will come together. I think people will get there. I just wish that they won't wait for it to get as bad as it might.
- [80:55]
C
It's going to be hard because the stakes are high when we see evidence that what RFK and what this administration has done is harming our kids, is keeping our grandparents from having the care they need, our parents, the care that they need. When we see that in front of our eyes, the scale of it could very well be impressive. Not a few cases here and there. It could really be a genuine degradation in the kind of quality of life that we expect. The mortality of our kids, the. The longevity of our parents and ourselves. That being the case, the stakes are so high that admitting fault is going to be nearly impossible. Can you imagine if I told you, hey, Mike, something that you said killed 10 million people, your instinct would 100% be, let me try to figure out a way how that's not true, because that wasn't your intention. It really wasn't. And so the stakes are so high that people will never back down. And so I actually fear that the moment that we are proven right will be a moment where it gets worse. Sorry, I know you want to be uplifting, but look at. I mean, look what happened. Do we. The measles outbreak that happened this year. Is this a moment where where the people where RFK is saying, yeah, I really misunderstood the measles, mumps and rubella vaccine science. And no, he occasionally talks out of both sides of his mouth, as you pointed out. One day he'll sort of give the talking point, oh, you have to get vaccinated. But then everyone knows that he's winking because there's 10 other times where he said the opposite. And propagating lies about fetal material and all this sort of stuff.
- [82:43]
B
Yeah. Or by children. I wouldn't want them to get it. Well, hold on a second. You're in charge. You're telling Americans this is the best way to do it, but you won't get it yourself. It's the worst form of it.
- [82:53]
C
Right, but I just don't imagine how they're going to say. And maybe they don't need to say it. They can just sort of do the pivot. Right. So you're imagining an interview and you say, hey, Secretary Kennedy, there was just this horrible outbreak and it was in places where the vaccine uptake was really low. He's not going to say, gee, I'm sorry about that. He'll say, what really matters is this nutrition or obesity. And by the way, on some of these issues, he's totally right. There's a great paper from a year ago that looked at the health of people who got Covid and that GLPs, these WeGovy and Ozempic. Actually, patients in the trials who are randomized to have been on one of those drugs had a lower mortality from COVID just two years later. So that means, again, as we said before, who you are is much more important than the disease you get. So if you get a disease and you're pretty healthy, you can take that punch. Whereas if not. So he's right, but it's not novel. He's right that it matters that we get our system to respond to these metabolic syndromes of which obesity and heart disease is part of that and diabetes. I don't think he's offering us the way, but he's claiming to. So I think what'll happen is when there's evidence that what they're doing is harmful, it will not lead to a. We're watching a mystery show and they go, oh, geez, I was wrong. Sorry about that. And from here on out, I'll do better. You rarely see that. And so we have to just be ready, not necessarily to convince someone like him, but more to convince his followers that they were misled and that we are here for them and that I don't really care if you were bamboozled by something that someone said in the past. It's reasonable. Especially now when it's coming from hhs, hhs, these official places, right? We call this in medicine non judgmental regard or saying okay, hey, we're the ultimate, we're the ultimate forgivers, you know, great. You know, like we're not like oh yeah, you don't deserve that. So I think that we should and there's a really big campaign to sort of listen to Maha people and their concerns. A lot of my colleagues who do public health sort of messaging are out there doing that work and I think it's important to hear them and to be in that conversation because I think that a great number of them are going to wake up one day and say, oh this is not going well. And when that happens we should not dance on their graves and we shouldn't say haha, told you so. We might think that we might feel, that we might feel, yeah, this is kind of what we said was going to happen. We should just be there and say, hey, let's do better, let's do it this way. Right? So I think that, you know, you do some extent what I do is to make the playing field is to make it acceptable for people to change, change their views and change their teams.
- [86:11]
B
What's, as the final point to wrap up, it's 2035, where do you think we find ourselves? What's your 10 year prediction look like? On what, sorry, the state of US healthcare, state of healthcare innovation in the US.
- [86:33]
C
I'll tell you what I'm worried about. I'm worried that we're going to start to see two Americas, but that both Americas will be worse off, one much worse than the other. So in a very anti science community, vaccination rates will go down, access to care will, will, will be diminished and that people will be sicker than they were, their mortality will be higher sooner and that this will be a result of the policies that we're seeing today in, in other places it will mostly that will be, that will be somewhat cushioned by the fact that they make different choices. The problem is that some of these things cross borders, right? So if there's an uncontrolled measles outbreak in the neighboring state and your state is much better, it's all a game of numbers. If there's enough shots on goal, eventually one gets by. And so a vaccine that's 99% effective just on any disease you take 50 attempts at infecting probably it won't infect anybody. But if you give that same pathogen a million chances, even in that vaccinated population, it'll eventually make little outbreaks so that even we won't just be able to say, ah, well, I'm going to live in one of these places where we do healthcare the way we're supposed to and do science. That'll certainly be somewhat protective. I'm worried about two Americas emerging, both of them less healthy than today, one of them much less healthy than today. That's what concerns me. That's what worries me. What is hopeful? What's hopeful? Well, for one thing, it's not too late to restore the funding for research and science. Our voices matter. As you said, people have resigned over movements. There is a bridge that's too far. You never know what it's going to be. I'm surprised we haven't crossed it. But there is something, there is ground truth that there's something that someone can do that is too much for the public. And when that happens, we need to be ready to start fixing it. And it's going to be. We're going to. As much as I'm like any other human being, I've got a little bit of a rage streak in me, too. I'd love to hold accountable the people who are responsible for these deaths, and we're going to have to really rise above that and not do what they're doing, going after Fauci and pointing fingers. I believe that if science such as you and I conceive of it is to get the upper hand again, that we need to swallow our pride and not play that dirty game that they're doing and say, look, they just got it wrong and we're going to get it right. That's going to be really. That's going to be some serious adulting. But we've got to do it. That's the only way to make consensus. Otherwise you're just tit for tat. And when they gain control, they'll do worse. So that's. I think that we should fight for this research because it's. The average person needs to know that today's research is going to lead to a medicine 15, 20 years from now that's valuable and we should really insist on transparency for real. Let's do better than we did under any administration, not just this one. And that will lead to more nuance. I think that AI will make these questions easier to answer from trusted sources. If you and I are working, when you and I use Google differently, than other people use Google because we actually have priors. We have. Oh, yeah, I get it. This is how the study works for that. But I think that as time goes on, it'll be easier for physicians who work full time to get better answers that right now there's no time for. So I actually think there's a world in which we harness AI, we harnessed telemedicine. I think that we spend way too much time in person with health care. We're way too precious about that. The pandemic was good. And moving that forward, there's a universe in which you get more personalized medicine, that science is defended and in which the vitriol is back out of this, and that people are yelling at each other at the annual oncology meeting. But that's. But not calling each other names and saying that they should be jailed. I think that I'm hopeful that's like the part that's why we do this work, is to say, okay, when it's our turn, let's light the way forward.
- [91:11]
B
I'm very hopeful that that turns out to be the case because I have the viewpoint of fear of climate changing viruses evolving. I mean, I don't know if you saw the show the Last of Us. I just rewatched it with my girlfriend. And the first sequence of the show is a late night TV host is asking two scientists questions. And one is talking about how viruses are the plague that going to end us. And it's so scary. And the other scientist goes, viruses, no big deal. We faced them before. Yes, we have losses, but we could always rise above. Fungi are the real problem. And they're like, well, the fungi you're talking about don't live in the human body because the body's too warm. And he's like, well, that's because they've never been forced to adapt to warmer climates. And maybe now with the environmental change, and then this fungi outbreak happens and there's zombies and it's not realistic.
- [92:05]
C
But.
- [92:05]
B
But how interesting is it that we live in this world where we have environmental pressures on all these infections and now we have a drop in research and we also have a lack of vaccination, so more viral spread. You really have the perfect ingredients developing for a disaster.
- [92:23]
C
Oh, and this is the perfect time for it, right? I think the time that is ripe for another crisis is right about now when people have this memory of a recent pandemic and they're not sure exactly what went well and what didn't. They're being told the different things and there's some revisionism happening that I'm really concerned about. And. But it's so. It's recent enough where it's almost kind of like a bad memory, especially with the way public health was attacked, in my view, asymmetrically. It's a perfect time because we're not. We wouldn't do anything. Would there be a shutdown today?
- [92:56]
B
Yeah.
- [92:57]
C
Or what would it take? What would it take to get people to do some social distancing? And that's kind of the work that I was thinking about doing was what's a plan that people would do? What's a way we could do better next time? What's like some of these proposals that, frankly, the people in power now were advancing, that were impossible in 2020 and that if we had tried to do them, would have killed millions of people. That are actually possible if we plan ahead. Well, the best way to plan for that eventuality is to fund pandemic preparedness. What got cut? $5 billion of that so far. So. Oh, this is the moment. I think that as we get further and further away from the pandemic emergency phase, I think there at some point becomes a little bit of regeneration of people are willing to do something. No one's willing to put a mask on or stay home in 2023, because they just did that. And so it would take extraordinary amounts of death right now for people to change their behaviors pretty quickly, but they actually do. Even during the pandemic, when we thought we weren't in a phase where we were in that sort of mitigation phase, people actually. Did you look at Omicron? We didn't actually do any shutdowns, but people just. Their dining in restaurants decreased. People aren't. They pay attention. So I think that there's like, this moment maybe right now, where it's super dangerous, where I worry. So maybe with a little time, a little healing, there'll be a little more appetite. But I think that we should learn from this. We should learn from what happened and prepare for eventualities where. Okay, if they're not going to listen to us on this, here's what you could do. How do you keep your schools open? How do you. This is the juice and squeeze thing I'm always talking about. What's the most juice for the least amount of squeeze? That's an area where we can learn a lot. And I think that now is a dangerous time.
- [94:55]
B
Yeah, we've opened a cigar bar in a fireworks factory. Yeah, it's totally scary. But I appreciate your time. Even though this felt a little down, I still think that we've hammered some points in that I think will help people understand where we're coming from, why we are so worried. Even though no visible harm has happened yet. But but a lot of these are future problems that we're going to have to deal with. Where can people follow along your journey in your work? Where can you send folks to?
- [95:24]
C
Well, I'm the editor in chief of MedPage Today, which is really facing a lot of doctors and healthcare clinicians, but anyone can read it. I write a newsletter for everybody called Inside Medicine, which is on substack and all the various socials. There's a new YouTube channel and on Instagram my name Jeremy Samuel Faust and Threads and Blue Sky. However you do that, I'm still unexp. I'm sure I'm shadow banned because I get no views despite having some followers. But I will say that Inside Medicine, the newsletter on substack, is where I really go to think out loud, is where I go to tell people, okay, here's what is. And to some extent, here's what not to worry about. Here's this is a new cycle. It's going to be okay. And this one is more of a concern. Here's the deep dive. You can skip that one if you're not a big huge nerd. But that's where I do my outside out loud thinking. And so I invite people to be there because I think they do still trust their doctors. That's one upside. And they do still trust us. And their questions, the questions that my readers give me are very frequently what tells me what people want to know.
- [96:36]
B
Fair.
- [96:36]
C
So it's a great conversation.
- [96:38]
B
Well, thank you for the work that you're doing and your continued support. We need more of it. So hopefully people that are listening, that are in the medical space will also take after you and do something similar. So more voices is better.
- [96:49]
C
Likewise. Mike, thank you.