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The MeidasTouch Podcast
Meidas Health, Episode 7: Misinformation, MAHA, Measles, and the Future of Medicine (with Drs. Peter Hotez and Sapna Singh)
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- [00:01]
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Dr. Vin Gupta
This is episode eight of the Midas Health. I am so delighted that you're with us, that you've been sticking with us as we've been building out this health content for the Midas Touch Network, which as I'm sure many of you have seen, is the number one most downloaded podcast in the country. Big credit to the founders and especially for diversifying the content, really focusing in on health. As mentioned, we're trying to use this time as efficiently as possible, trying to bring the nation's best. Since the nation's best is not necessarily in government at the highest levels anymore, we're going to bring them to you through this venue. Dr. Calif was episode two, former FDA commissioner. We had the WHO lead on pandemic preparedness for episode four. Mina Sesher Shami, the Secretary of Health from Maryland. In Episode five, Shaquito Brooks Lachour, Head of cms. Episode six. You get the picture. These are the nation's best healthcare leaders. Clarify Coming in and speaking on topics that really matter to all of us. Matter to you, Especially as it pertains to the news cycle. Episode eight is not going to disappoint. I have two of the nation's leaders in all things pediatrics, infectious disease with us to talk about the state of the measles epidemic, especially in Texas. We have Dr. Peter Hotez, who I know is known to many of you, Dean of the National School of Tropical Medicine at the Baylor College of Medicine, and Dr. Sapna Singh, who's the Chief Medical Officer of Texas Children's I'm going to bring them in right now, and I really appreciate them both being here. I know they're very, very busy. Dr. Hotas, Dr. Singh, welcome.
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Dr. Peter Hotez
It's great to see you. Dr. Gupta, glad to be here.
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Dr. Sapna Singh
Thank you.
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Dr. Vin Gupta
Absolutely. Well, we're going to.
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Dr. Peter Hotez
Vin, I miss our discussions during the pandemic. A lot of people don't realize that a lot of the people were going on talking about COVID We were often talking behind the scenes to compare notes because there was so much incoming. I don't think any one person could keep it up, up with everything. So, you know, you were a valuable source for me, Vin, and helping me in many things.
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Dr. Vin Gupta
Oh, let me. Well, you know, I should say for all our listeners here, and it's a wide listener or wide audiences that, that we're reaching. So I should say for that audience that. And Dr. Singh, I don't know if I shared this with you, that I first met Dr. Hotez back in 2009 when I was doing a. It was before we all left for Fogarty Fellowships and I was going to China for a year. And Dr. Hotas gave an incredibly inspiring speech just on the purpose of an academic career in medicine, all things related to scholarship and medicine and really pursuing an impactful career beyond the bedside in addition to Bedside care Institute. So, Dr. Hotez, that has stuck with me 16 years later. And just thank you for, for everything in the intervening years in your leadership.
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Dr. Peter Hotez
Thank you.
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Dr. Vin Gupta
I sticking with you, Dr. Hotez. To begin with, I curious your. Your thoughts on the current state of. You know, we'll get to measles in a second. But, you know, again, I just said that I met you first at the nih. You're seeing what's happening. Wondering now three months in how you're digesting it all.
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Dr. Peter Hotez
Well, there's a lot to digest and I don't think we understand the full implications. But the attack on science, biomedicine, especially in the virology and infectious disease space, has been pretty awful. And I think it's starting to translate into breakdowns in our infectious disease and pandemic preparedness. I think the measles epidemic in West Texas was actually both predicted and predictable. It's not like this thing came out of nowhere. I had written an article in 2016, almost 10 years ago, called Texas and Its Measles Epidemics that more or less predicted this was going to happen. They even identified the county where it would begin, in Gaines county, because we had started to see this steep decline in vaccination rates across the rural conservative areas of West Texas, in part because of libertarian ideologies. But then it picked up momentum in two places. One, it kind of converged with the health and wellness and influencer movement that is based on buying in bulk whatever it can and jacking up the price and selling with a telehealth visit. That's where ivermectin comes from. That's where hydroxychloroquine come from. And so you starting to see those forces merge. And so when our good friend Mr. Kennedy, you know, his health and human services secretary, when asked about the MMR vaccine, you know, he pairs it with, hey, you can either get the MMR vaccine or you can get this kind of useless cocktail of interventions of budesonide and vitamin A and clarithromycin and cod liver oil, and people saying, well, where the heck does that come from? Comes out of the health and wellness and influencer movement, which is now he's, he's adopted that. And, and the reason why we need to care is not just because we like throwing darts at people, but because it's affecting public health. I mean, this, that those converging forces really accelerating during our time of COVID We estimate in Texas, of the hundred thousand Texans who died of COVID one of the worst affected states in the country, almost half died needlessly because they refused Covid immunizations. And especially starting in 2021, after vaccines became widely available with the start of the Delta wave, that's where we started seeing people die in droves. And guess where they died? They died in the same places where measles is now, in those rural conservative areas of West Texas, parts of East Texas. Not so much in the cities of the Texas triangle in some cases, but mostly in those areas. And now we're seeing that spill over again to childhood immunizations with a thousand measles cases, 90 plus hospitalizations and geopediatric deaths. Tragically.
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Dr. Vin Gupta
You know, Dutch charges, you do something. Great job sort of distilling out the macro. And I mean, it's not just the macro trends, but, you know, distilling what's happening then and how it pertains to west Texas. And I'm wondering, Dr. Singh, how much of what those trends are you are mapping to what you're seeing within the inpatient wards and Texas children's.
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Dr. Sapna Singh
Over. I mean, the inpatient wards, not as much. But in the outpatient world, we are certainly starting to see significant amount of vaccine hesitancy compared to what we saw even years ago. You know, it's interesting. We have been surveying our physicians for a while about burnout and moral injury. And in our third iteration of this assessment, patient resistance to our advice and to our recommendations is one of the second drivers of burnout amongst pediatricians right now. So I certainly think that what we're seeing is an increased hesitancy and also refusal to vaccinate. Much of it coming from what Dr. Hotez spoke about. The misinformation that you're finding out there, and there's so much of it and it's coming from so many different directions that for those of us in healthcare who are working in the trenches, it's hard. It's hard to kind of be the only voice that's fighting back against that and trying really hard to be thoughtful and compassionate and to educate families that this is. It's a decision that has really significant consequences. So I can certainly tell you we're obviously seeing small case rates here and there. In fact, Hays county just reported a positive case and now we're chasing that exposure history. So this happens not just in effect with the West Texas case, but what you're hearing now is literally week after week after week, we're chasing more exposures, more positive cases. It may be a one off, but I think our greatest fear is that as vaccine rates drop even across other areas of Texas, that that one off case will turn into an outbreak very, very quickly. And so that's something that we've been really, really concerned with because in the outpatient setting, our entire work has been around preventing these diseases. And that is really becoming significantly harder to do now.
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Dr. Vin Gupta
You know, Dr. Hotez, in hearing that and. And what's happening in just the broader catchment of Texas children's, it strikes me that when I hear the current health secretary sort of explain away what's happening and sort of passing the buck a bit, he says, well, if there's a measles case now is getting a headline. Whereas 40 years ago there was tens of thousands of cases, it wasn't getting nearly the same attention. Wondering your thoughts on that deflection and how much of this is the convergence with him now at the top and what you're. And what Dr. Singh was noting is happening in their outpatient clinics. Is this just business as usual or could you clarify that for our listeners?
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Dr. Peter Hotez
No, I mean, he has become sort of disinformation officer in chief. You know, he, you know, I was kind of hoping with the wind down of COVID not that it's totally wound down by any means, but I would get a break from TV. But Mr. Kennedy seems determined to call me out of retirement. You know, it's, and because he's, it's a zinger every few days. Right? And I mean, and it's very, and it all is a very consistent theme. I mean, what, what does he say? He says, first of all, you know, the draw is the false equivalency between MMR vaccine and these phony baloney nutritional supplements that nobody needs. That's, that's point one. Then he says the hospitalizations are due to, he says the hospitalizations are due to quarantine and isolation. When those 90 plus kids who've been hospitalized are really, really sick. They have measles, pneumonia and measles neurologic involvement in severe dehydration. And he keeps going. He says the MMR vaccine is a leaky vaccine, whatever that means. And he says that the MMR immunization rates declines 4% per, per year. It's, it's nonsense if there, you know, there's one modeling study suggesting it may decline 0.04% per year. It's a hundredfold difference. Or, you know, and it keeps on going. He says the MMR vaccine is contaminated with aborted fetal material, whereas the two M's, the measles and the mumps attenuated virus is grown in chick embryo cells and the rubella component is grown in a cell line that's been propagated for over 60 years after it came from two aborted either one of two aborted fetuses. But it's a cell line propagated in tissue culture for 60 years. There's no aborted fetal material in it. And the Vatican, the Pope have signed off on it. And then, you know, it keep, keeps on going. This consistent theme of, of downplaying the severity of the illness the vaccine's designed to prevent and exaggerating the very, very rare side effects. And of course, it's happening when we're, we've now had this measles epidemic going on since January. It's still going. You know, it'll. Every time there's an update from the Texas Department of State Health Services, which we get on Tuesdays and Fridays. Every time there's an increase, we know this epidemic's gonna last at least another two weeks longer because that' roughly the incubation period of measles. And now it's extended, as Dr. Singh points out, in other parts of Texas, in the Austin area, in the San Antonio area. We don't know if that's going to take off. And it's now moving up in the Great Plains, right. It's going up into Oklahoma, into Kansas, and by the way, it could meet in the middle for another trend that's happening which the same forces are on Plains, southern Alberta, which some people say as the Texas of Canada, there's a huge epidemic there, into southern Manitoba and coming down. So the entire Great Plains regions affected. And it wasn't by accident. It was due to an organized, politically driven and financially driven disinformation campaign. Financially driven by the health and wellness industry, politically driven by this libertarian ideology that gets PAC money, political action committee money, and it's having deadly consequences now. So the worry, of course, is that this continues and two things happen. One, we lose our measles elimination status, which was defined more than 25 years ago by the CDC for global immunization. And that says if transmission goes on for a full year, we've lost our measles elimination status. And remember, measles is usually the tip of the iceberg on this stuff. We. Measles is often the first breakthrough infection we see because it's so highly transmissible. But you know, we've got problem, We've got a six fold rise in pertussis cases, whooping cough cases from 2023 to 2024. We've got polio in the wastewater in New York State. So, so the, the concern is that our whole vaccine ecosystem is starting to unravel. And then you saw what the FDA did yesterday with blocking COVID vaccine use in kids and younger adults. And then the false claims that no childhood vaccines were tested through placebo controlled trial is absolute bs. I put up on my social media, just did a simple PubMed search, an informal PubMed search, and printed out dozens of placebo controlled trials for most of the childhood vaccines that, that I, that I searched for. So it's, it's, it's. I don't want to make this just about Mr. Kennedy. I, we'd, we'd have a big problem anyway. But now he's actively seeking to amplify this.
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Dr. Vin Gupta
You know, Dr. Singh, when I hear Dr. Hotez kind of just full gamut talk about all these challenges, measles just being the first indicator sign or public health playbook when it comes to vaccines potentially collapsing, I am wondering, it always feels like the response is, well, have a conversation with your medical provider or talk to your pediatrician. My wife's a pediatrician. We talk about this too. What are the horses?
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Dr. Peter Hotez
That, that's how you became such a nice guy. I didn't know.
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Dr. Vin Gupta
She definitely reigns me in. But I, I will say that it always feels like the corrective action is, okay, well, ignore what you see on social media or on TV and talk to the most trusted medical voice in your life, which for a lot of people is their medical provider. Is that working? Have you noticed that you're saying that, you know, you're able to parry some of these macro trends on these one on one conversations, or is that not working anymore?
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Dr. Sapna Singh
I think it, it works when you have the ability and the time to be able to spend in the room with these patients. And I think that one of the things, you know, there's certainly a population of parents, they are bought, sold, and opposed at a level that we're not going to convince them. You know, they're, they're the parents who come in with, I've done my research and in fact will try to convince us to do research in the same, you know, thread. But you've got this huge group of folks that are questioning, they're questioning whether what they've seen and heard is true. And as a parent, you can understand that. You don't want to make mistakes with your kid. You don't want to mess up. And so a big piece of this conversation for us, I think, is really finding a way to pull them back from that questioning of things that really are coming from places that are not rooted in science. I mean, a lot of the influencers out there do not have medical degrees, did not go to medical school, have never worked in the scientific field. And as Dr. Hotez said, there's not even evidence that half of the things they're discussing would work. I mean, vitamin C is not going to help an immune system that's been completely decimated by an illness, like measles or influenza, for example. And so it's kind of our job to give that education. I think what we are dealing with is I get 10 or 15 minutes in a room, and they are getting hours and hours and hours of this outside of my clinic exam room in all kinds of different forms. And I will say that we're working really hard to teach our physicians how to have a little bit better social media presence. This is not something we're taught in medical school. You know, you do a great job being out there. Dr. Hotez does. And I think it's so refreshing to have your voices out there supporting what we are, you know, working towards. But a majority of us are just not trained to do that. We don't have the ability to be on social media hours and hours and hours a day the way some of the influencers do. And so I certainly believe that the trust our patients have in us can convince many of them who are just kind of on the ledge or not sure or questioning. But I fear that there is enough people who've crossed over into the completely opposed side. And how we get them back and how we get that trust established again, I think that's something that is a really great concern for most of us, especially in primary care, not just pediatrics. I think even in adult medicine, but for sure in pediatrics, we struggle with that.
- [19:52]
Dr. Peter Hotez
I think the disinformation is so dominant right now. Parents are coming in and they make the pediatrician feel like they're not keeping up with the literature. They are keeping up with the literature, but just not the fake stuff. And it's getting more sophisticated. Well, yes, no, it's getting more sciency sounding to make it seem plausible. I mean, let me give you an example. So you had the Florida Surgeon General. Latipo gets up there and he says, MRNA vaccines are causing turbo cancers because they're, because they're inserting foreign nucleic acid into our genome. Okay, well, you know, if you think about it a minute, there's no such thing as a turbo cancer. It's a totally made up term. Or if you're, you know, if you're busy seeing patients all day saying, hmm, is that something I missed? The turbo cancer. And then, you know, the lipid nanoparticle will deliver its package of nucleic acid past the cell membrane into the cytoplasm, but it doesn't get into the nucleus. That's. For that you need electroporation. That's why we have no licensed DNA vaccines. But most pediatricians are, you know, not gonna have that information at their fingertips. And the fact that we have. Even if some residual nucleic acid does get into the nucleus, we have proteins of our innate immune system that block incorporation of foreign nucleic acid into our genome. Otherwise, if we didn't have that, that's part of our innate immune system. If we didn't have that, every time we ate a hamburger, we'd have cow DNA in our genome. And then the likelihood that's going to happen next to an oncogene is even more remote. So it's total BS, but I have an MD and a PhD and think about biochemistry in cells all the time. But, you know, there's not. One of the things I think would be helpful is that if we had, you know, an Uber website where the pediatrician or the primary care physician could go to it. And because, you know, these things tend to circulate and amplify and go viral in batches. So, you know, the same stuff keeps coming up for a month at a time until they switch to something else. It'd be nice if there was a disinformation website. You could look it up and say, oh, that's no, that's not true and here's why. And so pediatricians could debunk it in real time.
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Dr. Vin Gupta
Yeah. Building on this, really, I love where the two of you are headed. I am curious if I heard a stat that x percent greater than 10% of Google searches in any given month have some sort of healthcare intent. I have pink eye. Is the measles vaccine safe? Everything in between. And you know, both of you have mentioned, I mean, I agree, Dr. Sin, that Dr. Hotez is incredible on social and is very courageous and has paved the path for a lot of us. And it strikes me, I also feel like how we academia and how we're trained and what is considered a worthwhile use of time and what is judged. I will say in my own case, and I think I mentioned this privately to Dr. Hotez, that you know, still being in the meat of sort of, I think middle part of my career, I don't know if the division chief of pulmonary medicine understood, at least in the early days of the pandemic, the importance of pushing back across media channels and that that was valuable use of time versus self aggrandizing or complete waste of time. And there isn't that same judgment and sort of immediate, you know, focus on writing the research paper then not on, you know, a tweet or whatever it may be. And I don't feel like there's that same reflex, oh, that's not a good use of time on the MAHA side because they are fully embracing reaching as many people as possible. Midas fully embracing as reaching as many people as possible. You know, 20 million listeners potentially in a given day. And I like that. I, I do. I think if they've gotten one thing right, is that they're, they're out there in the digital space. I don't agree with 99% of their messaging, but all mechanisms of, of, of reach are fair game and we're not going to judge it. The question I have is going back to the Google search, I just Googled what ha. I'm curious what the AI summary was. If I googled, is the measles vaccine safe? And then it Gives me an AI readout that you know, cited to the study level of yes, it's safe and look at XYZ data points. I'm wondering if, if, if you don't have the 15 minutes that's not scalable your time to do 15 minutes with every patient to reassure them Dr. Sang or Dr. Hotas then we're in this world where it's all about digital misinformation and AI driven information at the point of search. Are, are we, are we just in that transition phase where then AI is going to allow us will be a buttress towards misinformation because people will have their searches and they're going to get you know, curated results back that are summarized, that actually summarize the data. Are you hopeful about the future in other words? And Dr. Singh curious your take?
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Dr. Sapna Singh
No, absolutely. I mean I think that if, if you're able to and I, I don't think that this is a problem. I mean this is where people are getting their information from now. We have to be super realistic. This is the future. We, we do not turn on the TV to watch the 5:30 news anymore to, to receive information. Majority of the people I know, I mean if they send me something, it's a TikTok or an Instagram post or you know, a reel off of Facebook book, It's bite size, 30 seconds, that's what people are looking for. And I think that if we can leverage AI which very rapidly can produce the results that you're talking about, but is able to produce results from the correct sources. Right. So what goes in is what comes out and that's what I think would be really, really important. You're absolutely right. It can be leveraged to really help us with our messaging. It certainly can become a resource that we can direct our patients to, to help get that message across. But certainly I think it would matter as to where is that coming from. I think for me the vision of where AI is going is something we have to evolve to, we certainly have to keep up with that and it can be a resource that we could definitely use because like you've said, I do think that the face to face makes a huge difference. But if you're able to also support that with something like this, where there's data, there's clinical trials, they actually can be sourced and put together and suddenly you see it's not one study, it's 150 studies that is backing this information up. That to me I think could potentially at least for that group that I consider to Be the questioning. They're not against it completely, but they're not totally sure about pulling, you know, the yes on the vaccine. I think that would be a tool that we could certainly use.
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Dr. Peter Hotez
Dr. Hotez AI is kind of a two edged sword too. Our friend Rene Diresta, who formerly heads the Stanford Internet Observatory until it had to close down because of political pressure, wrote an excellent article in the Atlantic early on in the pandemic entitled Disinformation is about to go Infinite and referring to the role of AI disinformation information. And I got asked a year or so ago to review an article and they invited me to write a commentary for it for JAMA Internal Medicine. And this group of from Australia had used three AI programs to see if they could generate health disinformation. And they picked two topics, vaping and vaccines. And they used the Google program, ChatGPT and the Microsoft AAR program. And actually Google and Microsoft blocked it, but ChatGPT I think it was let it rip and, and they generated something like 60, 100 disinformation blogs in an hour. And, and they were. So these disinformation blogs could be tailored to individual groups, whether it was African American populations or pregnant women. And it in a very clever and nefarious way mixed real references with fake references that sounded real. So you couldn't tell what was real, what was fake. So it was completely diabolical. And this is what we're going to be up against. So I think that's going to be a challenge. I think the other challenge in terms of pediatricians or docs having public outreach, the other barrier we face is it's not just the words of the enemies, it's the silence of the friends, which by that I mean the academic health centers in particular are not, as we both know, they're not terribly happy necessarily of us being out there because the offices of communications, most academic health centers and Baylor and Tex Children's are better than most, are all about fiercely protecting the brand. And they don't want the docs screwing it up for them. And so what you get is kind of, well, you're an academic, you're free to speak out, we can't stop that. But don't screw this up and get the institution in trouble. And of course if you're out there in the public domain enough, you will screw it up and you will get the institution in trouble. And you need to know you have the backing of the institution. And so I think the academic health centers have not. And actually in hospitals in general, have not evolved to the point where they've figured out how they want their doctors countering all the disinformation. So the results is silence. And this is, this is now having such a damaging effect on healthcare and partly with the situation we're in because of that.
- [30:15]
Dr. Vin Gupta
So well said to the two of you. And I appreciate both the last commentary, Dr. Houte's, but then just the conversation on AI, its applications and its promise and pitfalls, Both from you, Dr. San, Dr. Hotas, I will say, just to build on what you just said, I couldn't agree more. I think both of you have highlighted that docs, medical providers of all stripes, we aren't reared to be in a crisis communication type environment. We're not usually getting stones and darts thrown at us and being criticized in very direct terms. And so this is a very different. It's not like political communications or business communications where, sure, you, you have to, you have to be used to that type of environment. It's very different at scale. And, and I agree, I think it has led to a chilling silence because people don't want to get criticized. They don't want to hear negative, nasty things, which I don't blame them. And then the blowback potentially to the institution, that is, I've, I've seen that directly. Exactly to your point, Dr. Hotas.
- [31:25]
Dr. Peter Hotez
But, but no, I think the important question was how do we support our pediatricians? Because I am worried about the profession. We are starting to see declines in people interested in matching in pediatrics. It's happening in all the primary care specialties, but I think especially pediatrics. And people like to talk about the lower compensation of pediatricians, but that's not new. That's always been the case. I think part of it is, as Dr. Singh was starting to allude to, is just dealing with the moral injury, which then translates into burnout. And I think one of the things that I'd like to see is how do we better empower pediatricians and make them feel like what they are, which is the most important person in the room. I can't imagine anything more, and I still believe this more noble and more important than our nation's pediatricians. And how do we kind of schmooze them up and have them recognize their importance. And one of the things I've been kicking around is could we recreate pediatric residencies to make it more focused around education about how healthcare systems work, how private equity and health care works. You know, put them as leaders in healthcare rather than as individuals who are the first to get picked off by, by both the healthcare system and the disinformation system. And so I think we have to really look at some of those things.
- [33:08]
Dr. Sapna Singh
Yeah, I mean, I, I think every residency program honestly could benefit from that. I think that in, in, in general, in our training, we just don't. We don't get enough of that training. And to your point about the establishment and the idea that the larger systems, you know, hesitate, I will tell you something that I heard just a few days ago in a talk that was given by a Dr. Todd Woolens, who I think is in the influencer space and is kind of doing a lot of work with the vaccine hesitancy was that some of the same people who hold these beliefs about the vaccine scenes and, and just have this mistrust of clients at large find the larger systems to also be establishment. And so sometimes if the messaging is coming from that place, it may actually work against us to some extent. And so it kind of brought that focus back to what you were saying is, how do I put the trust back between myself and my patient? And that conversation has the value that I think most of us went into pediatrics for. I, I went into pediatrics because I wanted to be a part of someone's family at a really, just unbelievably, you know, vulnerable level. And to be able to watch that child go from day one to 18 years or some of them 21, because they don't want to leave us, but to be able to be a part of that experience. And I think, like you said, when these conversations that we, that was our compensation. It was the trust. It was these beautiful experiences with families when that begins to break down. And now our conversations are happening around, oh, well, we know that pharma pays you for your vaccines. We know that you're supposed to give us vaccines because that gives you a bonus. And we're lost in translation. I don't think that a lot of us as pediatricians even know what language people are speaking, because trust is fundamentally broken. And that is something, I think a lot of us are going to need education in terms of how do you respond and allow your emotional response to that, take a backseat and find a way to work around it so you can hear the patient and have the conversation go back to what we used to value, which was a foundation of trust. I still believe that that is where we're going to be when, if we're going to be able to move the needle, it is going to have to happen, I think, between us as Physicians and those families. But I think that's a huge undertaking, particularly what we're up against.
- [35:45]
Dr. Peter Hotez
I think the other and I totally agree, but I think part of that also is educating pediatricians and healthcare providers why patients are saying this. Remember, they themselves are victims of this disinformation machine. And, and so to the specific point that was made, you know, tying it to pharma, this is coming out of the, this is this unholy alliance between the health and wellness industry and the libertarian philosophy. Because one of the, one of the ways that the health and wellness industry, the, the, the business model depends on denigrating mainstream biomedical science and interventions. And so that means not only attacking the pharma companies but trying to make claims and I've even seen this, that the medical schools are nothing more than PR representatives of you know, public relations PR reps for the pharma companies. And there's this in they're intimately tied up. So that's where that comes from. Right. Because that was done because the health and wellness industry not only has to discredit the pharma companies, they have to discredit the medical schools that are telling patients don't take budesonide and vitamin A and clarithromycin, get the MMR vaccine and then they have to start portraying scientists and physicians as cartoon villains or public enemies. It's all very much a coordinated attack. And, and, and, and I think knowing that is makes it more helpful because then, then you realize where this is coming from.
- [37:24]
Dr. Vin Gupta
You know, I, as we've been having this incredible conversation, I didn't know which way this would go. And my gosh, as a branch into AI future of pediatrics we talked to our patients has just, it started with measles but I think it's, it's gone this incredible direction. I've been getting pinged because looks like the ma the highly anticipated to some. I don't know if I was highly anticipating it, but the Make America Healthy Again commission report just came out and Dr. Hotez and Dr. Singh, I'm sure you're going to be getting your queries to respond to it. But I guess the key takeaways there was a focus number one, ultra processed foods, which I think isn't surprising. A second focus on chemical exposures and potential toxins in the environment, probably not surprising given RFK's history and environmental health work. Three, quote unquote, more gold standard science. Four, a focus on the overuse also quote unquote of medicine. And then lastly corporate influence in medicine when you hear those pillars? I know, I have my opinions on this, but Dr. Otas, starting with you, Curious what you think about just the five pillars. I know this is a rapid reaction and you'll have time to sort of dig in after, but does any of that sound new to you?
- [38:55]
Dr. Peter Hotez
Curious, how do you feel about again? You know, I know I sound like a broken record. You know, the Maha movement is in my view little more than an economic stimulus package for the health wellness influencer industry. So, you know, let's take a couple of those points. The fact they're going to quote, do gold standard science. In fact, that's, that's what was said yesterday or two days ago in the New England Journal of Medicine paper about why they're going to withhold pediatric Covid vaccines because they make it sound like they're the ones coming in with gold standard science. It's, it's absolute nonsense. So the FDA and the CDC have been practicing gold standard science for, for decades where they've been a model for the world. But you know, this is part of how they, this is part of the propaganda machine to denigrate mainstream biomedical sciences. And then, you know, the environmental toxin. I mean, it's, you know, Ira, you know, one of the ways I got involved in combating anti vaccine activism was the NIH in 2017 asked me to talk to Mr. Kennedy and I had a year long of year of conversation with him. And that was the basis for my book Vaccines Did Not Cause Rachel's Autism about my daughter, because I would discuss with Bobby and as I was calling him the autism genes and the genetic basis of autism. And I said, it doesn't mean that it's all the rise and apparent rise in autism cases, mostly due to shifting definitions and case criteria for autism. But I said, there is some environmental influence. And I talked to him about several environmental exposures that could help to create autism. For instance, if you're pregnant and not aware of it and you're on an anti seizure medicine called Depakote or valproic acid that interacts with autism genes early on in pregnancy and your child has a higher likelihood of being born with an autism phenotype. And I said to him, I said, you know, you're an environmental attorney, you should be all over these environmental exposures because there is a role. And he had zero interest, I mean less than zero interest because it was all about suing vaccine companies. So, you know, all this stuff that he's saying is maybe there's a few threads of light there, but A lot of it is disingenuous and meant to pursue their own agenda, whatever that is, when they wake up in the morning.
- [41:31]
Dr. Vin Gupta
After saying, your thoughts.
- [41:34]
Dr. Sapna Singh
Yeah, I mean, I think it's interesting because our lived experience, especially my clinical experience, is just so wildly different from what I think is being put out there. I mean, I will tell you, I had a kid in the Pfizer trial for the COVID vaccine who received a placebo. I was witness to this happening. It was a clinical to, obviously we were testing vaccines against placebos. I had a kid who received one. And the idea that we would give kids anything or recommend anything that would be dangerous or not in the best interest of their health. And if you ask a majority of the pediatricians and physicians out there, we are vaccinating our own kids, you know, the, the, the cognitive dissonance of hearing us say, I am giving this to my own child, you know, why would that be something that would be in the thread of harm or somehow tied to some kickback or some other, you know, inappropriate intention? It's, it's really hard to fathom. And, and the things that you noted in those pillars, I mean, if you speak to my patients, they're going to tell you, I talk about that all the time. Please don't process foods. Please don't go out there and, you know, slather yourself on crazy chemicals. I mean, the general discussion about health and well being is 90% of what we do in pediatrics. And a piece of that includes preventing diseases that could potentially kill our beautiful, healthy kids. And so I think that it's fair to put that out there. And I think the way that it's messaged is very attractive because a general population wants to see these things tackled. But into Dr. Hotez's point, how are you going to accomplish that? What are you truly intending to do? Because I think that for, for us here working in those clinics, in the trenches, we would love support with that. We really would. I'd love for certain types of processed foods to disappear completely. But is that the point? Is that what we're working towards? Because if that's what we're working towards, I think that you'll have a lot of buy in from, from medical, you know, establishment as well. But I think we're all still waiting to see. Is that truly the intention here? Because we really need to make sure that we're getting back to what is rooted in evidence, science and facts. I mean, that's the most important thing. I think we need to be focused on.
- [44:09]
Dr. Vin Gupta
Gosh, you know, I both of you just said it beautifully. I feel like MAHA is a rebrand effort to exactly what you just said, which is stuff that we already talk about. There's nothing new here and. But it's a repackaged set of pillars, and that's being done and driven by people that know how to get attention and they know how to be controversial. And, you know, some would even say who really believe are believers in this. Compelling. And then also Dr. Hot as you, both of you have actually made this point somehow, othering the rest of us saying that we've been pulling the rug on the eyes of the American patient and that we've been withholding information, whereas we've been doing the exact opposite. Mindful of your collective time and the time of our listeners here, I do want to end on hopeful notes here. I think there's been some understanding the future of pediatrics applications of AI talked about the MAHA report. Dr. Singh, starting with you, what are you hopeful about in this? What is, I think, a challenging era across a range of dimensions. What gives you hope right now?
- [45:23]
Dr. Sapna Singh
I think what gives me hope is the absolute belief and trust that I have that most of us, particularly in the field that I'm in, in pediatrics, our calling to this is going to be what's going to give us strength to continue to work against the misinformation that's out there. I think we need better tools, and I think that that is something we can be provided with. So through better education, a little more training, scripting, helping us figure out how do we make the connection with these patients who are receiving all this information from the outside side, you know, that counter so much of what I'm saying. We've got to be able to do a better job of doing that, getting our physicians better training, better ability to get out there and speak in a way that reaches the patients that we know we can still be able to build trust with and establish that trust with. You know, I think that's going to be super important. And I have hope because fundamentally, what I think is really interesting is, you know, I think it was like a line from the show the Pit, where it's you come to us for the treatment, but not the advice. Well, if they're still coming to us for the treatment, I think the door is still open. So there is some fundamental belief in the back of everyone's mind that we are there to do the right thing, we are there to help, we are there to heal, and it's just a matter of kind of pushing past all the other stuff that's now coming at them to get back to that place where we can convince them. You know, my goal in this room is to just do my best job with your child. And I have the same focus that you do. You want what's best for your kid. So do I. And I think we really fundamentally have to find a better way to communicate that. It may take multiple different facets of communication and many different platforms. And I think we're going to have to move out of our comfort zone to do that. But I have, I have a lot of hope. I'm in clinic today and I'm telling you, every time I have the interaction with a family, it just refreshes my faith in the fact that I'm here for this purpose. And yes, things are tough, but we are going to be able to do this because this is our calling. This is what we were called to do, is take care of these children. So that. That keeps me hopeful and optimistic despite. Despite everything else that's out there.
- [47:51]
Dr. Vin Gupta
Well, doctor. Host. Host.
- [47:54]
Dr. Peter Hotez
Well, something that gives me hope is Dr. Singh. I mean, listening to her, how articulate she is. And, and I'm so proud that she's our. Our chief medical officer at Texas Children's Hospital. I mean, I mean, what could be better than that, right? I mean, just that was really brilliant. And, and by the way, the pediatricians at Texas children's are an extraordinary group of people and pediatricians in general in our country. I mean, the commitment, the passion, I mean, it comes through every time you talk to an American pediatrician most times. And so that gives me a lot of hope. The other thing gives me hope is the science itself is extraordinary. I mean, we made a low cost COVID vaccine that reached 100 million people in India and Indonesia, showing that you can actually bypass big pharma companies to do that. We did that in our labs at Texas Children's. Now we have a new hookworm anemia vaccine that's protecting close to 100%. We're excited about that. Finally we got the MRNA technology working to a point where we're getting rid of reliable results. And now we're looking at cancer vaccines with that technology. So I think I could imagine a whole new generation of cancer vaccines and maybe vaccines for other chronic conditions, including neurodegenerative conditions. That's exciting. The problem that we're going to face is our technology has outpaced our ability to do this, has outpaced our political social instruments to get it, to get Them accepted. And that's going to be the big challenge. And so how we kind of bring this back and start making that bridge and reaching people to get them to accept all this exciting developments in biomedical science and to somehow talk about the dangers of, of what's happening with disinformation, I think this is going to be one of our biggest challenges.
- [50:04]
Dr. Vin Gupta
I, I, I, I have a thought. Well, I, those answers were incredible, and I, I know that I'm coming up on time, but I do, I wonder if I can get both your takes on this. Something that I've been thinking a lot about is your areas of hope are fantastic. I do think we don't have enough of a stick approach in medicine, which is to say that we focus so much in the early years of entering the profession on first do no harm. We take an oath, we do all these things. I think all three of us, frankly, I say this on behalf of what I am committed to, and I know this to be true for the two of you, is we are very much committed to those ideals today, as always. What strikes me, though, is that if you don't, if, if you've taken a detour, if you've strayed from the path, and it's not about first do no harm, or it's against the basic pillars of medicine, what we've been taught, that there is no corrective action or there's no consequence aside from maybe getting the being in disrepute with your clinical peers, you don't really face any corrective action. There's no accountability like they had say in the legal profession that if you do certain things that are against the tenants of your profession, you might get disbarred. And I'm wondering real quick, I know this might not be a hopeful end here, but I do think we need to be a little prescriptive. Do you think we, we're just not, we don't have an accountability mechanism in place. And that's what's missing is that to keep people in line. Dr. Hotez, starting with you and then maybe Dr. Sn, I'll give you last word.
- [51:45]
Dr. Peter Hotez
Well, there is an accountability mechanism. Some of the worst offenders have now had their board certification revoked and that sort of thing. But it's a slow process. It could be years of litigation. And so it's not easy and it's extremely unpleasant, of course. And you like to hope that it doesn't get to that point. I think one of the ways we kind of build this in is I don't think we do Enough. Emphasize the bioethical aspects of medicine enough. Everyone is so focused on academic freedom. And you've got these contrarian physicians who just spout absolute garbage or they become talking heads on Fox News in some cases. And yes, there's academic freedom, but we also have something called ethics and professionalism. And somehow we have to build that better into our MD education or PhD education or residency education, that there is a responsibility here. And you don't go off espousing contrarian views just for the sake of contrarian views. And because you've sort of gone down that rabbit hole. There has to be that kind of check, better sense of checks and balances, which right now we don't have.
- [53:18]
Dr. Sapna Singh
I mean, I think, you know, accountability. I was raised in a household where the truth is the truth, and the truth eventually reveals itself, and it becomes obvious to everyone. I fear that we're going to have to suffer through more of the consequences before we get to a place where enough eyes are opened to what is happening. And at that point, the accountability will not have to come from our institutions. It will come from the people. Because if you have enough children who develop a disease that kills them, healthy, happy kids who die the way that we've already lost two in Texas, you will begin to have parents who will now begin to come back and say, I believed you. I thought what you were telling me was true. And that does not work out. Because the truth, whether you want to cover it up or preface it in some different way, is the truth. That is what it is. And I think ultimately what will happen is public health being a victim of its own good work.
- [54:17]
Dr. Vin Gupta
Right?
- [54:17]
Dr. Sapna Singh
We've spent years not seeing these diseases, but imagine a polio case popping up in this country, and we begin to see children paralyzed. We begin to see children who can't breathe, physically can't move their lungs anymore, those consequences. And I again, I hope we don't get to the point where that's what we have to see for us to understand what is happening. But that is where accountability will. It will be open and it will be very visible. And I do think that when parents begin to understand what is this risk I'm taking and what are the consequences? Because up until now, look, we've had enough herd immunity in a majority of our communities that people who didn't vaccinate, they're fine. They haven't had a consequence. But we have moved past that point where they're safe in the sheer numbers of us who. Who do vaccinate. And I fear that as that begins to show what that what's going to happen with the increased rates of outbreaks and hopefully not. But I'll tell you what, pertussis is back. I'm in clinic one day a week and I diagnosed a case two weeks ago. It's back. So these other emerging diseases, they will pull accountability. Because when you begin to see the catastrophic side effects of these decisions, then the people who have sold these inappropriate thoughts and lies to people are going to have to answer for why they did that. Because ultimately, the truth is the truth.
- [55:47]
Dr. Vin Gupta
Chief Medical Officer, Dr. Sapna Singh of Texas Children's and Dean of the National Tropical Medicine School at the Baylor College of Medicine, Dr. Peter Hotez. I am so grateful. You, you two are leading lights across healthcare, not just pediatrics. But thank you for your comments on the field, on artificial intelligence, on the state of the measles epidemic, on accountability in our profession. What gives you hope? Couldn't. I wanted to end on what gives you hope, but then there's just too much. And I wanted to get your last thoughts on accountability. So thank you for joining us. You've made us all smarter. I'm in debt to the two of.
- [56:26]
Dr. Peter Hotez
You and thank you, Dr. Gupta, for all your good work and absolutely thank.
- [56:31]
Dr. Sapna Singh
You for being a voice. Thank you.
- [56:34]
Dr. Vin Gupta
Thank you. Well, thank you listeners and on to the next one. But thank you so much. Have a great day.
- [56:41]
Dr. Sapna Singh
Bye.
- [56:41]
Dr. Vin Gupta
Bye. Love this video.
- [56:43]
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