U.S. Surgeon General Dr. Vivek Murthy: Efforts & Challenges in Promoting Public Health
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Welcome to the huberman lab podcast, where we discuss science and science space tools for everyday life. I'm Andrew huberman and i'm a professor of neurobiology and opened ology at stanford school of medicine today. My guest is doctor viva e mercy.

Doctor vivie mercy is a medical doctor in acting surgeon general of the united states. As surgeon general of the united states doctor mercy overseas, more than six thousand dedicated public health officers whose job is to protect, promote and advance our nation's public health. Doctor murphey received his bachelor's degree from harvard university and his medical degree from the yale university school of medicine.

Today's discussion cover some of the most important issues in public health, not just within the united states, but worldwide, including nutrition and the obesity crisis, as well as food additives and why certain food, chemicals and additives are allowed in the united states versus in other countries. We also discuss mental health, the youth mental health crisis, the adult mental health crisis and the global crisis of loneliness and isolation. We also talk about corporate interest, that is, whether not big food and big farming industries actually impact the research and or decisions that the U.

S. Surgeon general takes in his directives toward public health, and of course, we discuss some of the major public health events that occurred over the last five years and the current and future landscape of how to restore faith, both in public health officials, in public health policy and science more generally. By the end of today's episode, you not only will have learned a tremendous amount about public health and why you hear the particular public health directives that you do, but also how to Better interpret future public health directives.

You'll also come to learn that as surgeon general, doctor Murphy has both an extremely chAllenging job, but one that he meets with a tremendous amount of both rigor and compassion. Before we begin, i'd like to emphasize that this podcast is separate from my teaching and researchers at stanford. IT is, however, part of my desired effort to bring zero cost to consumer information about science and science related tools to the general public.

In keeping with that theme, i'd like to thank sponsors of today's podcast. Our first sponsor is element. Element is an electoral light drink with everything you need and nothing you don't.

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I started using the waking up up a few years ago because even though i've been doing regular meditation since my teens, and I started doing yoga ea about a decade ago, my dad mentioned to me that he had found an APP, turned out to be the waking up APP, which could teach you meditations of different durations. And that had a lot of different types of meditations to place, to bring your body into different states. And that he liked IT very much.

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If you'd like to try the waking up, you can go to waking up 点 com slash huberman and access a free thirty day trial。 Again, that's waking up dot com slash huberman to access a free thirty day trial. And now for my discussion with doctor vivid mercy, doctor vic mercy.

welcome. Thanks so much, Andrew, and please .

call me VC formal. My understanding based on my internet search is that the role of the U. S. Surgeon general is to provide scientific information on how to improve health and reduce risk of illness and injury. Do I have that .

correct that he's correct?

What are some other roles that you play that perhaps would not come up in a top, top hit google search that I ought to be aware of and that our audience ought to be aware of?

Well, here's how I just explain to people there. There are two primary rules the surgeon general has. One is to engage with the public and make sure that people know about critical public health issues that think so they know what they are, how to protect themselves in their families.

The second role of the surgeon general is less than known, but it's equally is important, which is to oversee one of the eight uniform services in the U. S. Government, and that is the united states public health service.

Many people are familiar with the army, the navy, the air force. Do we also have the U. S.

Public health service, which is six thousand officers? They include doctors, nurses, physical therapists, pharmacists, public health engineers, a whole range of health care folks. And their job is to protect our nation from public health threats.

So when ebola I came on the scene in two thousand and fourteen, in a major way in west africa, we sent hundreds of officers to west africa to set up the monrovia, a medical unit in liberia, to treat people with life with with ebola domestic when their hurricanes or tornados. We dispatch officers and deployed them to go help strengthen then the social, the public cult infrastructure, but also to provide direct care. We deployed thousands of officers during code.

So these officers are am incredibly proud of them, are they could be doing lots of stuff outside government, the private sector probably making to hold lot more money, get no, you know, working out as hard, but they're really committed to protecting the public health of the nation. So I have the privilege of overseeing that service is surge in general. And those, those, those are the jobs and that I ve signed up for in this role got IT.

I was not aware of that role. And if I understood correctly, these people, these public health officers, that presumes ly are made up of physicians and licence psychologists and nurses and so forth. Um you said they could be making a substantially hiring comes in the private sector, but the work that they are doing with you is their soul career at this point, they're completely devoted to that or they are doing this as a side hustle.

They are full time uh government employees and and members of the public health service their day job is often in public healthy agencies were their embedding communities, helping data day to advances public health and during times of emergency we deploy them. Ah you know and and they are extraordinary ly well trained. Uh they are experienced a dealing with diversity, but they bring a combination of skill and heart to their work. And you really need both to be effective a public help.

P i'm glad that you mention the word emergency because in preparing for our discussion today, IT occurred to me that in this list of roles that are your title assumes that scientific information on how to improve health comes first, then you mentioned emergency. So what i'd like to talk about first is health. Not lack of health, yeah, but health.

no. So often we hear about the mental health crisis, but what we're really talking about is the lack of mental health crisis, A K mental illness. And rarely do we hear, for instance, what constitutes mental health.

We hear what constitutes to mental illness, wherein the domain of physical health, there's a lot of information out there about how to be more physically healthy. Cardiff asked lar exercise resistance and exercise yoga type, exercise mobility, etta. And of course, some people have physical health films, and there's a lot of information terms of how do with that as well.

But what I would like to know before we get into the longest of issues that, uh, our nation confronts, everything from obesity to food additives to mental health issues, what is going well, in other words, in the last, let's say, five to ten years, have there been any areas of physical health and mental health improvement in the U. S. At large that we can attribute to some of the public health initiatives directly?

So that's a really good question. And let me just also say about the very first point, you rays that you're absolutely right that we have Operated primarily through an illness frame when we look at health. And in my mind, that's only one half of the equation, right? So when we are talking about physical illness, for example, you know, as a doctor, I learned how to diagnose and treat some with diabetes or with high blood pressure or with corner heart disease.

But we also know that even if I don't have diabetes or corner heart disease, uh, or high blood pressure, even if I don't have any diagnosable medical condition, I may not be at an optimal level of physical health, right? I may not be able to, for example, walk around the book without getting short of breath. I may not be able to play with my kids because my physical finance staminate is is insufficient.

I may not be able to lift to my luggage when I go to the airport ah because I don't have enough strength in my body yet, I couldn't have a diagnosable mental illness. So I think it's easier to understand there with physical health that we're not just aiming for a lack of illness, were aiming to optimize or our physical health. The same is true with mental health.

And I think when we talk about mental health, people think we're just the sole goal here is to prevent diagnosable mental illness. That is one go to both prevent to manage a mental ills when IT arises. But we also need to recognize the whole other half of the spectrum where people who may not have diagnosed tal illness but not Operating optimally in their lives.

And that's detracting from their fulfilment, from their functionality, like not just a work, but also in their communities and in their families. And so part of the conversation that that I want us to have as a country is about how to optimize mental health and well being, and that is includes preventing mental illness. But IT is much broader and bigger than that alone.

great. Ah I think it's so important that we recognize that treating disease is critical, obviously, but that there's a lot that can be done to improve one's health even in the absence of any known disease. And um and you've got all these officers, these incredible physicians and h nurses and h people at uh your disposal. And my hope is that they would also be accessible for and currently Carrying out um efforts to transmit information to people about, hey, here there are the things that you can do every day, every week, every month in order to make your life as as healthy as possible as well as you know rushing in under conditions of public health crisis.

Yeah, it's a good, good point and it's certainly you know many officers to focus on this, a broader rib grand well being. But it's part of how we need, I think, the the broader health system and public health system to Operate even outside of government. And this, I think, will require significant change and shift in how we think about our jobs.

Like when I went to medical school 的 vast majority， the focus was on diagnosing and treating illness. IT was much, much less focused on thinking about how to enhances well being. And when you ask and talk to people in their lives, IT becomes clear that they want to do more then just prevent diagnose illness.

They they want to be able to walk their their child and the air they want and have the durance to do that. They want to be able to um be independent often and and Carry their groceries or Carry their luggage. Um this is why I think we've got abroad focus in in public heal and look when I came into this role um by the way, I was not expecting to serve in government.

This is not part of some five, ten, thirty plan. Um when I was A A kid I was interested medicine, but I thought I was going to practice medicine. You like my dad did and like my the clinic my mom and know put up single, see patients and be a primary care doctor and and feel good about the work is doing but what happened to me along the way is, you know, I trained in medicine.

I got interested in technology, spent seven years building a technology company ah that was focused on held I got, I was I became increasingly worried about the way we were delivering health care. And I felt like our health care system is broken. People needed care, couldn't get IT.

IT was often too expensive to get care. We are focusing on treatment solely and not enough prevention. So I started getting involved in in advocating for a Better health care system with doctors around the country, when, despite all that, I still never thought I would work in government.

But in two thousand thirteen, a is when prisoner obama's team had reached out to me and asked if had been interested in considering the position of surgeon general. And what was interesting to me about this position is is actually very different from most positions ah that are appointed by president in government and that is supposed me an independent position. So my agenda the issues I do to take on are not determined by a president or a party. They're determined by science in the public interest uh and that's what what guides me, you know and that's what that's what got to mean that first term when I served and when present by ask me to come back and serve a surge in general second time, that's what guided me .

here too so why is not sending you note saying, hey could you put some effort into um you know getting messages out about you know cove IT or could you put more effort into um getting your team over to mi to deal with the you know the tragedy there and which is a long art tragedy right we get the news in in a blast of this happen and then the next blast comes in about something else and we forget that there are physical and mental health crisis that are ongoing um and and then I have to imagine then start to overlap with one another or is IT.

So is that your decision um where and how to deploy the financial and and human resources like OK, we're going to put ten people on mari yeah we're going to put you know five people in the central states, you know going around talking to um major organizations about what they need to do to prepare for this winter. Is that how IT works? Are you getting memos and in other words, whose your boss everyone has a boss at some level, minor is are the listeners of of this podcast at some level. I work for them IT used to also be my board castle, my boss.

my wife and my two kids who were five and seven. I do what they tell me that got IT.

So um but how we make our decisions .

in the office, actually it's it's a bit different with those two roles. So with the second one with overseeing the commission core or six thousand officers, they are the the decisions about how and when we deploy officers are collaborating, right? So you know we work with other colleagues through out the department of health human services.

We work with people in female across administration, but we also work with states. So sometimes states, uh often often states will put in a request and say, hey, we need support here, uh, can you help? So will work with colleagues across our department to say, okay, well, we can mobilize our commission core officers.

What access can you mobilize? And then collectively, we will send a team out there. So for example, we have officers helping in mary right now, uh, particularly with mental health needs a, which are, I worry, only going to continue to grow uh, over the weeks and months ahead.

On the other side of the house, when he comes to deciding which issues engage with the public on, like in this case, mental health has been a big focus, uh, area for me on on that front. Well, we certainly, you know, are open to suggestions from the public. Members of congress sometimes say, hey, can you help the public understand about this issue? You know, a lot of people have ideas and opinions. The decision about which issues to focus on those are our offices.

Uh, and to me, that's important because part of the reason over time, I believe the public came to have some degree of faith and trust in the office because they hope that the office is functioning the way you hope your doctor is functioning, which is being an independent source of information for you uh, and the source that has your best interest at heart that's not being pulled aside by political interests or by other agenda but the primary agenda is how can I help your help and so for me, like we have to make an independent assessment there and okay, where's the need? Uh, the greatest tea. Where can we make the biggest difference? Sometimes we may not build an initiative on an issue, and that doesn't mean issue is an important or that it's not affecting a lot of people. But we have make hard decisions about where to pull limited resources. And so when I was a certain general, the first time one of the big areas I focused on the opp o crisis, uh and we are dealing with as well as the e cigarette use among youth because we are seeing a dramatic increase among kids and his cigarette use that .

can I just ask you started interpret, I think it's relevant here. Um has that increase continued or uh e cigaret use A K wapping.

yeah. So we still see unfortunate there. There has been some improvements, but we still see way too many kids were using uh, vapor devices early on. And part of what we did IT from our office is recognizing that we actually issued the first federal report on e cigarettes in youth.

Uh, we call the country's attention to the fact that this is a crisis we worked with members of congress, uh, to talk about the kind of action we need IT a from a legislative and regulatory perspective and work with colleagues at the F T. N. In government as well.

Like there are two things that are really most important in guidance, our choice about priorities. Uh, one is data. We look at what the number numbers actually tell us about the impact these issues are having on the population.

Was the trajectory of rise if something is any dramatically worse and people don't realized, that might be area a Price of focus. But the other a critical factor is what I hear from people on the road. So I tried to spend as much time as I can visiting communities across the country, doing town halls, meeting with, uh, community members and just trying to Frankly just listen to what's on their mind. And that's where I guess you get a lot of information as well.

Tell that actually how I came to focus on the issue of only as an isolation that wasn't as a pop tup in a report uh as being uh the the leading public culture in the country is because everywhere I was going in two thousand fourteen, two thousand fifteen, when I was talking to college students, talking to retired americans, talking to parents in rural areas and urban aries, I kept hearing these stories about people who felt like they were all on their own, or they felt invisible, or they felt, if they disappeared tomorrow, no one would even care, but they felt like they just didn't belong. And it's heart breaking to hear that from anyone. It's ticula ly hard breaking to hear from kids, uh, who you hope are entering life and looking forward to what comes. Uh but many kids weren't feeling that way.

That is very useful context. We will get back to the isolation crisis such an important initiative that um I just will thank you now for having put out the the message on social media and elsewhere about that because I think one of the questions I have in later, what you just said is it's clear that you've got your ear to the ground. You're talking to different people. It's also critically important that people hear from you and know um not just what's happening but that you perhaps want to know what you know, where are the issues lie and what the um what the actionable steps are that people can take, right? And I think that we now live in a hyper connected world.

Um so you know that i'd just say that one of the reasons I launched this podcasts in twenty and twenty, I was going on podcast talking about things like maintaining sleep in circa dian rythm and stuffing my lab related to try to um adjust xiety under IT under conditions where I think everyone was an anxious and was sleep rythm were disrupted at at a and I was somewhat surprised that I didn't get a warning on my phone. Hey, make sure you're getting warning sunlight like i'll get a flood warning. I'll get a warning that I might get a warning, but it's only a test warning.

I'll get three days yesterday living here near the coast. But I don't think once during the pandemic did I get a email or a public service announcement saying, you know, if you are going to be indoors a lot, you're going have to be mindful of maintaining your circadian rythm because if you're not, am we know based on hundreds of studies now that giffin circadian ethnicity are a preventive mental health issues? I mean fact is a new idea that many, not all suicides um are preceded by a period of disrupted sleep which is economic sense and it's not caught of course but how come during the pandemic we each and all as U. S. Citizens did not get an email or a text message saying, hey, these are five things that you need to do everyday to try stay as stable as possible in this very uncertain landscape.

That were in well, the interview. Good question and and I think it's it's a reasonable and a very good suggestion to say that he, look, there should be a clear and comprehensive way that we can get messages out to everyone um like if we were working in a hospital system and there was a safety issue that came up, there would be email sent to all the hospital staff members saying, hey, this is something you need to be aware of, right? So I think it's a reasonable expectation.

Uh, practically if you go back alone of last twenty thirty years from on on healthy issues, there hasn't been sort of an an agency or an entity that has send emails out to everyone. First of how to send an email out everyone in amErica is not a simple proposition either are technically, it's chAllenging. There are some legal issues you've to .

deal with this well, but you could do and where you go CNN, fox, N B C, A B C, new ork times as well. Street like you could hit the right .

the right way in the left wing .

and but one one video, just where they all agree, like this is important information. So a political like.

no, yes, I would say that that kind of messaging, I would say through traditional media certainly has happened.

You know that happened during uh IT happened for example when um you know in the first year of covet I was a private citizen you know in the a part administration but I you know I watched both then and at the beginning of the the by administration um many officials would go out in front cameras and say, here are three things you need to do to keep yourself safe you know from from covin is and I was a big question, people had, how do I keep myself safe? Okay, here are three things you can do. A couple of chAllenges.

I would say here is that, number one, even if you hit all the major network and cable news shows, you're still not reaching everyone, right, because we're living in in a society, we're increasingly people are not watching T V right. They're getting their news from other sources. Um the other thing uh, that's important to know is that attention shifts quickly you know in traditional media also from issue the issue.

And so you might get a clip you know out at a certain a day or you may get on other sunday shows, for example. But the next day, you know, that message I S unnecessarily there. You know it's it's gone and people's attention has also switched off to.

So they were, I mean, I can count. And you know, we've log probably thousands of interviews at this point that we've done with mainstream media with sort of, you know, cause message about three things you can do to protect yourself, etra. And you know, glad we did those.

We ve got to do them. But I think one of things they don't we don't have right now in the country. And this is an, I think, a bit in health infrastructure chAllenge is we don't have a quick, efficient way to reach everyone in the country with the a help message. Just like what you said, you know, he wanted to get that message about three things to protect yourself from, let's say, copy, or three things to do to you support your health and well being during a time of crisis .

or during a time of health. I mean, again, like not just the flood warning, yes, the the daily because I do think that most of mental and physical health is the result of daily practices that are they build on themselves, sort like compound compounded investments. And then of course, there are acute chAllenges and chondrine Allen es in face, but things of that sort too.

I I think those kind of messages in time of health that are are absolutely important as well. And you know, I think ink, I think in the sort of, I think, fast pace crisis driven environment that we live in, uh, unfortunately, people are unless are paying less attention to those maintenance or an improvement messages, and they are to managing the crisis messages. But I think that their equally is important.

But I do think that what your pointing out is an infrastructure piece that that needs to be built, which is a way for uh you know health authorities to reach people you know with information quickly and comprehensively. Uh I to tell you that in the one hundred and eighties, when sea ever coup was certain general, one thing that he had done, which was interesting, is he had actually sent a letter, a physical letter, uh, to all households in amErica about H I V. A physical letter, a physical letter.

some of our listeners won't know what that is.

So think you read about the history books, something shows up in your mail box, and you open IT and hopefully something you want to read. But this in case, this case, he was worried about HIV, about the fact people know about IT. So he worked through an a with, as I understand, IT with a member of congress, found you the way, do this from a funding perspective. But IT was a very unusual move, uh, and one that was never replicated since and there was never infrastructure funding to do that again.

Um when I was surge the last you know some years ago and then this time around, one of things I did do as I was able to send a physical letter to the medical community, uh, the first time I was about the only crisis and about changing our prescribing practices in medicine so that we expose fewer patients to the harm of op ots while making sure people who needed them and he got them and the second time that was about covered their reputations IT was about making sure that when we had data about medicines that actually work like packs of IT, that we may actually often them to patients made them available to patients because we are realizing that many people weren't getting offered life saving medications even though they were in high risk groups. Um so we were able to find now and we again there too IT is out of creatively couple together resources funding this is also of IT is IT behind the scenes government stuff. But the bottom is in in what you want in an emergency uh and what you want, I think in the long term is a simple, clear, comprehensive way the public health messages can get out to people and to they say, what we still have to rely on, uh, are one traditional channels like, you know, when traditional media to cover the initiatives we put out, whether it's on social media news, al health or the or neth mental heath more broadly.

Uh, we really to rely on online channels uh which which we do as well or we have and looked to create partnerships that we build with people who reach different audiences and then together, uh, we try to get our messages, our office as all three uh of these but h it's a patchwork uh and and no and it's not always ideal, but it's what we do. Now I think part of what this reflects is a broader chAllenge, like in government, but also in society more broadly, which is that we have valued historically prevention and health communication very low. We put the mass majority of resources into treatment strategies, into any medications, to people, into diagnosis. And that's very important, don't get me wrong. But we are now seeing with mental hostis is one example that if we only focus on expanding treatment and deepening our well of knowledge there and we don't do anything to help people stay well, that we just can't keep up right.

because one problem fees, the other and the kids that are still listen, I would grown up in today's, yeah, i'd be on my phone and tablet late night because I was up reading magazines and talking friends on the phone later, right? It's not a criticism. But but you know, disruptions in sleep, disruptions in circles, yelm disruptions, lack of physical activity, poor nutrition, social, social isolation, I mean, they are all piling the sand much higher on this.

In the other side of what you do in terms of the hero of this stating the obvious, you know, so it's gonna create a mountain of is on the other side, which presumable has a larger budget is what i'm sensing but doesn't um but there's no way that budget is large enough to deal with that in if somebody's kid, for instance, is um trying to address the issue of whether or not to go on prescription medications and or by the way, folks and or change their Victorian and take because they feel they might have A D H D for instance. I mean, what are they going to do there gonna google. They're going to listen a podcast that they they should be able to write first to your organization and say no, what is the highest level stringency data, say, about these issues and A, I should be able to tell them accurately yeah, and maybe you have somebody time in for them.

I mean, we all pay taxes. I pay federal and state taxes and some extent happily. So yeah, right, because IT pays for public works, many, many important things, police officers, firefighters. But if you don't have a channel to communicate with people about what they and their kids and their relatives can do, then to some extent feels like it's a colder sac. It's like how how in the world can we get healthy again or healthier as as a country?

The part that keeps me up at night is and one of some the hardest decisions I have to make in the office or. Putting aside issues that we now deserve a lot more time and attention um but we just really don't have the resources to deal with, you know the issues that we have dealt with.

I saintly about my team that we worked hard to try to raise awareness issues we have taken on, whether it's around our social media, use a mental health, whether isolation or the clinic burn out or other issues like that. But the truth is that there's more that needs to be done, more issues that need to be tackled, and we have to get to a place where we can, uh, you know, talk about what I think of is the core pillars of of a healthy life, right, which are sleep. Our nutrition, our physical activity, our social relationships like these are all vital elements to living a healthy life.

Right now we're not teaching kids about this in school, right? But if you think about education, uh, and school as A A place and a force that should prop kids for the rest of their lives, actually lay a foundation for a healthy life going forward. These absolutely are important elements for kids to learn about. I I think it's as important for kids to learn about how to build and maintain healthy relationships in their life as IT is, Frankly, for them to learn how to read and right. And I know that's a strong samm to make, but IT is true in terms of its contribution to their they are happiness or fulfillment, their health and their success.

I could not agree more. We have a series is out now without psychiatrists, a ul county, about mental health, not mental illness, about self inquiry and how to use self inquiry and practices that do not require A A theriere in order to bolster mental mental health um of course therapist can be very useful but not everyone has access right and not everyone feels comfortable doing that um but we are but one channel and you are the governing body for this um you're the army, navy and marine so to speak of of health.

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There's a lots more to explore there. We may have to do several of these together, but to touch on all of them. But may we talk about a few the things that our listener's asked about when I licit for questions? And I got more than ten thousand responses across social media in a very short amount of time, but there were some redundancy. And one of the things that .

i'm very i'm really glad that you asked folks to the question and I was really excited to see you have many people actually wrote in uh but I think it's also just a testable to how you have been such an incredible job a building, uh uh a channel the public to let people know about these topics said, you know, that are so vital to our health and well being, whether it's sleep or physical activity or mental health. And so just want to thank you for all the work you're doing trying to help people understand more bad health and clearly, the fact that folks are engaging their sending questions in there, sending comments you means that you're building a relationship there with a lot of folks.

So just good dose you for doing well. Thank you. The audience of the human law podcasts is the only reason we do IT. I mean, I love learning and teaching but um that's the truth. So they are the podcast um the podcast is them um so thank you for that.

Um there were a lot of questions and I also wonder about why is IT that many food additives and preservative and dies and things of that sort that are not allowed in europe are allowed in U. S. Food products.

So a really good question. And decisions around food and food safety in particular are are made by the food and drug administration so that C F T A, uh, it's not it's a separate h agent. Independent agency is not one that our office uh is involved in the sort of directing in anyway.

Uh and so we're not involved in those decisions and don't have incited to how uh they're making their join their conclusions. But uh, they do IT in a process is that you know, guided by sciences like they do and with medications, with devices. Eec, with that said, you know, I am concerned that dietary practices, the food that many americans are consumer, are in fact not supporting their health.

And well, bing and in many ways are detracting from IT. When we look at highly processed foods, one of the concerns I have there is we often see sodium content is very high. We see the sugar content, uh, is very high.

And you know they are certainly additives in there as well. Uh, that I think we I would love to have more data on the actual health impacts of those. But the bottom line is that a significant proportion of our diet uh is comprised of highly progress foods in america.

And and that worries me the also other pizza is that worries me are just how much you know we're flying. Sugars are being added just so much of our foods. And most people think that sugars are only added to things like deserve.

When you look at speakeasy sauces, salad dressing, salad addresses a lot of these things, which we think of as savery products have sugar added to them as well. And so we are consuming, I think, unhealthy levels of sugar in our diet. We are consuming fair amount of additives given the processor composition in our diet.

And I think part of the reason this is happening, and they want to be very clear, I don't fault individuals out there for the composition they die necessarily because we have also made certain decisions in our country about what we subsidize about what's cheap er and more expensive for people and the cheapest foods。 Unfortunate are often the most unhealthy foods, the most highly processed foods 啊。 If you are somebody who lives in the low income neighborhoods, number of these neighbors ods don't even have grow three stores in them, which is a, you know, tragedy, because you can get fresh produce. Etra, a lot of times you're shopping your gross for shopping may be done at a local convenience store, uh, at the seven eleven, or you know, somewhere else that may not have, like the array of of fresh fruits and vegetables. S A unior family need.

I only they have vegetables. I think they have they're occasionally have some lemons or apples or oranges and bananas. But when I walk into a convenient store, what I see is a pharmacy.

I really do. I see alcohol, caffeine, energy drinks that have a number of different things in them designed to stimulate different, newer modulators like doping and serotonin. I see nickey products.

I see high sugar, high, highly process foods. And and keep in mind, I was a teenager. I mean, I drank my slow piece.

I had my butter fingers. You won. But something like in my love 点， but I liked them. But but IT was, he was a smaller for action of of what we aid.

And when we were at home, those foods were either not available or weren't we certainly weren't allowed to eat them in at liberum know. okay. So what's clear to me is that the fda makes decisions about what is safe, what's not safe.

But for instance, okay, this last year, there were several papa's publishing high quality journals showing that if people eat just high, just sweet and savery foods combined, that neural circuits in the brain rewire through process of neuroplasticity that drives increased appetite and changes the response to healthier food so that they don't taste as as associating okay, that sort of a door to a lot of people but I think he was an important set of findings because said the brain actually changes in response to the um the very rich flavorful foods that associated with with highly process or even processed and I mean. That's just a couple of studies. Um there was nothing in those studies that said if you eat these foods, you're going to develop cancer.

But know at some point, one has as a citizen or taxpaying citizen speaking on behalf of many other taxpaying citizen, I have to, so take a step, banks, that how long do we wait, right? Do we have to get a analyzed clinical trial about the know, you know, the five hundred thousand sick kids that grow into sick adults and then run a trial where they go on an elimination diet where they're eating only on proceed vegan or on process meat and vegetable or on process no starch and vegetable? I mean, I mean, then we're talking about a thirty year health crisis before we intervene.

Why not? I mean, if I were in charge ish, i'm not clearly I won't survive in a government organization because well, I got the uniform down. I was where the same thing but um a uniform but I wouldn't because I would want to say, wait, you know why not air on the side of caution? Why not send out this A I generate text message that tells everybody in all the languages that american speaking and can understand.

Hey, you get to make choices about what you eat. But you should be aware that um making your diet comprised of more than fifteen and twenty percent of these foods is potentially going to lead to serious issues down the road and those serious issues are extremely serious. And I mean the obesity crisis is really a crisis of both body and brain meta lic chAllenge um that we can talk about so you know who sets the thresh holds you know in other words, why is IT that in this country we have to wait until people start to get really sick and dying and really struggling before something is done in the direction of their health. And i'm not blaming you, I just want to understand because good that the wealthy people I know care a lot about their food sources and they pay a lot of attention to IT. And why on't we allowing everyone the opportunity to make Better choices?

So this is the right question, and this is something I think about a lot, because I am conscious ous about what I eat. But I also talked to folks around the country and realized a lot of people don't have either the information, uh, or the resources actually purchase healthy food, right? And to know like what's can be good for them, for their families.

This is why you, I mentioned we have a list of issues that, you know, we would work on you. We had more, more, more resources. This is actually one of them.

Because to me, one of the most common questions people ask is, what should I eat that simple? But it's it's a vacation. It's complicated.

It's incredibly confusing if you go online and just try to search for information. And it's a classic example of where it's important to have an objective scientific authority. They can come in and speak on broad principles around diet. They can talk about what we know and don't know. So the here's important thing, I think a lot of times people may see something as uh you know on the market, they might really list of ingredients.

They don't recognize half of them because you're additives, but they figure, well, if it's there, then you must have been studied for thirty, forty years and there must be no harmful consequences, right? But sometimes things are put out there because we have short term data that says that there okay and there might be uh, but there may be need for more long term data. Helping people understand what do we know, what do we not know is important, so that people can make decisions for themselves based on how much they wanna take.

The other thing that the concerns me, her, Andrew, is I look, I have, I have a bias here. And my bias is that I am worried about the no additives and other products we have in food. They don't have long term data ah that's clear in terms of healthy risk.

And so because of that, like my bias is generally to think how can we get people uh, you know, minimally or less process foods and how can we get them more fruit and vegetables? How can we make sure that they have that more available to them? But we've got to not only make the information available, but we have to make IT accessible from a cost perspective.

You don't have a grocery store in your community. If vegetable les and fruits cost three x what other friends do as be a problem, right? To change diet. The other thing we have to keep in mind is that, you know, food companies, you know a lot of do a great job, but actually trying to get healthy, nutritious food out to people, you know kudos to them. But I worry also that there is a an incentive also um to just try to sell more and more and more of your product. And one of the ways to do that is try to hack uh, the body to kind of figure out, okay, well, what kind of synthetic attitudes could I put together here or what kind of a combination nutrient could put together? They will get people coming back for more and more and more.

And we saw this in the nit.

You said the niche. You also I would say another in paralel, you see IT in social media as well, where the business model of the social media platforms is built on volume of views, right? How much time am I spending on the platform? It's not quality of time, it's quantity of time, right? So if that's the business model, then you're going to design your plan to maxim how much time someone spends on them.

Regardless of whether it's detracting from sleep, detracting from in person interaction, detracting from anything else is healthy regards of whether that may be causing certain harms, right? Like the business of dictates, you know in many ways how these things are designed. And that applies, I think, to food as well.

So which is why I think it's in comment upon us to be particularly cautious, uh, with highly process foods, foods that foods that have attitudes. How is this impacting our brain? How's that impacting our sauty? Uh, how is that a leading potentially to greater injection that is healthy and leading to things like obesity, which have a whole host of other medical conditions from cancer, are thus diabetes so and heart disease associated with that. Those are the questions as a as a citizen, as a father of two Young kids who trying to bring them up with with healthy lifetime. There's a the questions that I would want to know the answers to, and it's when the reasons I think these kind of objective reports are so important for the public.

I am trying to see that the scope of the problem in the mechanics involved in trying to alleviate these issues are complex. I I see that they are also the .

one of thing that is important to do that. So if you need to have authorities that can speak to these issues that are installation from political retribution, right? So and they explain this.

I mean to that ah I mean, listen, somebody forgive me for interview with somebody who from time to time will make not recommendations but will offer information about potential actionable items, things that people could do or not do according to a couple of that have come out. I mean, I have come under intense scrutiny my colleagues who are like IT that's not a real ized control trial.

How can you do that? And yet I know from being in this field for a long time that for instantly emerging therapies for for P T S D in depression that are now based on federal funding for things like and i'm not recommending this, by the way, for children or for everybody, but for instinct, the macro du suicide and diapered tec supported legal use of suicide and for major depression. The data they are they're not perfect, but they're pretty down good compared to the major asset arise.

But for years, if if an academic said the words I just said, they lose their job only since stanton's ously because they are controlled substances. Um that's that's to do. But then there are a number of things that we're talking about here that are just about making Better choices about things to avoid.

But if people understood, I think that um is sugar poison. While some of my audience will say sugar is poison is as addictive as cocaine. Look, IT is not as addictively or heron IT is not.

However, if a child or adult is eating very sweet or very savery food of any kind consistently, if those are not um healthy foods, if they are, if they contain unhealthy additives over time, the brain will rewire so that healthy foods don't taste as good. They won't be the choices that people make and you're going end up with a sick individual period. And I don't think we need one more clinical trial funded by federal tax dollars to support that statement. What i'm starting to gather is that you are a very rational, grounded, broad thinking individual, not just saying that because you're sitting here and you're trained in medicine and you understand the science, but that you don't have the means that your disposal to put out a call that says, hey folks having some sugar, everyone's while reading the kids to ice cream, great.

But if eighty percent or more of the diet IT of our kids isn't made up of minimum or non proceed foods, their brains are going to be required in unhealthy ways and you can almost expect that they're going to have some health chAllenge in the future that may not be um you know autism or schizophrenia a but is going to be a major health chAllenge of and that is serious and knows the time to intervene by avoiding certain things yeah and if you don't want to do IT look at a free country at that level, you're welcome to do IT. But you'd be Better off spending x number of dollars on these healthier foods yeah because there's also and we know this from my colleague, crimes laboratory is defers that even the mere knowledge that certain foods are nutritious can lead to more society for meeting those foods at the level of hormones release, not just psychological. You're telling us over the orange as as tasty and filling as a Candy bar.

But the understanding of of the fact that IT is nutrition actually leads to shifts in patterns of of you know gLance secretion is set a that that change so people can be feel Better on a healthier, slightly lower calorie new train and Richard diet, healthy proteins and fruits and vegetables and it's not a mind trick. It's physiology. yeah. Anyway, I think I feel your pain Frankly and i'll you look.

sometimes people asked when she's go and say a couple of things. You just said, will that be fine? Like why? Why is time needed to prop something that I resort needed? Actually here's actually why that I know IT in today's age is easy to just go like White off off.

off the of statements or shot from. And really to get the word out to millions.

I appreciate may take you up on that, but i'll take that one of the reasons, one of things we always to do recognizing that when put out statements that people, people when they they trust is coming from a scientific authority and that it's been invented, right? So we put the effort and time intervening this thread. We check sources, we look at the data, we talk to experts. We think about how the community in the right way.

That's the work, the behind the scenes work, sure uh, that we do before we put out that the reports and and initiatives because when people have confidence what they are hearing, we also know that when we put out initiatives that other people build on them, philanthropists, C O N and foundations will then think about, should I fn work in this area? Schools and workplaces will think about shifting some of their practice. Policymakers will also think about legislation are that they may uh want to design based on that.

So we want to make sure is it's really solid. But the point I was making when I said also that we have to make sure that not just all of us, but h folks who are you know in public health and who are in medicine, who are trying to speak to the public about their health, that they are protected from, uh, retribution attacks, is if this is what I meant, which is that saying things about diet, saying things about tobacco. These can be chAllenging for some folks because there are industries built around this, right, which may not always like what you have to say if IT hurts their business model with their bottomline.

And they may then lean on political leaders, elected leaders, others to then try to silence you or or shut you up. And i'll tell you, i've experienced this a in the past. You know I was certain general during my first term, I had issued to uh, good key reports.

One was on alcohol, drugs and health about the addiction crisis and the other was about the e cigarette crisis among youth. I will tell you that there were plenty of people who are very unhappy that I was issuing the first federal report on e cigarettes. Folks who felt that hey um is going to make focus unhappy and a create political pressure.

Uh, it's going to create a lot of problems. Uh, similarly with alcohol, drugs and health, there are many folks who said, hey, if you do this, you're really going to upset the alcohol industry. Do you really need to have alcohol in the report? Why not you just focus on other drugs? Um want to take alcohol out of the title you know all of these is sort of you know .

concerns are reason so so these are people who get paid by the alcohol industry.

These are people in government who are reading the tea leaves and who who are supportive of the work we're doing. But everything hey, like you're going to really upset a lot of people and industry .

and a lot .

of people yeah well, this is that comes down to they say, well, and if you upset folks, then they are onna try to fire you they going to try do all these things to which honor see like my my response to a lot of these. And the reason we just put them out anyway was because I said the worst thing that can happen is I get fired and that's okay. You know, I go out and know I did the right thing here, then i'm fine with that.

I'm not looking to build a lifelong korean government. I'm not doing this job to you know get to the next thing on the latter like IT. This is about serving for the time I can I wanted able to go to sleep at night, look less of the mirror.

I know I did so with integrity um so I was an easy decision for me. But but my point is that like we have to be thoughtful that in these issues that they're going to be headwinds, right? I'm sure in your case, for example, if you ve probably got and push back from folks about talking about certain things that may have rankled folks, you may have ve had an interest in those issues.

Not okay. I you keep talking about them as as you should and i'm grateful for that um but this is especially important at time where I think public trust in our institutions more broadly and in science and in medicine. I've taken a hit over the last few years and I think it's a time where we have to be even more vigilant, those of us in medicine, in public health, to make sure that what we do is based on data that we're transparent about, why we're saying, what we're saying, that we're also clear about what we know and what we don't know.

So that if recommendations change over time, people recognize that this isn't necessarily flip shopping. You should change recommendations if the data changes, uh, if the circumstances change. So, uh, anyway, this is all part of the work that we've got to do.

But to me, this is a really important part of the work. The integrity behind our work in public held is not just about the issue we're taken on today. It's about the trust that we need to rebuild uh, in the field more broadly.

So I understand correctly, if you were to, for instance, put out a call that has look, there are food additives that allowed in the U. S. That are not allowed in europe that maybe of risk.

We don't have enough data at present to say to avoid these things, but here's a kind of a yellow zone, you know, Green, known to be safe. Red, clearly known to be unsafe. Yellow, we just don't know yet.

Not enough data. So here's what my recommendation would be for my children. Yeah free country, you know um there are people they argue that it's not but at least at the level of which foods you want to buy with your own budget, it's it's a free country. So you are saying that you get messages, that warnings about certain things could lead to push back. But if I have to imagine that there's something, and i'm not a conspiracy theory, but there has to be either the people that are saying, look, there could be problems or just friction of verse.

They just don't like anyone to be angry at anyone or there there must be some incentive fruit, things to remain quiet mean, I mean, the government has not had problems saying to do things or to not do things that had that upset companies or shut down companies or or elevated companies. And there are success. So i'm i'd like to know more about the back on tour of this look.

I think and this is not to disable everything what happens in in other industries, but it's whenever you you do something in whether it's in the private sector, government people, we where are the post coins? What's a push back? Come and get, how do I deal with that? Push back, right? And push that is a bad thing, right? If you get push back from the public people, hey, that doesn't make sense of something that you should listen to that and then use .

IT inform your approach. But that's the public whose your job is to serve on time. Push back from companies is different.

right? When push back IT comes from people who have a al interest uh in the product that you may be commenting on. Then you you've got to be you need to know about never once so that you know how to had to mitigate.

And while people may take different approaches to this, my approach as a public official, as certain general has been to say, at the end of the day, like i'm happy to to hear from anyone in terms of their concerns or push back, but the end the day, what's gonna guide, my decisions about what we issues we take on, what decisions we make and what we say to the public, is going to be what is in driven by science in the public counters. And if that means is politically in community, that's OK. If that means, you know, something happens, you know to my job, that's OK too.

You know, like we look, the bottom mine is life is short. We know how much time we have here. We mean, as will make the time we have count, we as to do the things that are right and that's gna serve people. That's my simple lost me, my parents having when I was growing up. So that's other project I bring to this.

And that's why if we were to do, let's say, a an initiative on diet, and I have known doubt that some of the things that we would say we'd be perturbing at folks who had a financial interesting industry because I don't think that the current set up and industry is serving the public well. Uh, I I think we have made unhealthy foods cheap. That's a problem.

We made healthy foods expensive. That's a problem. We put health from a dietary perspective out of reach for millions of americans. That is a fundamental problem. And we've also disempower people with, but by not giving them the information that they need to make decision.

So even if you have resources, I enter their people listening to this pocket of many more people out there who go to the girls who saw and just feel confused, like what on earth should I buy? What's heavy? What's OK anymore? Um IT is hard to know. And so I think we've done a disservice by not doing more to help the public understand and access healthy foods. And again, it's why it's an issue that you know that that IT was on our list of issues that we would want to work on because I think that the public health needs is immense.

Ever question about trust in big institutions, in public health initiatives in general. The question is about masks. Early in the pandemic, as I recall, we were told that masks, we're not necessary. Then we were told they necessary.

And I think for a lot of people that flip in messaging um landed like a parent telling their teenage kid to always wear a seat belt, but then you look into the front seat and how and dad wearing seat belts. And the same one has been around teenagers. There has been one.

You make that mistake once you're not making IT again, and you may never recover from that particular example. In other words, the public felt like there was a switch of messaging. But what I don't recall happening was a like a, hey, we got that one wrong.

So sorry on us. You know what the new data say blank. What I recall was a message of don't and then do. But there wasn't a lot of um kind of acknowledgement of of how chAllenging the situation was.

IT was just a lot of top down Mandates and in my opinion, and this is just my opinion, I think that LED to a pretty rapid distrust of subsequent messages, 嗯， which we still haven't really recovered. And so why do you think it's so chAllenging for public facing officials to just. Say, look, doing the best we can at the moment screwed up before changing the message now may change again.

We're navigating this in in real time. It's dynamic. Yeah please stay with us because goes without saying there's been a huge chasm around this and related issues yeah look.

this is important question and like I I am always I want to be thoughtful um you know how I comment on what was done in the first year the panda I make I was I was the season as outside government and I don't know what was happening inside government in terms of the the decisions we made there.

But I do know sometimes from my experience, and I bollen in sika during those are experiences we had as a country that in the, you know, in the fog of war, when everything's coming at you, sometimes it's hard to make the right decision all the time, right? So I I want to give some of those folks who are there, uh, you know, in the first year, the pandemic, you know, some benefit the doubt, but I do think that the important thing are the principal I tried to follow, but I think that, uh, and you know, we can all do Better. I can do Better certainly too, uh, but I think important principle for us in public health communication has to be they were clear that were transparent about what we know and what we don't know.

I and that we explain the why to people. So we're testing someone to do something. Why is IT? Because there there's a lot of data behind IT.

Is that because it's a sort of expert agreement. Best practice because sometimes, as you know, in in medicine, sometimes we don't have enough data to guide us on on a therapy approach. But when the problem is imminent, then sometimes experts will get together and put together.

Experts inform guidelines to say, okay, look, based on our best judgment. And the limited data we have here is what we recommend. And as the data evolves, we will change, you know and and modify those recommendations.

We do that with hypertension, right? Evolve and update recommendations. We do that would let its um here too. I think that has to be A A key part of the approach.

I think one of the chAllenges that I saw many public health officials encounter was even when they went out with comprehensive messages like that, uh which are hard to fit into a sound bite or into a simple post on social media um often a lot of that wasn't uncovered. What gets covered is the top line. You know, this is what's being recommended. That's what's being required of all the explanation is losses its missing, right? And I think we also are living in a time where people are reading headlines like their living busy lives, right.

They're not necessarily you know hearing all of the new ones you know that's being explained um but I think that that's a chAllenge right is like they know many public officials struggle with how do you deliver new once information uh at a time when there isn't a clear black and White answer to things but I think the last piece around this is um and something I was taught to early in medical school is to approach your patience with humility recognizing that even though you have more training than they do uh you don't aren't living their life, you don't necessarily know what they're going through and you shouldn't assume um things about them right? So approaching with humility means that um you've gotten recognize that not everyone is going to be able to follow your guidance and if they aren't able to the do you criticize m IT also means recognizing that people may have ideas or suggestions for you that may actually improve your are how you communicate. And so I I these are the principle, I think that are important in public communication.

But I think that both the the chAllenge of translating nuances, arguments into what's actually covered that was tough for many public health officials. I think the other thing, honestly, just in a human level, that became hard for many of them, and I am thinking particularly about local and state public health officials were on the front lines that I talked to a lot, was they ended up getting attacked a lot and abuse a lot during the pandemic. I don't just mean like attacked online.

I mean people showing up at their houses, people harassing their children, a people threatened their safety um and and this was often people who are upset about some of the requirements that were being put down from local departments of health. And you can understand what cove IT was as stressful the time as we've seen recently. People lost their jobs. People were losing loved ones.

I mean, talk about a stressful time but I think at a human level, public health officials who are exposed to that kind of abuse who start to worry about their children safety um many of them stepped out of the rena said, is this really worth that to put my family at risk? Um and that was hard because we lost a lot of good public health people in that respect. So diving, in addition to having sort of these core principles of public of communication in place.

And what we also need to restore is an environment where we a Frankly of humidity and civility where we don't attack people you know who maybe have different views, are coming out recommendations that um you know are not palatable uh to us. And and I think it's also combined upon our leaders in society to not stoke that kind of resentment and violence as well because that happened during the panama is cover, got increasingly politicized. And you know, while that may have been at times done for political reasons, here there the people who suffered or both the public health leaders were trying to do the right thing for their communities and the public themselves who weren't able to have a clear direct channel uh, to end a dialogue with their public health officials uh, because a lot of that ended up getting closed off yeah .

I feel like there was a lot of talking down to the dissenters in the general public yeah .

and I totally I agree .

that um you know getting violent or harassing people h with whom you disagree is is totally an appropriate and do the one thing this to say .

about the humility piece and are giving example here of where I think this could have should have been done Better, is in an effort, for example, round masks, uh, to recommend the people wear mask. And one important thing just know is that when IT comes to like schools requiring masks, like those are decisions that are made on local levels, right? The federal government doesn't Mandate masks and schools and doesn't the authority to do that.

So there are local, local decisions. But in the end of the day, they were people who did not want their children to wear masks, right? For a variety of reasons.

Uh, some worried about their development, social development. Some worried that he was adding stress to their kids, like people had different reasons why the mayor may not have one of their children to wear masks. And one of the things I think that was not helpful was that when they were keep parenting made the decision, I don't want their kids to wear masks.

Um I think some of them received a lot of criticism, uh, without people necessarily stopping to understand why they may have been making that decision because also is a parent whose children were in school and my kids are five and seven and um the first year the pandemic, they were doing every school virtual, which was a nightmare that was incredibly hard Price even when they got back to school and the fall of twenty twenty one um IT was a really tough like adjustment for them. And I could understand like some of the concerns that parents are were having wondering about, hey, how are these precautions affecting my child's experience and social development? So on the whole, this recommendation may still be, uh, hey, improve, mention your classrooms, recommend making, recommend testing ta. But those recommendations, I think, have to be made in a way that acknowledges like the humanity of people who are may have a different point of view or may make a different decision uh, for their child and I know that when the local charities made the decision in many cases to require uh, schools and they know kids in their district to wear mask, that puts some parents who didn't want that I put them in a hard place right and but I think that our failure that actually have an open on as respectful conversation about this or we didn't feel like we were uh each being attacked, you know, as parents for our decisions or as community members for the decisions we are making, I think that not only hindered I think, the response, but I think IT actually contributed to this division.

The sense of black and witness that he also against them and then suddenly, if I was against one measure and I was against all of them, you know if I was four one measure as for all of them, because we just started segregating into sites uh and this became A A polarized ah you know experience at a time where really should have been a crisis that brought us together as message that was um and that honesty, Andrew is what I worry about most for the next pandemic right like I think we've on a lot from this pandemic about uh how to manufactured vaccines and and ah how to develop them quickly ah how to distribute them uh efficiently uh and you know we are one of the I think most historic and effective vacation distribution efforts in this country even though certainly could have been Better, but IT was historic by all measures. Um we've learned a lot about how to do vaccines, their putis, uh a lot of the nuts and bolts of a pandemic c response well but I worry what we are still struggling with is how we build trust, how we communicate with the public and how we staying together as a country in the face of adversity. Because if we're going, if we're divided the way we were doing covin during the next pen time, then the next you know, threat that may come from foreigners.

Sary, that's a huge national security issue for us. And so that's what keeps me up. And I when I think about the next pandemic that may come.

two questions related to what you just said. First of all, as IT relates to vaccines, in my opinion, and I think the opinion of many people out there that the response to the next pandemic will be heavily contingent on at least some sort of acknowledged that there are people who at least feel that there have been vaccine injuries, right, to simply say, okay, the previous round with covet went this way and now there is no virus x right? Let's hope not, go forbid, but sounds like gets coming at some point. And people are going to think to the last time and they're going to immediately say, well, the last time we were told to you take a vaccine, some people had a good experience with.

Other people didn't and in in this empathy model of acknowledging and you know, letting your moral compass guide and understanding the why behind what people are are doing and how they reacting IT seems to me that now would be the time to at least trying to understand where they are coming from even if one disagrees, maybe even especially if one disagrees and trying get people aligned now before the next pandemic and so what efforts are being made of any to try and acknowledge um that some people really do feel as if they were harmed. I'm not saying they were or not, but clearly there are people who feel that they were people they know were harmed. Is there an effort to present them with data, to have discussions with them, to try and get people line so that the next time around we can be more of a unified front, whatever the necessary response happens to be?

Yeah no is a really important question. And to me, I always go back to sort of first principles from practicing medicine, right? Which is if there is a medicine you give a patient, and even if that helps, nine, nine, nine, nine percent of patience, but this one particular patient happen to be harmed. Buy IT. You go in your knowledge, you talk about IT, and you together try out a path for how you wanted move forward.

And the platform might be, yes, let's get to that medication, but let's use an alternative, let's try IT or we can use that medication anymore here, the risks you may sustain, but we'll find other ways to protect you, right? So that's what we would do in medicine, right? That's what i've done with patients over the years.

I think here to similarly when I think when IT comes to tracking a adverse events from vaccines, es, this is an area where the C D C in the F D A track and collaborate uh and tracking means not just not only collecting reports from the public and from clinical when they see uh and effect that may be related to a vaccine, but IT also involves analyzing those to see where they correlated with the actual causation there right because um you know if if I if today, for example, uh I felt on well um and I traced back what happened yesterday IT turns out, hey, I ate this brito that was out the the sun for way too long um the question is am I feel sick because the breeder or did the breeder just happen to be, you know uh you know something that happened that is independent of how i'm feeling um maybe turns that somebody was actually sick uh with A G I bug you know around me and that's a reason uh that i'm playing the way I am today. So the analysis that needs to be done on cases that are reported h is important and it's something that the city seems the F D A. Do together.

Now that analysis, I think is essential to communicate clearly to the public. Um and whenever I engage with fost in the public, which we do often and people will talk to me about their experiences with vaccines, I did this is important to acknowledge people have gone through um like some people for example, like when I got vacation for copy, for example, I I felt like I had mild food like symptoms for a couple days. You know that wasn't great.

I would have prefer I didn't you know have those feelings like you know and and then I fl Better couple days later and then I moved on, but you know I acknowledged didn't feel good feel that way. There are people who may have had uh, experiences, but they felt that they had more serious uh, you know, side effects and there may be questioned without related to the vaccine or not. So I think we have to both here and acknowledge those.

I finally try to do that. I know probably I think it's important to keep doing that across all of government, but I also think its important for us to to help people understand the process that we have to go through to understand whether those are related or not. If you go online and the cdc site that where they collect a lot of this information and you just purely look at reports that are given of potential adverse effects that you can't sort of take that and say, oh, those are all related to the vaccine, look at this rate of harm.

It's extraordinary high because we don't actually do that with any other of vaccinium medicine. sure. We we start there, we do the analysis and we try to understand what's actually related or not.

So I think that's that's what we ve got to do here too. One last thing I says that it's important thing also for us to to help put this in context of other vaccines and medicines and interventions uh, that we use. So for example, just take thailand for example.

Like most people think all time, all it's safe. There's nothing bad happens if you take time, etra. But people who track the data know that thailand by a large, is a generally speaking a safe medication.

But there are people experience adverse affects from thailand, all liver damage, you and and other adverse effects. Uh, and you know that data is available. But what has happened in the case of that medication is that the risks and benefits of both analyze and then a recommendation is put forward about a generally safe way to use IT. And then there's data put out about the the suite effects, common or rare, right? But I think sometimes we also forget that a lot of the medicines that we've come to take and just see is a Normal part of our life, just like any other vaccine, like there is some rate of our side effects that will happen.

I say that because what I worry about in the black and White environment that we're living in is sometimes people will take an anecdo uh, about a potential adverse effect and will portray that is the rule, right and will say, well, look, I know somebody who had this side effect so nobody should take this because this is what's going to happen to you. If we did that, nobody would ever take time and all. No one would ever take, I be profit.

No one would take nicol, like no one would take any of the common medications that we pick up at the drug store and that we commonly use. So, uh that's how I think we have to approaches with a combination of of clear communication, empathy, ic listening and and data and context um again, that doesn't fit neily in in in a social media post persae. But I think part of what what what we need to do is a country is rebuild the relationship, honestly, between the medical public, health establishment and the public. And I think that starts with this kind of communication.

The other question I had about the next pandemic, and the one we just had, is why not have committees of people of diverse background, service, economic diversity, racial diversity, uh, every aspect of diversity, rather than individual standing there telling us what to do for several reasons one is um we are country of many different people yeah I think we um there are dozens, if not hundreds of scientific papers showing that patients follow the advice of doctors that look like them and sound like them or to whom they would aspire to be like.

We know this. And yet public health officials typically are unitary. One person telling us, do this, don't do that. This is a good idea. That's a bad idea. I'm but one citizen but i'm putting up both hands and both feet and all toes and saying that committees small but diverse committees that people can relate to and feel as if um the messages that they're getting are vented through a common understanding yeah so is a really good suggestion .

and and I couldn't give you more that a diversity of voices is really important to get a message out. And in during copa SHE, that's one of the things that our office actually was was helping to build with something called the community core, right, where we actually, we recognize very clear is something I you I came to see as a doctor. Sometimes I was the right person, a message patients went right, sometimes that was the nurse, sometimes that was, uh, the medical students, sometimes that was an administrator or the social worker with different background, different life experiences.

So part of this work is when I want to step up, want to step back, right? But the community court that we were a building was a really diverse uh a group of people um and lot of public health backgrounds, but a lot of more community leaders who understood held even though they can have formal training um but there are people who knew their communities right and they had the trust of their communities and they understood what was going on and they wanted to be helpful so we brought them together to say, okay look, here's what the science is telling us here the general recommendations um years we would provide a you ask any questions you have like if someone we don't know go back and look IT up um but you're the leaders in your community, they should be hearing from you you know about about these messages and then that those folks went out and actually we work closely with them, collaborated with them. They would design the messages for their community based on what they thought made sense, weren't taking what we had work for word and we didn't want them to um but to me, like that kind of diverse approaches, what we need more now you know say I would I would have liked I would have liked if more immediate networks put those folks on T, V and got them on the radio, right? Because it's important that many that we're showing up in their communities, we're knocking on doors were doing local, you know, podcast, etra.

And that was great. But I would have like more their faces. I Carried on T. V, right? So that's A A place where when when we talked to media and I talked to folks in media, one of things I encourage him important to do also to say, look, if you can take more of these diverse faces and voices and put them out there, that's actually good for the community.

And IT also helps people see that it's not like one or two people who are sort of pushing agenda here. This is like the public health community is big. It's broad, it's diverse and a lot of voices in the and as the more voices we can hear from as public, I think the Better off we are.

Yeah, here here I I, you know again, I genuinely hope and pray that we don't have another pandemic. But even when we do, I hope there will be committees rather than the individuals. I know we, this is thing in this country.

We like the idea that one person's gone to save the climate, one person's gona save transportation. One person the other covers person of the year type approach. we.

But then we get frustrated when that person does things or make decisions that we don't like in their public or personal life. And then IT all seems to fall into division. And I just feel like not talking about groups of hundreds of people with small groups.

Yeah so I think we're aligned in that way. Yeah and there's that notion that I think sometimes we do want like the one person who cannot only necessarily have all our trust and we can look to, but also who we can hold accountable. You know something I doesn't quite work but we don't like something.

Um and and when I get that sort of mentality, I think that in this moment special we are trying to rebuild trust. I think it's important for people to know what they may be hearing in terms of medical assign public health recommendations. It's worked for them to know how broad and audience sets coming from or bride a group of experts, right? And we there was a lot more brought agreement, for example, during copy and during ebola， during zaka on public alth recommendations. But you would never know if if you turn on the T V, because you were seeing the same a couple of faces. So I think we have to differently diversify that.

Um one other thing I think i'll tell you that important here is I think we have to also think about how we fd groups on the ground that are doing the the hard work of getting public health messages out because one of things that those groups often will tell me, and these are md groups, i'm talking about the committee organization that spent years in neighbor od getting to know families where folks who recognize them when they are walking down the street, they go, yeah, that's a person for the organization x they understand as they get as there looking out for us. A lot of those organizations had spent their resources helping the community, getting to know the community. But they didn't have sophisticated mechanism to apply for grants.

For example, they didn't have grand writers who had done this a thousand times. So historically, those routes have a hard time getting support and funding. So I say one is sing.

My my wife did, which I was very proud of, is SHE was helping to to build an effort and to build an on profit organization with a couple of colleagues, that a big organization of people who knew how to get money, how to apply for grants, how to get foundation support, but who also had the wisdom to know that the most important they could do we, to give portions about money, took groups on the ground. So they saw themselves as an organization that channel money to groups that had trust, and they executed their, their, their mission that way. And that was very effective, and I think we need more of that.

When IT comes to disseminating funding, one thing I think many people may not maybe may not appreciate is that when you is actually hard from government to put out a lot of money at once and to do so quickly, right um when you ve got a lot of funds that you need to get into communities, what happens is a federal government after will give IT to states. States will then give IT to local communities, uh, like the local department of public health potentially. And then they will look to distribute the others.

That takes time. But that also means if you're not connected to that network, if you don't know your local department of health, you're not connected the state department held sometimes you can be chAllenging to figure out how to get the money. And so I think we need more Operations like you know like what my wife and others have been building to try to get those funds directly to the folks who not you don't actually have the most fatty you know grant writing Operation, but they have their relationships.

The end of the day, it's those relationships that create the trust. It's a trust that allows in for lifesaving information to get to people. And that's a link .

that's missing interesting farmer, big farmer. I got a lot of questions about whether not big farmer is on the take for every public health initiative.

Now, as somebody who understands a bit about, and certainly believes in the use of certain prescription medications, I find most questions about calling big farmer to overlook at the fact that they are thousands of hundreds of thousands of medications that save lives and enrich people's lives that are prescription drugs. I also believe my audience knows, I said over over again that Better living through chemistry still requires Better living. We still have to get our sunlight, get our sleep, social connection, nutrition, exercise and all those things.

There's just no pill that's going to replace those OK. But I think it's a valid question that people are asking. Is there a direct relationship between big former and public health initiatives in a way that should have us concerned about the messaging that we're getting in at times and the fact that the united states consumes the vast majority of drugs from mental health, for instance, as compared to other countries? So that's one question.

And then I want to dove tale into that question. What are your thoughts on the fact that you know there's a history of six, the tobacco industry being, you know, very interdigitated, shall we say, with government policies in ways that had us basically injure, if not killed, millions of americans and then eventually say you can't smoke on in a hospital, you can't smoke anywhere. There's a very few places where you can consume to products. You know that that kind of relationship and financial incentives and then a lot of backpedalling later, I think, war on people's trust. So how should we frame the relationship between the pharmaceutical industry, government and public health initiatives in a way that is at least half .

f way functional? Hey, IT, look, I understand where the concern and suspicion comes from, right? And look, I I think it's important that public health ih is in medical advice, is independent of the influence of industries and may seek to profit uh, from what's being recommended or from medications that are being prescribed.

And we look, we have a history in medicine, right, of doctors who were given gifts and vacations and all kinds of fancy things, uh, by pharma companies and an offer to influence what they prescribe that was really problematic. And now we're seeing a lot lesser. That which is good by the rules, are being put in place by medical societies and professional societies and by academy institutions. To say this is an unacceptable way to practice. And that's really important because I do think the human psychologies that sometimes we underestimate how much we are influenced by incentives, we think getting that, but I know how to make independent decisions, but then they were human and and we're influenced .

or is a great drug. IT could be well, this is a drug is really helping my patients. I'm happy to recommend IT to .

them yeah so the this so what is everyone thing though like taking money from form a companies as a physician, I think is highly problematic, right? I think it's hard to say that IT doesn't influence practice, maybe doesn't for some people, but it's it's really hard to know who those people are. Um I do think that separate from that, you can be a physician who prescribes medications because you believe they work.

Look, as a doctor, I have prescribed many antibiotics s during cases of infection that have helped my patience and I would prescribed those again. I am glad that those uh exist um in many cases they ve ve saved the lives in patients, are caring for in the hospital. So that's what we should drive.

This is is is this the data shows that they work and dissertations need them, right? That's what should driver decisions when he comes up. Public culture recommendations here to, I think, is similar principal holds, which is that I don't think that foreign money uh should be influencing our public health decisions, which means that IT shouldn't funding our public health organizations that are making recommendations.

Certainly all you know that this is obvious to you, but i'll say just be clear for everyone who's listening like our office uh, doesn't take any money from industry, not just farm industry for many industry like our uh the money that we get is uh, allocated by congress. At the end of the day, it's taxpaying money and that's all we get. And and that's important.

We don't want money from the um you know from pharmacology companies um but that's important because people need to know that these decisions are not being made for for financial gain. Um that being said, there's a broader concern I have, Andrew, which is I think that we have become a pal for every problem society. Will we look for a quick fix of a medicine for every chAllenge uh that we may incurred and sometimes yes, I am a believer that if science you know helps us create uh, medications that can help solve disease, we should use them appropriately.

But I think we discount heavily the behavioral changes that we need to make, the more broader societal and environmental changes that we need to make that influence our health. Like our food environment matters for our health, our decisions about how physically active we are matter for our health, whether not we sleep matters for our health. And all of these impact our mental health and well being as well.

And so I I when when I think about that bias that that to me is not always seeing him steaming from money that came from a pharmaceutical company. Although I think the ads we see all the time uh, from farmers, a company is something try to convince that, hey, just take this pill one today and all your problems will go away. But I think it's more complex than that.

And and I think that even for you know in the health care setting, like if you are a if you are seeing a patient who has pain, uh, who's having a intense pain, IT feels easier sometimes to prescribe a medication for that pain rather than trying to to deal with non medicated and based you know approaches are try to get the deeper origins of the pain. I'm not saying that's where doctors do all the time, but i'm saying that were living in an environment and a broader culture where we, I think, increasingly reach for something that we see as a quick immediate fix. Uh, and again, don't blame people for that.

We take a quick fix over. So it's going to take a long time. But I think IT is selling us, I think sometimes a of false hope, which is that that's all we need to solve our problems and other times you need more. You need the behavioral changes, you need the environmental changes. Um that's one of my big concerns in terms of how we communicate about health.

Would a potential solution be this idea of small committees? So let's say, somebody is experiencing chronic pain, localized or general, that they would go to their general practitioner, but in the room would also be somebody who understands thematic medicine, A A C trained clinical psychologists who understand saumaise that the body in the brain are linked through the nervous system. Um and could also assess um you know possible psychological roots a of the issue and then somebody in the room who can make behavioral nutrition um maybe in supplementation based, safe supplementation based recommendations and then the physician who can say, you know in addition to that I think the person should have on hand you know a five milligram dosage of a prescription drug that if they need IT they could take and I think IT would provide a lot of protections against you know potential adverse effects of any one of those things in isolation um there are great protections in having people meet in groups um for lots of reasons and the person would feel very well cared for um so again, small committees of people with diverse expertise pulling together to treat people from a for lack of a Better word, a more holistic perspective.

Why not I mean, you're just wim in the dream. I think this exactly what we need, inter disciplinary teams that can provide innovative care, recognizing that in this in age, this is not one person who has all the expertise that help us figure out how to best manage or help the chAllenges. Um I think what we have not figured out are a couple of things.

Number one, who are all the right people who need to be in the room, uh, or the sort of virtual room, if you will. The second is how do we create A A structure, a healthcare system where that can actually happen with efficiency, where can be be immersed appropriately, but that's what we should be doing. And then the third leg of that is the the group experience for patients, right? And there is increasingly in more clinics and health care systems around the country that are working on creating group experiences, were patient to all, let say, are working on died on their diabetes.

Uh come together, let's take once a week and they meet uh, with the health care practitioner that might be in addition to their individual appointments. But there is so much power in groups coming together, uh, a groups of patients who can find community, who can help each other learn from each other's experiences. Uh that's highly under utilized right now in medicine um but to really do this well, Andrew, I think means that we have to we have to pull back from the model we have had for years in medicine, which has been a very a highly individual a type model which says, okay, you go to your doctor, you see your doctor one and one.

You get everything you need, maybe you need to go here special, okay, you wait a few weeks, get another point in and drive thirty miles, go see somebody else. Maybe they're connected to the election onic help system. Maybe they're not.

Maybe they know what what is discussed. Maybe they don't. Maybe they will call and talk to their primary care daughter, but maybe they won't because they're too busy. And then you as a patient are stuck trying to peace all this together.

what? Well.

often in pain? Well, yeah.

in in physical and emotional anguish. Yeah, referring to my own experience that i've had mild examples compared to what other people who dealt with, but with chronic pain are irritable for understandable reasons. I mean, it's or maybe somebody y's close viewing towards suicide, depression, then there's the interpersonal effects.

I mean, I feel like that the crisis is is one of a lack of efficiency and theron's. And and again, i'm not throwing stones to the medical profession. I I like you believe that it's a collection mostly um well meaning people trying to do their best. But the specialist model and the referral model is incredibly converser.

IT really is conversion. And and like you look at having work with many medical professions over the years, like these are colleagues. So I deeply admire me.

They are there for the right reasons. They want to help people live a suffering. But they too are feeling burned out and frustrated by the inefficiently of the system. Because I tell you, one of the greatest contributors to burn out for doctors and nurses is a lack of self efficacy, is seeing a patient who has a problem in front of you and feeling like you can get them the help that they need. That is the the greatest paper cut, if you will, 啊， to the sort of spirit of clinical.

And many find themselves in that circumstance SE, where they either find that they know what needed, but the system is drawing up prior authorizations or other insurance hurdles and preventing their patient from getting that care, or they are kind of the edge, their expertise, right? This happens to pedestrians and primary hair doctors more broadly all the time with mental health, right? Most of the mental health care that's delivered in this country is delivered in primary care offices right now.

Primary care doctors is necessarily trained specifically and only in mental health, yet they find themselves having to manage a lot of that, including increasingly complex substance use disorders uh, and in treatment resistance depression. And they need to help figure that out. But if you don't have a lot of resources to get that referral to collaborate with the mental health professionals and you're stuck on your own figuring that out.

And so you I think the pain is being experienced mostly by patients and but also very much so by clinical. And that's why that overhaul is needed. And I think a lot of this i'm not a healthy economists persue, but I will say that a lot of this, I think, is tied into the business model that we built around medicine.

Uh, the notion that um you know were paying individual people for individual services and individual procedures that are done well, that has some married in some cases. What we really care about is that the person's getting efficient, integrated mult disciplinary care overall. And so when health systems, for example, come together and say okay, rather than um focusing on the amount of any reinberg procedure, we're onna take more a value based approach here.

What we say okay, we ve got turn out of money to care for certain people. What's the most efficient way for us to provide them care? Recognizing if we don't do that is only bad for them. But our costs in the long term will go up because we're not getting reimbursed for every procedure. We're getting reimbursed for the the care overall care that we're taking for a patients.

So there are more of these value based models are that are are are being adopted certainly in two thousand and ten when the affordable character was passed and when uh other measures are taken in the obama administration in medicare like that really pushed the value based payment models forward. Um and again, they're not perfectly, but they they need their own tweet. But I don't think that the existing financial structure that we had in medicine was serving us in terms of delivering the kind of multi disciplinary, integrated, efficient care that we increasingly need.

Tough problem, but through recognition of tough problems, good solutions, that's my belief. I'm an optimist. At the end of the day, you mention mental health. Lately you ve been increasingly vocal about the crisis isolation.

This is like we the thing that the top problems are, you're exactly right. And the problem is a long ger. We take to acknowledge and address these tough problems, the more entrenched the interest to become that profit from the satistics.

right? So if you look at um the private insurance industry, uh right now, there are so many chAllenges we have right now with patients and clinton saying that they know what care is needed but he gets denied. They know care is needed but prior authorizations you know geh thrown up there and IT required uh even for a medicine that clearly your patient needs urgently.

You know i've had the experience myself of having a family member who is needed a medication for an urgent situation and then being told that the pharmacy will not fill IT because IT requires a prior authorization but that can be processed, uh, until the weekend is over because no is in the office to approve the prior authorization. And you think in yourself, this is make any sense, like this is an urgent situation. My family member needs his medication.

I've also had the experience as a doctor of fighting for my patients who have been denied care by an insurance company, being on the phone saying, I am sitting here in front of my patient. I know that they are sick, I know they can go home. I know they need to be in rehab. There is nobody literally to help them at home.

But then not having like the rahab's approved by somebody who's not even there, right? And there's also just A A practice that we've seen time and time again where in turn, companies will also just burden with more and more request for information before they will agree to reimburse for services that have already been delivered for patient who needs them, which is just creating more and more barriers, hoping that you are small time dog out there who's got no yeah single you put up. You don't have a lot of resources.

Are are you going to keep fighting all and sending more, more paperwork and eventually you'll just give up? Um we have a lot of problems right there in industry that should be delivering care and often is doing good things, but too often, I think, is allowing barriers to be put up. I do the care that needed and this is particularly true with mental health and over going to talk about that.

But mental health care is just been such a difficult thing for people to get in our country. And part of the reason there, many reasons for one of them, is that insurance companies historically did not remembers adequately or in the same level for mental health care they did for physical health care. Or if they did, they're only reimbursed for a limited number of sessions that you could have.

Uh but how if you if you're a mom out there who sees her child struggling, uh, with depression, you're really worried. Um you don't want to be told, you know what uh you can only get three sessions that's IT what are useful to do after three sessions right? Uh and so what has happened is that even though in two thousand and eight there was a law past called the addiction a equity and mental health ity law, even though that was passed to try to close that gap, there were many ways that insurance companies were skirting IT, right?

So one of the law isn't even being axed, reinforced for many years. But two insurance company sometimes would say, okay, you know, we remembering adequately. But when you look in the network, they had very few provider so you really could access somebody, right? So that was a problem for patients.

And then the other chAllenge is that they would say, okay, you can see somebody, but you've got ta complete this prior authority. Zo, have I completed by your primary of Carry doctor exact and thring of more more barriers. So very recently back just a few weeks ago, a present by just announced that we are from as administrating putting out a proposed rule to actually strengthen uh the mental health herd law to prevent some of these.

What I think of as abusive practices because they are preventing people who need care from getting in. And if you've ever been, as I know, many people have been who are listening to this, if you've ever been in a situation where you or somebody you love has struggled with the mental health concern, what you need in that circumstances help. You don't need to be filling out paperwork.

You don't need to be waiting three months actually get care. You don't need to show up and be told only only have two more appointments. You need to know that help is there when you need IT.

And a lot of these denials are are being issued to people who have done there, there part of the bargain. They paid their premiums. They've held up their end of the bargain. And care should be there for them when they need IT.

So and this is something that upsets me up because I just I have seen too many patients over the years struggle without the care that they deserve and should get because the bears are being thrown up, uh, by industry. But I say all that just to say that when you take on big problems, you will brun up against entrenched interests. And that's a fight we have to take on.

We can shy away from IT. We can say, know, this is politically too difficult. Like one of things i'm very proud of is we're finally negotiating on drug Prices are through the medicare program, something they should have been done decades ago but is finally happening now. Um administration decided this has got to happen. IT was passed by congress.

This is good ah and we just IT makes no sense that we would pay more than we need to and pass the cost onto taxpayers uh, when we can negotiate and we gotto get, look, you ve got if you're collecting taxes as government, you should be doing your best to make sure every one of those dollars is being spent well, right? Because somebody took money out their paycheck, uh, didn't use IT for their family, didn't use IT for their kids. And they gave you to the government for good reason because that supports first responders, police officers, a whole bunch of services that we need. But the responsible in government is to make sure that money being used well and to pay more for medications and we should makes no sense at all, and especially for patients and taxpayers.

So clearly, some steps in the right direction are occurring. While on the topic of mental health, let's talk about the isolation crisis. What is the isolation crisis? What aspects of mental and physical health is IT impacting? And then, and perhaps most importantly, what can we each and all do about IT?

Well, this is one of those issues that I, if you had told me, Andrew, ten years ago here you can be sent here talking about learning is an isolation I would say I don't think so um but I was really educated by people I met across the country about the fact that this is a real problem. And the truth is IT was familiar to me because of my own personal experiences.

You know, as a child, I strugling a lot with a sense of, long as isolations really shy as a kid, I was pretty introverted, and I wanted to to make friends and hang out other kids. But I took me a while actually build those relationship. So um I spent a lot of time feeling left out. You know there were times when I I I would like elementary schools and days where I pretended I had a stomach.

He and so my mom wouldn't make me go to school and I wasn't because I was scared of a test teacher want to like walk into the cafeteria one more time and be scared that there is nobody to sit next to or that no one would want me to a to be other bench um I as I know what that feels like, I also know what the shame is like because I never told my parents about this H I never told anyone about that um because even though I knew that parents love me, I just felt, hey, i'm feeling this lonely. I means something is wrong with me. I'm not like people not love L, M, got to, it's got to be my fault in some way.

He was only years later, Andrew, when I talk to friends from great school, that I realized that a lot of we're feeling the same thing. We all struggling by ourselves. No one really knew IT. And I came to see a lot of this as a doctor when I taking care patients. And I never took a class on loneliness in medical school was in part of our residency curriculum.

Yet when I showed up in the hospital, I found that the patient who had come in with the a diabetic tic wound infection, or who had come in um because they had had a heart attack, when I SAT down and talk to them, often in the background, they were talking about how lonely they were. Sometimes I would I M hey ah you know we need to have a difficult conversation about, uh, your diagnosis, somebody you want me to call a to be with you during this time and too often the answer was, you know, I wish there was, but there's nobody. I just have a conversation by myself.

So but I was, when I was certain general, I realized that those experiences weren't limit IT to me and my patients, but they were incredibly common. And two things I learned when I duggin into the data, Andrew, was number one, that lonely is exceed ly common with one in two adults in amErica reporting measurable levels of lonely. But the numbers are actually even higher among Young adults and adolescence.

The numbers among uh you actually, depending on the surveys you look at or between seventy eighty percent um who say that there are struggling with loneliness. So that's the first thing that I learned. But the second thing was how consequently loneliness was.

I used to think lonely was just a bad feeling, but what I came to see and digging into the scientific literature was that feeling socially disconnected, being lonely and isolated was actually associated with increased risk of depression, anxiety suite, but also an increased risk of cardiac disease of dementia. And these are not small risks. We're talking about.

Twenty nine percent increase the risk of corner heart disease, thirty one percent risk in the increased risk of stroke, fifty percent increase rise of dementia among older people, increase the risk of premature death. And the mortality impact of of loneliness, by the way, and lonely and isolation uh is comparable uh um you know to the mortality impact of many other illnesses. In fact, it's even greater in the mortality impact we see associated with obesity, which is something we clearly recognize as a public health issue.

So you put all this together. And for me, one of the key takeaway is that lonely and isolation are critical public health chAllenges that are hiding a behind the curtain, behind this wall of stigand shame. And unless we talk about IT and address IT, unless we reconcile what's been happening to us over the last fifty years where fewer and fewer people are participating in community organizations, where more more people feel feel isolated and we're not going to be able to repair the frame foundations of society, which are grounded fundamentally, and our connection to one another.

Imagine community organizations. Could you elaborate on those? Uh, you know, growing up in the seventies and eighties, I was exposed to like community soccer teams, swim team.

There was a community poor. These are all public things. Are there were churches, synagogues and mosques. Are we not seeing as much participation in those those types of organizations anymore? And what other types of organizations are are out there that you know, come to mind when you think about the isolation crisis.

yes. So there are several factors that i've LED to as being as isolated as we are. One of them, as you mention, is the decline in participation in community organza.

This isn't a recent phenomenon. This has been happening over the last half century in america. We've seen lower participation in faith organizations and recreation leagues in service organizations and other community groups are used to bring us together.

And I think, you know we can talk about the reasons why that has been the case um but one of the key consequences of that is that people don't have places where they can come together and get to know one, especially across differences. So we actually associated more more with people who are like us. But this has also been fuel by few other factors uh, that are going on at the same time.

One is that just from a cultural perspective, as majority ity has arrived, not just the U. S. But in other other countries, we seen that people are more mobile, right? They move around more.

We don't always see in the community that we grew up, and we tend to even if we move somewhere else for school, we may go somewhere else for a job, we may change jobs and move somewhere else. We are leaving behind communities that we grew up with, that we went to school with, that we worked with. And i'm not saying that's all bad thing, right? We will have more opportunities and that's a really good thing. But I think one thing that we have not accounted for is the cost of these changes, right? If we know what the cost of certain actions, we may still take those actions, but we may find ways mitigate the cost.

We may in this case, invest more in our relations should be more conscious of our reaching out other people going to visit them um but that has been I A quiet but but devastate in consequence the other pieces with modernity is that we have more convenience in our life, which means that we also don't need to see other people to get certain things done like buying groceries or mAiling an item out or getting something from the store. I can sit in the comfort my home and have everything just come to me. Now on the one hand, that's incredibly efficient, right? But I think efficiency is an interesting thing because it's only one factor we should be consider in our lives.

There are two, we have to ask the cost and what to interest me, my covin. As many people in the first year of covin, we are all separated from one another. You know, when we finally came back together, and I had so many people who said to me, you know, I expected to miss my parents and my siblings and my friends not being able to see them, but I didn't expect was missing the strangers that I saw the coffee shop where the folks who are ran into the growth restore, or seeing neighbors as I walked down the street, like I actually missed that more than I thought I was.

So we have lost out on some of those interactions in those loose ties. But the final thing to keep in mind also is about what is happening with how we are using social media technology, which I think is fundamentally transformed, how we interact with one another. And how we see ourselves and each other.

And this is particularly true for Young people, uh, who are growing up, is digital natives. But what has happened there, I worry, is that and he thought that social media, all bad, just to be clear, you know, technology, I am a believer that in technology, broadly speaking, you know, I user of technology has been seven years building a tech company. Am a believer in tech.

But I think whether technology helps or hurts us is about how it's designed and automate, about how IT ends up being used. And what we've seen with social media as well is that uh for many people, IT ended up leading to in person connections being replaced with online connections. Um we came to somehow value and um almost seek out more and more followers and friends on social media, feeling somehow that made us more connected.

But the nature of dialogue also changed like human beings we evoked over thousands of years not just understand the word someone is saying, but to hear the tone of their voice, to see their facial expression. Here and I are sitting across and we're both processing of your body language, right and i'm seeing you not your head and i'm seeing your eyes focus like all of that matters to how we communicate um but also like you and are less likely to say something hurtful right now to one another because we can see each other. If I said something you're hurtful to you like I probably see that the pain or conservation on your face and that might give me pause right when you're communicating online with other people without any of that information or without any of the, uh, sort of barriers, if you will, that make you pause before you hurt someone.

IT leads a very different kind of communication, uh, one that can be quite herself at times. And I also think that one thing many people don't recognize that to communicate with somebody else and reach out and build a relationship with someone, IT actually takes a certain amount, self, a steam. To do that, you have to believe the other person's gonna want to hang out with you.

They are going to see something valuable in you. And for many Young people, what has happened, and I think Frankly, for many older people too, is your experience on social media has shrew itself as steam as they're constantly comparing themselves to other people. Like, you knew I was growing up, uh, you know, in the eighties, we we compared ourselves of the people too, right? People have for millennia.

But what's fundamentally different now is that in a given day, you can compare yourself to thousands of images that you see online. That's actually literally what people, Young people, tell me. I do round tables with color student and high school students all the time around the country.

The three things they tell me most consistently about their experience of social media that makes them feel worse about themselves, worse about their friendships. But they can get off IT because the platforms are designed to maximize at the time they spend on them. So you put all of this together, and I think what has happened is that we're talking more, but we understand each other less.

We have a lot of information, but we are lacking in the wisdom that comes from human relationships. Uh, and I think that that's really hurt us. You know we see IT certainly in the data that tells us about mental and physical health outcomes, but is also the human suffering component.

Andrew, okay. It's really heart breaking for me to travel on the country to hear from people of all ages, often in quite whispers about their struggles with isolation, about how they feel like the just don't matter at all, but how they feel like they just don't have a place really belong. And it's these are people are in the outside look perfectly fine, right? They're posting happy things online to the folks of work they're seeing like everything's going great as well.

Always tell people like you, lineless is a great mascara or they can look like withdraw and sadness. They can look like anger and ritually IT can look like a love ness as well. And so it's only when we stopped to ask someone how they're doing, when we take pause for a moment and maybe reflect on what's happening in their life, that we realized that, wow, the majority of people in our country are actually struggling with loneliness.

Yeah, I A firm believer that our nervous system evolved under conditions of close interpersonal indirect connection, and to suddenly throw a technology in front of ourselves that deprives are in the system of its Normal development is is clearly going to lead bad places.

It's also clear to me as a based on what you just describe, that you know when we go on social media we see something, but if they don't really see us, you know hence perhaps why people get an aggressive in the comments section um they want to be heard yeah we want to be seen I think all of us want to be seen and see other people yeah and social media doesn't allow for IT so easily um I also know that a lot of Young people will congregate with their friends to play video games online. But that's different. You're essentially showing up as an avatar.

And when we were kids, we also play different characters in our in our games, but also different. Now do you think that there will be a youth rebellion movement against these kinds of technologies? I think there's a long history of Young people were rebelling against the stuff that been put in front of them and then like no more, we're going to rebel.

In fact, I was the way that you've overcame the the nickey epidemic. You recall IT was the advertising pitching them against or pitting them, excuse me, against um wealthy cackling older men in chair in rooms counting their money. That was what actually was successful in getting kids to not smoke, because kids have a rebellious streak.

I supposed when they were told, hay, smoking terrible for you. Your lungs are gonna ill with cancer. Kids didn't stop smoking. Teens didn't stop smoking. He was, rebellion has been begged into our nervous system in the adolescent years.

So do you see a rebellion against this social isolation? Or kids going to start putting away their phones and hang out together again? And that's onna rescue us.

And that's a way of saying, what can we do for them? What can they do for themselves and what can we do as adults? Because there are a lot of the silence of fine is the thing I also really worry about.

So it's a good question. And I think there is already A A movement, this building among Young people to create distance between them themselves and their devices and particularly social media and IT. It's it's cropping up in different ways.

I'm meeting more and more some of these are organized efforts, but i'm also meeting more uh, families, uh, where the parents kids together decided that they are going to delay using social media and you know the past metal school, in some cases even later or they're deciding that they're going to drop boundaries around social media use or they're going to replace their smart phone with a dumb phone that allows them to do things like text and make phone calls and news maps and and and all that up, but doesn't necessarily social media apps on IT that this is still a small minority and and we're dealing with a bit of network effect or right? Because if you're the only one who's not on social media uh in your middle school class, and you might feel left out, which is White, so important for parents and and kids actually do this together. But I do think that to use your analogy with smoking, that one thing that is in many Young people brave against is this notion of being manipulated and used for the profit of of a social media platform.

And the reality is that the, again, we ve talked about how the fundamental business model is, most social media platforms is built on how much time you spend on those platforms that transits ad revenue and translates the bottom mine. Where's what I care about as a parent, as certain general, is about how well that time is being spent. Is that actually contributing to the health and well being of a Young person or or is not isn't actually harming them? And this is where I think when I go out and talk to Young people about this, number one, i'm so impressed by lot Young people because they they rely, have a lot of these insight.

They are the ones living IT, right? They are not thinking that this is all, you know, perfect and it's all A A pure benefit here. They're the ones telling me that they makes them feel worse about themselves and and their friendships. But they are also have a hard time getting off IT because again, of how these platforms are designed about a third about lessons are saying that they're staying up till midnight or later on week nights using their devices. And lot of that a social media use.

And this takes away from sleep, which we know and you know Better than anyone, is so critical to the mental health and well being of all of us but of Young people in particular who are a critical phase uh you know development. Um the other thing that is very concerning to me is nearly half of adolescence say that using social media has made them feel worse about their body image as we're costly comparing them to also to others online. And we used to think of this is just girls for experience in this and yes, IT is uh a lot of Young girls were experiencing this body and issues been out increasingly, uh, boys as well.

This is happening across the board. But the other peace I think that concerns me thinking about mental health symptoms is IT. You look at how much time uh, kids are using social media. On average, adolescence are using a for three and half hours .

a day on average .

is a social media. And that means many you are using a far more than that. And what you're finding though is that fred lessons to use IT three hours or more in a given day their risk of anxiety or depressive symptoms to double, right? So and if the average ces tween a half days, that means that millions of kids all across our country, and the majority where kids are, are at risky.

And so, you know, you put all this together and and the paints a very concerning picture, whatever benefits there may be for some kids of using social media. And there some, and we lay out some less, and advisory and social media. Some kids find social media great way to express themselves, to reach other people, to find support, especially if there from a community that doesn't have a lot of folks who like them around, they can be really be assuring to connect with others.

But we can say that just needed to get those benefits. We have to subject our children to all of these other harm, right? Like kids are experiencing exposure to harmful content, to harassment and bullying online. Six at a ten. Uh adolescent girls are saying theyve been approach by strangers on social media ways that made them feel very comfortable.

Um our people are also finding that health promoting activities in their lives are being canabal zed by their use of social media that is detracting from time for sleep in person interaction, physical activity and the rational self team really concerns me as well because you know, you need that not just for social interaction but look, look as as a father. I want my children to grow up being confident about who they are, being infinite enough to be authentic as they show up in the world, and not feel like they need to create some brand that's different from who they fundamentally are, just to sell that to the world. I want them to know who they are and to be comfortable being who they are, and to encourage other people to do the same, to support them and their efforts to be authentic.

That's what I want my kids to do. That's not what's happening to a lot of kids on social media. So I think we not only need more kids to understand this and to support them in their efforts to create space and sacred spaces away from social media, but we need to support parents here too.

Because, Andrew, my big concern with parents, we've taken this technology, which is rapidly evolving, which wedding grow up with his kids and we've told parents you manage IT all in your own, put the entire burden on parents and kids to manage this you know when we were growing up, you remember the motor vehicle fatalities were really high ah in amErica and we didn't say, okay, you know what? That's just the Price of modern life. We just have to accept that and keep moving on with our lives.

We said, hold on, we don't have to go back to horses and buggy, but we also don't need to accept the Catherine. We need to make this experience safer. And so we put in place with the advocating supporter, incredible groups like mad and others across the country, adding mothers inst strong driving.

Ultimately, the government put place safety standards. They got as seatbelts, airbags, crash testing to make sure the frame of cars were robust, and they setting up an accident. And that helped us reduce motive vehicle accident and death. And that's what we need here to like. We need to have the backs appearances in kids.

And that means from a policy perspective, putting in place safety standard are protect kids from exposure onal harmful content from from the experience of bullying and harassment, and that also protect them from features that would seek to manipur them into excessive use, uh, which is happening far too often right now. We also need the policy that requires data transparency from the companies. You know, the researchers tell us all the time that they is their independent researchers.

They tell they are having a hard time getting full access to the data from the social media platforms about the full impact of the platforms on the mental health, the kids and is a parent. Look, I I don't when we bought car seats for my children, when when when they were report, we looked up the safety data like many parents who want them to make sure the car seats were safe. But if you had told me that, hey, you know, the manufacturer, these carsey are actually not disclosing some of the data on the impact on children 啊， but go head buy IT anyway.

You know, i'm sure other people are are buying these cases. You should be fine. I would have been very disturbed by that, right? No parent wants to feel that information being hidden from them about the health impact of products on their kids. That's what we have right now.

So this is a place where I think, well, yes ah and we should we will talk about himself's parents can take because I want to get to practical steps of people who are here as parents for people of kids in their lives can take but we we we need policymakers to step up and step into the void here and to fill the gap because this is too much again to just ask parents to manage entirely on their own and this isn't again, about telling parents what to do and restricting them. This is about giving them the support thing. So they have confidence uh, when they see uh you know an uh, technology at their device, at their product out there for kids that they know it's been tested, that it's been studied and that it's actually safe for their children.

Understanding is that in countries like china, there are limits as to how many hours kids can be on screens, period. And when I was a kid, we were allowed to watch TV for a certain number of, I think, was a half an hour or now my mom was constantly kicking us at the house, like literally you've got to leave the house, you got to go down the street and play. Yes, unfortunately I like outdoor activities.

Um nowaday we also have the issue that a lot of parents are on their phones at soccer games and kids events. And so the kids are modeling their parents. Yes, parents are distracted as well.

So there's a lack of social connection. People even in immediate family people are screened in you know TV. There's laptops, there's multiple phones, ipad people.

Are you more engaging the screen portals than often than their own portals? You go to a concert and people are watching the concert through their screen so that they can send the same image that everyone around them is in out to the world. If you think that's kind of crazy, but I guess they want to capture that unique experience.

Yeah, but it's not unique at all. That's the that's the myth. That's the illusion.

There's nothing unique about the your post of something that you went to go see what would be truly unique as to just experience that in real time. Yeah right. Is a wild to think about. Like what we think of is our unique portal is actually not unique at all. What we do with IT learn on my mysta is clean and learn information online and go use IT in real life, come back from time to time, you know, maybe our day, maximum or so. Can I just .

underscore the two words you said of real life? Because that thing is a really important key here, which is that all of your life isn't happening on social media. There's a whole world out there, which I think is real life, which is happening offline. And what happy online too often is distorted, right?

It's giving us like like even just take on just take the images though that we see of people there, uh, you know, there summer beach images there, like great vacation images that's not representative of their entire life, of how they are living their life. But we see that we see people's anger and their vital all. And we come to believe over time that that's how people feel.

That's what people are dealing with an experienced in their life and and we've just got to get, you know your mom A I love with your mom did getting you guys outside um my parents said the same thing too like I I was very blush to have two parents who didn't count, you know they didn't have a lot of resources working up, didn't come to this country with a lot of resources. But the one of the greatest st gifts they gave gave us is that they love us unconditionally. And the other great gift that they gave us as they pushed us to just explore, to meet people, to learn about the world they wanted as outside playing, you know, experimenting, just little, discovering the world, you know, writing our biker on neighbor.

Od, and and that's what we did. But right now, and two critical things that kids need for their mental health development are two important forces, I should say, that are impact in their mental alf and development. One is social media.

But the second also is the lack of unstructured playtime ah that kids have like on structure. Playtime is time when we is kids learn how to negotiate situations with other kids, had a resolve contract, had a recognize what's going on, and someone else is, you know, eyes before they say something. We learn how to collaborate and play.

And with other kids is a lot. You learn on the playground, that turns out. But I worry that right now that we've almost somehow made that kind of on structure time seem inefficient. We've set these standards uh for our kids that they need to be uh you know getting fancy jobs s and into fancy colleges and making x amount of money in the path of doing that is you know to be enrolled in x number activities after school and to do all the stuff in school and their lives are so hyper structured um that I worry that the time to just play, to be creative, to reflect and think they just have on structure time with other kids has evaporated and I think that that also is hurting the mental helping while being of our children.

I love the idea that that unstructured playtime could be framed in the accurate context of the nerve system developing the way I was supposed to develop. I would argue that um success is going to be easiest for children that engage in the real world more. In fact, there's great risk to posting everything that you do online.

We've seen some examples of that preventing people from getting into a staying in college based on one things they said that did previously that they should to have said or done. That's those kind of a negative highlighted cases. But in general, we know that the the other system thrives on diversity of type of interactions and social interactions in particular.

I am just restating what you just said. So if ever there was a call for kids to get out into non screen life, let's call IT and engage their nervous system, that way, without question, is going to benefit them in terms of their ability to learn and retain information, perform well in school, which is not everything is about. But let's face that, we still live in a society where hitting those milestones on a consistent basis are the best, is the best predictor of people being able to live self, sustain lives, build families and that sort of thing.

So you mention a few actionable items for parents that relates to kids, and maybe, well, not maybe limits their screen time, forced them outside in the safe weather and safe conditions, of course. But what about adults as well? And what what can we all do? Should we be restricting our screen time to x number of hours per day?

I mean, you're the surgeon general if you had a magic one which I realized you don't um and you could make A A A highly informed recommendation about what the thresholds for too much time on social media are um what would I be? Two hours? Three hours?

yeah. If so, it's a good question. And let me actually go through some of these things that parents can can do for kids and that we can all do for ourselves. With kids in particular. Um what I would do specifically with social media is and this is this is Frankly what i'm planning to do with my wife for our kids as they grow up. Number one, I would seek to delay the use of social media past middle school, uh, at at minimum and I know that that is hard to do at a time when all kids are on social media, you don't want your child to be, tell them and left out and to be lonely is a result.

So that means no account of their own.

That means no account of their own. okay. And I would make seat to the best of your abilities. See if there are other parents that you can partner with to do this because it's hard to do alone as a parent. But it's also if there are other parents are partners with, that means you are other kids who are also delaying you, that means your child is not alone.

And I think if you start the conversation with other parents who will realize a lot of them are worried about the same things you are, they may have thought about use, but they also don't want their kid to be the only ones. So this becomes the numbers chAllenge. But partnership can help us if your child are already on social media. What i'd recommend is to create sacred spaces in their lives that are technology free.

And specifically, I would think about the hour before bed time and throughout the night as time that you want to protect as kids are losing not just sleep because they are going to sleep later because they're on their devices, but they are also waking up in the milk the night before, use the bathroom maybe to get some water, and then they get back on their devices again. So the quality of their sleep is being signally impacted by access to these device, sir, in the night. So I would protect that time ever before back through out the night.

I would also create, make sure meal times or tech free zone. So the people, actually, that you talk to one another, you see one another and time with friends and family members when you're out, you know, at a birthday party eeta think the tech free time, let them focus on their time with other people. Those three tech free zones can do a world of good, uh, to help your child.

And then the last thing i'd recommend here, the many things I think parents could do IT, is start a dialogue with your child about their use of social media. Um we don't always know how social media making our kids feel. And we may realize when we talk to them, they actually have their own concerns.

They might say, yeah, some making me feel really good but this is like card not to beyond and that wants like texting others or everyone is ah you know everyone's you know sharing information and posting pictures on that. I think I need to be on IT. You can only help them start to manage that if you know that that's a chAllenge that they are having. So opening conversations who your child knows that you're not judging them but you're trying to understand their experience is important also. So you can help that understand what is not acceptable for them to experience on social media if they are being harasser, bully by strangers uh that is a problem.

You want your child to tell you about that to report that um if they see something posted online that's really concerning to them, say they see a friend post, that they're thinking of taking their own life for harming themselves in another way you want them to know that that's important to flying and to get help, you know that they shouldn't just no score past that. So that conversation is really important. And finally, as parents, we can lead by example, right? And this is hard because the truth is we've been talking about social media.

U then that's what the subject of my certain general advisory was on. But I have concerns about adults too. I said, is somebody who's had chAllenges in my own news, you know, of social media finding sometimes bleed.

So, you know, past my bedtime and I realized, you know I think i'm in a checks, something for five minutes, an hour or later, i'm still there. You know it's rolling through something uh and sometimes I you know like, you know I find myself over over the years, I find myself comparing myself also uh, to post I see online in unhealthy ways. Sometimes I find myself um sort of pulled into uh content uh that uh you know ends up being angry and patriotic can leave me feeling worse at the end.

So i've experienced this as well. And I think his parents, one of the hardest things to do is to fall this advice for giving our kids to draw those boundaries as well and to put our devices away. When were around our kids? Uh, one experience I had, which I still feel bad about, but which really helped kind of knoxy m sense to me, was after my my son was born, my older child, I was actually, I was searching of that time.

You know, I had was the local, I was busy job exception. But I wanted to make sure that I protected bad times and meal times for our study together, a family yet one day when I came home, you know, after dinner when we were doing the bad time and bad time routine, get my and ready, uh, for the night, uh, my wife is changing his dip and instead of helping, I was just standing at the sites, throwing through my inbox. And my wife, who is infinite patients, said, is that one of the most well adjusted people that I know just passed? And he turned to me and Alice said, do you really need to be doing that right now? And he said, just very quietly, but I felt this like such a sensor, shame.

And he did that because was like, what am I doing? Like, this is my infant child. You know, in the rare few hours I have with them during the day, I am just song to my inbox, my phone like a like, this is terrible.

And look, I know that all of us do this and maybe in different context, but I was wake up moment for me because I realized that one like, as you know, well, as a neuroscientist, we can't really multitask right? We're rapidly tasks switching, right? And that was time in my when I head was in my inbox and my head wasn't with him, you know, my heart wasn't like them, right? I was just distracted.

And so as parents, if we can honor those sacred times, you know, when we're with our children to keep our devices away, meal times, sleep time as well, it's not easy to do. But IT really sets a good example for our kids. Um all behavior change that we're talking about here, the kind of behavior change I worked with patients over the years are in physical activity and diet.

All this is harder to do when were doing by yourself. It's a lot easier to do when where we have a couple of friends or family members. So we agree to do this with, we hold each other accountable, we encourage and support each other.

Um it's how i've been able to make the most successful behavior changes i've made in my life have come about because I have two good buddies uh and they even Sunny, who are my my part of my brotherhood and the three of us his brothers talk about health, we talk about our finances. We talk about our family and our friendships and our fAilings and we help keep each other accountable. And so I would just encourage parents like is to see that sounds daunting or overwhelming.

You don't have to do this alone. Think about one or two people are other parents you might want to do this with, and I caring to you. There are a lot of us a strugling with the same stuff, and they would probably welcome an opportunity to do this in collaboration .

with another parent. Spectacular advice that I hope everyone will follow, not just for their kids, but for themselves. I think that whether not social media is addictive in the in the true sense of the world is is kind of a meaningless debate at this point.

It's at the very least a compulsive behavior for many of us. And as you described IT in example, you gave IT becomes reflective. We're just and we're not certain ly seeking pleasure or looking to to engage in online battles. It's just it's become reflexive sort like finding yourself with your hand in the refrigerator, just even even think about IT and just doing IT yeah so becoming more conscious of the use and thereby more conscious of the value of putting away the screens and social media for extended periods of time each day and certainly in middle the night folks, neural plasticity, brain rewriting happens in the middle of the night while you are asleep and I this when you mention kids awake in all the night looking at their phone. I just just something .

oh my good just pains me and .

like i've looked in my phone in the bill and I D try not to but um but I am certainly not in the window of maximum plasticity either. It's terrible for everybody, but especially terrible for kids.

What you just provided IT is an incredible leit a all all a monday you didn't say about a suggestion of teeming up with people to become more like minded around these issues and to really promote health along those lines that I really want to thank you, first of all, for the conversation today. You're incredibly busy. Responsible for an entire country is the worth of people. So to take time to sit down with me and to discuss these topics for our audiences is incredibly appreciated by me and by them like I feel comfortable extending their gratitude here. And it's also clear, based on today's conversation, that you face an enormous number of chAllenges at the level of budgetary chines.

By the way, i'm going to work on that hard to shut me up um as well as that the huge ray of the issues that you can front and and it's clear that it's a chAllenge that you've embraced for many years now, hundred difficult conditions in that you're clearly willing to get out and talk to people in here, their criticism here, their concerns here um and learn from them. And so it's been a great benefit us to hear and learn from you. And I hope this won't be the the last of our conversations and there's many more topics to cover.

But just really want to thank you thanks ever so much for the the the intellectual power a and the emotional power that you put into what you do because that is very clear. You're a physician first and you care about your patients and your patients are all of us. So thank .

you so much. Thank you. I appreciate that. And i've loved our conversation. And you know for me what what I hope most of all for my kids, for country more broadly, is that. Is that we can go deeper like beneath these services issues. I've worried that we find ourselves, disagree about and fighting about online and recognize that there is a deeper chAllenge that we are facing that I think I realize a lot of a these the anger in the vitreal and this issue around how disconnected we will become from one another, I think, is at the heart of that.

I don't think that there's any policy here programme we can implement that's going to ultimately fix what A E society without fundamentally realizing that a lot of this is a manifestation of a society that has become more disconnected and more this invested in one another and over time, and that is not who we are, so how we evolved over thousands of years and how we're going na thrive in the future. So I know that sometimes when you look at these big intractable problems, uh, like widespread lonely in the united states, that I can see my hard to address these. But I do want to encourage everyone to to recognize that when he comes to human connection, that IT is small steps that can make a big difference, because we are hardwired to connect as human beings.

And if you, if you just pauses for a moment, and if you just think for a moment in your own life, about is someone who has been there for you during a time, a great need, somebody who has suit up for you and you couldn't stand up yourself, and someone who's helped remind you why you're still a good person, why you still have worth and value to add to the world. Even when you have lost faith in yourself, you think about their faith in you, about their support for you, about their love for you. Think about how healing that was.

That's the power that we have to help each other heal. We are going through an identity crisis in many ways as a country where I think we need to ask ourselves, who are we like? What defines we are? What are the set of values that we want to guide us in our life and to guide our country? And I know that IT feels like were a nation of people who are mean, only care about ourselves.

We're throwing blame and anger each other all the time. We're pessimistic about the future, but I actually don't think that's really who we are. I think at our heart, we are hopeful and optimistic people. I think in our true nature, we are kind and generous to one another.

Um in our hearts we we wear interdependent creatures who recognized that if someone else is suffering, we want to be out there to support them uh and we want want people to be there to support us as well. That's who we really are but we have to to make a clear choice here about our identity, you know as as individuals and as a country, and recognize that, that choice is real implications for everything else we're talking about here. That's the foundation.

And when I think about my own kids growing up like like many parents, I worry about the world they're coming into. Um I I worry that they're gonna use the wrong word even though their intentions are right and people can I blame them or cast them out? You know, I worried that they're going going to summer fall down and they were thinking, you walking by not caring, you know, because everyone's living their own life.

I worried that they might become someone who does the same thing. Other people, right? None of which I want.

What I want for all of our kids is for them to grow up in a society where we care about one another. We have each other other's backs, we recognize. And that whole african problem goes, that we can go fast if we go along.

But we really want to go far, we go together. And that's what I want for my kids in our country. But that's what we each have the power to create in our own lives. IT starts with the decisions we make. But how we treat one another, do we, for example, reach out for five minute today to someone that we care about, we pick up the phone and call them to say, hey, i'm thinking about you. We can all do that today.

Do we give people the benefit of our full attention, recognizing that while time is scattered, our attention has the ability to stretch time? I can make five minutes, feel like half an hour, but it's a hard thing for people to get because are distracted by their devices. But do we give people the benefit of our full attention? And do we look for a ways to serve one another, recognizing its tour active service that we actually forge powerful connections.

But we also remind ourselves how much of value we have to bring to the world. And this is important and a time when the selfish team of so many of us and our Young people particular is being eroded, a, particularly by their uses, social media. So these are the steps that we can take to build connection in our life.

But the core values, I believe, I have to be at the heart of our identity. These values around kindness and generosity, around courage and service. These also have to enemy the decisions that we make in our life, about programs we advocate for, the policies we support, the leaders we choose.

They should all be reflections of the values that we want to see in our children and in society more broadly. Because i'll tell you that ninety percent of plus of the decisions leaders make, they make behind closed doors, and what's guiding them in those moments of their values, that's true whether you're the leader of a company or or on profit organization uh, or a leader government. So those values matter.

And I want us as a country to speak more about the values that we choose, about the identity that we want to anchor ourselves to um that's the way in which I feel like amErica can be even greater beacon a of hope for the world because the world is strugling with this too. We're not the only ones who are dealing with the loneliness and isolation, who are seeing anger uh and resented ted bitrate al bub up uh at extraordinary levels who are seeing this trust and institutions sore. Many countries are experiencing this.

I would love amErica to lead the way in some ways and showing what it's like to embrace some more human identity that centered around kindness and service and friendship, uh, and generosity. Like to me, all of these values, ultimately Andrews them from love, right? Love is our our greatest source of power, is our greatest source of healing.

Uh, I see that as the doctor is prescribed any medicine over the years, but a few things more powerful than love in its ability to help us through difficult times and help mend the wounds seen and unseen uh, that we all Carry with us. And I think if we recognize that, we recognize that, you know, we don't have to have an md after our name uh or have gone to nursing school to be healers. We all have the power to help each other heal like Andrew, we are not fundamentally a nation of bystanders.

Ds which just stand by while other people suffer like our nation of of healers and homemakers, who can restore hope that the future can be Better, who can create a Better life for ourselves and the people around us right now. So we're capable, love and what we're beautiful. And that's him identity that I think we now more than ever need to embrace a man.

Thank you for that. Agree, love is definitely the verbs that can get us where we need to go. Thank you so much for your words, for your incredible efforts to support public health and leak to continue to support public health.

I know you've been at this a long time and we have all benefitted. And and thanks for your open windiness, especially around some of the questions that invoke some chAllenge again for your taking the time to come talk with us today. And I really also enjoyed IT.

It's been a real pleasure. There was a lot of learning for me. And like I said before, I hope I won't be the last time.

I hope not either. Now I look forward to the next time to stay in touch and just love this conversation. Thank you for what you've done for being this beautiful channel of information for the public.

But if you thank you for who you are, you know, like, who are Andrew? I come across very clearly, inc. You know, when I meet you, you just, you have a good heart, you have good intentions, a good man, and we will need more people like you in the world.

Thank you right back at you. Thank you for joining me for today's discussion with doctor vivid mercy, the surgeon general of the united states. I hope you found IT to be as informative as I did.

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