So much of public health revolves around collective action — that is government working on our behalf to do things like fund biomedical research, regulate polluting factories, or clean our water. But what happens when we lose trust in government? Adam Conover is a comedian and host of the podcast Factually, as well as the new Netflix series “The G Word.” He joined Abdul to talk about how he uses comedy as a tool for truthtelling, what he learned about our public health system, and what it’ll take to fix it.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: Covid’s fall surge has yet to arrive, but a rise in flu cases and a COVID outbreak in Europe indicate it may be getting closer. President Biden signed an executive order to reduce prescription drug prices, and scientists believe there’s a pathway to eradicating malaria. But it’s complicated. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] I like to think I’m funny, but my brand is really just dad jokes, which most people call bad jokes and I call rad jokes. See what I mean? But where I’m a touch too earnest for comedy, I like to think I’m okay at explaining hard concepts. Well, at least you all seem to think so. Or you’re just here for the rad jokes. But in today’s crowded media environment, it’s not enough to just be accurate or clear. You have to offer something more to cut through the noise. Education must also be entertainment. If there’s one thing our COVID response got wrong, it’s that public health authorities never really adapted to the environment in which they were operating. For too long, public health has assumed that our expertise was our authority and that that authority implied that we’d be listened to. But that’s not enough anymore. In a world where information has to increasingly be entertaining to break through, the challenge of moving real information against disinformation falls on folks who can both be entertaining and informative at the same time. Comedy is best when it highlights the absurdity in the things we take for granted every single day. It’s a lens that magnifies that absurdity and forces us to look at it. Our instinct is to laugh because otherwise, well, you might cry. America’s approach to health is one of those absurdities that it’s easier to just laugh at. If it didn’t create so much pain and heartache for so many, whether it’s a federal bureaucracy forced to bear the worst pandemic in a century under the leadership of the most ineffective and poorly prepared president in as much time, or a health care system that forces millions to go without care so that 300 CEOs can make a collective $4.5 billion dollars in a single year. Over the past decade, few comedians have been as effective at leveraging their skills to explain and inform as Adam Conover, his hit TV show Adam Ruins Everything, use basic humor to force conversations about some of the most frustrating, weird and downright absurd things about our society. His podcast factually engages experts, including yours truly, on some of America’s most pressing topics, and he’s out with a new series on Netflix called The G Word, which explores all the ways that American government works and sometimes doesn’t. In one episode, he takes on the pandemic and why compared to other countries, our government failed to address Covid’s worst consequences under the leadership of Donald Trump. I invited Adam on the pod to talk about his new show, using comedy to teach and what he hopes we learn from the pandemic. My conversation with Adam Conover. 

Dr. Abdul El-Sayed: All right, we’re we’re recording. Adam, you uh you all set? 

Adam Conover: I’m good to go. Let’s do it. 

Dr. Abdul El-Sayed: All right, let’s do it. Um. Can you introduce yourself for the tape? 

Adam Conover: Yeah, I am uh just for the for the tape. I’m Adam Conover. Hello.

Dr. Abdul El-Sayed: Hey, um Adam, I got to ask you a very serious question first um. Are you the one who really ruined everything? 

Adam Conover: [laughing] I do my best, man. I do my best to ruin everything. I mean, I don’t I don’t characterize what I do as ruining quite as often as I used to uh, because that shows off the air. But, uh you know, I we managed to ruin uh 65 episodes, three segments an episode. So, you know, we ruined, uh what, 195 things? 

Dr. Abdul El-Sayed: Yeah, I mean, 195 things and I’m just I’m just putting it out there, during the time which you were ruining uh everything. Everything feels like it is now ruined. Um. And so uh I feel like uh I feel like in some respects, your uh your new show, The G Word um is about trying to rebuild the things that you have now ruined. Uh uh. And I say that obviously tongue in cheek, but, you know, you sort of thrive at the edge of comedy and explanation. Um. 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: I got to ask you, how did you find that niche for yourself? 

Adam Conover: Oh, God. Well, you know, I was just always fascinated in, you know, as I was trying to be a comedian, I have always been an information sponge. You know I’ve uh suck up, uh you know, articles, books, you know, podcasts. That’s just sort of my entertainment. And, you know, as a comic, you are, you know, in the soup of you know the New York City open mic scene, trying to, like, make people laugh. You know, after a while you learn how to make people laugh. And the challenge becomes, how do you make people remember you? And I found that once I started, like sharing the things that I had learned, the horrible truths about the world that I had gathered uh with audiences, they started like sitting for a little, little bit in their seats. They started, you know, paying a little bit more attention. People started zooming in a little bit more. And so I just sort of ran with that. 

Dr. Abdul El-Sayed: And I really appreciate the sort the approach that you’ve taken to some very serious topics. That you know that the beautiful thing about being a comedian is that you can say truths that other people can’t get away with, you know? And in my line of work, in uh either advocacy or uh in public health, uh even in my media work, it’s difficult to joke about some of these things that truly are really quite absurd. But they are the the facts of how so much of our American system work. I mean, the notion that you need to be employed to have health care, but then you can lose your employment if you get sick and then you can’t have the health care anymore, so you can’t get– 

Adam Conover: Mm hmm. 

Dr. Abdul El-Sayed: –Employed anymore. These are matters really fit for like a jester. Um and you’re sort of saying these truths to folks in a way that I can’t. What is it you think about comedy that allows us to really capture some of the absurdity uh inside very serious brokenness that we live every day? And, you know, how do you think about that and how do you take advantage of that? 

Adam Conover: Well, comedy is the art form that captures and represents absurdity. That is what it does fundamentally in you know, the human psyche and human culture. So it’s sort of like asking, you know, what is it about a painting that allows you to capture beauty, you know, or uh or what is it about architecture that allows you to you know create a space? It’s like this is the this is the art form. This is the medium. This is what we do. So, you know, when you when the human mind encounters absurdity, the reaction is to laugh. And I think uh, you know, a lot of people have probably had that experience when they’re, you know, confronting a health insurance bill. And, you know, even as they’re devastated by it, they’re looking at it going this is fucking ridiculous. 

Dr. Abdul El-Sayed: Yeah. 

Adam Conover: What is that like, can you believe what they said to me? You know, there’s that reaction, right? And so for a comedian, all you have to do is push on that a little bit more to take it to a joke. You know, and uh , you know, the critical thing is in my line of work uh because people say, oh, how do you joke about serious topics? Well, it’s actually quite easy because people love to joke about serious topics but the way you have to do it as a communicator and as a comedian who’s actually trying to reach people is you need to tell a joke that is aligned with the subject that you’re telling. You don’t do, there are jokes that distract, right, that go off in another direction that are about something else. Right. You you might use the topic as a starting point, but you might go off on a tangent or there’s jokes that actually stick to the seriousness of the subject matter, you know. So, you know, we were doing a segment about on the G word, which is my new Netflix show about the United States government. We did a segment about, you know, how ludicrous it is that the government was not able to protect, you know, the most vulnerable after a hurricane, right that it’s able to you know, after the hurricanes hit Houston. Right. A couple of years ago, um there was massive support from FEMA. Right? But every time a hurricane hits Puerto Rico, as we talked about Hurricane Maria, but it just happened again this year, you know the that help was nowhere to be found. And, you know, this is despite the fact that the federal government invests a huge amount of money in tracking the hurricanes. They fly pilots through the hurricanes over and over again. To find out where the hurricanes are, it’s incredibly sophisticated, you know, scientific apparatus that we use to gather all that information. 

Dr. Abdul El-Sayed: Mm hm. 

Adam Conover: And so this is what we want to talk about on the show. Now, when we’re writing jokes, we don’t go off and make jokes about how, oh, the hurricanes have funny names. You know, that’s like a sort of common thing. Oh, you know, oh, my aunt’s named Maria or whatever. Right. That’s a different sort of joke you make about hurricanes. Let’s talk about the topic at hand. Right. We say, why the fuck is it that that the government can fly a plane through a hurricane, but it can’t bring bottled water to people who need it? 

Dr. Abdul El-Sayed: Mm hmm. 

Adam Conover: Now, that’s not the joke. That’s the thesis that leads you to the joke. 

Dr. Abdul El-Sayed: Mm hmm. 

Adam Conover: But you see how, you know, we we do jokes off of, you know, off of the idea of not being able to get bottled water. Um. And so if you’re doing it about the subject in question, then you’re then you are doing comedy that highlights the specific absurdity that you want to talk about. 

Dr. Abdul El-Sayed: I appreciate that, that point, which is that in the end, you know, comedy is sort of the search for absurdity. And there is a lot absurd about the way things work often. And, you know, in some respects, what I what I really appreciate about what you’re doing is you are almost uh hand in hand walking the viewer through a system and pointing out the absurd. And that absurd ends up being your punch line. Um. But it’s in in in allowing them to sort of, you know, to use a pun on the term of this or the name of this podcast. You’re dissecting out the system to sort of demonstrate the absurd. I remember very clearly being in med school, right, where you’d have a, um you know, an expert surgeon or expert anatomy professor sort of helping you find these nerves and these arteries that seem just buried in a thicket of fascia, you know, inside the body. And what you’re doing is sort of pointing this out and saying, look, I’m going to I’m just going to show you what this is for, what it is. And it’s going to it’s going to create laughter simply because it is so absurd. And, you know–

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: –what that allows us to do is to sort of see these systems that end up crushing us that feel just like a thicket of fascia, but also to appreciate the structures underneath them and inside them that ultimately are really so absurd on their face, but also, you know, so profoundly um tragic uh that this is so often how the system works. 

Adam Conover: Yeah, that’s very true. I mean, I, I think that in the United States, we have so much focus on individuals uh and on individual action. And, you know what you can do to change your life. And, you know, the great man theory of history, that, you know, history is created by great people doing great things, etc.. And, you know, my view is that uh our lives are controlled by systems, as you say, structures, social structures, and also, by the way, physical structures, you know, and that these are you know, the structures are what you need to talk about and need to be addressed. You can’t solve problems. Look, the transportation sucks in Los Angeles, right? Traffic’s really bad. It’s hard to get from point A to point B. I can’t solve that problem individually. I can’t drive a little better. You know, I can’t, uh you know, get up extra early and, you know, dig my own, like, heavy rail line, right. In order to run a subway somewhere new. That’s a problem that can only be solved together. And we need to talk about like, okay, why are the streets built this way and what is the problem with them? Right. That’s a very simple example, but that’s true throughout our lives, throughout like the medical systems are great example too. And so a lot of my work, you’re absolutely right. I try to show people the structures that undergird their lives and the systems that they’re a part of and how they affect them and try to reveal that to the audience. And that’s enormously powerful because it gives the audience that feeling of, oh, I have felt this my entire life. I have felt the system around me, but I’ve never had a name for it. I’ve never had uh a way to talk about it. I’ve never truly been able to see it. But now I can. And that brings them, you know, a lot of solace and catharsis and also anger that can then spur them into hopefully action. 

Dr. Abdul El-Sayed: Now, Adam, I have to take issue. Um. I think you’re forgetting about a great man named Elon Musk who’s going to build a hyperloop. [laughter] Uh either that or he’s going to build you a a car that drives itself in traffic. 

Adam Conover: Come on. This is the Hyperloop that was an Elon Musk scam from ten years ago. He hasn’t talked about that shit in half a decade. Right. 

Dr. Abdul El-Sayed: Well, he’s gotta buy Twitter so he can tweet about it–

Adam Conover: Because by the way–

Dr. Abdul El-Sayed: –like automatically that’s that’s the game. 

Adam Conover: Oh my God. And that that was the most ludicrous. That never worked. It never never was going to work. It was always half baked and California threw so much money at it because they loved that guys, uh let’s not even get into Elon Musk. It’ll overpower the rest of the conversation. [laughing]

Dr. Abdul El-Sayed: Um. I want to you know talk about about this new series. I hear you’ve um teamed up with a celebrity couple from Martha’s Vineyard uh to do this uh this new series uh called The G Word um, one of whom happened to, both of whom happened to live in the White House, one of whom happened to be president. What’s it like doing a series on government with a guy who used to run American government? 

Adam Conover: [laughong] Well, uh look, so here’s how the show came about. I had read this wonderful Michael Lewis book called The Fifth Risk. You know, Michael Lewis is one of our very best uh journalists, especially narrative journalists. Um. He wrote an incredible book about how the federal government works, all the hidden things that it does that you don’t realize it’s also about the Trump transition. But the part that interests me was you know, the uh that piece of it. And as I was reading it, I was like, man, if I’m, you know, next time I’m on the air, I would love to do some of these stories. There’s some really good stories in here. Um. You know, my story sense was tingling. And then about six months later, I get a call from my manager who says, I don’t know if you’re going to be interested in this, but, you know, the Barack and Michelle Obama have optioned this book and they want to know– they want to make a comedy series. That’s all that they– it’s the only idea that they have is that they want to make a comedy series about this book. Do you want to pitch on it? And I was like, uh yeah, I do. And I pitched it and you know, I pitched, hey, I’ll do it. I’ll use my, you know, sort of signature blend of of information and comedy to, to you know, enlighten people to all the wild ways the federal government affects our lives, both good and bad. And they bit. And we made the show. And the thing I said from the beginning was, you know, this has to be my show. Like, this is if the audience has a whiff that this is the Obama party line, that this is, you know, part of his political machine. They’re not going to trust the show. And they were smart enough to grant me that space. And, you know, we had a couple of phone calls where, you know, the former president was like, uh well, you know, here’s how here’s how I see it a little bit uh, I differ from you a little bit on this point. You know, and, you know, he’s he’s an executive producer on the show. So we listened and we said, well, thank you very much. That’s some insight. Uh. But, uh you know, I’m afraid we disagree. [laughter]

Dr. Abdul El-Sayed: Yeah. What do you know about government uh? 

Adam Conover: What’d you say? 

Dr. Abdul El-Sayed: What do you know about government? 

Adam Conover: Yeah, well, you know, we have different analysis. 

Dr. Abdul El-Sayed: Yeah. I feel that. 

Adam Conover: That’s part of it. And and by the way, we criticize his administration um over the course of the show, so on, you know, the Affordable Care Act and, you know, the drone program and etc.. And, you know, he he made it clear he didn’t agree with that analysis and we made it clear we were going to do the show our way anyway, because that’s what that was the deal and that was what we were able to do. 

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Dr. Abdul El-Sayed: I watched quite a bit of the show uh and I was drawn by a couple of aspects of it. The first is that almost every episode gets back to some fundamental about public health. Um. Obviously– 

Adam Conover: Mm hmm. 

Dr. Abdul El-Sayed: –You have an episode specifically called Disease uh where you talk quite a bit about the pandemic. But even when we talk about, you know, the question of food and food production and the, you know, the absurd subsidies, policies um that have been the the function of a huge level of lobbying from big AG and big food, um you point that out, you know, you think about our um inability to tackle climate change or even to tackle the consequences of climate change on the ground. And that, you know, in the end redounds to whether or not people are kept healthy. And um I you know, I wanted to ask you, uh when people think about government, you talk to this quite a bit in in the series, but they don’t really think about it in terms of the nuts and bolts of their personal well-being, like, why do you think that is? 

Adam Conover: Um. I think that a big thesis of the show or a big reason we made the show is because the government doesn’t have a PR department for the most part, like for its own work and for the importance of what it’s work is. The only part of government that has a PR department, frankly, is NASA. If you go to nasa.gov right, NASA has an incredible website and you can go and learn everything about space, you know, and that’s because NASA was part of the point of the space program, was a PR exercise towards the American people and towards, you know, uh the rest of the world. But in terms of what the government itself does, most of it does not have uh any sort of promotional budget or and they don’t employ anybody who knows how to tell that story. 

Dr. Abdul El-Sayed: Mm hmm. 

Adam Conover: So one of the big ones we tell about it is, you know, the National Weather Service, which is this incredible, you know, country spanning globe, spanning uh information gathering and analysis service that uh collects weather data all around the country. There’s thousands of scientists employed by the National Weather Service, and they generate the predictions that are essentially repeated by all the weather people you see on the news. You know, the meteorologists that you see on the news will read the government prediction and add his or her own little spice to it and say, well, here’s what I think’s going to happen in this area. But for the most part, like, you know, there it’s the National Weather Service. And by the way, the National Weather Service has an office like in your location. You know, you live in Bozeman, Montana. You are getting the weather from a National Weather Service meteorologist who lives, you know, in your area. And so why don’t and by the way, these are the same people who fly the planes through the hurricanes. Right. Every time you turn on the Weather Channel and you see that cyclone, right as we were all doing, uh you know, just a week ago, watching it, you know, bear down on Tampa and you’re looking at that cone of probability that is coming from uh American pilots flying through these storms over and over again, risking their lives. So why do we know that? It’s because the government, none of these departments have a PR person, right? None of these governments tell their story. They’re not given the money to tell their story. And part of that is because the forces that don’t want our government to be healthy don’t want it to, you know, they’re the uh there’s a large political movement in this country that its only goal is to shrink the government and its goal is to do so in order to save money on taxes. And that’s it. And they want to uh take it over. And the other thing that they want to do is take over the the the actual duties of the government um themselves uh or or essentially turn government ends towards their own gain. So we talk about on the show how AccuWeather the the for profit weather company has spent the past decades lobbying to prevent the National Weather Service from doing things like preventing or creating a free public app or communicating with the public better or making its website more, you know, more splashy and more fun to use um because AccuWeather sees the Government as competition and it has in fact has lobbied in order to prevent the Weather Service from communicating with the public at all. And so that AccuWeather is the only source. So they want us to pay again for, you know, their for profit company for the weather data that we are already paying for as taxpayers. Now this is just weather, right? You asked about public health. Um. The same I think goes for, you know, NIH’s research, right? Uh. The same goes for that, I know so many of these departments like like end up working in secret. The USDA is is half captured by the food industry, quite obviously. Right. Plenty of great work being done at the USDA still. But this is a agency that is like, you know, in the thrall of industry. And yeah, as a result, you know, the story of what the government actually does doesn’t get told. And by the way, this extends to the bad things the government does as well. Those stories are also very buried and hidden for for obvious reasons. And so the result is that the public just doesn’t know. The public is like, oh, yeah, the weather report comes from the people on TV. The pharmaceutical companies invent the drugs. The you know right um my my uh my private insurer is responsible for my health. Uh, we don’t acknowledge the fact that so many of these problems are only solvable together. Right. The government is the structure that allows us to pool our money and our efforts together in order to uh solve these problems. And we don’t even know what the government is already doing to protect us from these threats. 

Dr. Abdul El-Sayed: Yeah, I really appreciate um that that point that you made about the role that private industry has had in making government worse. Right. 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: You look at um Medicare, which is a remarkable health insurance program for people over 65 and with certain disabilities. And it, one of the crazy gaps in Medicare is that it doesn’t fund one of the three things that almost everybody over 65 I know needs, which is vision correction, hearing correction, and dental service. And– 

Adam Conover: Mm hmm. 

Dr. Abdul El-Sayed: –you ask why? And it’s because you have a private version of Medicare which allows large health insurance corporations to take Medicare’s money and pocket every dollar that they don’t spend. And what their goal is, is to entice particularly the healthier seniors, the ones they don’t have to pay as much in medical cost for, and they entice them by offering them vision, dental and hearing. And so if the government were to offer vision, dental and hearing, then all of a sudden the difference between the private product that allows them to pocket money and the public product is just not as big. And so less people are going to choose it and so they’ve lobbied and lobbied to make sure that Medicare stays mediocre um and not as good as it could be. And you see the same story when it comes to the NIH right or or Moderna, right? Moderna was a company founded out of NIH research. It literally, the reason it’s called Moderna is RNA um on the back mode RNA. And um when they filed patents on the uh the COVID vaccine that were developed in NIH labs, they just happened to lop off all the government funded scientists off those patents. Um. 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: And now they’re making billions and billions of dollars off of government funded research. And you’re never going to know it because, well, Moderna’s CEO is out there all the time telling us we need one more vaccine. Right. And, you know. 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: That’s and also like what happens is it undercuts the the public’s belief in that v vaccine. 

Adam Conover: Mm hmm. 

Dr. Abdul El-Sayed: These vaccines have saved millions of lives. And yet when you see a CEO saying we need to give people one more right, it forces anybody who’s inquisitive enough to be like, mmm why is that guy so eager to make sure I get one more vaccine? Yeah. And these stories abound, so I appreciate you telling them. 

Adam Conover: Yeah. I mean, look, there’s if you talk to the people at the NIH, which I have, and you ask them like, hey, isn’t this weird that, you know, these corporations are profiting off of the research that’s done on the I mean, the NIH research, if you go down the list of what NIH research has changed for people’s lives in America, it is mind boggling, like literally decades added to the average American lifespan because of, you know, advancements, basic advancements like heart disease, cancer, the fact that, you know, if you get breast cancer today, it’s like, you know, it’s still scary, but it’s not a death sentence the way it was 40 years ago. You know, this is this is because of government research. And, you know, the first uh lithium for depression, the first like all of these different treatments. And, yes, like, you know, these these RNA vaccines as well. But if you ask NIH, hey, isn’t that weird that these companies are profiting off of it? The people at NIH will tell you, no, this is how it’s supposed to work. You know, if you if you talk to, you know, Francis Collins. Well, we live in a capitalist system, right? You need somebody to fund it. The government funds the basic research. The private corporations bring it to market. And I don’t think we need to argue about that. You know, like, I think maybe we could come up with something better, but but hey, I’ll take that as good faith that that’s what the folks at NIH think. Right? But if that’s the system we’re going to have, we don’t need those companies to be so egregiously profiting off of the free research that they’re getting from the government. You know, there’s so many public goods that the government offers that say, hey, this is for everybody to use. And if someone wants to make money off of it, fine. The National Weather Service publishes the weather data. If you want to start a, you know, weather media company that uses that data and blasts it out to people, go nuts. That’s what it’s there for. Right. But don’t then with your other hand, try to undermine the government, try to undercut the government. Don’t try to take credit where it’s not due and say, hey, we did it all by ourselves. So don’t we know we don’t want to pay our taxes um and don’t try to egregiously gouge the American people and hoard all of the advancements. So if you’re getting a free you know, if the NIH discovers a drug. Right. Or does the basic research that helps you discover a drug and you want to then sell it to the public, well, why don’t you make it a dollar a pill instead of 500? You know what I mean, like that that I think would be a fair tradeoff for the public investment. If the public is investing, the public should also be profiting in these drugs being affordable and effective and not, you know, gouging us. 

Dr. Abdul El-Sayed: And the other side of it is also is all the public goods that never do come to market because of the way our system works. Right. So you you think–

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: –About the drugs that a pharmaceutical corporation really wants to make like the ultimate drug is Viagra. It’s something that uh treats something [laughter] that somebody really cares about. They have to take it often, well often enough, and they will pay consistently for it. But then you think about antibiotics, right? Um. Which are mission critical, considering the fact that we’re starting to lose the arms race with bacteria. 

Adam Conover: Mm hmm. 

Dr. Abdul El-Sayed: Uh. That are evolving faster than we’re producing new antibiotics. But like if you’re a pharmaceutical company, you don’t really care so much about making new antibiotics because think about it. These are drugs that doctors specifically try not to use. Right. And you only use them every once in a while and every patient uses them once for two weeks. And that’s that right? 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: And so while there’s great NIH research that’s being done to study and understand where bacteria are turning, where they’re zigging and zagging to, uh to beat what we have and we’re we’re discovering new pharmaceuticals, we don’t have the incentive to take them to market because no corporation thinks they can make enough money off of them. And so, you know, it’s also one of those things where it’s just like, well, you know, our system is what it is, but it also sometimes could be better if we were to go the rest of the way. 

Adam Conover: Absolutely. And look, the function of the government in a even in the capitalist system. Right. What is the most basic function of the government, is to provide public goods that cannot that cannot be provided any other way, specifically through private means. So, you know, education of kids, you can’t do that with all private schools because you’re going to have a lot of kids left out no matter what you do. So you need to create a floor that’s a public school system. This is everybody can get the same education. It’s going to be a quality education. That’s something that we need the government to do or, uh you know, ensuring the safety of food. Right. Very basic example of this. Um. Every meat factory in the country has USDA meat inspectors who are in there on the line, not inspecting every single piece of meat. And we go meet some of them on the show, the G word. Not a uh not a perfect system. Right. Certainly one that is subject to industry meddling, as it has been for decades. But this is a basic thing we need the government to do. And so I would say, yeah, hey, is there a need for basic antibiotics that come out, you know, regularly to keep up with antibiotic resistance? Absolutely. Maybe the government should buy a fucking pill factory and, you know, just like make some of these things. That would be my pitch. Right? Um. 

Dr. Abdul El-Sayed: You and me both.

Adam Conover: But [laughing] we don’t need to. Like, there’s. There’s so much else that we can do following that same principle. Right. I tend to not get too stuck in the in the details and say like, hey, let’s look at there’s so many areas in which the government could be fulfilling that public good role better and that we can advocate for. But the the overall principle that this is what the government’s role is is something that’s eroded in American society. And uh and once you reeducate people to the fact that that is what the government is supposed to do, um then it becomes easier to make those arguments. 

Dr. Abdul El-Sayed: Yeah, I agree with you. And I think the central um premise that government can be a source of great good in American society is one that needs to be uh said over and over again. And, you know, you mentioned the sort of turn against government in the late seventies, eighties and nineties. And, we know, you also mentioned the the sort of uh con– the way that even the Obama administration took that consensus on and sort of agreed to the notion that, you know, government is part of the problem rather than part of the solution. 

Adam Conover: Mm hmm. 

Dr. Abdul El-Sayed: Um. 

Adam Conover: Yup. 

Dr. Abdul El-Sayed: When it comes to this pandemic, which uh you highlight uh in the course of your episode on disease. Government really did get it wrong in a number of ways, but so much of that isn’t because the people in government weren’t working like hell to get it done. In fact, I remember sitting in a uh in a room at a uh medical school listening to one Dr. Anthony Fauci, tell me uh in his thick Brooklyn Brooklyn accent that sometime during my career there was probably going to be a major pandemic simply because of all of these secular trends. So these are people who’ve been working on this their whole lives, but they didn’t have the resources that they needed, nor the coordination that they needed. And you talked a little bit about, you used a really brilliant analogy of a uh orchestra that had been stripped out of some of its most important uh portions and then conducted by a conductor who really did not quite care how they sounded in aggregate. Um. Can you speak to, you know, as you were doing your research for the show, some of um what you found in terms of the way that our government had been uh stripped out for parts, uh turned into a scaffold of itself before the pandemic. Um. How that played out during the pandemic and what it takes to fix it. 

Adam Conover: Yeah. So, look, the the question of why did the government fail the pandemic, is enormously complex. And it’s what what people call overdetermined. Right. There are there were so many factors that caused those failures to happen and they all interlocked. And frankly, there were so many of them that if you take out one or two of them. It would still be a failure, right? Um. A good — My favorite example, by the way, of overdetermined as a concept was when people were trying to explain why Donald Trump beat Hillary Clinton. Right. It’s like, well, there was a polling error and maybe some Bernie people didn’t show up and there was the emails thing and the Anthony Weiner thing and you know what I mean? And if you take out one or two of those things, right. Like maybe the same thing would have happened. So when you tell the story, it becomes difficult because there’s too many things happening at once. Um. But so our focus, our goal was to focus on, you know, which ones do we feel were the most important? And one of them was, yes, that the Trump administration specifically engaged in a process of like dismantling the federal government. And, uh you know, they dismantled specific pandemic preparedness agencies, but more importantly, they didn’t show care in getting the government ready for its challenges and confirming, you know, they had the longest backlog of confirmed of empty posts in American history. It’s already a big problem when any president comes in to get the people running the departments confirmed quickly enough because a lot of them need Senate approval. Um. And, you know, every single person you appoint is like a big fucking decision, right? Like if I asked you Abdul to, like, you know, appoint the new Anthony Fauci. Well, that’s not a presidential appointee appointee, but, you know, like appoint the new Francis Collins. Right. Head of the NIH. He’s he’s leaving soon too if he’s not already gone. And uh and I asked you to do that. My God, you would spend two years of your life trying to figure out who the best person to run that agency is because it’s such a big thing. Now, multiply that by 5000, right? That’s how many roles need to be filled. If you don’t give a shit about who’s running the departments because you don’t think they should exist in the first place, you’re, you know, you’re going to leave them open forever or you’re going to appoint idiots? Right. And so that sort of neglect of the structure of government was a big part of the story. But um there’s a lot of other places you could point the finger. You know, for instance, Michael Lewis in his follow up to the fifth risk, he wrote a book called The Premonition um about the Pandemic. He pointed the finger at the CDC and he said the CDC has become too academic, it’s become too you know hidebound, it’s become too bureaucratic, it’s becoming too slow moving for an agency that is supposed to be our pandemic fire department. This is supposed to be the agency that springs into action and, you know, like takes control. And instead, it’s become sort of a a research agency that’s become very cautious in what it says to do. And I think that’s a great argument to make. It’s just happens to be not the one that we decided to devote our 25 minutes of television to. The one that we devoted our time to was the uh uh death of local public health departments across the United States, state and local. Um. So, you know, speaking of fire departments, you know, your police department, you know your fire department, right? There is another department in your city, county, state government, um the the public health department. And they exist in every single city uh and every single town in the country. And they’re responsible for basic public health, STD prevention, uh you know, making sure people aren’t, you know, being contaminated by shit like, you know, making whatever, getting flu shots out there, whatever you need. Public health, right? The kind of stuff that doctors don’t even do, you know what I mean? Making sure that the public as a whole is well taken care of. And guess what we’ve been doing for the past like three or four decades, disemboweling those departments. Politicians from both parties have been doing that. Those departments have been shrinking every single year. So to give you an example where I live uh during there was a in California, there’s a big budget surplus um during Governor Schwarzenegger, a Republican’s time. And he created have you heard about this? He created an entire pandemic preparedness program, including like a bunch of mobile hospitals that could, like drive around and set up in case there was like a shortage of beds somewhere, like a hu– like a whole pandemic preparedness thing uh when Governor Jerry Brown, a Democrat, took office. Well, there was a budget shortfall and he cut that entire program less than a decade before COVID. And this is like reported on in the paper, but not that much right. 

Dr. Abdul El-Sayed: Yeah. 

Adam Conover: Now. That’s California. California, you know, doesn’t have that problem as much as other states. Um. We went to uh Lawrence County, Alabama, which is a very poor majority Black uh county, rural county in Alabama outside of Montgomery. And uh it at one point had the highest positivity rate in America um in uh early 2021, I believe. And so we went down there because we went to visit the there’s only one doctor in the entire county, and he works for a uh federally qualified health center, which is basically a federally subsidized doctor’s office like the federal government is paying for, paying for him to be there. If they weren’t, there’d be no doctor there whatsoever. 

Dr. Abdul El-Sayed: Yeah. 

Adam Conover: And we went to meet uh the people at the local public health departments run by this woman named Shawanda, who was a very incredible woman, hard working. But she’s like in an office of a couple people. She’s she’s like, I’m doing three or four jobs. She’s the office manager and the H.R. rep and the, you know, coordinator of all the services. You know, she’s she’s working like crazy. And why does she not have help? Why are there not more nurses there? Why aren’t they able to get, you know, people uh vaccinated? It’s because they’ve been starved of funds for decades. So when when we say like when we talk about in America, why is our vaccination rate so low? When we invented the fucking vaccines. Right. America simultaneously. I mean, the vaccine program, an incredible feat up there with the space program in what, less than a year– 

Dr. Abdul El-Sayed: Yeah. 

Adam Conover: –We had we had incredible vaccines made with brand new technology we had just invented in the previous five years. And we were able to learn how the the human body’s immune system works so well that we were able to inject a little bit of code into it that creates an antibody for this specific virus that’s killing us right now. It’s like makes you cry to think about what humanity is possible. But why can’t we get the vaccines into people’s arms? Well, there’s so much arguing in the U.S.. There was so much focus on, oh, people are vaccine resistant. The people in the red hats don’t want to take the vaccines. That was what was in the paper every single day. That wasn’t the main story. Yes. That is a minority of people who are, you know, reading the wrong forums on the Internet and getting the bad idea about the vaccines. Right. But the people of Lawrence county, that’s not why they weren’t getting the vaccines. The reason they weren’t getting the vaccines is because they make fucking $20,000 a year and they live in the middle of the country. Right. And they maybe don’t have transportation. They don’t have a regular doctor. They don’t even know where to go to get the vaccine. If you want to get those people vaccinated, you know what you need to do. You need people to go to their door and knock on the door and say, hello, ma’am, remember me? I was here last year to check up you know, check up on you and the kids. Well, I’m here again. We’ve got a vaccine. Would you like to get it today? It’s really safe. You know me because I’m I’m around. I’m I’m like the local fire department. I come around every day, you know, um that’s what we would need. And guess what? We didn’t have that because we have systematically eliminated those positions in a way that we have not for all these other essential departments. Again, police budgets ballooned over the last couple of decades. Public health did not. And if we actually cared about protecting people’s lives, we wouldn’t do that. So that that, to me is the biggest underreported part of the story. 

Dr. Abdul El-Sayed: Your mouth to the American public’s ears. 

[AD BREAK]

Dr. Abdul El-Sayed: I ran one of those health departments, and uh our health department had been uh shut down during austerity. They literally privatized a city health department in a city um that was one of America’s biggest and decided that you know– 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: –Private nonprofits could could do this thing. And unfortunately, obviously, they could not. It takes the will and the capacity of government uniquely to be able to look after some of these public goods. And if it was possible to do them privately, we probably wouldn’t need a health department. The problem, though, right, is that prevention is a public problem. It’s fascinating to me and in our country, we spend more per capita on health care than any other high income country in the world and it’s not even close. And not only are we spending more, but the rate at which those costs are increasing is going up um faster than anywhere else in the world. And all of that is because, well, the minute you know you’re sick, you’ll do anything to get a doctor. Even though we deny nearly 10% of people in this country even that access. And so you’ll pay a lot more once you’re already sick. And a funny thing is, when you talk to most people, you say, hey, look, if I could rewind the tape back to when you weren’t sick, which would you choose? Would you choose getting the health care you needed now, or would you choose going back in time and not getting sick in the first place? And everybody will say, I’d rather go back in time and not have gotten sick. And you’re like, okay, well, the thing that would have protect you if you went back in time would have been all of what we’re doing to keep you safe. The problem, though, right, is that we are always stymied by non events, meaning it’s very difficult to point to a thing and say that’s what we’re solving when the thing hasn’t manifested yet and it’s only after it manifests and people are like, Oh, I wish somebody would have protected me from this. Um. But just seconds before they would have said, Well, you know, I’m probably not going to be the one who gets sick, [laugh] even though– 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: –We can we can say with most illnesses, some proportion of the population is going to get sick. 

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: We don’t know who you are, when it’s going to happen, what the circumstances are. But like these are these are the numbers. Um. And yet, as a society, we’re just not willing to make that investment. And we’re not willing to make that investment because nobody makes money off of it. Right. There’s no world where [laughter] someone’s like, hey, listen, I’m going to prevent a nonentity from happening to you and uh and you’re going to pay me good money to do it. Most folks are like, Well, it hasn’t happened yet, so I don’t think it’s going to happen. So no. Um. And then, you know, instead you’re giving, you know, 10x, 20x more money uh to hospitals and health insurers and pharmaceuticals–

Adam Conover: Yeah. 

Dr. Abdul El-Sayed: –To pay for the care only after it’s manifested. And by the way, we end up in situations where we are just sicker and we’re poorer for it. I want to uh just just turn attention now to leadership. It’s hard, right? Because we have these systems and these systems are so built in the structures and and your show does an amazing job highlighting those structure. And at the same time, we we have seen over the past the past several years that leadership does matter what you how you choose to move uh the great structures of American government or choose to disembowel them uh makes a huge difference um in terms of how they function and in terms of what they end up doing. Um. And we’re in a situation where, you know, our our our policy uh and our government entities are determined by our politics and our politics has never been more polarized. And I want to ask you, you know, how how did we get here? What does it take for us to get out of it? And I think, you know, your show is a great intervention to demonstrate what’s really at stake. But, you know, where do we go from here? How do we keep moving a conversation that highlights what’s at stake for us, what the future could look like with or without a functional government. And that, you know, politics isn’t a clown show of a bunch of folks who, you know say the the sickest burn on a debate stage and therefore get elected. You actually want people who are competent at running the machinery of American government. 

Adam Conover: Yeah. Well, uh first of all, the look, what’s wrong with American political culture is again, is another overdetermined problem. Right. 

Dr. Abdul El-Sayed: Right. 

Adam Conover: There are so many problems that it’s it’s a media problem. It’s a social media problem. It’s a uh problem of the you know that the parties themselves have created. It’s it’s a cultural problem in many ways. And cultural problems are the hardest ones to solve, because that’s just like, hey, that’s what people do, you know what I mean? Like, hey, that’s just what we’re used to doing. There’s a lot of cultural problems, you know, go to Japan. Oh, my God. They’ve got a such an overworked culture there, right? Where people people die from overwork. How do you solve a problem, a cultural problem like that? How do you solve a cultural problem in America like um guns or like alcoholism, for instance? Right, in American culture, those are the hardest things to solve. There’s no way to snap your fingers. Right. And you could spend your lifetime screaming about them. And, you know, it’s not going to get that much better. You can do your bit and say, hey, I think this is harmful um and try to spread the word as I do, you know, talking about how to restore that positive feeling about our government and try to, you know, restore people’s desire to have competent public officials and etc.. I think that’s a little bit easier, or at least that’s what I try to focus on because people really do love public goods, and they love a government that provides it to them. Like, if you take anybody in America and you take them to their local public library, and I think we still have in general in America a pretty healthy system of local public libraries. In some states, they’re very they’re not as good as others. Right. But like, if you go to most towns in America and you go to the local public library and you walk in there, you will be thunderstruck by what a wonderful place it is. Right. You’ll see people using the Internet, you’ll see them studying. You’ll check out a book for free. You’ll talk to the librarian behind the counter, and they’ll be nice to you. You know what I mean? Like, uh this is something that people love and cherish, and they understand when they walk through the doors the importance of the public good. There’s a couple of libertarians out there saying, hey, what if we just abolish public libraries and give everyone ten bucks a month they can spend on Amazon? Right. Uh. But I think most people know that’s bullshit. They know this is a wonderful place and it wouldn’t exist if we weren’t all pooling our money for it to be there. Right.

Dr. Abdul El-Sayed: Right. 

Adam Conover: And uh people feel that way about the fire department, you know. And look, I’ve got plenty of problems with policing in America, but a lot of people do feel that way about the police department. A lot of especially, you know, white, affluent people especially. But they will look at the police department and they’ll say, oh, I really like the police. They help me out sometimes, you know, and they understand the value of having, you know, that money pooled together too for the public good, even though I would say police in America aren’t actually, you know, executing that good. In fact, they’re hurting a lot of people. So if you can focus on that, on giving people the experience and the feeling that they actually want to have, they will like it, you know, and you can build a policy around that. And so I think like local public health departments, that that should be a easy sell to the American public. You know, um if you look at the way before Anthony Fauci, for example, was undermined, right, by, you know, the sort of anti-vaccine forces who hated his guts, right? There was there was an outpouring of support. Oh, my God. Here’s a public official I’ve never met before who, you know, is, you know, uh was instrumental in the AIDS crisis and, you know, all these other things and like, oh, here he is. And he’s telling me in his nice Brooklyn accent, you know, he’s given me the facts straight and like people really respond to that, right? He became a genuine celebrity uh in the American public. And I think we can work hard to create more people like that. Right. And to and to share those success stories with the public. And when we do that, I think we can find areas of agreement. And if you look in Washington right now, there are some surprising areas of agreement. Uh. One of them, for instance, is antitrust reform. You know, the idea that corporations shouldn’t have massive power over, uh you know, of American society, that we can’t have monopolies formed that determine, you know, the way that our society runs. Well, guess what? Both Republicans and Democrats are starting to agree about that. And, uh you know, Joe Biden’s new appointees to the FTC and to the DOJ are having some success um even when they talk to Congress. And uh that’s an example where, you know, people everybody kind of knows, yeah, we need we need a we need public servants overseeing this to make sure that we are not at the whims of giant corporations. That’s an argument that, you know, it’s common sense power is poking through our horrible toxic politics, not all the way, but you see the glimmer of it. And I think if we keep focusing on those types of solutions, I think we stand a chance. 

Dr. Abdul El-Sayed: I appreciate that perspective and that is a hopeful position to end on. Our guest today was was was comedian Adam Conover. He is the host of uh the newest Netflix special on government called The G Word. And he is also the host of a podcast called Factually! Uh which I have appeared on. And um I really hope that you all check it out. Uh. It features different experts on different topics, um you know, just chopping it up with uh with Adam, who, uh of course, brings that special blend of um of comedy and and education uh to you every week. So I hope that you’ll check it out. Um. The show is called Factually! 

Adam Conover: Thank you so much, Abdul. I really appreciate it. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. The air outside is crisp. I’ve been to like four different apple orchards, and there’s football on TV all weekend. It’s fall, and with fall comes the inevitable climb in common respiratory illnesses. And now, well, we ought to add COVID to the usual cold and flu. Cases began to bottom out over the past week. And there’s fresh worry that we’re going to see another jump. I’ve been talking about this for weeks and the fact that it hasn’t happened yet. That’s pretty good news. And given that we have yet to see a non Omicron sub variant take hold, it’s unlikely that this is going to be a major wave and yet this virus has proven us wrong before. The common flu, however, is on the rise. Cases are ticking upwards. Remember, for the past two years of the pandemic, people have been engaging in everything from social distancing to wearing masks. Those mechanical forms of COVID prevention don’t just work against COVID. They work against any and all forms of communicable respiratory illnesses, including the common flu. Needless to say, we’ve had pretty mild seasonal flu waves. This year, though COVID is still spreading. There’s far less masking or social distancing going on, and the flu is ready to rock. Right now, about 2.5% of all flu tests are coming back positive. That may not sound like a lot, but it is. To put it in perspective, that 2.5% this year compares to 0.1% at this time last year. Remember, flu is deadly. It kills thousands of people every single year. And it’s also preventable. So right now might be a good time to remind you to get your flu shot. President Biden signed a new executive order on prescription drugs on Friday that directs the Department of Health and Human Services to, quote, “explore additional actions it can take to further lower prescription drug prices.” I’ll be honest with you, I’m not really sure what that means. It feels like the administration is just taking a victory lap to remind everyone, particularly midterm voters, of its real accomplishments when it comes to prescription drug costs. And that came in the form of passing the Inflation Reduction Act. And honestly, I’m inclined to remind you that, too, alongside capping insulin costs and overall prescription drug costs, the Inflation Reduction Act also empowers Medicare to negotiate prescription drug costs with pharmaceutical companies. Perhaps more importantly, the law forces drug manufacturers to pay a rebate if they raise the prescription drug costs higher than the price of inflation in a year. A few months back, I sat down with Professor Aaron Kesselheim, a prescription drug pricing guru, to talk about the impact of those real reforms in the Inflation Reduction Act. You can check out the episode to learn more about it. Finally, scientists believe that there may be a pathway to eradicating malaria. This is a big deal. Malaria is one of the biggest killers in human history. The mosquito borne parasite still runs rampant in low income tropical countries around the world, killing half a million children every single year. Half a million kids. One disease. Eradicating malaria all hinges on two new vaccines. One that’s 35 years in the making and could be deployed as soon as next year. A robust vaccination campaign, as we’ve learned, isn’t so simple anymore. Misinformation has marred the COVID vaccine rollout in the countries hit hardest by malaria. And then there’s the perpetual problem of funding. Though there’s hundreds of millions of dollars on the table. A full eradication effort would require high income governments to put their muscle into it, which just hasn’t happened at the level that it’s needed yet. And yet we’re closer now than we’ve ever been. We’ll watch this space. 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. We’ve got our logo mugs and T-shirts and our science always win sweatshirts and dad caps are available on sale. [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. Veronica Simonetti mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sara 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.