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We here at the Gist are in need of a booker. This is a person who goes out and gets the guests. Gets the guests for the Gist and all the other great shows that we have and are coming up with at Peach Fish Productions. Now I'd like to say that we're looking for someone who would say, oh yeah, booker is my middle name. That actually literally is the case with my son and he'd be a terrible booker because he's a freshman in college and quite disorganized. So what we need from our booker could be you, could be someone you know is organization, experience, knowledge of the news, someone who will go out and work for us. It is a part time job. The pay is quite competitive and we are Contactable at the gist@mike pesca.com thanks. It's Tuesday, January 27, 2026. From Peach Fish Productions, it's the Gist. I'm Mike Pesca. Donald Trump, the man, if not the administration, seems to be somewhat backing off his collision course with chaos in Minnesota. The critical words of members of the House and Senate, including Senators Tillis, Collins, Murkowski, Ricketts of Nebraska, Curtis of Utah, Moran of Kansas appear to have had some impact. Representative James Comer, prominent committee head, has also suggested ICE might be better deployed elsewhere. Admiral of Texas, Gabarino of New York, they've called for real investigations into ice as with such slim margins in the House and a Department of Homeland Security funding bill hanging in the balance, Trump at least has been chastened. He has put Tom Homan in charge of Ice seems to have pulled back his personal Frank Nitty or Luca Brasi. Greg, sorry to use the Italian comparisons, but when the black shirt fits, wear it. I have no deeper analysis of why Trump changed his mind. You could normally say optics got too bad, though. Weren't they fairly horrible after the Renee Good shooting? You could say Kristi Noem got too stupid. I'm not denying that she's not extremely sharp in these matters. Her and Bevino's immediate comments would seem to stand as ipso facto examples of the indefensible. Except that Carolyn Levitt says this stuff every day and only seems to appreciate an esteem in the eyes of the President. Stephen Miller's in this category too. Here was one explanation offered by a guy I don't put too much stock into, but if the quote that he's relaying is accurate, I thought it was worth listening to. This is Michael Wolf, but one of.
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B
His aides said to me, you know.
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C
He sets these fires constantly, but it's really not the fire that he's the.
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B
That he focuses on. What he focuses on is the fire.
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C
Engines rushing to put the fire out. So it's the noise and the lights and the drama. He's addicted to the drama. Exactly. And yes, maybe there's something to that. I don't think Trump is a great calculator. He's instinctive and has a reptilian sense of things. But there might be something to his rough perception that he has maximized the upset caused to the other side and now perceives there is more downside to his position. Or, I don't know, maybe the blizzard that has me recording in a closet in Florida because I can't fly back to New York, maybe that has just rested the attention away from Minnesota. And now he only sees the downside of having killed what very much seemed to be innocent people not breaking the law. You know, sometimes when Democrats and liberals are upset, it breaks containment. And the whole country is a little upset. And that's why the Democrats and the liberals are upset. A reflection, not a leading or bleeding edge of bleeding hearts. And Donald Trump, though diminished in mind, though never a brilliant tactician, he is at least cunning enough to correctly feel out this situation as the unmanageable, unmitigated headache it seems to be becoming. On the show today. I will spiel a little bit more about this and a word that keeps coming up in relation to Trump's tactics in Minnesota and elsewhere. But first, Thomas Goetz is the host of a really interesting new podcast where he essentially does a story a week on a drug a week. This being American 2026, he could live the rest of his life and not get to all the drugs, but live so long. Maybe by taking most of the drugs anyway. We're going to concentrate on a couple of big ones, blockbusters if you will. Thomas Getz with Drug Story up next. I don't even know where to start with folding a fitted sheet in the middle somewhere. And hymns can't help you with that either, but it can help you with other aspects of performance in bed. So if you have ed, it doesn't mean your love life is over. With hims, it may be getting started or some rocket fuel. Through hims, you can access personalized prescription treatments for ed, though not for fitted sheets. You need a prescription, but getting a prescription is very easy if you qualify and the price is really affordable. Generics that cost 95% less than name brands if prescribed. They bring the experts straight to you. It's all online personalized treatment and it's not a one size fits all care that forgets you in the waiting room. They put your health and goals first with real medical providers. So think of HIMS as the digital front door that gets you back to your old self where you did not care about sheets except what activities occur on top of them as opposed to how to fold them. To get simple online access to personalized affordable care for ED, hair loss, weight loss and more, visit hims.com the gist that's hims.com the gist for your free online visit hims.com the gist Featured products include compounded drug products which the FDA does not approve or verify for safety, effectiveness or quality. Prescription required. See website for details, restrictions and important safety information. Actual price will depend on product and subscription plans.
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There's a great new podcast that I've been listening to and one of the things I try to do on the gist is surface. Okay, sorry about the verb there. But bring to your attention podcasts that are great. That because of the very broken system of discovery in the world of podcasts, you might not have heard about before. So here's one. It's called Drug Story. It's put together by Thomas Getz, who is an award winning science journalist who's won Webbies and National magazine awards. And this is right from his bio, FDA contracts. Which brings us to why he's in a position to report the story of Drug Story. Drug Story is a timed release that should only be prescribed by doctors. Ask your doctor if Drug Story is right for you, Thomas. Welcome to the Gist.
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B
Thank you. Thanks for having me.
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C
So many drugs have these great stories. And the first two episodes are about EpiPens and Lipitor. And I got to tell you, as an inducement, hey, I'm going to tell you the story of Lipitor. It wouldn't have done it for me until I heard the story on Lipitor and I said, holy shit, that's a crazy story. So let's start with episode two and Lipitor and fdr, because that's a great place to start. And everyone knows that FDR died in office. And I think I had the conception that, well, he was old and in a wheelchair and this is what happens. But what really killed him.
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B
Yeah, no, he was only in his early 60s. I think he was 64.
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C
Right. So smoke those. Smoke those thin cigarettes.
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B
Yes, well, therapy. For therapy. He was prescribed smoking and drinking as a way to calm himself. So, so, yeah, you know, without, without the drinking, you're.
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C
The humors in your blood are excited, from what I understand.
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B
Yeah, exactly. Exactly. So. So, yeah, so FDR famously died in his fourth term in 1945 of, of a stroke. And at the time, his high blood pressure was through the roof. And they kept measuring the high blood pressure, but they really, at that time, it's, it's staggering to think about today. But they had no idea what caused high blood pressure or really whether it was bad or not. So.
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C
Well, it was called high. That would indicate that, but they didn't. There's no value judgment there but they.
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B
Had no idea what that meant in terms of, like, the chain of causation or the chain of risk. So even though heart disease was and still is a leading killer of the day, they didn't understand anything about heart disease. There was very little medical science or research into heart disease. So FDR died. It was a national tragedy. And in 1948, his successor, Harry Truman, signed a law creating the National Institutes of Blood and Heart Science that created a study that is still going on today, where they took the town of Framingham, Massachusetts, which is conveniently near Harvard Medical School. And they have been studying the population of Framingham ever since for generation after generation. And what they've tried to do is figure out, well, what are the causes of heart disease and stroke? And it's only because of FDR and his death that they set up this research project that they set up the National Institutes to study heart and blood science, and that has given us a greater understanding of heart disease. And so what they came up with out of that study was a handful of risk factors, including high blood pressure, that actually, if you watch a population over time, you could see, okay, you have high blood pressure, and then a high percentage of those people had a heart attack or died a few years ago.
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C
So there's definitely a correlation. And they've done a bunch to figure out the causation. And then we get to cholesterol, which when FDR died, we didn't even understand, as you said, if high blood pressure was bad when. What was our understanding of the concept or mechanisms of cholesterol?
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B
Yeah, well, it was. There was no conception of it at all. They knew it was something. Maybe they measured it in the blood, like if you did an experiment, but they didn't routinely examine your blood for a cholesterol level because there was no understanding of that. It was, in fact, a risk factor. So it was only after this Framingham study had gotten started that. That they saw that. Oh. Because what they. What they did is they took 3,000 citizens of Framingham, and they basically gave them physicals every six months. They. They worked them up, they measured their blood. They. They gave them. They. They gave them a kind of classic lab workup, and that gave them a bunch of data that then they could trace over time. And that's when cholesterol kind of popped up as not only a. One of the risk factors, but a leading risk factor for eventual heart disease or heart attacks or death. So all of a sudden, they had something. But the question was, well, how do you bring it down? And that they weren't able, even though they understood cholesterol as a risk factor by the early 1960s. It wasn't until the 1970s and 1980s that a product actually came onto the market, which was the first statin that actually lowered cholesterol and therefore lowered. Lowered your risk of heart disease.
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C
Now, in some of these episodes, you get into the mechanisms by which the drug works. The EpiPen episode deals with the poison of the man of war, and some dogs died along the way. We understand. Right. So we understand the analogy. We understand that there's something in science. And then you could come kind of think about, all right, so what combats that in science? We'll make drug version of that, either through natural means or synthetic. What about with the statins and cholesterol? Is it important to know how it works?
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B
Important to note for scientists or for.
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C
The patient, you and me. Does it tell us something? Yeah.
- [14:26]
B
No, no. I mean, a lot of these drugs, a lot of the drugs that we take. If you think about medications, there are about 3,000 drugs in a typical pharmacy. Right. 3,000 different chemicals, largely that. That have some impact on the body. And what those are the result of is this. This long scientific process of experimentation where they take a chemical, they think it has certain properties, they eventually put it in humans, and it does things. And some of those things are. Are considered positive. Like, we want those things to happen, and a bunch of them are negative. And we call those side effects. And the. The ultimate question is, do the benefits outweigh the risks? Do the. Do the benefits that the good things that happen to our bodies outweigh the bad things? And that's what the FDA has to decide. And that. That either is an approved drug or not.
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C
Right. With the statins, it's really interesting because there is this causation or correlation and a causation. Cholesterol highly correlated and causes heart disease. And there is this drug. Let's consider it a black box, a little chemical miracle that really does lower cholesterol and lower the hdl, the bad cholesterol, right?
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B
Yep.
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C
But. So you would think if you added.
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B
LDL is the bad one.
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C
Oh, ldl. Sorry, sorry.
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B
Everyone get it to hdl.
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C
You're the hero. Heroic deal and loser deal. We should.
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B
Exactly, exactly.
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C
So we have the drug that Lipitor became the statin, and we could get into how that happened. And the drug does treat the condition. It really does work to lower cholesterol. And cholesterol really does factor into this number one killer of Americans and number Five or something when you count strokes. But the problem is, or the question is the connection between drug and end result, saving lives. And you introduce this concept that I hadn't heard of, and I kind of beat myself up because I love this concept that would have clarified so much that I think about in life and drugs. This number needed to treat the T. So can you tell me what NNT is and how. And how it works with some other drugs? This will concentrate our minds and then how it works in the Lipitor context.
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B
Right. Okay. So this is a fascinating concept. The number needed to treat is a very simple idea. It's how many people need to take the drug in order for one person to benefit. Okay. So with Advil, if people have a headache and you give four people Advil, one will actually kind of feel a benefit from that. Their headache will go away. So the number they need to treat for Advil is four. Four people take the drug, one benefit, and it turns out that that's actually a pretty good number. Four is a really effective drug.
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C
Yes.
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B
When we get to a drug, I.
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C
Think you said in the show that ibuprofen and fever is also for. That was surprising to me. But, you know, it's better to take it than not. Meningitis and steroids. That's one. Like, it always works.
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B
Yeah. Okay.
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C
That's great, I guess, except for the fact that meningitis.
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B
You've got meningitis.
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C
Yeah, yeah. So give us. I want everyone to think. What do you think the Lipitor number is? The number of people. The number of people that need to take it for one person to forestall a heart attack. Okay. You got that number in your head. Now you tell us what the real number is.
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B
Yeah, it's 100. Yeah. Basically, you have to treat 100 people or 100 people have to take the drug in order for one to get a benefit. In order for one.
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C
99% of us taking this statin, it will do nothing for us in life for a few, statistically. Right, right. So 1. And it's not that it won't lower cholesterol. It's things like does. Does. We might die of something else first. I don't know if that factors in. But what factors in is that the causal chain, though established and real, isn't so strong that the thing that lowers cholesterol is going to stave off the heart attack. That might not have happened anyway. But what are the downsides then?
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B
Well, so like any drug, like I said before, if you put a chemical into your body, good Things happen. And some bad things happen with statins. It's a known side effect that people have muscle pain, joint pain. It can actually affect the cholesterol in the brain. So there's a risk of increased dementia. So there are various side effects that happen or various kind of consequences when people take statins. For the most part, if you have high cholesterol, those risks are worth it. Right. Your chances of getting the benefit are pretty high. But if you're on the threshold, if you have a kind of high cholesterol level and you still are taking a statin, you might get all those side effects without ever getting the benefit. So when you multiply that times millions of people or tens of millions of people who are taking these drugs, you end up creating a lot of people who are getting the side effects without ever getting the benefit. And so that's, that's kind of one of the risks of mass prescribing of these, these drugs.
- [19:20]
C
And there is a constant recalibration going on in the scientific and pharmaceutical community today about that benefit and that risk. Right, right.
- [19:29]
B
So, so I always say medicine is the, is the science and art of groping towards the truth. So, so things that we're always learning new things. And, and when, when science learns new things, the recommendations change. So it used to be you get a colonoscopy at 40. Now you get a colonoscopy at 50. Whatever it is, it used to be every bit. All men get PSA exams. Now it's not recommended to get a PSA exam. So, so the science changes with, with statins, they have lowered that cutoff level under the theory that will help more and more people. If millions and millions of more people take these drugs and you'll end up avoiding more and more heart attacks. That's true. But you'll also end up treating a lot of people, giving people these drugs who will never get the benefit. And so that's a social benefit. That's a kind of social evaluation that we need to make as a society. Ultimately, it happens in the doctor's office. One patient at a time though.
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A
Look at your face and your hands.
- [20:29]
B
It's still getting worse.
- [20:30]
A
Is it your allergy? There weren't peanuts in the brownies. Right? Peanut butter. Oh, no, I forgot what she asked you.
- [20:38]
C
Call 91 1.
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A
So sorry.
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C
Hey.
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B
Okay.
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A
Every six minutes, life threatening food allergies, Send someone to the hospital. Always avoid your allergens. And talk to your doctor about a prescription treatment you should carry for severe reactions. Learn more@faceyourisk.com.
- [20:56]
C
Yes. And what this episode reminded me of, the resonance with your first episode, which was about EpiPens, was the scientific community. You said that's where the science changed. I would say, and maybe scientists would say the science iterated. And with EpiPens and food allergies, it was the case that there was no nefarious scheme to convince us to do the wrong thing. Maybe. I don't know if taking Lipitor at such grand scale is definitely the wrong thing, but science iterates and there is no mustache twirling person behind it. But well intentioned scientists and parents were doing all these things about exposing their babies to food and bathing their babies too much that did increase allergies. So that happens. And I do think, and you tell me if this was one of the motivations with the series, that the pharmaceutical companies have this weird status in our society in that they save millions of lives and are hated by millions of people. So if you assassinate a guy who's in charge of one of them, they cheer you, but at the same time the companies themselves, like I said, without them we'd be billions of people years shorter. So I just wanted to get at that idea that. Did you want to demonstrate early on that it was through no one's fault that maybe we were doing things that were not helpful to the public health?
- [22:25]
B
Yeah, I think part of the, one of the concepts that I've always kind of enjoyed kind of exploring is this idea of groping our way towards the truth. And with EpiPens, you know, well intentioned people, well intentioned bodies of medicine, in this case the American Academy of Pediatrics, they thought that the best guidance to give parents was to have them avoid peanuts, have their kids, their newborns or their young children avoid peanuts until they were like two or three. But it turned out eventually it took 15, 20 years to discover this or to prove it, but it turned out that that was exactly the wrong advice. What is better is to expose your kids, expose them as early as you can, like six months to peanuts and other potential food allergies or allergens. Now, the intention was what falls what's being described as the precautionary principle, which is like, do no harm, right? Better safe than sorry. So the idea was, let's be better safe than sorry, not expose your young children to peanuts. But the immune system doesn't quite work that way. It turns out you want to expose your immune system to things that might later become infection or, sorry, might later become allergic. And so it was just a process of Figuring out what is the best recommendation, what is the best guidelines, and what is the truth, like, what is the ground truth? How does the immune system actually work? It's a mystery still in many ways. And so that's kind of what the riddle of medicine does, is we. We try to figure out what is the best thing we can do. And that changes over time, when it.
- [24:13]
C
Changes and when a drug company is locked in on making money through the old idea. So EpiPens thrived when there were all these food allergies because of the bad advice. And Lipitor was doing well. They have record sales and they've cornered the market and all. But now there might be advice to give it to fewer potential beneficiaries. Do the drug companies always fight it, or are there other clever ways for them to continue making their money?
- [24:44]
B
Yeah, well, it depends, right? I mean, it depends on kind of the. The different scenarios, like with EpiPen. You know, the. The. The manufacturer of the EpiPen was very well positioned, and they were very. They were very well positioned to take advantage of that surge in food allergies, and they took advantage of it. They encouraged the recommendation for parents to not just have one EpiPen handy, but to have two EpiPens handy in case there was a severe reaction. Well, that has the side effect of doubling their sales. Right. If you are selling two instead of one in a package, you've just doubled their sales. They also were very smart or effective, I guess I should say, in raising their prices about 10% every year, until after a few years, the price of EpiPens had actually doubled. And for a lot of people, their insurance didn't cover EpiPens. And so that was cash out of pocket for the parents. So that became a national scandal. The CEO of the. Of Mylan Pharmaceuticals was called before Congress. They didn't really change their price, but they didn't raise it quite as much going forward.
- [25:51]
C
Well, also, the reason we say EpiPen, and maybe we're thinking, well, that's the only thing there is to treat potential anaphylactic shock, is they were very clever crowding out a competitor. How they do that?
- [26:02]
B
Yeah. Yes, they were. They. They. They took advantage of something called economists call lock in. So they, they very generously created training programs free of charge for school nurses and teachers that trained them on how to administer the EpiPen. So the EpiPen is actually a machine. It's a. It's a little plastic machine that has a spring inside. And when you. When you push it down, the needle comes out and it ejects a very specific dose of the epinephrine into the body. So you have to learn, though, how to do that injection, how to make that stabbing motion. Well, the manufacturer trained, had these training programs for nurses and teachers on how to administer it. So they were all trained on the EpiPen. Now, there happened to be a generic device that basically worked the same way, but a little differently. The cap functioned a little bit differently. And because the. The school staff was not trained in those devices, many schools typically would not let parents buy them and store them at the school because understandably, the staff wasn't trained in it. But that created lock in for the EpiPen. And so. So the parents were obliged to spend more money on these more expensive devices that.
- [27:19]
C
Oh, so the other one wasn't a different pharmaceutical companies. It was just the generic and I guess.
- [27:24]
B
No, no, no, no. I should say Y called Adrena Click, or it is called Adrenal Click and it's done by a different manufacturer now.
- [27:30]
C
Okay, so then wasn't Adrenal Click trying to do its own lock in? It just wasn't as successful.
- [27:35]
B
Yeah, exactly.
- [27:35]
C
It's not like EpiPen invented the concept of lock in.
- [27:38]
B
No, no. But it takes a lot of money to fund free training programs nationwide. And AdrenalClick just did not, did not do that.
- [27:47]
C
That's good. Good insight. Right? Don't worry, doesn't end. We'll be back tomorrow on the gist. Now, the spiel. The word has been in the air frequently used to describe the methods and tactics of the Trump administration in all forms and specifically ICE deployments, and quite specifically the ICE deployments in Minnesota. Here is Senator Angus King of Maine, Minnesota Attorney General Keith Ellison, and Vermont Congresswoman Becca Balance. Using that word, this worst of the worst thing is a pretext. What they're really doing is going after people who are here. They're asylum seekers. They're in the process. They have green cards. We've had. This is about terror.
- [28:41]
A
This is about retribution.
- [28:43]
C
This is about punishment. This is about vindictiveness.
- [28:46]
A
This is about giving a pretext to.
- [28:49]
C
Incite the Insurrection Act. This is a pretext, and it's not supported by the facts at all. This is the use by Maryland Congresswoman April McLean Delaney to really house such mass incarceration.
- [29:04]
A
And ICE is running out of space. Their lethal use of force under the pretext of the Supremacy Clause, which is without legality or merit, is misleading. And I have been pushing back forcefully.
- [29:16]
C
About it not to convene the Pesca pedantism parlor for too much, I would say Delaney doesn't get it exactly right. The other three really do. The Supremacy Clause is more of a misleading invocation or a legally baseless appeal than a pretext. A pretext is when the stated reason is not the real reason, but the real reason is something else. Thus ends Pesca's pedantic parlor. And the real reason that Trump and ICE are shooting people in Minnesota or claim to have the authority to do so, is that they want to shoot people in Minnesota. They want to crack down hard for political reasons. And though this is debatable, and I'm not sure how clear all the motivations of all the members of the administration are, they wouldn't mind some high profile incidents to inspire reaction among protesters. This might be too much of a reaction or too warranted a reaction. The administration would say we're doing this crackdown for policy reasons, but I think they're wrong about that. The crackdown specifically in the interior with non criminals in such an aggressive fashion. And we're seeing the wrongness show up in Trump's recent retrenchment from the most aggressive ICE tactics, or at least the people in charge of these tactics. Swapping out Homan for Nome and Bavino the reason that the near ubiquitous use of pretext jumped out at me is that it demonstrates a couple peculiarities of the nature of the lawlessness of the administration. Namely, they try pretextual or fig leaf rationalizations until they can't. And if I'm going to find the silver lining, the pewter lining, the tinfoil lining, so far, it's that when they no longer have the pretext or some fig leaf of legal rationalization, they have abided by court decisions so far. They appeal, they rhetorically denounce, but they abide. It doesn't mean they always will, but so far that has been the case after a lot of delay. Another interesting aspect of pretextual considerations, the use thereof, is that using them tells you that there are forces within the administration that believe it is the best strategy to behave as if it's acting normally. Granted, autocrats usually don't start from I shall be lawless. I will not even attempt to justify my actions via existing law. But Trump has done more than his fiercest critics allege to actually, if not adhere to glance at the law. And he has done more to actually hew to the actual law than at times I might have worried that he would Stephen Miller gets a lot of attention and that guy goes off half baked on lawless theories all the time, once yelling about the 2017 travel ban on Face the Nation. The powers of the president to protect our country are very substantial and will not be questioned. Even so, the persistence of pretexts is bad because pretexts are lies, knowing lies. And I'm not going to say it's good, but it's less horrible than it could be if Stephen Miller's twisted ID were allowed to run roughshod over the United States. Steve Miller, the joker. Trump used a pretext to go after James Comey, and I think it didn't work. The Comey prosecution looks like it will stall, and in part because they're out of available pretexts, plausible pretexts. I suspect that the investigation into Fed Chair Jerome Powell will proceed along similar lines. Although of course you got to say, just the prosecution alone with a pretext and all that's going nowhere. That's enough to damage the individuals and to damage the system. But it's interesting on how much Trump relies on the pretext and how, when the pretext dissipates, so often does the prosecution. I can anticipate all the objections at this point. They're not wrong. You should say something like, Hitler used pretexts and pretexts won't save us. True, true, true, true, true. But pretexts are, I think, an interesting and notable presence within the tactics of Trump administration 2.0 and one that is better than the worst alternatives. Though, of course, the constant use of pretexts or bullshit reasons to do lawless things is actually much worse than just following the letter and spirit of the law. And that's it for today's show. The Gist is produced in my in laws closet without a real microphone. Corey War is also the producer. Kathleen Sykes does the Gist list. Lia Yan is our production coordinator. Jeff Craig runs our socials and our video. And Michelle Pesca is the person who introduced me to the owners of this closet. There is a word for that in Tagalog, but it's too long to get into now. And thanks for the listening. Marketing is hard, but I'll tell you a little secret. It doesn't have to be. Let me point something out. You're listening to a podcast right now, and it's great. You love the host, you seek it out and download it. You listen to it while driving, working out, cooking, even going to the bathroom. Podcasts are a pretty close companion. And this is a podcast ad. Did I get your attention? You can reach great listeners like yourself with podcast advertising. From Libsyn Ads. Choose from hundreds of top podcasts offering host endorsements or run a pre produced ad like this one across thousands of shows. To reach your target audience in their favorite podcasts with Libsyn ads, go to Libsynads.com that's L I B S Y N ads.com today.
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