U.S. Surgeon General Dr. Vivek Murthy: Efforts & Challenges in Promoting Public Health

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford school of

medicine today my guest is Dr vivc

Murthy Dr vivc Murthy is a medical

doctor and acting Surgeon General of the

United States as Surgeon General of the

United States Dr Murthy oversees more

than 6,000 dedicated Public Health

officers whose job is to protect protect

promote and Advance our nation's Public

Health Dr Murthy received his bachelor's

degree from Harvard University and his

medical degree from the Yale University

School of Medicine today's discussion

covers some of the most important issues

in public health not just within the

United States but worldwide including

nutrition and the Obesity crisis as well

as food additives and why certain food

chemicals and additives are allowed in

the United States versus in other

countries we also discuss mental health

the youth mental Mental Health crisis

the adult Mental Health crisis and the

global crisis of loneliness and

isolation we also talk about corporate

interests that is whether or not big

food and big Pharma Industries actually

impact the research Andor decisions that

the US Surgeon General takes in his

directives toward public health and of

course we discussed some of the major

public health events that occurred over

the last 5 years and the current and

future landscape of how to restore Faith

both in public health officials in

public health policy and science more

generally by the end of today's episode

you not only will have learned a

tremendous amount about public health

and why you hear the particular Public

Health directives that you do but also

how to better interpret future Public

Health directives you will also come to

learn that as Surgeon General Dr Murthy

has both an extremely challenging job

but one that he meets with a tremendous

amount of both rigor and compassion

before we begin I'd like to emphasize

that this podcast is separate from my

teaching and research roles at Stanford

it is how however part of my desire and

effort to bring zero cost to Consumer

information about science and science

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and now for my discussion with Dr vivc

Murthy Dr vivec Murthy welcome thanks so

much Andrew and please call me vi I'm

informal okay VI my understanding based

on my internet search is that the role

of the US Surgeon General is to provide

scientific information on how to improve

health and reduce risk of illness and

injury do I have that correct that is

correct what are some other roles that

you play that perhaps would not come up

in a a top uh top hit uh Google search

that that I ought to be aware of and

that our audience ought to be aware of

well here's how I I generally explain to

people there there two primary roles the

Surgeon General has one is to engage

with the public and make sure that

people know about critical public health

issues that they so they know what they

are how to protect themselves and their

families this second role of the General

is lesser known but it's equally as

important which is to oversee one of the

eight Uniformed Services in the US

government and that is the United States

Public Health Service many people are

familiar with the Army the Navy the Air

Force we also have the US Public Health

Service which is 6,000 officers they

include doctors nurses physical

therapists pharmacists Public Health

Engineers a whole range of of healthcare

folks and their job is to protect our

nation from public health threats so

when Ebola came on the scene in

2014 in a major way in West Africa we

sent hundreds of officers to West Africa

to set up the Monrovia medical unit in

Liberia to treat people with li with uh

with ebola domestically when there are

hurricanes or tornadoes we dispatch

officers and deploy them to go help

strengthen the social the public health

infrastructure but also to provide

Direct Care we deployed thousands of

officers during coid so these officers

uh I'm incredibly proud of them uh they

could be doing lots of stuff you know

outside government in the private sector

probably making a whole lot more money

and getting a you know working a lot

less hard but they're really committed

to protecting the public health of the

nation so I have the privilege of

overseeing that service as Surgeon

General and those those are those are

the jobs that I've signed up for in this

role got it I was not aware of that role

and if I understood correctly these

people um these Public Health officers

um that presumably are made up of

physician

and licensed psychologists and nurses

and so forth um you said they could be

making uh substantially higher incomes

in the private sector but the work that

they're doing with you is their sole

career at this point they're completely

devoted to that or they're doing this as

a side Hustle No they are full-time uh

government employees and and members of

the Public Health Service their day job

is often in public health agencies where

they're embedded in communities helping

day-to-day to advance public health and

during times of emergency uh we deploy

them uh you know and and they're they're

extraordinarily well trained uh they're

experienced at dealing with adversity

but they bring a combination of skill

and heart to their work and you really

need both to be effective at public

health I'm glad that you mention the

word emergency because in preparing for

our discussion today it occurred to me

that in this uh list of roles that uh

your title assumes that scientific

information on how to improve health

comes first then you mentioned emergency

so what I'd like to talk about first is

Health not lack of Health but Health you

know so often we hear about um the

Mental Health crisis but what we're

really talking about is the lack of

Mental Health crisis AKA mental illness

and rarely do we hear for instance what

constitutes mental health we hear what

constitutes mental illness whereas in

the domain of physical health there's a

lot of information out there about how

to be more physically healthy

cardiovascular exercise resistance

exercise yoga typee exercise Mobility

Etc and of course some people have

physical health ailments and there's a

lot of information in terms of how to

deal with that as well but what I would

like to know before we get into the long

list of issues that uh our nation

confronts um everything from obesity to

food additives to mental health

issues what is going well in other words

in the last let's say five 5 to 10 years

have there been any areas of physical

health and mental health Improvement in

the US at large that we can attribute to

some of the public health initiatives uh

directly so that's a really good

question and let me just also say about

the very first point you raised that

you're absolutely right that we have

operated primarily through an illness

frame when we look at health and in my

mind that's only one half of the

equation right so when we are talking

about physical illness for example uh

you know as a doctor I learned how to

diagnose and treat someone with diabetes

or with high blood pressure or with

coronary heart disease but we also know

that even if I don't have diabetes or

coronary heart disease uh or high blood

pressure even if I don't have any

diagnosable medical condition I may not

be at an optimal level of physical

health right I may not be able to for

example walk around the block without

getting shorter breath I may not be able

to play with my kids because my physical

fitness and stamina is is insufficient I

may not be able to lift my luggage when

I go to the airport because I don't have

enough strength in my body yet I

wouldn't have a diagnosable mental

illness so I think it's easier to

understand there with physical health

that we're not just aiming for lack of

illness we're aiming to optimize our

physical health the same is true with

mental health and I think when we talk

about mental health people think we're

just the sole goal here is to prevent

diagnosable mental illness that is one

goal to both prevent and to manage uh

mental illness when it arises but we

also need to recognize there's a whole

other half of the spectrum where there

people who may not have diagnosable

mental illness but are not operating

optimally in their lives and that's

detracting from their fulfillment from

their functionality like in not just at

work but also in their communities and

in their families and so I think part of

the conversation that that I want us to

have as a country is about how to

optimize mental health and well-being

and that is includes preventing Mental

Illness but it is much broader and

bigger uh than that alone great yeah I

think it's so important that we

recognize that um treating disease is

critical obviously but that there's a

lot that can be done to improve one's

Health even in the absence of any known

disease and um and you've got all these

officers these incredible Physicians and

uh nurses and uh people at uh your

disposal I My Hope Is that they would

also be accessible for and currently

carrying out um efforts to transmit

information to people about hey here are

the things that you can do every day

every week every month in order to make

your life as as healthy as possible um

as well as you know rushing in under

conditions of you know Public Health

crisis yeah it's a good good point and

it's certainly you know many of our

officers do focus on this broader rubric

around well-being but it's part of how

we need I think the the broader health

system and public health system to

operate even outside of government

and this I think will require

significant change and shift in how we

think about our jobs like when I went to

medical school the vast majority of the

focus was on diagnosing and treating

illness it was much much less focused on

thinking about how to enhance

well-being and when you ask talk to

people in their lives it becomes clear

that they want to do more than just

prevent diagnosable illness they they

want to be able to walk their their

child down the aisle they want and have

the endurance to do that they want to be

able to uh be independent often and

carry their groceries or carry their

luggage um this is why I think we've got

to broaden our focus in in public health

and look when I came into this role um

by the way I was not expecting to serve

in government this was not part of some

5 10 30 year plan uh when I was a a kid

I was interested in medicine but I

always thought I was going to practice

medicine you know like my dad did and

like my like the clinic my mom ran you

know set up put up a shing sing Le see

patients and uh be a primary care doctor

and and feel good about the work I was

doing but what happened to me along the

way is uh you know I I trained in

medicine I got interested in technology

spent seven years building a technology

company uh that was focused on health I

got I was I became increasingly worried

about the way we were delivering

Healthcare and it felt like our

healthare system was broken people who

needed care couldn't get it it was often

too expensive to get care we were

focusing on treatment solely and not

enough on prevention so I started

getting involved in in advocating for a

Better Health Care system with doctors

around the country when despite all that

I still never thought I would work in

government but in 2013 uh is when

President Obama's team had reached out

to me and asked if I'd be interested in

considering the position of Surgeon

General and what was interesting to me

about this position is it's actually

very different from most positions uh

that are appointed by President and

government and that it's supposed to be

an independent position so my agenda the

issues I choose to take on are not

determined by a president or a party

they're determined by science and the

public interest uh and that's what's

what guides me you know and that's what

that's what guided me in that first term

when I served and when President Biden

asked me to come back and serve as

Surgeon General a second time that's

what's guided me here too um so Biden um

is not sending you notes saying hey

could you put some effort into uh you

know getting messages out about you know

Co or could you put more effort into um

getting your team over to Maui to deal

with the you know the you know the

tragedy there and which is a long Arc

tragedy right we get the news in a in a

in a blast of this happened and then the

next blast comes in about something else

and we forget that there are physical

and mental health crises that are

ongoing um and and then I have to

imagine then start to overlap with one

another or is it so is it your decision

um where and how to deploy the financial

and and Human Resources like okay we're

going to put 10 people on Maui yeah

we're going to um put uh you know five

people in the Central States you know

going around talking to um major

organizations about what they need to do

to prepare for this winter is that how

it works or are you getting memos and um

in other words who's your boss everyone

has a boss at some level mine are is are

the listeners of of this podcast at some

level I work for them it used to also be

my bulldog

um but my my boss my wife and my two

kids who are five and seven they I do

what they tell me to got it got it so um

but how we make our decisions in the

office actually it's a bit different uh

with those two roles so on with with the

second one with overseeing the

commission Corp our 6,000 officers they

the the decisions about how and when we

deploy officers are collaborative right

so I you know we work with other

colleagues throughout the Department of

Health and Human Services we work with

people in FEMA across the administration

but we also work with States so

sometimes states often often States will

put in a request and say hey we need

support here uh can you help so we'll

work with colleagues across our

department to say okay well we can

mobilize our commission core officers

what assets can you mobilize and then

collectively we will send a team out

there so for example we have officers

helping in Maui right now uh

particularly with mental health needs uh

which are I worry only going to continue

to grow over the weeks and months ahead

on the other side of the house when when

it comes to deciding which issues we

engage with the public on like in this

case mental health has been a big Focus

uh area for me on on that front well we

certainly you know are open to

suggestions from the public members of

Congress sometimes say hey can you help

the public understand about this issue

you know a lot of people have ideas and

opinions but the decision about which

issues to focus on those are our offices

uh and to me that's important because

part of the reason over time I believe

the public came to have some degree of

faith and trust in the office office is

because they hope that the office was

functioning the way you hope your doctor

is functioning which is being an

independent source of information for

you uh and a source that has your best

interest at heart that's not being

pulled aside by political interests or

by other agendas but the primary agenda

is how can I help your health and so for

me like we have to make an independent

assessment there and say okay where is

the need uh the greatest tier where can

we make the biggest difference sometimes

we may not build an initiative on an

issue and that doesn't mean that that

ISU is not important or that it's not

affecting a lot of people but we have to

make hard decisions about where to put

limited resources and so when I was a

Surgeon General the the first time one

of the big areas I focused on was the

opioid crisis uh that we were dealing

with as well as the E ecigarette use

among youth because we were seeing a

dramatic increase uh among kids in

ecigarette use that was can I just ask

you sorry to interrupt but I think it's

relevant here um has that increase

continued or ecigarette use AKA vaping

yeah yeah so we still see unfortunately

there there's been some improvements but

we still see way too many kids who are

using uh vaping devices early on and

part of what we did from our office is

recognizing that we actually issued the

first Federal report on ecigarettes and

youth uh we call the country's attention

to the fact that this is a crisis we

worked with members of Congress uh to

talk about the kind of action we needed

uh from a legislative and Regulatory

perspective and worked with colleagues

at the FDA and in government as well but

there are two things that are really

most important in guiding our choice

about priorities uh one is data we look

at what the numbers actually tell us

about the impact these issues are having

on the population as well as the

trajectory of Rise if something's

getting dramatically worse and people

don't realize it might be an area for us

to focus but the other critical factor

is what I hear from people on the road

so I try to spend as much time as I can

visiting communities across the country

doing Town Halls meeting with uh

community members and just trying to

frankly just listen to what's on their

mind and that's where I actually get a

lot of information as well that tell

like that's actually how I came to focus

on the issue of loneliness and isolation

it wasn't because it popped up in a

report uh as being uh the the leading

public health issue in the country it

was because everywhere I was going in

2014

2015 whether I was talking to college

students talking to retired Americans

talking to parents in rural areas and

urban areas I kept hearing these stories

about people who felt like they were on

their own or they felt invisible or they

felt if they disappeared tomorrow no one

would even care or they felt like they

just didn't belong and it's

heartbreaking to hear that from anyone

it's particularly heartbreaking to hear

it from kids uh who you hope are

entering life and looking forward to

what comes uh but many kids weren't

feeling that

way that is very useful context and we

will get back to the isolation um crisis

um such an important initiative that

that um I just will thank you now for

having put out the the message on social

media and elsewhere um about that um

because I think one of the questions I

have in light of what you just said is

it's clear that you got your ear to the

ground you're talking to different

people um it's also critically important

that people hear from you and know um

not just what's happening but that you

perhaps want to know what uh you know

where the issues lie and what the um

what the actionable steps are that

people can take right and I think that

we now live in a hyperconnected world um

so you know in fact I'll just say that

one of the reasons I launched this

podcast is in 2020 I was going on

podcast talking about things like

maintaining sleep and circadian rhythm

and stuff from my lab related to trying

to um adjust anxiety under under

conditions where I think everyone was

anxious and sleep rhythms were disrupted

Etc um and I was somewhat surprised that

that I didn't get a warning on my phone

hey make sure you're getting morning

sunlight you know like I I'll get a

flood warning uh you know I'll get a

warning that I might get a warning but

it's only a test warning I'll get three

of those yesterday living here near the

coast but um I don't think once during

the pandemic did I get a email or a

public service announcement saying hey

you know if you are going to be indoors

a lot you're going to have to be mindful

of maintaining your circadian rhythm

because if you're not I we know based on

hundreds of studies now that drifts and

circadian rhythmicity are a precursor to

mental health issues I mean in fact

there's a new idea that many not all

suicides um are preceded by a period of

disrupted sleep which is you know kind

of makes sense in in um and it's not uh

causal of course but how come during the

pandemic we each and all as US citizens

did not get

an email or a text message saying hey

these are five things that you need to

do every day to try and stay as stable

as possible in this very uncertain

landscape that we're in well it's a

really good question and and I think

it's a it's a

reasonable and a very good suggestion to

say that hey look there should be a

clear and comprehensive way that we can

get messages out to everyone um like if

we were working in a hospital system and

there was a safety issue that came up

there would be an email sent to all the

hospital staff members saying hey this

is something you need to be aware of

right so I think it's a reasonable

expectation uh practically if you go

back though over the last 20 30 years

for on a on health issues there hasn't

been sort of an agency or an entity that

has sent emails out to everyone first of

all how to send an email out to everyone

in America is not a simple proposition

either technically it's challenging

there's some legal issues you'd have to

deal with as well but you could do a

night where you go CNN Fox NBC ABC New

York Times Wall Street like you could

hit the right the the right wi the left

wing and everything yeah that's a really

interesting suggest like one but one one

video just where they all agree like hey

this is important information so a

apolitical like no yeah so I would say

that that kind of messaging I would say

through traditional media certainly has

happened you know and it happened during

coid uh it happened for example when um

you know during the first year of coid I

was a private citizen you know in the

private private Administration but I you

know I watched both then and at the

beginning of the the Biden

Administration um many officials would

go out in front of cameras and say here

are three things you need to do to keep

yourself safe uh you know from from coid

as and that was a big question people

had how do I keep myself safe okay here

are three things you can do a couple of

challenges I would say here is that

number one even if you hit all the major

Network and cable news shows

you're still not reaching everyone right

because we're living in a in a society

where increasingly people are not

watching TV right they're getting their

news from other sources um the other

thing uh that's important to know is

that attention shifts quickly you know

in traditional media also from issue to

issue and so you might get a clip you

know out at a certain uh day or you

might get on all the Sunday shows for

example but the next day you know that

message isn't necessarily there you know

it's it's gone and people's attention

has also switched off too so there were

I mean I can count and you know we've

logged probably thousands of interviews

at this point that we've done with

mainstream media with sort of you know

concise messages about three things you

can do to protect yourself Etc and you

know I'm glad we did those we got to do

them but I think one of the things we

they don't we don't have right now in

the country and this is an I think a bit

of an Health infrastructure challenge is

we actually don't have a quick efficient

way to reach everyone in the country

with a health message just like what you

you said you know what if you wanted to

get that message about three things to

protect yourself from let's say coid or

three things to do to you know support

your health and well-being during a time

of Crisis or during a time of Health I

mean again like not just the flood

warning but the the the daily because I

I do think that most of mental and

physical health is the result of daily

practices that are you know that build

on themselves sort of like compounding

compounded Investments and then of

course there are acute challenges and

chronic challenges that people face but

things of that sort too I I I think

those kind of messages in time of Health

are are absolutely important as well and

uh you know I think I think in the sort

of I think fast-paced crisis-driven

environment that we live in uh

unfortunately people are often less are

paying less attention to those

maintenance and Improvement messages

than they are to managing the crisis

messages but I think that they're

equally as important but I do think that

what you're pointing out is an

infrastructure piece that that needs to

be built which is a way for uh you know

Health authorities to reach people you

know with information quickly and

comprehensively uh I'll just tell you

that in the 1980s when C ever coup was

Surgeon General one thing that he had

done done which was interesting is he

had actually sent a letter a physical

letter uh to all households in America

about HIV a physical letter a physical

letter some of our listeners won't know

what that is yeah so thing you read

about in the history books or something

shows up in your mailbox and you open it

and um hopefully something you want to

read this Cas this case he was worried

about HIV about the fact that people

didn't know about it so he worked

through

an with as I understand it with a member

of Congress found you know a way to do

this from a funding perspective but it

was a very unusual move uh and one that

was never replicated since and there was

never infrastructure or funding to do

that again um when I was Surge General

last time you know you know some years

ago and then this time around one of the

things I did do is I was able ble to

send a physical letter to the medical

community uh the first time it was about

the opioid use crisis and about changing

our prescribing practices in medicine so

that we expose fewer patients to the

harm of opioids while making sure people

who needed them actually got them and

the second time it was about coid

Therapeutics it was about making sure

that when we had data about medicines

that actually work like paid that we may

actually offered them to patients made

them available to patients because we

were realizing that many people weren't

getting offered life-saving medic

iations even though they were in high

risk groups um so we were able to find

you know and we had to again there two

had to sort of creatively Cobble

together resources funding this is all

sort of you know sort of behind the

scenes government stuff but the the

bottom line is in in what you want in an

emergency uh and what you want I think

in the long term is a simple clear

comprehensive way that public health

messages can get out to people and to

this day what we still have to rely on

are one traditional channels like you

know traditional media to cover the

initiatives we put out whether it's on

social media and youth mental health or

on loneliness or on youth mental health

more broadly uh we will have to rely on

online channels uh which which we do as

well or we have to look to creative

Partnerships that we build with people

who reach different audiences and then

together uh we try to get out messages

our office does all three uh of these

but uh it's a patchwork uh and and you

know and it's not always ideal but it's

what we do now I think part of what this

reflects is a broader challenge like in

government but also in society more

broadly which is that we have valued

historically prevention and health

communication very little we put the

mass majority of our resources into

treatment strategies into getting

medications to people into diagnosis and

that's very important don't get me wrong

but we are now seeing with mental health

just as one example that if we only

focus on expanding treatment and

deepening our well of knowledge there

and we don't do anything to help people

stay well that we just can't keep up

right and right because one problem

feeds the other the kids that are stay

listen I if I would grown up in today's

era I'd be on my phone and tablet late

at night because I was up reading

magazines and talking to friends on the

phone late at night right so it's not a

criticism but but you know disruptions

in sleep disruptions in circadian rhythm

disruptions lack of physical activity

poor nutrition social social isolation I

mean these are all piling the sand much

higher on this in this other side of

what you do in terms of and here I'm

obviously stating the

obvious you know so it's just going to

create a mountain of issues on the other

side which presumably has a larger

budget is what I'm sensing but doesn't

um but there's no way that budget is

large enough to deal with that I mean if

somebody's kid for instance is um trying

to address the issue of whether or not

to go on prescription

medications and or by the way folks and

or change their dietary intake because

they feel they might have ADHD for

instance I mean what are they going to

do they're going to Google they're going

to listen to podcast that they they

should be able to write first to your

organization and say you know what is

the highest level

stringency data say about these issues

and AI should be able to tell them

accurately yeah and maybe you have

somebody chime in for them I mean we all

pay taxes

I pay federal and state taxes um me too

and and and to some extent happily so

right um because it pays for public

works and and many many important things

police officers firefighters Etc but if

you don't have a channel to communicate

with people about what they and their

kids and their relatives can do

then like to some extent it feels like

it it's um it's a culde saac it's like

how how how how in the world can we get

healthy again or healthier as a as a

country the part that keeps me up at

night is and one of some of the hardest

decisions I have to make in the office

are putting aside issues that we know

deserve a lot more time and attention uh

but we just really don't have the

resources to deal with you know the

issues that we have dealt with I'm

certainly proud of my team that we

worked hard to try to raise awareness of

the issues we have taken on whether it's

around you know social media and youth

and mental health or whether around

isolation or clinical clinician burnout

or other issues like that but the truth

is that that there's more that needs to

be done more issues that need to be

tackled and we have to get to a place

where we can uh you know talk about what

I think of as the core pillars of a

healthy life right which are sleep our

nutrition our physical activity our

social relationships like these are all

vital elements to living a healthy life

right now we're not teaching kids about

this in school right but if you think

about education uh and school

as a place and a force that should PR

prep kids for the rest of their lives

they should lay a foundation for a

healthy life going forward these

absolutely are important elements for

kids to learn about I I think it's as

important for kids to learn about how to

build and maintain healthy relationships

in their life as it is frankly for them

to learn how to read and write and I

know that's a strong statement to make

but it is true in terms of its

contribution to their their happiness

their fulfillment their health and their

success yeah I I I could not agree more

uh we have a series that's out now with

a psychiatrist Paul kti about mental

health not mental illness about

self-inquiry and how to use self-inquiry

and practices that do not require uh a

therapist in order to bolster mental

mental health um of course therapists

can be very useful but not everyone has

access right and not everyone feels

comfortable doing that um but we are but

one channel I mean you are the governing

body for this um you're the Army uh Navy

and Marine so to speak of of Health as

many of you know I've been taking ag1

daily since 2012 so I'm delighted that

they're sponsoring the podcast ag1 is a

vitamin mineral probiotic drink that's

designed to meet all of your

foundational nutrition needs now of

course I try to get enough servings of

vitamins and minerals through whole food

sources that include vegetables and

fruits every day but often times I

simply can't get enough servings but

with ag1 I'm sure to get enough vitamins

and minerals and the probiotics that I

need and it also contains adaptogens to

help buffer stress simply put I always

feel better when I take ag1 I have more

focus and energy and I sleep better and

it also happens to taste great for all

these reasons whenever I'm asked if you

could take Just One supplement what

would it be I answer ag1 if you'd like

to try ag1 go to drink a1.com huberman

to claim a special offer they'll give

you five free travel packs plus a year

supply of vitamin D3 K2 to again that's

drink a1.com

huberman there's lots more to explore

there um we may have to do several uh of

these together but um to touch on all of

them but maybe we could um talk about a

few of the things that um our

listeners asked about when I solicited

for questions I got more than 10,000

responses across social media in a very

short amount of time but there was some

redundancy um one of the things that I'm

very curious can I just say on that

point though and one I'm really glad

that you asked uh folks to submit

questions and it was really excited to

see how many people actually wrote in uh

but I think it's also just a testament

to how you've done such an incredible

job building a channel to the public to

let people know about these topics that

you know that are so vital to our health

and well-being whether it's sleep or

physical activity or mental health uh

and so I just want to thank you for all

the work you're doing trying to help

people understand more about health and

clearly the fact that that folks are

engaging they're sending questions and

they're sending comments to you means

that you're building a relationship

there with a lot of folks so just kudos

to you for doing that well thank you the

the audience of the huberman Lab podcast

is is the only reason we do it I mean I

love learning and teaching but um that's

the truth so they are the podcast um the

podcast is them um so thank you for that

uh there were a lot of questions and I

also wonder about why is it

that many food

additives and preservatives and dyes and

things of that sort that are not allowed

in Europe are allowed in US Food

Products it's a really good question and

decisions around food and food safety in

particular are made by the Food and Drug

Administration so that's the FDA uh it's

not it's a separate agent independent

agency it's not one that our office uh

is involved in then sort of directing in

any way uh and so we're not involved in

those decisions and don't have insight

into how they're making their drawing

their conclusions but uh they do it in a

process just that's you know Guided by

science just like they do with

medications with devices Etc with that

said you know I am concerned

that dietary practices the food that

many Americans are consuming are in fact

not supporting their health and

well-being and in many ways are

detracting from it uh when we look at

highly processed foods one of the

concerns I have there is we often see

sodium content is very high we see the

sugar content uh is very high and you

know there are certainly additives in

there as well U that I think we I would

love to have more data on the actual

Health impacts of those but the bottom

line is that a significant portion of

our diet uh is comprised of Highly

processed foods in America and and that

worries me the AL other piece of this

that worries me are just how much you

know refined sugars are being added to

so much of our foods and most people

think that sugars are only added to

things like desserts Etc but you look at

spaghetti sauces salad dressing salad

dressings a lot of these things which we

think of as Savory products have have

sugar added to them as well and so we

are

consuming I think unhealthy levels of

sugar in our diet we're consuming a fair

amount of additives given the processed

food composition in our diet and I think

part of the reason this is happening and

I want to be very clear I don't fault

individuals out there for the

composition of their diet necessarily

because we have also made certain

decisions in our country about uh what

we subsidize about what's cheaper and

more expensive for people and the

cheapest Foods unfortunately are often

the most unhealthy Foods the most highly

processed foods uh if you are somebody

who lives in a low-income neighborhood

number of these neighborhoods don't even

have grocery stores in them which is a

you know a tragedy because you can't get

fresh produce Etc a lot of times your

shopping your grocery shopping may be

done at a local convenience store uh at

a 7-Eleven or at you know or somewhere

else that may not have like the array of

of fresh fruits and vegetables that you

and your family need I don't even think

they have vegetables I think they have

they'll occasionally have some lemons or

apples or oranges and bananas but when I

walk into a convenience store what I see

as a pharmacy I really do I see alcohol

caffeine energy drinks that have a

number of different things in them

designed to stimulate different

neuromodulators like dopamine and

serotonin I see nicotine products I see

high sugar high highly processed foods

and keep in mind I was a teenager I mean

I drank my Slurpees I had my butter

fingers you know I wasn't you know Bart

Simpson like in my lovely butter fingers

but I liked them but but it was it was a

smaller fraction of of what we ate and

when we were at home those Foods were

either not available or we weren't we

certainly weren't allowed to eat them

and um at libum you know um okay so

what's clear to me is that the FDA makes

decisions about what is safe what's not

safe but for

instance okay this last year there were

several papers published in highquality

journals showing that if people

eat just High just Sweet and Savory

Foods combined that neural in the brain

rewire through process of

neuroplasticity that drives increased

appetite and changes the response to

healthier food so that they don't taste

as as satiating okay that's sort of a

duh to a lot of people but I think it

was an important set of findings because

it said the brain actually changes in

response to the um the very uh Rich

flavorful foods that are associated with

with highly processed or even moderately

processed foods okay I mean

um that's just a couple of studies um

there was nothing in those studies that

said if you eat these Foods you're going

to develop cancer but you know at some

point one has to as a citizen a

taxpaying citizen speaking on behalf of

many other taxpaying citizens I have to

sort of take a step back and say how

long do we wait right do we have to get

a randomized clinical trial about the

you know the you know the five 100,000

sick kids that grow into sick

adults um and then run a trial where

they go on a an Elimination Diet where

they're eating only unprocessed vegan or

unprocessed meat and vegetable or

unprocessed you know starch and

vegetable but I mean I mean then we're

talking about a 30-year Health crisis

before we intervene why not I mean if I

were in charge which I'm not and clearly

I wouldn't survive in a government

organization because um well I've got

the uniform down um I always wear the

same thing but um a uniform but I

wouldn't because I would want to say

wait you know why not a on the side of

caution why not send out this AI

generated text message that tells

everybody in all the languages that

Americans speak and can understand hey

you get to make choices about what you

eat but you should be aware that um

making your diet comprised of more than

15 to 20% of these Foods is potentially

going to lead to serious issues down the

road and those serious issues are

extremely serious I mean the Obesity

crisis is really a crisis of both body

and brain metabolic challenge um that we

can talk about so you know who sets the

thresholds you know in other words why

is it that in this country we have to

wait until people start to get really

sick and dying and really struggling

before something is done in the

direction of their health and I'm not

blaming you I just want to understand

because um good question the the wealthy

people I know care a lot about their

food sources and they pay a lot of

attention to it and why aren't we

allowing everyone the opportunity to

make better choices so this is the right

question and this is something I I think

about a lot because I'm conscious about

what I eat but I also talk to folks

around the country and realize a lot of

people don't have either the information

uh or the resources to actually purchase

healthy food right and to know like

what's going to be good for them and for

their families this is why you know I

mentioned we have a list of issues that

you know we would work on you know if we

had more more more resources this is

actually one of them because to me one

of the most common questions people ask

is what should I eat

that's simple but it's it's vexing it's

complicated it's incredibly confusing if

you go online and just try to search for

information and it's a classic example

of where it's important to have an

objective

scientific Authority that can come and

then speak on Broad principles around

diet that can talk about what we know

and don't know so here's important thing

I think a lot of times people may see

something as uh you know on the market

they might read list of ingredients they

don't recognize how of them because

they're additives but they figure well

if it's there then it must have been

studied for 30 40 years and there must

be no harmful consequences right but

sometimes things are are put out there

because we have short-term data that

says that they're okay and there might

be uh but there may be a need for more

long-term data helping people understand

what do we know what do we not know is

important so that people can make

decisions for themselves based on how

much risk they want to take the other

thing that that concerns me here Andrew

is I look I I have I'll tell you I have

a bias here and my bias is that I am

worried about the you know additives and

other products we have in food that

don't have long-term data uh that's

clear in terms of health risk and so

because of that like my bias is

generally to think how can we get people

uh you know minimally or less processed

foods and how can we get them more

fruits and vegetables how can we make

sure that they have that more available

to them but we've got to not only make

the information available but we have to

make it accessible from a cost

perspective if you don't have a grocery

store in your community if vegetables

and fruits cost 3x what other foods do

that's going to be a problem right to

change diet the other thing we have to

keep in mind is that you know food

companies you know a lot of them do a

great job of actually trying to get

healthy nutritious food out to people

you know and kudos to them but I worry

also that there's an incentive also to

just try to sell more and more and more

of your product and one of the ways to

do that is to try to hack uh the body to

kind of figure out okay well what kind

of synthetic additives could I put

together here or what kind of uh

combination of nutrients could I put

together that will get people coming

back for more and more and more and we

saw this in the nicotine industry you

saw the Nick industry you also I would

say another parallels you see it in

social media as well where the business

model of the social media platforms is

built on volume of use right how much

time am I spending on the platforms it's

not quality of time it's quantity of

time right so if that's the business

model then you're going to design your

platform to Max maximize how much time

someone spends on them regardless of

whether it's detracting from sleep

detracting from inperson interaction

detracting from anything else it's

healthy regardless of whether that may

be causing certain harms right like the

business model dictates you know in many

ways how these things are designed and

that applies I think to food as well so

which is why I think it's incumbent upon

us to be particularly cautious uh with

highly processed foods foods that foods

that have additives and to understand

how is this impacting our brain how is

that impacting our satiety

how is it um leading potentially to

Greater ingestion that is healthy and

leading to things like obesity which

have a whole host of other medical

conditions from cancer to arthritis to

diabetes and heart disease associated

with it those are the questions as a as

a citizen as a father of two young kids

who's trying to bring them up at with a

healthy lifestyle those are the

questions that I would want to know the

answers to and it's one of the reasons I

think these kind of objective reports

are so important for the

public I'm starting to see the the scope

of the problem and the mechanics

involved in trying to alleviate these

issues are complex I I I I see that they

are also one other thing that is

important to do that so is you need to

have

authorities that can speak to these

issues that are insulated from political

retribution right so and to explain this

like Amen to that yeah I mean listen as

somebody forgive me for interrupting but

somebody who from time to time will um

make not recommendations but we'll offer

information about potential actionable

items you know things that people could

do or not do according to a couple of

studies that come have come out I mean

have come under intense scrutiny from my

colleagues um who are like wait that's

not a randomized control trial how can

you do that and yet I know from being in

this field for a long time that for

instance the emerging therapies for for

PTSD and depression that are now based

on federal funding for things like um

and I'm not recommending this by the way

for children or for everybody but for

instance the um macro do psilocybin

therapeutically supported uh legal use

of psilocybin for for uh major

depression the data there are they're

not perfect but they're pretty darn good

compared to the major

ssris um but for years if if an academic

said the the words I just said they'd

lose their job almost instantaneously

because they're Controlled Substances um

that's a that's a Todo but then there

are a number of things that we're

talking about here that are just about

making better choices about things to

avoid right if people understood I think

that um is sugar poison well some of my

audience will say sugar is poison it's

as addictive as cocaine look it is not

as addictive as cocaine or heroin it is

not however if a child or adult is

eating very sweet or very Savory Foods

of any kind consistently if those are

not um healthy foods or if they are if

they contain unhealthy additives over

time the brain will rewire so that

healthy foods don't taste is good they

won't be the choices that people make

and you're going to end up with a sick

individual period And I don't think we

need one more clinical trial funded by

federal tax dollars to support that

statement what I'm starting to gather is

that you're a very rational grounded

broad thinkinking individual I'm not

just saying that because you're sitting

here and you're trained in medicine and

you understand the science uh but that

you don't have the means at your

disposal to put out a call that says hey

folks having some sugar every once in a

while treating the kids to ice cream

great but if 80% or more of the diet it

of our kids isn't made up of minimally

or non-processed Foods their brains are

going to be rewired in unhealthy ways

and you can almost expect that they're

going to have some Health Challenge in

the future that may not be um you know

autism or schizophrenia but is going to

be a major Health Challenge of a and

that is serious and Now's the Time to

intervene by avoiding certain things and

if you don't want to do it look it's a

free country at that level you're

welcome to do it but you'd be better off

spending X number of dollars on these

healthier foods yeah because there's

also and we know this from my colleague

Ali crum's laboratory at Stanford that

even the mere knowledge that certain

foods are nutritious can lead to more

satiety from eating those Foods at the

level of hormone release not just

psychologically you're telling yourself

the Orange is as tasty and and filling

as a candy bar but the understanding of

of the fact that it is nutritious

actually leads to shifts in patterns of

of you know grillin secretion Etc that

that change so people can be feel better

on a healthier slightly lower calorie

nutrient enrich diet of healthy proteins

and fruits and vegetables and it's not a

mind trick it's it's physiology anyway I

I I think um I I feel your pain frankly

and I'll tell you look sometimes people

ask hey why don't you just go out and

say a couple of statements that you just

said would that be fine like why why is

time needed to prep something like that

why are resources needed Etc here's

actually why like I know in today's day

and age it's easy to just go and like

rattle off off you know off the cff

statements or shoot from the Welcome on

my social media channels anytime and

really to get the word out to millions

of people I appreciate that and I may

take you up on that but I'll tell you

that one of the reason one of the things

we always do recognizing that when we

put out statements that people people

one they they trust it's coming from a

scientific Authority and that it's been

vetted right so we put the effort and

time into vetting this thoroughly we

check sources we look at the data we

talk to experts we think about how to

communicate this in the right way that's

the work the behind the scenes work sure

uh that we do before we put out sort of

reports and and initiatives because we

want people to have confidence you know

in in what they're hearing we also know

that when we put out initiatives that

other people build on them

philanthropists you know and and

foundations will then think about should

I fund work in this area uh you know

schools and workplaces will think about

shifting some of their practice policy

makers will also think about legislation

uh that they may uh want to design based

on that so we want to make sure it it's

really solid but the point I was making

when I said also that we have to make

sure that not just our office but folks

who are you know in public health and

who are in medicine who are trying to

speak to the public about their health

that they're protected from retribution

and taxes this is what I meant which is

that saying things about diet saying

things about

tobacco these can be challenging for

some folks because there are Industries

built around these right which may not

always like what you have to say uh if

it hurts their business model or their

bottom line and they may then lean on um

political leaders elected leaders others

to then try to silence you or or shut

you up and I'll tell you I've

experienced this in the past you know

when I was Surgeon General during my

first term I had issued two uh key

reports one was on alcohol drugs and

health about the addiction crisis uh and

the other was about the ecigarette

crisis among youth I will tell you that

there were plenty of people who were

very unhappy that I was issuing the

First Federal report on ecigarettes um

folks who felt that hey um this is going

to make folks unhappy it's going to

create political pressure uh it's going

to create a lot of problems uh similarly

with alcohol drugs and health there are

many folks who said hey if you do this

you're really going to upset the AL alol

industry do you really need to have

alcohol in the report why don't you just

focus on other drugs um why don't you

take alcohol out of the title you know

all of these sort of you know concerns

telling you this who so these are people

who get paid by the alcohol industry no

these are people in government who are

reading the te leaves and who who are

supportive of the work we're doing but

are saying hey like you're going to

really upset a lot of people in industry

and you're also going to help a lot of

people yeah well this is what it comes

down to they say well and if you upset

folks then they're going to try to fire

you they're going to try to do all these

things to which honestly like my my

response to a lot of these and the

reason we just put them out anyway was

because I said well the worst thing that

can happen is I get fired and that's

okay you know if I if I go out knowing I

did the right thing here then I'm fine

with that I'm not looking to build a

lifelong career in government I'm not

doing this job to like you know get to

the next thing on the ladder like this

is about serving for the time I can I

want to be able to go to sleep at night

look myself in the mirror and know I did

so with Integrity um so that was an easy

decision for me but but my point is that

like we have to be thoughtful that in

these issues that there are going to be

headwinds right I'm sure in your case

for example you've probably gotten push

back from folks about talking about

certain things that may have rankled

folks who may have had an interest in

those issues and that's okay you keep

talking about them as as you should and

I'm grateful for that um but this is

especially important at a time where I

think public trust in our institutions

more broadly and in science and in

medicine medicine have taken a hit over

the last few years and I think it's a

time where we have to be even more

Vigilant those of us in medicine and

public health to make sure that what we

do is based on data that we're

transparent about why we're saying what

we're saying that we're also clear about

what we know and what we don't know so

that if recommendations change over time

people recognize that this isn't

necessarily flip-flopping you should

change your recommendations if the data

changes uh if the circumstances change

so uh anyway this is all part of the

work that we've got to do but to me this

is a really important part of the work

the Integrity behind our work in public

health is not just about the issue we're

taking on today it's about the trust

that we need to rebuild uh in the field

more

broadly so if I understand

correctly if you were to for instance uh

put out a call that says look you know

there are food additives that are

allowed in the US that are not allowed

in Europe that may be of risk we don't

have enough data at present to say to

avoid these things but here's a kind of

a yellow zone you know you Green known

to be safe red clearly known to be

unsafe yellow we just don't know yet not

enough data um so here's what my

recommendation would be for my children

yeah it's free country you know um there

are people that argue it's not but at

least at the level of which foods you

want to buy with your own budget um it's

it's a free country so you're saying

that um you get messages that warnings

about certain things could lead to push

back but if I have to imagine that

there's something and I'm not a

conspiracy theorist but there has to be

either the people that are saying look

there could be problems are just

friction averse they're just don't like

anyone to be angry at anyone or um there

there must be some incentive for things

to remain quiet I mean I mean certainly

the government has not had problems

saying uh to do things or to not do

things that had uh that upset companies

or shut down companies or or elevated

companies and their success so I I'm

conf I'd like to know more about the

back Contour of this well look I think

and this is not too dissimilar for I

think what happens in in other

Industries but it's you know whenever

you you do something in whether it's in

the private sector or in government

people we what what are the pros cons

what's the push back I'm going to get

how do I deal with that push back right

uh and push back isn't always a bad

thing right if you get push back from

the public people hey that doesn't make

sense to makees that's you should listen

to that and and use it to inform your

approach but that's the public whose

your job is to serve I'm talking about

push back from companies is is different

right so when push back comes from

people who have a financial interest uh

in the product that you may be

commenting on then you you've got to be

you need to know about that number one

so that you know how to how to mitigate

it and while people may take different

approaches to this my Approach as a

public official as Surgeon General has

been to say at the end of the day like

I'm happy to to hear from anyone and in

terms of their concerns or push back but

at the end of the day what's going to

guide my decisions about what we issues

we take on what decisions we make and

what we say to the public is going to be

what is in driven by science in the

public interest and if that means it's

politically inconvenient that's okay if

that means that you know something

happens you know to my job that's okay

too you know like we look the bottom

line is life is short we don't know how

much time we have here we may as well

make the time we have count we as to do

the things uh that are right and that

are going to serve people that's my

simple philosophy my parents taught me

when I was growing up so that's the

approach I I bring to this and that's

why if we were to do let's say an

initiative on diet I have no doubt that

some of the things that we would say

would be perturbing uh to folks who had

a financial interest in the industry

because I don't think that the current

setup in the industry is serving the

public well uh I I think we have made

unhealthy Foods cheap that's a problem

we've made healthy foods expensive

that's a problem we put Health from a

dietary perspective Out Of Reach for

millions of Americans that is a

fundamental problem and we've also

disempowered people with by not giving

them the information that they need to

make decisions so even if you have

resources I guarantee there are people

listening to this podcast and many more

people out there who go to the grocery

store and just feel confused like what

on Earth should I buy what's healthy

what's okay anymore um it's just hard to

know and so I think we've done a

disservice by not doing more to help the

public understand and access healthy

foods and again it's why it's an issue

that

you know that that was on our list of

issues that we would want to work on

because I think that the public health

need here is is

immense I'd like to just take a brief

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huberman I have a question about trust

in big institutions and public health

initiatives in general um the question

is about masks um early in the pandemic

as I recall we were told that masks were

not necessary then we were told they are

necessary and I think for a lot of

people that flip in messaging um landed

like a parent telling their teenage kid

to always wear a seat belt but then you

look into the front seat and Mom and Dad

aren't wearing seat belts and as anyone

who's been around teenagers there has

been one you make that mistake once

you're not making it again and you may

never recover from that particular

example in other words the public felt

like there was a switch of messaging but

what I don't recall happening was a like

a hey we got that one wrong so sorry on

us MH you know what the new data say

blank what I recall was a message of

don't and then do but there wasn't a lot

of um kind of acknowledgment of of how

challenging the situation was it was

just a lot of top down

mandates and in my opinion and this is

just my opinion I think that led to a

pretty rapid distrust of subsequent

messages from which we still haven't

really recovered um and

so why do you think it's so challenging

for public facing officials to just say

look doing the best we can at the moment

screwed up

before changing the message now may

change again we're navigating this in in

real time it's Dynamic yeah please stay

with us because you know goes without

saying there's been a huge Chasm around

this and related issues yeah look this

it's an important question and look I

I'm always I want to be thoughtful about

um you know how I comment on what was

done in the first year of the pandemic I

was I was a citizen I was outside

government and I don't know what was

happening inside government in terms of

the the decisions that were made made

there but I do know sometimes from my

experience in Ebola and in zika during

those uh experiences we had as a country

that in the you know in the fog of War

when everything's coming at you

sometimes it's hard to make the right

decision all the time right so I I want

to give some of those folks who were

there uh you know in the first year of

the pandemic you know some benefit of

the doubt but I do think that the

important thing uh the principle I I

certainly try to follow but one I think

that uh and you know we can all do

better I Can Do Better certainly too uh

but I think an important principle for

us in public health communication has to

be that we're

clear that we're transparent about what

we know and what we don't know uh and

that we explain the why to people so if

we're telling someone to do something

why is it because there's a lot of data

behind it is it because it's a sort of

expert agreement best practice because

sometimes as you know in in medicine

sometimes when we don't have enough data

to guide us on on a therapeutic approach

but when the problem is imminent then

sometimes experts will get together and

put together expert inform formed

guidelines to say okay look based on our

best judgment and the limited data we

have here's what we would recommend and

as the data evolves we will change you

know and and modify those

recommendations we do that with

hypertension right you evolve and update

recommendations we do that with lipids

um here too I think that has to be like

a key part of the approach I think one

of the challenges that I saw many public

health officials encounter was even when

they went out with Comprehensive

messages like that uh which are hard to

fit into a sound bite or into simple

posts on social media um often a lot of

that wasn't covered what gets covered is

the Top Line you know this is what's

being recommended that's what's being

required Etc all the explanation is lost

it's missing right and I think we also

are living in a time where people are

reading headlines like they're living

busy lives right they're not

necessarily you know always hearing all

of the Nuance you know that's being

explained um but I think that that's a

challenge right is like I know many

public officials struggled with how do

you deliver nuanced information uh at a

time when there isn't a clear black and

white answer to things but I think the

last piece around this is um I think

something I was taught early in medical

school is to approach your patients with

humility recognizing that even though

you have more training than they do uh

you don't aren't living their life you

don't necessarily know what they're

going through and you shouldn't assume

um things about them right and so

approaching with humility means that um

you've got to recognize that not

everyone's going to be able to follow

your guidance and if they aren't able to

that doesn't mean you criticize them it

also means recognizing that people may

have ideas or suggestions for you that

may actually improve your

recommendations or how you communicate

and so I these are the principles I

think that are important in public

communication but I think that both the

challenge of translating nuanced

arguments into what's actually covered

that was tough for many public health

officials I think the other thing

honestly just on a human level that

became hard for many of them and I I'm

thinking particularly about local and

state public health officials who are on

the front lines that I talked to a lot

was they ended up getting attacked a lot

and abused a lot during the pandemic and

I don't just mean like attacked online I

mean people showing up at their houses

people harassing their children uh

people threatening their safety um and

and this was often people who were upset

about some of the requirements that were

being put down from local Departments of

health and you can understand Co was as

stressful a time as we've seen recently

people lost their jobs people were

losing loved ones I mean talk about a

stressful time but I think at a human

level Public Health officials who were

exposed to that kind of abuse and who

started to worry about their children's

safety um many of them stepped out of

the arena and said is this really worth

it to put my family at risk um and that

was hard because we lost a lot of good

Public Health people in that respect so

I think I think in addition to having

sort of these core principles of public

health communication in place I think

what we also need to restore is an

environment where we of frankly of

humility and civility where where we

don't attack people you know who maybe

have different views or are coming out

with recommendations that um you know

are not palatable uh to us and uh and I

think it's also incumbent upon our

leaders in society to not Stoke that

kind of resentment and violence as well

CU that happened during the pandemic as

Co got increasingly politicized and you

know while that may have been at times

done for political reasons here or there

the people who suffered were both the

public health leaders who were trying to

do the right thing for their communities

and the public themselves who weren't

able to have a clear direct channel uh

to and a dialogue with their Public

Health officials uh because a lot of

that ended up getting closed off yeah I

feel like there was a lot of talking

down to the dissenters in the general

public yeah uh and I totally agree that

um you know getting violent or harassing

people with whom you disagree is is

totally inappropriate Andrew the one

thing just to say about the humility

piece and I'll give you an example here

of where I think this could have and

should have been done better is it an

effort for example around masks uh to

recommend that people wear masks and one

important thing just to know is that

when it comes to like schools requiring

masks like those are decisions that are

made on local levels right the federal

government doesn't mandate masks in

schools uh doesn't have the authority to

do that so those are local local

decisions but at the end of the day

there were people who did not want their

children to wear masks right for a

variety of reasons uh some worried about

their develop Social Development some

worried that it was adding stress to

their kids like people had met different

reasons why they may or may not have

wanted their children to wear masks and

one of the things I think that was not

helpful was that when there were parents

who made the decision they didn't want

their kids to wear masks um I think some

of them received a lot of critic iism uh

without people necessarily stopping to

understand why they may have been making

that decision because I'll say as a

parent whose children were in school you

know my kids are five and seven and um

in the first year of the pandemic they

were doing preschool virtually which was

a nightmare it was incredibly hard for

us even when they got back to school in

the fall of 2021 um it was a really

tough like adjustment for them and I

could understand like some of the

concerns that parents uh were having

wondering about hey how are these

precautions affecting my child's

experience and Social Development so on

the whole this the recommendation may

still be uh Hey improve ventilation your

classrooms recommend masking recommend

testing Etc but those recommendations I

think have to be made in a way that

acknowledges like the humanity of people

who are may have a different point of

view or may make a different decision uh

for their child and I know that when loc

localities made the decision in many

cases to require uh schools in their you

know kids in their District to wear a

mask that put some parents who didn't

want that they put them in a hard place

right and but I think that our failure

to actually have an open honest

respectful conversation about this where

we didn't feel like we were uh each

being attacked you know as parents for

our decisions or as community members

for the decisions we were making I think

that not only hindered I think the

response but I think it actually

contributed to this division the sense

of black and whiteness that hey it's us

against them and then suddenly if I was

against one measure then I was against

all of them you know or if I was for one

measure I was for all of them because we

just started segregating into sites uh

and this became a polarized uh you know

experience at a time where really it

should have been a crisis that brought

us together as messy as it was um and

that honestly Andrew is what I worry

about most for the next pandemic right

like I think we've learned a lot from

this pandemic about uh how to

manufacture vaccines and de and how to

develop them quickly uh how to

distribute them uh efficiently uh and

you know we had one one was one of the I

think most historic and and effective

vaccine distribution efforts in this

country even though certainly could have

been better but it was historic by by

all measures um we've learned a lot

about how to do vaccines Therapeutics uh

a lot of the nuts and bolts of a

pandemic response well but I worry what

we are still struggling with is how we

build trust how we communicate with the

public and how we stay together as a

country in the face of adversity because

if we're going to if we're divided the

way we were during coid during the next

pandemic or the next you know for a

threat that may come from a foreign

adversary that's a huge national

security issue for us and so that that's

what keeps me up at night when I think

about the next pandemic that may come

two questions relate to what you just

said first of all um as it relates to

vaccines in my opinion um and I think

the opinion of many people out there

that the response to the next pandemic

um will be heavily contingent

on at least some sort of acknowledgment

that there are people who at least feel

that there have been vaccine injuries

right to Simply say um okay the previous

time round with coid went this way and

now there's now virus X right let's hope

not God forbid but sounds like it's

coming at some point and people are

going to think to the last time and

they're going

to immediately say well the last time we

were told to you know uh take a vaccine

some people had a good experience with

that other people didn't and it in this

empathy model of acknowledging and you

know you know letting your moral compass

guide and understanding the why behind

what people are are are doing and how

they're reacting it seems to me that now

would be the time to at least try and

understand where they're coming from

even if one disagrees maybe even

especially if one disagrees and try and

get people aligned now before the next

pandemic it and um so what efforts are

being made if any to try and acknowledge

um that some people really do feel as if

they were harmed I'm not saying if they

were or not but clearly there are people

who feel that they were people they know

were harmed is there an effort to

present them with data to have

discussions with them to try and get

people aligned so that the next time

around uh we can be more of a unified

front whatever the necessary response

happens to be yeah no it's a really

important question and and to me I

always go back to sort of first

principles from practicing medicine

right which is if there is a medicine

you give a patient and even if it helps

99.99% of patients but this one

particular patient happen to be harmed

by it you go in you acknowledge it you

talk about it and you together TR out a

path for how you want to move forward

and the path forward might be yes let's

get rid of that medication but let's use

an alternative let's try it or we can't

use that medication anymore here are the

risks you may sustain but we'll find

other ways to protect you right so

that's what we would do in medicine

right that's what I've done with

patients over the years I think here too

similarly when I think when it comes to

tracking Adverse Events from vaccines

this is an area where the CDC and the

FDA track and collaborate uh and

tracking means not just not only

collecting reports from the public and

from clinicians when they see uh an

effect that may be related to a vaccine

but it also involves analyzing those to

see were they correlated or were there's

actual causation there right because um

you know if I if today for example uh I

felt unwell uh and I trace back what

happened yesterday and it turns out hey

I ate this burrito that was out in the

the Sun for way too long um the question

is am I feeling sick because the burrito

or did the burrito just happen to be you

know a you know something that happened

but it's independent of how I'm feeling

um maybe it turns out somebody was

actually sick uh with a GI bug you know

around me and that's the reason uh that

I'm feeling the way I am today so the

analysis that needs to be done on cases

that are reported uh is important and

it's something that the CDC and the FDA

do together now that analysis I think is

essential to communicate clearly to the

public um and whenever I engage with

folks in the public which we do often

and people will talk to me about their

experiences with vaccines I do think

it's important to acknowledge what

people have gone through um like some

people for example like when I got uh

vaccinated for Co for example I I felt

like I had mild flu like symptoms for a

couple of days you know it wasn't great

I would have preferred I didn't you know

have those feelings like you know and uh

then I felt better a couple of days

later and then I moved on but you know I

acknowledge it didn't feel good you know

to to feel that way there are other

people who may have had U experiences

where they felt that they had more

serious uh you know side effects and

there may be a question was that related

to the vaccine or not so I think we have

to both hear and acknowledge those I

certainly try to do that I know I think

it's important to keep doing that across

all of government but I also think it's

important for us to to help people

understand the process that we have to

go through to understand whether those

are related or not if you go online and

the cdc's uh site where they collect a

lot of this information and you just

purely look at reports that are given of

potential adverse effects

that you can't sort of take that and say

ah those are all related to the vaccine

look at this rate of harm it's

extraordinarily High because we don't

actually do that with any other vaccine

or medicine right sure we we start there

we do the analysis and we try to

understand what's actually related or

not so I think that's that's what we've

got to do here too one last thing I'll

say is that it's important I think also

for us to to help put this in context of

other vaccines and medicines and

interventions that we use so for example

just take Tylenol for example like most

people think oh well Tylenol it's safe

there's nothing bad happens if you take

Tylenol Etc but people who track the

data know that Tylenol by and large is a

generally speaking a safe medication but

there are people who experience adverse

effects from Tylenol liver damage you

know and and other adverse effects uh

and you know that data is available but

what has happened in the case of that

medication is that the risks and

benefits are both analyzed and then a

recommendation is put forward about a

generally safe way to use it and then

there's data put out about the the side

effects common or rare right but I think

sometimes we also forget that a lot of

the medicines that we have come to take

and just see as normal part of our life

just like any other vaccine like there's

some rate of rare side effects that will

happen I say that because what I worry

about in the black and white environment

that we're living in is sometimes people

will take an anecdote about a potential

adverse effect and we'll portray that as

the rule right and we'll say well look I

know somebody who had this side effect

so nobody should take this because this

is what's going to happen to you if we

did that nobody would ever take Tylenol

no one would ever take Ibuprofen no one

would take NyQuil like no one would take

any of the common medications that we

pick up at the drugstore and that we

commonly use so uh that's how I think we

have to approach this with a combination

of of clear communication empathic

listening and and data and cont text um

again that doesn't fit neatly in a in a

in a social media post per se but I

think part of what we're we need to do

as a country is rebuild the relationship

honestly between the medical and public

health establishment and the public and

I think it's starts with this kind of

communication uh the other question I

had about the next pandemic and the one

we just had is uh why not have

Committees of people of diverse

backgrounds socioeconomic diversity

racial diversity

uh every aspect of diversity rather than

individuals standing there telling us

what to do for several reasons one is um

we are a country of many different

people yeah I think we um there are

dozens if not hundreds of scientific

papers showing that patients follow the

advice of doctors that look like them

and sound like them or to whom they

would aspire to be like yeah we know

this and yet Public Health officials

typically are unitary one person telling

us do this don't do that this is a good

idea that's a bad idea I I'm but one

citizen but I'm putting up both hands

both feet and all toes and saying that

committees small but diverse committees

that people can relate to and feel as if

um the messages that they're getting are

vetted through a common understanding

yeah so it's a really good suggestion

and and I could agree with you more that

A diversity of voices is really

important to to get a message out out

and during Co actually that's one of the

things that our office actually was was

helping to build was something called

the community core right where we

actually we recognize so very clearly

this is something I you know I came to

see as a doctor sometimes I was the

right person to message to a patient

sometimes I wasn't right sometimes it

was the nurse sometimes it was uh the

medical student sometimes it was an

administrator or the the social worker

with different background different life

experiences so part of this work is

knowing when to step up when to step

back right but the community Corp that

we were building was a really diverse uh

you know group of people um and a lot of

them had Public Health backgrounds but a

lot of them were Community leaders who

understood Health even though they

didn't have formal training um but

they're people who knew their

communities right and they had the trust

of their communities and they understood

what was going on they wanted to be

helpful so we brought them together to

say okay look here's what the science is

telling us here the general

recommendations um here's what we would

provide uh you ask us any questions you

have like if there's something we don't

know we'll go back and look it up um but

you're the leaders in your community

they should be hearing from you you know

about about these messages and then that

those folks went out and actually we

worked closely with them collaborated

with them uh they would design the

messages for their community based on

what they thought made sense they

weren't taking what we said word for

word and we didn't want them to um but

to me like that kind of diverse approach

is what we need more of now you know

I'll tell you what I would I would have

liked I would have liked if more media

networks put those folks on TV and got

them on the radio right because it's

important that many of them were showing

up in their communities were knocking on

doors were uh doing local you know

podcasts Etc and that was great but I

would have liked more of their faces I

carried on TV right so that's a place

where when when we talk to media and

when I talk to folks in media one of the

things I encourage them and push them to

do also is to say look if you can take

more of these diverse faces and voices

and put them out there that's actually

good for the community and it also helps

people see that it's not like one or two

people who are sort of pushing an agenda

here this is like the Public Health

Community is Big it's broad it's diverse

it has a lot of voices and and as the

more voices we can hear from as public I

think the better off we are yeah here

here I I you know again I

genuinely hope and pray that we don't

have another pandemic but if and when we

do I hope there will be committees

rather than individuals I know we you

know this is a thing in this country we

like the idea that one person's going to

save the climate one person's going to

save transportation one person you know

the covers the person of the year type

approach um but we but then we get

frustrated when that person does things

or makes decisions that we don't like in

their public or personal life and then

it all seems to fall into Division and I

just feel like we not talking about

groups of hundreds of people but small

groups so I think we're aligned in that

way yeah and and look there there's I

think a notion that um I think sometimes

we do want like the one person who can

not only necessarily have all our trust

and we can look to but also who we can

hold accountable you know if something

uh doesn't quite work out if we don't

like something um and and while I get

that sort of mentality I think that in

this moment especially when we're trying

to rebuild trust I think it's important

for people to know that what they may be

hearing in terms of medical or SC Public

Health recommendations it's important

for them to know how broad an audience

that's coming from or broad a group of

experts right and we there was a lot

more broad agreement for example during

coid and uh during Ebola during zika on

Public Health recommendations but you

wouldn't always know it if you turn on

the TV because you were seeing the same

couple of faces so I think we have to to

certainly diversify that um one other

thing I think I'll tell you that's

important here is I think we have to

also think about how we fund groups on

the ground that are doing the the hard

work of getting Public Health messages

out because one of the things that those

groups often would tell me and these are

I might say the groups I'm I'm talking

about the community organization that

spent years in a neighborhood getting to

know families where folks recognize them

when they're walking down the street

they're like oh yeah that's a person

from organization X they understand us

they get us they're looking out for us a

lot of those organizations had spent

their resources helping the community

getting to know the community but they

didn't have sophisticated mechanisms to

apply for grants for example they didn't

have grant writers who had done this a

thousand times so

historically those groups have a hard

time getting support and funding so I'll

tell you one interesting thing my my

wife did which I certainly was very of

is she was helping to to build an effort

and to build a nonprofit organization

with a couple of colleagues that

organization of people who knew how to

get money how to apply for Grants how to

get Foundation support but who also had

the wisdom to know that the most

important they could do was to give

portions of that money to groups on the

ground so they saw themselves as an

organization that channeled money to

groups that had trust and they executed

their their their mission that way and

that was very effective and I think we

need more of that when it comes to

disseminating funding one thing I think

many people may not uh may or may not

appreciate is that when you it's

actually hard from government to put out

a lot of money uh at once and to do so

quickly right um like when you've got a

lot of funds that you need to get into

communities what happens is the federal

government often will give it to States

states will then give it to local

communities uh to like the local

Department of Public Health part

potentially and then they will look to

distribute it to others that takes time

but also means if you're not connected

to that network if you don't know your

local Department of Health or you're not

connected to the State Department of

Health sometimes it can be challenging

to figure out how to get the money and

so I think we need more operations like

you know like what my wife and others

have been building to try to get those

funds directly to the folks who not you

don't necessarily have the most fancy

you know grant writing operation but

they have their relationships because at

the end of the day it's those

relationships that create the trust it's

a trust that allows in life-saving

information

to get to people and that's the link

that's missing very

interesting Pharma big Pharma I got a

lot of questions

about whether or not big Pharma is on

the take for every Public Health

Initiative now as uh somebody

who understands a bit about and

certainly believes in the use of certain

prescription medications I find most um

questions about quote unquote big Pharma

to overlook fact that there are

thousands if not hundreds of thousands

of medications that save lives and

enrich people's lives that are

prescription drugs um I also believe my

audience knows I say it over and over

again that Better Living Through

Chemistry still requires Better Living

we still have to get our sunlight get

our sleep social connection good

nutrition exercise and all those things

there's just no pill that's going to

replace those yeah okay but I think it's

a valid question that people are

asking is there a direct relationship

between between big Pharma and public

health initiatives in a way that should

have us concerned about the messaging

that we're getting and at times and the

fact that the United States consumes the

vast majority of drugs for mental health

for instance as compared to other

countries so that's one question and

then um I want to dovetail into that

question what are your thoughts on the

fact that you know there's a history of

say the tobacco industry being you know

uh very uh interdigitated shall we say

with um government policies in ways that

had us basically injure if not kill

millions of Americans and then

eventually say you can't smoke on near a

hospital you can't smoke anywhere

there's very few places where you can

consume tobacco products you know that

that kind of um relationship and

financial incentives and then a lot of

backpedaling later um I think wore on

people's um trust MH so how should we

frame the relationship

between the pharmaceutical industry

government and public health initiatives

in a way that is you know at least

halfway functional it look I I

understand where the concern and

suspicion comes from right and look I I

think it's important that public health

initiatives and medical advice is

independent of the influence of

industries that may seek to profit uh

from what's being recommended or from

medications that are being prescribed

and we look we have a history in

medicine right of doctors who were you

know given gifts and vacations and all

kinds of fancy things by Pharma

companies in an effort to influence what

they prescribed that was really

problematic and now we're seeing a lot

less of that which is good a lot of

rules are being put in place by medical

societies and professional societies and

by academic institutions to say this is

an unacceptable way to practice and

that's really important because I do

think that human psychology is that

sometimes we underestimate how much

we're influenced by incentives we think

ah yeah I'm getting that but I know how

to make independent decisions but at the

end of the day we're human and and we

influenced or it's a great drug it could

be wow this is a drug that's really

helping my patients I'm happy to

recommend it to them yeah so the this so

I want to separate one thing though like

taking money from Pharma companies as a

physician I think is highly problematic

right I think it's hard to say that it

doesn't influence practice maybe it

doesn't for some people but it's just

it's really hard to know who those

people are um I do think that separate

from that you can be a physician who

prescribes medications because you

believe they work look as a doctor I

have prescribed many antibiotics during

cases of infection that have helped my

patients and I would prescribe those

again I am glad that those exist um in

many cases they've saved the lives you

know of patients I was caring for in the

hospital so that's what what should

drive us is is does the data show that

they work and does our patient need them

right that's what should drive our

decisions when it comes to Public Health

recommendations here too I think a

similar principle holds which is that I

don't think that Pharma money uh should

be influencing our Public Health

decisions which means that it shouldn't

be funding our public health

organizations that are making

recommendations certainly I'll you know

I know this is obvious to you but I'll

say just to be clear for everyone who's

listening like our office uh doesn't

take any money from industry not just

Pharma industry from any industry like

our the money that we get is allocated

by Congress at the end of the day it's

taxpayer money and that's all we get and

and that's important we don't want money

from the you know from pharmaceutical

companies um but that's important

because people need to know that these

decisions are not being made for for

financial gain um with that being said I

there's a broader concern I have Andrew

which is I think that we have become a

pill for every problem Society where we

look for a quick fix of a medicine for

every challenge uh that we may incur and

sometimes yes I'm I'm a believer that if

science you know helps us create uh

medications that can help solve disease

we should use them appropriately but I

think we discount heavily the behavioral

changes that we need to make the more

broader societal and environmental

changes that we need to make that

influence our health like our food

environment matters for our health our

decisions about

how Physically Active we are matter for

our health whether or not we sleep

matters for our health and all of these

impact our mental health and well-being

as well and so I I when when I think

about the that bias that that to me is

not always you know stemming from money

that came from a pharmaceutical company

although I think it the ads that we see

all the time uh from Pharma companies I

think try to convince us that hey just

take this pill once a day and all your

problems will go away but I think it's

more complex than that and and I think

that even for you know in the health

care setting like if you're uh if you're

seeing a patient who has pain uh who's

having intense pain it feels easier

sometimes to prescribe a medication for

that pain rather than trying to to deal

with non-medication based you know

approaches or try to get the deeper

origins of the pain I'm not saying

that's what doctors do all the time but

I'm saying that we're living in an

environment and a broader culture where

we I think increase ly reach for

something that we see as a quick

immediate fix uh and again don't blame

people for that we rather take a quick

fix over something that's going to take

a long time but I think it is selling us

I think sometimes a false hope which is

that that's all we need to solve our

problems and I think a lot of times you

need more you need the behavioral

changes you need the environmental

changes um that's one of my big concerns

in terms of how we communicate about

health would a potential solution be

this idea of small committees so let's

say uh somebody is experiencing chronic

pain localized or general that they

would go to their general practitioner

but in the room would also be somebody

who understands sematic medicine uh a

trained clinical psychologists who

understand sematics that the body and

the brain are linked through the nervous

system um and could also assess um you

know possible psychological Roots uh of

the issue and then somebody in the room

who can make um Behavior

nutritional um maybe even

supplementation based safe

supplementation based recommendations

and then the physician who can say you

know and in addition to that I think the

person should have on hand you know a 5

milligram dosage of a prescription drug

that if they need it they could take and

I think it would provide a lot of

protections against you know uh

potential adverse effects of any one of

those things in isolation um there are

great Protections in having people meet

in groups um for lots of reasons and the

person would feel very well cared for um

so again small Committees of people with

diverse expertise pooling together to

treat people from a for lack of a better

word a more holistic perspective why not

I mean you're describing the dream I

think that's exactly what we need

interdisciplinary teams that can provide

integrative care recognizing that in

this day and age there's not one person

who has all the expertise to help us

figure out how to best manage our health

challenges

um I think what we have not figured out

are a couple of things number one who

are all the right people who need to be

in the room uh or the sort of virtual

room if you will the second is how do we

create a a structure a Health Care

System where that can actually happen

with efficiency where it can be

reimbursed appropriately but that's what

we should be doing and then the Third

Leg of that is the the group experience

for patients right and there's

increasingly in more clinics and healthc

Care Systems around the country that are

working on creating group experiences

where patients who all let's say are

working on diabet on their diabetes uh

come together let's say once a week and

they meet uh with the healthcare

practitioner that might be an addition

to their individual appointments but

there is so much power in groups coming

together uh groups of patients who can

find Community who can help each other

learn from each other's experiences uh

that's highly underutilized right now in

medicine um but to really do this well

Andrew I think means that we have to we

have to pull back from the model we have

had for years in medicine which has been

a very a highly individual type model

which says okay you go to your doctor

you see your doctor oneon-one you get

everything you need maybe you need to go

see a specialist okay then you wait a

few weeks get another appointment Drive

30 miles go see somebody else maybe

they're connected to the electronic

health system maybe they're not maybe

they know what was discussed maybe they

they don't maybe they'll call and talk

to their primary care doctor but maybe

they won't because they're too busy and

then you as a patient are stuck trying

to piece all this together while often

in pain well yeah in in physical and

emotional anguish I'm not referring to

my own experience although I've had you

know mild examples compared to what

other people have dealt with but you

know people with chronic pain are

irritable for understandable reasons I

mean it it it's or maybe somebody's

close veering towards suicidal

depression then there's the

interpersonal effects I mean I feel like

the the crisis is is one of a lack of

efficiency and thoroughness and um and

again I'm not throwing stones at the

medical profession I I like you believe

that it's a collection of mostly um

well-meaning people trying to do their

best but the specialist model and the

referral model is incredibly cumbersome

it really is cumbersome and and like you

look I having worked with many medical

professions over the years like these

are colleagues who I deeply admire I

mean like they're there for the right

reasons they want to help people

alleviate suffering but they too are

feeling burned out and frustrated by the

inefficiencies of the system because

I'll tell you one of the greatest

contributors to burnout for doctors and

nurses is a lack of self-efficacy it's

seeing a patient who has a problem in

front of you and feeling like you can't

get them the help uh that they need that

is a the greatest paper cut if you will

uh to the sort of spirit of clinicians

and many find themselves in that

circumstance where they either find that

they know what's needed but the system

is throwing up prior authorizations or

other insurance hurdles and prev their