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
To promote and Advance our nation's Public Health dr. Murphy 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
All Health crisis, the adult Mental Health crisis and the global crisis of loneliness and isolation. We also talked 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 discussed some of the major public health events that occurred over the last five years and the current and future landscape of how to restore Faith. Both in public health officials in public health policy,
And science more generally, by the end of today's episode, you not only will have learned a tremendous amount about public health and why you hear the particular Public Health directives that you do. But also how to better interpret future Public Health directives, you'll also come to learn that as Surgeon General 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,
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And enter the code huberman at checkout and now for my discussion with dr. Vivek Murthy, dr. Vivek Murthy, welcome, thanks so much Andrew, and please call me Vivek, I'm informal. Okay. Back 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?
Or some other roles that you play that perhaps would not come up in a top, top hit Google search that I ought to be aware of and that our audience ought to be aware of. Well here is 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 that they actually know what they are, how to protect themselves and their families. The second role of the surgeon.
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 six thousand officers, they include doctors nurses, physical therapists, pharmacists, Public Health, engineer's, 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 live, with, with ebola domestically, when they 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 kovin. So these officers are I'm incredibly
Out of them, they could be doing lots of stuff. You know, outside government in the private sector. Probably making a whole lot more money getting a little, you know, working a lot less hard but they're really committed to protecting the public health of the nation. So I have the privilege of overseeing that Services Surgeon General. And those, those are, those are the jobs that I've signed up for, in this role. Got it. I was not aware of that role, and if I understood correctly, these people, these Public Health officers that presumably are made up of Physicians
And and licensed psychologists and nurses and so forth. You said, they could be making substantially, hiring comes 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 are full-time government employees, and members of the Public Health Service. Their day job is often in public, health agencies where they're embedded in communities, helping day to day to advance public health. And during times of emergency, we
Play them, you know, and they're extraordinarily. Well trained. They're experienced a 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.
His first, then you mentioned emergency. So what I'd like to talk about first is Health not lack of Health. Yeah, but Health, you know, 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 5 to 10 years, have there been any areas of physical health and mental health Improvement in the u.s. at large that we can attribute to some of the public health initiatives directly. So that's a really good question and let me just also say about the very first point you raised that you're absolutely right that we have operated primarily through an illness frame. When
Look at health and in my mind that's only one half of the equation. Right. So when we are talking about physical illness for example, you know as a doctor I learned how to diagnose and treat someone with diabetes or with high blood pressure or with coronary heart disease. But we also know that even if I don't have diabetes or coronary heart disease or high blood pressure, even though 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 is insufficient. I mean, I'll 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 their 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 is a whole other half of the spectrum where 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 then part of the conversation that that I want us to have as a country is about how to optimize mental health and well-being.
And that is includes preventing Mental Illness, but it is much broader and bigger than that alone. Great? Yeah, 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, and you've got all these officers, these incredible Physicians and nurses and people at your disposal. I, My Hope Is that they would also be accessible for an currently carrying out efforts to transmit information to people about, hey, here are the things that you can do every day, every week, every
He month in order to make your life as healthy as possible as well as you know, rushing in under conditions of you know 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.
When I went to medical school, the 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 you ask and talk to people in their lives, it becomes clear that they want to do more than just prevent diagnosable illness, they want to be able to walk there there, child down the aisle. They want and have the endurance to do that. They want to be able to be independent off and carry their groceries or
Or carry their luggage. This is why I think we've got to broaden our 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 510 30-year plan. When I was a kid, I was interested in medicine, but I always thought I was going to practice medicine, you know, like my dad did and like my mom like the clinic. My mom ran, you know, set up, put up a shingle, see 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, you know I trained in medicine and got interested in technology spent seven years building, a technology company that was focused on health. I got where I was where I became increasingly worried about the way we were delivering Healthcare and I felt like our Healthcare System was broken, people needed care, couldn't get. It was often too expensive to get care. We are focusing on treatment solely and not enough on prevention. So I started getting involved in in advocating for a Better Health Care System, where doctors around the country. When despite all that I still never
Ever 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 see what was interesting to me about this position is, it's actually very different from most positions that are appointed by president in government in that, it's supposed to be an independent position. So my agenda issues I choose to take on, or not, determined by a president or a party. They're determined by science in the public interest.
Rest, and that's what guides me, you know. And that's what, that's what got to be in that first term when I served. And when President Biden asked me to come back and serve a Surgeon General a second time. That's what's guided me here, too. So, Biden is not sending you note saying, hey could you put some effort into, you know, getting messages out about, you know, Cove ID, or could you put more effort into getting your team over to Maui to deal with the, you know?
Oh, 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 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 like? Okay, we're going to put 10 people on Maui. Yeah.
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? Where are you getting memos? And in other words who's your boss everyone has a boss at some. Level minor is a the listeners of this podcast at some level. I work for them. It used to also be my Bulldog Costello, but my boss, my wife, and my two kids who are five and seven, they I do what they tell me, John got it.
So but how we make our decisions in the office actually it's a bit different with those two roles. So on went with the second one with overseeing, the commissioned Corps are six thousand officers, they are the their decisions about how and when we deploy officers or collaborative, right? So you know, we work with other colleagues throughout the Department of Health and Human Services. We work with people and 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
Can you help? So we'll work with colleagues across our department. To say? Okay well we can mobilize our commissioned Corps officers, what assets can you mobilize? And then collectively we will send a team out there. So for example we have officers helping in Maui right now particularly with mental health needs which are I worry only 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
For me on that front. Well, we certainly you know are open to suggestions from the public members of Congress sometimes say hey can you help the public understand about this issue? You know, a lot of people have ideas and opinions but the decision about which issues to focus on those are our offices. And to me that's important because part of the reason overtime, I believe the public came to have some degree of faith and trust in the office is because they hope that the office was functioning the way, you hope your doctor is functioning which is being an independent source.
First of information for you and a source that has your best interest at heart. That's not being pulled aside by political interests or by other agendas, but the primary agenda is how can I help your help? 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 it doesn't mean that that issues are important or that it's not affecting a lot of people but we have to make hard decisions about where to put limited resources and
So when I was a Surgeon General, the 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-cigarette use among youth because we are seeing a dramatic increase among kids in e-cigarette, use, that was, can I just ask you? Sorry, to interrupt? But I think it's relevant here. Has that increased continued or e-cigarette? Use AK vaping. Yeah. So we still see, unfortunately our 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 it from our office is recognizing that we actually issue the First Federal report on e-cigarettes 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 need it 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 numbers actually tell us about.
The impact these issues are having on the population, as well as the trajectory of Rise of Something's getting dramatically worse and people don't realize. It might be an area for us to focus, but the other critical factor is what I hear from people on the road. And 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 guess you get a lot of information as well. That tells like that's actually how I came to.
Focus on the issue of loneliness and isolation. It wasn't because it popped up in a report as being the leading public health issue in the country was because everywhere I was going and 2014-2015 with our 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 disappear 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 by 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 what, you know, where the issues lie. And what the what the actionable steps are that people can take, right? And I think that we now live in a
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 it was sleep. Rhythms were disrupted etcetera and I was somewhat surprised that I didn't get a warning on my phone. Hey, make sure you're getting morning sunlight. You know, like I'll get a flood warning. Uh-huh. You know I'll get
Get a warning that I might get a warning but it's only a test warning. I 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 and circadian rhythmicity are a precursor
Certain 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 in and and it's not causal of course. But how come during the pandemic we each an 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.
Try and stay as stable as possible in this very uncertain landscape that we're in. Well, in it's a really good question. And and I think it's a, it's a reasonable rent, a very good suggestion to say that it 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 member 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 though, of the last 20 30 years from now, on health issues, there hasn't been sort of an agency or an entity that has sent emails out to everyone. First of all, how to send an email out to everyone in America is not a simple proposition either. Technically, it's challenging there, some legal issues you have to deal with as well, but you could do a night where you go CNN Fox and NBC ABC New York.
As Wall Street like you could hit the right the right wing, the left wing and every so that's yeah that's really interesting. Like one but 11 video. Yes. Where they all agree like hey this is important information. So eight a political like no. Yes I would say that that kind of messaging I would say through traditional media certainly has happened, you know, and it happened during kovin. It happened for example, when you know, either in the first year of covet, I was a private citizen, you know, in the prior Administration. But I, you know, I watched both then and at the beginning of the the bye.
Administration, many 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 covet 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 and day or you might you get on all the Sunday shows, for example but the next day you know that message isn't necessarily there. You know it's gone and people's attention is also Switched Off to. So they were I mean I can count and you know we've long probably thousands of interviews at this.
That we done with mainstream media with sort of, you know, concise message is about three things you can do to protect yourself excetera and, you know, I'm glad we did those, we got to do them but I think one of things 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 should 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, you protect yourself from let's say covet or three things to do to, you know, support your
And well-being during a time of Crisis or during a time of Health. I mean, again, like not just the flood warning. Yes, the, the daily because I do think that most of mental and physical health is the result of daily practices that are, you know, the build on me themselves, sort of like compound in absolute founded in the estimates and then of course, there are acute challenges and chronic challenges. Yeah face but there are things of that sort to. I think those kind of messages aren't um of Health 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 are equally as important. But I do think that, what you're pointing out is in infrastructure piece that they 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 Koop.
It was surgeongeneral, one thing that he had done which was interesting. Is he had actually sent a letter, a physical letter to all households in America. About HIV a physical letter, a physical letter, some of our listeners, who don't know what that is. Yeah. So I think you read about in the history books, or something shows up in your mailbox and you open it and hopefully something you want to read. But it is getting kids. This case he was worried about HIV but the fact that people didn't know about it and so he worked through and you with as I
And it with them member of Congress. Found you know, 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 ever infrastructure funding to do that again, when I was searched on a last time, you know you know if 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 perspective.
Scribing practices in medicine so that we expose fewer patients to the harm of opioids while making sure people who needed them actually got them and the second time it was about Kovac 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 many medications even though they were in high risk groups. So we were able to find you know and we had to again they're too had to sort of creatively Cobble together.
Versus finding. This is all sort of, you know, is it behind the scenes, government stuff? But the bottom line is in what you want in an emergency and what you want. I think in the long-term is a simple clear, comprehensive way, the public health messages can get out to people. And to this day, we still have to rely on our 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
I have 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 as 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 in society, more broadly, which is it, we have valued his
Darkly prevention and health communication, very little. We put the mass majority of our resources into treatment strategies into getting medications to people into diagnosis and that's very important. Don't get me wrong but we are now seeing with mental health issues, as one example that if we only focus on expanding treatment and deepening, our well of knowledge there and we don't do anything to help people stay well that we just can't keep up.
Right. And it because one problem feeds the other, exactly, the kids that are stateless. And if I would grown up in today's era, I'd be on my phone and tablet late at night because I was up reading magazines and talking to friends on the phone later, right? So it's not a criticism but but you know, disruptions in sleep, disruptions in circadian rhythm disruption, lack of physical activity, poor nutrition, social social isolation. I mean, these are all piling, the sand, much higher, on this, in this other side of what you do in terms of and here obviously state
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 podcast that 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 a, I 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, and to some extent happily so, yeah, right? Because it pays
For public works and many, many important things police officers, firefighters Etc. But if you don't have a channel to communicate with people about what they and their kids, and their relatives can do, then it 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
is and one of the hardest decisions. I have to make in the office are putting aside issues that we know deserve a lot more time and attention. But we just really don't have the resources to deal with, you know, the issues that we have dealt with. I'm certainly proud of my team that we worked hard to try to raise awareness of the issues. We have taken on, whether it's around, you know, social media and youths, and mental health, or whether it's around isolation or clinical, clinician burnout, or other issues like that. But the truth is the, there's more than needs to be done more.
Is a need to be tackled and we have to get to a place where we can, you know, talk about what I think of is a core pillars of a healthy life, right? Which are sleep or nutrition, or 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 perhaps
Kids for the rest of their lives, they should lay a foundation for a healthy life. Going forward, these absolutely are important elements for kids to learn about. I 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 us.
Hydras appalled Conte about mental health, not mental illness about self inquiry and how to use self inquiry in practices that do not require a therapist in order to bolster mental health. Of course, their apis can be very useful, but not everyone has access and not, everyone feels comfortable doing that, but we are, but one channel, I mean, you are the governing body for this. Your, the Army, Navy, and Marine so to speak of Health as
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There's lots more to explore their, 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 found that point the Yankees one? I'm really glad that you asked folks.
The 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 at building a channel that the public to let people know about these topics that, you know, that are so vital to our health and well-being. Whether it's sleep or physical activity, or mental health, and so, 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. You means that you're building
A relationship there with a lot of folks, so just kudos to you for doing this. Thank you. The audience of the uberman Lab podcast is 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 are allowed in u.s. food products. Mmm? 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 sort of
Directing it anyway 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 processor that's you know, 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 their 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 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 and that worries me, the also other piece of this, that worries, me are just how much, you know, refined sugars are being added to so much of our food. So, most people think that sugars are only added to things like desserts excetera, you look at spaghetti, sauces, salad, dressing salad, dressings, a lot of these things, which we think of, as Savory products, have sugar added to them as well. And so, we are consuming
I think unhealthy levels of sugar in our diet we are consuming fair amount of additives given the processed food composition in our diet and I think part of the reason this is happening and I want to be very clear. I don't fault, individuals out there for the composition of their diet necessarily because we have also made certain decisions in our country about what we subsidize about what's cheaper and more expensive for people and the cheapest Foods unfortunately are often the most
Unhealthy Foods the most highly processed foods, 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, you know, it tragedy because you can't get fresh produce excetera. A lot of times you're shopping, your grocery shopping may be done at a local convenience store at a 7-Eleven or it's, you know, it was somewhere else that may not have liked the array of fresh fruits and vegetables that you and your family need. I don't even think they have vegetables.
Yes, I think they have they'll occasionally have some lemons or apples or oranges and bananas. But when I walk into a convenience store, what I see is a pharmacy. I really do. I see alcohol, caffeine energy drinks that have a number of different things in them designed to stimulate different neuromodulators like dopamine and serotonin. I see nicotine products, I see, high sugar, high, highly processed food. And keep in mind, I was a teenager. I mean, I drank my Slurpees I had my Butterfingers you know I was
You know, Bart Simpson, like, in my left fingers, but I like them, but, 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 in ad libitum, 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
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 or taxpaying citizen speaking on behalf of many other tax paying citizens. I have to sort of take a step back and say, how long do we, wait, right? Do we have to get a randomized clinical trial about the, you know, the, you know, the 500,000 sick kids that grow into sick adults and then,
Trial, where they go on an Elimination Diet where they're eating only on processed vegan or unprocessed meat and vegetable or unprocessed, 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've got the uniform down. I always wear the same thing, but a uniform. But I wouldn't because I would want to say wait, you know, why not
Err on the side of caution, why not? Send out this AI generated, text message? That tells everybody and all the languages that Americans speak in 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. And 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 to wait until people start to get really sick and dying and really struggling before something is done in the direction of their health and I'm not blaming you, I just want to understand because good question that 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 going to be good for them 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 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 a vexing. It's complicated. It's incredibly confusing. If you go online and just try to search for information and it's a classic example of where it's important to have an objective scientific Authority that can come in and speak on Broad principles around diet that 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.
If 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 look, 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 how the 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 make the information available but we have to make it accessible from a cost perspective. If you don't have a grocery store,
In your community. If a vegetables and fruits cost 3x, what other foods do that's going to be a problem right to change diet. The other thing we have to keep in mind is that, you know, food companies, you know, a lot of them do a great job of actually trying to get healthy, nutritious food out to people, you know, and kudos to them. But I worry also that there's an incentive also to just try to sell more and more and more of your product. And one of the ways to do that is to try to hack the body to kind of figure out. Okay. Well, what kind of synthetic additives could I
Together here or what kind of combination of nutrients, kind of put together, they will get people coming back for more and more and more. And we saw this in the nicotine industry, you saw the nicotine industry. You also, I would say another in parallel, as 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
Mais how much time someone spends on them regardless of whether it's detecting from sleep and 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 important comment 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, and diabetes, and heart disease associated with it. Those are the questions is 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 scope of the problem and the mechanics involved in trying to alleviate. These issues are complex. I I see that they aren't all so take one of the it is important to do that though is you need to have authorities that can speak to these issues that are insulated from political retribution, right? So and the explain this like I'm into that. Yeah, look, I mean, listen, I somebody I forgive me for interrupting my
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'm gonna have come under intense scrutiny, from my colleagues who are like, wait, that's not a randomized control trial. How can you do that? And yet I know from being in this field for a long time, that for instance, the emerging therapies for, for PTSD and depression that are now based on federal funding for things, like,
And I'm not recommending this, by the way for children or for everybody. But for instance, the macro do 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. But for years, if if an academic said the words, I just said they lose their job, only is instantaneously because they're Controlled Substances. That's that's a to do. But then there are a number of things that were talking about.
Here that are just about making better choices about things to avoid, right? If people understood, I think that is sugar poison while some of my audience will say, sugar is poison, it's as addictive as cocaine. Look, it is not as addictive as cocaine or heroin. It is not however, if a child or adult is eating very sweet, or very Savory food of any kind consistently, if those are not healthy foods or if they are, if they contain unhealthy additives over time, the brain will
Wire. So, that healthy foods don't taste as good, they won't be the choices that people make and you're going to end up with a sick individual period. And I don't think we need one more clinical trial, funded by federal tax dollars to support that statement. What I'm starting to gather is that you're a very rational grounded broad thinking individual. I'm not just saying that because you're sitting here and you're trained in medicine and you understand the science but that you don't have the means at your disposal.
To put out a call that says, hey, folks, having some sugar. Every once in awhile to 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 not processed foods, their brains are going to be rewired in unhealthy ways and you can almost expect that they're going to have some Health Challenge in the future that may not be you know, autism or schizophrenia but is going to be a major Health Challenge of a and that is
Serious and Now's the Time to intervene by avoiding certain things. 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 crumbs 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 of 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 etcetera, that that change. So people can be feel better on a healthier slightly lower calorie nutrient-enriched, diet healthy, proteins and fruits and vegetables and it's not a mind trick its physiology. Yeah anyway I think I feel your pain for frankly and I'll
You look sometimes people ask me, why don't you just go ahead and say a couple of statements that you just said when that be fine? Like why are why is time needed to prep some like that? Why resourcing it etcetera? Here's actually why that I know in today's day and age, it's easier to just go in like rattle off off, you know, off-the-cuff statements or shoot from the, Welcome to my social media channels and really well to get their word out to Millions. I appreciate that. And I may take you up on that, but I'll tell you the, one of the reasons, one of the things we always do recognizing that when we put out statements that people
One day, they trust, it's coming from a scientific Authority and that it's been vetted, right? So we put the effort and time into wedding this thoroughly, we check sources. We look at the data, we talked 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 what they're hearing. We also know that when we put out an issue divs that other people build on them philanthropists, you know and foundations will
Well then think about. Should I fund work in this area? You know, schools and workplaces will think about shifting some of their practice policymakers will 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. But folks who are, you know, in public health and who are in medicine, who are trying to speak to the public about their health that they are protected from retribution attacks is 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, that and 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 is going to make folks on. Happy tune, a crepe 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? Once you take alcohol out of the title, you know, all of these is sort of, you know, concerns are really this. So these are people who get paid by the alcohol industry. These are people in government who are reading the tea leaves and who are supportive of the work we're doing, but her saying, hey, like you're going to really upset a lot of people and so watery and also going to help a lot of people. Yeah. Well this is what it comes down to it. They say well and if you upset folks, then they're going to try to fire you.
You they're gonna try to do all these things to which honestly like 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 go out, know 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 and know I did. So with integrity.
It 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 pushback from folks about talking about certain things and may have rankled folks who may have had an interest in those issues and that's okay. You keep talking about them as you should and I'm grateful for that. 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. 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 seeing what we're saying that we are 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.
The circumstances changed. 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 were taken on today. It's about the trust that we need to rebuild 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 u.s. that are not allowed in Europe. That may be a 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, your green known to be safe. Read 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.
People. There are you it's not but at least at the level of which foods you want to buy with your own budget, 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 a verse there. 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 tell me 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 elevated companies, and their success. So I'm confused, I'd like to know more about the back Contour of this. Well, look, I think in this is not too dissimilar for, I think, what happens and, you know, their Industries. But it's, you know, whenever you do something and
Whether it's in the private sector and government people way with what are the pros cons were to push back? I'm going to get, how do I deal with that push back? Right? And push back isn't always a bad thing, right? If you get pushed off in the public people. Hey, that doesn't make sense to me, except for, that's you should listen to that and use it to inform your approach, but that's the public. Who's your job is? To serve, I'm trying to push back from companies is different, right? So when push back, a comes from people who have a financial interest in the product that you may be commenting on, then you've got to be, you need to know about that, number one, so that you
You know, how to add a mitigate it. And while people may take different approaches to this, my Approach as a public official is Surgeon, General has been to say at the end of the day, like I'm happy to hear from anyone in terms of their concerns or pushback, but the end of the day. What's going to guide my decisions about what we issues. We take on what decisions we make and what we say to the public is going to be, what is in driven by science in the public interest and if that means it's politically inconvenient, that's okay. If that means that, you know something happens, you know, it's a
Job. That's okay too. You know, like we look at the bottom line is, life is short. We don't have much time we have here, we may as well. Make the time we have count me as a do, the things that are right, and that I'm going to serve people. That's my simple philosophy. My parents taught me when I was growing up. So that's a bad 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 and Industry is serving the public. Well, I think we have
I've 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 again to other people, listening to this podcast, so 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.
More. 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 to 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 media is immense,
I'd like to just take a brief break and thank one of our sponsors, which is element. Element is an electrolyte drink. That has everything you need and nothing. You don't. That means plenty of salt, sodium, magnesium and potassium, the so-called electrolytes and no sugar salt, magnesium and potassium are critical to the function of all the cells in your body, in particular, to the function of your nerve cells also called neurons. Now, people of course, have varying levels of requirements for sodium. So people with hypertension or prehypertension, probably shouldn't increase.
Sodium. However, many people are surprised to find that by increasing their sodium intake. They are able to function better cognitively and physically, and that's because a lot of people especially people were falling low carbohydrate or even moderate carbohydrate. And really clean diets, often times they're excreting a lot of water and electrolytes along with it and simply by increasing their electrolyte intake using element, they just feel better and function better. I typically drink element first thing in the morning, when I wake up in order to hydrate my body and make sure I have enough electrolytes and while I do any kind of physical training and certainly
I drink element in my water when I'm in the sauna and after going in the sauna because that causes quite a lot of sweating. If you'd like to try element, you can go to drink element. That's LMN t.com huberman to claim a free element sample pack with your purchase again, that drink element. LMN t.com huberman. Have a question about trust in big institutions and public health initiatives in general. The question is about masks early in the pandemic as I recall we were told that man.
Six were not necessary. Then we were told, they are necessary and I think for a lot of people that flip in messaging landed like a parent telling their teenage kid to always wear a seatbelt, but then you look into the front seat and Mom and Dad aren't wearing seat belts and as anyone who's been around teenagers or was been one, you make that mistake, once you're not making it again and you may never recover from that particular,
Particular example, in other words the public felt like there was a switch of messaging, but what I don't recall happening was a like a hey we got that one wrong so sorry on us. You know what the new data say blank. What I recall was a message of don't and then do but there wasn't a lot of kind of acknowledgement of how challenging the situation was. It was just a lot of talk.
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 and so why do you think it's so challenging for public facing officials to just say, look doing the best we can at the moment. Screwed up before, changing the message. Now may change again, we're navigating this in
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 it look this it's important question. And look, I I'm always I want to be thoughtful about how I comment on what was done in the first year of the pendant make. 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 we made there. But I do know, sometimes for my experience in Ebola and zika during those experiences, we
Is a country that in the, you know, in the fog of War, when everything is 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 are 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 II certainly try to follow. But when I think that and you know we can all do better, I Can Do Better certainly to. 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. And then we explain the why to people so 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, and 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 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 an update recommendations. We do that with lipids here too. I think that has to be 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 inter simple posts on social media often, a lot of that was uncovered. What gets covered is their Top Line. You know, this is what's rubbing recommended, that's what's being required, Etc. All the explanation is lost its 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. But I think that that's a challenge, right? It was like, I didn't 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 he something? I was taught early in medical school is to approach your patients with humility recognizing that even though you have more training and then they do you don't aren't living their life. You don't necessarily know what they're going through and you shouldn't assume things about them, right? And so approaching with humility means that you've got to
recognize that not everyone's going to be able to follow your guidance. And if they aren't able to, that doesn't mean you criticize them. And 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, argument 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.
I'm thinking in particular about local and state public health officials who are on the front lines that I talk to a lot, was they ended up getting attacked a lot and abused a lot during the pandemic, and I don't just mean like attacked online. I mean, people showing up at their houses. People harassing their children, people threatening their safety and, and this was often people who were upset about some of the requirements that were being put down from local Departments of health, and you can understand what Kobe do as stressful.
The time is we've seen recently people lost their jobs before losing loved ones. I mean talk about a stressful time but I think at a human level Public, Health officials, who were exposed to that kind of abuse and you start to worry about their children's safety, many of them stepped out of the arena and said, is this really worth it to put my family at risk 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,
But we also need to restore is an environment where we of frankly of humility and civility where we don't attack people. You know, who maybe have different views or are coming out the recommendations that, you know, are not palatable to us is and 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 is Kovac got increasingly politicized and, you know, while that may have been at times done
For political reasons here, they're 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. The weren't able to have a clear direct channel to end 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. And I totally agree that, you know, getting violent or harassing people with whom
You disagree is totally inappropriate and you're 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 been should have been done. Better isn't an effort for example, around masks 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 and doesn't have the authority to do that. So there's our local local decisions.
But at the end of the day, they were people who did not want their children to wear masks. Right? For a variety of reasons, some worried about their development, Social Development, some worried that it was adding stress to their kids. Like, people had many 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 don't want their kids to wear masks. I think some of them received a lot of criticism without people necessarily stopping to understand why they
Been making that decision because I'll say, is a parent whose children were in school in. My kids are five and seven. And the first year, 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, it was a really tough, like, adjustment for them. And I could understand like, some of the concerns that parents were having wondering about, hey, how are these precautions affecting my child's experience and Social Development? So, on the whole day?
It's the recommendation may still be. Hey, improved 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 for their child. And I know that when localities made the decision in many cases to require schools and there are no 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 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, this sense of black and whiteness that, hey, it's us against them. And then suddenly, if I was against one measure that I was against all of them, you
No, if I was 41 measures for all of them because we just started segregating into sight and this became a polarized you know experience at a time where really it should have been a crisis that brought us together as messy as it was. 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 how to develop them quickly, how to distribute them, if
Suddenly in, we had what I wanted, was one of the most historic and effective vaccine distribution efforts in this country. Even though you 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 going to, if we're divided the way, we were during kovin during the next pandemic or the next, you know what, I thought that may come from foreign adversary, that's a huge national security issue for us and so that's what keeps me up at night when I think about the next pandemic. That may come from 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
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. Okay the previous top round with coded went this way and now there's now virus X. Right. Let's hope. Not God forbid but it 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, 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, letting your moral compass guide in 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 so what efforts are being made if any to try and acknowledge that some people really do feel as if they were harmed, I'm not saying they were or not, but clearly there are people who feel that they were people. They know were harmed. Is there an effort to present?
Sent 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, I know it's a really important question. And to me, I always go back to sort of first principles from practicing medicine, right? Which is if there is a medicine, you give a patient and even if it helps 99.99 percent of patients, but this one particular patient happened to be harmed by it. You go in, you acknowledge it, you talk about it. And you
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. Here, the risks you may sustain, but will find other ways to protect you, right? So, that's what we would do in medicine, right? That's what I've done with patients over the years, I think here to similarly, when I think, when it comes to tracking 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 correlated or where there's actual causation there, right? Because, you know, if I if today, for example, I felt unwell and I trace back, what happened yesterday? And it turns out, hey, I ate this burrito. That was out in the sun for way too long. The question is, am I feeling sick because the burrito or did the breeder just happen to be you?
Something that happened, but 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 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 covert, for example, 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 acknowledge it in feel good. You know, 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?
I think we have to both a here and acknowledge those. I certainly try to do that. I know I probably I 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 site that where they collect a lot of this information and you just purely. Look at reports that are given of potential adverse effects that you can't sort of take that and say, ah, those are all related to the vaccine.
And look at this rate of harm. It's extraordinarily High because we don't actually do that with any other vaccine or medicine. I'm sure we start there. We do the analysis and we try to understand what's actually related or not. So I think that's what, 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 example. Like, most people think, oh, well Tylenol, it's safe, there's nothing bad.
Happens if you take Tylenol Etc but people who track the data know that Tylenol by and large is a generally speaking a safe medication, but there are people who experience adverse effects from Tylenol, liver damage, you know, and 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 boast analyze. And then a recommendation is put forward about a generally safe, way to use it. And then there's data put out about the
The 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 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 Court re that as the rule, right? And we'll say, We'll look, I know,
Somebody who had this side effects, so nobody should take this because this is what's going to happen to you. If we did that, nobody would ever take Tylenol. No one would ever take Ibuprofen. No one would take NyQuil. Like, no one would take any of the common medications that we pick up at the drugstore and that we commonly use. So that's how I think we have to approach this with a combination of clear communication, empathic listening and and data and context again, that doesn't fit neatly in a social media post per
Say, but I think part of what we're we need to do is 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 individual standing there, telling us what to do.
Two for several reasons. One is, we are a country of many different people. Yeah, I think we, 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 Altos and saying that committees small, but diverse committees that people can relate to and feel as if the messages that they're getting are vetted through a common understanding. Yeah. So it's really good suggestion and I couldn't agree with you more. That A diversity of voices is really important to get a message out and enduring Club it actually. That's one of the things that our office actually was always
Need to build with something called the community Corps, right? Where we actually, we recognize it's a very clearly this is something. I, you know, I came to see as a doctor, sometimes I was the right person, a message to patients, sometimes I wasn't right. Sometimes it was the nurse and sometimes it was the medical student. Sometimes it was an administrator or the social worker would different background different life experiences. So part of this work is knowing when to step up when to step back, right? But the community Corps that we were building was a really diverse, you know, group of
People and a lot of men Public Health backgrounds, but a lot of more Community leaders who understood Health even though they didn't have formal training, but they're people who knew their communities, right? And they had their trust in their communities and they understood what was going on. They wanted to be helpful so we brought them together to say, okay look here's what the science is. Telling us here the general recommendations, here's what we would provide you. Ask us any questions, you have. Like if there's something, we don't know, we'll go back and look it up, but you're the leaders in your community, they should be hearing from you, you know?
Out 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 taken what we said, word for word and we don't want them to. But to me like that kind of diverse approach is what we need more of now. You know, I'll tell you what, I would have liked. I would have liked if more media networks but those folks on TV and got them on the radio, right? Because it's important, that many of them were showing up in their communities were knocking on doors were
Doing local, you know, podcasts, Etc. And that was great. But I would have liked more of their faces. I carried on TV, right? So that's a place where when, when we talk to media and when I talk to folks, in media, one of the things I encouraged him and pushed him 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. Its broad its diverse at us.
Voices in the. And as the more voices, we can hear from his public. I think the better off we are 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 where we, you know, this is a thing in this country. We like the idea that one person is going to save the climate. One person's going to save Transportation one person. The other covers that person of the year type approach, I know, but we
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 the into Division. And I just feel like I'm 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 that thing a notion that I think sometimes we do want like the one person who could not only necessarily have all our trust and we can look to, but also who we can hold accountable, you know, something doesn't quite work out if we don't like something. And while I get that sort of mentality,
I think that in this moment especially when we're trying to rebuild trust I think it's important for people to know that what they may be hearing in terms of medical or scientific Public Health recommendations. They, it's an order for them to know how broad an audience that's coming from or brought a group of experts, right? And we there was a lot more broad agreement for example during covet and during Ebola during zika on public health recommendations. But you wouldn't always note if you turn on the TV because you were seeing the same
A couple of phases. So I think we have to certainly diversify that 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 group's. I'm talking about the community organization that spent years in a neighborhood getting to know families where folks recognize them when they're walking down the street. They'll go. Yeah, that's a person from organization X.
They understand if 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 about my wife did, which I certainly was very proud of. Is she was helping to build an effort and to build a nonprofit organization.
In 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 their mission that way. And that was very effective. And I think we need more of that. When it comes to disseminating finding one thing,
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 the 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 the state,
Apartment how sometimes it can be challenging to figure out how to get the money. And so I think we need more operations. Like you know like what my wife and others have been building to try to get those funds. Directly to the folks who not, you don't necessarily have the most fancy you know, grant writing operation but they have their relationships because at the end of the day it's those relationships that create their trust. It's a trust that allows infirm 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
Rich 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, 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 I want to dovetail into that question. What are your thoughts on the fact that you know, there's a history of 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 kind of relationship and financial incentives and then a lot of back pedaling 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 it look, 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 given gifts and vacations and all kinds of fancy things by Pharma companies, in an effort to influence, what they prescribe that was really problematic. And now we're seeing a lot less of that which is good by the rules had been 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
You think that human psychology is that sometimes we underestimate how much were influenced by incentives? We thank Allah. Yeah, I'm getting that but I know how to make independent decisions but it ended a we're human and 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, it was 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.
As maybe doesn't for some people, but it's just, it's really hard to know who those people are. I do think that's 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 in many cases. They've saved the lives. You know patients has caring for in the hospital so that's what which should drive us. That is dead.
The data showed that they work and there's 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 Pharma 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 I know this is obviously you but I'll say just to be clear for everyone who's listening, like our office doesn't take any money from
Industry, not just for Ministry, for many 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 that's important, we don't want money from the from, you know, from a pharmaceutical companies, but that's important because people need to know that these decisions are not being made for for financial gain. 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. What 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
Hours 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 when 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 adds 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 health care setting. Like if you're, if you're seeing a patient who has pain, who's having intense pain, it feels easier. Sometimes a prescribed 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.
Sure where we I think increasingly reach for something that we see as a quick immediate fix. And again, don't blame people for that. You 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. That's one of my big concerns in terms of how we communicate about health.
Would a potential solution be this idea of small committees. So let's say somebody is experiencing chronic pain localized or general that they would go to their general practitioner. But in the room would also be somebody who understands somatic medicine aside trained clinical psychologist, who understands cymatics that the body and the brain are linked through the nervous system and could also assess, you know, possible, psychological roots of the issue.
And then somebody in the room who can make behavioral nutritional maybe even supplementation based safe, supplementation based recommendations and then the physician who can say, you know, and in addition to that, I think the person should have on hand, you know, a 5 milligram dosage of a prescription drug that if they need it, they could take. And I think it would provide a lot of protections against, you know, potential adverse effects of any one of those things in isolation.
They're great protections and having people meet in groups for lots of reasons and the person would feel very well cared for. So, again, small Committees of people with diverse expertise pooling together to treat people from, for lack of a better word, a more holistic perspective, why not? I mean you're just driving the dream. I didn't 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.
Figure out how to best manage our health challenges. I think what we have not figured out or a couple things number one who are all the right people who need to be in the room. Or if you're the sort of virtual room if you will. The second is, how do we create a structure, a Healthcare 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 group experience for patients, right? And there's increasingly a no more
clinics and Health Care Systems around the country that are working on creating group experiences where patients, who all let's say are working on diabete, on their diabetes, come together. Let's say once a week and they meet with the healthcare practitioner, that might be an addition to their individual appointments, but there is so much power in groups coming together. Groups of patients who can find Community, who can help each other. Learn from each other's experiences. That's highly underutilized right now in Madison, but to really do this well and
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 the 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 not referring to my own experience. Although, I've had, you know, mild examples compared to what other people dealt with. But people with chronic pain, are irritable for understandable reasons. I mean, it, it's or maybe somebody is close to veering towards suicidal depression. Then there's the, inter personal effects. I mean, I feel like that the crisis is, is one of a lack of a
Chauncey and thoroughness. And and again, I'm not throwing stones at the medical profession. 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, the date.
A two are feeling burned out and frustrated by the inefficiencies of the system, because I'll tell you one of the greatest contributors to burn out for doctors. And nurses is a lack of self, efficacy, it seeing a patient who has a problem in front of you and feeling like you can get them, the help that they need. That is like 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.
Are 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 if 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 trained specifically, in only in mental health. Yet, they find themselves having to manage a lot of that including increasingly complex substance use disorders and treatment
Resistant depression and they need help figuring that out. But if you don't have a lot of resources to get that referral to collaborate with mental health professionals and you're stuck on your own figuring that out. And so you know 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 multidisciplinary care overall and so when health systems for example come together and say okay rather than sort of focusing on the amount I'm getting reimbursed for every procedure. We're going to take more of a value based approach here, what we say, okay? We got certain amount of money to care for certain people.
What's the most efficient way for us to provide them care? Recognizing if we don't do that, 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, the care overall care that we're taking for a patient. So there are 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 modifier,
Forward. And again they're not perfect if they need their own tweaks. But I don't think that the existing Financial structure that we had in Madison 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 just
Once again, Drew before we go there just one thing I thought 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 the private insurance industry 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 a required even for a medicine that you clearly your patient need to 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 his medication. I've also had the experience as a doctor of fighting. For my patients who have been denied Care by an
Current company being on the phone. Saying I am sitting here in front of my patient. I know that they are sick. I know, they can't 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 patient who needs them, which is just in creating more and more barriers. Hoping that you're a small-time doc out there. Who's got, you know, your shingle 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 until eventually you'll just give up. We've a lot of problems right there and Industry. There 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.
This is particularly true with mental health. I know we're going to talk about that but Mental Health Care is just been such a difficult thing for people to get in our country and part of the reason they're many reasons. But one of them is that insurance companies historically did not reimburse adequately out. We're 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 can have. But how if you're a mom out there who sees her child,
Struggling with depression, you're really worried, you don't want to be told, you know what, you can only get three sessions, that's it. What are you supposed to do after three sessions, right? And so, what has happened is that 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. They were many ways that insurance companies were skirting it, right? So one of the law wasn't even being a
He reinforced for many years but to insurance companies sometimes would say, okay, you know we reimbursing adequately but when you look in the network they had very few provider 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 a complete this prior authorization, have that completed by your primary care doctor Etc. Again, throwing up more and more barriers. So very recently, in fact just a few weeks ago, President Biden just announced that we are from as Administration.
Putting out a proposed rule to actually strengthen the mental health parity law to prevent some of these. What I think of, as abusive practices because they're preventing people who need care from getting it, 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 a 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
He told only only have two more appointments. You need to know that help is there when you need it. And a lot of these denials are are being issued to people who have done 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, hey, 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 the Bears 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 say, you know, this is 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 a look at. You got to, if you're collecting taxes is government, you should be doing your best to make sure every one of those dollars is being spent well, right? Because somebody took money out of their, paycheck 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's supports First Responders police officers a whole bunch of services that we need. But the response we in government is to make
Sure that money is 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 or occurring while on the topic of mental health, let's talk about ice the isolation crisis. What is the isolation crisis, what aspects of mental and physical health, is it impacting? And then perhaps most importantly, what can we each and all do about it?
Well, this is one of those issues that I, if you had told me Andrew ten years ago. Hey, you and I are going to be sitting here talking about loneliness and 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 was 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 was really shy as a kid. I was pretty introverted and I wanted to
To make friends and hang out with other kids, but it took me a while to actually build those relationships. So, I spent a lot of time feeling left out, you know, there were times when I would like mine elementary schools in there were days where I pretended, I had a stomach ache and so 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 her. That no one would want me to to be at their bench.
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 love me, I just felt like, hey, if I'm feeling this lonely, it means something's wrong with me. I'm not likeable, I'm not lovable. I'm someone's got to be, it's got to be my fault in some way. It was only years later. Andrew, when I talk 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
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 and medical school wasn't part of our residency curriculum. Yet when I showed up in the hospital, I found that the patient who had 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 were talking about how lonely they were sometimes. I would ask them, hey, you know where I need to have a difficult conversation about
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, 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, 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 into adults in America, reporting measurable levels of loneliness, but the numbers are actually even higher.
Are among young adults and adolescents the numbers and among youth. Actually depending on the surveys you look at are between 70 to 80 percent who say that there are struggling with loneliness. So that's the 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 and 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 of dementia. And these are not small risks. We're talking about 29%, increase the risk of coronary heart disease, 31 percent risk, in the increased risk of stroke. 50 percent increased risk of dementia among older people increased risk of premature death and immortality impact of loneliness, by the way, and loneliness and isolation is comparable.
No, to the mortality impact have many other illnesses. In fact, it's even greater than the mortality impact. We see associated with obesity, which is something we clearly recognized 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 talked 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, where 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 could you elaborate on those? You know, growing up in the 70s and 80s I
I was exposed to, like, Community soccer teams swim team. There was a community pool. These were all public 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. Yeah, so there are several factors that have led to us being as isolated as we are. One of them, is you mentioned, is the decline.
Nine and participation and 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 and service organizations and other community groups. A 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 is 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 the 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 maybe 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 about thing, right? We're have more opportunities and that's a really good thing. But I think one thing that we have not accounted for, it's a cost of these changes, right? So if we know what the costs are certain actions, we may still take those actions but we may find ways to mitigate that a cost. We met in this case, invest more in our relationships, be more conscious about reaching out to other people going to visit them, but that has been a
Quiet, but devastating Consequence. The other piece is that it, 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
Us. And one of the interesting thing about Cove, it has many people in the first year of cloven, 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. What I didn't expect was missing. The strangers that I saw at the coffee shop or the folks who I ran into at the grocery store or seeing neighbors, as I walk down the street, like I actually miss that more than I thought I would. So we have lost out on.
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 who are growing up as digital natives. But what has happened there? I worry. Is that and it is thought 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 a user of technology. I spent 7 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
Lawyers and friends on social media feeling somehow that made us more connected but the nature of dialogue also changed like a spume and beings. We evolved over thousands of years to not just understand the word, 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 a car body language, right? And I'm seeing you nod your head and I'm seeing your eyes focused like all of that matters to how we communicate but also like you and I are less likely to say
Being hurtful right now to one another because we can see each other. If I said something hurtful to you, like I probably see that 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 with 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 going to want to hang out with you. They're going to see something valuable in you. And for many young people, what has happened? And I think, frankly, for many older people to is their experience on social media, has shredded, their self-esteem, as they're constantly comparing themselves to other people. Like, when you and I were growing up, you know, in the 80s, we compared ourselves other people too, right?
People have for Millennia, but what's fundamentally different now, is in any 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 experiences. Social media. Is it makes him feel worse about themselves worse about their friendships, but they can't get off it because of platforms are designed to maximize the amount of time they spend on them. So you put all of this together and I think, what is
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. And I think that that's really hurt us. You know, we see it, 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 there posting happy things online to the folks at work. Their 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 the 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 that, 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 all so 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
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 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 Technologies? I mean there's a long history of young people rebelling against the stuff that's been put in front of them and they're like no more we're going to Rebel. In fact that was the way that youth overcame the the nicotine epidemic. If you recall it was the advertising, pitching them against or pitting them, scuse me against 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 is terrible for you. Your lungs are going to fill with cancer. Kids didn't stop smoking teens and stop smoking. He was you know Rebellion has been baked into our nervous system in the Adolescent and teen years. So do you see a rebellion against this social isolation or kids going to start putting away their phones and hanging out together again and that's going to 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 as the thing. I also really worried
about. 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 social media and 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
Our families where the parents that gets together have decided that they're going to 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 going to draw boundaries around a social media use or they're going to 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. But doesn't necessarily 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 your
Only one who's not on social media in your middle school class and you might feel left out, which is why it's so important for parents to, and, and kids 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 prophet and you know of a social media platform.
And the reality is that the again, we've talked about how the fundamental business model is for most social media platforms is built on. How much time you spend on those platforms, that translates to add revenue and translates to the bottom line. Whereas what I care about is apparent as Surgeon, 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 is it not is it actually harming them? And this is where I think when I go out and talk to young people about
Number one, I'm so impressed by a lot of young people because they already have a lot of these insights are the ones living in, right? They're not thinking that. This is all, you know, perfect, and it's all pure benefit here. They're the ones telling me that it makes them feel worse about themselves 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 if 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 adolescence, say that using social media has made them feel worse about their body image as are 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 I think that concerns me think about mental health symptoms, is it? 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 major social media, your social media, and that's means many are using it for far more than that and we'll, 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 3 and
Fda's 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 are 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 are 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 6. Out of 10 adolescent girls are saying they've been approached by strangers on social media in ways that made them feel very uncomfortable. Our kids are also finding that Health promoting activities in their lives are being cannibalized by their use of social media that it's detracting from time for Sleep, in-person interaction, physical.
Vitti and the erosion of self-esteem, really concerns me as well. Because you need that. Not just for social interaction. But like look as a as a father. I want my children to grow up being confident about who they are, being confident 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.
Be authentic. That's what I want my kids to do. That's not what's happening to a lot of kids on social media. So I think we not only need more kids to understand this and to support them in their efforts to create space and sacred spaces away from social media. But we need to support parents here, too. Because, Andrew my big concern with parents is that we've taken this technology which is rapidly evolving, which we didn't grow up with as kids, and we've told parents, you manage it all on your own.
Put the entire burden on parents and kids to manage this. When we were growing up. Remember the motor vehicle fatalities are really high in America and we didn't say okay you know what? That's just a price of Modern Life. You just have to accept it and keep moving on with our lives. We said, hold on. What do I have to go back to horses and Buggies? But we also don't need to accept this Saturday. We need to make this experience safer, and so we put in place with the advocacy and support of incredible groups. Like
Matt and others across the country, add me Mothers, Against Drunk Driving. Ultimately the government put in place, safety standards that God has seat belts. Airbags crash, testing to make sure the frame of cars were robust and they setting of an accident and that helped us reduce motor vehicle accidents and deaths. And that's what we need here to like. We need to have the backs of parents and kids and that means from a policy perspective, putting in place safety standards or protect kids from exposure to harmful
10 from X, 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 there is 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, as a parent looking.
Okay, I don't when we bought car seats for my children, when they when they were born. We looked at the safety data, like many parents who 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 Wilt we should, we'll talk about some steps parents can take, because I want to get the Practical steps that people who are here as parents or people of kids in their lives, can take, but 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 about telling parents what to do and restricting them. This is about giving them the support. They
They need so they have confidence when they see you know and Technology out there device out there product out there for kids that they know it's been tested that it's been studied and then 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 got to leave the house. You
Go down the street and play. Yeah, unfortunately I liked outdoor activities nowadays. We also have the issue that a lot of parents are on their phones at soccer games and it 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, you know, the TV, there's laptops, there's multiple phones, iPads, people are in you more engaged in the screen portals than often than their own
Yells at 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 but I guess they want to capture that unique experience. Yeah. But it's not unique at all. That's the that's the myth. That's the illusion. There's nothing unique about the your post of something that you went to go see what would be truly unique is to just experience that in real time, right? Is so wild to think about like what we think of as you are unique port,
Is actually not unique at all. It's what we do with it, learn my stances 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 a thing 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
Just take the images that we see of people there, you know, their summer beach images. They're like great vacation images, that's not representative of their entire life, 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 didn't getting you guys outside my parents did.
The same thing to like we I was very blessed to have two parents who didn't count, you know, they didn't have a lot of resources, wearing up. They didn't come to this country with a lot of resources, but the one of the greatest gifts they give that gave us is that they loved us unconditionally and 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 discovering the world, you know, riding a bike around the neighborhood and that's what
Did but right now, at 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, how to resolve conflict, how to recognize, what's going on in 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 seemed 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 make an x amount of money in 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 his 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 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 her, 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, - 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.
Ian 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 limit their screen time, force them outside.
In the safe weather and safe conditions, of course. But what about adults as well? And 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, 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, what I would do specifically with social media is and this is this is frankly what I'm planning to do with my wife for our kids as they grow up. Number one, I would seek to delay, the use of social media, past the 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 me lonely as a
result. So that means no account of their
own means no account of their own, okay? And I would make seat 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 your other kids who are also delaying use. I means your child is not alone and I think if you start the conversation with other parents,
It's you'll 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 is 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 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 mealtimes were Tech free zone, so that people actually that you talk to one another, you see one another and time with friends and family members. When you're out, you know, at a birthday party Etc. Think that
Take 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, 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 atom. 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 hard not to be on it. Everyone's like,
Next thing on this Earth everyone is, you know, everyone's sharing information and posting pictures on. 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. That is a problem. You want your child to to tell you about that to report that?
If they see something posted online, that's really concerning to them. Let's say they see a friend post that they're thinking of taking their own life or harming themselves in another way you want them to know that that's important to flying in to get help, you know that they shouldn't just you know scroll past that so that conversation is really important and finally as parents we can lead by example right? And this is hard because the truth is we've been talking about social media and youth and that's what the subject of my surgeon general's advisory was on but I have concerns about adults to. I said, if somebody
Had challenges in my own use, you know, of social media. Finding sometimes it bleeds, you know, past my bedtime. And I'm realized, you know, I think I'm going to check something 45 minutes an hour later. I'm still there, you know, scrolling through something and sometimes I, you know, like, you know, I find myself I have over the years. I find myself comparing myself, also to posts I see online in unhealthy ways. Sometimes I find myself sort of pulled into content that you know, ends up being angry and betray all like and leaves me feeling worse.
No, at the end. So I've experienced this as well, and I think his parents, 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 were around our kids, one experience, I had with should have I still feel bad about, but which really helped kind of knock some sense into me was after my son was born, my older child. I was actually, I was searching General at that time, you know, I had a lot going on. I was busy job, Etc, but I wanted to make sure that I protected bedtimes
mealtimes for us to be together as a family yet one day when I came home, you know, after dinner when we were in the bath time and bedtime routine getting my son ready for the night, 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 this 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 a like this is terrible and look, I know that all of us do this and it may be in different context, 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 life when I had was in my inbox and my head wasn't with him, you know, and my heart wasn't with him right now, he's 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, mealtimes sleep time as well, it's not easy to do but it really sets a good example for our kids. All
All Behavior change that we're talking about here, the kind of behavior change. I worked with patients over the years or in physical activity and diet. All of this is harder to do when we're doing it by herself. 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 had two good buddies, Dave and sunny or my partner.
Other Hood, and the three of us is 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? It sounds daunting or overwhelming. You don't have to do this alone. Think about one or two people. Other parents, you might want to do this with and I guarantee you there are 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.
Tacular 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 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 the example, you gave it becomes reflexive. Yes. We're just, you know, we're not necessarily seeking pleasure or looking to engage in online battles. It's just it's become reflexive. Sort of like, finding yourself with your hand.
Refrigerator just 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 like this, when you mention kids awake until the night, looking at their phone, I just I thought you had plans. Oh my goodness, pains me and I've looked at my phone in the middle, the night. I try not to
But but I'm certainly not in the window of Maximum plasticity, either. It's terrible for everybody but especially terrible for kids. What you just provided an incredible
Let's just call it a, I'll call it a mandate, you didn't say it, but a suggestion 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, first of all, for the conversation today. You're incredibly busy. You're responsible for an entire country is worth of people. So to take time to sit down with me and to discuss these topics for our audiences incredibly
Appreciated by me. And by them, I feel comfortable, extending their gratitude here and it's also clear based on today's conversation that you face an enormous number of challenges at the level of budgetary challenges. By the way, I'm going to work on that hard to shut me up, as well as the huge array of issues that you confront. And and it's clear that it's a challenge that you've embraced for many years now. Under
Difficult conditions and that you're clearly willing to get out and talk to people and hear their criticism hear their concerns here 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 last of our conversations. 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 and the emotional power that you put into what you do. Because that is very clear your
Or a physician first and you care about your patients and your patients are all of us. So thank you so
much and do this. First thing is incredibly 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 for
my kids for our country more broadly, is that
Is it? We can go deeper like beneath the Seas surface issues. I worry that we find ourselves disagreeing about in fighting about online and recognize that there is a deeper challenge that we are facing that I think underlies a lot of these, the anger, and the vitriol, and this issue around, how disconnected we 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
So what else is? Heidi without fundamentally realizing that a lot of this is a manifestation
Of a society that's has become more disconnected and More disinvested in one another I think over time. And that's just not who we are. It's not how we evolved over thousands of years and somehow we're going to thrive in the future. So I know that sometimes when you look at these big intractable problems, like widespread loneliness in the United States that it can seem like hard to address these, but I do want to encourage everyone to recognize it when it comes to human connection that it is small steps that can make a big difference.
Because we are hard-wired 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 someone who's 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 help to remind you?
Why you're still a good person, why you still have worth in value to add to the world even when you had lost faith in yourself?
You think about their faith in you about their support for you about their love for you?
I think that how healing that was.
That's the power that we have.
To help each other heal.
We are going through an identity crisis, in many ways. As a country, where I think we need to ask ourselves. Who are we, like what defines we are? What are the set of values that we want to guide us in our life and to guide our country?
and I know that it feels like We're a nation of people who are mean, who only care about ourselves were 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 in our hearts, we are interdependent creatures, who recognize that if someone else is suffering, we want to be out there to support them. And he wanted 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 has real implications, for everything else that 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, I worried that they're going to use the wrong word even though their intentions are right.
And people are going to blame them or cast them out. No I worry that they're going to stumble and fall down and people just keep walking by not caring, you know, because everyone's live in their own life. I worried that they might become a someone who does the same thing to other people, right? None of, which I want what I want. For all of our kids is for them to grow up in a society where we care about one another, we have each other's backs, we recognize is 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.
Yeah. 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 to 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.
They 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? 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. And a time when the self-esteem 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% Applause of the decisions leaders, make they make behind closed doors and what's guiding them in those moments are their values. 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 that.
Identity that we want to Anchor ourselves to. That's the way in which I feel like I'm Erica 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. That extraordinary levels who are seeing mistrust and institutions sore, many countries are experiencing this
I would love America to lead the way in some ways and showing what it's like to embrace. A 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, has prescribed many medicines over the years, but if you things more powerful than love and its ability to help us through,
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, or I've gone to nursing school to be healers. We all have the power to help each other heal. Like, Andrew, we are not fundamentally a nation of bystanders who just stand by while other people suffer like, We're a nation of healers and hope maketh.
Workers 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 it's what were built for that same intensity that I think we now more than ever. We need to embrace, amen,
and thank you for that. I agree. Love is definitely the verb that can get us where we need to go. Thank you so much for your word.
For your incredible efforts to support public health and Fleet to continue to support Public Health. I know you've been at this a long time and we've all benefited and and thanks for your open-mindedness especially around some of the questions that invoke some Challenge and again for your
taking the time to come talk with us today and I really also enjoyed it. It's been a real pleasure and there was a lot of learning for me and like I said before, I hope it won't be the last
time, I hope not either. Now I look forward to the next time to staying in touch and just love this conversation. Thank you for what you've done for being this beautiful channel of information for the public. But it's mostly thank you for who you are. You know like who you're Andrew like comes across very clearly with
You know, when I meet you you just have a good heart and you have good intentions. You're good man. Then we need more people like you in the world.
Thank you right back at you. Thank you for joining me for today's discussion with dr. Vivek Murthy, 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 are enjoying this podcast, please subscribe to our YouTube channel. That's a terrific. Zero cost way to support us. In addition, please subscribe to the podcast on both Spotify, and apple and on both Spotify and
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