Public Health was on the ballot in the 2022 midterm elections — and public health won! Abdul reflects on the politics of public health. He sits down with de Beaumont Foundation President & CEO and former Georgia State Health Director Dr. Brian Castrucci to break down the biggest public health victories — and challenges — coming out of the midterms.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: [music break] The Biden administration renews its effort to pass critical COVID funding. Global leaders met in Egypt this week for COP27, aiming to curb the world’s greatest public health challenge, the climate crisis. The U.S. is facing a shortage of several key prescription drugs, including the commonly prescribed ADHD medication, Adderall. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Today we’re talking about the wins and losses for public health coming out of the midterm elections. I want to register the fact that as you went to the polls and I know you went to the polls, public health probably wasn’t the first thing on your mind. I’ll be honest, I do this for a living and it wasn’t on mine either. Before we get going, I just want to explore why. We only really ever think about public health when we’re facing a public health crisis, when it’s not working. The pandemic is a perfect example. So many of us were glued to our social media in the first days of the pandemic, trying to glean every last piece of information to keep our family safe. As it went on, some soured on public health. Asking why public health offered more questions rather than answers. The answer, of course, is circular. We don’t pay attention to public health until it’s failing, and then we don’t even take the time to look back and figure out why it failed. We just move on. For many of us, we thought the pandemic was finally the moment we needed to have a grand reckoning. Instead, the crisis transmogrified from a health crisis to an economic one, which then became the most important question as we headed into the midterms. We didn’t take the time to connect the dots. You know how an underfunded, decrepit public health system that allowed a pandemic to spiral out of control, that then required massive government investments to bail out the economy while grinding global supply chains to a halt, all kicked off the worst inflation in half a century? No. Instead, it was just the inflation crisis, as if it had no context, no beginning. The Supreme Court made sure we couldn’t ignore health entirely when they abrogated a person’s fundamental right to choose whether or not to carry a pregnancy to term. And while some have framed abortion rights correctly as the health issue they are, it occupies a singular space in the American consciousness because of just how broadly abortion impacts lives. People didn’t come out to vote on abortion because its public health implications, no, it’s because it’s about so much more. Which brings us back to public health. The fact remains that despite a pandemic that killed more than a million Americans, despite the ways that it continues to ravage our economy, despite the fact that all of this could have been vastly mitigated, public health was a non-issue in these midterms. And yet public health was still on the ballot in so many ways. Though it was a way better night than expected for Democrats. The House will fall to Republican control and they’re coming for blood. You better believe they’ll be launching witch hunt investigations into public health agencies around the country. Not to better understand how to improve them, no, but to further cut their support. And in states around the country, the fact that MAGA Republicans like Kari Lake have been defeated may have averted some of the most dire consequences for public health in those states. Yes, public health was squarely on the ballot, even if public health had little to say about it. And that’s in part because the public health community simply hasn’t organized as a political force. One person trying to lead that effort is our guest today, Dr. Brian Castrucci, a long time veteran of state public health and president and CEO of the De Beaumont Foundation. I wanted to have him on today to talk about all the ways, big and small, the midterm election shaped the future of public health in this country. And as a note, the De Beaumont Foundation, as you know, is a sponsor of this podcast. Here’s my conversation with Dr. Brian Castrucci: 

Dr. Abdul El-Sayed: Ready to roll? 

Brian Castrucci: Sure. 

Dr. Abdul El-Sayed: Okay. Can you introduce yourself for the tape? 

Brian Castrucci: Uh Brian Castrucci, President and CEO of the De Beaumont Foundation. 

Dr. Abdul El-Sayed: So, Brian, we had a um we’ll just say a hell of a mid-terms uh a couple of weeks ago, and what we wanted to do was step into the conversation about what these midterms and more broadly, what American politics means for American public health. So I want to just step back and ask you, what were the key storylines that you were watching uh throughout the midterms? 

Brian Castrucci: Well, I’m a public health person, right? That’s that’s all I’ve ever done. So that’s what I was watching. This was a public health election. I mean, every election is a public health election. And if we someday we’ll get this through the electorate, I’ll be a really happy guy, because no matter what it is, the economy, education, everything has this baseline of health to it. And so what I was watching were those COVID deniers, the COVID minimizers, the Brian Kemps’, the Ron DeSantis’ and how they did. And so I’ve read a lot of folks saying this was a win for public health. I think it was a win for some aspects of public health. South Dakota expanded Medicaid, abortion rights, you know, did really well. But public health, I don’t know that we did so well. I think it’s a draw at best. 

Dr. Abdul El-Sayed: Hmm. So the interesting thing about that is that a lot of folks, when we talk about public health, we miss a fundamental characteristic of what we’re talking about, which is that in public, we only really trade on public health when we’re in the midst of a public health crisis. The minute that people see the crisis moving on or don’t even connect the crisis to public health, I would say that this inflation crisis that we’re in the midst of right now is actually a public health crisis that’s just transmogrified from a pandemic that slowed down global supply chains into an inflating currency. But people don’t read it that way. And so what happens is that as folks are making decisions about what to vote on, what key issues they are voting on, public health is very rarely in their minds. What do you think it will take to engage folks about what’s at stake every election when it comes to public health? I mean, to me, it seems like a very, very big project just in terms of educating about public health more generally. But I’d love to hear your perspective on that. 

Brian Castrucci: I think we have to start aculturating people to public health as kids. I mean, this is the problem is, you know, when you think about what, you know, I have an 11 and a 13 year old, but when they were when they were toddlers, their physician grandfather gave them the Melissa and Doug dress up as a physician play kit. And so you’re acculturated to medicine early on and you know I took that that Melissa and Doug dress up physician play kit and I took out the stethoscope and I put in a little little notepad and we did outbreak investigations among the adults. And so my kids know public health. They get it. But but I acculturated them to that. I mean, when do we even learn about public health? When do we even have the concept that individual health is indelibly tied to community health? I mean, most of our high school health class is wearing condoms and washing your private bits. So those of us in power, those of us with privilege. Our community has been constructed to make us as healthy as we can be. And we miss the fact that that’s not true for every American. And so that’s what we have to start really you know, we have to hit on the fact that what is the what is the what’s in it for me, for public health, right? For businesses, it’s about staying open. You want to keep your businesses open next pandemic? Invest in public health now. You want kids to graduate from high school, invest in public health. You want employees to show up and be their best selves, invest in public health. But we’re not doing that work right. We’re not doing the work that the lobbying groups for soda and tobacco and alcohol do. We’re just kind of in the background doing the good public health work we do, and we’ve got to be less humble. 

Dr. Abdul El-Sayed: And that’s the I think that’s the key point, is that traditionally we’ve always seen ourselves in public health as people who operate in the background. Right. We’re just we’re just back here doing our thing to make sure that you stay healthy in ways that you cannot actually tie to what it is that we’re doing. And we expect you to allocate the fact that you’re doing as well as you are to what we do, even though we’re not really showing it to you. And so what what I’m hearing is that we need to be a lot bolder about explaining what we do and how we do it, why we do it, and making sure that folk’s first uh interaction with public health isn’t in the midst of a public health crisis where public health is clearly failing, but rather uh in the midst of their day to day lives. When folks are asking, you know, why is it that we’re so much less likely to die in a car accident in the United States? Why is it that I’m so much less likely to have childhood asthma in this country, although not not entirely true for uh low income Black folk in particular. I want to sort of switch gears because there are a couple of key things um that that you discussed and that I think are really important to engage with. One of the most important public health issues on the ballot, certainly that I think people understood as a health issue, perhaps not a public health issue was abortion. And it was actually explicitly on the ballot in five different states. You have California and Michigan, uh Montana and Kentucky and Vermont. And in every single ballot initiative, whether it was to codify the right to an abortion uh or um to take away the right to an abortion, the people came out overwhelmingly and voted for abortion rights. What does that tell you and what do you think are the downstream implications of that? 

Brian Castrucci: I hope it tells people that we really don’t want politicians deciding our medical care, that these are these are issues that people will mobilize on. I mean, when you saw the Kansas constitutional amendment go down as you know vehemently as it did, that should have that should have sent a message. And I think some of the red wave that didn’t happen is probably because of the abortion rights issue. And so these are things we have to mobilize around and really not just talk about women’s reproductive health, but what that means for public health. You know, public health is hard because it’s an umbrella with a lot of single issues inside of it. And when we engage, we have people really interested in this one issue, but they missed the umbrella. And we have to take this moment of whether it was expanding Medicaid or abortion rights or any of the other ballot initiatives. And really just you know hammer home your governors, your state legislatures, they will have a greater influence on your health than your physician because they’re making the policies that shape your everyday life. And this is a place where the voters finally got to stand up and say, we don’t want you in this area of our care. I mean, and again, in South Dakota, the legislature didn’t expand Medicaid. So there’s a real disconnect there when the public when the voters are willing to move on a referendum that the state legislators were not willing to do. And we got to push that. We got to there’s some momentum here that we got to we got to really try to capitalize on. 

Dr. Abdul El-Sayed: I think one of the things about abortion uh care that I think is so cross-cutting, right, is that it’s not just the ability to get an abortion, but it’s also all the implications downstream of the inability to get an abortion. It’s the ways that being forced into carrying a pregnancy to term fundamentally shapes everything from your economic outlook to the way that you form a family, to uh the way that you partner, to um what the implications are for that that person um that ends up being born. All of these things we don’t appreciate fall far further than the ability to get specific care for an illness that you have. This is about the way that we structure society and um and allow people to make choices about the way they build lives. And um and I think in that respect, one of the pieces of public health that we sometimes miss is that because most folk’s engagement with public health tends to come through some particular disaster, usually a infectious disease disaster. People don’t quite appreciate how cross-cutting the failure to invest in public health can be or uh what it means to invest in public health, because it just seems humdrum and normal when when we do those things right, bad things just don’t happen. And so people don’t register that bad things were prevented. They just assume that that would have been the course of of of the world as it was. And I think the court’s um destruction of Roe v Wade uh in the Dobbs decision was one of those moments where folks looked at the their their lives and society outside the bounds of a world where the right to an abortion was protected and said, no, no, no. Like you can’t fundamentally unearth or upend uh the way we think about our lives like this. Um. And similarly, right. The investment and all of those things that that protect us, we ought to be thinking of the same way. But, you know, you’re absolutely right. We don’t um I want to think through the implications of what happens next for uh the right to an abortion following this. I think, you know, to my mind, I think that the right has recognized just how big of a losing issue this is. I think they’re going to be very, very quiet about it, because I think it was always sort of the interest of a small uh marginal group um that, you know, was very smart about packing the court to to build. But I think the party, as it stands right now, is more interested in winning than they are in continuing to fight this fight because it’s such a losing battle. Um. That being said, the hope was that we could codify uh Roe, we could pass federal law that protected the right to an abortion. Um. Where is the state of play uh in your mind and um what comes next for the right to choose? 

Brian Castrucci: With the House flipping to the Republicans, I don’t think we’re gonna get any federal legislation that codifies much of anything, uh let alone abortion. But– 

Dr. Abdul El-Sayed: –Yeah. 

Brian Castrucci: I think now this becomes a state fight because I think you’re right. I think we did see that this was a losing issue for Republicans. However, I think in Texas, in Georgia, in Florida, there were Republicans there, they got big mandates to keep going. Uh. I never really thought that–

Dr. Abdul El-Sayed: –Right. 

Brian Castrucci: –Governor Abbott would would be able to dismiss Beto O’Rourke so easily or that Stacey Abrams would lose so spectacularly to to Brian Kemp. And what was really upsetting, watching the post-election coverage, the number of Georgia voters that were interviewed who really highlighted COVID and the lack of COVID restrictions in Georgia as a reason for voting for Governor Kemp. And so there’s been a real referendum on public health in some states. And that’s really the problem, right, is that our public health system isn’t doesn’t exist. There is no public health system. There are actually thousands of little public health systems throughout the throughout the country. And each has their own person who claims to be the director of that public health system. And it’s really hard to bring the kind of collaboration and coordination that we need in a federated system. And this is just, you know, if I could go back in time, I might go to when we wrote the Constitution and say, hey, guys, by the way, can you can you make public health a power of the federal government and not give it to the states? Because this is the issue is that we’re only going to be as safe as our least healthy state. So if we have that next pandemic and Florida and Georgia are doing things that that don’t support a nationwide response, we’re weaker for it. And that’s unfortunately, what the what the folks in those states have have voted for. They voted for minimizing COVID. I mean, in Florida, we’ve weaponized the state health official like I had never thought I would see in my lifetime. We actually have a state health official producing misinformation, not just parroting it, producing it. 

Dr. Abdul El-Sayed: And Brian, can you can you dig into that a little bit? Um. What actually happened? Who is this person? Um. What did they do? 

Brian Castrucci: So you have um the surgeon general of the state of Florida, Joe Ladapo, who is an appointee by Ron DeSantis who, it was really talking a lot about COVID minimizing. And the talk was talk. And I can live with talk. Right. That’s that’s just things people say. But where he crossed the line is the Florida Department of Health put out an analysis that was not peer reviewed, that was not authored, that had limitations, that were actually longer than the the actual article. And this based on this analysis, he issued a warning to 18 to 39 year old males that they shouldn’t take the vaccine because of the risk of myocarditis. And this then fed the right wing echo chamber. So let’s just lay this out. You have FDA, CDC, W.H.O., universities, all of them are somehow involved in a grand conspiracy to force us to get this vaccine. But this one person in Florida with this weak analysis, well, he’s telling us the truth. And, you know, I read an op ed today that was really interesting to me because it said pro-science candidates won in Oklahoma. Well, pro-science now, that’s a point of view. That’s what scares me. It’s it’s not clear anymore what’s pro-science and what’s anti-science. It’s that I have scientists that agree with me. And you have scientists who agree with you. So here is this Harvard trained, gubernatorial appointed physician leading the health department. And he said that 18 to 39 year old males shouldn’t take the vaccine. So how is that guidance worse or better than the guidance that I’m giving you from this other physician? Right. We have like it’s white coat on white coat crime. And we’re going to have to really be thoughtful, because what if I got a mathematician like, I just found this MIT mathematician and I mean you know hugely respected. He’s telling me that two plus two is seven. 

Dr. Abdul El-Sayed: Right. 

Brian Castrucci: Maybe it is. Maybe it’s a left wing conspiracy that two plus two is four. But why is that fact? But the safety of the vaccine is something that we’re debating. And this is the biggest problem is people have asked me repeatedly throughout the pandemic, I want you to debate me and you can’t debate facts. I can’t debate the sky is blue. It’s blue. I can’t debate gravity exists. It does. So I can’t, I can debate with you, mask mandates. I can debate with you vaccine mandates. Those are policy decisions. I cannot debate with you that that COVID is real, that COVID has killed over a million people, and that these vaccines are safe. 

Dr. Abdul El-Sayed: Right. And you’re pointing to a couple of pieces here. Number one, you’re pointing the power of a governor and the power of an electorate to choose a governor and the implications that that can have for public health in that state. Sure. But also, when you have a level of COVID denialism that dabbles in these kinds of conspiracies, what a governor can also do is platform someone for purposes of their own gain, their own positionality will parrot a lot of these uh disinformation points. What happens then is you create sort of an opposite pole, right? It becomes now a he said, she said, rather than the consensus of scientists who believe in a particular thing. And that’s just one governor. Right. And so, you know, you illustrated that with DeSantis. You look at um where where Kemp is headed in the in the referendum on uh COVID restrictions, uh as if opening up Georgia and thereby leading to substantially more uh cases and likely deaths um was a good thing. And you have the situation now where those have become really, really politically potent. I want to ask you, you’ve been a state health official. Um. What’s it like to be someone who believes in actual science um working in a setting where the politics seem to be against you or is this just a new thing? 

Brian Castrucci: That’s a great question. I mean, I spent a decade in government public health practice. I’m not a clinically trained public health person. So I actually had to work my way up through public health. Um. And of course, I worked in I worked with in Texas in the Perry administration. Um. I was in Georgia when Nathan Deal was there. Um. I never thought it would get this bad. This is a level of weaponization that I never expected. And I think we all kind of are sitting back looking at this, trying to figure out what we can do because, you know, governors within their states are all powerful. There’s very little you can do. And so I remember watching the confirmation hearing for Joe Ladapo in Florida and the Democrats walked out. I mean, one of the, it was the senator from Broward County asked Ladapo whether the vaccines were safe and effective. And I believe his response was something to the effect of science is rarely a yes or no question. And then they were like, listen, y’all aren’t doing this fair, y’all aren’t doing this right. We’re leaving. We’re not going to be part of this. And so I think the people of Florida are not as safe as they once were because, again, health had always been, yes, there’s a leaning there’s political parties appointing that health commissioner, but there was always at least science. There was something that those health officials could stand on and say, oh, you know, Governor, this this isn’t really in line with science. Now, make your own decision. But let me give you the science. Let me be that voice of of fact and you know, that’s the most interesting thing in this election, Abdul is it’s almost like we were voting for a slate of facts. Which facts are you going to believe? So how crazy is that that we are actually voting for which facts we want to believe? So I mean a vote for for Ron DeSantis was a vote for 18 to 39 year olds are at greater risk for myocarditis and therefore shouldn’t take the vaccine. But you can’t vote for facts. Facts are supposed to be true regardless. And I got in trouble with my wife because my daughter came to me and she was doing one of these like fact and opinion worksheets for school. And, you know, I was like, I don’t know, I think everything’s an opinion now. I don’t know what’s a fact anymore. And of course, my wife was like, no, that’s not true. There are really facts. And, and I don’t know, I think we’ve we’ve lost that in some ways. When you have the state health official in Virginia saying in The Washington Post that racism’s not a public health crisis, that racism isn’t impacting how our health is constructed, especially the health of Black and Brown people. That’s that’s a big statement. I mean, I’ve seen health officials lose their job for far less. 

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Dr. Abdul El-Sayed: Facts were supposed to be the substrate upon which our politics were decided, and we were supposed to take an objective viewpoint of the facts. We were supposed to assess who had policy that was more in line with the direction the facts seemed to be headed, and then make a decision that way. And that fundamental substrate is now up for question, which I think gets us into a far broader conversation about the nature of a public conversation, the fact that, you know, you have huge corporations that have monetized, showing us the worst of ourselves. They’ve created um points for uh concentration of this particular ideology where everything is self-reinforcing. I want to turn to the federal level. You know, we’re in this this odd position now where we’re going to have a split Congress. Uh. The House is called for Republicans and there are a couple of pieces um specific to the pandemic. But then more broad uh about the federal public health infrastructure that’s already on its last leg that I think are really important to consider here. The first is Congress still has not passed um COVID funding and we don’t really know where we’re headed. But you know I was just thinking about this and this episode is going to come out a couple of days before Thanksgiving. And I remember after Thanksgiving meal getting an alert on my phone about this new variant called Omicron. Right. And I think a lot of us sort of want to think that we’re out of the woods when it comes to COVID this year, because thankfully, there just hasn’t been that much increase. And you’ve got, you know, this whole plethora of new variants, but none of them seems to um have the escape velocity that Omicron had. But that’s not to say that it couldn’t yet happen. I mean, when you look at the timeline last year, we’re right about there. And we are in effect at this point flying blind. We don’t have the testing capacity that we need. Uh. We know that um though, we have antigen testing ability, the capacity to get all the testing that you need uh when you need it, if there’s another surge that’s going to be questionable yet again. And then you talk about vaccines and treatments uh which have been woefully under, underaccepted by the public. And so we’re in this situation where we could have another surge and we could yet again be caught without our pants on. Um. What do you see as the the potential for passing another tranche of COVID funding in lame duck? Um. Do you think that they’ll be able to do that? Um. And if so, how does that happen? If not, why not? 

Brian Castrucci: I mean, I think lame duck’s the only shot. 

Dr. Abdul El-Sayed: Yeah. 

Brian Castrucci: If we don’t if we don’t pass it in the lame duck session, it’s going to be hard. And I mean, I guess, you know, my question for elected officials is how many Americans have to die before you’re willing to act? Just give us a number so we won’t bother you with our trivial requests until we hit that number. A million wasn’t enough. What’s it going to take? A million five? 2 million? How many of your constituents have to die before we mobilize against this virus in an effective way? You’re watching public health tools get taken off the table one by one. Again, what’s it going to take to to put a mask mandate back? What’s it going to take to have to do social distancing again and not have concerts? I mean, we we’ve so just moved on and accepted mass death among American people. It’s going to be super hard. And the [?] for us to actually get back to to in a divided Congress. If we were able to pass COVID funding. That means a lot of Americans are sick. That means the health care system is about to break because that’s what it’s going to take to get these guys to mobilize past their political ideologies. We have put partisan political agendas over the health of the people. And we’ve convinced people that COVID wasn’t that bad, that we need to move on. These are really dangerous ideas that place the American people at an amazing vulnerability. It would be like if China parked an aircraft carrier off the coast of Georgia and we just kind of ignored it. Like could you imagine? Imagine? Just no death, just a foreign nation put a ship in our waters, we’d lose our mind. There would be an immediate reaction. But this virus is still here. It is still circulating and still making people sick and is still costing lives. And the reaction has been, well, we’re just going to move on. Nothing to see here. And again, I just worry what it’s going to take to get the action that we’re going to need. And I hope it’s not a major outbreak of a new variant that either causes a lot of death. That’s one bad scenario. But the other, even if it’s not, if people aren’t dying, we still could break health care with a variant that causes hospitalization even if it doesn’t cause death. 

Dr. Abdul El-Sayed: You know, you know the funny thing about this, um and it’s not funny it’s actually tragic. But uh the ironic thing about it is that the current economic crisis that we’re in, which is that we’re teetering on the edge of recession, we are facing the worst inflation in half a century. That is a COVID outcome. And our choice not to control the virus from the jump, our choice not to invest in a public health system that could keep us safe while at the same time um allowing for the level of economic activity that was possible under the circumstances. Like all of that, uh we are still dealing with as an economic crisis. And the irony is that politicians focus a lot on the economy, um but it’s like we’ve decontextualized the current economic circumstance from the thing that caused it. It’s like all of a sudden inflation just happened on its own, or uh that we’re facing a recession on its own, rather than this being the clear, direct outcome, a uh pandemic that we had not seen, like the likes of which we had not seen in a century. And we we are like assenting to a discussion that doesn’t actually include well, there is a pandemic and that pandemic has consequences. I want to ask you also, because, you know, it’s about to be silly season in the House of Representatives. And um the irony of all this is that despite the fact that the public really did come out and land a rebuke against the MAGA ideology, um the slim minority uh implies that Republicans are going to need every last vote that they can get, which means that basically the MAGA faction um has a lot more power than it did. And so they’re going to be a lot more interested in investigating than they are going to be legislating simply because they don’t control the Senate. And a lot of those investigations are going to focus on uh the pandemic. And the goal will be prosecute a narrative about the public health institutions of this country that they manufactured a pandemic, that that’s going to be what their goal is going to be. It’s going to be investigating everyone from the CDC to Dr. Fauci, to uh NIH to everyone. Um. What do you think the long term implications of that kind of behavior in the House could be for the work that we need to do to actually rebuild these institutions and build public trust in these institutions? 

Brian Castrucci: Uh. This is going to be a huge challenge when we put CDC on trial in the House and begin to just pound on every mistake that was made and mistakes were made. This is not to absolve CDC. I think CDC made some significant mistakes uh with communication with state and local health officials, with um just the way they communicated with the public, how they reached out to businesses. I mean, there were mistakes made. But this is going to become partisan theater, not an after action report. And that’s what we need. We need an after action report. We need to figure out how to get better, not how to dismantle the CDC or how to persecute them on primetime TV. Right. This is just going to feed the Tucker Carlson’s and the Ben Shapiro’s and the others who are going to just, you know, take this as red meat to continue to pound on the CDC and the elite scientists who thought they could get it right but misled the American people. I mean, this is going to be the narrative. Now, what I hope because I still have hope. We had if you go to the website, changingtheCOVIDConversation.org. I got 13 Republican members of Congress who also happen to be physicians and pharmacists and other health care professionals who cut PSAs for free, telling people um that they need to think about getting vaccinated to make the decision for themselves, but that they were vaccinated themselves. Now, CNN didn’t really cover that because it didn’t fit the narrative that they were pushing. And Fox definitely didn’t cover it because it didn’t fit their narrative. And so these like moderate, well minded health first Republicans, you never really heard their voice. Uh. Right at the start of the pandemic, we did a focus group with Kevin McCarthy, with Leader McCarthy, and he was there telling people, this is how we need this is why we need to get vaccinated. And that never really got the traction that we wanted. We know that every single person in the house is vaccinated. 

Dr. Abdul El-Sayed: Mm hmm. 

Brian Castrucci: And so I am hopeful that those people who want to win will not allow those folks who are trying to perpetuate an unhinged ideology to have free reign over whatever hearing they want to have. 

Dr. Abdul El-Sayed: This is the thing that kills me, right, is that so much of this particular strain in our politics is about doing the thing and then blaming the other side for doing it. So the entire point here that they’re trying to make is that somehow the pandemic was this giant conspiracy. When you look at the behavior of uh these folks, the fact that they’ve all been vaccinated and yet they want to peddle in this mis and disinformation because it seems to speak to a particular strain in the base. That to me sounds like a conspiracy. Right. I’m going to tell you to do a thing that I, myself or my family would not do. And I think it’s just really important for us to take the fight back in public health. And I know this is an issue that you’re really passionate about. Obviously, having run for office, I’m quite passionate about it, too, it’s that public health doesn’t really have a political arm. And I think the worry we sometimes have is that if we become political, we’re going to become partisan. And if we become partisan, then we’re basically dismissing our ability to work with a different side. And yet you named 13 different congresspeople who are Republicans who cut PSAs for the vaccine. And what’s happening is we are allowing ourselves to label our own work as partisan, because we tend to ignore the folks on the other side who agree entirely with what we’re saying and doing. I want I want to ask you, you know, what does it look like for public health to truly get political? What does it look like to take the fight back um against this this strain of ideology uh that has tried to, you know, tear down all of our institutions um of of collective action in this country, public health included. Um. And what is the what is the tip of the spear on that fight? 

Brian Castrucci: Well, it’s interesting. So I think when it comes to misinformation and disinformation, we tend to think this is a COVID thing. This happened just now. It’s not, right. I mean, the entire diet pill industry is in some ways misinformation with the little thing that says, you know, none of these things were FDA, none of these claims were FDA approved. Right. So you still have folks in white coats selling diet pills. I get on Facebook at least four times a day. I’m a Type two diabetic. And somehow Facebook knows this because Facebook knows everything. And I’ll get, you know, four or five ads every day for cures for diabetes. I didn’t I didn’t know that there was a cure. I think if there was, hopefully they would have told everybody. But no, I just get on my Facebook. So, you know, the Bollingers and their push. 

Dr. Abdul El-Sayed: The doctors don’t want you to know this one trick. 

Brian Castrucci: Right and that, isn’t it it’s like, you know, here’s this secret. Come to this website. There’s not a secret, right? Diabetes is a chronic disease that can be managed and managed effectively, but there’s no cure. But–

Dr. Abdul El-Sayed: Right. 

Brian Castrucci: –I get it. Like I get the challenge of having chronic disease. Of course you want to find a cure. Of course you want to hear that your cancer isn’t terminal. It can be cured by just, you know, taking turmeric. I mean, you know snake oil didn’t go away, it just kind of got into the spotlight with COVID. It had never been done on that level. Uh. Michelle Smith from the AP wrote a brilliant piece on the Bollingers and their grift. Uh. And that’s really the challenge, right? Whether it’s Simone Gold and America’s Frontline Doctors or the Bollingers, it’s a grift. They are making money off of the fears of Americans. And, you know, that’s not that’s not what physicians are supposed to do. Physicians are one of the most trusted professions in our society, and public money goes to train them. I think we missed this. Right? Residency is supported by public dollars, so we have an interest in this. And so public health needs to we needs to find we need to find our voice. We need to find our talking points. We need to have consistent messaging. We just start there. Let’s even talk about political organizing. Let’s let’s talk about, you know, if I asked every one of the listeners right now to just draw a hamburger and post that to Twitter, all the hamburgers will look kind of the same. We have a brain architecture for what a hamburger is. But but, you know, I could get ten public health geniuses in a room and ask them to draw public health. And if I even got anything on the paper, I’d get ten different things. And so we can’t expect the public to understand public health. We can’t expect elected leaders to understand public health when we can’t articulate it. 

Dr. Abdul El-Sayed: Right. 

Brian Castrucci: Right. Coca-Cola spends four, Coca-Cola spends $4 billion dollars every year on global advertising. But why are they? Why? What are they afraid of? Pepsi? Like you know, you don’t even I I only drink Diet Pepsi. Uh. I don’t drink Diet Coke almost at all. Um. I just don’t like it. 

Dr. Abdul El-Sayed: And so [indistinct]–

Dr. Abdul El-Sayed: This is the problem, Brian. I mean, this is why they’re spending 4 billion bucks. 

Brian Castrucci: Right I, but this is [laughter] I and I but even when I go to a restaurant, I ask for, I say, hey, can I have a Diet Coke? And they say, Oh, no, we have Pepsi. Is that okay? I’m like, Oh, my God, that’s great. But it’s, you know, Coke, Xerox, Kleenex. They’ve become words, not brands. So here’s this this brand that has global market share dominate domination in the market, and they’re still spending $4 billion dollars on on marketing. And we can’t get people to even understand what public health is. So we have to really, you know, this is get back to basics. We have to get back and begin to educate the American people on what public health is, why it’s important, what’s the return on investment? And then we can begin to have a political movement, because right now, whether it’s whether it’s guns or alcohol or or fast food or whatever the the ill that we’re talking about is, those folks have kind of mobilized in a way to get people to to vote, to contribute. And we haven’t even. I mean, it’s just, you know, they’re trying to take your guns. I mean, this is my you know, this is our other problem. And I do this all the time when I when I give talks, I ask I ask my, you know, typically liberal public health audience. What did Donald Trump want to do to Hillary? And everyone gets up and you see them squirming in their chair and someone will you know sheepishly say, lock her up, like, right that’s what he wanted to do. What did he want to do on the southern border? And they still squirm and they say, you know, build that wall, like, absolutely, that’s what he wanted to do. And you’re going to remember that forever. Now someone asks you what’s public health? And five days later and that’s what public health is. That that can’t be. I’m not saying that we have three words, but man, we have to get better at communicating what we are, what we do, and how we make your life better. Because that’s what’s missing from all of our public health discourse. 

Dr. Abdul El-Sayed: I worry and I appreciate that and I agree with you entirely. I worry that so often in public health we are so siloed and we we operate in such an echo chamber that we think that the justification that one should invest in public health is so self-evident that we don’t actually have to talk about it. And maybe even what’s worse is that we talk about it outside of the public health space in the same way we talk about it in the public health space, which forgets that you have to convince somebody that public health matters in the first place. And I worry a lot about what that looks like. The other side of it is that, you know, as someone who spent a lot of my time in public health, but also outside of public health, talking um about why we should invest in public health. From a political standpoint, I actually find the conversations hardest with public health folks, because what’ll happen is you you tell a very simple story about what public health is and does, and they’ll say, well, that’s not complex enough. You’re not being comprehensive. You’re missing this important piece. And, you know, if there’s anything that I’ve learned in public communication, either in politics uh or in media, it’s if you tell people everything, they’ll remember nothing. If you tell people something, they have a real good shot at remembering something, especially if you make it interesting. And I think we’re so busy trying to tell people everything that we forget to tell them something and that something is that, you know, we are doing this amazing work that that invests in people’s ability to learn, earn and thrive. Um. And without it, really, really bad things happen like this one, that one and the third. Um. And if we continue to fail to do this, I worry that um the window is closing uh when it comes to our institutional capacities. Right. It’s a lot easier to tear something down than to build it up. And if you have a concerted movement of people trying to tear it down, um it’s going to be a lot harder on the back end to build it up. Uh Brian, I really appreciate you joining us to talk about some of the implications of this election for public health. Um. Appreciate your work uh at De Beaumont, and uh we thank you for uh joining us this morning. 

Brian Castrucci: Thanks Abdul, it was a lot of fun. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. In some good news, while COVID cases have been climbing steadily over the past few weeks, they seem to have evened out. That said, yet one more Omicron subvariant BN1 has begun to spread, with some fears over immune escape owing to a particular mutation it has. Meanwhile, two new sub variants have overtaken BA.5 as the top of the heap. BQ.1 and BQ1.1 now account for 44% of cases collectively. For their part, the Biden administration is trying one last time to pass a critical tranche of COVID funding, now pared back substantially to $10 billion dollars for everything from COVID vaccines to testing to treatments. If they can’t come to an agreement on this before the New Year, Democrats will have lost the House, all but foreclosing on any opportunities for passing that funding. 

[clip of President Joe Biden] Historic drought and wildfires in the West. Devastating hurricanes and storms in the east. Here in Africa, here in Africa, home to many nations considered most vulnerable to climate change, food insecurity, hunger follows four years of intense drought in the Horn of Africa. 

Dr. Abdul El-Sayed: That was President Joe Biden at the COP27 meeting in Sharm el-Sheikh, Egypt, where global leaders gathered to take on the world’s most existential public health challenge, the global climate crisis. For the first time, the US came to the table with serious accomplishments owing to the Inflation Reduction Act, the biggest single climate legislation ever passed anywhere. And yet I don’t have to tell you this we have way further to go and far more to do. Global climate policy is particularly knotty because of the inequities involved. The basic gist of the challenge is this, the countries that built their economies on greenhouse gas emissions continue to produce the most greenhouse gases, but they’re also the least likely to suffer climate change’s worst consequences. They’re also the world’s most powerful countries. Throw in the awful history of colonization that so many of the least developed countries were colonies of the most developed. And you can start to appreciate just how challenging this gets. And yet, nothing can be more important than the survival of the Earth itself. The U.S. is facing a critical shortage of several prescription drugs, including the common antibiotic amoxicillin and the ADHD medication Adderall. Both have seen a spike in demand. Amoxicillin, one of the most commonly prescribed antibiotics, is in short supply considering the high rate of RSV and flu. If you paid attention in high school biology, you know that RSV and the flu are both viruses and antibiotics don’t treat them. But one of the consequences of a long viral infection can be a bacterial pneumonia as bacteria take advantage of the warm flemmy atmosphere of the lungs. The other issue, though, is that parents often demand antibiotics for viral illnesses, and doctors too often oblige them, leading to overprescribing and antibiotic resistance. This shortage, though, will have real consequences for kids who need amoxicillin. The spike in Adderall use isn’t seasonal. Instead, we’ve seen a 15% increase since the pandemic started. The shortage isn’t just about increasing use, though. It’s also about a, quote, “delay” in manufacturing by Teva Pharmaceuticals, one of the biggest suppliers. Adderall is a critical medication for people with ADHD, helping them marshall their attention and order their lives. The shortage is leaving people to ration their medications. Worse, when people run out of the medication, Adderall can leave folks with some serious, uncomfortable withdrawal symptoms that can last from a few days to several weeks. In other pharma news, insulin manufacturer Eli Lilly stock price tumbled. This happened after a fake Twitter account was able to buy verification through Elon Musk’s Twitter blue subscription program. That account then tweeted that the manufacturer would start to give away insulin for free. And just like that, just for a moment, some genius with a fake Twitter account exposed the absurdity of our financialized pharmaceutical industry. A drug that millions of people rely on to stay alive sits behind absurd pay walls that leave them rationing it all so that a corporation can keep its stock price up. And in America folks, tell me again how public health isn’t political. That’s it for today. On your way out. Don’t forget to rate and review. It goes a long way. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and Ines Maza. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It is not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health.