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

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.280 | where we discuss science and science-based tools

00:00:04.880 | for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.300 | and I'm a professor of neurobiology and ophthalmology

00:00:13.320 | at Stanford School of Medicine.

00:00:15.200 | Today, my guest is Dr. Vivek Murthy.

00:00:17.680 | Dr. Vivek Murthy is a medical doctor

00:00:20.080 | and acting Surgeon General of the United States.

00:00:23.280 | As Surgeon General of the United States,

00:00:24.880 | Dr. Murthy oversees more than 6,000

00:00:27.120 | dedicated public health officers,

00:00:29.020 | whose job is to protect, promote,

00:00:30.920 | and advance our nation's public health.

00:00:33.200 | Dr. Murthy received his bachelor's degree

00:00:35.140 | from Harvard University and his medical degree

00:00:37.640 | from the Yale University School of Medicine.

00:00:40.440 | Today's discussion covers some of the most important issues

00:00:43.480 | in public health, not just within the United States,

00:00:46.060 | but worldwide, including nutrition and the obesity crisis,

00:00:50.080 | as well as food additives

00:00:51.480 | and why certain food chemicals and additives

00:00:54.020 | are allowed in the United States versus in other countries.

00:00:57.320 | We also discuss mental health,

00:00:59.380 | the youth mental health crisis,

00:01:00.860 | the adult mental health crisis,

00:01:02.500 | and the global crisis of loneliness and isolation.

00:01:06.000 | We also talk about corporate interests,

00:01:08.100 | that is whether or not big food and big pharma industries

00:01:11.660 | actually impact the research and/or decisions

00:01:14.480 | that the U.S. Surgeon General takes

00:01:16.000 | in his directives toward public health.

00:01:18.500 | And of course, we discuss

00:01:19.560 | some of the major public health events

00:01:21.000 | that occurred over the last five years,

00:01:22.960 | and the current and future landscape

00:01:25.320 | of how to restore faith both in public health officials,

00:01:28.820 | in public health policy, and science more generally.

00:01:31.920 | By the end of today's episode,

00:01:33.280 | you not only will have learned a tremendous amount

00:01:35.800 | about public health and why you hear

00:01:37.540 | the particular public health directives that you do,

00:01:40.200 | but also how to better interpret

00:01:42.040 | future public health directives.

00:01:43.860 | You'll also come to learn that as Surgeon General,

00:01:46.760 | Dr. Murthy has both an extremely challenging job,

00:01:49.560 | but one that he meets with a tremendous amount

00:01:51.540 | of both rigor and compassion.

00:01:53.780 | Before we begin, I'd like to emphasize that this podcast

00:01:56.780 | is separate from my teaching and research roles at Stanford.

00:01:59.420 | It is, however, part of my desire and effort

00:02:01.520 | to bring zero cost to consumer information

00:02:03.400 | about science and science-related tools

00:02:05.400 | to the general public.

00:02:06.760 | In keeping with that theme,

00:02:07.860 | I'd like to thank the sponsors of today's podcast.

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00:04:32.800 | And now for my discussion with Dr. Vivek Murthy.

00:04:36.240 | Dr. Vivek Murthy, welcome.

00:04:38.400 | - Thanks so much, Andrew, and please call me Vivek.

00:04:40.560 | I'm informal. [laughs]

00:04:41.840 | - Okay, Vivek.

00:04:43.720 | My understanding, based on my internet search,

00:04:47.000 | is that the role of the U.S. Surgeon General

00:04:50.320 | is to provide scientific information

00:04:52.540 | on how to improve health

00:04:54.640 | and reduce risk of illness and injury.

00:04:56.760 | Do I have that correct?

00:04:58.580 | - That is correct.

00:04:59.580 | - What are some other roles that you play

00:05:02.520 | that perhaps would not come up in a top-hit Google search

00:05:07.520 | that I ought to be aware of

00:05:11.340 | and that our audience ought to be aware of?

00:05:13.140 | - Well, here's how I generally explain to people.

00:05:15.220 | There are two primary roles.

00:05:16.740 | The Surgeon General has.

00:05:18.100 | One is to engage with the public

00:05:20.820 | and make sure that people know

00:05:22.500 | about critical public health issues

00:05:24.580 | so they know what they are,

00:05:25.940 | how to protect themselves and their families.

00:05:28.220 | The second role of the Surgeon General is lesser known,

00:05:32.020 | but it's equally as important,

00:05:33.300 | which is to oversee one of the eight uniformed services

00:05:36.580 | in the U.S. government,

00:05:37.740 | and that is the United States Public Health Service.

00:05:40.180 | Many people are familiar with the Army,

00:05:41.700 | the Navy, the Air Force.

00:05:43.820 | We also have the U.S. Public Health Service,

00:05:46.460 | which is 6,000 officers.

00:05:48.040 | They include doctors, nurses, physical therapists,

00:05:50.800 | pharmacists, public health engineers,

00:05:53.180 | a whole range of healthcare folks,

00:05:55.580 | and their job is to protect our nation

00:05:58.640 | from public health threats.

00:05:59.980 | So when Ebola came on the scene in 2014

00:06:04.060 | in a major way in West Africa,

00:06:06.720 | we sent hundreds of officers to West Africa

00:06:09.660 | to set up the Monrovia Medical Unit in Liberia

00:06:12.140 | to treat people with Ebola.

00:06:15.300 | Domestically, when there are hurricanes or tornadoes,

00:06:17.460 | we dispatch officers and deploy them

00:06:20.220 | to go help strengthen the public health infrastructure,

00:06:23.060 | but also to provide direct care.

00:06:25.220 | We deployed thousands of officers during COVID.

00:06:27.860 | So these officers, I'm incredibly proud of them.

00:06:30.940 | They could be doing lots of stuff outside government

00:06:33.100 | in the private sector,

00:06:34.260 | probably making a whole lot more money

00:06:35.680 | and working a lot less hard,

00:06:37.380 | but they're really committed

00:06:38.780 | to protecting the public health of the nation.

00:06:40.540 | So I have the privilege of overseeing

00:06:42.900 | that service as Surgeon General,

00:06:44.160 | and those are the jobs that I've signed up for in this role.

00:06:48.400 | - Got it, I was not aware of that role.

00:06:50.720 | And if I understood correctly,

00:06:52.680 | these people, these public health officers

00:06:56.560 | that presumably are made up of physicians

00:07:00.040 | and licensed psychologists and nurses and so forth,

00:07:03.640 | you said they could be making substantially higher incomes

00:07:08.100 | in the private sector,

00:07:08.940 | but the work that they're doing with you

00:07:11.140 | is their sole career at this point.

00:07:13.520 | They're completely devoted to that,

00:07:14.740 | or they're doing this as a side hustle?

00:07:16.620 | - No, they are full-time government employees

00:07:19.500 | and members of the Public Health Service.

00:07:21.420 | Their day job is often in public health agencies

00:07:24.060 | where they're embedded in communities,

00:07:25.700 | helping day-to-day to advance public health.

00:07:27.660 | And during times of emergency, we deploy them.

00:07:30.700 | And they're extraordinarily well-trained.

00:07:34.260 | They're experienced at dealing with adversity,

00:07:37.400 | but they bring a combination of skill and heart

00:07:41.060 | to their work.

00:07:41.900 | And you really need both to be effective at public health.

00:07:45.060 | - I'm glad that you mentioned the word emergency,

00:07:47.100 | because in preparing for our discussion today,

00:07:49.280 | it occurred to me that in this list of roles

00:07:54.280 | that your title assumes,

00:07:56.340 | that scientific information on how to improve health

00:07:59.760 | comes first, then you mentioned emergency.

00:08:03.280 | So what I'd like to talk about first is health,

00:08:06.540 | not lack of health, but health.

00:08:09.260 | So often we hear about the mental health crisis,

00:08:11.980 | but what we're really talking about

00:08:13.340 | is the lack of mental health crisis, AKA mental illness.

00:08:16.620 | And rarely do we hear, for instance,

00:08:19.260 | what constitutes mental health.

00:08:21.100 | We hear what constitutes mental illness.

00:08:23.700 | Whereas in the domain of physical health,

00:08:25.340 | there's a lot of information out there

00:08:26.700 | about how to be more physically healthy,

00:08:28.400 | cardiovascular exercise, resistance exercise,

00:08:30.920 | yoga type exercise, mobility, et cetera.

00:08:33.780 | And of course, some people have physical health ailments,

00:08:37.480 | and there's a lot of information

00:08:38.900 | in terms of how to deal with that as well.

00:08:40.740 | But what I would like to know before we get into

00:08:43.540 | the long list of issues that our nation confronts,

00:08:47.280 | everything from obesity to food additives

00:08:50.780 | to mental health issues, what is going well?

00:08:55.780 | In other words, in the last, let's say five to 10 years,

00:09:00.780 | have there been any areas of physical health

00:09:03.540 | and mental health improvement in the US at large

00:09:07.220 | that we can attribute to some of

00:09:09.420 | the public health initiatives directly?

00:09:12.060 | - So that's a really good question.

00:09:14.060 | And let me just also say about the very first point

00:09:16.900 | you raised, that you're absolutely right

00:09:19.700 | that we have operated primarily through an illness frame

00:09:23.780 | when we look at health.

00:09:25.000 | And in my mind, that's only one half of the equation.

00:09:29.420 | So when we are talking about physical illness, for example,

00:09:33.120 | as a doctor, I learned how to diagnose and treat someone

00:09:35.780 | with diabetes or with high blood pressure

00:09:38.060 | or with coronary heart disease.

00:09:40.260 | But we also know that even if I don't have diabetes

00:09:42.580 | or coronary heart disease or high blood pressure,

00:09:46.080 | even if I don't have any diagnosable medical condition,

00:09:48.300 | I may not be at an optimal level of physical health.

00:09:51.340 | I may not be able to, for example, walk around the block

00:09:54.200 | without getting short of breath.

00:09:55.420 | I may not be able to play with my kids

00:09:57.100 | 'cause my physical fitness and stamina is insufficient.

00:10:00.620 | I may not be able to lift my luggage

00:10:02.620 | when I go to the airport because I don't have enough

00:10:04.720 | strength in my body,

00:10:06.300 | yet I wouldn't have a diagnosable mental illness.

00:10:09.060 | So I think it's easier to understand there

00:10:10.900 | with physical health that we're not just aiming

00:10:12.660 | for lack of illness, we're aiming to optimize

00:10:15.180 | our physical health.

00:10:16.440 | The same is true with mental health.

00:10:18.420 | And I think when we talk about mental health,

00:10:20.600 | people think we're just, the sole goal here

00:10:22.780 | is to prevent diagnosable mental illness.

00:10:26.020 | That is one goal, to both prevent and to manage

00:10:29.480 | mental illness when it arises.

00:10:31.660 | But we also need to recognize there's a whole other half

00:10:33.540 | of the spectrum where there are people who may not have

00:10:35.340 | diagnosable mental illness but are not operating optimally

00:10:38.500 | in their lives and that's detracting from their fulfillment,

00:10:42.300 | from their functionality, like in not just at work

00:10:45.300 | but also in their communities and in their families.

00:10:47.800 | And so I think part of the conversation that I want us

00:10:50.240 | to have as a country is about how to optimize mental health

00:10:53.180 | and well-being and that includes preventing mental illness

00:10:56.800 | but it is much broader and bigger than that alone.

00:11:00.140 | - Great.

00:11:00.980 | I think it's so important that we recognize

00:11:03.860 | that treating disease is critical, obviously,

00:11:08.860 | but that there's a lot that can be done

00:11:10.820 | to improve one's health, even in the absence

00:11:13.540 | of any known disease.

00:11:15.360 | And you've got all these officers,

00:11:17.600 | these incredible physicians and nurses

00:11:20.280 | and people at your disposal.

00:11:23.620 | My hope is that they would also be accessible

00:11:25.840 | for and currently carrying out efforts

00:11:29.940 | to transmit information to people about,

00:11:32.180 | hey, here are the things that you can do every day,

00:11:34.460 | every week, every month in order to make your life

00:11:37.060 | as healthy as possible as well as rushing in

00:11:42.060 | under conditions of public health crisis.

00:11:45.780 | - Yeah, it's a good point and it's certainly,

00:11:48.220 | many of our officers do focus on this broader rubric

00:11:51.460 | around well-being but it's part of how we need,

00:11:54.300 | I think, the broader health system and public health system

00:11:57.380 | to operate even outside of government.

00:11:59.500 | And this, I think, will require significant change

00:12:03.000 | and shift in how we think about our jobs.

00:12:05.620 | Like when I went to medical school,

00:12:06.800 | the vast majority of the focus was on diagnosing

00:12:10.320 | and treating illness.

00:12:11.980 | It was much, much less focused on thinking about

00:12:14.060 | how to enhance well-being.

00:12:16.740 | And when you talk to people in their lives,

00:12:20.740 | it becomes clear that they want to do more

00:12:23.020 | than just prevent diagnosable illness.

00:12:25.900 | They want to be able to walk their child down the aisle.

00:12:29.140 | They want to have the endurance to do that.

00:12:31.120 | They want to be able to be independent often

00:12:33.980 | and carry their groceries or carry their luggage.

00:12:36.600 | This is why I think we've got to broaden our focus

00:12:40.060 | in public health.

00:12:41.500 | And look, when I came into this role,

00:12:44.520 | by the way, I was not expecting to serve in government.

00:12:46.420 | This was not part of some five, 10, 30 year plan.

00:12:49.660 | When I was a kid, I was interested in medicine

00:12:52.380 | but I always thought I was gonna practice medicine

00:12:55.180 | like my dad did and like the clinic my mom ran.

00:12:57.860 | You know, set up, put up a shingle,

00:12:59.420 | see patients and be a primary care doctor

00:13:02.100 | and feel good about the work I was doing.

00:13:04.340 | But what happened to me along the way

00:13:07.500 | is, you know, I trained in medicine.

00:13:09.580 | I got interested in technology.

00:13:10.900 | Spent seven years building a technology company

00:13:13.500 | that was focused on health.

00:13:14.740 | I became increasingly worried about

00:13:17.620 | the way we were delivering healthcare.

00:13:19.740 | I felt like our healthcare system was broken.

00:13:21.340 | People who needed care couldn't get it.

00:13:23.180 | It was often too expensive to get care.

00:13:24.820 | We were focusing on treatment solely and not enough

00:13:27.860 | on prevention.

00:13:28.700 | So I started getting involved in advocating

00:13:31.020 | for a better healthcare system

00:13:32.720 | with doctors around the country.

00:13:34.340 | When despite all that, I still never thought

00:13:35.860 | I would work in government.

00:13:37.040 | But in 2013 is when President Obama's team

00:13:42.040 | had reached out to me and asked if I'd be interested

00:13:43.900 | in considering the position of Surgeon General.

00:13:46.420 | And what was interesting to me about this position

00:13:49.500 | is it's actually very different from most positions

00:13:52.780 | that are appointed by a president in government

00:13:54.460 | in that it's supposed to be an independent position.

00:13:57.180 | So my agenda, the issues I choose to take on

00:14:00.440 | are not determined by a president or a party.

00:14:03.640 | They're determined by science and the public interest.

00:14:06.580 | And that's what guides me.

00:14:08.500 | You know, and that's what guided me in that first term

00:14:11.700 | when I served and when President Biden asked me

00:14:14.420 | to come back and serve as Surgeon General a second time,

00:14:16.360 | that's what's guided me here too.

00:14:18.620 | - So Biden is not sending you notes saying,

00:14:21.860 | "Hey, could you put some effort into getting messages out

00:14:26.740 | "about COVID or could you put more effort

00:14:30.420 | "into getting your team over to Maui

00:14:34.080 | "to deal with the tragedy there?"

00:14:38.140 | Which is a long arc tragedy, right?

00:14:40.320 | We get the news in a blast of this happened

00:14:43.500 | and then the next blast comes in about something else

00:14:46.380 | and we forget that there are physical

00:14:48.140 | and mental health crises that are ongoing.

00:14:51.900 | And then I have to imagine

00:14:54.260 | then start to overlap with one another.

00:14:56.180 | Or is it, so is it your decision

00:14:58.620 | where and how to deploy the financial and human resources?

00:15:02.780 | Like, okay, we're gonna put 10 people on Maui.

00:15:05.380 | We're going to put, you know,

00:15:07.980 | five people in the central states, you know,

00:15:10.740 | going around talking to major organizations

00:15:13.860 | about what they need to do to prepare for this winter.

00:15:16.220 | Is that how it works?

00:15:17.580 | Or are you getting memos?

00:15:19.300 | And in other words, who's your boss?

00:15:21.220 | Everyone has a boss at some level.

00:15:22.740 | Mine are the listeners of this podcast at some level.

00:15:26.100 | I work for them.

00:15:27.220 | It used to also be my bulldog, Costello, but--

00:15:30.260 | - My boss, my wife, and my two kids,

00:15:32.220 | who are five and seven, I do what they tell me to.

00:15:34.260 | - Got it, got it.

00:15:35.900 | So--

00:15:37.220 | - But how we make our decisions in the office,

00:15:38.900 | actually, it's a bit different with those two roles.

00:15:41.260 | So with the second one,

00:15:43.300 | with overseeing the Commission Corps, our 6,000 officers,

00:15:46.700 | there, the decisions about how and when we deploy officers

00:15:50.300 | are collaborative, right?

00:15:51.340 | So, you know, we work with other colleagues

00:15:54.220 | throughout the Department of Health and Human Services.

00:15:56.220 | We work with people in FEMA, across the administration.

00:15:59.300 | But we also work with states.

00:16:00.420 | So sometimes states often, often,

00:16:02.580 | states will put in a request and say,

00:16:04.180 | "Hey, we need support here.

00:16:06.300 | "Can you help?"

00:16:07.380 | So we'll work with colleagues across our department

00:16:09.300 | to say, "Okay, well, we can mobilize

00:16:10.820 | "our Commission Corps officers.

00:16:12.420 | "What assets can you mobilize?"

00:16:13.860 | And then collectively, we will send a team out there.

00:16:16.740 | So, for example, we have officers helping in Maui right now,

00:16:20.540 | particularly with mental health needs,

00:16:22.300 | which are, I worry, only gonna continue to grow

00:16:25.060 | over the weeks and months ahead.

00:16:27.180 | On the other side of the house,

00:16:28.460 | when it comes to deciding which issues

00:16:30.820 | we engage with the public on,

00:16:32.100 | like, in this case, mental health

00:16:33.860 | has been a big focus area for me.

00:16:36.540 | On that front, well, we certainly, you know,

00:16:38.940 | are open to suggestions from the public.

00:16:40.900 | Members of Congress sometimes say,

00:16:42.100 | "Hey, can you help the public understand about this issue?"

00:16:44.780 | You know, a lot of people have ideas and opinions,

00:16:46.420 | but the decision about which issues to focus on,

00:16:48.980 | those are our offices.

00:16:50.500 | And to me, that's important,

00:16:51.820 | because part of the reason over time,

00:16:54.140 | I believe, the public came to have some degree

00:16:57.020 | of faith and trust in the office is because

00:16:59.900 | they hoped that the office was functioning

00:17:01.540 | the way you hope your doctor is functioning,

00:17:03.580 | which is being an independent source

00:17:05.980 | of information for you,

00:17:08.140 | and a source that has your best interest at heart,

00:17:09.940 | that's not being pulled aside by political interests

00:17:12.820 | or by other agendas,

00:17:13.780 | but the primary agenda is,

00:17:15.340 | "How can I help your health?"

00:17:16.620 | And so, for me, like,

00:17:18.100 | we have to make an independent assessment there

00:17:20.060 | and say, "Okay, where is the need, the greatest here?

00:17:22.820 | "Where can we make the biggest difference?"

00:17:24.940 | Sometimes we may not build an initiative on an issue,

00:17:27.660 | and that doesn't mean that that issue's not important

00:17:29.340 | or that it's not affecting a lot of people,

00:17:32.060 | but we have to make hard decisions

00:17:33.300 | about where to put limited resources.

00:17:34.940 | And so, when I was a surgeon general,

00:17:36.780 | the first time, one of the big areas I focused on

00:17:39.300 | was the opioid crisis that we were dealing with,

00:17:41.940 | as well as the e-cigarette use among youth,

00:17:44.820 | because we were seeing a dramatic increase

00:17:46.980 | among kids in e-cigarette use that was--

00:17:49.540 | - Can I just ask you, sorry to interrupt,

00:17:50.980 | but I think it's relevant here,

00:17:53.220 | has that increase continued or e-cigarette use,

00:17:57.300 | AKA vaping?

00:17:58.260 | - Yeah, so we still see, unfortunately,

00:18:01.060 | there's been some improvements,

00:18:02.300 | but we still see way too many kids

00:18:04.620 | who are using vaping devices early on,

00:18:07.500 | and part of what we did from our office

00:18:09.420 | is recognizing that we actually issued

00:18:11.820 | the first federal report on e-cigarettes in youth.

00:18:14.900 | We call the country's attention

00:18:16.100 | to the fact that this is a crisis.

00:18:17.420 | We worked with members of Congress

00:18:19.460 | to talk about the kind of action we needed

00:18:21.660 | from a legislative and regulatory perspective

00:18:23.660 | and worked with colleagues at the FDA

00:18:25.420 | and in government as well.

00:18:26.780 | But there are two things that are really most important

00:18:28.700 | in guiding our choice about priorities.

00:18:31.340 | One is data.

00:18:32.660 | We look at what the numbers actually tell us

00:18:35.340 | about the impact these issues are having

00:18:37.180 | on the population as well as the trajectory of rise.

00:18:39.500 | If something's getting dramatically worse

00:18:41.060 | and people don't realize it,

00:18:42.380 | might be an area for us to focus.

00:18:44.100 | But the other critical factor

00:18:46.300 | is what I hear from people on the road.

00:18:48.780 | And so I try to spend as much time as I can

00:18:51.060 | visiting communities across the country,

00:18:52.660 | doing town halls, meeting with community members,

00:18:55.660 | and just trying to, frankly,

00:18:57.460 | just listen to what's on their mind.

00:19:00.300 | And that's where I actually get

00:19:01.860 | a lot of information as well.

00:19:03.300 | That's actually how I came to focus

00:19:05.740 | on the issue of loneliness and isolation.

00:19:07.260 | It wasn't 'cause it popped up in a report

00:19:09.380 | as being the leading public health issue in the country.

00:19:13.020 | It was because everywhere I was going,

00:19:15.820 | in 2014, 2015,

00:19:18.660 | when I was talking to college students,

00:19:20.500 | talking to retired Americans,

00:19:22.020 | talking to parents in rural areas and urban areas,

00:19:25.100 | I kept hearing these stories about people

00:19:26.820 | who felt like they were all on their own

00:19:29.300 | or they felt invisible

00:19:30.580 | or they felt if they disappeared tomorrow,

00:19:32.540 | no one would even care

00:19:33.860 | or they felt like they just didn't belong.

00:19:35.820 | And it's heartbreaking to hear that from anyone.

00:19:38.780 | It's particularly heartbreaking to hear it from kids

00:19:42.060 | who you hope are entering life

00:19:44.460 | and looking forward to what comes,

00:19:46.940 | but many kids weren't feeling that way.

00:19:48.900 | - That is very useful context.

00:19:52.060 | And we will get back to the isolation crisis,

00:19:56.940 | such an important initiative that I just will thank you now

00:20:00.740 | for having put out the message on social media

00:20:03.900 | and elsewhere about that,

00:20:06.300 | because I think one of the questions I have

00:20:09.340 | in light of what you just said is,

00:20:11.780 | it's clear that you've got your ear to the ground,

00:20:13.920 | you're talking to different people.

00:20:15.620 | It's also critically important that people hear from you

00:20:21.020 | and know not just what's happening,

00:20:23.580 | but that you perhaps want to know where the issues lie

00:20:28.180 | and what the actionable steps are that people can take.

00:20:33.180 | And I think that we now live in a hyper-connected world.

00:20:37.620 | So, in fact, I'll just say that one of the reasons

00:20:40.700 | I launched this podcast is in 2020,

00:20:42.900 | I was going on podcasts talking about things

00:20:44.580 | like maintaining sleep and circadian rhythm

00:20:46.480 | and stuff from my lab related to trying to adjust anxiety

00:20:51.100 | under conditions where I think everyone was anxious

00:20:53.660 | and sleep rhythms were disrupted, et cetera.

00:20:56.460 | And I was somewhat surprised

00:20:58.140 | that I didn't get a warning on my phone.

00:21:00.740 | Hey, make sure you're getting morning sunlight.

00:21:03.460 | I'll get a flood warning.

00:21:05.180 | I'll get a warning that I might get a warning,

00:21:07.440 | but it's only a test warning.

00:21:08.820 | I'll get three of those yesterday

00:21:10.940 | living here near the coast.

00:21:12.500 | But I don't think once during the pandemic

00:21:16.340 | did I get a email or a public service announcement saying,

00:21:21.340 | if you are going to be indoors a lot,

00:21:24.580 | you're going to have to be mindful of maintaining

00:21:27.060 | your circadian rhythm because if you're not,

00:21:29.340 | I mean, we know based on hundreds of studies now

00:21:31.840 | that drifts in circadian rhythmicity

00:21:34.620 | are a precursor to mental health issues.

00:21:37.160 | I mean, in fact, there's a new idea

00:21:38.860 | that many, not all suicides are preceded

00:21:43.380 | by a period of disrupted sleep,

00:21:45.300 | which kind of makes sense and it's not causal, of course.

00:21:50.300 | But how come during the pandemic,

00:21:54.500 | we each and all as US citizens

00:21:57.120 | did not get an email or a text message saying,

00:22:00.980 | hey, these are five things that you need to do every day

00:22:04.240 | to try and stay as stable as possible

00:22:07.640 | in this very uncertain landscape that we're in?

00:22:11.180 | - Well, it's a really good question.

00:22:12.500 | And I think it's a reasonable and a very good suggestion

00:22:17.500 | to say that, hey, look, there should be

00:22:20.520 | a clear and comprehensive way

00:22:22.300 | that we can get messages out to everyone.

00:22:24.740 | Like if we were working in a hospital system

00:22:27.260 | and there was a safety issue that came up,

00:22:29.940 | there would be an email sent

00:22:30.860 | to all the hospital staff members saying,

00:22:32.380 | hey, this is something you need to be aware of, right?

00:22:34.520 | So I think it's a reasonable expectation.

00:22:37.020 | Practically, if you go back, hello,

00:22:38.940 | over the last 20, 30 years on health issues,

00:22:43.940 | there hasn't been sort of an agency or an entity

00:22:48.420 | that has sent emails out to everyone.

00:22:51.660 | First of all, how to send an email out to everyone

00:22:53.580 | in America is not a simple proposition either.

00:22:55.500 | Technically, it's challenging.

00:22:57.180 | There are some legal issues

00:22:58.660 | you'd have to deal with as well.

00:22:59.780 | - But you could do a night where you go CNN, Fox, NBC, ABC,

00:23:04.700 | New York Times, Wall Street.

00:23:05.900 | Like you could hit the right wing, the left wing,

00:23:08.140 | and everything in between.

00:23:08.980 | - Yeah, that's a really interesting suggestion.

00:23:10.480 | - But one video just where they all agree,

00:23:13.260 | like, hey, this is important information, so apolitical.

00:23:17.460 | - Yeah, so I would say that that kind of messaging,

00:23:19.780 | I would say through traditional media,

00:23:21.820 | certainly has happened, and it happened during COVID.

00:23:25.340 | It happened, for example, when in the first year of COVID,

00:23:29.580 | I was a private citizen in the prior administration,

00:23:32.280 | but I watched both then and at the beginning

00:23:34.820 | of the Biden administration,

00:23:36.540 | many officials would go out in front of cameras and say,

00:23:40.180 | here are three things you need to do

00:23:42.140 | to keep yourself safe from COVID.

00:23:45.100 | And that was a big question people had.

00:23:46.540 | How do I keep myself safe?

00:23:47.580 | Okay, here are three things you can do.

00:23:50.140 | A couple of challenges I would say here is that,

00:23:52.500 | number one, even if you hit all the major network

00:23:56.340 | and cable news shows, you're still not reaching everyone.

00:24:00.740 | Because we're living in a society

00:24:03.020 | where increasingly people are not watching TV.

00:24:05.540 | They're getting their news from other sources.

00:24:08.140 | The other thing that's important to know

00:24:10.460 | is that attention shifts quickly in traditional media,

00:24:13.660 | also from issue to issue.

00:24:15.260 | And so you might get a clip out at a certain day,

00:24:19.460 | you might get on all the Sunday shows, for example,

00:24:22.340 | but the next day, that message isn't necessarily there.

00:24:25.740 | It's gone and people's attention has also switched off too.

00:24:28.740 | So they were, I mean, I can count,

00:24:31.700 | and we've logged probably thousands of interviews

00:24:34.980 | at this point that we've done with mainstream media

00:24:37.300 | with sort of concise messages about three things

00:24:40.300 | you can do to protect yourself, et cetera.

00:24:42.220 | And I'm glad we did those, we gotta do them.

00:24:44.820 | But I think one of the things we don't have right now

00:24:47.220 | in the country, and this is I think

00:24:49.300 | a bit of a health infrastructure challenge,

00:24:51.620 | is we actually don't have a quick, efficient way

00:24:54.420 | to reach everyone in the country with a health message,

00:24:57.380 | just like what you said.

00:24:58.900 | If you wanted to get that message

00:25:00.060 | about three things to protect yourself from, let's say, COVID

00:25:02.980 | or three things to do to support your health and wellbeing

00:25:05.860 | during a time of crisis.

00:25:07.100 | - Or during a time of health.

00:25:08.300 | I mean, again, like not just the flood warning,

00:25:10.620 | but the daily, 'cause I do think that most of mental

00:25:14.340 | and physical health is the result of daily practices

00:25:17.900 | that are, you know, that build on themselves,

00:25:20.180 | sort of like compounded investments.

00:25:22.660 | And then, of course, there are acute challenges

00:25:24.620 | and chronic challenges that people face,

00:25:26.300 | but things of that sort, too.

00:25:28.540 | - I think those kind of messages in terms of health

00:25:30.780 | are absolutely important as well.

00:25:32.660 | And, you know, I think in the sort of,

00:25:36.740 | I think, fast-paced, crisis-driven environment

00:25:39.060 | that we live in, unfortunately, people are often less,

00:25:41.940 | are paying less attention to those maintenance

00:25:44.380 | or improvement messages than they are

00:25:45.940 | to managing the crisis messages.

00:25:47.820 | But I think that they're equally as important.

00:25:49.700 | But I do think that what you're pointing out

00:25:50.980 | is an infrastructure piece that needs to be built,

00:25:54.060 | which is a way for, you know, health authorities

00:25:56.780 | to reach people, you know,

00:25:58.100 | with information quickly and comprehensively.

00:26:00.980 | I'll just tell you that in the 1980s,

00:26:03.980 | when C. Everett Koop was Surgeon General,

00:26:07.020 | one thing that he had done, which was interesting,

00:26:09.180 | is he had actually sent a letter, a physical letter,

00:26:12.500 | to all households in America about HIV.

00:26:15.780 | - A physical letter. - A physical letter.

00:26:17.420 | - Some of our listeners won't know what that is.

00:26:19.260 | - Yeah. (laughs)

00:26:21.420 | This thing you read about in the history books,

00:26:22.700 | there's something shows up in your mailbox,

00:26:24.460 | and you open it, and hopefully it's something

00:26:26.740 | you want to read.

00:26:27.580 | But in this case, he was worried about HIV,

00:26:30.060 | about the fact that people didn't know about it.

00:26:31.380 | So, he worked through, and with, as I understand it,

00:26:35.640 | with a member of Congress,

00:26:37.140 | found a way to do this from a funding perspective.

00:26:41.060 | But it was a very unusual move,

00:26:44.060 | and one that was never replicated since,

00:26:47.460 | and there was never infrastructure or funding

00:26:48.820 | to do that again.

00:26:49.740 | When I was Surgeon General some years ago,

00:26:54.240 | and then this time around,

00:26:55.620 | one of the things I did do is I was able

00:26:57.740 | to send a physical letter to the medical community.

00:27:01.060 | The first time, it was about the opioid use crisis,

00:27:03.540 | and about changing our prescribing practices in medicine

00:27:06.700 | so that we expose fewer patients to the harm of opioids,

00:27:10.180 | while making sure people who needed them actually got them.

00:27:12.740 | And the second time, it was about COVID therapeutics.

00:27:15.580 | It was about making sure that when we had data

00:27:18.340 | about medicines that actually work, like Paxovit,

00:27:20.340 | that we actually offered them to patients,

00:27:22.700 | made them available to patients,

00:27:24.420 | 'cause we were realizing that many people

00:27:25.700 | weren't getting offered life-saving medications,

00:27:28.060 | even though they were in high-risk groups.

00:27:30.220 | So, we were able to find, and we had to, again,

00:27:32.660 | there too, had to creatively cobble together

00:27:35.160 | resources, funding.

00:27:36.000 | This is all sort of behind-the-scenes government stuff.

00:27:40.280 | But the bottom line is, what you want in an emergency,

00:27:44.460 | and what you want, I think, in the long term,

00:27:46.620 | is a simple, clear, comprehensive way

00:27:49.800 | that public health messages can get out to people.

00:27:51.660 | And to this day, what we still have to rely on

00:27:54.240 | are, one, traditional channels, like traditional media,

00:27:57.500 | to cover the initiatives we put out,

00:27:59.680 | whether it's on social media and youth mental health,

00:28:01.660 | or on loneliness, or on youth mental health more broadly.

00:28:04.420 | We have to rely on online channels, which we do as well.

00:28:09.300 | Or we have to look to creative partnerships

00:28:11.400 | that we build with people who reach different audiences,

00:28:13.860 | and then together, we try to get at messages.

00:28:16.220 | Our office does all three of these,

00:28:18.380 | but it's a patchwork, and it's not always ideal,

00:28:23.380 | but it's what we do now.

00:28:24.600 | I think part of what this reflects is a broader challenge,

00:28:28.100 | like in government, but also in society more broadly,

00:28:31.920 | which is that we have valued, historically,

00:28:36.340 | prevention and health communication, very little.

00:28:39.760 | We have put the mass majority of our resources

00:28:43.080 | into treatment strategies,

00:28:44.740 | into getting medications to people, into diagnosis,

00:28:48.860 | and that's very important, don't get me wrong.

00:28:51.320 | But we are now seeing, with mental health,

00:28:53.080 | this is one example,

00:28:54.880 | that if we only focus on expanding treatment

00:28:58.800 | and deepening our well of knowledge there,

00:29:00.640 | and we don't do anything to help people stay well,

00:29:03.480 | then we just can't keep up, right?

00:29:05.600 | - Right, because one problem feeds the other.

00:29:07.520 | - Exactly. - The kids that are,

00:29:08.900 | listen, if I had grown up in today's era,

00:29:11.640 | I'd be on my phone and tablet late at night,

00:29:13.380 | 'cause I was up reading magazines

00:29:14.800 | and talking to friends on the phone late at night, right?

00:29:16.800 | So it's not a criticism, but disruptions in sleep,

00:29:21.000 | disruptions in circadian rhythm,

00:29:22.560 | disruptions, lack of physical activity,

00:29:24.780 | poor nutrition, social isolation,

00:29:27.440 | I mean, these are all piling the sand much higher

00:29:30.120 | on this, in this other side of what you do,

00:29:32.840 | in terms of, and here I'm obviously stating the obvious.

00:29:35.940 | You know, so it's just gonna create a mountain of issues

00:29:39.700 | on the other side, which presumably has a larger budget,

00:29:42.280 | is what I'm sensing, but doesn't,

00:29:44.300 | but there's no way that budget

00:29:46.040 | is large enough to deal with that.

00:29:47.240 | I mean, if somebody's kid, for instance,

00:29:49.880 | is trying to address the issue of whether or not

00:29:53.060 | to go on prescription medications and/or,

00:29:57.580 | by the way, folks, and/or change their dietary intake

00:30:00.560 | because they feel they might have ADHD, for instance,

00:30:03.380 | I mean, what are they gonna do?

00:30:04.940 | They're gonna Google, they're gonna listen to podcasts,

00:30:06.980 | they should be able to write first to your organization

00:30:11.500 | and say, you know, what does the highest level stringency

00:30:15.780 | data say about these issues?

00:30:17.620 | And AI should be able to tell them, accurately.

00:30:21.900 | And maybe you have somebody chime in for them.

00:30:24.900 | I mean, we all pay taxes.

00:30:27.820 | I pay federal and state taxes.

00:30:30.300 | - Me too.

00:30:31.140 | - And to some extent, happily so, right?

00:30:34.540 | 'Cause it pays for public works and many,

00:30:37.220 | many important things, police officers,

00:30:38.820 | firefighters, et cetera.

00:30:40.020 | But if you don't have a channel to communicate with people

00:30:44.300 | about what they and their kids and their relatives can do,

00:30:49.900 | then to some extent, it feels like it's a cul-de-sac.

00:30:54.900 | It's like, how in the world can we get healthy again

00:31:00.940 | or healthier as a country?

00:31:03.180 | - The part that keeps me up at night is,

00:31:06.040 | and one of some of the hardest decisions

00:31:07.420 | I have to make in the office are putting aside issues

00:31:10.820 | that we know deserve a lot more time and attention,

00:31:14.340 | but we just really don't have the resources to deal with.

00:31:16.940 | You know, the issues that we have dealt with,

00:31:18.460 | I'm certainly proud of my team that we've worked hard

00:31:21.240 | to try to raise awareness of the issues we have taken on,

00:31:23.700 | whether it's around social media and youth and mental health

00:31:26.980 | or whether it's around isolation or clinician burnout

00:31:29.700 | or other issues like that.

00:31:31.540 | But the truth is that there's more that needs to be done,

00:31:34.540 | more issues that need to be tackled.

00:31:36.060 | And we have to get to a place where we can talk about

00:31:39.940 | what I think of as the core pillars of a healthy life,

00:31:43.260 | which are sleep, our nutrition, our physical activity,

00:31:47.680 | our social relationships.

00:31:49.380 | These are all vital elements to living a healthy life.

00:31:52.960 | Right now, we're not teaching kids about this in school,

00:31:56.560 | but if you think about education and school

00:31:59.620 | as a place and a force that should prep kids

00:32:04.620 | for the rest of their lives, it should lay a foundation

00:32:08.380 | for a healthy life going forward.

00:32:10.480 | These absolutely are important elements

00:32:12.820 | for kids to learn about.

00:32:13.660 | I think it's as important for kids to learn

00:32:16.060 | about how to build and maintain healthy relationships

00:32:18.620 | in their life as it is, frankly, for them to learn

00:32:21.160 | how to read and write.

00:32:22.360 | And I know that's a strong statement to make,

00:32:23.980 | but it is true in terms of its contribution

00:32:26.120 | to their happiness or fulfillment,

00:32:28.300 | their health and their success.

00:32:29.740 | - Yeah, I could not agree more.

00:32:33.060 | We have a series that's out now with a psychiatrist,

00:32:35.760 | Paul Conte, about mental health, not mental illness,

00:32:38.540 | about self-inquiry and how to use self-inquiry

00:32:41.120 | in practices that do not require a therapist

00:32:44.420 | in order to bolster mental health.

00:32:46.540 | Of course, therapists can be very useful,

00:32:49.340 | but not everyone has access.

00:32:51.140 | And not everyone feels comfortable doing that.

00:32:53.600 | But we are but one channel.

00:32:56.140 | I mean, you are the governing body for this.

00:32:59.620 | You're the Army, Navy and Marines, so to speak, of health.

00:33:04.620 | As many of you know, I've been taking AG1 daily since 2012.

00:33:08.300 | So I'm delighted that they're sponsoring the podcast.

00:33:10.780 | AG1 is a vitamin mineral probiotic drink

00:33:13.060 | that's designed to meet all of your foundational

00:33:14.820 | nutrition needs.

00:33:16.140 | Now, of course, I try to get enough servings

00:33:17.760 | of vitamins and minerals through whole food sources

00:33:20.060 | that include vegetables and fruits every day,

00:33:22.300 | but oftentimes I simply can't get enough servings.

00:33:24.980 | But with AG1, I'm sure to get enough vitamins and minerals

00:33:27.940 | and the probiotics that I need,

00:33:29.700 | and it also contains adaptogens to help buffer stress.

00:33:32.880 | Simply put, I always feel better when I take AG1.

00:33:35.680 | I have more focus and energy and I sleep better,

00:33:38.220 | and it also happens to taste great.

00:33:40.460 | For all these reasons, whenever I'm asked,

00:33:42.300 | if you could take just one supplement, what would it be?

00:33:45.020 | I answer, AG1.

00:33:46.700 | If you'd like to try AG1, go to drinkag1.com/huberman

00:33:51.260 | to claim a special offer.

00:33:52.860 | They'll give you five free travel packs

00:33:54.620 | plus a year supply of vitamin D3K2.

00:33:57.280 | Again, that's drinkag1.com/huberman.

00:34:00.940 | There's lots more to explore there.

00:34:03.860 | We may have to do several of these together,

00:34:07.160 | but to touch on all of them,

00:34:08.900 | but maybe we could talk about a few of the things

00:34:11.200 | that our listeners asked about

00:34:15.980 | when I solicited for questions.

00:34:18.880 | I got more than 10,000 responses across social media

00:34:22.940 | in a very short amount of time,

00:34:24.260 | but there was some redundancy.

00:34:26.400 | One of the things that I'm very curious-

00:34:27.860 | - Can I just say on that point though?

00:34:28.960 | - Yeah, please.

00:34:29.800 | - One, I'm really glad that you asked folks

00:34:31.800 | to submit questions, and I was really excited

00:34:33.660 | to see how many people actually wrote in,

00:34:35.840 | but I think it's also just a testament

00:34:38.500 | to how you've done such an incredible job

00:34:41.120 | of building a channel that the public,

00:34:43.740 | to let people know about these topics

00:34:46.940 | that are so vital to our health and wellbeing,

00:34:48.680 | whether it's sleep or physical activity or mental health.

00:34:51.780 | And so I just want to thank you

00:34:52.940 | for all the work you're doing

00:34:53.960 | trying to help people understand more about health.

00:34:56.100 | And clearly the fact that folks are engaging,

00:34:58.340 | they're sending questions,

00:34:59.300 | and they're sending comments to you

00:35:00.780 | means that you're building a relationship there

00:35:02.300 | with a lot of folks.

00:35:03.140 | So just kudos to you for doing that.

00:35:04.620 | - Well, thank you.

00:35:05.580 | The audience of the Huberman Lab podcast

00:35:08.020 | is the only reason we do it.

00:35:10.300 | I mean, I love learning and teaching, but that's the truth.

00:35:13.680 | So they are the podcast.

00:35:15.440 | The podcast is them.

00:35:16.580 | So thank you for that.

00:35:18.720 | There were a lot of questions,

00:35:23.340 | and I also wonder about why is it

00:35:26.760 | that many food additives and preservatives

00:35:31.760 | and dyes and things of that sort

00:35:34.960 | that are not allowed in Europe

00:35:37.120 | are allowed in US food products?

00:35:39.240 | - Mm, that's a really good question.

00:35:41.140 | And decisions around food and food safety in particular

00:35:46.140 | are made by the Food and Drug Administration,

00:35:48.700 | so that's the FDA.

00:35:49.800 | It's not, it's a separate independent agency.

00:35:53.820 | It's not one that our office is involved in

00:35:56.740 | and sort of directing in any way.

00:35:59.580 | And so we're not involved in those decisions

00:36:01.980 | and don't have insight into how they're making their,

00:36:04.420 | drawing their conclusions,

00:36:05.400 | but they do it in a process that's, you know,

00:36:08.860 | guided by science, just like they do with medications,

00:36:11.420 | with devices, et cetera.

00:36:13.160 | With that said, you know, I am concerned

00:36:16.560 | that dietary practices,

00:36:19.560 | the food that many Americans are consuming,

00:36:22.300 | are in fact not supporting their health and wellbeing

00:36:25.480 | and in many ways are detracting from it.

00:36:27.600 | When we look at highly processed foods,

00:36:30.780 | one of the concerns I have there

00:36:32.580 | is we often see sodium content is very high.

00:36:35.340 | We see the sugar content is very high.

00:36:38.500 | And you know, there are certainly additives in there as well

00:36:41.700 | that I think we, I would love to have more data

00:36:44.460 | on the actual health impacts of those.

00:36:46.860 | But the bottom line is that a significant portion

00:36:49.500 | of our diet is comprised of highly processed foods

00:36:54.100 | in America and that worries me.

00:36:57.060 | The other piece of this that worries me

00:36:58.900 | are just how much refined sugars are being added

00:37:03.720 | to so much of our foods.

00:37:04.740 | And most people think that sugars are only added

00:37:07.080 | to things like desserts, et cetera.

00:37:09.280 | But you look at spaghetti sauces.

00:37:10.720 | - Salad dressings.

00:37:11.560 | - Salad dressings.

00:37:12.520 | A lot of these things which we think of as savory products

00:37:15.720 | have sugar added to them as well.

00:37:17.880 | And so we are consuming, I think,

00:37:21.280 | unhealthy levels of sugar in our diet.

00:37:23.940 | We're consuming a fair amount of additives

00:37:26.560 | given the processed food composition in our diet.

00:37:29.360 | And I think part of the reason this is happening,

00:37:31.240 | and I want to be very clear,

00:37:32.640 | I don't fault individuals out there

00:37:35.560 | for the composition of their diet necessarily

00:37:38.080 | because we have also made certain decisions

00:37:41.520 | in our country about what we subsidize,

00:37:44.840 | about what's cheaper and more expensive for people.

00:37:47.360 | And the cheapest foods, unfortunately,

00:37:49.800 | are often the most unhealthy foods,

00:37:51.360 | the most highly processed foods.

00:37:53.280 | If you are somebody who lives

00:37:54.600 | in the low-income neighborhood,

00:37:56.880 | a number of these neighborhoods

00:37:57.800 | don't even have grocery stores in them,

00:38:00.200 | which is a tragedy

00:38:02.120 | because you can't get fresh produce, et cetera.

00:38:04.500 | A lot of times your shopping,

00:38:05.840 | your grocery shopping may be done

00:38:07.680 | at a local convenience store,

00:38:09.640 | at a 7-Eleven or somewhere else

00:38:13.340 | that may not have the array of fresh fruits and vegetables

00:38:17.100 | that you and your family need.

00:38:18.600 | - I don't even think they have vegetables.

00:38:20.840 | I think they'll occasionally have some lemons or apples

00:38:23.400 | or oranges and bananas.

00:38:25.000 | But when I walk into a convenience store,

00:38:27.380 | what I see is a pharmacy.

00:38:29.460 | I really do.

00:38:30.300 | I see alcohol, caffeine, energy drinks

00:38:32.720 | that have a number of different things in them

00:38:34.360 | designed to stimulate different neuromodulators

00:38:36.420 | like dopamine and serotonin.

00:38:38.760 | I see nicotine products.

00:38:40.960 | I see high sugar, highly processed foods.

00:38:43.880 | And keep in mind, I was a teenager.

00:38:45.820 | I mean, I drank my Slurpees.

00:38:47.880 | I had my Butterfingers.

00:38:49.600 | You know, I wasn't Bart Simpson-like

00:38:51.680 | in my level of Butterfingers, but I liked them.

00:38:53.640 | But it was a smaller fraction of what we ate.

00:38:57.440 | And when we were at home,

00:38:58.540 | those foods were either not available

00:39:00.740 | or we certainly weren't allowed to eat them

00:39:03.100 | and ad lib them, you know?

00:39:05.180 | - Yeah.

00:39:06.340 | - Okay, so what's clear to me is that the FDA

00:39:08.400 | makes decisions about what is safe, what's not safe.

00:39:11.440 | But for instance, okay, this last year,

00:39:15.400 | there were several papers published

00:39:16.660 | in high quality journals showing that

00:39:18.800 | if people eat just sweet and savory foods combined,

00:39:23.800 | that neural circuits in the brain rewire

00:39:27.920 | through process of neuroplasticity,

00:39:29.500 | that drives increased appetite,

00:39:31.700 | and changes the response to healthier foods

00:39:34.780 | so that they don't taste as satiating.

00:39:37.440 | Okay, that's sort of a duh to a lot of people,

00:39:41.200 | but I think it was an important set of findings

00:39:43.440 | because it said the brain actually changes

00:39:44.900 | in response to the very rich, flavorful foods

00:39:49.760 | that are associated with highly processed

00:39:51.520 | or even moderately processed foods.

00:39:53.700 | Okay, I mean, that's just a couple of studies.

00:39:59.240 | There was nothing in those studies that said

00:40:02.040 | if you eat these foods, you're going to develop cancer.

00:40:04.960 | But, you know, at some point one has to,

00:40:07.440 | as a citizen, a taxpaying citizen,

00:40:09.680 | speaking on behalf of many other taxpaying citizens,

00:40:11.700 | I have to sort of take a step back and say,

00:40:13.720 | how long do we wait, right?

00:40:15.400 | Do we have to get a randomized clinical trial

00:40:17.620 | about the 500,000 sick kids that grow into sick adults

00:40:22.620 | and then run a trial where they go on an elimination diet

00:40:28.960 | where they're eating only unprocessed vegan

00:40:31.080 | or unprocessed meat and vegetable

00:40:32.840 | or unprocessed starch and vegetable.

00:40:36.000 | I mean, then we're talking about a 30-year health crisis

00:40:39.180 | before we intervene.

00:40:40.400 | Why not, I mean, if I were in charge, which I'm not,

00:40:43.560 | and clearly I wouldn't survive in a government organization

00:40:46.360 | because, well, I've got the uniform down.

00:40:49.000 | I always wear the same thing, a uniform,

00:40:52.240 | but I wouldn't because I would want to say, wait,

00:40:55.240 | you know, why not err on the side of caution?

00:40:58.060 | Why not send out this AI-generated text message

00:41:00.960 | that tells everybody in all the languages

00:41:02.820 | that Americans speak and can understand,

00:41:04.540 | hey, you get to make choices about what you eat,

00:41:07.440 | but you should be aware that making your diet

00:41:11.020 | comprised of more than 15 to 20% of these foods

00:41:15.200 | is potentially going to lead to serious issues down the road

00:41:17.800 | and those serious issues are extremely serious.

00:41:20.160 | I mean, the obesity crisis is really a crisis

00:41:22.500 | of both body and brain metabolic challenge

00:41:25.760 | that we can talk about.

00:41:27.700 | So, you know, who sets the thresholds?

00:41:30.600 | You know, in other words, why is it that in this country

00:41:33.560 | we have to wait until people start to get really sick

00:41:36.960 | and dying and really struggling

00:41:39.260 | before something is done in the direction of their health?

00:41:41.640 | And I'm not blaming you.

00:41:42.600 | I just want to understand because--

00:41:44.960 | - Good question.

00:41:46.080 | - The wealthy people I know

00:41:48.420 | care a lot about their food sources

00:41:50.400 | and they pay a lot of attention to it.

00:41:52.080 | And why aren't we allowing everyone the opportunity

00:41:54.840 | to make better choices?

00:41:56.380 | - So this is the right question

00:41:57.840 | and this is something I think about a lot

00:41:59.860 | because I'm conscious about what I eat,

00:42:01.700 | but I also talk to folks around the country

00:42:03.520 | and realize a lot of people don't have

00:42:05.640 | either the information or the resources

00:42:08.600 | to actually purchase healthy food, right?

00:42:10.880 | And to know what's gonna be good for them

00:42:12.680 | and for their families.

00:42:13.980 | This is why I mentioned we have a list of issues

00:42:16.220 | that we would work on if we had more resources.

00:42:20.240 | This is actually one of them because to me,

00:42:22.200 | one of the most common questions people ask is

00:42:25.320 | what should I eat?

00:42:26.200 | That's simple, but it's vexing, it's complicated,

00:42:30.220 | and it's incredibly confusing if you go online

00:42:32.200 | and just try to search for information.

00:42:34.400 | And it's a classic example of where it's important

00:42:37.400 | to have an objective scientific authority

00:42:41.160 | that can come and then speak on broad principles

00:42:44.280 | around diet, that can talk about what we know

00:42:46.040 | and don't know.

00:42:47.120 | So here's the important thing.

00:42:48.340 | I think a lot of times people may see something

00:42:52.160 | as on the market, they might read a list of ingredients,

00:42:55.440 | they don't recognize half of them 'cause they're additives,

00:42:57.760 | but they figure, well, if it's there,

00:42:59.800 | then it must have been studied for 30, 40 years

00:43:02.160 | and there must be no harmful consequences, right?

00:43:04.520 | But sometimes things are put out there

00:43:06.360 | because we have short-term data that says

00:43:07.960 | that they're okay, but there may be a need

00:43:10.640 | for more long-term data.

00:43:11.520 | Helping people understand what do we know,

00:43:13.080 | what do we not know is important

00:43:14.560 | so that people can make decisions for themselves

00:43:17.120 | based on how much risk they wanna take.

00:43:19.040 | The other thing that concerns me here, Andrew,

00:43:20.800 | is I, look, I'll tell you, I have a bias here

00:43:25.800 | and my bias is that I am worried about the additives

00:43:31.480 | and other products we have in food

00:43:34.520 | that don't have long-term data that's clear

00:43:36.920 | in terms of health risk.

00:43:38.120 | And so because of that, my bias is generally to think,

00:43:40.860 | how can we get people minimally or less processed foods

00:43:45.280 | and how can we get them more fruits and vegetables,

00:43:47.200 | how can we make sure that they have that

00:43:48.720 | more available to them?

00:43:49.960 | But we've got to not only make the information available,

00:43:52.020 | but we have to make it accessible from a cost perspective.

00:43:55.180 | If you don't have a grocery store in your community,

00:43:57.180 | if vegetables and fruits cost 3X what other foods do,

00:44:01.200 | that's gonna be a problem, right, to change diet.

00:44:03.400 | The other thing we have to keep in mind is that,

00:44:05.520 | you know, food companies, you know,

00:44:07.280 | a lot of them do a great job of actually trying

00:44:09.280 | to get healthy, nutritious food out to people,

00:44:11.440 | you know, and kudos to them.

00:44:12.960 | But I worry also that there's an incentive also

00:44:16.520 | to just try to sell more and more and more of your product.

00:44:18.800 | And one of the ways to do that is to try to hack the body

00:44:22.140 | to kind of figure out, okay, well,

00:44:23.520 | what kind of synthetic additives could I put together here

00:44:27.100 | or what kind of combination of nutrients

00:44:29.560 | could I put together that will get people coming back

00:44:31.640 | for more and more and more?

00:44:32.960 | - And we saw this in the nicotine industry.

00:44:35.200 | - You saw the nicotine industry, you also,

00:44:37.280 | I would say another, it parallels,

00:44:38.800 | you see it in social media as well,

00:44:40.580 | where the business model of the social media platforms

00:44:44.720 | is built on volume of use, right?

00:44:47.180 | How much time am I spending on the platforms?

00:44:49.760 | It's not quality of time, it's quantity of time, right?

00:44:52.600 | So if that's the business model,

00:44:54.080 | then you're going to design your platform

00:44:55.720 | to maximize how much time someone spends on them,

00:44:58.440 | regardless of whether it's detracting from sleep,

00:45:00.720 | detracting from in-person interaction,

00:45:02.340 | detracting from anything else that's healthy,

00:45:04.740 | regardless of whether that may be causing certain harms,

00:45:07.000 | right, like the business model dictates, you know,

00:45:09.720 | in many ways how these things are designed.

00:45:11.660 | And that applies, I think, to food as well.

00:45:13.580 | So which is why I think it's incumbent upon us

00:45:15.720 | to be particularly cautious with highly processed foods,

00:45:19.660 | foods that have additives, and to understand

00:45:22.040 | how is this impacting our brain?

00:45:24.040 | How is that impacting our satiety?

00:45:26.580 | How is it leading potentially to greater ingestion

00:45:30.660 | that is healthy and leading to things like obesity,

00:45:33.000 | which have a whole host of other medical conditions

00:45:35.240 | from cancer to arthritis to diabetes

00:45:37.440 | and heart disease associated with it?

00:45:39.700 | Those are the questions as a citizen,

00:45:42.540 | as a father of two young kids who's trying to bring them up

00:45:44.840 | with a healthy lifestyle, those are the questions

00:45:46.520 | that I would wanna know the answers to.

00:45:48.640 | And it's one of the reasons I think

00:45:49.640 | these kind of objective reports

00:45:51.680 | are so important for the public.

00:45:53.320 | - I was trying to see the scope of the problem

00:45:57.280 | and the mechanics involved in trying

00:46:00.160 | to alleviate these issues are complex.

00:46:02.920 | I see that.

00:46:04.800 | - They aren't all so, one other thing that is important

00:46:06.720 | to do, though, is you need to have authorities

00:46:11.380 | that can speak to these issues that are insulated

00:46:14.920 | from political retribution, right?

00:46:16.960 | So, and to explain this, like--

00:46:19.560 | - Amen to that.

00:46:20.660 | - Yeah, look, I--

00:46:21.660 | - I mean, listen, as somebody, forgive me for interrupting,

00:46:24.000 | but as somebody who, from time to time,

00:46:25.820 | will make not recommendations, but will offer information

00:46:29.660 | about potential actionable items,

00:46:32.720 | things that people could do or not do,

00:46:34.160 | according to a couple of studies that have come out.

00:46:36.800 | I mean, I've come under intense scrutiny from my colleagues

00:46:40.960 | who are like, wait, that's not a randomized controlled trial.

00:46:43.060 | How can you do that?

00:46:43.980 | And yet, I know from being in this field for a long time

00:46:47.520 | that, for instance, the emerging therapies

00:46:49.620 | for PTSD and depression that are now based

00:46:52.140 | on federal funding for things like,

00:46:54.120 | and I'm not recommending this, by the way,

00:46:55.840 | for children or for everybody, but for instance,

00:46:57.740 | the macrodosilicibin therapeutically supported legal use

00:47:02.740 | of psilocybin for major depression.

00:47:06.500 | The data there, they're not perfect,

00:47:08.360 | but they're pretty darn good compared

00:47:09.980 | to the major SSRIs.

00:47:11.580 | But for years, if an academic said the words I just said,

00:47:16.040 | they'd lose their job almost instantaneously

00:47:18.500 | 'cause they're controlled substances.

00:47:20.940 | That's a to-do, but then there are a number of things

00:47:23.740 | that we're talking about here

00:47:24.580 | that are just about making better choices

00:47:26.820 | about things to avoid.

00:47:28.380 | If people understood, I think, that, is sugar poison?

00:47:32.460 | Well, some of my audience will say sugar is poison.

00:47:34.460 | It's as addictive as cocaine.

00:47:35.740 | Look, it is not as addictive as cocaine or heroin.

00:47:38.540 | It is not.

00:47:39.420 | However, if a child or adult is eating very sweet

00:47:44.420 | or very savory foods of any kind consistently,

00:47:47.600 | if those are not healthy foods

00:47:50.000 | or if they contain unhealthy additives,

00:47:52.840 | over time, the brain will rewire

00:47:54.500 | so that healthy foods don't taste as good.

00:47:56.780 | They won't be the choices that people make,

00:47:59.420 | and you're gonna end up with a sick individual, period.

00:48:02.220 | And I don't think we need one more clinical trial

00:48:05.780 | funded by federal tax dollars to support that statement.

00:48:09.540 | What I'm starting to gather is that you're a very rational,

00:48:12.060 | grounded, broad-thinking individual.

00:48:13.820 | I'm not just saying that 'cause you're sitting here,

00:48:15.540 | and you're trained in medicine,

00:48:17.940 | and you understand the science,

00:48:19.460 | but that you don't have the means at your disposal

00:48:24.340 | to put out a call that says,

00:48:25.480 | "Hey, folks, having some sugar every once in a while,

00:48:27.640 | "it's reading the kids to ice cream, great."

00:48:29.780 | But if 80% or more of the diet of our kids

00:48:34.260 | isn't made up of minimally or non-processed foods,

00:48:37.340 | their brains are gonna be rewired in unhealthy ways,

00:48:39.940 | and you can almost expect that they're going to have

00:48:42.840 | some health challenge in the future

00:48:44.700 | that may not be autism or schizophrenia,

00:48:49.700 | but is going to be a major health challenge.

00:48:53.180 | And that is serious, and now's the time to intervene

00:48:56.060 | by avoiding certain things.

00:48:57.740 | And if you don't wanna do it,

00:48:58.700 | look, it's a free country at that level.

00:49:00.220 | You're welcome to do it,

00:49:01.480 | but you'd be better off spending X number of dollars

00:49:03.820 | on these healthier foods, because there's also,

00:49:06.660 | and we know this from my colleague,

00:49:08.020 | Ali Krum's laboratory at Stanford,

00:49:10.120 | that even the mere knowledge

00:49:11.820 | that certain foods are nutritious

00:49:13.500 | can lead to more satiety from eating those foods

00:49:16.120 | at the level of hormone release,

00:49:17.860 | not just psychologically, you're telling yourself

00:49:19.660 | that the orange is as tasty and filling as a candy bar,

00:49:23.500 | but the understanding of the fact that it is nutritious

00:49:28.360 | actually leads to shifts in patterns

00:49:30.860 | of ghrelin secretion, et cetera,

00:49:33.900 | that change, so people can be feel better

00:49:36.960 | on a healthier, slightly lower calorie,

00:49:40.420 | nutrient-enriched diet of healthy proteins

00:49:42.900 | and fruits and vegetables.

00:49:44.920 | And it's not a mind trick, it's physiology.

00:49:48.940 | Anyway, I think I feel your pain, frankly.

00:49:53.820 | - And I'll tell you, look, sometimes people ask,

00:49:55.260 | hey, why don't you just go out and say

00:49:56.500 | a couple of statements that you just said?

00:49:58.280 | Would that be fine?

00:49:59.120 | Why is time needed to prep something like that?

00:50:02.200 | Why are resources needed, et cetera?

00:50:03.900 | Here's actually why.

00:50:04.900 | I know in today's day and age,

00:50:06.300 | it's easy to just go and rattle off off-the-cuff statements

00:50:09.900 | or shoot from the hip, et cetera.

00:50:10.740 | - You're welcome on my social media channels any time,

00:50:13.440 | really, to get their word out to millions of people.

00:50:15.520 | - No, I appreciate that, and I may take you up on that.

00:50:17.800 | But I'll tell you that one of the reasons,

00:50:19.080 | one of the things we always do,

00:50:20.200 | recognizing that when we put out statements,

00:50:23.000 | that people, one, they trust it's coming

00:50:26.640 | from a scientific authority and that it's been vetted, right?

00:50:29.560 | So we put the effort and time into vetting this thoroughly.

00:50:32.880 | We check sources, we look at the data, we talk to experts,

00:50:36.040 | we think about how to communicate this in the right way.

00:50:38.780 | That's the work, the behind-the-scenes work

00:50:41.400 | that we do before we put out reports and initiatives.

00:50:45.000 | Because we want people to have confidence

00:50:46.960 | in what they're hearing.

00:50:48.220 | We also know that when we put out initiatives,

00:50:50.600 | that other people build on them.

00:50:51.960 | Philanthropists and foundations will then think about,

00:50:54.940 | should I fund work in this area?

00:50:57.440 | Schools and workplaces will think about

00:50:59.420 | shifting some of their practice.

00:51:00.800 | Policymakers will also think about legislation

00:51:03.600 | that they may want to design based on that.

00:51:06.200 | So we want to make sure it's really solid.

00:51:08.320 | But the point I was making when I said also that

00:51:10.680 | we have to make sure that, not just our office,

00:51:13.140 | but folks who are in public health and who are in medicine,

00:51:17.520 | who are trying to speak to the public about their health,

00:51:19.600 | that they are protected from retribution and taxes.

00:51:22.800 | This is what I meant,

00:51:23.640 | which is that saying things about diet,

00:51:26.800 | saying things about tobacco,

00:51:29.620 | these can be challenging for some folks

00:51:31.880 | because there are industries built around these, right?

00:51:34.400 | Which may not always like what you have to say

00:51:36.980 | if it hurts their business model or their bottom line.

00:51:40.160 | And they may then lean on political leaders,

00:51:44.000 | elected leaders, others to then try to silence you

00:51:46.680 | or shut you up.

00:51:47.520 | And I'll tell you, I've experienced this in the past.

00:51:50.380 | You know, I was Surgeon General during my first term.

00:51:53.700 | I had issued two key reports.

00:51:56.980 | One was on alcohol, drugs, and health

00:51:58.900 | about the addiction crisis.

00:52:00.860 | And the other was about the e-cigarette crisis among youth.

00:52:04.620 | I will tell you that there were plenty of people

00:52:06.400 | who were very unhappy that I was issuing

00:52:09.340 | the first federal report on e-cigarettes.

00:52:12.140 | Folks who felt that, hey, this is gonna make folks unhappy.

00:52:15.860 | It's gonna create political pressure.

00:52:17.960 | It's gonna create a lot of problems.

00:52:20.520 | Similarly, with alcohol, drugs, and health,

00:52:22.640 | there are many folks who said, hey, if you do this,

00:52:24.240 | you're really gonna upset the alcohol industry.

00:52:26.360 | Do you really need to have alcohol in the report?

00:52:28.240 | Why don't you just focus on other drugs?

00:52:30.600 | Why don't you take alcohol out of the title?

00:52:32.480 | You know, all of these sort of concerns were raised--

00:52:35.080 | - Who was telling you this?

00:52:36.360 | So these are people who get paid by the alcohol industry?

00:52:39.240 | - No, these are people in government

00:52:40.520 | who are reading the tea leaves

00:52:41.740 | and who are supportive of the work we're doing

00:52:43.600 | but are saying, hey, you're gonna really upset

00:52:46.020 | a lot of people in the industry.

00:52:48.120 | - You're also gonna help a lot of people.

00:52:49.280 | - Yeah, well, this is what it comes down to.

00:52:50.980 | They say, well, and if you upset folks,

00:52:52.920 | then they're gonna try to fire you.

00:52:54.160 | They're gonna try to do all these things.

00:52:55.520 | To which, honestly, my response to a lot of these,

00:52:59.000 | and the reason we just put them out anyway,

00:53:01.300 | was because I said, well, the worst thing that can happen

00:53:04.160 | is I get fired, and that's okay.

00:53:06.400 | You know, if I go out knowing I did the right thing here,

00:53:09.200 | then I'm fine with that.

00:53:10.100 | I'm not looking to build a lifelong career in government.

00:53:13.360 | I'm not doing this job to get to the next thing

00:53:15.680 | on the ladder.

00:53:17.000 | This is about serving for the time I can.

00:53:19.700 | I want to be able to go to sleep at night,

00:53:21.160 | look myself in the mirror, and know I did so with integrity.

00:53:24.060 | So that was an easy decision for me.

00:53:25.940 | But my point is that we have to be thoughtful

00:53:30.280 | in these issues that they're gonna be headwinds.

00:53:33.420 | I'm sure in your case, for example,

00:53:34.920 | you've probably gotten pushback from folks

00:53:36.820 | about talking about certain things

00:53:38.540 | that may have rankled folks who may have had an interest

00:53:40.900 | in those issues, and that's okay.

00:53:41.820 | You keep talking about them as you should,

00:53:43.560 | and I'm grateful for that.

00:53:46.100 | But this is especially important at a time

00:53:48.840 | where I think public trust in our institutions more broadly

00:53:53.840 | and in science and in medicine have taken a hit

00:53:56.800 | over the last few years.

00:53:58.720 | And I think it's a time

00:53:59.880 | where we have to be even more vigilant,

00:54:02.000 | those of us in medicine and public health,

00:54:04.320 | to make sure that what we do is based on data,

00:54:07.880 | that we're transparent about why we're saying

00:54:10.520 | what we're saying, that we're also clear about what we know

00:54:12.840 | and what we don't know so that if recommendations change

00:54:16.940 | over time, people recognize

00:54:18.780 | that this isn't necessarily flip-flopping.

00:54:20.600 | You should change your recommendations if the data changes,

00:54:23.980 | if the circumstances change.

00:54:25.260 | So anyway, this is all part of the work that we've got to do,

00:54:28.040 | but to me, this is a really important part of the work.

00:54:30.780 | The integrity behind our work in public health

00:54:33.120 | is not just about the issue we're taking on today.

00:54:35.300 | It's about the trust that we need to rebuild

00:54:38.140 | in the field more broadly.

00:54:40.820 | - So if I understand correctly, if you were to,

00:54:45.100 | for instance, put out a call that says,

00:54:47.540 | look, there are food additives that are allowed in the US

00:54:51.000 | that are not allowed in Europe that may be a risk.

00:54:53.540 | We don't have enough data at present

00:54:55.320 | to avoid these things, but here's a kind of a yellow zone.

00:54:58.820 | You know, green, known to be safe.

00:55:00.840 | Red, clearly known to be unsafe.

00:55:03.260 | Yellow, we just don't know yet, not enough data.

00:55:06.380 | So here's what my recommendation would be for my children.

00:55:09.140 | - Yeah.

00:55:10.940 | - It's a free country, you know?

00:55:13.300 | There are people that argue it's not,

00:55:14.700 | but at least at the level of which foods

00:55:15.940 | you want to buy with your own budget, it's a free country.

00:55:19.320 | So you're saying that you get messages

00:55:24.320 | that warnings about certain things could lead to pushback,

00:55:28.660 | but I have to imagine that there's something,

00:55:31.840 | and I'm not a conspiracy theorist,

00:55:33.280 | but there has to be, either the people that are saying,

00:55:35.780 | look, there could be problems are just friction averse.

00:55:40.780 | They just don't like anyone to be angry at anyone.

00:55:43.520 | Or there must be some incentive for things to remain quiet.

00:55:48.520 | I mean, certainly the government has not had problems

00:55:53.100 | saying to do things or to not do things

00:55:55.820 | that upset companies or shut down companies

00:55:59.140 | or elevated companies and their success.

00:56:02.140 | So I'd like to know more about the back contour

00:56:05.740 | to this.

00:56:06.580 | - Well, look, I think, and this is not too dissimilar

00:56:08.420 | for I think what happens in other industries,

00:56:10.460 | but it's, you know, whenever you do something

00:56:13.100 | and whether it's in the private sector or in government,

00:56:15.380 | people weigh what are the pros, cons,

00:56:17.460 | what's the pushback I'm gonna get?

00:56:18.540 | How do I deal with that pushback, right?

00:56:20.860 | And pushback isn't always a bad thing, right?

00:56:22.560 | If you get pushback from the public,

00:56:23.580 | people say, hey, that doesn't make sense to me, et cetera.

00:56:25.380 | You should listen to that and use it to inform your approach.

00:56:28.180 | - But that's the public who your job is to serve.

00:56:30.420 | I'm talking about pushback from companies is different.

00:56:32.940 | - Right, so when pushback comes from people

00:56:34.960 | who have a financial interest in the product

00:56:37.820 | that you may be commenting on,

00:56:39.640 | then you've gotta be, you need to know about that,

00:56:42.240 | number one, so that you know how to mitigate it.

00:56:45.020 | And while people may take different approaches to this,

00:56:47.080 | my approach as a public official, as Surgeon General,

00:56:50.580 | has been to say at the end of the day,

00:56:52.460 | like I'm happy to hear from anyone

00:56:54.900 | in terms of their concerns or pushback,

00:56:56.820 | but at the end of the day,

00:56:57.660 | what's gonna guide my decisions about what issues we take on,

00:57:00.460 | what decisions we make and what we say to the public

00:57:04.060 | is gonna be what is driven by science

00:57:06.900 | and the public interest.

00:57:07.740 | And if that means it's politically inconvenient, that's okay.

00:57:10.200 | If that means that something happens to my job,

00:57:13.480 | that's okay too.

00:57:14.500 | The bottom line is life is short.

00:57:17.000 | We don't know how much time we have here.

00:57:18.320 | We may as well make the time we have count

00:57:19.760 | and we may as well do the things that are right

00:57:22.380 | and that are gonna serve people.

00:57:23.380 | That's my simple philosophy my parents taught me

00:57:25.640 | when I was growing up.

00:57:27.080 | So that's the approach I bring to this.

00:57:28.920 | And that's why if we were to do, let's say,

00:57:31.100 | an initiative on diet,

00:57:32.600 | I have no doubt that some of the things that we would say

00:57:35.080 | would be perturbing to folks

00:57:37.220 | who had a financial interest in the industry

00:57:38.780 | 'cause I don't think that the current setup in the industry

00:57:40.700 | is serving the public well.

00:57:42.300 | I think we have made unhealthy foods cheap.

00:57:44.800 | That's a problem.

00:57:45.680 | We've made healthy foods expensive.

00:57:47.240 | That's a problem.

00:57:48.080 | We put health from a dietary perspective out of reach

00:57:51.760 | for millions of Americans.

00:57:53.240 | That is a fundamental problem.

00:57:55.120 | And we've also disempowered people

00:57:58.000 | by not giving them the information

00:57:59.860 | that they need to make decisions.

00:58:01.480 | So even if you have resources,

00:58:03.200 | again, Terry, there are people listening to this podcast

00:58:05.720 | and many more people out there

00:58:06.800 | who go to the grocery store and just feel confused.

00:58:09.520 | Like what on earth should I buy?

00:58:11.840 | What's healthy?

00:58:12.680 | What's okay anymore?

00:58:14.400 | It's just hard to know.

00:58:15.640 | And so I think we've done a disservice by not doing more

00:58:19.100 | to help the public understand and access healthy foods.

00:58:23.240 | And again, it's why it's an issue that,

00:58:25.840 | it was on our list of issues that we would wanna work on

00:58:28.760 | because I think that the public health need here is immense.

00:58:32.400 | - I'd like to just take a brief break

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00:58:44.140 | the so-called electrolytes, and no sugar.

00:58:46.960 | Now, salt, magnesium, and potassium are critical

00:58:49.800 | to the function of all the cells in your body,

00:58:51.660 | in particular to the function of your nerve cells,

00:58:54.300 | also called neurons.

00:58:55.540 | Now, people of course have varying levels of requirements

00:58:57.900 | for sodium, so people with hypertension or prehypertension

00:59:00.900 | probably shouldn't increase their sodium.

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00:59:04.820 | that by increasing their sodium intake,

00:59:06.720 | they're able to function better cognitively and physically.

00:59:09.440 | And that's because a lot of people,

00:59:10.380 | especially people who are following low carbohydrate

00:59:12.520 | or even moderate carbohydrate and really clean diets,

00:59:15.260 | oftentimes they're excreting a lot of water

00:59:16.880 | and electrolytes along with it.

00:59:18.040 | And simply by increasing their electrolyte intake

00:59:20.320 | using Element, they just feel better and function better.

00:59:23.120 | I typically drink Element first thing in the morning

00:59:25.160 | when I wake up in order to hydrate my body

00:59:27.280 | and make sure I have enough electrolytes.

00:59:29.080 | And while I do any kind of physical training,

00:59:31.320 | and certainly I drink Element in my water

00:59:34.160 | when I'm in the sauna and after going in the sauna

00:59:36.640 | because that causes quite a lot of sweating.

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00:59:46.200 | Again, that's Drink Element, lmnt.com/huberman.

00:59:50.860 | - I have a question about trust in big institutions

00:59:53.520 | and public health initiatives in general.

00:59:56.380 | The question is about masks.

00:59:57.900 | Early in the pandemic, as I recall,

01:00:01.240 | we were told that masks were not necessary.

01:00:03.400 | Then we were told they are necessary.

01:00:06.320 | And I think for a lot of people,

01:00:09.680 | that flip in messaging landed like a parent

01:00:14.080 | telling their teenage kid to always wear a seatbelt,

01:00:18.800 | but then you look into the front seat

01:00:20.780 | and mom and dad aren't wearing seatbelts.

01:00:23.120 | And as anyone who's been around teenagers,

01:00:25.120 | there has been one, you make that mistake once,

01:00:27.140 | you're not making it again.

01:00:29.660 | And you may never recover from that particular example.

01:00:33.220 | In other words, the public felt like

01:00:36.500 | there was a switch of messaging.

01:00:38.380 | But what I don't recall happening was a, like a,

01:00:42.420 | hey, we got that one wrong, so sorry, on us.

01:00:47.420 | You know what?

01:00:48.540 | The new data say blank.

01:00:50.420 | What I recall was a message of don't and then do,

01:00:55.420 | but there wasn't a lot of kind of acknowledgement

01:00:58.840 | of how challenging the situation was.

01:01:00.900 | It was just a lot of top-down mandates.

01:01:04.680 | And in my opinion, and this is just my opinion,

01:01:08.020 | I think that led to a pretty rapid distrust

01:01:10.520 | of subsequent messages

01:01:12.260 | from which we still haven't really recovered.

01:01:15.140 | And so why do you think it's so challenging

01:01:18.340 | for public-facing officials to just say,

01:01:21.620 | look, doing the best we can at the moment,

01:01:24.920 | screwed up before, changing the message now,

01:01:28.300 | may change again, we're navigating this in real time,

01:01:32.480 | it's dynamic, please stay with us.

01:01:34.780 | Because it goes without saying

01:01:37.180 | there's been a huge chasm around this and related issues.

01:01:40.220 | - Yeah, and look, it's an important question.

01:01:41.920 | And look, I'm always, I wanna be thoughtful

01:01:45.180 | about how I comment on what was done

01:01:47.960 | in the first year of the pandemic.

01:01:49.160 | I was a citizen as outside government

01:01:51.920 | and I don't know what was happening inside government

01:01:53.860 | in terms of the decisions that were made there.

01:01:56.720 | But I do know sometimes from my experience in Ebola

01:01:59.260 | and in Zika, during those experiences we had as a country,

01:02:03.340 | that in the fog of war when everything's coming at you,

01:02:06.540 | sometimes it's hard to make the right decision

01:02:09.120 | all the time, right?

01:02:09.960 | So I wanna give some of those folks who were there

01:02:12.300 | in the first year of the pandemic some benefit of the doubt.

01:02:16.760 | But I do think that the important thing,

01:02:19.740 | the principle I certainly try to follow,

01:02:21.840 | but when I think that, and we can all do better,

01:02:24.580 | I can do better, certainly too.

01:02:26.460 | But I think an important principle for us

01:02:27.820 | in public health communication has to be that we're clear,

01:02:32.320 | that we're transparent about what we know

01:02:35.620 | and what we don't know,

01:02:36.940 | and that we explain the why to people.

01:02:40.540 | So if we're telling someone to do something, why?

01:02:42.940 | Is it because there's a lot of data behind it?

01:02:45.580 | Is it because it's a sort of expert agreement, best practice?

01:02:49.480 | 'Cause sometimes, as you know, in medicine,

01:02:52.120 | sometimes when we don't have enough data

01:02:54.280 | to guide us on a therapeutic approach,

01:02:56.460 | but when the problem is imminent,

01:02:59.100 | then sometimes experts will get together

01:03:00.900 | and put together expert-informed guidelines

01:03:03.240 | to say, okay, look, based on our best judgment

01:03:05.340 | and the limited data we have,

01:03:06.460 | here's what we would recommend.

01:03:08.060 | And as the data evolves, we will change

01:03:10.180 | and modify those recommendations.

01:03:11.880 | We do that with hypertension, right?

01:03:13.060 | We evolve and update recommendations.

01:03:14.660 | We do that with lipids.

01:03:15.760 | Here too, I think that has to be

01:03:18.420 | like a key part of the approach.

01:03:20.140 | I think one of the challenges

01:03:21.500 | that I saw many public health officials encounter

01:03:24.700 | was even when they went out

01:03:26.060 | with comprehensive messages like that,

01:03:28.460 | which are hard to fit into a soundbite

01:03:30.380 | or into simple posts on social media,

01:03:32.440 | often a lot of that wasn't covered.

01:03:34.920 | What gets covered is the top line.

01:03:37.020 | This is what's really being recommended.

01:03:38.580 | That's what's being required, et cetera.

01:03:40.320 | All the explanation is lost, it's missing, right?

01:03:42.980 | And I think we also are living in a time

01:03:44.980 | where people are reading headlines

01:03:46.420 | like they're living busy lives, right?

01:03:48.300 | They're not necessarily always hearing

01:03:51.200 | all of the nuance that's being explained.

01:03:53.340 | But I think that that's a challenge, right?

01:03:55.560 | It was like, I know many public officials struggled with

01:03:57.860 | how do you deliver nuanced information

01:04:01.160 | at a time when there isn't a clear black and white answer

01:04:04.180 | to things.

01:04:05.020 | But I think the last piece around this is,

01:04:07.180 | I think something I was taught early in medical school

01:04:09.980 | is to approach your patients with humility,

01:04:12.900 | recognizing that even though you have more training

01:04:15.780 | than they do, you aren't living their life,

01:04:19.420 | you don't necessarily know what they're going through,

01:04:21.660 | and you shouldn't assume things about them, right?

01:04:25.020 | And so, approaching with humility means

01:04:26.580 | that you've gotta recognize

01:04:29.500 | that not everyone's gonna be able to follow your guidance,

01:04:31.540 | and if they aren't able to,

01:04:32.520 | that doesn't mean you criticize them.

01:04:34.100 | It also means recognizing that people may have ideas

01:04:36.820 | or suggestions for you that may actually improve

01:04:39.100 | your recommendations or how you communicate.

01:04:41.380 | And so, these are the principles, I think,

01:04:43.800 | that are important in public communication,

01:04:45.780 | but I think that both the challenge

01:04:48.460 | of translating nuanced arguments

01:04:50.980 | into what's actually covered,

01:04:52.760 | that was tough for many public health officials.

01:04:55.140 | I think the other thing, honestly, just on a human level,

01:04:56.900 | that became hard for many of them,

01:04:58.520 | and I am thinking particularly about local and state

01:05:01.300 | public health officials who are on the front lines

01:05:03.080 | that I talk to a lot,

01:05:04.820 | was they ended up getting attacked a lot

01:05:08.140 | and abused a lot during the pandemic.

01:05:10.180 | And I don't just mean like attacked online.

01:05:12.340 | I mean, people showing up at their houses,

01:05:14.100 | people harassing their children,

01:05:16.300 | people threatening their safety.

01:05:17.940 | And this was often people who were upset

01:05:21.820 | about some of the requirements that were being put down

01:05:24.180 | from local departments of health.

01:05:26.020 | And you can understand, look, COVID was as stressful a time

01:05:28.960 | as we've seen recently.

01:05:30.580 | People lost their jobs, people were losing loved ones.

01:05:32.780 | I mean, talk about a stressful time.

01:05:34.920 | But I think at a human level,

01:05:36.620 | public health officials who were exposed

01:05:38.820 | to that kind of abuse

01:05:39.660 | and who started to worry about their children's safety,

01:05:42.580 | many of them stepped out of the arena and said,

01:05:45.200 | "Is this really worth it to put my family at risk?"

01:05:48.840 | And that was hard because we lost

01:05:51.420 | a lot of good public health people in that respect.

01:05:53.520 | So I think in addition to having sort of these core

01:05:56.200 | principles of public health communication in place,

01:05:59.200 | then what we also need to restore is an environment

01:06:02.240 | where we, frankly, of humility and civility,

01:06:05.820 | where we don't attack people who maybe have different views

01:06:09.100 | or are coming out with recommendations

01:06:10.580 | that are not palatable to us.

01:06:13.820 | And I think it's also incumbent upon our leaders in society

01:06:17.900 | to not stoke that kind of resentment and violence as well,

01:06:21.780 | 'cause that happened during the pandemic

01:06:23.780 | as COVID got increasingly politicized.

01:06:26.140 | And while that may have been at times done

01:06:28.440 | for political reasons here or there,

01:06:31.000 | the people who suffered were both the public health leaders

01:06:34.240 | who were trying to do the right thing for their communities

01:06:36.320 | and the public themselves who weren't able

01:06:38.880 | to have a clear, direct channel and a dialogue

01:06:42.100 | with their public health officials

01:06:44.520 | because a lot of that ended up getting closed off.

01:06:47.340 | - Yeah, I feel like there was a lot of talking down

01:06:49.280 | to the dissenters and the general public.

01:06:52.440 | And I totally agree that getting violent

01:06:56.700 | or harassing people with whom you disagree

01:06:59.680 | is totally inappropriate.

01:07:01.360 | - Andrew, the one thing just to say

01:07:02.400 | about the humility piece, and I'll give you an example here

01:07:04.960 | of where I think this could've and should've been done better

01:07:08.600 | is in an effort, for example, around masks

01:07:11.580 | to recommend that people wear masks.

01:07:14.480 | And one important thing just to know is that

01:07:16.980 | when it comes to schools requiring masks,

01:07:19.720 | those are decisions that are made on local levels.

01:07:21.920 | The federal government doesn't mandate masks in schools.

01:07:24.560 | It doesn't have the authority to do that.

01:07:26.080 | So those are local decisions.

01:07:28.700 | But at the end of the day,

01:07:29.680 | there were people who did not want their children

01:07:31.420 | to wear masks for a variety of reasons,

01:07:34.200 | some worried about their social development,

01:07:36.820 | some worried that it was adding stress to their kids.

01:07:39.240 | People had different reasons

01:07:40.580 | why they may or may not have wanted their children

01:07:42.100 | to wear masks.

01:07:43.520 | And one of the things I think that was not helpful

01:07:45.900 | was that when there were parents who made the decision

01:07:48.900 | they didn't want their kids to wear masks,

01:07:51.460 | I think some of them received a lot of criticism

01:07:55.280 | without people necessarily stopping to understand

01:07:57.560 | why they may have been making that decision.

01:08:00.000 | Because I'll say as a parent whose children were in school,

01:08:03.060 | my kids are five and seven,

01:08:04.180 | and in the first year of the pandemic

01:08:06.380 | they were doing preschool virtually,

01:08:07.820 | which was a nightmare.

01:08:09.060 | It was incredibly hard for us.

01:08:10.660 | Even when they got back to school in the fall of 2021,

01:08:15.100 | it was a really tough adjustment for them.

01:08:17.380 | And I could understand some of the concerns

01:08:20.300 | that parents were having wondering about,

01:08:22.800 | hey, how are these precautions

01:08:24.420 | affecting my child's experience in social development?

01:08:27.160 | So on the whole, this recommendation may still be,

01:08:30.700 | hey, improve ventilation in your classrooms,

01:08:33.020 | recommend masking, recommend testing, et cetera.

01:08:35.940 | But those recommendations I think have to be made

01:08:38.860 | in a way that acknowledges the humanity of people

01:08:42.460 | who may have a different point of view

01:08:44.420 | or may make a different decision for their child.

01:08:47.260 | And I know that when local localities made the decision,

01:08:50.340 | in many cases to require kids in their district

01:08:54.420 | to wear a mask,

01:08:55.440 | that put some parents who didn't want that,

01:08:57.620 | they put them in a hard place, right?

01:08:59.820 | But I think that our failure to actually have

01:09:02.720 | an open, honest, respectful conversation about this,

01:09:06.380 | where we didn't feel like we were each being attacked

01:09:09.700 | as parents for our decisions

01:09:11.300 | or as community members for the decisions we were making,

01:09:14.260 | I think that not only hindered, I think, the response,

01:09:17.880 | but I think it actually contributed to this division,

01:09:20.540 | the sense of black and whiteness,

01:09:21.860 | that, hey, it's us against them.

01:09:24.020 | And then suddenly if I was against one measure,

01:09:26.880 | then I was against all of them.

01:09:28.560 | Or if I was for one measure, I was for all of them

01:09:30.460 | because we just started segregating into sides.

01:09:33.840 | And this became a polarized experience at a time

01:09:38.620 | where really it should have been a crisis

01:09:40.520 | that brought us together, as messy as it was.

01:09:43.440 | And that honestly, Andrew, is what I worry about most

01:09:46.360 | for the next pandemic, right?

01:09:48.000 | Like I think we've learned a lot from this pandemic

01:09:50.000 | about how to manufacture vaccines

01:09:53.780 | and how to develop them quickly,

01:09:56.420 | how to distribute them efficiently.

01:09:59.200 | And it was one of the, I think, most historic

01:10:02.600 | and effective vaccine distribution efforts in this country,

01:10:04.900 | even though it certainly could have been better,

01:10:06.340 | but it was historic by all measures.

01:10:09.200 | We've learned a lot about how to do vaccines, therapeutics,

01:10:12.000 | a lot of the nuts and bolts of a pandemic response well.

01:10:16.260 | But I worry what we are still struggling with

01:10:19.540 | is how we build trust, how we communicate with the public,

01:10:24.360 | and how we stay together as a country

01:10:27.000 | in the face of adversity.

01:10:28.780 | 'Cause if we're divided the way we were during COVID,

01:10:32.560 | during the next pandemic or the next threat

01:10:35.980 | that may come from a foreign adversary,

01:10:38.520 | that's a huge national security issue for us.

01:10:41.280 | And so that's what keeps me up at night

01:10:43.300 | when I think about the next pandemic that may come.

01:10:46.440 | - Two questions relate to what you just said.

01:10:48.880 | First of all, as it relates to vaccines, in my opinion,

01:10:53.700 | and I think the opinion of many people out there,

01:10:56.480 | that the response to the next pandemic

01:10:59.760 | will be heavily contingent

01:11:03.700 | on at least some sort of acknowledgement

01:11:07.780 | that there are people who at least feel

01:11:10.040 | that there have been vaccine injuries, right?

01:11:12.120 | To simply say, okay, the previous round with COVID

01:11:17.960 | went this way and now there's now virus X, right?

01:11:22.640 | Let's hope not, God forbid,

01:11:24.200 | but it sounds like it's coming at some point.

01:11:27.100 | And people are going to think to the last time

01:11:30.040 | and they're going to immediately say,

01:11:33.540 | well, the last time we were told to take a vaccine,

01:11:37.740 | some people had a good experience with that,

01:11:39.720 | other people didn't.

01:11:40.940 | And in this empathy model of acknowledging

01:11:45.600 | and letting your moral compass guide

01:11:48.480 | and understanding the why behind what people are doing

01:11:51.820 | and how they're reacting,

01:11:52.660 | it seems to me that now would be the time

01:11:55.220 | to at least try and understand where they're coming from,

01:11:58.840 | even if one disagrees,

01:12:00.200 | maybe even especially if one disagrees,

01:12:02.360 | and try and get people aligned now before the next pandemic.

01:12:07.360 | And so what efforts are being made, if any,

01:12:11.560 | to try and acknowledge that some people

01:12:15.100 | really do feel as if they were harmed?

01:12:17.880 | I'm not saying they were or not,

01:12:19.940 | but clearly there are people who feel that they,

01:12:23.480 | or people they know were harmed.

01:12:25.880 | Is there an effort to present them with data,

01:12:29.440 | to have discussions with them,

01:12:31.040 | to try and get people aligned so that the next time around

01:12:34.400 | we can be more of a unified front,

01:12:35.920 | whatever the necessary response happens to be?

01:12:38.840 | - Yeah, no, it's a really important question.

01:12:40.280 | And to me, I always go back to sort of first principles

01:12:43.380 | from practicing medicine, right?

01:12:44.880 | Which is, if there is a medicine you give a patient,

01:12:48.080 | and even if it helps 99.99% of patients,

01:12:50.980 | but this one particular patient happened to be harmed by it,

01:12:54.500 | you go in, you acknowledge it, you talk about it,

01:12:56.680 | and you together trot out a path

01:12:59.660 | for how you wanna move forward.

01:13:01.000 | And the path forward might be,

01:13:02.560 | yes, let's get rid of that medication,

01:13:04.000 | but let's use an alternative, let's try it.

01:13:06.000 | Or we can't use that medication anymore,

01:13:08.040 | here are the risks you may sustain,

01:13:09.660 | but we'll find other ways to protect you, right?

01:13:11.240 | So that's what we would do in medicine, right?

01:13:13.000 | That's what I've done with patients over the years.

01:13:14.960 | I think here too, similarly,

01:13:16.180 | when it comes to tracking adverse events from vaccines,

01:13:21.180 | this is an area where the CDC and the FDA

01:13:24.140 | track and collaborate.

01:13:26.000 | And tracking means not only collecting reports

01:13:29.720 | from the public and from clinicians

01:13:31.680 | when they see an effect that may be related to a vaccine,

01:13:35.280 | but it also involves analyzing those

01:13:36.840 | to see were they correlated

01:13:38.600 | or were there's actual causation there, right?

01:13:40.240 | Because if today, for example, I felt unwell,

01:13:45.240 | and I trace back what happened yesterday,

01:13:48.560 | and it turns out, hey, I ate this burrito

01:13:51.240 | that was out in the sun for way too long.

01:13:53.960 | The question is, am I feeling sick because of the burrito

01:13:56.300 | or did the burrito just happen to be something that happened

01:14:00.320 | but it's independent of how I'm feeling?

01:14:02.800 | Maybe it turns out somebody was actually sick

01:14:05.240 | with a GI bug around me,

01:14:07.240 | and that's the reason that I'm feeling the way I am today.

01:14:09.480 | So the analysis that needs to be done

01:14:12.140 | on cases that are reported is important,

01:14:14.580 | and it's something that the CDC and the FDA do together.

01:14:17.320 | Now, that analysis, I think,

01:14:18.760 | is essential to communicate clearly to the public.

01:14:22.600 | And whenever I engage with folks in the public,

01:14:26.160 | which we do often,

01:14:27.000 | and people will talk to me

01:14:27.940 | about their experiences with vaccines,

01:14:30.000 | I do think it's important to acknowledge

01:14:31.320 | what people have gone through.

01:14:33.000 | Like some people, for example,

01:14:34.120 | like when I got vaccinated for COVID, for example,

01:14:36.620 | I felt like I had mild flu-like symptoms

01:14:39.220 | for a couple of days, you know?

01:14:40.380 | It wasn't great.

01:14:41.220 | I would have preferred I didn't have those feelings,

01:14:42.880 | and then I felt better a couple of days later,

01:14:45.540 | and then I moved on.

01:14:46.380 | But I acknowledge it didn't feel good to feel that way.

01:14:49.740 | There are other people who may have had experiences

01:14:52.700 | where they felt that they had more serious side effects,

01:14:55.620 | and there may be a question,

01:14:56.460 | was that related to the vaccine or not?

01:14:58.240 | So I think we have to both hear and acknowledge those.

01:15:00.580 | I certainly try to do that.

01:15:01.700 | I know, I think, it's important to keep doing that

01:15:04.060 | across all of government.

01:15:05.740 | But I also think it's important for us

01:15:07.740 | to help people understand the process

01:15:10.340 | that we have to go through

01:15:11.180 | to understand whether those are related or not.

01:15:12.880 | If you go online, and the CDC's site

01:15:16.500 | where they collect a lot of this information,

01:15:18.240 | and you just purely look at reports that are given

01:15:21.300 | of potential adverse effects,

01:15:24.040 | you can't sort of take that and say,

01:15:25.860 | "Ah, those are all related to the vaccine.

01:15:28.460 | "Look at this rate of harm.

01:15:29.560 | "It's extraordinarily high."

01:15:31.100 | Because we don't actually do that

01:15:32.080 | with any other vaccine or medicine, right?

01:15:34.300 | We start there, we do the analysis,

01:15:36.620 | and we try to understand what's actually related or not.

01:15:38.980 | So I think that's what we've got to do here, too.

01:15:41.640 | One last thing I'll say is that it's important,

01:15:43.500 | I think, also for us to help put this in context

01:15:47.300 | of other vaccines and medicines

01:15:49.500 | and interventions that we use.

01:15:51.460 | So for example, just take Tylenol, for example.

01:15:54.580 | Most people think, "Oh, well, Tylenol, it's safe.

01:15:57.860 | "Nothing bad happens if you take Tylenol," et cetera.

01:16:00.420 | But people who track the data know that Tylenol, by and large,

01:16:05.380 | generally speaking, is safe medication,

01:16:07.220 | but there are people who experience adverse effects

01:16:09.620 | from Tylenol, liver damage, and other adverse effects.

01:16:14.260 | And that data is available.

01:16:16.600 | But what has happened in the case of that medication

01:16:19.440 | is that the risks and benefits are both analyzed,

01:16:22.180 | and then a recommendation is put forward

01:16:23.980 | about a generally safe way to use it.

01:16:26.500 | And then there's data put out

01:16:27.720 | about the side effects, common or rare, right?

01:16:31.540 | But I think sometimes we also forget

01:16:33.460 | that a lot of the medicines that we have come to take

01:16:35.520 | and just see as a normal part of our life,

01:16:38.140 | just like any other vaccine,

01:16:39.660 | like there's some rate of rare side effects that will happen.

01:16:43.460 | I say that because what I worry about

01:16:45.980 | in the black and white environment that we're living in

01:16:48.520 | is sometimes people will take an anecdote

01:16:51.480 | about a potential adverse effect

01:16:54.420 | and will portray that as the rule, right?

01:16:57.100 | And we'll say, "Well, look, I know somebody

01:16:58.920 | "who had this side effect, so nobody should take this

01:17:02.080 | "'cause this is what's gonna happen to you.

01:17:03.860 | "If we did that, nobody would ever take Tylenol.

01:17:06.420 | "No one would ever take ibuprofen.

01:17:08.040 | "No one would take NyQuil.

01:17:09.280 | "No one would take any of the common medications

01:17:11.440 | "that we pick up at the drugstore and that we commonly use."

01:17:14.280 | So that's how I think we have to approach this

01:17:16.960 | with a combination of clear communication,

01:17:20.480 | empathic listening, and data and context.

01:17:23.680 | Again, that doesn't fit neatly

01:17:26.160 | in a social media post per se,

01:17:28.940 | but I think part of what we need to do as a country

01:17:32.000 | is rebuild the relationship, honestly,

01:17:34.440 | between the medical and public health establishment

01:17:37.720 | and the public.

01:17:38.560 | And I think it starts with this kind of communication.

01:17:41.520 | - The other question I had about the next pandemic

01:17:44.280 | and the one we just had is why not have committees

01:17:49.240 | of people of diverse backgrounds, socioeconomic diversity,

01:17:52.340 | racial diversity, every aspect of diversity,

01:17:55.200 | rather than individuals standing there telling us

01:17:57.800 | what to do for several reasons.

01:17:59.600 | One is we are a country of many different people.

01:18:03.480 | I think there are dozens, if not hundreds,

01:18:07.000 | of scientific papers showing that patients

01:18:09.360 | follow the advice of doctors that look like them

01:18:12.060 | and sound like them or to whom they would aspire to be like.

01:18:17.060 | We know this.

01:18:19.260 | And yet, public health officials typically are unitary.

01:18:23.800 | One person telling us, "Do this, don't do that.

01:18:26.140 | "This is a good idea, that's a bad idea.

01:18:28.120 | "I'm but one citizen, but I'm putting up both hands,

01:18:30.780 | "both feet, and all toes," and saying committees.

01:18:33.560 | Small, but diverse committees that people can relate to

01:18:38.560 | and feel as if the messages that they're getting

01:18:43.680 | are vetted through a common understanding.

01:18:46.480 | - Yeah, so it's a really good suggestion.

01:18:48.040 | And I couldn't agree with you more

01:18:49.440 | that a diversity of voices is really important

01:18:52.200 | to get a message out.

01:18:53.740 | And during COVID, actually, that's one of the things

01:18:56.080 | that our office actually was helping to build

01:18:58.880 | was something called the community core,

01:19:00.940 | where we actually, we recognize very clearly,

01:19:03.680 | and this is something I came to see as a doctor,

01:19:06.560 | sometimes I was the right person to message to patients,

01:19:08.520 | sometimes I wasn't.

01:19:09.840 | Sometimes it was the nurse,

01:19:11.320 | sometimes it was the medical student,

01:19:13.640 | sometimes it was an administrator or the social worker

01:19:16.760 | with different background, different life experiences.

01:19:19.200 | So part of this work is knowing when to step up

01:19:21.960 | and when to step back.

01:19:23.400 | But the community core that we were building

01:19:25.200 | was a really diverse group of people.

01:19:28.960 | And a lot of them had public health backgrounds,

01:19:30.720 | but a lot of them were community leaders

01:19:32.280 | who understood health,

01:19:33.120 | even though they didn't have formal training.

01:19:35.320 | But they're people who knew their communities, right?

01:19:37.220 | And they had the trust of their communities,

01:19:38.920 | and they understood what was going on,

01:19:40.260 | they wanted to be helpful.

01:19:41.100 | So we brought them together to say,

01:19:42.200 | "Okay, look, here's what the science is telling us.

01:19:46.000 | "Here are the general recommendations.

01:19:48.160 | "Here's what we would provide.

01:19:49.960 | "You ask us any questions you have.

01:19:51.920 | "Like, if there's something we don't know,

01:19:53.000 | "we'll go back and look it up.

01:19:54.860 | "But you're the leaders in your community.

01:19:56.460 | "They should be hearing from you about these messages."

01:19:59.680 | And then those folks went out and actually,

01:20:02.200 | we worked closely with them, collaborated with them.

01:20:04.460 | They would design the messages for their community

01:20:06.920 | based on what they thought made sense.

01:20:08.220 | They weren't taking what we said word for word,

01:20:09.720 | and we didn't want them to.

01:20:11.440 | But to me, that kind of diverse approach

01:20:13.420 | is what we need more of.

01:20:14.260 | Now, I'll tell you what I would have liked.

01:20:16.740 | I would have liked if more media networks

01:20:19.440 | put those folks on TV and got them on the radio, right?

01:20:23.040 | Because it's important that many of them

01:20:25.160 | were showing up in their communities,

01:20:26.520 | were knocking on doors, were doing local podcasts, et cetera,

01:20:30.700 | and that was great.

01:20:31.860 | But I would have liked more of their faces

01:20:33.400 | I carried on TV, right?

01:20:34.800 | So that's a place where when we talk to media

01:20:38.060 | and when I talk to folks in media,

01:20:39.720 | one of the things I encourage them and push them to do also

01:20:42.020 | is to say, "Look, if you can take more of these

01:20:44.480 | "diverse faces and voices and put them out there,

01:20:47.480 | "that's actually good for the community."

01:20:49.320 | And it also helps people see that it's not like

01:20:51.480 | one or two people who are sort of pushing an agenda here.

01:20:53.840 | This is like, the public health community is big.

01:20:56.440 | It's broad, it's diverse, it has a lot of voices,

01:20:58.820 | and the more voices we can hear from as public,

01:21:02.280 | I think the better off we are.

01:21:03.920 | - Yeah, here, here.

01:21:04.920 | Again, I genuinely hope and pray

01:21:10.080 | that we don't have another pandemic,

01:21:11.640 | but if and when we do, I hope there will be committees

01:21:14.460 | rather than individuals.

01:21:15.600 | I know this is a thing in this country,

01:21:18.720 | we like the idea that one person's gonna save the climate,

01:21:21.340 | one person's gonna save transportation,

01:21:23.020 | one person, you know, the covers,

01:21:24.200 | the person of the year type approach.

01:21:26.400 | - I know, yeah.

01:21:27.240 | - But then we get frustrated when that person

01:21:29.960 | does things or makes decisions that we don't like

01:21:32.100 | in their public or personal life,

01:21:34.380 | and then it all seems to fall into division.

01:21:36.580 | And I just feel like, I'm not talking about groups

01:21:38.660 | of hundreds of people, but small groups.

01:21:40.580 | So I think we're aligned in that way.

01:21:42.080 | - Yeah, and look, there's, I think, a notion that,

01:21:44.580 | I think sometimes we do want the one person

01:21:48.140 | who can not only necessarily have all our trust

01:21:50.780 | and we can look to, but also who we can hold accountable.

01:21:52.820 | You know, if something doesn't quite work out

01:21:54.740 | or we don't like something.

01:21:56.060 | And while I get that sort of mentality,

01:21:58.340 | I think that in this moment,

01:22:00.780 | especially when we're trying to rebuild trust,

01:22:02.460 | I think it's important for people to know

01:22:05.020 | that what they may be hearing in terms of medical

01:22:07.580 | or public health recommendations,

01:22:09.740 | it's important for them to know how broad an audience

01:22:12.060 | that's coming from or a broader group of experts, right?

01:22:14.940 | And there was a lot more broad agreement.

01:22:17.660 | For example, during COVID and during Ebola, during Zika,

01:22:22.500 | on public health recommendations.

01:22:24.020 | But you wouldn't always know it if you turn on the TV,

01:22:26.280 | 'cause you were seeing the same couple of faces.

01:22:28.900 | So I think we have to just certainly diversify that.

01:22:33.520 | One other thing I think I'll tell you that's important here

01:22:35.540 | is I think we have to also think about how we fund groups

01:22:39.800 | on the ground that are doing the hard work

01:22:42.380 | of getting public health messages out.

01:22:44.320 | Because one of the things

01:22:45.160 | that those groups often would tell me,

01:22:46.360 | and these are, I might say these groups,

01:22:47.680 | I'm talking about the community organization

01:22:50.060 | that spent years in a neighborhood getting to know families

01:22:53.440 | where folks who recognize them

01:22:54.860 | when they're walking down the street,

01:22:56.000 | they're like, "Oh yeah, that's the person

01:22:56.920 | "from organization X.

01:22:58.180 | "They understand us, they get us.

01:22:59.360 | "They're looking out for us."

01:23:01.040 | A lot of those organizations had spent their resources

01:23:04.640 | helping the community, getting to know the community,

01:23:06.320 | but they didn't have sophisticated mechanisms

01:23:08.720 | to apply for grants, for example.

01:23:10.520 | They didn't have grant writers

01:23:11.600 | who had done this a thousand times.

01:23:13.320 | So historically, those groups

01:23:16.520 | have a hard time getting support and funding.

01:23:18.840 | So I'll tell you one interesting thing my wife did,

01:23:20.920 | which I certainly was very proud of,

01:23:23.200 | is she was helping to build an effort

01:23:26.240 | and to build a nonprofit organization

01:23:28.180 | with a couple of colleagues,

01:23:29.760 | that a big organization of people who knew how to get money,

01:23:33.680 | how to apply for grants, how to get foundation support,

01:23:36.480 | but who also had the wisdom to know

01:23:38.700 | that the most important they could do

01:23:40.480 | was to give portions of that money

01:23:43.200 | to groups on the ground.

01:23:44.560 | So they saw themselves as an organization

01:23:46.980 | that channeled money to groups that had trust,

01:23:49.680 | and they executed their mission that way.

01:23:52.820 | And that was very effective,

01:23:54.380 | and I think we need more of that

01:23:55.800 | when it comes to disseminating funding.

01:23:57.720 | One thing I think many people may or may not appreciate

01:24:00.760 | is that it's actually hard from government

01:24:03.240 | to put out a lot of money at once

01:24:05.760 | and to do so quickly, right?

01:24:07.680 | Like when you've got a lot of funds

01:24:09.120 | that you need to get into communities,

01:24:10.400 | what happens is the federal government

01:24:11.600 | often will give it to states.

01:24:13.320 | States will then give it to local communities,

01:24:16.160 | to like the local department of public health potentially,

01:24:19.040 | and then they will look to distribute it to others.

01:24:21.320 | That takes time, but it also means

01:24:22.960 | if you're not connected to that network,

01:24:25.140 | if you don't know your local department of health

01:24:26.920 | or you're not connected to the state department of health,

01:24:28.580 | sometimes it can be challenging

01:24:29.960 | to figure out how to get the money.

01:24:31.320 | And so I think we need more operations

01:24:34.000 | like what my wife and others have been building

01:24:37.720 | to try to get those funds directly

01:24:39.780 | to the folks who don't necessarily have

01:24:42.060 | the most fancy grant writing operation,

01:24:44.260 | but they have their relationships.

01:24:45.720 | 'Cause at the end of the day,

01:24:47.360 | it's those relationships that create the trust.

01:24:50.060 | It's a trust that allows life-saving information

01:24:53.060 | to get to people, and that's the link that's missing.

01:24:56.000 | - Very interesting.

01:24:57.000 | Pharma, big pharma.

01:25:01.060 | I got a lot of questions about whether or not big pharma

01:25:05.120 | is on the take for every public health initiative.

01:25:08.000 | Now, as somebody who understands a bit about

01:25:12.220 | and certainly believes in the use

01:25:14.060 | of certain prescription medications,

01:25:15.600 | I find most questions about quote unquote big pharma

01:25:20.540 | to overlook the fact that there are thousands,

01:25:24.540 | if not hundreds of thousands of medications

01:25:26.340 | that save lives and enrich people's lives

01:25:29.080 | that are prescription drugs.

01:25:30.940 | I also believe, my audience knows,

01:25:33.420 | I say it over and over again,

01:25:34.260 | that better living through chemistry

01:25:35.420 | still requires better living.

01:25:36.600 | We still have to get our sunlight,

01:25:37.920 | get our sleep, social connection,

01:25:39.580 | good nutrition, exercise, and all those things.

01:25:41.480 | There's just no pill that's going to replace those.

01:25:43.980 | - Yeah. - Okay.

01:25:45.300 | But I think it's a valid question that people are asking.

01:25:48.500 | Is there a direct relationship between big pharma

01:25:54.940 | and public health initiatives

01:25:57.080 | in a way that should have us concerned

01:25:59.300 | about the messaging that we're getting at times

01:26:02.900 | and the fact that the United States consumes

01:26:07.100 | the vast majority of drugs for mental health, for instance,

01:26:09.960 | as compared to other countries?

01:26:11.520 | So that's one question.

01:26:12.780 | And then I want to dovetail into that question.

01:26:16.500 | What are your thoughts on the fact that there's a history

01:26:18.780 | of the tobacco industry being very interdigitated,

01:26:23.580 | shall we say, with government policies

01:26:26.080 | in ways that had us basically injure,

01:26:28.760 | if not kill millions of Americans,

01:26:31.160 | and then eventually say you can't smoke near a hospital.

01:26:34.740 | You can't smoke anywhere.

01:26:36.000 | There's very few places

01:26:37.380 | where you can consume tobacco products.

01:26:39.940 | That kind of relationship and financial incentives

01:26:44.460 | and then a lot of backpedaling later,

01:26:47.600 | I think, war on people's trust.

01:26:51.300 | So how should we frame the relationship

01:26:54.040 | between the pharmaceutical industry, government,

01:26:57.620 | and public health initiatives

01:26:58.780 | in a way that is at least halfway functional?

01:27:02.940 | - Look, I understand where the concern

01:27:05.220 | and the suspicion comes from, right?

01:27:06.980 | And look, I think it's important

01:27:10.500 | that public health initiatives and medical advice

01:27:14.300 | is independent of the influence of industries

01:27:17.340 | that may seek to profit from what's being recommended

01:27:20.700 | or from medications that are being prescribed.

01:27:22.900 | And we have a history in medicine, right,

01:27:26.160 | of doctors who were given gifts and vacations

01:27:31.160 | and all kinds of fancy things by pharma companies

01:27:34.140 | in an effort to influence what they prescribe.

01:27:36.140 | That was really problematic.

01:27:37.620 | And now we're seeing a lot less of that, which is good.

01:27:39.860 | A lot of rules are being put in place

01:27:41.220 | by medical societies and professional societies

01:27:43.900 | and by academic institutions to say

01:27:45.460 | this is an unacceptable way to practice.

01:27:48.100 | And that's really important.

01:27:49.700 | 'Cause I do think that human psychology

01:27:51.260 | is that sometimes we underestimate

01:27:53.540 | how much we're influenced by incentives.

01:27:55.560 | We think, eh, yeah, I'm getting that,

01:27:57.100 | but I know how to make independent decisions.

01:27:59.380 | But at the end of the day, we're human and we're influenced.

01:28:01.540 | - Or it's a great drug.

01:28:02.740 | It could be, wow, this is a drug

01:28:03.980 | that's really helping my patients.

01:28:05.380 | I'm happy to recommend it to them.

01:28:07.420 | - Yeah, so I wanna separate one thing though.

01:28:11.060 | Taking money from a pharma company as a physician

01:28:14.740 | I think is highly problematic, right?

01:28:16.680 | I think it's hard to say that it doesn't influence practice.

01:28:20.220 | Maybe it doesn't for some people,

01:28:21.440 | but it's really hard to know who those people are.

01:28:23.940 | I do think that separate from that,

01:28:26.980 | you can be a physician who prescribes medications

01:28:30.280 | 'cause you believe they work.

01:28:31.220 | Look, as a doctor, I have prescribed many antibiotics

01:28:35.540 | during cases of infection that have helped my patients.

01:28:38.820 | And I would prescribe those again.

01:28:40.040 | I am glad that those exist.

01:28:42.860 | In many cases, they've saved the lives

01:28:44.940 | of patients I was caring for in the hospital.

01:28:46.820 | So that's what should drive us,

01:28:48.940 | is does the data show that they work

01:28:51.580 | and does our patient need them, right?

01:28:54.300 | That's what should drive our decisions.

01:28:55.600 | When it comes to public health recommendations,

01:28:57.980 | here too I think a similar principle holds,

01:28:59.840 | which is that I don't think that pharma money

01:29:03.620 | should be influencing our public health decisions,

01:29:06.760 | which means that it shouldn't be funding

01:29:08.760 | our public health organizations

01:29:10.240 | that are making recommendations.

01:29:12.020 | Certainly, I know this is obvious to you,

01:29:14.040 | but I'll say just to be clear for everyone who's listening,

01:29:17.220 | our office doesn't take any money from industry,

01:29:20.700 | not just pharma industry, from any industry.

01:29:23.220 | The money that we get is allocated by Congress

01:29:26.040 | at the end of the day.

01:29:26.880 | It's taxpayer money, and that's all we get.

01:29:29.840 | And that's important.

01:29:31.580 | We don't want money from pharmaceutical companies.

01:29:35.220 | But that's important because people need to know

01:29:38.520 | that these decisions are not being made for financial gain.

01:29:42.320 | With that being said, there's a broader concern

01:29:45.520 | I have, Andrew, which is I think that we have become

01:29:50.180 | a pill for every problem society,

01:29:53.220 | where we look for a quick fix of a medicine

01:29:56.020 | for every challenge that we may incur.

01:29:59.280 | And sometimes, yes, I'm a believer that if science

01:30:03.120 | helps us create medications that can help solve disease,

01:30:06.160 | we should use them appropriately.

01:30:07.460 | But I think we discount heavily the behavioral changes

01:30:12.460 | that we need to make, the more broader societal

01:30:14.640 | and environmental changes that we need to make

01:30:17.460 | that influence our health.

01:30:18.720 | Like our food environment matters for our health.

01:30:21.040 | Our decisions about how physically active we are

01:30:23.920 | matter for our health, whether or not we sleep matters

01:30:26.340 | for our health.

01:30:27.180 | And all of these impact our mental health

01:30:29.420 | and wellbeing as well.

01:30:30.500 | And so when I think about that bias,

01:30:34.260 | that to me is not always stemming from money

01:30:39.100 | that came from a pharmaceutical company,

01:30:40.740 | although I think the ads that we see all the time

01:30:43.860 | from pharma companies I think try to convince us

01:30:45.780 | that hey, just take this pill once a day

01:30:47.160 | and all your problems will go away.

01:30:49.080 | But I think it's more complex than that.

01:30:51.100 | And I think that even for in the healthcare setting,

01:30:56.100 | like if you're seeing a patient who has pain,

01:31:00.860 | who's having intense pain, it feels easier sometimes

01:31:04.340 | to prescribe a medication for that pain

01:31:07.260 | rather than trying to deal with non-medication-based

01:31:11.660 | approaches or try to get the deeper origins of the pain.

01:31:14.120 | I'm not saying that's what doctors do all the time,

01:31:16.780 | but I'm saying that we're living in an environment

01:31:19.240 | and a broader culture where we I think increasingly reach

01:31:22.740 | for something that we see as a quick, immediate fix.

01:31:26.760 | And again, don't blame people for that.

01:31:28.200 | We'd rather take a quick fix over something

01:31:29.980 | that's gonna take a long time.

01:31:31.360 | But I think it is selling us I think sometimes a false hope,

01:31:35.740 | which is that that's all we need to solve our problems.

01:31:38.860 | And I think a lot of times you need more.

01:31:41.060 | You need the behavioral changes.

01:31:42.300 | You need the environmental changes.

01:31:44.440 | That's one of my big concerns in terms of how we communicate

01:31:47.080 | about health.

01:31:49.020 | - Would a potential solution be this idea

01:31:52.100 | of small committees?

01:31:53.060 | So let's say somebody is experiencing chronic pain,

01:31:56.840 | localized or general, that they would go

01:31:59.260 | to their general practitioner, but in the room

01:32:02.400 | would also be somebody who understands somatic medicine,

01:32:06.900 | trained clinical psychologists who understand somatics

01:32:09.200 | that the body and the brain are linked

01:32:10.940 | through the nervous system and could also assess

01:32:14.740 | possible psychological roots of the issue.

01:32:18.860 | And then somebody in the room who can make behavioral,

01:32:22.020 | nutritional, maybe even supplementation-based,

01:32:25.960 | safe supplementation-based recommendations.

01:32:27.980 | And then the physician who can say,

01:32:29.620 | and in addition to that, I think the person

01:32:31.660 | should have on hand a five milligram dosage

01:32:35.220 | of a prescription drug that if they need it,

01:32:37.700 | they could take.

01:32:38.780 | And I think it would provide a lot of protections

01:32:41.540 | against potential adverse effects

01:32:45.780 | of any one of those things in isolation.

01:32:48.560 | There's great protections in having people meet in groups

01:32:52.200 | for lots of reasons.

01:32:53.780 | And the person would feel very well cared for.

01:32:56.960 | So again, small committees of people with diverse expertise

01:33:00.960 | pooling together to treat people from,

01:33:03.660 | for lack of a better word, a more holistic perspective.

01:33:06.300 | Why not?

01:33:07.740 | - I mean, you're describing the dream.

01:33:09.120 | I think that's exactly what we need,

01:33:10.700 | interdisciplinary teams that can provide integrative care,

01:33:13.940 | recognizing that in this day and age,

01:33:15.740 | there's not one person who has all the expertise

01:33:18.340 | to help us figure out how to best manage

01:33:20.780 | our health challenges.

01:33:22.440 | I think what we have not figured out are a couple things.

01:33:25.600 | Number one, who are all the right people

01:33:27.600 | who need to be in the room?

01:33:29.360 | Or the sort of virtual room, if you will.

01:33:32.940 | The second is how do we create a structure,

01:33:36.180 | a healthcare system where that can actually happen

01:33:38.260 | with efficiency, where it can be reimbursed appropriately?

01:33:41.460 | But that's what we should be doing.

01:33:42.780 | And then the third leg of that is the group experience

01:33:45.560 | for patients, right?

01:33:46.960 | And there's increasingly more clinics

01:33:49.000 | and healthcare systems around the country

01:33:50.960 | that are working on creating group experiences

01:33:53.740 | where patients who all, let's say,

01:33:55.480 | are working on their diabetes come together,

01:33:59.220 | let's say, once a week and they meet

01:34:01.120 | with the healthcare practitioner.

01:34:02.620 | That might be in addition to their individual appointments.

01:34:05.340 | But there is so much power in groups coming together,

01:34:08.520 | groups of patients who can find community,

01:34:10.480 | who can help each other,

01:34:11.320 | learn from each other's experiences.

01:34:13.680 | That's highly underutilized right now in medicine.

01:34:17.200 | But to really do this well, Andrew,

01:34:19.720 | I think means that we have to pull back

01:34:22.840 | from the model we have had for years in medicine,

01:34:25.800 | which has been a highly individual type model,

01:34:29.160 | which says, okay, you go to your doctor,

01:34:32.220 | you see your doctor one-on-one,

01:34:33.760 | you get everything you need.

01:34:34.920 | Maybe you need to go see a specialist.

01:34:36.320 | Okay, then you wait a few weeks,

01:34:37.880 | get another appointment, drive 30 miles,

01:34:39.480 | go see somebody else.

01:34:40.860 | Maybe they're connected to the electronic health system.

01:34:42.880 | Maybe they're not.

01:34:43.720 | Maybe they know what was discussed.

01:34:44.640 | Maybe they don't.

01:34:45.900 | Maybe they'll call and talk to their primary care doctor,

01:34:47.960 | but maybe they won't 'cause they're too busy.

01:34:49.560 | And then you as a patient are stuck

01:34:51.480 | trying to piece all this together.

01:34:53.160 | - While often in pain.

01:34:55.160 | - Well, yeah.

01:34:56.000 | - In physical and emotional anguish.

01:34:58.320 | I'm not referring to my own experience,

01:34:59.680 | although I've had mild examples

01:35:02.000 | compared to what other people have dealt with.

01:35:03.360 | But people with chronic pain are irritable

01:35:06.560 | for understandable reasons.

01:35:08.360 | I mean, it's, or maybe somebody is close,

01:35:11.560 | veering towards suicidal depression.

01:35:13.700 | Then there's the interpersonal effects.

01:35:15.120 | I mean, I feel like the crisis is one

01:35:17.940 | of a lack of efficiency and thoroughness.

01:35:20.880 | And again, I'm not throwing stones

01:35:23.200 | at the medical profession.

01:35:24.460 | I, like you, believe that it's a collection

01:35:27.660 | of mostly well-meaning people trying to do their best.

01:35:31.340 | But the specialist model and the referral model

01:35:34.420 | is incredibly cumbersome.

01:35:36.500 | - It really is cumbersome.

01:35:37.640 | And like you, look, I, having worked

01:35:39.940 | with many medical professions over the years,

01:35:41.780 | like these are colleagues who I deeply admire.

01:35:44.320 | I mean, they're there for the right reasons.

01:35:45.680 | They wanna help people alleviate suffering.

01:35:48.100 | But they too are feeling burned out and frustrated

01:35:51.280 | by the inefficiencies of the system.

01:35:53.240 | 'Cause I'll tell you, one of the greatest contributors

01:35:55.200 | to burnout for doctors and nurses is a lack of self-efficacy.

01:36:00.160 | It's seeing a patient who has a problem in front of you

01:36:03.840 | and feeling like you can't get them the help that they need.

01:36:06.880 | That is the greatest paper cut, if you will,

01:36:09.880 | to the sort of spirit of clinicians.

01:36:12.120 | And many find themselves in that circumstance

01:36:14.440 | where they either find that they know what's needed,

01:36:16.340 | but the system is throwing up prior authorizations

01:36:19.760 | or other insurance hurdles in preventing their patient

01:36:22.000 | from getting that care.

01:36:23.380 | Or they are kind of at the edge of their expertise.

01:36:25.840 | This happens to pediatricians and primary care doctors

01:36:28.000 | more broadly all the time with mental health.

01:36:30.840 | Most of the mental health care that's delivered

01:36:32.720 | in this country is delivered in primary care offices.

01:36:36.700 | Now, primary care doctors didn't necessarily

01:36:39.080 | train specifically and only in mental health,

01:36:41.220 | yet they find themselves having to manage a lot of that,

01:36:43.880 | including increasingly complex substance use disorders

01:36:47.620 | and treatment-resistant depression.

01:36:49.500 | And they need help figuring that out.

01:36:51.700 | But if you don't have a lot of resources

01:36:53.900 | to get that referral to collaborate

01:36:56.160 | with mental health professionals,

01:36:58.020 | then you're stuck on your own figuring that out.

01:37:00.080 | And so, I think the pain is being experienced

01:37:03.040 | mostly by patients, but also very much so by clinicians.

01:37:06.820 | And that's why that overhaul is needed.

01:37:08.300 | And I think, look, a lot of this is, you know,

01:37:11.040 | I'm not a healthcare economist per se,

01:37:12.520 | but I will say that a lot of this, I think,

01:37:14.440 | is tied into the business model

01:37:15.840 | that we've built around medicine.

01:37:17.440 | The notion that we're paying individual people

01:37:21.020 | for individual services and individual procedures

01:37:23.480 | that are done.

01:37:24.440 | While that has some merit in some cases,

01:37:27.480 | what we really care about is that the person

01:37:29.640 | is getting efficient, integrated,

01:37:32.200 | multidisciplinary care overall.

01:37:34.040 | And so, when health systems, for example,

01:37:36.040 | come together and say, okay, rather than sort of focusing

01:37:39.880 | on the amount I'm getting reimbursed for every procedure,

01:37:42.460 | we're gonna take more of a value-based approach here,

01:37:45.020 | where we say, okay, we've got a certain amount of money

01:37:47.340 | to care for certain people.

01:37:48.640 | What's the most efficient way for us to provide them care?

01:37:51.900 | Recognizing if we don't do that,

01:37:53.340 | it's not only bad for them,

01:37:55.580 | but our costs in the long term will go up,

01:37:58.140 | because we're not getting reimbursed for every procedure.

01:38:00.080 | We're getting reimbursed for the care,

01:38:02.500 | overall care that we're taking for our patients.

01:38:04.460 | So, there are more of these value-based models

01:38:06.760 | that are being adopted.

01:38:08.880 | Certainly in 2010, when the Affordable Care Act was passed,

01:38:12.680 | and when other measures were taken,

01:38:14.580 | and the Obama administration in Medicare,

01:38:16.860 | that really pushed value-based payment models forward.

01:38:20.260 | And again, they're not perfect.

01:38:21.620 | But they need their own tweaks.

01:38:23.860 | But I don't think that the existing financial structure

01:38:27.220 | that we had in medicine was serving us,

01:38:29.020 | in terms of delivering the kind of multidisciplinary,

01:38:32.300 | integrated, efficient care that we increasingly need.

01:38:36.340 | - Tough problem, but through recognition of tough problems,

01:38:39.520 | comes good solutions.

01:38:40.880 | That's my belief.

01:38:41.720 | I'm an optimist at the end of the day.

01:38:43.560 | You mentioned mental health.

01:38:45.020 | Lately, you've been increasingly vocal

01:38:46.500 | about the crisis of isolation.

01:38:48.260 | - Just one second, Andrew, before we go there,

01:38:50.160 | one thing about the tough problems, right?

01:38:51.620 | You're exactly right.

01:38:52.460 | And the problem is the longer we take to acknowledge

01:38:55.240 | and address these tough problems,

01:38:57.060 | the more entrenched the interests become

01:38:59.660 | that profit from the status quo, right?

01:39:01.980 | So if you look at the private insurance industry right now,

01:39:06.980 | there are so many challenges we have right now

01:39:10.260 | with patients and clinicians saying that

01:39:14.140 | they know what care is needed, but it gets denied.

01:39:17.280 | They know what care is needed, but prior authorizations

01:39:20.220 | get thrown up there and required,

01:39:23.020 | even for a medicine that clearly

01:39:24.460 | your patient needs urgently.

01:39:26.140 | I've had the experience myself of having a family member

01:39:30.620 | who has needed a medication for an urgent situation,

01:39:34.040 | and then being told that the pharmacy will not fill it

01:39:36.860 | because it requires a prior authorization,

01:39:39.260 | but that can't be processed until the weekend is over

01:39:42.760 | because no one's in the office

01:39:44.120 | to approve the prior authorization.

01:39:46.020 | And you're thinking to yourself, does this make any sense?

01:39:48.460 | Like, this is an urgent situation.

01:39:50.100 | My family member needs this medication.

01:39:52.500 | I've also had the experience as a doctor

01:39:54.960 | of fighting for my patients who have been denied care

01:39:58.340 | by an insurance company and being on the phone

01:40:00.200 | saying, I'm sitting here in front of my patient.

01:40:03.760 | I know that they are sick.

01:40:05.460 | I know they can't go home.

01:40:06.920 | I know they need to be in rehab.

01:40:08.760 | There's nobody literally to help them at home,

01:40:11.980 | but then not having the rehab bed approved

01:40:15.620 | by somebody who's not even there, right?

01:40:17.820 | And there's also just a practice that we've seen

01:40:21.120 | time and time again where insurance companies

01:40:23.780 | will also just burden clinicians

01:40:25.940 | with more and more requests for information

01:40:28.200 | before they will agree to reimburse for services

01:40:31.100 | that have already been delivered

01:40:32.300 | for a patient who needs them,

01:40:33.740 | which is just creating more and more barriers,

01:40:35.440 | hoping that if you're a small-time doc out there

01:40:38.020 | who's got a shingle that you put up,

01:40:40.260 | you don't have a lot of resources,

01:40:41.340 | how are you gonna keep fighting all of this

01:40:43.300 | and sending more and more paperwork?

01:40:44.540 | And eventually you'll just give up.

01:40:47.100 | We have a lot of problems right there.

01:40:48.660 | In an industry that should be delivering care

01:40:52.380 | often is doing good things,

01:40:54.140 | but too often I think is allowing barriers to be put up

01:40:57.740 | to the care that's needed,

01:40:58.700 | and this is particularly true with mental health.

01:41:00.380 | I know we're gonna talk about that,

01:41:01.800 | but mental health care has just been such a difficult thing

01:41:06.800 | for people to get in our country,

01:41:08.540 | and part of the reason, there are many reasons,

01:41:10.420 | but one of them is that insurance companies historically

01:41:13.280 | did not reimburse adequately or in the same level

01:41:16.720 | for mental health care as they did for physical health care,

01:41:19.420 | or if they did, they would only reimburse

01:41:21.400 | for a limited number of sessions that you could have.

01:41:24.820 | But if you're a mom out there who sees her child struggling

01:41:29.740 | with depression, you're really worried,

01:41:31.740 | you don't wanna be told, you know what,

01:41:35.420 | you can only get three sessions, that's it.

01:41:38.660 | What are you supposed to do after three sessions, right?

01:41:41.300 | And so what has happened is that even though in 2008

01:41:44.180 | there was a law passed called the Addiction Equity

01:41:47.920 | and Mental Health Parity Law,

01:41:49.460 | even though that was passed to try to close that gap,

01:41:53.620 | there were many ways that insurance companies

01:41:55.740 | were skirting it, right?

01:41:56.880 | So one, the law wasn't even being adequately reinforced

01:41:59.580 | for many years, but two, insurance companies sometimes

01:42:02.300 | would say, okay, we're reimbursing adequately,

01:42:04.340 | but when you look in the network,

01:42:06.140 | they had very few providers,

01:42:07.380 | so you really couldn't access somebody, right?

01:42:09.620 | So that was a problem for patients.

01:42:11.380 | And then the other challenge is that they would say,

01:42:14.020 | okay, you can see somebody,

01:42:15.200 | but you've gotta complete this prior authorization,

01:42:17.540 | have that completed by your primary care doctor, et cetera,

01:42:19.780 | again, throwing up more and more barriers.

01:42:21.740 | So very recently, in fact, just a few weeks ago,

01:42:24.580 | President Biden just announced that we are,

01:42:27.760 | from as an administration, putting out a proposed rule

01:42:29.940 | to actually strengthen the Mental Health Parity Law

01:42:33.400 | to prevent some of these,

01:42:34.980 | what I think of as abusive practices,

01:42:37.120 | because they're preventing people

01:42:38.700 | who need care from getting it.

01:42:40.080 | And if you've ever been, as I know many people have been

01:42:43.380 | who are listening to this,

01:42:44.200 | if you've ever been in a situation where you

01:42:46.140 | or somebody you love has struggled

01:42:47.580 | with a mental health concern,

01:42:49.540 | what you need in that circumstance is help.

01:42:52.500 | You don't need to be filling out paperwork.

01:42:54.600 | You don't need to be waiting three months

01:42:56.260 | to actually get care.

01:42:57.700 | You don't need to show up and be told

01:42:59.220 | only you only have two more appointments.

01:43:00.680 | You need to know that help is there when you need it.

01:43:02.820 | And a lot of these denials are being issued to people

01:43:07.140 | who have done their part of the bargain.

01:43:10.300 | They've paid their premiums.

01:43:11.900 | They've held up their end of the bargain,

01:43:13.900 | and care should be there for them when they need it.

01:43:15.900 | So anyway, this is something that upsets me a lot

01:43:18.100 | because I have seen too many patients over the years

01:43:21.660 | struggle without the care that they deserve and should get

01:43:25.100 | because the barriers are being thrown up by industry.

01:43:27.640 | But I say all that just to say that

01:43:29.680 | when you take on big problems,

01:43:31.860 | you will run up against entrenched interests.

01:43:34.540 | And that's a fight we have to take on.

01:43:36.980 | We can't shy away from it.

01:43:38.720 | We can't say, this is politically too difficult.

01:43:41.340 | Like one of the things I'm very proud of

01:43:42.620 | is that we're finally negotiating on drug prices

01:43:46.540 | through the Medicare program,

01:43:47.820 | something that should have been done decades ago.

01:43:50.980 | But it's finally happening now.

01:43:53.300 | The administration just decided this has gotta happen.

01:43:55.380 | It was passed by Congress.

01:43:56.420 | This is good.

01:43:57.780 | And it makes no sense that we would pay more than we need to

01:44:02.500 | and pass the cost on to taxpayers when we can negotiate.

01:44:07.060 | And we gotta get, look,

01:44:09.100 | if you're collecting taxes as government,

01:44:10.660 | you should be doing your best to make sure

01:44:12.180 | every one of those dollars is being spent well, right?

01:44:15.260 | 'Cause somebody took money out of their paycheck,

01:44:18.300 | didn't use it for their family,

01:44:19.420 | didn't use it for their kids,

01:44:20.420 | and they gave it to the government.

01:44:21.640 | For good reason, because that supports first responders,

01:44:24.260 | police officers, a whole bunch of services that we need.

01:44:27.140 | But the response to being in government

01:44:28.380 | is to make sure that money's being used well.

01:44:30.180 | And to pay more for medications than we should

01:44:32.580 | makes no sense at all,

01:44:34.980 | especially for our patients and taxpayers.

01:44:37.300 | - So clearly some steps in the right direction are occurring.

01:44:39.900 | While on the topic of mental health,

01:44:43.360 | let's talk about the isolation crisis.

01:44:45.660 | What is the isolation crisis?

01:44:48.640 | What aspects of mental and physical health is it impacting?

01:44:51.460 | And then perhaps most importantly,

01:44:53.700 | what can we each and all do about it?

01:44:56.960 | - Well, this is one of those issues that I,

01:45:02.040 | if you had told me, Andrew, 10 years ago,

01:45:04.360 | hey, you and I are gonna be sitting here

01:45:05.400 | talking about loneliness and isolation, I would have said,

01:45:08.120 | I don't think so.

01:45:10.020 | But I was really educated by people I met

01:45:12.080 | across the country about the fact

01:45:14.180 | that this is a real problem.

01:45:15.380 | And the truth is, it was familiar to me

01:45:18.340 | because of my own personal experiences.

01:45:20.460 | As a child, I struggled a lot

01:45:21.820 | with a sense of loneliness and isolation.

01:45:24.020 | I was really shy as a kid.

01:45:25.200 | I was pretty introverted.

01:45:26.940 | And I wanted to make friends and hang out with other kids,

01:45:29.740 | but it took me a while to actually build those relationships.

01:45:32.460 | So I spent a lot of time feeling left out.

01:45:35.820 | There were times when I would, like in elementary school,

01:45:40.500 | there were days where I pretended I had a stomach ache

01:45:42.680 | and so that my mom wouldn't make me go to school.

01:45:45.160 | And it wasn't 'cause I was scared of a test or a teacher

01:45:47.680 | 'cause I didn't wanna walk into the cafeteria one more time

01:45:51.380 | and be scared that there was nobody to sit next to

01:45:53.440 | or that no one would want me to be at their bench.

01:45:56.360 | As I know what it feels like,

01:45:59.000 | and I also know what the shame is like,

01:46:00.800 | 'cause I never told my parents about this.

01:46:03.380 | I never told anyone about that

01:46:05.040 | because even though I knew my parents loved me,

01:46:07.760 | I just felt like, hey, if I'm feeling this lonely,

01:46:10.240 | it means that something's wrong with me.

01:46:11.460 | I'm not likable.

01:46:12.300 | I'm not lovable.

01:46:13.800 | Something's gotta be, it's gotta be my fault in some way.

01:46:16.340 | It was only years later, Andrew,

01:46:17.580 | when I talked to friends from grade school

01:46:19.680 | that I realized that a lot of them

01:46:21.540 | were feeling the same thing.

01:46:22.900 | We were all struggling by ourselves.

01:46:25.500 | No one really knew it.

01:46:27.320 | And I came to see a lot of this as a doctor

01:46:29.220 | when I was taking care of patients.

01:46:31.220 | And I never took a class on loneliness in medical school.

01:46:33.780 | It wasn't part of our residency curriculum.

01:46:36.320 | Yet when I showed up in the hospital,

01:46:38.680 | I found that the patient who had come in

01:46:41.400 | with a diabetic wound infection

01:46:43.760 | or who had come in because they had had a heart attack,

01:46:47.120 | when I sat down and talked to them,

01:46:49.080 | often in the background they would talk about

01:46:50.680 | how lonely they were.

01:46:52.340 | Sometimes I would ask them,

01:46:54.000 | hey, I need to have a difficult conversation

01:46:57.200 | about your diagnosis.

01:46:59.080 | Is there somebody you'd want me to call

01:47:00.800 | to be with you during this time?

01:47:02.040 | And too often the answer was,

01:47:04.040 | I wish there was, but there's nobody.

01:47:05.560 | I'll just have the conversation by myself.

01:47:08.520 | But it was when I was surgeon general

01:47:09.760 | I realized that those experiences

01:47:11.100 | weren't limited to me and my patients,

01:47:13.320 | that they were incredibly common.

01:47:14.520 | And two things I learned when I dug into the data, Andrew,

01:47:17.960 | was number one, that loneliness is exceedingly common

01:47:21.340 | with one in two adults in America

01:47:23.080 | reporting measurable levels of loneliness.

01:47:25.480 | But the numbers are actually even higher

01:47:28.640 | among young adults and adolescents.

01:47:31.240 | The numbers among youth actually,

01:47:34.280 | depending on the surveys you look at,

01:47:35.820 | are between 70 to 80%

01:47:38.000 | who say that they are struggling with loneliness.

01:47:41.120 | So that's the first thing that I learned.

01:47:42.600 | But the second thing was how consequential loneliness was.

01:47:45.520 | I used to think loneliness was just a bad feeling.

01:47:48.000 | What I came to see in digging into the scientific literature

01:47:51.220 | was that feeling socially disconnected,

01:47:54.060 | being lonely and isolated,

01:47:55.160 | was actually associated with increased risk of depression,

01:47:58.560 | anxiety, suicide, but also an increased risk

01:48:02.200 | of cardiovascular disease, of dementia.

01:48:06.040 | And these are not small risks.

01:48:07.300 | We're talking about 29% increase

01:48:09.400 | in the risk of coronary heart disease,

01:48:11.460 | 31% risk in the increased risk of stroke,

01:48:14.340 | 50% increased risk of dementia among older people,

01:48:17.840 | increased risk of premature death,

01:48:20.240 | and the mortality impact of loneliness, by the way,

01:48:23.880 | and loneliness and isolation is comparable

01:48:26.840 | to the mortality impact of many other illnesses.

01:48:30.440 | In fact, it's even greater than the mortality impact

01:48:32.820 | we see associated with obesity,

01:48:34.760 | which is something we clearly recognize

01:48:36.360 | as a public health issue.

01:48:37.380 | So you put all this together.

01:48:39.040 | And for me, one of the key takeaways

01:48:41.940 | is that loneliness and isolation

01:48:45.220 | are critical public health challenges

01:48:47.440 | that are hiding behind the curtain,

01:48:50.180 | behind this wall of stigma and shame.

01:48:52.920 | And unless we talk about it and address it,

01:48:55.060 | unless we reconcile what's been happening to us

01:48:58.680 | over the last 50 years,

01:48:59.940 | where fewer and fewer people are participating

01:49:02.340 | in community organizations,

01:49:03.720 | where more and more people are feeling isolated,

01:49:05.960 | and we're not gonna be able to repair

01:49:08.080 | the fraying foundations of society,

01:49:10.360 | which are grounded fundamentally

01:49:12.280 | in our connection to one another.

01:49:13.980 | - You mentioned community organizations.

01:49:17.580 | Could you elaborate on those?

01:49:21.480 | Growing up in the '70s and '80s,

01:49:24.840 | I was exposed to community soccer teams,

01:49:29.600 | swim team, there was a community pool.

01:49:31.600 | These were all public things.

01:49:34.000 | There were churches, synagogues, and mosques.

01:49:38.040 | Are we not seeing as much participation

01:49:40.560 | in those types of organizations anymore?

01:49:42.840 | And what other types of organizations are out there

01:49:45.720 | that come to mind when you think about the isolation crisis?

01:49:50.440 | - Yeah, so there are several factors

01:49:52.040 | that have led to us being as isolated as we are.

01:49:54.720 | One of them, as you mentioned,

01:49:55.840 | is the decline in participation in community organizations.

01:49:59.240 | This isn't a recent phenomenon.

01:50:01.280 | This has been happening over the last half century

01:50:03.520 | in America.

01:50:04.360 | We've seen lower participation in faith organizations,

01:50:07.640 | in recreational leagues, in service organizations,

01:50:10.600 | and other community groups that used to bring us together.

01:50:14.140 | And I think we can talk about the reasons

01:50:17.280 | why that has been the case,

01:50:19.280 | but one of the key consequences of that

01:50:21.060 | is that people don't have places

01:50:24.040 | where they can come together and get to know one another,

01:50:26.120 | especially across differences.

01:50:28.140 | So we actually associate more and more

01:50:29.600 | with people who are like us.

01:50:31.280 | But this has also been fueled by a few other factors

01:50:33.820 | that are going on at the same time.

01:50:35.760 | One is that just from a cultural perspective,

01:50:38.060 | as modernity has arrived, not just in the U.S.,

01:50:40.320 | but in other countries,

01:50:42.400 | we've seen that people are more mobile, right?

01:50:44.380 | They move around more.

01:50:45.360 | We don't always stay in the community that we grew up in.

01:50:47.920 | We tend to, even if we move somewhere else for a school,

01:50:50.060 | we may go somewhere else for a job.

01:50:51.440 | We may change jobs and move somewhere else.

01:50:54.000 | We are leaving behind communities that we grew up with,

01:50:56.520 | that we went to school with, that we worked with.

01:50:58.360 | And I'm not saying that's all a bad thing, right?

01:51:00.520 | We have more opportunities, and that's a really good thing.

01:51:03.480 | But I think one thing that we have not accounted for

01:51:06.240 | is the cost of these changes, right?

01:51:08.280 | If we know what the costs are of certain actions,

01:51:10.440 | we may still take those actions,

01:51:11.840 | but we may find ways to mitigate the costs.

01:51:14.400 | We may, in this case, invest more in our relationships,

01:51:17.640 | be more conscious about reaching out

01:51:19.080 | to other people going to visit them.

01:51:20.840 | But that has been a quiet but devastating consequence.

01:51:25.140 | The other pieces with modernity

01:51:26.960 | is that we have more convenience in our life,

01:51:29.960 | which means that we also don't need to see other people

01:51:33.040 | to get certain things done, like buying groceries,

01:51:36.040 | or mailing an item out,

01:51:37.460 | or getting something from the store.

01:51:38.680 | I can sit in the comfort of my home

01:51:40.480 | and have everything just come to me.

01:51:42.200 | Now, on the one hand, that's incredibly efficient, right?

01:51:45.220 | But I think efficiency is an interesting thing,

01:51:47.960 | because it's only one factor

01:51:49.280 | we should be considering in our lives.

01:51:51.340 | There, too, we have to ask the costs.

01:51:52.800 | And one of the interesting things about COVID

01:51:54.400 | is many people, in the first year of COVID,

01:51:56.160 | when we were all separated from one another,

01:51:58.700 | when we finally came back together again,

01:52:00.240 | I had so many people who said to me,

01:52:01.200 | "You know what, I expected to miss my parents,

01:52:04.220 | "and my siblings, and my friends,

01:52:06.480 | "not being able to see them.

01:52:07.740 | "What I didn't expect was missing the strangers

01:52:11.560 | "that I saw at the coffee shop,

01:52:13.180 | "or the folks who I ran into at the grocery store,

01:52:15.780 | "or seeing neighbors as I walked down the street."

01:52:18.780 | I actually missed that more than I thought I would.

01:52:20.480 | So we have lost out on some of those interactions

01:52:24.340 | and those loose ties.

01:52:25.820 | But the final thing to keep in mind also

01:52:28.920 | is about what is happening

01:52:30.000 | with how we're using social media technology,

01:52:32.880 | which I think has fundamentally transformed

01:52:34.720 | how we interact with one another,

01:52:36.640 | and how we see ourselves and each other.

01:52:39.720 | And this is particularly true for young people

01:52:42.520 | who are growing up as digital natives.

01:52:44.800 | But what has happened there, I worry,

01:52:46.680 | is that, and it is thought that social media is all bad,

01:52:49.720 | just to be clear.

01:52:50.680 | Technology, look, I'm a believer

01:52:52.120 | that in technology, broadly speaking,

01:52:55.480 | a user of technology.

01:52:56.420 | I spent seven years building a tech company.

01:52:57.920 | I'm a believer in tech.

01:52:59.420 | But I think whether technology helps or hurts us

01:53:02.360 | is about how it's designed,

01:53:03.820 | and ultimately about how it ends up being used.

01:53:05.900 | And what we've seen with social media as well

01:53:08.120 | is that for many people,

01:53:10.480 | it ended up leading to in-person connections

01:53:13.860 | being replaced with online connections.

01:53:17.160 | We came to somehow value and almost seek out

01:53:21.780 | more and more followers and friends on social media,

01:53:24.660 | feeling somehow that made us more connected.

01:53:27.680 | But the nature of dialogue also changed.

01:53:29.920 | Like as human beings, we evolved over thousands of years

01:53:32.640 | to not just understand the words someone is saying,

01:53:35.300 | but to hear the tone of their voice,

01:53:37.120 | to see their facial expression.

01:53:38.520 | Like you and I are sitting across,

01:53:40.080 | and we're both processing our body language, right?

01:53:42.820 | And I'm seeing you nod your head,

01:53:44.460 | and I'm seeing your eyes focus.

01:53:45.960 | Like all of that matters to how we communicate.

01:53:48.880 | But also, like you and I are less likely

01:53:52.000 | to say something hurtful right now to one another

01:53:54.560 | because we can see each other.

01:53:56.020 | If I said something hurtful to you,

01:53:57.420 | like I'd probably see the pain or consternation on your face,

01:54:01.160 | and that might give me pause, right?

01:54:03.100 | When you're communicating online with other people

01:54:05.560 | without any of that information

01:54:07.900 | or without any of the sort of barriers, if you will,

01:54:11.140 | that make you pause before you hurt someone,

01:54:13.180 | it leads to a very different kind of communication,

01:54:15.700 | one that can be quite hurtful at times.

01:54:18.680 | And I also think that one thing many people don't recognize

01:54:22.240 | is that to communicate with somebody else

01:54:24.440 | and reach out and build a relationship with someone,

01:54:26.800 | it actually takes a certain amount of self-esteem

01:54:28.840 | to do that.

01:54:29.680 | You have to believe the other person's

01:54:31.580 | gonna wanna hang out with you.

01:54:33.020 | They're gonna see something valuable in you.

01:54:35.540 | And for many young people, what has happened,

01:54:38.040 | and I think frankly for many older people too,

01:54:40.160 | is their experience on social media

01:54:41.580 | has shredded their self-esteem

01:54:43.540 | as they're constantly comparing themselves to other people.

01:54:46.820 | Like when you and I were growing up in the '80s,

01:54:50.100 | we compared ourselves to other people too, right?

01:54:52.620 | People have for millennia.

01:54:54.180 | But what's fundamentally different now

01:54:56.120 | is that in a given day, you can compare yourself

01:54:58.840 | to thousands of images that you see online.

01:55:01.240 | That's actually literally what young people tell me.

01:55:03.500 | I do roundtables with college students

01:55:05.340 | and high school students all the time around the country.

01:55:07.660 | And the three things they tell me most consistently

01:55:09.700 | about their experience with social media

01:55:11.200 | is it makes them feel worse about themselves,

01:55:13.440 | worse about their friendships, but they can't get off it

01:55:16.320 | because the platforms are designed

01:55:17.580 | to maximize the amount of time they spend on them.

01:55:19.860 | So you put all of this together.

01:55:21.840 | And I think what has happened is that we're talking more,

01:55:25.960 | but we understand each other less.

01:55:28.240 | We have a lot of information,

01:55:30.360 | but we're lacking in the wisdom

01:55:32.920 | that comes from human relationships.

01:55:36.320 | And I think that that's really hurt us.

01:55:38.080 | We see it certainly in the data that tells us

01:55:40.520 | about mental and physical health outcomes,

01:55:42.960 | but there's also the human suffering component, Andrew.

01:55:45.840 | It's really heartbreaking for me to travel around the country

01:55:49.400 | to hear from people of all ages, often in quiet whispers,

01:55:53.680 | about their struggles with isolation,

01:55:56.080 | about how they feel like they just don't matter at all,

01:55:58.680 | about how they feel like they just don't have a place

01:56:00.740 | where they belong.

01:56:01.920 | And these are people on the outside look perfectly fine.

01:56:06.920 | They're posting happy things online to the folks at work.

01:56:10.160 | They're seeming like everything's going great.

01:56:12.520 | This is what I always tell people.

01:56:14.080 | Loneliness is a great masquerader.

01:56:16.060 | It can look like withdrawal and sadness.

01:56:17.880 | It can look like anger and irritability.

01:56:20.120 | It can look like aloofness as well.

01:56:22.400 | And so it's only when we stop to ask someone

01:56:26.280 | how they're doing, when we take pause for a moment

01:56:28.320 | to maybe reflect on what's happening in their life,

01:56:30.840 | that we realize that, wow, the majority of people

01:56:33.360 | in our country are actually struggling with loneliness.

01:56:36.120 | - Yeah, I'm a firm believer that our nervous system evolved

01:56:39.920 | under conditions of close interpersonal

01:56:43.680 | and direct connection.

01:56:45.820 | And to suddenly throw a technology in front of ourselves

01:56:49.720 | that deprives our nervous system of its normal development

01:56:53.020 | is clearly gonna lead bad places.

01:56:55.180 | It's also clear to me, based on what you just described,

01:56:58.440 | that when we go on social media, we see something,

01:57:01.120 | but they don't really see us.

01:57:02.840 | Hence perhaps why people get aggressive

01:57:06.700 | in the comment section.

01:57:08.040 | They wanna be heard.

01:57:11.080 | We wanna be seen.

01:57:11.940 | I think all of us wanna be seen and see other people.

01:57:15.560 | And social media doesn't allow for it so easily.

01:57:19.160 | I also know that a lot of young people

01:57:21.380 | will congregate with their friends

01:57:23.200 | to play video games online, but that's different.

01:57:25.540 | You're essentially showing up as an avatar.

01:57:28.280 | And when we were kids, we also played different characters

01:57:31.920 | in our games, but oh so different now.

01:57:36.420 | Do you think that there will be a youth rebellion movement

01:57:39.080 | against these kinds of technologies?

01:57:42.560 | I mean, there's a long history of young people rebelling

01:57:45.560 | against the stuff that's been put in front of them.

01:57:48.000 | And they're like, "Nope, no more.

01:57:49.240 | "We're gonna rebel."

01:57:50.120 | In fact, that was the way that youth overcame

01:57:52.320 | the nicotine epidemic, if you recall.

01:57:56.840 | It was the advertising pitting them against

01:58:01.120 | wealthy, cackling older men in rooms counting their money.

01:58:07.160 | That was what actually was successful

01:58:09.280 | in getting kids to not smoke,

01:58:10.500 | because kids have a rebellious streak,

01:58:12.920 | as opposed to when they were told,

01:58:13.800 | "Hey, smoking's terrible for you.

01:58:15.060 | "Your lungs are gonna fill with cancer."

01:58:17.840 | Kids didn't stop smoking.

01:58:19.120 | Teens didn't stop smoking.

01:58:20.980 | Rebellion has been baked into our nervous system

01:58:24.700 | in the adolescent and teen years.

01:58:26.460 | So do you see a rebellion against this social isolation?

01:58:30.680 | Are kids gonna start putting away their phones

01:58:32.260 | and hanging out together again, and that's gonna rescue us?

01:58:35.060 | And that's a way of saying, what can we do for them?

01:58:38.220 | What can they do for themselves?

01:58:40.120 | And what can we do as adults?

01:58:41.180 | 'Cause there are a lot of, the silent suffering

01:58:43.420 | is the thing I also really worry about.

01:58:45.920 | - So it's a good question, and I think there is already

01:58:49.360 | a movement that's building among young people

01:58:52.140 | to create distance between themselves and their devices,

01:58:57.140 | and particularly social media.

01:58:59.560 | And it's cropping up in different ways.

01:59:02.300 | I'm meeting more and more.

01:59:03.980 | Some of these are organized efforts,

01:59:05.560 | but I'm also meeting more families,

01:59:08.400 | where the parents that gets together have decided

01:59:10.540 | that they're gonna delay using social media,

01:59:12.980 | and they'll pass middle school, or in some cases,

01:59:15.780 | even later, or where they're deciding

01:59:18.060 | that they're gonna draw boundaries around social media use,

01:59:21.140 | where they're gonna replace their smartphone

01:59:22.880 | with a dumb phone that allows them to do things like text

01:59:25.780 | and make phone calls and use maps and all that stuff,

01:59:29.100 | but doesn't necessarily have social media apps on it.

01:59:31.160 | That this is still a small minority.

01:59:32.920 | And we're dealing with a bit of a network effect here,

01:59:35.800 | because if you're the only one who's not on social media

01:59:39.120 | in your middle school class, then you might feel left out,

01:59:41.680 | which is why it's so important for parents

01:59:43.860 | and kids to actually do this together.

01:59:46.340 | But I do think that, to use your analogy with smoking,

01:59:49.960 | that one thing that I think many young people

01:59:53.080 | bristle against is this notion of being manipulated

01:59:58.080 | and used for the profit of a social media platform.

02:00:03.760 | And the reality is that, again, we've talked about

02:00:06.880 | how the fundamental business model is,

02:00:09.560 | or most social media platforms is built

02:00:11.280 | on how much time you spend on those platforms.

02:00:13.960 | That translates to ad revenue,

02:00:15.280 | and that translates to the bottom line.

02:00:17.640 | Whereas what I care about as a parent,

02:00:19.680 | as a surgeon general, is about how well

02:00:22.860 | that time is being spent.

02:00:24.280 | Is it actually contributing to the health and wellbeing

02:00:26.740 | of a young person, or is it not?

02:00:28.480 | Is it actually harming them?

02:00:30.340 | And this is where I think, when I go out

02:00:32.240 | and talk to young people about this,

02:00:33.480 | number one, I'm so impressed by a lot of young people,

02:00:35.460 | 'cause they already have a lot of these insights.

02:00:37.280 | They're the ones living it, right?

02:00:38.760 | They're not thinking that this is all perfect

02:00:41.440 | and it's all a pure benefit here.

02:00:43.740 | They're the ones telling me that it makes them feel worse

02:00:46.120 | about themselves and their friendships.

02:00:48.600 | But they're also having a hard time getting off of it,

02:00:50.680 | because, again, of how these platforms are designed.

02:00:52.680 | So about a third of adolescents are saying

02:00:54.240 | that they're staying up 'til midnight or later on weeknights

02:00:57.400 | using their devices, and a lot of that is social media use.

02:01:00.000 | And this takes away from sleep, which we know,

02:01:02.440 | and you know better than anyone,

02:01:03.960 | is so critical to the mental health and wellbeing

02:01:05.880 | of all of us, but of young people in particular

02:01:07.840 | who are at a critical phase of development.

02:01:11.040 | The other thing that is very concerning to me

02:01:12.880 | is nearly half of adolescents say that using social media

02:01:16.300 | has made them feel worse about their body image,

02:01:19.340 | as they're constantly comparing themselves to others online.

02:01:22.080 | And we used to think, oh, this is just girls

02:01:24.000 | who are experiencing this.

02:01:24.840 | And yes, it is a lot of young girls

02:01:27.360 | who are experiencing these body image issues,

02:01:28.840 | but now it's increasingly boys as well.

02:01:31.180 | So this is happening across the board.

02:01:34.120 | But the other piece I think that concerns me

02:01:35.860 | thinking about mental health symptoms

02:01:37.560 | is that when you look at how much time

02:01:40.540 | kids are using social media, on average,

02:01:42.760 | adolescents are using it for three and a half hours a day,

02:01:45.240 | on average, so many-- - Just social media.

02:01:47.540 | - Just social media.

02:01:48.380 | And that means many are using it for far more than that.

02:01:51.560 | And what you're finding, though,

02:01:52.720 | is that for adolescents who use it three hours or more

02:01:57.060 | in a given day, their risk of anxiety

02:01:59.600 | or depression symptoms double.

02:02:01.200 | And if the average uses three and a half days,

02:02:04.240 | that means that millions of kids all across our country,

02:02:07.100 | the majority of our kids, are at risk here.

02:02:09.100 | And so you put all this together,

02:02:12.080 | and it paints a very concerning picture.

02:02:14.300 | Whatever benefits there may be for some kids

02:02:17.100 | of using social media, and there's some,

02:02:18.580 | and we lay out some of this in our advisory on social media,

02:02:21.240 | some kids find social media's a great way

02:02:23.000 | to express themselves, to reach other people,

02:02:24.960 | to find support, especially if they're from a community

02:02:27.740 | that doesn't have a lot of folks who are like them around.

02:02:30.700 | It can be really reassuring to connect with others.

02:02:33.600 | But we can't say that just to get those benefits,

02:02:37.160 | we have to subject our children

02:02:38.620 | to all of these other harms, right?

02:02:40.900 | Kids are experiencing exposure to harmful content,

02:02:44.280 | to harassment and bullying online.

02:02:45.820 | Six out of 10 adolescent girls are saying

02:02:48.260 | they've been approached by strangers on social media

02:02:50.380 | in ways that made them feel very uncomfortable.

02:02:53.100 | Our kids are also finding that health-promoting activities

02:02:57.060 | in their lives are being cannibalized

02:02:59.020 | by their use of social media,

02:03:00.380 | that it's detracting from time for sleep,

02:03:02.300 | in-person interaction, physical activity.

02:03:05.020 | And the erosion of self-esteem really concerns me as well,

02:03:07.460 | because you need that not just for social interaction,

02:03:10.600 | but look, as a father, I want my children to grow up

02:03:14.460 | being confident about who they are,

02:03:16.420 | being confident enough to be authentic

02:03:18.580 | as they show up in the world,

02:03:19.660 | to not feel like they need to create some brand

02:03:21.900 | that's different from who they fundamentally are

02:03:23.720 | just to sell that to the world.

02:03:25.540 | I want them to know who they are

02:03:27.240 | and to be comfortable being who they are

02:03:29.300 | and to encourage other people to do the same,

02:03:32.260 | to support them in their efforts to be authentic.

02:03:34.260 | That's what I want my kids to do.

02:03:36.020 | That's not what's happening

02:03:37.100 | to a lot of kids on social media.

02:03:38.620 | So I think we not only need more kids to understand this

02:03:42.300 | and to support them in their efforts to create space

02:03:46.060 | and sacred spaces away from social media,

02:03:47.820 | but we need to support parents here too.

02:03:49.780 | 'Cause Andrew, my big concern with parents is,

02:03:52.140 | look, we've taken this technology, which is rapidly evolving,

02:03:56.080 | which we didn't grow up with as kids,

02:04:00.380 | and we've told parents, you manage it all on your own.

02:04:03.800 | We put the entire burden on parents and kids to manage this.

02:04:06.740 | When we were growing up,

02:04:08.740 | you remember that motor vehicle fatalities

02:04:10.460 | were really high in America.

02:04:12.360 | And we didn't say, okay, you know what?

02:04:15.940 | That's just the price of modern life.

02:04:18.900 | We just have to accept it

02:04:20.360 | and keep moving on with our lives.

02:04:21.740 | We said, hold on.

02:04:22.980 | We don't have to go back to horses and buggies,

02:04:24.740 | but we also don't need to accept this death rate.

02:04:26.640 | We need to make this experience safer.

02:04:29.020 | And so we put in place,

02:04:30.660 | with the advocacy and support of incredible groups

02:04:33.420 | like MADD and others across the country,

02:04:35.460 | MADD mean Mothers Against Drunk Driving,

02:04:37.900 | ultimately the government put in place safety standards

02:04:41.100 | that got us seat belts, airbags, crash testing

02:04:44.980 | to make sure the frame of cars were robust

02:04:47.460 | in the setting of an accident.

02:04:48.500 | And that helped us reduce motor vehicle accidents

02:04:50.960 | and deaths.

02:04:52.100 | And that's what we need here too.

02:04:53.460 | Like we need to have the backs of parents and kids.

02:04:57.020 | And that means from a policy perspective,

02:05:00.020 | putting in place safety standards to protect kids

02:05:02.560 | from exposure to harmful content,

02:05:04.100 | from the experience of bullying and harassment,

02:05:06.940 | and that also protect them from features

02:05:09.460 | that would seek to manipulate them into excessive use,

02:05:12.260 | which is happening far too often right now.

02:05:14.580 | We also need a policy that requires data transparency

02:05:17.960 | from the companies.

02:05:19.000 | You know, researchers tell us all the time

02:05:21.820 | that these are independent researchers.

02:05:24.220 | They tell us they are having a hard time

02:05:25.480 | getting full access to the data

02:05:27.060 | from the social media platforms

02:05:28.540 | about the full impact of the platforms

02:05:31.420 | on the mental health of kids.

02:05:32.920 | As a parent, look, I don't,

02:05:34.460 | when we bought car seats for my children,

02:05:36.320 | when they were born, we looked up the safety data.

02:05:39.940 | Like many parents, we wanted to make sure

02:05:41.780 | the car seats were safe.

02:05:43.500 | But if you had told me that, hey, you know,

02:05:45.060 | the manufacturers of these car seats

02:05:46.500 | are actually not disclosing some of the data

02:05:49.160 | on the impact on children,

02:05:51.080 | but go ahead and buy it anyway.

02:05:52.280 | You know, I'm sure other people are buying these car seats.

02:05:54.360 | You should be fine.

02:05:55.320 | I would have been very disturbed by that, right?

02:05:57.100 | No parent wants to feel that information

02:05:58.640 | is being hidden from them

02:05:59.800 | about the health impact of products on their kids.

02:06:02.720 | That's what we have right now.

02:06:03.760 | So this is a place where I think,

02:06:05.920 | while, yes, and we'll talk about some steps

02:06:08.560 | parents can take, 'cause I wanna get to practical steps

02:06:10.920 | that people who are here as parents

02:06:12.580 | or people with kids in their lives can take,

02:06:15.360 | but we need policymakers to step up

02:06:18.860 | and step into the void here and to fill the gap,

02:06:22.000 | because this is too much, again,

02:06:24.220 | to just ask parents to manage entirely on their own.

02:06:27.100 | And this isn't, again, about telling parents what to do

02:06:29.220 | and restricting them.

02:06:30.720 | This is about giving them the support they need

02:06:32.580 | so they have confidence when they see, you know,

02:06:35.900 | a technology out there, a device out there,

02:06:38.300 | a product out there for kids

02:06:40.120 | that they know it's been tested, that it's been studied,

02:06:43.200 | and that it's actually safe for their children.

02:06:45.640 | - My understanding is that in countries like China,

02:06:48.260 | there are limits as to how many hours

02:06:50.600 | kids can be on screens, period.

02:06:53.440 | And when I was a kid, we were allowed to watch TV

02:06:55.320 | for a certain number of,

02:06:56.680 | I think it was a half an hour or an hour.

02:06:58.280 | My mom was constantly kicking us out of the house.

02:07:00.440 | Like, literally, you gotta leave the house.

02:07:02.080 | You gotta go down the street and play.

02:07:03.720 | Unfortunately, I liked outdoor activities.

02:07:06.540 | Nowadays, we also have the issue

02:07:07.940 | that a lot of parents are on their phones

02:07:10.240 | at soccer games and at kids' events,

02:07:11.960 | and so the kids are modeling their parents.

02:07:14.520 | Parents are distracted as well,

02:07:16.160 | so there's a lack of social connection,

02:07:18.740 | people even in immediate family.

02:07:20.500 | People are screened in, you know, the TV.

02:07:23.620 | There's laptops, there's multiple phones, iPads.

02:07:26.320 | People are more engaged in the screen portals

02:07:29.480 | than often than their own portals.

02:07:32.660 | You go to a concert, and people are watching the concert

02:07:35.440 | through their screens so that they can send the same image

02:07:37.760 | that everyone around them is sending out to the world.

02:07:40.740 | If you think about it, it's kind of crazy,

02:07:43.520 | but I guess they wanna capture that unique experience,

02:07:46.680 | but it's not unique at all.

02:07:48.540 | That's the myth, that's the illusion.

02:07:51.040 | There's nothing unique about your post

02:07:53.300 | of something that you went to go see.

02:07:54.580 | What would be truly unique is to just experience that

02:07:56.720 | in real time, right?

02:07:58.360 | It's so wild to think about what we think of

02:08:00.860 | as our unique portal is actually not unique at all.

02:08:04.260 | It's what we do with it.

02:08:06.120 | My stance is glean and learn information online,

02:08:09.360 | and go use it in real life.

02:08:11.160 | Come back from time to time, you know,

02:08:13.480 | maybe an hour a day maximum or so.

02:08:15.760 | - Can I just underscore the two words you said, real life?

02:08:18.860 | 'Cause that, I think, is a really important key here,

02:08:21.280 | which is that all of real life isn't happening

02:08:24.680 | on social media.

02:08:25.700 | There's a whole world out there, which I think is real life,

02:08:28.140 | which is happening offline.

02:08:29.180 | And what's happening online too often is distorted, right?

02:08:32.960 | It's giving us, like, even just take the images

02:08:37.960 | that we see of people, their, you know,

02:08:41.040 | their summer beach images, their, like,

02:08:43.280 | great vacation images.

02:08:45.120 | That's not representative of their entire life,

02:08:47.240 | of how they're living their life, but we see that.

02:08:49.340 | We see people's anger and their vitriol,

02:08:51.460 | and we come to believe over time

02:08:53.480 | that that's how people feel.

02:08:55.080 | That's what people are dealing with

02:08:56.540 | and experiencing in their life.

02:08:57.560 | And we've just got to get, you know, your mom,

02:09:00.800 | I love what your mom did of getting you guys outside.

02:09:04.200 | My parents did the same thing too.

02:09:06.420 | Like, I was very blessed to have two parents

02:09:09.100 | who didn't come, you know,

02:09:10.300 | they didn't have a lot of resources growing up.

02:09:11.840 | They didn't come to this country with a lot of resources.

02:09:14.260 | But one of the greatest gifts they gave us

02:09:17.140 | is that they loved us unconditionally.

02:09:19.440 | The other great gift that they gave us is they pushed us

02:09:21.820 | to just explore, to meet people, to learn about the world.

02:09:25.660 | They wanted us outside, playing, you know, experimenting,

02:09:29.580 | just discovering the world, you know,

02:09:32.800 | riding our bike around the neighborhood.

02:09:34.940 | And that's what we did.

02:09:36.020 | But right now, two critical things that kids need

02:09:39.020 | for their mental health and development

02:09:41.100 | are two important forces, I should say,

02:09:42.860 | that are impacting their mental health and development.

02:09:45.100 | One is social media, but the second also

02:09:46.900 | is the lack of unstructured playtime that kids have.

02:09:49.980 | Like, unstructured playtime is time when we, as kids,

02:09:53.560 | learn how to negotiate situations with other kids,

02:09:55.900 | how to resolve conflict,

02:09:57.020 | how to recognize what's going on in someone else's eyes

02:10:00.660 | before they say something.

02:10:01.820 | We learn how to collaborate and play with other kids.

02:10:04.260 | There's a lot you learn on the playground, as it turns out.

02:10:07.820 | But I worry that right now that we've almost somehow

02:10:10.620 | made that kind of unstructured time seem inefficient.

02:10:13.580 | You know, we've set these standards for our kids

02:10:16.060 | that they need to be, you know, getting fancy jobs

02:10:19.100 | and into fancy colleges and making X amount of money.

02:10:22.060 | And the path to doing that is, you know,

02:10:23.840 | to be enrolled in X number of activities after school

02:10:26.940 | and to do all this stuff in school.

02:10:28.320 | And their lives are so hyper-structured

02:10:31.180 | that I worry that the time to just play,

02:10:34.660 | to be creative, to reflect and think,

02:10:37.420 | to just have unstructured time with other kids

02:10:40.180 | has evaporated, and I think that that also

02:10:42.580 | is hurting the mental health and wellbeing of our children.

02:10:45.700 | - I love the idea that unstructured playtime

02:10:48.820 | could be framed in the accurate context

02:10:51.420 | of the nervous system developing

02:10:53.180 | the way it was supposed to develop.

02:10:54.900 | I mean, I would argue that success is going to be easiest

02:10:58.580 | for children that engage in the real world more.

02:11:01.180 | In fact, there's great risk to posting everything

02:11:03.120 | that you do online.

02:11:04.480 | We've seen some examples of that preventing people

02:11:06.640 | from getting into or staying in college

02:11:09.300 | based on things they said or did previously

02:11:11.000 | that they shouldn't have said or done.

02:11:13.260 | Those are kind of, you know, negative highlighted cases.

02:11:16.440 | But in general, we know that the nervous system thrives

02:11:20.620 | on diversity of types of interactions

02:11:22.480 | and social interactions in particular.

02:11:24.080 | I'm just restating what you just said.

02:11:25.460 | So if ever there was a call for kids to get out

02:11:28.180 | into non-screen life, let's call it,

02:11:31.220 | and engage their nervous system that way,

02:11:34.700 | without question is going to benefit them

02:11:36.720 | in terms of their ability to learn and retain information,

02:11:40.340 | perform well in school,

02:11:41.540 | which is not everything life's about, but let's face it,

02:11:44.240 | we still live in a society where hitting those milestones

02:11:48.260 | on a consistent basis is the best predictor

02:11:50.820 | of people being able to live self-sustained lives,

02:11:53.700 | build families, and that sort of thing.

02:11:55.300 | So you mentioned a few actionable items

02:12:00.000 | for parents as it relates to kids,

02:12:02.340 | well, not maybe, limits their screen time,

02:12:04.900 | force them outside in the safe weather

02:12:07.300 | and safe conditions, of course.

02:12:08.380 | But what about adults as well?

02:12:10.980 | I mean, what can we all do?

02:12:13.220 | Should we be restricting our screen time

02:12:15.780 | to X number of hours per day?

02:12:18.700 | I mean, you're the surgeon general.

02:12:19.980 | If you had a magic wand, which I realize you don't,

02:12:24.180 | and you could make a highly informed recommendation

02:12:28.260 | about what the thresholds for too much time

02:12:32.020 | on social media are, what would it be?

02:12:36.620 | Two hours, three hours?

02:12:38.100 | - Yeah, so it's a good question,

02:12:40.220 | and let me actually go through some of these things

02:12:42.500 | that parents can do for kids

02:12:44.380 | and that we can all do for ourselves.

02:12:46.120 | With kids in particular,

02:12:47.820 | what I would do specifically with social media is,

02:12:50.820 | and this is frankly what I'm planning to do

02:12:53.260 | with my wife for our kids as they grow up.

02:12:56.060 | Number one, I would seek to delay the use of social media

02:13:01.060 | past middle school at minimum.

02:13:04.520 | And I know that that is hard to do

02:13:06.680 | at a time when all kids are on social media

02:13:08.700 | and you don't want your child to be the only one left out

02:13:10.700 | and to be lonely as a result.

02:13:12.860 | - So that means no account of their own.

02:13:15.020 | - It means no account of their own.

02:13:17.300 | And I would make, to the best of your ability,

02:13:21.480 | see if there are other parents that you can partner with

02:13:24.220 | to do this, because it's hard to do alone as a parent,

02:13:26.900 | but it's also, if there are other parents

02:13:28.220 | you're partnering with, that means there are other kids

02:13:30.140 | who are also delaying use.

02:13:31.300 | That means your child is not alone.

02:13:33.020 | And I think if you start the conversation

02:13:34.940 | with other parents, you'll realize a lot of them

02:13:36.940 | are worried about the same things you are.

02:13:38.620 | They may have thought about delaying use,

02:13:40.100 | but they also don't want their kid to be the only one.

02:13:42.020 | So this becomes a numbers challenge,

02:13:43.780 | but partnership can help us.

02:13:45.300 | If your child's already on social media,

02:13:47.460 | what I'd recommend is to create sacred spaces

02:13:51.260 | in their lives that are technology free.

02:13:53.740 | And specifically I would think about the hour before bedtime

02:13:57.360 | and throughout the night as time that you want to protect,

02:14:00.360 | 'cause kids are losing not just sleep

02:14:03.080 | because they're going to sleep later

02:14:04.360 | 'cause they're on their devices,

02:14:05.940 | but they're also waking up in the middle of the night,

02:14:07.840 | maybe to use the bathroom, maybe to get some water,

02:14:09.660 | and then they get back on their devices again.

02:14:11.560 | So the quality of their sleep is being significantly

02:14:14.640 | impacted by access to those devices during the night.

02:14:17.760 | So I would protect that time, hour before bed,

02:14:20.200 | throughout the night.

02:14:21.420 | I would also make sure meal times were tech-free zones

02:14:26.280 | so that people actually, that you talk to one another,

02:14:28.600 | you see one another, and time with friends

02:14:31.320 | and family members when you're out at a birthday party,

02:14:34.200 | et cetera, make that tech-free time.

02:14:36.080 | Let them focus on their time with other people.

02:14:38.840 | Those three tech-free zones can do a world of good

02:14:42.700 | to help your child.

02:14:44.040 | And then the last thing I'd recommend here,

02:14:45.460 | the many things I think parents could do,

02:14:48.120 | is to start a dialogue with your child about their use

02:14:51.080 | of social media.

02:14:52.940 | We don't always know how social media

02:14:54.720 | is making our kids feel.

02:14:56.560 | From the, and we may realize when we talk to them

02:14:59.040 | that they actually have their own concerns.

02:15:01.000 | They might say, "Yeah, it's not making me feel really good,

02:15:03.500 | "but it's just like hard not to be on it.

02:15:05.040 | "Everyone's like texting on this, or everyone is,

02:15:07.560 | "everyone's sharing information and posting pictures on it.

02:15:10.440 | "I feel like I need to be on it."

02:15:12.180 | You can only help them start to manage that

02:15:14.880 | if you know that that's a challenge that they're having.

02:15:16.800 | So opening up a conversation so your child knows

02:15:19.480 | that you're not judging them,

02:15:21.120 | but you're trying to understand their experience

02:15:22.720 | is important.

02:15:23.540 | Also so that you can help them understand

02:15:25.160 | what is not acceptable for them to experience

02:15:27.300 | on social media.

02:15:28.140 | If they're being harassed or bullied by strangers,

02:15:31.360 | that is a problem.

02:15:32.360 | You want your child to tell you about that, to report that.

02:15:36.280 | If they see something posted online

02:15:38.440 | that's really concerning to them,

02:15:39.600 | let's say they see a friend post

02:15:41.340 | that they're thinking of taking their own life

02:15:42.880 | or harming themself in another way,

02:15:45.400 | you want them to know that that's important to flag

02:15:47.760 | and to get help,

02:15:48.600 | that they shouldn't just scroll past that.

02:15:51.240 | So that conversation is really important.

02:15:52.960 | And finally, as parents, we can lead by example.

02:15:55.360 | And this is hard,

02:15:56.440 | 'cause the truth is we've been talking about social media

02:15:59.160 | in youth, and that's what the subject

02:16:00.540 | of my Surgeon General's advisory was on.

02:16:02.600 | But I have concerns about adults too.

02:16:04.420 | I see it as somebody who's had challenges in my own use

02:16:07.440 | of social media,

02:16:08.320 | finding sometimes it bleeds past my bedtime,

02:16:11.780 | and I realize, I think I'm gonna check something

02:16:14.000 | for five minutes, an hour later I'm still there,

02:16:16.080 | scrolling through something.

02:16:18.280 | And sometimes I find myself,

02:16:21.160 | over the years I find myself comparing myself also

02:16:23.960 | to posts I see online in unhealthy ways.

02:16:26.480 | Sometimes I find myself sort of pulled into content

02:16:31.480 | that ends up being angry and vitriolic

02:16:34.320 | and leaves me feeling worse at the end.

02:16:36.200 | So I've experienced this as well.

02:16:38.240 | And I think as parents, one of the hardest things to do

02:16:40.640 | is to follow this advice we're giving our kids,

02:16:42.480 | to draw those boundaries as well,

02:16:44.200 | and to put our devices away when we're around our kids.

02:16:47.220 | One experience I had which sort of I still feel bad about

02:16:50.440 | but which really helped kind of knock some sense into me

02:16:52.800 | was after my son was born, my older child,

02:16:57.640 | I was actually, I was Surgeon General at that time.

02:16:59.680 | I had a lot going on, it was a busy job, et cetera,

02:17:02.120 | but I wanted to make sure that I protected bedtimes

02:17:05.280 | and mealtimes for us to be together as a family.

02:17:08.400 | Yet one day when I came home after dinner

02:17:10.640 | when we were doing the bath time and bedtime routine

02:17:13.360 | and getting my son ready for the night,

02:17:15.860 | my wife was changing his diaper and instead of helping,

02:17:20.120 | I was just standing at the side scrolling through my inbox.

02:17:23.360 | And my wife, who has infinite patience

02:17:25.200 | and is like one of the most well-adjusted people

02:17:26.960 | that I know, just paused and she turned to me

02:17:31.200 | and Alice said, "Do you really need

02:17:33.880 | "to be doing that right now?"

02:17:35.320 | And she said it just very quietly,

02:17:38.820 | but I felt such a sense of shame when she did that

02:17:42.500 | 'cause I was like, what am I doing?

02:17:45.300 | This is my infant child and the rare few hours

02:17:49.300 | I have with him during the day

02:17:51.540 | and I'm just scrolling through my inbox and my phone.

02:17:54.540 | This is terrible and look, I know that all of us do this

02:17:59.180 | and maybe in different contexts,

02:18:00.780 | but it was a wake-up moment for me

02:18:03.260 | 'cause I realized one, as you know well as a neuroscientist,

02:18:07.500 | we can't really multitask, we're rapidly task switching

02:18:11.700 | and that was time when my head was in my inbox

02:18:14.840 | and my head wasn't with him and my heart wasn't with him.

02:18:17.820 | I was just distracted and so as parents,

02:18:20.740 | if we can honor those sacred times

02:18:24.820 | when we're with our children to keep our devices away,

02:18:27.420 | meal times, sleep time as well, it's not easy to do,

02:18:31.840 | but it really sets a good example for our kids.

02:18:35.780 | All behavior change that we're talking about here,

02:18:39.060 | the kind of behavior change I've worked with patients

02:18:40.900 | over the years around physical activity and diet,

02:18:43.620 | all of this is harder to do when we're doing it by ourself.

02:18:46.660 | It's a lot easier to do when we have a couple of friends

02:18:49.940 | or family members who we agree to do this with,

02:18:52.420 | we hold each other accountable,

02:18:53.700 | we encourage and support each other.

02:18:56.180 | It's how I've been able to make,

02:18:57.740 | the most successful behavior changes I've made in my life

02:19:00.380 | have come about because I have two good buddies,

02:19:03.620 | Dave and Sonny, who are part of my brotherhood

02:19:06.900 | and the three of us as brothers talk about health,

02:19:09.660 | we talk about our finances, we talk about our family

02:19:12.460 | and our friendships and our failings

02:19:14.700 | and we help keep each other accountable

02:19:16.740 | and so I would just encourage parents,

02:19:19.060 | like this sounds daunting or overwhelming,

02:19:21.620 | you don't have to do this alone.

02:19:23.400 | Think about one or two people,

02:19:24.780 | other parents who you might wanna do this with

02:19:26.580 | and I guarantee you, a lot of us

02:19:27.900 | are struggling with the same stuff

02:19:29.560 | and they would probably welcome an opportunity

02:19:31.700 | to do this in collaboration with another parent.

02:19:34.660 | - Such spectacular advice that I hope everyone will follow,

02:19:38.500 | not just for their kids but for themselves.

02:19:40.920 | I think that whether or not social media is addictive

02:19:44.900 | in the true sense of the word

02:19:46.820 | is kind of a meaningless debate at this point.

02:19:49.220 | It's at the very least a compulsive behavior for many of us

02:19:52.640 | and as you described it in the example you gave,

02:19:55.700 | it becomes reflexive.

02:19:57.380 | We're just, we're not necessarily seeking pleasure

02:20:00.060 | or looking to engage in online battles,

02:20:02.660 | it's just, it's become reflexive.

02:20:04.580 | Sort of like finding yourself

02:20:05.540 | with your hand in the refrigerator,

02:20:06.760 | just you don't even think about it, you're just doing it.

02:20:09.380 | So becoming more conscious of the use

02:20:11.340 | and thereby more conscious of the value

02:20:16.020 | of putting away the screens and social media

02:20:19.660 | for extended periods of time each day

02:20:21.220 | and certainly in the middle of the night.

02:20:22.320 | Folks, neuroplasticity, brain rewiring happens

02:20:24.480 | in the middle of the night while you're asleep

02:20:26.060 | and when you mentioned kids awake in the middle of the night

02:20:29.380 | looking at their phone, I just--

02:20:31.100 | - I saw you flinch.

02:20:31.940 | - Oh my goodness, it just pains me.

02:20:33.980 | I've looked at my phone in the middle of the night,

02:20:35.160 | I try not to but I'm certainly not in the window

02:20:38.700 | of maximum plasticity either.

02:20:40.300 | It's terrible for everybody

02:20:41.300 | but especially terrible for kids.

02:20:42.940 | What you just provided is an incredible,

02:20:47.580 | let's just call it a, I'll call it a mandate,

02:20:51.140 | you didn't say it but a suggestion of teaming up with people

02:20:55.220 | to become more like-minded around these issues

02:20:57.580 | and to really promote health.

02:21:00.220 | Along those lines, I really want to thank you.

02:21:02.720 | First of all, for the conversation today.

02:21:05.380 | You're incredibly busy, you're responsible

02:21:07.040 | for an entire country's worth of people.

02:21:11.380 | So to take time to sit down with me

02:21:13.380 | and to discuss these topics for our audience

02:21:16.180 | is incredibly appreciated by me and by them.

02:21:20.460 | I feel comfortable extending their gratitude here.

02:21:24.660 | And it's also clear based on today's conversation

02:21:27.220 | that you face an enormous number of challenges

02:21:29.520 | at the level of budgetary challenges.

02:21:31.460 | By the way, I'm going to work on that.

02:21:33.460 | It's hard to shut me up.

02:21:35.080 | As well as the huge array of issues that you confront.

02:21:40.560 | And it's clear that it's a challenge that you've embraced

02:21:43.900 | for many years now, 100 difficult conditions,

02:21:47.080 | and that you're clearly willing to get out

02:21:49.740 | and talk to people and hear their criticism,

02:21:52.900 | hear their concerns, hear and learn from them.

02:21:56.320 | And so it's been of great benefit to us

02:21:58.820 | to hear and learn from you.

02:22:00.140 | And I hope this won't be the last of our conversations.

02:22:03.580 | There's many more topics to cover,

02:22:05.000 | but I just really want to thank you.

02:22:07.140 | Thanks ever so much for the intellectual power

02:22:11.460 | and the emotional power that you put into what you do,

02:22:14.180 | 'cause that is very clear.

02:22:15.300 | You're a physician first and you care about your patients

02:22:18.020 | and your patients are all of us.

02:22:19.720 | So thank you so much.

02:22:21.060 | - Andrew, that's just incredibly kind of you.

02:22:23.140 | Thank you, I appreciate that.

02:22:24.660 | And I've loved our conversation.

02:22:26.900 | And for me, what I hope most of all for my kids,

02:22:31.900 | for our country more broadly is that we can go deeper,

02:22:40.120 | like beneath these surface issues,

02:22:43.340 | I worry that we find ourselves disagreeing about

02:22:46.900 | and fighting about online.

02:22:48.360 | And recognize that there is a deeper challenge

02:22:51.640 | that we are facing that I think underlies

02:22:53.520 | a lot of the anger and the vitriol.

02:22:57.840 | And this issue around how disconnected

02:23:01.420 | we've become from one another,

02:23:03.300 | I think is at the heart of that.

02:23:04.460 | I don't think that there's any policy

02:23:05.920 | or program we can implement.

02:23:07.760 | That's gonna ultimately fix what ails society

02:23:10.100 | without fundamentally realizing that

02:23:12.240 | a lot of this is a manifestation of a society

02:23:16.140 | that has become more disconnected

02:23:18.300 | and more disinvested in one another over time.

02:23:21.220 | And that's just not who we are.

02:23:22.860 | It's not how we evolved over thousands of years.

02:23:24.660 | It's not how we're gonna thrive in the future.

02:23:26.940 | So I know that sometimes when you look

02:23:28.900 | at these big intractable problems,

02:23:31.580 | like widespread loneliness in the United States,

02:23:34.700 | that it can seem like hard to address these.

02:23:37.600 | But I do want to encourage everyone to recognize

02:23:40.600 | that when it comes to human connection,

02:23:42.260 | that it is small steps that can make a big difference.

02:23:45.520 | Because we are hardwired to connect as human beings.

02:23:48.140 | And if you just pause for a moment,

02:23:51.080 | and if you just think for a moment in your own life

02:23:54.920 | about someone who has been there for you

02:23:58.800 | during a time of great need,

02:24:00.260 | somebody who has stood up for you

02:24:03.300 | and you couldn't stand up for yourself,

02:24:06.700 | someone who's helped to remind you

02:24:08.360 | of why you're still a good person,

02:24:11.680 | why you still have worth and value to add to the world,

02:24:14.100 | even when you had lost faith in yourself.

02:24:16.140 | When you think about their faith in you,

02:24:20.220 | about their support for you, about their love for you,

02:24:23.520 | think about how healing that was.

02:24:26.220 | That's the power that we have to help each other heal.

02:24:31.800 | We are going through an identity crisis

02:24:35.900 | in many ways as a country,

02:24:37.660 | where I think we need to ask ourselves, who are we?

02:24:41.540 | Like, what defines who we are?

02:24:43.380 | What are the set of values that we want to guide us

02:24:46.460 | in our life and to guide our country?

02:24:49.400 | And I know that it feels like we're a nation of people

02:24:53.620 | who are mean, who only care about ourselves,

02:24:56.120 | who are throwing blame and anger at each other all the time,

02:24:59.420 | who are pessimistic about the future.

02:25:01.440 | But I actually don't think that's really who we are.

02:25:04.780 | I think at our heart, we are hopeful and optimistic people.

02:25:09.780 | I think in our true nature,

02:25:12.020 | we are kind and generous to one another.

02:25:16.720 | In our hearts, we're interdependent creatures

02:25:20.340 | who recognize that if someone else is suffering,

02:25:22.420 | we want to be out there to support them,

02:25:24.380 | and who want people to be there to support us as well.

02:25:28.340 | That's who we really are.

02:25:29.960 | But we have to make a clear choice here about our identity,

02:25:35.500 | you know, as individuals and as a country,

02:25:39.140 | and recognize that that choice has real implications

02:25:41.780 | for everything else that we're talking about here.

02:25:43.620 | That's the foundation.

02:25:45.500 | And when I think about my own kids growing up,

02:25:49.680 | like many parents, I worry about the world

02:25:52.140 | that they're coming into.

02:25:53.560 | I worry that they're gonna use the wrong word,

02:25:59.220 | even though their intentions are right,

02:26:00.660 | and people are gonna blame them or cast them out.

02:26:03.540 | No, I worry that they're gonna stumble and fall down,

02:26:05.680 | and people are just gonna keep walking by, not caring,

02:26:08.600 | you know, because everyone's living their own life.

02:26:11.600 | I worry that they might become someone

02:26:13.040 | who does the same thing to other people, right?

02:26:14.760 | None of which I want.

02:26:16.240 | What I want for all of our kids is for them to grow up

02:26:18.400 | in a society where we care about one another.

02:26:21.240 | We have each other's backs.

02:26:22.880 | We recognize, as that old African proverb goes,

02:26:25.560 | that we can go fast if we go alone,

02:26:28.240 | but if we really want to go far, we go together.

02:26:31.560 | And that's what I want for my kids and our country,

02:26:34.400 | but that's what we each have the power

02:26:36.320 | to create in our own lives.

02:26:38.060 | It starts with the decisions we make,

02:26:40.460 | but how we treat one another.

02:26:42.740 | Do we, for example, reach out for five minutes a day

02:26:46.460 | to someone that we care about?

02:26:47.680 | Do we pick up the phone and call them to say,

02:26:49.280 | "Hey, I'm thinking about you."

02:26:50.540 | We can all do that today.

02:26:52.540 | Do we give people the benefit of our full attention,

02:26:55.540 | recognizing that while time is scarce,

02:26:58.300 | our attention has the ability to stretch time.

02:27:00.740 | It can make five minutes feel like half an hour,

02:27:03.220 | but it's a hard thing for people to get

02:27:05.400 | 'cause they're distracted by their devices,

02:27:06.940 | but do we give people the benefit of our full attention?

02:27:09.620 | And do we look for ways to serve one another,

02:27:12.220 | recognizing that it's through our acts of service

02:27:14.940 | that we actually forge powerful connections,

02:27:17.300 | but we also remind ourselves how much value

02:27:20.060 | we have to bring to the world.

02:27:21.380 | And this is important at a time when the self-esteem

02:27:24.460 | of so many of us and our young people in particular

02:27:26.980 | is being eroded, particularly by their use of social media.

02:27:30.480 | So these are the steps that we can take

02:27:33.540 | to build connection in our life.

02:27:36.420 | But the core values, I believe,

02:27:37.900 | that have to be at the heart of our identity,

02:27:39.580 | these values around kindness and generosity,

02:27:42.160 | around courage and service.

02:27:45.280 | These also have to animate the decisions

02:27:47.140 | that we make in our life about programs we advocate for,

02:27:52.140 | the policies we support, the leaders we choose.

02:27:56.140 | These should all be reflections of the values

02:27:58.600 | that we wanna see in our children

02:28:00.040 | and in society more broadly.

02:28:01.740 | 'Cause I'll tell you that 90% plus

02:28:03.700 | of the decisions leaders make,

02:28:05.980 | they make behind closed doors.

02:28:07.580 | And what's guiding them in those moments are their values.

02:28:09.860 | That's true whether you're the leader of a company

02:28:12.460 | or a nonprofit organization or a leader in government.

02:28:16.520 | So those values matter.

02:28:17.680 | And I want us as a country to speak more

02:28:19.700 | about the values that we choose,

02:28:22.060 | about the identity that we want to anchor ourselves to.

02:28:26.420 | That's the way in which I feel like America

02:28:29.580 | can be an even greater beacon of hope for the world.

02:28:33.140 | Because the world is struggling with this too.

02:28:34.940 | We're not the only ones who are dealing

02:28:36.460 | with loneliness and isolation,

02:28:38.260 | who are seeing anger and resentment and vitriol bubble up

02:28:42.380 | at extraordinary levels,

02:28:44.340 | who are seeing mistrust in institutions soar.

02:28:47.760 | Many countries are experiencing this.

02:28:50.540 | I would love America to lead the way in some ways

02:28:53.180 | in showing what it's like to embrace a more human identity

02:28:56.740 | that's centered around kindness and service

02:28:59.200 | and friendship and generosity.

02:29:01.860 | Like to me, all of these values,

02:29:03.820 | ultimately, Andrew, stem from love, right?

02:29:06.700 | Love is our greatest source of power.

02:29:09.540 | It's our greatest source of healing.

02:29:11.500 | I say that as a doctor who's prescribed many medicines

02:29:14.060 | over the years, but there are few things more powerful

02:29:17.340 | than love and its ability to help us through difficult times

02:29:20.640 | and help mend the wounds seen and unseen

02:29:23.820 | that we all carry with us.

02:29:25.480 | And I think if we recognize that, we recognize that,

02:29:29.420 | you know, we don't have to have an MD after our name

02:29:33.060 | or have gone to nursing school to be healers.

02:29:35.320 | We all have the power to help each other heal.

02:29:38.940 | Like Andrew, we are not fundamentally a nation

02:29:42.580 | of bystanders who just stand by while other people suffer.

02:29:46.360 | Like we're a nation of healers and hope makers

02:29:51.240 | who can restore hope that the future can be better,

02:29:54.180 | who can create a better life for ourselves

02:29:56.020 | and the people around us right now.

02:29:57.780 | It's what we're capable of.

02:29:59.020 | It's what we're built for.

02:30:00.540 | And that's the identity that I think we now more than ever

02:30:04.340 | need to embrace.

02:30:07.020 | - Amen.

02:30:07.860 | Thank you for that.

02:30:10.080 | I agree, love is definitely the verb

02:30:15.580 | that can get us where we need to go.

02:30:17.840 | Thank you so much for your words,

02:30:20.420 | for your incredible efforts to support public health

02:30:24.740 | and hopefully to continue to support public health.

02:30:28.660 | I know you've been at this a long time

02:30:31.180 | and we have all benefited.

02:30:33.220 | And thanks for your open-mindedness,

02:30:36.100 | especially around some of the questions

02:30:38.140 | that invoke some challenge.

02:30:39.580 | And again, for your taking the time

02:30:42.460 | to come talk with us today.

02:30:43.820 | And I really also enjoyed it.

02:30:46.420 | It's been a real pleasure

02:30:47.540 | and there was a lot of learning for me.

02:30:49.660 | And like I said before, I hope it won't be the last time.

02:30:53.980 | - I hope not either.

02:30:54.900 | No, I look forward to the next time to staying in touch

02:30:57.800 | and just love this conversation.

02:31:00.180 | Thank you for what you've done

02:31:01.260 | for being this beautiful channel of information

02:31:04.800 | for the public.

02:31:05.640 | But it's most importantly, thank you for who you are.

02:31:08.100 | Like who you are, Andrew, like comes across very clearly.

02:31:10.900 | When I meet you, you just, you have a good heart

02:31:14.300 | and you have good intentions.

02:31:16.300 | You're a good man.

02:31:17.140 | And we need more people like you in the world.

02:31:19.500 | - Thank you, right back at you.

02:31:20.960 | Thank you for joining me for today's discussion

02:31:22.740 | with Dr. Vivek Murthy,

02:31:24.120 | the Surgeon General of the United States.

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

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