The Gist – "Obama CDC Director Tom Frieden: 'Believe in Science' Is a Terrible Idea"

Podcast Overview

Host: Mike Pesca
Guest: Dr. Tom Frieden (Former CDC Director, CEO of Resolve to Save Lives, author of "The Formula for Better Health: How to Save Millions of Lives, Including Your Own")
Date: October 7, 2025
Main Theme:
The episode explores how public health advances, policy, and the scientific process interact—what the public often misunderstands about "believing in science," how progress has been made on issues like hypertension, air quality, and lead removal, and the dangers and consequences of undermining scientific institutions like the CDC. Dr. Tom Frieden shares insights from his new book and reflects on both the promise and pitfalls of public health learning.

Key Discussion Points & Insights

1. The Misconception of “Believing in Science” (12:33 – 13:50)

• Dr. Frieden critiques the phrase "believe in science," explaining that true scientific rigor is about humility, uncertainty, and following evidence, not faith.
  • Quote:

    "Believe in science is a terrible idea. You know, follow the facts and follow the science is misleading. Science doesn't tell you what to do. It gives you facts with which you can make a judgment for yourself, or we as a society can make a judgment for ourselves." – Dr. Frieden (13:11)

• He emphasizes the scientific process as ongoing, self-correcting, and open to being wrong due to changing conditions or new data.

2. Public Health Successes and Their Underappreciated Impact

Hypertension: From Discovery to Treatment (13:50 – 15:40)

• The late discovery and incremental victories over high blood pressure: It took decades from the first measurements, through new medications, to reach the understanding that lowering systolic BP to 120 or below saves lives and prevents dementia.
  • Quote:

    "No one in the world had measured [blood pressure] until 1896 ...It was another 50 or 60 years before we had a single medication to treat it." – Dr. Frieden (13:54)

Small Particulate Matter in Air (PM2.5) (15:40 – 16:57)

• Significant but incomplete progress: Regulation and cleaner technologies have drastically reduced deaths from air pollution in places like the US, saving hundreds of thousands of lives yearly, though millions still die globally.
• The “see the invisible” principle: People don’t notice deaths prevented (e.g., “No one woke up saying, ‘I didn’t die from smallpox yesterday,’”) but those preventions are major public health wins.

Lead Exposure and Alice Hamilton’s Legacy (17:29 – 20:16)

• Alice Hamilton’s early warning about lead was ignored for decades, leading to unnecessary suffering and loss.
  • If listened to in 1925, “We would have had a completely different country. Less violent, less chronic disease, smarter, higher income levels.” – Dr. Frieden (19:06)
• After the eventual phase-out of lead in gasoline and paint, average childhood blood levels fell, with massive gains in cognition and health.

"Prevention Paradox" and Invisible Benefits (20:41 – 22:03)

• Small individual benefits aggregated across millions can transform society, but make public health measures a hard "sell" politically.

3. Why Americans Die Younger than Europeans (22:03 – 25:56)

• Lack of universal access to primary care, less robust prevention, and policy scale-up are main drivers.
  • Issues include high rates of hypertension, obesity, tobacco use, and poor nutrition.
  • Quote:

    "We don't have a good primary healthcare system...Many of the countries that do better than us...have really good primary healthcare systems. 100 million Americans don't have a primary healthcare doctor." – Dr. Frieden (23:29)

• Instead of a silver-bullet problem (like opioids), a combination of systemic failures results in lower life expectancy.

4. The Limits and Achievements of the ACA (“Obamacare”) (30:41 – 32:56)

• Principal achievement: Expanded access and removed financial barriers to preventive care.
• Dr. Frieden notes that while some state-level data links Medicaid expansion to lower mortality, comprehensive national data directly attributing increased lifespan to the ACA is complex and confounded by other negative trends (like opioids).

5. Current Threats To the CDC and Public Health Infrastructure (32:56 – 34:47)

• Dr. Frieden characterizes recent shifts at the CDC as not left vs. right, but fact vs. fiction.
  • Cuts to tobacco, cancer, and cardiovascular programs.
  • Quote:

    "What we have is basically it's not Democratic versus Republican, it's fact versus fiction. It's health versus disease. It's simple truths versus simplistic misinformation that's dangerous and deadly." – Dr. Frieden (33:16)

• Concerns that undermining research and evidence-based programs will have cascading long-term negative effects on cancer survival, chronic diseases, and environmental health.

6. Reflecting on Pandemic Lessons (37:14 – 40:38)

• CDC’s early Covid test failure and the Trump administration’s silencing of experts were costly errors that shaped the pandemic.
  • Dr. Frieden defends CDC experts like Nancy Messonier, whose unfiltered advice was prescient and accurate.
• Mistakes in pandemic policy:
  • Vaccine mandates: After it became clear Covid vaccines protected individuals more than communities, mandates lost their communal justification.
  • School closures: Lengthy closures had devastating impacts, and alternatives were possible through targeted mitigation.
  • Quote:

    "I didn't think schools should be closed. I thought they should be renovated quickly...I got criticized by the then Governor Cuomo administration because I said that repeatedly on TV." – Dr. Frieden (39:06)

• Real problem wasn’t “public health,” but a failure to use public health principles correctly.

Notable Quotes

• On scientific humility:

  "Good science doesn't give you certainty. It gives you humility of what you know and what you don't know." – Dr. Frieden (12:06)

• On invisible public health victories:

  "You don't see what you don't see. Nobody...woke up and said, 'Oh, thank goodness I didn't die from smallpox yesterday.'" – Dr. Frieden (15:55)

• On the politicization of the CDC:

  "They say they care about health, but they're really undermining a lot of our protections of health. And that really bothers me because it means that we're less safe." – Dr. Frieden (34:20)

• Summary on America's mortality gap:

  "If you look at the healthiest populations in the US, they do as well as anywhere in the world ... but if you look at the average, [the US] doesn't do well." – Dr. Frieden (22:58)

Timestamp Guide for Important Segments

| Timestamp | Topic | |-----------|------------------------------------| | 07:14 | Introduction, Frieden joins | | 08:38 | Book’s origins; Seeing, believing in, and creating public health progress | | 12:33 | Why “believe in science” is a flawed concept | | 13:50 | Hypertension as public health victory | | 15:40 | Particulate matter & invisible benefits | | 17:29 | Alice Hamilton, lead poisoning, and silent threats | | 20:41 | Prevention paradox in public health | | 22:03 | Why U.S. life expectancy lags Europe | | 23:29 | The role of primary care | | 26:00 | Simple solutions: potassium, sugar, micronutrients | | 30:41 | ACA’s impact examined | | 32:56 | CDC’s current crisis and program cuts | | 34:47 | Consequences of shutting down research | | 37:14 | Covid lessons: CDC failures, mandates, closures | | 39:33 | School closures revisited |

Memorable Moments & Tone

• Pesca’s dry, skeptical humor: He pokes at political spin and delves into details others ignore (“No one talks about PM2.5 except me…”).
• Frieden’s grounded optimism: He points to what’s worked, but remains clear-eyed about threats—balancing celebration of public health successes with urgency about new challenges.
• Candid critique and self-reflection: Frieden doesn’t shy from analyzing policy failures—both in his time and in the recent past—and is refreshingly humble about the continued process of scientific learning.

Conclusion

This is an episode for anyone who wants to understand not just the “what” of public health, but the “how” and “why”—why facts don’t always win, how invisible victories improve every life, and what’s at stake as science becomes politicized. Dr. Tom Frieden’s advice: Seek transparency, recognize the reality and limits of scientific knowledge, and focus policy not on slogans but on what really saves lives.