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

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and Ophthalmology at Stanford School of Medicine. Today my guest is Dr. Vivek Murthy. Dr. Vivek Murthy is a medical doctor and acting surgeon general of the United States.

As surgeon general of the United States, Dr. Murthy oversees more than 6,000 dedicated public health officers whose job is to protect, promote and advance our nation's public health. Dr. Murthy received his bachelor's degree from Harvard University and his medical degree from the Yale University School of Medicine.

Today's discussion covers some of the most important issues in public health, not just within the United States, but worldwide, including nutrition and the obesity crisis, as well as food additives and why certain food chemicals and additives are allowed in the United States versus in other countries. We also discuss mental health, the youth mental health crisis, the adult mental health crisis, and the global crisis of loneliness and isolation.

We also talk about corporate interests, that is whether or not big food and big pharma industries, actually impact the research and or decisions that the US 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 will also come to learn that as surgeon general, Dr. Murthy has both an extremely challenging job, but one that he meets with a tremendous amount of both rigor and compassion.

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and 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 the sponsors of today's podcast. Our first sponsor is Maui Newi Venison. Maui Newi Venison is the most nutrient dense and delicious red meat available.

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Vivek, okay. Vivek, my understanding based on my internet search is that the role of the US Surgeon General is to provide scientific information on how to improve health and reduce risk of illness and injury. Do I have that correct? That is correct. What are some other roles that you play that perhaps would not come up in a 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 generally explain to people.

There are two primary roles the Surgeon General has. One is to engage with the public and make sure that people know about critical public health issues. So they know what they are, how to protect themselves and their families. The second role of the Surgeon General is lesser known, but it's equally as important, which is to oversee one of the eight uniformed services in the US government. And that is the United States Public Health Service.

Many people are familiar with the Army, the Navy, the Air Force. We also have the US Public Health Service, which is 6,000 officers. They include doctors, nurses, physical therapists, pharmacists, public health engineers, a whole range of health care folks. And their job is to protect our nation from public health threats.

So when Ebola came on the scene in 2014 in a major way in West Africa, we sent hundreds of officers to West Africa to set up the Monrovia Medical Unit in Liberia to treat people with Ebola domestically. When there are hurricanes or tornadoes, we dispatch officers and deploy them to go help strengthen the social, the public health infrastructure, but also to provide direct care. We deployed thousands of officers during COVID. So these officers, I'm incredibly proud of them.

They could be doing lots of stuff, you know, outside government in the private sector, probably making a whole lot more money and getting a work in all less hard, but they're really committed to protecting the public health of the nation. So I have the privilege of overseeing that services, Surgeon General, and those are the jobs that I've signed up for in this role.

God it, I was not aware of that role. And if I understood correctly, these people, these public health officers that presumably are made up of physicians and licensed psychologists and nurses and so forth, you said they could be making substantially higher incomes in the private sector, but the work that they're doing with you is their sole career at this point. They're completely devoted to that or they're doing this as a side hustle.

Now, they're a full-time government employees and members of the public health service. Their day job is often in public health agencies where they're embedding communities helping day-to-day to advance public health. And during times of emergency, we deploy them. And they're extraordinarily well trained. They're experienced at dealing with adversity, but they bring a combination of skill and heart to their work. And you really need both to be effective at public health.

I'm glad that you mentioned the word emergency because in preparing for our discussion today, it occurred to me that in this list of roles that your title assumes, that scientific information on how to improve health comes first. Then you mentioned emergency. So what I'd like to talk about first is health, not lack of health, but health. So often we hear about the mental health crisis, but what we're really talking about is the lack of mental health crisis, aka mental illness.

And rarely do we hear, for instance, what constitutes mental health. We hear what constitutes mental illness. Whereas in the domain of physical health, there's a lot of information out there about how to be more physically healthy, cardiovascular exercise, resistance exercise, yoga type exercise, mobility, etc. And of course, some people have physical health ailments and there's a lot of information in terms of how to deal with that as well.

But what I would like to know before we get into the long list of issues that 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 10 years, have there been any areas of physical health and mental health improvement in the US at large that we can attribute to some of the public health initiatives directly? So that's a really good question.

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

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

I may not be able to lift my luggage when I go to the airport because I don't have enough strength in my body. Yet I wouldn't have a diagnosable mental illness. So I think it's easier to understand there with physical health that we're not just aiming for lack of illness. We're aiming to optimize our physical health. The same is true with mental health, and I think when we talk about mental health, people think we're just the sole goal here is to prevent diagnosable mental illness.

That is one goal to both prevent and to manage mental illness when it arises. But we also need to recognize as a whole other half of the spectrum where there are people who may not have diagnosable mental illness, but are not operating optimally in their lives. And that's detracting from their fulfillment, from their functionality, like in not just at work, but also in their communities and in their families.

And so I think part of the conversation that I want us to have as a country is about how to optimize mental health and well-being. And that includes preventing mental illness, but it is much broader and bigger than that alone. Great. I think it's so important that we recognize that treating diseases 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 you've got all these officers, these incredible physicians and nurses and people at your disposal. My hope is that they would also be accessible for and currently carrying out efforts to transmit information to people about, hey, here are the things that you can do every day, every week, every month in order to make your life as healthy as possible, as well as rushing in under conditions of public health crisis.

Yeah, it's a good point. And it's certainly many of our officers do focus on this broader rubric around well-being. But it's part of how we need, I think, 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.

And I went to medical school to vast majority of the focus was on diagnosing and treating illness. It was much, much less focus on thinking about how to enhance well-being. And when we ask and talk to people in their lives, it becomes clear that they want to do more than just prevent diagnosis of illness.

They want to be able to walk their child down the aisle. They want to have the endurance to do that. They want to be able to be independent often and carry their groceries or carry their luggage. This is why I think we've got a broadener focus in public health. And look, when I came into this role, by the way, I was not expecting to serve in government. This is not part of some 5, 10, 30-year plan.

When I was a kid, I was interested in medicine, but I always thought I was going to practice medicine like my dad did and the clinic, my mom ran. You know, set up, put up a single C-patients and be a primary care doctor and feel good about the work I was doing. But what happened to me along the way is I trained in medicine. I got interested in technology. He spent seven years building a technology company that was focused on health.

I was, I was, I became increasingly worried about the way we were delivering health care. I felt like our health care system was broken. People in needed care couldn't get it. It was often too expensive to get care. We were focusing on treatment solely and not enough on prevention. So I started getting involved in advocating for a better health care system with doctors around the country.

When despite all that, I still never thought I would work in government. But in 2013, is when President Obama's team had reached out to me and asked if I'd be interested in considering the position of Surgeon General. And what was interesting to me about this position is it's actually very different from most positions that are appointed by President and government in that it's supposed to be an independent position.

So my agenda, the issues I choose to take on are not determined by a president or a party. They're determined by science and the public interest. And that's what guides me. You know, and that's what, that's what guided me in that first term when I served and when President Biden asked me to come back and serve as Surgeon General. Second time, that's what's guided me here too.

So Biden is not sending you notes saying, hey, could you put some effort into getting messages out about COVID or could you put more effort into getting your team over to Maui to deal with the, you know, the tragedy there. And which is a long arc tragedy, right? We get the news in a blast of this happened. And then the next blast comes in about something else. And we forget that there are physical and mental health crises that are ongoing.

And then I have to imagine then start to overlap with one another. Or is it, so is it your decision where and how to deploy the financial and human resources? Okay, we're going to put 10 people on Maui. Yeah, we're going to put, you know, five people in the central states, you know, going around talking to major organizations about what they need to do to prepare for this winter.

Is that how it works? Or are you getting memos? And in other words, who's your boss? Everyone has a boss at some level. The winner is the listeners of this podcast at some level. I work for them. It used to be also be my bulldog Costello. But my boss, my wife and my two kids were five and seven. They I do what they tell me.

Got it. Got it. So, but how we make our decisions in the office, actually, it's a bit different with those two roles. So on with the second one with overseeing the commission core, our 6000 officers. And there are the decisions about how and when we deploy officers are collaborative. Right. So, you know, we work with other colleagues throughout the department of health and human services. We work with people in FEMA across the administration.

But we also work with states. So sometimes states, often often states will put in a request and say, Hey, we need support here. Can you help? So we'll work with colleagues across our department to say, okay, we'll, we can mobilize our commission core officers.

Can you mobilize and then collectively, we will send a team out there. So, for example, we have officers helping in Maui right now, particularly with mental health needs, which are I worry when they're going to continue to grow over the weeks and months ahead. On the other side of the house, when it comes to deciding which issues we engage with the public on like in this case, mental health has been a big focus area for me.

On that front, while we certainly, you know, are open to suggestions from the public, members of Congress sometimes say, Hey, can you help the public understand about this issue? You know, a lot of people have ideas and opinions, but the decision about which issues to focus on those are our offices.

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 offices because they hope that the office was functioning the way you hope your doctor is functioning, which is being an independent source. Of information for you and a source that has your best interests at heart that's not being pulled aside by political interests or by other agendas, but the primary agenda is how can I help your health.

And so for me, like, we have to make an independent assessment there and say, Okay, where is the need the greatest here? Where can we make the biggest difference? Sometimes we may not build an initiative on an issue and that doesn't mean that that issue is not important or that it's affecting a lot of people, but we have to make hard decisions about where to pull limited resources.

And so when I was a surgeon general, the first time one of the big areas I focused on was the opioid crisis and that we're dealing with as well as the e-sigurate use among youth because we were seeing a dramatic increase among kids in e-sigurate use. Can I just ask you sorry to interrupt, but I think it's relevant here. Has that increased continued or e-sigurate use? Okay, vaping.

Yeah, so we still see unfortunate there. There's been some improvements, but we still see way too many kids who are using vaping devices early on. And part of what we did from our office is recognizing that we actually issued the first federal report on e-sigurates in youth.

We call the country's attention to the fact that this is a crisis we worked with members of Congress to talk about the kind of action we needed from a legislative and regulatory perspective and work with colleagues at the FDA and in government as well.

But there are two things that are really most important in guiding our choice about priorities. One is data. We look at what the number numbers actually tell us about the impact these issues are having on the population as well as the trajectory of rise if something's getting dramatically worse and people don't realize it might be an area of our focus.

But the other critical factor is what I hear from people on the road. So I try to spend as much time as I can visiting communities across the country doing town halls meeting with community members and just trying to frankly just listen to what's on their mind. And that's where I actually get a lot of information as well. That's actually how I came to focus on the issue of loneliness and isolation.

It wasn't because it popped up in a report as being the leading public health issue in the country. It was because everywhere I was going in 2014-2015. Whether I was talking to college students, talking to retired Americans, talking to parents in rural areas and urban areas. I kept hearing these stories about people who felt like they were all on their own or they felt invisible or they felt if they disappeared tomorrow.

No one would even care where they felt like they just didn't belong. And it's heartbreaking to hear that from anyone. It's particularly heartbreaking to hear it from kids who you hope are entering life and looking forward to what comes. But many kids weren't feeling that way. That is very useful context. And we will get back to the isolation crisis, such an important initiative that I just will thank you now for having put out the message on social media and elsewhere about that.

Because I think one of the questions I have in light of what you just said is it's clear that you got your ear to the ground, you're talking to different people. It's also critically important that people hear from you and know not just what's happening but that you perhaps want to know where the issues lie and what the actionable steps are that people can take.

And I think that we now live in a hyper connected world. So, you know, in fact, I'll just say that one of the reasons I launched this podcast is in 2020. I was going on podcast talking about things like maintaining sleep and circadian rhythm and stuff from my lab related to trying to adjust anxiety under under conditions where I think everyone was anxious and sleep rhythms were disrupted, etc.

And I was somewhat surprised that I didn't get a warning on my phone. Hey, make sure you're getting warning sunlight. You know, like I'll get a flood warning. You know, I'll get a warning that I might get a warning, but it's only a test warning. I'll get three of those yesterday living here near the coast.

But 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 to have to be mindful of maintaining your circadian rhythm because if you're not, I mean, we know based on hundreds of studies now that Drifts in circadian rhythmicity are a precursor to mental health issues.

I mean, in fact, there's a new idea that many not all suicides are preceded by a period of disrupted sleep, which is, you know, kind of makes sense. And it's not a causal, of course, but how come during the pandemic, we each and all as US citizens did not get an email or a text message saying, hey, these are five things that you need to do every day to try and stay as stable as possible in this very uncertain landscape that we're in.

Well, it's a really good question. And I think it's a reasonable and a very good suggestion to say that, hey, look, there should be a clear and comprehensive way that we can get messages out to everyone. Like if we were working in a hospital system and there was a safety issue that came up, they would be an email sent to all the hospital staff members saying, hey, this is something you need to be aware of.

Right. So I think it's a reasonable expectation. Practically, if you go back, hello, of last 20, 30 years from on a health issues, there hasn't been sort of an agency or an entity that has sent emails out to everyone. First of all, how to send an email out to everyone in America is not a simple proposition either technically it's challenging. There are some legal issues you'd have to deal with as well.

You could do a night where you go CNN Fox NBC ABC New York Times Wall Street, like you could hit the right, the right wing, the left wing and every. Yeah, that's really interesting. But one, one video, just where they all agree, like, hey, this is important information. So a political, like, no, yeah.

I would say that that kind of messaging, I would say through traditional media certainly has happened, you know, and it happened during COVID, it happened, for example, when, you know, in the first year of COVID, I was a private citizen, you know, in the private, private administration, but I, you know, I watched both then and at the beginning of the Biden administration.

And so, you know, the first thing that officials would go out in front of cameras and say here are three things you need to do to keep yourself safe, you know, from from COVID as, and that was a big question people had, how do I keep myself safe? Okay, here are three things you can do. A couple of challenges, I would say here is that number one, even if you hit all the major network and cable news shows.

You're still not reaching everyone, right, because we're living in a society where increasingly people are not watching TV, right, they're getting their news from other sources. The other thing that's important to know is that attention shifts quickly, you know, in traditional media also from issue to issue.

And so you might get a clip, you know, out at a certain day or you might get on all this Sunday shows, for example, but the next day, you know, that message isn't necessarily there, you know, it's it's gone and people's attention has also switched off too. So they were, I mean, I can count. And you know, we've logged probably thousands of interviews at this point that we've done with mainstream media with sort of, you know, concise messages about three things you can do to protect yourself, etc.

And you know, I'm glad we did those, we got to do them. But I think one of these we don't we don't have right now in the country. And this is an I think a bit of a health infrastructure challenge is we actually don't have a quick, efficient way to reach everyone in the country with a health message.

Just like what you said, you know, what are you wanted to get that message about three things to protect yourself from, let's say, COVID or three things to do to, you know, support your health and well being during a time of crisis. Or during a time of health. I mean, again, like not just the flood warning. Yes.

The daily, because I do think that most of mental and physical health is the result of daily practices that are, you know, the build on themselves sort of like compounded in, compounded investments. And then of course there are acute challenges and chronic challenges that face. But there are things that that sort to I think those kind of messages in time of health that are absolutely important as well. And, you know, I think I think in the sort of.

I think fast paced crisis driven environment that we live in. Unfortunately, people are often less or paying less attention to those maintenance or an improvement messages and they are to managing the crisis messages. But I think that they're equally as important. But I do think that what you're pointing out is an infrastructure piece that that needs to be built, which is a way for, you know, health authorities to reach people, you know, with information quickly and comprehensively.

I'll just tell you that in the 1980s when C. Everett Coop was the surgeon general. One thing that he had done, done, which was interesting is he had actually sent a letter, a physical letter to all households in America about HIV. Physical letter, a physical letter. Some of our listeners won't know what that is.

So, you read about the history books. There's only shows up in your mailbox and you open it and hopefully something you want to read. But this case, this case, he was worried about HIV about the fact that people didn't know about it. He worked through and with, as I understand it with a member of Congress, found a way to do this from a funding perspective. But it was a very unusual move and one that was never replicated since and there was never infrastructure funding to do that again.

When I was a general last, you know, some years ago and then this time around, one of the things I did do is I was able to send a physical letter to the medical community. The first time it was about the opioid use crisis and about changing our prescribing practices in medicine so that we expose fewer patients to the harm of opioids while making sure people who needed them actually got them.

The second time it was about COVID therapeutics. It was about making sure that when we had data about medicines that actually work like packs of it that we may actually offer them to patients made them available to patients because we were realizing that many people weren't getting offered, life saving medications, even though they were in high risk groups.

So we were able to find, you know, and we had to, again, there too, it was sort of creatively cobbled together resources funding is all sort of, you know, is sort of behind the scenes government stuff. But bottom line is that you want an emergency.

And what you want, I think, in the long term is a simple, clear, comprehensive way that public health messages can get out to people. And to this day, what we still have to rely on are one traditional channels, like, you know, traditional media to cover the initiatives we put out. Whether it's on social media, and youth mental health or on loneliness or on youth mental health more broadly, we rely to rely on online channels, which we do as well.

Or we have to look to creative partnerships that we build with people who reach different audiences. And then together we try to get a message is our office does all three of these, but it's a patchwork. And, and, you know, and it's not always ideal, but it's what we do now. I think part of what this reflects is a broader challenge, like in government, but also society more broadly, which is that we have valued historically prevention and health communication very little.

And we put the mass majority of our resources into treatment strategies into getting medications to people into diagnosis. And that's very important. Don't get me wrong. But we are now seeing with mental health 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, but we just can't keep up.

Because one problem feeds the other, but the kids that are state, listen, if I would grown up in today's era, I'd be on my phone and tablet late at night, because I was up reading magazines and talking friends on the phone late at night.

So it's not a criticism, but, you know, disruptions in sleep, disruptions in circadian rhythm, disruptions lack of physical activity, poor nutrition, social isolation. I mean, these are all piling the sand much higher on this in this other side of what you do in terms of, and here I'm obviously stating the obvious. You know, so it's just going to create a mountain of issues on the other side, which presumably has a larger budget is what I'm sensing, but doesn't.

But there's no way that budget is large enough to deal with that. I mean, if somebody's kid, for instance, is trying to address the issue of whether or not to go on prescription medications and or, by the way, folks, and or change their dietary intake because they feel they might have ADHD, for instance.

I mean, what are they going to do? They're going to Google, they're going to listen to podcasts that they they should be able to write first to your organization and say, you know, what is the highest level stringency. Data say about these issues and AI should be able to tell them accurately. Yeah. And maybe you have somebody chime in for them. I mean, we all pay taxes. I pay federal and state taxes.

And to some extent happily so. Right. Because it pays for public works and many, many important things, police officers, firefighters, et cetera. 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, it feels like it's, it's a cul-de-sac. It's like how in the world can we get healthy again or healthier as a country?

The part that keeps me up at night is, and one of some of the hardest decisions I have to make in the office are putting aside issues that we no deserve a lot more time and attention. But we just really don't have the resources to deal with, you know, the issues that we have dealt with. I'm certainly proud of my team that we've worked hard to try to raise awareness of the issues we have taken on, whether it's around, you know, social media.

And youths and mental health or whether it's around isolation or clinical clinician burnout 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, you know, talk about what I think of as a core pillars of a healthy life, right, which are sleep, our nutrition, our physical activity, our social relationships.

Like these are all vital elements to living a healthy life. Right now we're not teaching kids about this in school. Right. But if you think about education and school as a place and a force that should prep, prep kids for the rest of their lives, it should lay a foundation for a healthy life going forward.

These absolutely are important elements for kids to learn about. I think it's as important for kids to learn about how to build and maintain healthy relationships in their life as it is, frankly, for them to learn how to read and write. And I know that's a strong statement to make, but it is true in terms of its contribution to their, their happiness or fulfillment, their health and their success.

I could not agree more. We have a series that's out now with a psychiatrist, a Paul Conti about mental health, not mental illness, about self inquiry and how to use self inquiry and practices that do not require a therapist in order to bolster mental health. Of course, therapists can be very useful, but not everyone has access. Right. And not everyone feels comfortable doing that.

But we are, but one channel. I mean, you are the governing body for this. You're the army, Navy and Marines, so to speak of health. As many of you know, I've been taking AG1 daily since 2012. So I'm delighted that they're sponsoring the podcast. AG1 is a vitamin mineral probiotic drink that's designed to meet all of your foundational nutrition needs.

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There's lots more to explore there. We may have to do several of these together, but to touch on all of them. But maybe we could talk about a few of the things that our listeners asked about when I solicited for questions. And I got more than 10,000 responses across social media in a very short amount of time. But there was some redundancy. One of the things that I'm very curious.

Can I just say on that point, one, I'm really glad that you asked folks to submit questions. And it was really excited to see how many people actually wrote in. But I think it's also just a testament to how you've done such an incredible job of building a channel to the public to let people know about these topics that are so vital to our health and well-being, whether it's sleep or physical activity or mental health.

And so I just want to thank you for all the work you're doing trying to help people understand more about health. And clearly the fact that folks are engaging, they're sending questions and they're sending comments to you means that you're building a relationship there with a lot of folks. So just kudos to you for doing that.

Thank you. The audience of the Huberman Lab podcast is the only reason we do it. I mean, I love learning and teaching, but that's the truth. So they are the podcast. The podcast is them. So thank you for that. There were a lot of questions. And I also wonder about why is it that many food additives and preservatives and dies and things of that sort that are not allowed in Europe or allowed in US food products.

So really good question and decisions around food and food safety in particular are made by the food and drug administration. So that's the FDA. It's not it's a separate agent independent agency. It's not one that our office is involved in and sort of directing in any way.

And so we're not involved in those decisions and don't have insight into how they're making their drawing their conclusions, but they do it in a process that's guided by science, just like they do and with medications with devices, etc.

With that said, you know, I am concerned that dietary practices, the food that many Americans are consuming are in fact not supporting the health and well being 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 is very high.

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

And that worries me the also other piece of this that worries me are just how much we're you know we're fine sugars are being added just so much of our foods and most people think that sugars are only added to things like desserts, etc. But you look at spaghetti sauces salad dress and salad dressings a lot of these things which we think of as savory products.

And so we are consuming. I think unhealthy levels of sugar in our diet we're consuming a fair amount of additives given the process food composition in our diet. And I think part of the reason this is happening and there won't be very clear I don't fault individuals out there for the composition of their diet necessarily because we have also made certain decisions in our country about what we subsidize about the diet.

And we subsidize about what's cheaper and more expensive for people and the cheapest foods unfortunately are often the most unhealthy foods the most highly processed foods if you are somebody who lives in the low income neighborhood.

Number of these neighborhoods don't even have grocery stores in them which is a tragedy because you can't get fresh produce etc. And your shopping your grocery shopping may be done at a local convenience store at a 7-11 or somewhere else that may not have like the array of fresh fruits and vegetables that you and your family need. I don't even think they have vegetables. I think they have they'll occasionally have some lemons or apples or oranges of bananas.

But when I walk into a convenience store what I see as a pharmacy I really do I see alcohol caffeine energy drinks that have a number of different things in them designed to stimulate different neuromodulators like dopamine and serotonin. I see nicotine products I see high sugar high highly processed foods and keep in mind I was a teenager I mean I drank my slurpees I had my butter fingers you know I wasn't you know Bart Simpson like in my level of butter fingers but I liked them.

But it was it was a smaller fraction of what we ate and when we were at home those foods were either not available or we weren't we certainly weren't allowed to eat them and add libdom you 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 papers published in high quality journal showing that if people eat just high just sweet and savory 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 satiating okay.

That sort of a duh to a lot of people but I think it was an important set of findings because it said the brain actually changes in response to the very rich flavorful foods that are associated with with highly processed or even moderately processed foods okay I mean.

That's just a couple of studies there was nothing in those studies that said if you eat these foods you're going to develop cancer but you know at some point one has to as a citizen a tax paying citizen speaking on behalf of many other tax

things as I have to sort of take a step back and say how long do we wait right do we have to get a randomized clinical trial about the you know the you know the five 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 processed vegan or unprocessed meat and vegetable or unprocess you know starch and vegetable I mean I mean then we're talking about a 30 year health crisis before we intervene

why not I mean if I were in charge which I'm not and clearly I wouldn't survive in a government organization because well I got the uniform down I was where the same thing but 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 AI generate text message that tells everybody in all the languages that Americans speak and can understand

hey you get to make choices about what you eat but you should be aware that making your diet comprised of more than 15 to 20% of these foods is potentially going to lead to serious issues down the road and those serious issues are extremely serious I mean the obesity crisis is really a crisis of both body and brain metabolic challenge that we can talk about so you know who sets the thresholds you know in other words why is it that in this country we have a

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 the wealthy people I know care a lot about their food sources and they pay a lot of attention to it and why aren't we allowing everyone the opportunity to make better choices.

So this is the right question and this is something I think about a lot because I'm conscious about what I eat But I also talked to folks around the country and realize a lot of people don't have either the information Or the resources actually purchase healthy food right and to know like what's gonna be good for them and for their families This is why you know, I mentioned we have a list of issues that you know, we would work on You know if we had more more more resources

This is actually one of them because to me one of the most common questions people ask is What should I eat?

That's simple, but it's it's a vexing. It's complicated and it's incredibly confusing if you go online and just try to search for information And it's a classic example of where it's important to have an objective scientific Authority that can come and then speak on broad principles around diet They can talk about what we know and don't know so the here's an important thing I think a lot of times

People may see something as you know on the market. They might really list of ingredients They don't recognize half of them because they're additives, but they figure well if it's there Then it must have been studied for 30 40 years and there must be no harmful consequences, right?

But sometimes things are put out there because we have short-term data that says that they're okay and there might be But there may be a need for more long-term data helping people understand what do we know what do we not know is important so that people can make Decisions for themselves based on how much risk they want to take the other thing that the concerns me here Andrew is I You look I'll I have I'll tell you I have a bias here and my bias is that I am worried about the

You know additives and other products we have in food. They don't have long-term data That's clear in terms of health risk and so because of that like my bias is generally to think how can we get people? You know minimally or less processed foods and how can we get the more fruits and vegetables? How can we make sure that they have that more available to them?

But we've got to not only meet the information available But we have to make it accessible from a cost perspective if you don't have a grocery store in your community If vegetables and fruits cost three X what other foods do that's gonna be a problem right to change diet the other thing

We have to keep in mind is that you know food companies, you know a lot of them do a great job of actually trying to get Healthy nutritious food out to people, you know and kudos to them But I worry also that there's an incentive also to just try to sell more and more more of your product

And one of the ways to do that is to try to hack the body to kind of figure out okay Well, what kind of synthetic additives could I put together here or what kind of Combination of nutrients could I put together that will get people coming back for more and more and more and more?

We saw this in the nicotine industry You saw the nicotine industry you also I would say another in parallels you see it in social media as well where the Business model of the social media platforms Is built on volume of use right how much time am I spending on the platforms? It's not quality of time. It's quantity of time right?

So if that's the business model then you're going to design your platform to maximize how much time someone spends on them Regardless of whether it's detecting from sleep

You're tracking from in-person interaction detracting from anything else. It's healthy regardless of whether that may be causing certain harms right like The business model dictates, you know In many ways how these things are designed and that applies I think to food as well So which is why I think it's incumbent upon us to be particularly cautious With highly processed foods foods that foods that have additives and to understand how is this impacting our brain?

How is that impacting our satiety? How is it Leading potentially to greater ingestion that is healthy and leading to things like obesity which have a whole host of other Medical conditions from cancer to arthritis to diabetes is so and heart disease is associated with it those are the questions as a

As a citizen as a father of two young kids who's trying to bring them up at the with healthy lifestyle Those are the questions that I would want to know the answers to and it's one of the reasons I think these kind of objective Reports are so important for the public

I'm starting to see the the scope of the problem and the mechanics involved in trying to alleviate these issues are complex I I see that they aren't also to one of the things is important to do that though is you need to have authorities That can speak to these issues

Better insulated from political retribution right so and do you explain this like I mean to that yeah Yeah, I mean listen to somebody forgive me for interrupting me somebody who from time to time will Make not recommendations, but will offer information about potential actionable items you know things that people could do or not do according to a couple of studies that come have come out I mean I've come under intense scrutiny from my colleagues

Um who are like wait that's not a randomized controlled trial. How can you do that and yet I know from being in this field for a long time that for instance the emerging therapies for for PTSD and depression that are now based on federal funding for things like

And I'm not recommending this by the way for children or for everybody, but for instance the macrodose psilocybin therapeutically supported legal use of psilocybin for Major depression the data there are they're not perfect, but they're pretty darn good compared to the major SSRIs

um, but for years if if an academic said the the words I just said they'd lose their job almost instantaneously Because they're controlled substances Um, that's that's a 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 right if people understood I think that um

It sugar poison well some of my audience will say sugars poison. It's as addictive as cocaine. Look it is not as addictive as cocaine or heroin It is not however if a child or adult is eating Very sweet or very savory foods of any kind consistently if those are not

Healthy foods or 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 gonna end up with a sick individual period And I don't think we need one more clinical trial funded by federal tax dollars to support that statement What I'm starting to gather is that you're a very rational grounded broad thinking individual

I'm not just saying that because you're sitting here and you're trained in medicine and you understand the science uh But that you don't have the Means that your disposal to put out a call that says hey folks having some sugar every once in a while it's reading the kids to ice cream great

But if 80% or more of the diet of our kids isn't made up of Minimally or non-process foods their brains are gonna be rewired in unhealthy ways and you can almost expect That they're going to have some health challenge in the future that may not be um you know Autism or schizophrenia

But is going to be a major health challenge of a bit and that is serious and now's the time to intervene by avoiding certain things Yes, and if you don't want to do it look it's a free country at that level You're welcome to do it

But you'd be better off spending x number of dollars on these healthier foods. Yeah because there's also and we know this from my colleague Ali Crumb Laboratory at Stanford that even the mere knowledge that certain foods are nutritious Can lead to more satiety from eating those foods at the level of hormone release Not just psychologically you're telling yourself whether the orange is as tasty and and filling as a candy bar but The understanding of

The fact that it is nutritious actually leads to shifts in patterns of you know, grill and secretion etc That that chain so people can be feel better on a healthier slightly lower calorie nutrient and rich diet Yeah, healthy proteins and fruits and vegetables

And it's not a mind trick. It's it's physiology. Yeah. Anyway, I think um I feel your pain Yeah, frankly, and I'll tell you look sometimes people ask hey, why don't you just go and say a couple of statements Are you just said when that be fine like why? Why's time needed to prep someone that why are we sourcing it etc Here's actually why that I know it in today's day ages easier to just go and like rattle off off You know off the golf statements or shoot from the open social media channels

And really to get the word out to millions. No, I appreciate that and that may take you up on that But I'll tell you that one of the reasons one of the things we always do recognizing that when we put out statements that people people One they they trust it's coming from a scientific authority and that it's been vetted right So we put the effort and time into vetting this thoroughly

We check sources. We look at the data. We talk to experts. We think about how to communicate this in the right way That's the work the behind the scenes work Sure That we do before we put out sort of reports and initiatives because we want people to have confidence You know in in what they're hearing we also know that when we put out initiatives That other people build on them philanthropists, you know and foundations will then think about should I fund work in this area

You know schools and workplaces will think about shifting some of their practice policy makers We'll also think about legislation that they may want to design based on that So we want to make sure it's really solid But the point I was making when I said also that we have to make sure that not just our office 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

Retribution and taxes. This is what I meant which is that is saying things about diet saying things about tobacco These can be challenging for some folks because their industries built around these right which may not always like what you have to say If it hurts their business model or their bottom line and they may then lean on Political leaders elected leaders others to then try to silence you or shut you up And I'll tell you I've experienced this in the past, you know

Then I was surgeon general during my first term. I had issued two 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 they were plenty of people who are very unhappy that I was issuing the first federal report on e-cigarettes Folks who felt that hey

This is going to make folks unhappy. It's going to create political pressure It's going to create a lot of problems 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 don't you just focus on other drugs?

Why don't you take alcohol out of the title? You know all of these sort of you know Concerns were telling you this so so are people who get paid by the alcohol industry? No these are people in government who are reading the tea leaves and 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 you're also going to help a lot of people Yeah, well, this is what it comes on to they say well

And if you upset folks then they're going to try to fire you they're going to try to do all these things to which honestly like my My response to a lot of these and the reason we just put them out anyway Was because I said well the worst thing that can happen Is I get fired and that's okay You know if I if I go out knowing I did the right thing here Then I'm fine with that. I'm not looking to build a lifelong

Career in government. I'm not doing this job to like you know get to the next thing on the ladder or like it This is about serving for the time I can I want to be able to go to sleep at night look myself in the mirror I know I did so with integrity So that was an easy decision for me, but But my point is that like we have to be thoughtful that in these issues that

They're going to be headwinds right? I'm sure in your case for example You probably gotten pushed back from folks about talking about certain things that may have wrinkled

Uh folks who may have had an interest in those issues, and that's okay. You keep talking about them as as you should and I'm grateful for that um But this is especially important at a time where I think public trust in Our institutions more broadly and in science and in medicine have taken a hit over the last few years And I think it's a time where we have to be even more vigilant Uh those of us in medicine and public health to make sure that what we do is based on data that we're transparent

About why we're saying what we're saying that we're also clear about what we know and what we don't know So that if recommendations change over time people Recognize that this isn't necessarily flip-flopping you should change your recommendations if the data changes Uh if the circumstances change so Anyway, this is all part of the work that we've got to do But to me this is a really important part of the work the integrity behind our work in public health is not just about the issue

We're taking on today. It's about the trust that we need to rebuild uh in the field more broadly So if I understand correctly If you were to for instance put out a call that says look you know There are food additives that are allowed in the US that are not allowed in Europe that may be of risk We don't have enough data at present to say to avoid these things But here's a kind of a yellow zone, you know, you're 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 It's free country, you know There are people that argue it's not but at least at the level of which foods you want to buy with your own budget

It's it's a free country. So you're 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 theorist But there has to be either the people that are saying look there could be problems are just

Friction averse they're just don't like anyone to be angry at anyone or There there must be some incentive for things to remain quiet I mean, I mean, totally 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 their success So I'm confused I'd like to know more about the the back contour of this Well, look on I think and this is not too dissimilar for I think what happens in you know their industries But it's you know Whenever you do something in Whether it's in the private sector and government people weigh what what are the pros cons? What's a pushback? I'm gonna get how do I deal with that pushback right?

Uh, and pushback isn't always a bad thing right if you get pushed back from the public people Hey, that doesn't make sense to me etc That's you should listen to that and then use it to inform your approach

But that's the public who's your job is to serve. I'm talking about pushback from companies is different Right so when pushback comes from people who have a financial interest In the product that you may be commenting on Then you you've got to be you need to know about that number one so that you know how to how to mitigate it And while people may take different approaches to this my approach as a public official as surgeon General has been to say at the end of the day

Like I'm happy to to hear from anyone in terms of their concerns or pushback But the end of 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 and the public interest and if that means it's politically inconvenient That's okay if that means that you know something happens You know to my job that's okay too, you know like we look the bottom line is life is short

We don't know how much time we have here. We may as well make the time we have count. We must do the things That are right and that are going to serve people That's my simple philosophy my parents taught me when I was growing up So that's the approach I bring to this and that's why if we were to do let's say

An initiative on diet. I have no doubt that some of the things that we would say would be perturbing To folks who had a financial interest in industry because I don't think that the current setup in the industry is serving the public well I think we have made unhealthy foods cheap. That's a problem

We've made healthy foods expensive. That's a problem. We put health From a dietary perspective out of reach for millions of Americans That is a fundamental problem and we've also Disempowered people with but that by not giving them the information that they need to make decisions So even if you have resources I guarantee there people listening to this podcast and many more people out there who go to the grocery store and just feel confused

Like what on earth should I buy what's healthy? What's okay anymore? Um, it's just hard to know and so I think we've done a disservice by not doing more to help the public understand and access Healthy foods and again, it's why it's an issue that You know that that was on our list of issues that we would want to work on because I think that the public health need here is immense I'd like to just take a brief break and thank one of our sponsors, which is element

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If you'd like to try element you can go to drink element that's LMNT.com slash Huberman to claim a free element sample pack with your purchase again That's drink element LMNT.com slash Huberman I have a question about trust in big institutions and public health initiatives in general

The question is about masks Um early in the pandemic as I recall we were told that masks were not necessary then we were told they are necessary and I think for a lot of people That flip in messaging Um landed like a parent telling their teenage kid to always wear a seatbelt

But then you look into the front seat and almond ad aren't wearing seat belts and is anyone who's been around teenagers There has been one you make that mistake once you're not making it again And you may never recover from that particular example in other words the public felt like There was a switch of messaging But what I don't recall happening was a like a hey we got that one wrong. Mm-hmm. So sorry. Mm-hmm on us

You know what the new data say blank. Mm-hmm. What I recall was a message of Don't and then do but there wasn't a lot of 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 from which we still haven't really recovered um, and so Why do you think it's so challenging for public facing officials to just say look Doing the best we can at the moment screwed up before Changing the message and out may change again

We're navigating this in in real time. It's dynamic. Yeah, please stay with us because You know goes without saying there's been a huge chasm around this and related issues Yeah, and look this it's an important question and look I I'm always I want to be thoughtful about

You know how I comment on what was done in the first year of the pandemic. I was I was a citizen as outside government and I don't know what was happening inside government in terms of the the decisions that were made there But I do know sometimes from my experience in Ebola and in Zika during those 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 want to give some of those folks who were there You know in the first year of the pandemic, you know some benefit of the doubt But I do think that the important thing The principal I certainly try to follow but when I think that

And you know we can all do better. I can do better certainly too But I think an important principle for us in public health communication has to be that were clear That were transparent about what we know and what we don't know Uh, and then we explain the why to people so if we're telling someone to do something

Why is it because there's a lot of data behind it? Is it because it's a sort of expert agreement best practice because sometimes as you know in In medicine sometimes when we don't have enough data to guide us on a therapeutic approach, but when the problem is imminent

Then sometimes experts will get together and put together expert informed guidelines To say okay, look based on our best judgment and the limited data we have here is what we would recommend And as the data evolves we will change you know and and modify those recommendations We do that with hypertension right now you evolve and update recommendations. We do that with lipids

Um here too. I think that has to be like a key part of the approach I think one of the challenges that I saw many public health officials encounter Was even when they went out with comprehensive messages like that Which are hard to fit into a sound bite or into simple posts on social media Um often a lot of that wasn't covered what gets covered is the top line You know, this is what's really recommended. That's what's being required etc

All the explanation is lost. It's missing right and I think we also are living in a time where people are reading headlines Like they're living busy lives right there. Not necessarily You know always hearing all of the nuance, you know, that's being explained

Um, but I think that that's a challenge right? It was like I think I know many public officials struggled with how do you deliver nuanced information At a time when there isn't a clear black and white answer to things, but I think the last piece around this is um I think something I was taught early in medical school is to approach your patients with humility Recognizing that even though you have more training than they do

Uh, you don't aren't living their life. You don't necessarily know what they're going through and you shouldn't assume Um things about them right and so approaching with humility means that um, you've got to Recognize that not everyone's going to be able to follow your guidance And if they aren't able to the dissimini criticism It also means recognizing that people may have ideas or suggestions for you that may actually improve your recommendations or how you communicate

And so I these are the principles. I think that are important in public communication but I think that both The challenge of translating nuanced Arguments into what's actually covered That was tough for many public health officials I think the other thing honestly just on a human level that became hard for many of them and I am thinking particularly about Local and state public health officials who are in the front lines that I talked to a lot Was they ended up getting

attacked a lot and abused a lot during the pandemic and I don't just mean like I attacked online I mean people showing up at their houses people harassing their children People threatening their safety um and and this is often people who were upset about some of the requirements that were being put down from local departments of health And you can understand what covid was as stressful a time as we've seen recently people lost their jobs people were losing loved ones

I mean talk about a stressful time But I think at a human level public health officials who were exposed to that kind of abuse who started to worry about their children safety Um many of them stepped out of the rena and said is this really worth it?

To put my family at risk Um and that was hard because we lost a lot of good public health people in that respect So I think in addition to having sort of these core principles of public health communication in place Then what we also need to restore is an environment where we Of frankly a humility and civility where we don't attack people You know who maybe have different views or are coming out the recommendations that um, you know are not palatable

To us and uh and I think it's also incumbent upon our leaders in society to not stoke that kind of resentment and violence as well Because that happened during the pandemic as covid got increasingly politicized And you know while that may have been at times done for political reasons here and there

The people who suffered were both the public health leaders who are trying to do the right thing for their communities And the public themselves who weren't able to have a clear direct channel To and a dialogue with their public health officials Because a lot of that ended up getting closed off

Yeah, I feel like there was a lot of talking down to The dissenters in the general public yeah, uh, and I totally agree that um, you know getting violent or harassing people With whom you disagree is is totally inappropriate Andrew the one thing just to say about the humility piece and I'll give you an example here of where I think this Could have and should have been done better Is in an effort for example around masks Uh to recommend that people

Wear masks and one important thing just to know is that when it comes to like schools requiring masks Like those are decisions that are made on local levels right the federal government doesn't mandate masks in schools Uh, it doesn't have the authority to do that So those are local local decisions

But at the end of the day they were people who did not want their children to wear masks right for variety of reasons Some worried about their development social development some worried dead who's adding stress to their kids People had met in different reasons why they may or may not have wanted their children to wear masks And one of the things I think that was not helpful Was that when they were to keep parents who made the decision they didn'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 I'll say is a parent whose children were in in school you know my kids are five and seven and

Um in the first year of the pandemic they were doing preschool virtually which was a nightmare It was incredibly hard for us Even when they got back to school and the fall of 2021 Um, it was a really tough like adjustment for them And I could understand like some of the concerns that parents

Uh, we're having wondering about hey, how are these precautions affecting my child's experience and social development So on the whole this the recommendation may still be Uh, hey improve ventilation your classrooms recommend masking recommend testing etc

But those recommendations I think have to be made in a way that Acknowledges like the humanity of people who are may have a different point of view or may make a different decision Uh for their child and I know that when local localities made the decision in many cases to require

Uh schools and their you know kids in their district to wear a 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 to actually have An open honest respectful conversation about this where we didn't feel like we were

Uh each being attacked, you know as parents for our decisions or as community members for the decisions we were making I think that not only hindered I think the response But I think it actually contributed to this division the sense of black and whiteness that hey it's us against them

And then suddenly if I was against one measure then I was against all of them, you know Or if I was 401 measures for all of them because we just started Segregating into sites, uh, and this became a polarized, uh, you know experience at a time where Really it should have been a crisis that brought us together as messies it was Um, and that honestly Andrew is what I worry about most for the next pandemic, right?

Like I think we've learned a lot from this pandemic about how to manufacture vaccines and do and yeah how to develop them quickly How to distribute them efficiently, uh, and you know, we had one one who was one of the I think most historic and effective vaccine distribution efforts in this country even though Certainly could have been better, but it was historic by by all measures We've learned a lot about how to do vaccines therapeutics a lot of the nuts and bolts of a pandemic response well

But I worry what we are still struggling with is How we build trust how we communicate with the public and how we stay together as a country in the face of adversity Because if we're gonna if we're divided the way we were during COVID during the next pandemic or the in the next

You know or I thought that may come from foreign adversary That's a huge national security issue for us and so that that's what keeps me up at night when I think about the next pandemic that may come I'm 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 acknowledgement that there are people who at least feel that there have been vaccine injuries right to simply say um

Okay, the previous taught round with COVID went this way and now there's now virus X right let's hope not God forbid, but Sounds like it's coming at some point and people are going to think to the last time and they're going to Immediately say well the last time we were told to you know

Uh take a vaccine some people had a good experience with that other people didn't and it in this empathy model of acknowledging and you know You know you're letting your moral compass guide and understanding the why behind what people are Are doing and how they're reacting it seems to me that now would be the time to at least try and understand where they're coming from Even if one disagrees maybe even especially if one disagrees and try and get people aligned now before

The next pandemic it and um so what efforts are being made if any to try and acknowledge Um that some people really do feel as if they were harmed Mm-hmm. I'm not saying if they were or not but Clearly there are people who feel that they or people they know were harmed Is there an effort to present them with data to have discussions with them to try and get people aligned so that the next time around

We can be more of a unified front whatever the necessary response happens to be yeah No, it's a really important question and and to me I always go back to sort of first principles from practicing medicine right which is if there is a medicine you give a patient and

Even if it helps 99.99 percent of patients, but this one particular patient it happened to be harmed by it You go in you acknowledge it you talk about it and You've together tried out a path for how you want to move forward and the path forward might be yes Let's get rid of that medication, but let's use an alternative. Let's try it or we can't use that medication anymore Hear the risks you may sustain, but we'll find other ways to protect you right

So that's what we would do in medicine, right? That's what I've done with patients over the years I think here too similarly when I think when it comes to tracking adverse events from vaccines This is an area where the CDC and the FDA track and collaborate

And tracking means not just not only collecting Reports from the public and from clinicians when they see an effect that may be related to a vaccine But it also involves analyzing those to see where they correlate or where there's actual causation there, right?

because You know if I if today for example, I felt unwell And I traced back what happened yesterday and it turns out hey, I ate this burrito that was out in the the sun for way too long The question is am I feeling sick because the burrito or did the burrito just happen to be you know You know something that happened that it's independent of how I'm feeling Maybe turns out somebody was actually sick With a GI bug you know around me and that's the reason that I'm feeling the way I am today

So the analysis that needs to be done on cases that are reported is important and it's something that the CDC and the FDA do together now that analysis I think is essential to communicate clearly to the public And Whenever I engage with Folks in the public which we do often and people will talk to me about their experiences with vaccines I do think it's important to acknowledge what people have gone through Like some people for example like when I got vaccinated for COVID for example

I I felt like I had mild flu like symptoms for a couple of days, you know

It wasn't great. I would have preferred. I didn't you know have those feelings like you know And then I felt better a couple of days later and then I moved on But you know I acknowledged it didn't feel good, you know to to feel that way There are other people who may have had Experiences where they felt that they had more serious, you know Side effects and there may be a question was that related to the vaccine or not So I think we have to both here and acknowledge those

I certainly try to do that. I know I probably think it's important to keep doing that across all of government But I also think it's important for us to help people understand the process that we have to go through to understand whether those are related or not If you go online and the CDC's

A site where they collect a lot of this information and you just purely look at reports that are given of Potential adverse effects that you can't sort of take that and say ah those are all related to the vaccine Look at this rate of harm. It's extraordinarily high because we don't actually do that with any other

Vaccine or medicine, right? Sure. We start there. We do the analysis and we try to understand what's actually related or not So I think that's that's what we've got to do here too one last thing I'll say is that it's important I think also for us to To help put this in context of other Vaccines and medicines and interventions that we use so for example just take Tylenol

For example like most people they go well Tylenol it's safe. There's nothing bad happens if you take Tylenol etc But people who track the data know that Tylenol by and large is a Generally speaking is safe medication, but there are people who experience adverse effects from Tylenol liver damage

You know and other adverse effects And you know that data is available But what has happened in the case of that medication is that the risks and benefits are both analyzed and then a recommendation is put forward about a Generally safe way to use it and then there's data put out about the the side effects common or rare, right?

But I think sometimes we also forget that a lot of the medicines that we have come to take and just see is a normal part of our life Just like any other vaccine like there's some rate of rare side effects that will happen I say that because what I worry about in the black and white environment that we're living in is sometimes people will take an anecdote About a potential adverse effect and we'll portray that as the rule, right?

And we'll say we'll look I know somebody who had this side effect so Nobody should take this because this is what's going to happen to you if we did that

Nobody would ever take Tylenol. No one would ever take ibuprofen No one would take NICWAL like no one would take any of the common medications that we pick up at the drugstore and that we commonly use so That's how I think we have to approach this with a combination of of clear communication and pathoclistening and data and context Again, that doesn't fit neatly in a in a social media post per se But I think part of what we're what we need to do as a country is rebuild the relationship honestly

between the medical and public health establishment and the public and I think it 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 backgrounds socio economic diversity racial diversity Every aspect of diversity rather than individuals standing there telling us what to do for several reasons one is We are a country of many different people Yeah, I think we were there are

Dozens if not hundreds of scientific papers showing that patients follow the advice of doctors that look like them and sound like them or To whom they would aspire to be like yeah, we know this and yet Public health officials typically are

Unitary one person telling us do this don't do that. This is a good idea. That's a bad idea I'm but one citizen But I'm putting up both hands both feet and all toes and saying that committees small But diverse committees that people can relate to and Feel as if um the messages that they're getting are vetted through a common understanding Yeah, so it's a really good suggestion and and I couldn't agree with you more that a diversity of voices is really important to get a message out

and during COVID actually 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 it's very clearly This is something I you know I came to see as a doctor sometimes I was a right person a message to patients sometimes I wasn't right sometimes It was the nurse sometimes it was the medical student sometimes it was an administrator or the the social worker

We're different background different life experiences. So Part of this work is going one to step up one to step back right but the community core that we were building was a really diverse You know group of people

And a lot of them had public health backgrounds, but a lot of more community leaders who understood health even though they didn't have formal training Um, but they're people who knew their communities Right and they had the trust of their communities and they understood what was going on

They wanted to be helpful. So we brought them together to say okay look here's what the science is telling us Here are the general recommendations Here's what we would provide Uh you ask us any questions you have like if there's something we don't know we'll go back and look it up

Um, but you're the leaders in your community. They should be hearing from you, you know about about these messages And then that those folks went out and actually we work closely with them collaborated with them They would design the messages for their community based on what they thought made sense

They weren't taking what we said word for word and we didn't want them to Um, but to me like that kind of diverse approaches what we need more of now you know, I'll tell you what I would I would have liked I would have liked if more Media networks put those folks on TV And got them on the radio right because it's important that many of them were showing up in their communities We're knocking on doors were uh doing local, you know podcasts etc and that was great

But I would have liked more of their faces. I carried on TV right so that's a place where when we talked to media And when I talked folks in media One of the things I encourage them and push them to do also is to say look If you can take more of these diverse Faces and voices and put them out there That's actually good for the community and it also helps people see that it's not like one or two people who are sort of pushing an agenda here. This is like the public health community is big

It's broad. It's diverse as a lot of voices and the and as the more voices we can hear from his public I think they're better off we are Yeah here here. I You know again, I genuinely Hope and pray that we don't have another pandemic, but if and when we do I hope there will be committees rather than individuals I know we you know, this is a Thing in this country we like the idea that one person's gonna save the climate one person's gonna save transportation one person

You know the covers the person of the year type approach. I know But we but then we get frustrated when that person does things or makes decisions that we don't like in their Public or personal life and then it all seems to fall into division and I just feel like

We're not talking about groups of hundreds of people with small groups. Yeah, so I think we're aligned in that way Yeah, and look there's the thing in notion that um I think sometimes we do want like the one person who can not only necessarily

Have all our trust and we can look to but also who we can hold accountable You know something it doesn't quite work out if we don't like something um, and while I get that sort of mentality I think That in this moment especially when we're trying to rebuild trust

I think it's important for people to know The what they may be hearing in terms of medical or science and public health recommendations They it's important for them to know how broad an audience sets coming from or brought a group of experts

Right, and we there was a lot more broad agreement for example during COVID and During Ebola during Zika on public health recommendations But you wouldn't always know it if you turn on the TV because you were seeing the same couple of faces So I think we have to just certainly diversify that Um one other thing I need I'll tell you that's important here is I think we have to also think about how we fund Groups on the ground that are doing the hard work of getting public health messages out

Because one of the things that those groups often would tell me and these are I might say the groups I'm talking about the community organization that spent years in a neighborhood getting to know families Where folks who recognize them when they're walking down the street

They'll go yeah, that's a person organization x they understand as they get us. They're looking out for us A lot of those organizations Had spent their resources helping the community getting to know the community But they didn't have sophisticated mechanisms to apply for grants for example They didn't have grant writers who had done this a thousand times So historically Those groups have a hard time getting support and funding So I'll tell you one interesting thing my wife did which I

Certainly was very proud of is she was helping to to build an effort and to build a non-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 was to give Portions of that money to groups on the ground So they saw themselves as an organization that channeled money to groups that had trust and they executed their

Their 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 May or may not appreciate is that when you it's actually hard from government to put out a lot of money At once and to do so quickly right

Like when you've got a lot of funds that you need to get into communities what happens is a federal government Often will give it to states States will then give it to local communities To like the local department of public health part potentially and then they will look to distribute it to others

That takes time, but it also means if you're not connected to that network If you don't know your local department of health or you're not connected to the state department of health Sometimes it can be challenging to figure out how to get the money and so I think we need more operations like

You know like what my wife and others have been building to try to get those funds directly to the folks who not You don't necessarily have the most fancy, you know grant writing operation But they have the relationships because at the end of the day It's those relationships that create the trust it's a trust that allows in for life saving information to get to people And that's the link that's missing very interesting pharma Big pharma I got a lot of questions about

Whether or not big pharma is on the take for every public health initiative now as somebody who

understands a bit about and certainly believes in the use of certain prescription medications. I find most questions about quote-unquote big pharma to Overlook the fact that there are Thousands if not hundreds of thousands of medications that save lives and enrich people's lives that are prescription drugs I also believe my audience knows I say it over and over again that better living through chemistry still requires better living

We still have to get our sunlight get our sleep social connection good nutrition exercise and all those things

There's just no pill that's going to replace those. Yeah, okay But I think it's a valid question that people are asking Is there a direct relationship between Big pharma and public health initiatives in a way that should have us concerned about the messaging that we're getting and at times and the fact that The United States consumes the vast majority of drugs for mental health for instance as compared to other countries So that's one question and then um, I want to dovetail into that question

What are your thoughts on the fact that you know, there's a history of say the tobacco industry being you know Very interdigitated shall we say with government policies in ways that had us basically injure If not kill millions of Americans and then eventually say you can't smoke on near a hospital

You can't smoke anywhere. There's very few places where you can consume tobacco products, you know that that kind of um Relationship and financial incentives and then a lot of backpedaling later 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 you know at least halfway functional hey? It look I I understand where the concern and suspicion comes from right and look i think it's important that Public health initiatives and medical advice is independent of the influence of Industries that may seek to profit from what's being recommended or for medications that are being prescribed and we look we have a history In medicine right of Doctors who were you know given gifts and vacations and all kinds of fancy things

uh by pharma companies and an effort to influence what they prescribed that was really problematic And now we're seeing a lot less of that which is good Lot of rules that are being put in place by medical societies and professional societies And by academic institutions to say this is an unacceptable way to practice And that's really important Because I do think that human psychology is that sometimes we underestimate how much we're influenced by incentives

We think yeah, yeah, I'm getting that but I know how to make independent decisions But at the end of the day we're human and when we're influenced or it's a great drug It could be wow. This is a drug is really helping my patients. I'm happy to recommend it to them Yeah, so the this so what a separate one thing though like taking money from a pharma companies as a physician

I think is highly problematic right? I think it's hard to say that it doesn't Influence practice maybe doesn't for some people but it's just it's really hard to know who those people are um I do think that separate from that you can be a physician who prescribes medications because you believe they work Look as a doctor I have prescribed many antibiotics During cases of infection that have helped my patients and I would prescribe those again. I'm glad that those exist

Um, in many cases they've saved the lives, you know, patients. I was caring for in the hospital So that's what which should drive us is does the data show that they work and does our patient need them right?

That's what should drive our decisions when it comes to public health recommendations Here to I think a similar principle holds which is that I don't think that Farma money should be influencing our public health decisions Which means that it shouldn't be funding our public health organizations that are making recommendations Certainly, I'll you know, this is obvious to you, but I'll say just be clear for everyone who's listening like our office Doesn't take any money from

Industry not just farm industry from any industry like our the money that we get is allocated by congress at the end of the day. It's taxpayer money And that's all we get and and that's important. We don't want money from the for you know from pharmaceutical companies um But that's important because people need to know that these decisions are not being made for for financial gain

Well, that's it being said. I there's a broader concern. I have Andrew Which is I think that we have become a pill for every problem society Where we look for a quick fix of a medicine for every challenge that we may incur And sometimes yes, I'm a believer that if science you know helps us create

Medications that can help solve disease. We should use them appropriately, but I think we discount heavily The behavioral changes that we need to make the more broader societal and environmental changes that we need to make That influence our health like our food environment matters for our health our decisions about How physically active we are matter for our health whether or not we sleep matters for our health And all of these impact our mental health and well-being as well

And so I I when I think about that bias that that to me is not always you know Stemming from money that came from a pharmaceutical company. Although I think it the ads that we see all the time

From pharma companies. I think try to convince us that hey just take this pill once a day and all your problems will go away but I think it's more complex than that and And I think that even for you know in the healthcare setting Like if you're If you're seeing a patient who has pain who's having intense pain It feels easier sometimes to prescribe a medication for that pain rather than trying to To deal with non-medication based you know approaches or try to get the deeper origins of the pain

I'm not saying that's what doctors do all the time But I'm saying that we're living in an environment and a broader culture Where we I think increasingly reach for something that we see as a quick immediate fix And again, don't blame people for that. We rather take a quick fix over some it's going to take a long time But I think it is selling us I think sometimes A false hope which is that that's all we need to solve our problems

And I think a lot of times you need more you need the behavioral changes. You need the environmental changes Um, that's one of my big concerns in terms of how we communicate about health Would a potential solution be this idea of small committees? So let's say uh somebody is experiencing chronic pain Localized or general that they would go to their general practitioner But in the room would also be somebody who understands Sematic medicine

Acyc train clinical psychologist who understands somatics that the body in the brain are linked through the nervous system um and could also assess um, you know possible psychological roots of the issue and then somebody in the room who can make um behavioral nutritional

um, maybe even supplementation based safe supplementation based recommendations And then the physician who can say you know in an 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 pooling together to treat people from a for lack of a better word a more holistic perspective

Why not? I mean you're just writing the dream. I think it's exactly what we need Interdisciplinary teams that can provide integrative care Recognizing that in this day and age there's not one person who has all the expertise to help us figure out How to best manage our health challenges?

Um, I think what we have not figured out Our 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 structure a health care system where that can actually happen with efficiency where it can be reimbursed appropriately But that's what we should be doing and then the third leg of that is the the group experience for patients

Right, and there's increasingly and more clinics and healthcare systems around the country That are working on creating group experiences where patients who all let's say are working on diabetes Uh come together Let's say once a week and they meet with the health care practitioner

That might be an addition to their individual appointments But there is so much power in groups coming together Uh groups of patients who can find community who can help each other learn from each other's experiences Uh that's highly underutilized right now in medicine Um but to really do this well Andrew I think means that we have to We have to pull back from the model we have had for years in medicine Which has been a very highly individual type model which says

Okay, you go to your doctor. You see your doctor one on one you get everything you need Maybe you need to go see a specialist. Okay, then you wait a few weeks get another appointment drive 30 miles Go see somebody else. Maybe they're connected to the electronic health system. Maybe they're not

Maybe they know what was discussed. Maybe they don't maybe they'll call and talk to their primary care doctor But maybe they won't because they're too busy and then you as a patient are stuck trying to piece all this together What while often in pain while yeah in in physical and emotional anguish

Yeah, I'm referring to my own experience although I've had you know mild Examples compared to what other people dealt with but you know people with chronic pain are irritable for understandable reasons I mean it it's or maybe somebody is close veering towards suicidal depression Then there's the interpersonal effects. I mean I feel like the the crisis is is one of a lack of efficiency and Theronis and

And again, I'm not throwing stones at the medical profession. I I Like you believe that it's a collection of mostly Well-meaning people trying to do their best But the specialist model and the referral model is incredibly cumbersome It really is cumbersome and and like you look I having worked with many medical professions over the years like

These are colleagues who I deeply admire. I mean like they're there for the right reasons. They want to help people alleviate suffering But they too are feeling burned out and frustrated by the inefficiencies of the system Because I'll tell you one of the greatest contributors to burnout for doctors and nurses is a lack of self-efficacy It's seeing a patient who has a problem in front of you And feeling like you can get them to help that they need that is the greatest paper cut if you will

To the sort of spirit of clinicians and many find themselves in that circumstance where they either find that they know what's needed But the system is throwing up prior authorizations or other insurance hurdles and preventing their patient from getting that care Or they are kind of at the edge of their expertise right this happens at pediatricians and primary care 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 didn't necessarily Train specifically and only in mental health yet. They find themselves having to manage a lot of that Including increasingly complex substance use disorders And you know treatment resistant depression and they need to help figuring that out

But if you don't have a lot of resources to get that referral to collaborate with the mental health professionals and your stuff on your own figuring that out And so you look I think the pain is being experienced mostly by patients and but also very much so by clinicians

And that's why that overhaul is needed and I think look a lot of this is you know I'm not a health care economist per se but I will say that a lot of this I think is tied into the business model that we built around medicine the notion that You know we're paying individual people for individual services and individual procedures that are done While that has some merit in some cases What we really care about is that the person is getting efficient

Integrated multi-disciplinary care overall and so when health systems for example come together and say okay rather than sort of focusing on the amount of getting reimbursed for every procedure We're gonna take more of a value-based approach here where we say okay We've got to run amount of money to care for certain people. What's the most efficient way for us to provide them care Uh recognizing if we don't do that. It's not 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 care overall care that we're taking for patients So they're more of these value-based models that are are being adopted certainly in 2010 when the Affordable Care Act was passed and when other measures were taken in the Obama administration in Medicare Like that really pushed value-based payment models forward

Um, and again, they're not perfect. They've got them they need their own tweaks 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 multidisciplinary integrated efficient care that we increasingly need Tough problem, but through recognition of tough problems comes good solutions. That's my belief. I'm an optimist at the end of the day

You mentioned mental health lately. You've been increasingly vocal about the crisis of isolation

You just went to Andrew before we go there. There's one thing out of the tough problems Right, you're exactly right and the problem is a longer we take to acknowledge and address these tough problems The more entrenched the interests become that profit from the status quo 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 clinicians saying that they know what care is needed, but it gets denied

They know what care is needed, but prior authorizations, you know get thrown up there and required 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't be processed Until the weekend is over because no one's in the office to approve the prior authorization

And you're thinking yourself this is make any sense like this is an urgent situation my family member needs is 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'm 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's nobody literally to help them at home But then not having like the rehab bed approved by somebody who's not even there right and There's also just a practice that we've seen time and time again where Insurance companies will also just burden clinicians with more and more requests for information Before they will agree to reimburse for services that have already been delivered for a patient who needs them

Which is just creating more and more barriers hoping that if you're a small time doc out there who's got you know Yeah, you're single you put up. You don't have a lot of resources. How are you going to keep fighting all this and sending more and more paperwork and so eventually you'll just give up Um, we have a lot of problems right there and and and industry this should be delivering care

Often is doing good things but too often. I think is allowing barriers to be put up To the care that's needed and this is particularly true with mental health I know we're gonna 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 Well one of them is that insurance companies historically did not reimburse adequately Or in the same level for mental health care as they did for physical health care

Or if they did they would only reimburse for a limited number of sessions that you could have uh But how 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 you supposed to do after three sessions right uh and so what has happened is it even though in 2008 There was a law passed called the addiction equity and mental health parity law Even though that was passed to try to close that gap

There were many ways that insurance companies were scurting it right so one of the law wasn't even being adequately reinforced for many years But two insurance companies sometimes would say okay, you know, we're reimbursing adequately But when you look in the network They had very few providers

So you really couldn't 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 to complete this prior authorization and have that completed by your primary or care doctor etc Again throwing up more and more barriers So very recently in fact just a few weeks ago Um present Biden just announced that we are From as administration putting out a proposed rule to actually strengthen uh the mental health

Heritage law to prevent some of these what I think of as abusive practices because they're 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 circumstance is help You don't need to be filling out paperwork

You don't need to be waiting three months to actually get care You don't need to show up and be told only you 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 their their 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 any this is something that upsets me a lot because I just I have seen too many patients over the years

struggle without the care that they deserve and should get because of barriers that are being thrown up By industry, but I say all that just to say that when you take on big problems You will run up against entrenched interests and that's a fight we have to take on we can't shy away from it

We can't say you know, it's just politically too difficult like one of the things I'm very proud of is that we're finally Negotiating on drug prices through the Medicare program something that should have been done decades ago But it's finally happening now

You know the administration just decided this has got to happen. It was passed by Congress. This is good and It just it makes no sense that we would pay more than we need to and pass the cost on to taxpayers When we can negotiate and we got to get look you got to if you're collecting taxes as government You should be doing your best and make sure every one of those dollars is being spent well, right? Because somebody took money out of their paycheck

Uh, didn't use it for their family. Didn't use it for their kids and they gave it to the government for good reason Because that supports first responders police officers a whole bunch of services that we need But the response being government is to make sure that money's being used well and to pay more for medications than we should Makes no sense at all especially for our patients and taxpayers So clearly some steps in the right direction are occurring while on the topic of mental health

Let's talk about ice the isolation crisis uh What is the isolation crisis what aspects of mental and physical health is it impacting and then I'm perhaps most importantly what can we each and all do About it um Well This is one of those issues that I if you had told me Andrew

Ten years ago. Hey you and I are gonna be sitting here talking about well, and then it's an isolation I would have said I don't think so 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 struggled a lot with a sense of loneliness and isolation is really shy as a kid I was pretty introverted and I wanted to make friends and hang out with other kids But it took me a while to actually build those relationships. So um I spent a lot of time feeling left out, you know, there were times when I I I would like man elementary schools and there were days where I pretended I had a stomach ache and

So that my mom wouldn't make me go to school and it wasn't because I was scared of a test or a teacher Because I didn't want to like walk into the cafeteria one more time And be scared that there was nobody to sit next to where they know and would want me to To be at their bench um I as I know what it feels like and I also know what the shame is like because I never told my parents about this Well, I never told anyone about that

Because even though I knew my parents loved me. I just felt like hey if I'm feeling this lonely It means it's something's wrong with me. I'm not likable. I'm not Lovable. I'm something's gotta be it's gotta be my fault in some way There's only years later Andrew when I talked to friends from grade school

That I realized that a lot of them were feeling the same thing. We were all struggling by ourselves No one really knew it And I came to see a lot of this as a doctor when I was taking care of patients

And I never took a class on loneliness in medical school. It wasn't part of our residency curriculum Um, yet when I showed up in the hospital I found that the patient who would come in with a diabetic wound infection or who would come in You know because they had a heart attack when I sat down and talked to them Often in the background they would talk about how lonely they were sometimes I would Ask some hey, you know, we're I need to have a difficult conversation about

Uh, your diagnosis is there somebody you'd want me to call to be with you during this time and

Too often the answer was you know, I wish there was but there's nobody. I'll just have the conversation by myself So but it was when I was surgeon general I realized that those experiences weren't limited to me and my patients But they were incredibly common and two things I learned when I dug into the data Andrew was Number one that loneliness is exceedingly common with one in two adults in America reporting measurable levels of loneliness But the numbers are actually even higher

Among young adults and adolescents the numbers and among youth actually depending on the surveys you look at are between 70 to 80% Uh, who say that they're struggling with loneliness So that's a first thing that I learned but the second thing was how consequential loneliness was I used to think loneliness was just a bad feeling What I came to see in digging into the scientific literature was that

Feeling socially disconnected being lonely and isolated was actually associated with Increased risk of depression anxiety suicide but also an increased risk of cardiovascular disease Dimension and these are not small risks. We're talking about 29% increase in the risk of coronary heart disease 31% risk and the increased risk of stroke 50% increased risk of dementia among older people increased risk of premature death and the mortality impact of

of loneliness by the way and loneliness and isolation is comparable You know to the mortality impact of many other illnesses in fact, it's even greater than 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 takeaways is that loneliness and isolation Are critical public health challenges that are hiding behind the curtain Behind this wall of stigma and shame and unless we talk about it and address it unless we reconcile What's been happening to us over the last 50 years where fewer and fewer people are participating in community organizations We're more and more people are feeling isolated and we're not going to be able to repair the fraying

Foundations of society which are grounded fundamentally in our connection to one another You mentioned community organizations um Could you elaborate on those uh, you know growing up in the 70s and 80s? I

Was exposed to like community soccer teams swim team. There was a community pool. These were all public. Yeah things 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 have led to us being as isolated as we are one of them as you mentioned is the decline

In participation in community organizations. 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 recreational leagues In service organizations and other community groups that used to bring us together and

I think you know we can talk about the reasons why that has been the case 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 another especially across differences So we actually associate more and more with people who are like us

But this has also been fueled by a few other factors that are going on at the same time One is that just from a cultural perspective as modernity has arrived not just in the US but in other Other countries We've seen that people are more mobile right they move around more We don't always stay in the community that we grew up in

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 a bad thing right we 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 to mitigate the the cost we may in this case invest more in our Relations as we more conscious about reaching out to other people going to visit them

But that has been a quiet but devastating consequence the other pieces of 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 of 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 considering in our lives There too we have to ask the cost and one is just something about COVID as many people in the first year of COVID when we were 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 what 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 at the coffee shop or the folks who are ran into at the grocery store Or seeing neighbors as I walked down the street like I actually missed that more than I thought I would so we have lost out on Some of those interactions and 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, we're growing up as digital natives But what has happened there I worry is that and it is not that Social media is all bad just to be clear, you know technology look I'm a believer that

In technology broadly speaking, you know, I'm a user of technology. I spent seven years building a tech company I'm a believer in tech, but I think whether technology helps or hurts us is about how it's designed and ultimately about how it ends up being used

And what we've seen with social media as well is that For many people it ended up leading to in-person connections being replaced with online connections We came to somehow value and 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 as human beings we evolved over thousands of years to not just Understand the words someone is saying but to hear the tone of their voice to see their facial expression Like you and I are sitting across and and we're both processing our body language, right?

And I'm seeing you nod your head and I'm seeing your eyes focus like all of that matters to how we communicate But also like you and I are less likely To say something hurtful right now to one another because we can see each other If I said something or hurtful to you like I probably see the pain or consternation 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

Sort of barriers if you will that make you pause before you hurt someone It leads to a very different kind of communication One that can be quite hurtful at times and I also think that one thing people many people don't recognize is that To communicate with somebody else and reach out and build a relationship with someone It actually takes a certain amount of self-esteem to do that You have to believe the other person's gonna want to hang out with you They're gonna 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 shredded their self-esteem As they're constantly comparing themselves to other people like you when you and I were growing up You know in the 80s we we compared ourselves other 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 college students and high school students All the time around the country and the three things they tell me most consistently about their experience in social media As it makes them feel worse about themselves

Worse about their friendships, but they can't get off it because the platforms are designed to maximize the amount of 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're 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 there's also the human suffering component Andrew like it's really heartbreaking for me to Travel around the country to hear from people of all ages Often in quiet whispers about their struggles with isolation about how they feel like they just don't matter at all

about how they feel like they just don't have a place where they belong and It's these are people on the outside look perfectly fine, right? They're posting happy things online to the folks at work They're seeming like everything is going great This is why I always tell people like you loneliness is a great masquerader

It can look like withdrawal and sadness. They can look like anger and irritability It can look like aloofness as well And so it's only when we stop to ask someone How they're doing when we take pause for a moment to maybe reflect on what's happening in their life

That we realize it wow the majority of people in our country are actually struggling with loneliness Yeah, I'm a firm believer that our nervous system evolved under conditions of close interpersonal and direct connection and to suddenly throw a technology in front of ourselves that

Deprives our nervous system of its normal development is it's clearly going to lead bad places It's also clear to me as based on what you just described that you know when we go on social media We see something but it they don't really see us, you know hence Perhaps why people get

aggressive in the comment section You know 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 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 you're essentially showing up as an avatar And when you when we were kids we also played Different characters in our in our games, but oh so different now Do you think that there will be a youth rebellion movement against

These kinds of technology. So I mean there's a long history of young people rebelling against the the stuff That's been put in front of them and they're like no no more we're gonna rebel in fact That was the way that youth overcame the um the nicotine epidemic if 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 as opposed to when they were told hey smoking's terrible for you your lungs are gonna Fill with cancer Kids didn't stop smoking teens didn't stop smoking It was you know rebellion has been baked into our nervous system In the adolescent in teen years. So do you see a rebellion against this Social isolation our kids gonna start putting away their phones and hanging out together again And that's gonna 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 silent suffering is the thing I also really worry about yeah So it's a good question and I think there is already a movement that's building among young people to Create distance between them of themselves and their devices and particularly a social media and

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 Families where the parents that gets together have decided that they're gonna delay using social media and you know till past middle school or in some cases even later

Or where they're deciding that they're gonna drop boundaries around a social media use or they're gonna replace their smartphone with A dumb phone that allows them to do things like text and make phone calls and use maps and and all that stuff It doesn't necessarily have social media apps on it that this is still a small minority and and where's you dealing with a bit of a network effect here 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 why it's so important for parents to and kids to actually do this together But I do think that to use your analogy with smoking That one thing that I think many young people bristle against Is this notion of being Manipulated and used for the profit you know of a social media platform

And the reality is that the again, we've talked about how the fundamental business model is or most social media platforms is built on how much time you spend on those platforms that translates to add revenue and to translate to the bottom line Whereas what I care about as a parent as search in general is About how well that time is being spent is it actually contributing to the health and well-being of a young person or or is it not is it 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 a lot of young people because they already have a lot of these insights. They're the ones living it Right, they're not thinking that this is all you know perfect and it's all a pure benefit here They're the ones telling me that it makes them feel worse about themselves and and their friendships But they are also having a hard time getting off of it Because again of how these platforms are designed

So about a third of adolescents are saying that they're staying up till midnight or later on weeknights Using their devices and a lot of that is 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 at a critical phase, you know of development The other thing that is very concerning to me is nearly half of adolescents

Say that using social media has made them feel worse about their body image as they're constantly comparing themselves To others online and we used to think of this is just girls who are experiencing this and yes, it is a lot of young girls who are experiencing these body image issues But now it's increasingly

Boys as well. So this is happening across the board But the other piece that he that concerns me thinking about mental health symptoms is that We look at how much time Kids are using social media on average adolescents are using it for three and a half hours a day on average

So just social media your social media and that's means many are using it for far more than that And what you're finding though is that for adolescents who use it three hours or more in a given day Their risk of anxiety or depression symptoms double Right, so and if the average uses three and a half days that means that Millions of kids all across our country the majority of our kids are at risk here and so You know you put all this together and and it paints a very concerning picture

Whatever benefits there may be for some kids of using social media And there's some and we lay out some of this in our advisory on social media some kids find social media is a great way to express themselves to reach other people to find support especially if they're from a

Community that doesn't have a lot of folks who are like them around It can be really reassuring to connect with others But we can't say that just you know that to get those benefits we have to subject our children to all of these other harms

Right like kids are experiencing exposure to harmful content to harassment and bullying online six out of ten Adolescent girls are saying they've been approached by strangers on social media and ways it made them feel very uncomfortable Our kids are are also finding that

Health promoting activities in their life are being cannibalized by their use of social media that it's detracting from time for sleep in person interaction physical activity And the erosion of self-esteem really concerns me as well because

You know you need that not just for social interaction, but like look is Is 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 to 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 in their efforts to be authentic. That's what I want my kids to do But 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 just 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 might be concerned with Parents is look we've taken this technology which is rapidly evolving Which we didn't grow up with as kids and we've still parents

You manage it all in your own we 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 in America And we didn't say okay, you know what that's just a price of modern life Which is that we accepted and keep moving on with our lives We said hold on we don't have to go back to horses and buggies But we also don't need to accept this death rate we need to make this experience safer

And so we put in place with the advocacy and support of incredible groups like mad and others across the country Admin mothers against strong driving Ultimately the government put in place safety standards that got us seat belts

Airbags crash testing to make sure the frame of cars were robust in the setting of an accident And that helped us reduce motor vehicle accidents and deaths And that's what we need here too like we need to Have the backs of parents and kids and that means from a policy perspective

Putting in place safety standards to protect kids from exposure to harmful content from From the experience of bullying and harassment and that also protect them From features that would seek to manipulate them into excessive use Which is happening far too often right now

We also need to policy that requires data transparency From the companies, you know to researchers tell us all the time That they are independent researchers They tell us 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 of kids And as a parent look I don't when we bought car seats for my children when they were born We looked up the safety data like many parents wanted to make sure the car seats were safe But if you had told me that hey, you know the manufacturers of these car seats are actually Not disclosing some of the data on the impact on children But go ahead and buy it anyway, you know

I'm sure other people are buying these car seats. You should be fine I would have been very disturbed by that right no parent wants to feel that information is 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 while yes, and we'll we should we'll talk about some steps parents can take Because I want to get to practical steps that people who are here as parents or people of kids in their lives can take

But 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 they need so they have confidence when they see You know and technology out there a device out there a 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

My 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 it was a half an hour or an hour My mom was constantly kicking us out of the house

Like literally you gotta leave the house you gotta go down the street and play yeah, unfortunately. I liked outdoor activities Um nowadays we also have the issue that a lot of parents are on their phones at soccer games and at kids events And so the kids are modeling their parents. Yeah, parents are distracted as well. So there's a lack of social connection People even in immediate family people are screened in

Um, you know the TV there's laptops. There's multiple phones iPads people are You're more engaged in the screen portals than often then 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 sending out to the world if you think that's kind of crazy

Um, but I guess they want to capture that unique experience. Yeah, but uh, 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 is to just experience that in real time

Yeah, it's so wild to think about like what we think of as you our unique portal is actually not unique at all It's what we do with it learn on my my stance is Glean and learn information online then go use it in real life Come back from time to time. You know, maybe an hour a day maximum or so Can I just underscore the two words you said real life? Because that anything is a really important key here which is that

All of real 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's happening online?

Too often is distorted right it's giving us like like even just take um You know just take the images that we see of people there uh, you know, there are summer beach images there like great vacation images That's not representative of their entire life of how they're living their life But we see that we see people's anger we and their vitriol and we Come to believe over time that that's how people feel that's what people are dealing with and experiencing their life and

And we've just got to get you know your mom. I love what your mom did if you're getting you guys outside um My parents did the same thing too like we I was very blessed to have two parents who didn't come you know

They didn't have a lot of resources worrying up. They didn't come to this country with a lot of resources But the one of the greatest gifts they gave that gave us is that they loved us unconditionally The other great gift that they gave us is they pushed us to just explore to meet people to learn about the world They wanted us Outside playing you know experimenting just little discovering the world, you know writing our bike around the neighborhood

And that's what we did but right now like two critical things that kids need for their mental health and development Are two important forces I should say that are impacting their mental health and development One is social media, but the second also is the lack of unstructured playtime

That kids have like unstructured playtime is time when We as kids learn how to negotiate situations with other kids had a resolve conflict had to recognize what's going on and someone else's You know eyes before they say something we learn how to collaborate and play with other kids

Is a lot you learn on the playground is it turns out But I worry that right now that we've almost somehow made that kind of unstructured time seem inefficient You know, we've set these standards for our kids that they need to be

You know getting fancy jobs and into fancy colleges and making an X amount of money and the path to doing that is You know to be enrolled in X number of activities after school and to do all this stuff in school and their lives are so hyper structured That I worry that the time

To just play to be creative to reflect and think to just have unstructured time with other kids Has evaporated and I think that that also is hurting the mental health and well-being of our children I love the idea that that unstructured playtime could be framed in the

Accurate context of the nervous system developing the way it was supposed to develop. I mean, I would argue that 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 or staying in college based on things they said or did previously that they shouldn't have said or done That's what those are kind of you know negative highlighted cases But in general We know that the nervous system thrives on diversity of types of interactions and social interactions in particular I'm 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 it 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 life's about but let's face it We still live in a society where hitting those milestones on a consistent basis or the best is the best predictor of people being able to

You know live self-sustained lives build families and that sort of thing. So You mentioned a few actionable Items for parents as it relates to kids maybe well not maybe limits their screen time force them outside In the safe weather and safe conditions of course, but what about adults as well? 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 wand Which I realize you don't And you could make a Highly informed recommendation about what the thresholds for too much time on social media are What would it be two hours three hours

Yeah, 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 frankly what I'm planning to do with my wife for our kids

As they grow up and number one I would seek to delay the use of social media past middle school at minimum And I know that that is hard to do at a time where all kids are on social media And you don't want your child to be the only one left out and to be lonely as a result

So that means no account of their own means no account of their own okay and I would Make see to the best of your ability 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 you're partnering with that means there are other kids who are also delaying use 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 delaying use But they also don't want their kid to be the only one so this becomes a numbers challenge But partnership can help us if your child's already on social media But I'd recommend is to create sacred spaces in their lives that are technology free

And specifically I would think about The hour before bedtime and throughout the night as time that you want to protect this kids are losing Not just sleep because they're going to sleep later because they're on their devices But they're also waking up in the middle of the night

Maybe to use a bathroom maybe to get some water and then they get back on their devices again So the quality of their sleep is being significantly impacted by access to those devices during the night So I would protect that time hour before bed throughout the night

I would also create make sure meal times were tech free zones So the people actually that you talked to one another you see one another And time with friends and family members when you're out you know at a birthday party etc Make their tech free time let them focus on their time with other people

Those three Tech free zones can do a world of good to help your child And then the last thing I'd recommend here are the many things I think parents could do Is to start a dialogue with your child about their use of social media We don't always know how social media is making our kids feel

From the item and we may realize when we talk to them that they actually have their own concerns They might say yeah, it's not making me feel really good, but it's just like card not to be on it Everyone's like texting on this or everyone is

You know everyone's you know sharing information and posting pictures on it I feel like 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're having So opening a conversation so your child knows that you're not Judging them, but you're trying to understand their experience is important also so that you can help them understand What is not acceptable for them to experience on social media if they're being harassed or bullied 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. It's really concerning to them. Let's 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 you know

Scroll past that so that conversation is really important and finally his parents we can lead by example Right and this is hard because the truth is we've been talking about Uh, social media and youth and that's what the subject of my search and channels advisory was on But I have concerns about adults too. I said is somebody who's had challenges in my own use You know of social media finding sometimes it Bleeds so you know past my bedtime and I'm realized, you know

I think emanate checks on things for five minutes an hour later. I'm still there, you know scrolling through something Uh, and sometimes I you know, like you know, I find myself I have over the years I find myself comparing myself also uh to posts I see online in unhealthy ways

Sometimes I find myself sort of pulled into content uh that uh, you know, ends up being angry and vitriolic and leaves me feeling worse, you know at the end So I've experienced this as well and I think experience one of the hardest things to do is to follow this advice

We're giving our kids to draw those boundaries as well and to put our devices away when we're around our kids One experience I had which sort of I still feel bad about but which really helped kind of knock some sense into me was after my my son was born uh my older child I was actually I was searchin general at that time, you know, I had you know The local non was busy job, etc But I wanted to make sure that I protected bedtimes and meal times for us to be together as a family

Yet one day when I came home, you know after dinner when we were doing the bath time and bedtime routine to get my son ready Uh for the night uh My wife is changing his diaper and instead of helping I was just standing at the side scrolling through my inbox And my wife who has infinite patience and is like one of the most well-adjusted people that I know Just paused and she turned to me and Alice said Do you really need to be doing that right now?

And she said just very quietly But I felt Like such a sense of shame when she did that because I was like what am I doing like this is my infant child, you know, and the rare few hours I have with him during the day And I'm just scrolling through my inbox my phone like like this is terrible and

Look, I know that all of us do this and it may be in different contexts, but It was a wake up moment for me because I realized like One like as you know well as a neuroscientist we can't really multitask right we're rapidly task 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 with him 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 All behavior change That we're talking about here the kind of behavior change I've worked with the patients over the years are on physical activity and diet All of this is harder to do when we're doing it by ourselves It's a lot easier to do when we're we have a couple of friends or family members who we agree to do this with

We hold each other accountable. We encourage and support each other 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 Dave and Sunny who are my part of my brotherhood and the three of us as 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 this sounds daunting or overwhelming You don't have to do this alone

Think about one or two people other parents who you might want to do this with and I guarantee you there a lot of us are struggling with the same stuff And they would probably welcome an opportunity to do this in collaboration with another parent Such

Spectacular advice that I hope everyone will follow not just for their kids, but for themselves I think that Whether or not social media is addictive in the in the true sense of the word 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 reflexive. Yes We're just you know, we're not necessarily seeking pleasure or looking to to engage in online battles It's just it's become reflexive

So like finding yourself with your hand in the refrigerator. Just you can't even think about it. Yeah, just doing it 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 the middle of the night folks neuroplasticity brain rewiring happens in the middle of the night while you're asleep

And I this when you mentioned kids awake in middle of the night looking at their phone. I just I saw you say oh my goodness. It just it pains me and I've looked at my phone in the middle of the night. I try not to but

Um, but I'm certainly not in the window of maximum plasticity either. It's terrible for everybody, but especially terrible for kids um What you just provided is an incredible Let's just call it a I'll call it a mandate you didn't say it but a suggestion of of teaming up with people To become more like minded around these issues and to really promote health

Along those lines. I I really want to thank you um first of all for the conversation today you're incredibly busy you're responsible for Uh, an entire country is worth of um people So to take time to sit down with me and to discuss these

Topics for our audiences it incredibly appreciated by me and by them. I feel comfortable extending their gratitude here and uh, it's also clear based on today's conversation that you face an enormous number of challenges at the level of budgetary challenges by the way i'm going to work on that um as hard to shut me up um As well as that the huge array of of issues that you confront and um and it's clear that it's a challenge that you've embraced for many years now 100

Difficult conditions and that you're clearly willing to get out and talk to people and hear Their criticism here their concerns here um and learn from them and so it's been a great benefit to us to hear and learn from you And I hope this won't be the the last of our conversations Now there's many more topics to cover but i just really want to thank you Thanks ever so much for the the the intellectual power Uh 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 and you that's for so many just incredible kind of you i thank you. I appreciate that and I've loved our conversation and You know for me what What i hope most of all uh for My kids for our country more broadly is that

Is it we can go deeper like beneath this these surface issues. I've i worry that we find ourselves Disagreement about and fighting about online and recognize that there is a deeper challenge That we are facing that i think underlies a lot of uh these uh The anger and the vitriol and this issue around How disconnected we've become from one another i think is at the heart of that I don't think that there's any policy or program we can implement

That's going to ultimately fix what ails society without fundamentally realizing that a lot of this is a manifestation Of a society that has become more disconnected and more disinvested in one another like over time And that's just not who we are it's not how we evolved over thousands of years

It's not how we're going to thrive in the future So i know that sometimes when you look at these big intractable problems Uh Like widespread loneliness in the United States That it can seem a hard to address these

But i do want to encourage everyone to to recognize that when it 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 pause 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 of great need Somebody who has stood up for you and you couldn't stand up for yourself Someone who's helped to remind you Of why you're still a good person Why you still have worth and value to add to the world even when you had lost faith in yourself When 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 who 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

We're a nation of people who are mean who only care about ourselves We're throwing blame and anger at each other all the time Who are 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're interdependent creatures who recognize that if someone else is suffering we want to be out there to support them Uh

And who want to 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 also 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 that they're coming into um I worry that they're gonna use the wrong word

Even though their intentions are right and people are gonna blame them or cast them out No, I worry that they're gonna stumble and fall down and people just think you're 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 to other people right none of which I want But 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's backs We recognize as that old African proverb goes that

We can go fast if we go alone, but if 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 minutes a day just someone that we care about do 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 scarce our attention has the ability to stretch time it can make five minutes feel like half an hour But it's a hard thing for people to get because they're distracted by their devices But do we give people the benefit of our full attention and do we look for ways to serve one another recognizing that it's through our acts of service That we actually forge powerful connections, but we also remind ourselves

How much value we have to bring to the world and this is important in the time when the self-esteem of so many of us and our young people in particular is being eroded Particularly by their use of social media. So these are the steps that we can take to build connection in our life But the core values I believe that have to be at the heart of our identity these values around kindness and generosity Around courage and service

These also have to animate the decisions that we make in our life about Programs we advocate for The policies we support the leaders we choose these 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 90% of plus of the decisions leaders make They make behind closed doors and what's guiding them in those moments are their values Well, that's true whether you're the leader of a company or a nonprofit organization or a leader in 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 That's the way in which I feel like America can be an even greater beacon of hope for the world

Because the world is struggling with this too. We're not the only ones who are dealing with loneliness and isolation We're seeing anger and resentment and vitriol bubble up at extraordinary levels We're seeing mistrust and institutions soar 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 and generosity Like to me all of these values ultimately Andrew stem from love

Right love is our greatest source of power. It's our greatest source of healing I see that as a doctor who's prescribed many medicines over the years But if you think it's more powerful Then love and its ability to help us through difficult times and help mend the wounds seen and unseen 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 that power to help each other heal Like Andrew, we are not fundamentally a nation of bystanders We just stand by while other people suffer like we're a nation of Of healers and hope makers

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 of and so what we're built for And that's him in dignity that I think we now more than ever need to embrace Amen Thank you for that um, I agree love is Definitely the verb 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

uh, fleet to continue to support public health. Uh, I know you've been at this a long time um And we have all benefited and um and thanks for your open mindedness Especially around some of the questions that invokes some challenge and again for your Taking the time to come talk with us today and uh, I really also enjoyed it It's been a real pleasure and there was a lot of learning for me and um like I said before

Uh, I hope it won't be the last time. I hope not either. No, I look forward to the next time to stay in touch and Uh, just love this conversation. Thank you for what you've done for Being this beautiful channel of information for the public

But it's most importantly. Thank you for who you are, you know, like who you're Andrew like come to cross very clearly with Uh, you know, when I meet you, you just you have a good heart and you have good intentions You're good man, and we need more people like you in the world Hmm. Thank you right back at you. Thank you for joining me for today's discussion with Dr. Vivek Murphy

The surgeon general of the United States. I hope you found it to be as informative as I did If you're learning from and or enjoying this podcast

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