Feel that in your nose? If you’re like everyone else this time of year, you’ve probably got that dreaded nasal congestion that comes with the colds and flus this time of year. But nasal congestion is more complicated than you think. Abdul reflects on the collective burden of the annoying illnesses we fight through every year. Then he speaks with Sarah Zhang, a staff writer at the Atlantic who recently wrote about why nasal congestion is more complicated than you might think.

TRANSCRIPT

[AD BREAK] 

Dr. Abdul El-Sayed, narrating: Donald Trump wants to repeal the ACA again. The Supreme Court heard oral arguments in a case that will decide the fate of the Sackler family’s culpability in the opioid epidemic. The Biden administration announces a new prescription drug patent reform that could vastly lower prices. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Last week, we sat down with your local epidemiologist, Katelyn Jetelina. We talked about all the ways we could tackle the cold and flu season. As we discussed the challenges of getting people to do the very basic things they need to do to protect themselves. We stumbled upon what I think is a pretty important insight. When it comes to trying to get people to get vaccinated or test before they sit down for holiday meals. We tend to focus on the extremes. We talk about how many people die of the flu every year or what the Covid hospitalization rate is, but that misses a vital point. You literally can’t experience a death rate. The vast majority of people have never been hospitalized with an infectious disease. And when it comes right down to it, convincing someone to do something is about appealing to their experiences. And that’s because we’re just not that good at juggling numbers in our minds. What does it mean to have 53 times the risk of Covid 19 mortality when the overall risk of dying of Covid is less than 1%? It may just be that rather than reaching for the extremes, we’d be better off if we just spoke to the mundane. This is literally the second episode in a row we’re doing on cold and flu season because, well, everyone knows what cold and flu season is like. No matter who you are, you’ve had one of these. That constellation of sore throats, runny noses, body aches and pains, itchy eyes and nasal congestion. See, congestion probably never killed a single person, but it still sucks. And because all of us have had it, literally all of us can put ourselves in the experience of it. And when we tell folks what they can do to prevent it, it just may be that giving folks advice about how to avoid congestion is just more tangible and therefore more effective than giving folks advice about how to avoid hospitalization or death. Look, I’m probably wrong about this, so don’t at me. But because for the most part, congestion sits so low on the radar of the medical establishment, most folks don’t even know how it works. I mean, I sat through years of medical lectures, and I don’t remember a single lecture about it. That may also be because there are lots of lectures I’ve long since pushed out of my brain. But it also might be because nobody lectured on it, because nobody’s died of it. And at the same time, because so many of us have suffered it and so many of us would rather not. I was intrigued when I came upon an article in The Atlantic by Sarah Zhang. See it taught me a lot about what congestion really is, how it works, and why it’s so hard to do anything about. I wanted to have her on the show to share what she learned in reporting the piece and the implications it has for getting some relief during the impending season we’re all facing. Here’s my conversation with Sarah Zhang. 

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

Sarah Zhang: My name is Sarah Zhang, I’m a staff writer with The Atlantic. 

Dr. Abdul El-Sayed: All right. Well, Sarah, we really appreciate you uh coming on again uh because you’ve written yet another really, really interesting piece. And for folks who haven’t read uh Sarah’s writing, I do hope that you’ll check it out. Um. Really, really insightful about some of these like, foundational questions about things we often take for granted in health. Um. Like I want to ask you. So so what got you interested in writing about congestion? 

Sarah Zhang: [laugh] Well, I have a lot of personal interest in congestion right now because I have a kid in daycare, so I am literally sick about every two weeks. So I think I am more congested than uncongested these days. Um. But the actual genesis for this article was that a couple of months ago I wrote about how the FDA had a meeting to talk about these very popular, quote unquote “decongestants” that you can buy in the store. You might know notice those as like Sudafed, PE. It’s also found in lot of things like DayQuil and, you know, Tylenol, cold and flu, uh things like that. It’s actually just a decongestant that doesn’t work. And that’s the reason the FDA was having the meeting. Funny enough, they were um just making the decision to pull this drug from the shelf. And in the course of reporting that story, I got in touch with a um an old professor based in the UK who happens to be the world’s expert in nasal cycles. And then my first question is, what is a nasal cycle? Uh. And that’s when I got started about how oh I need to write about the nose. 

Dr. Abdul El-Sayed: One of the one of my favorite parts of medical school was um stepping back and appreciating like all the different things, these body parts we take for granted do for us. And one of the things that you kind of had to do was was start from first principles, like what does this body part do? And obviously the body is not built that way. It’s all sort of one big system and some things that do things don’t do them very well just because of the nature of of evolution and how we came to be. I mean, a knee is like a really, really poorly designed joint if as anyone who’s ever tried to cut really hard on their knee and snapped an ACL will tell you. But–

Sarah Zhang: I’ve done that. So I can, I agree with you. 

Dr. Abdul El-Sayed: It’s just like, why is this designed this way? It’s like literally two pieces of bone that are that are um end on end with a bunch of, in effect, elastic bands holding them together like that’s that’s what a knee is. And you’re like, this is not a–

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: –great design for a knee, but hey, you know, uh our knees do some cool things. So there’s that. Um. So stepping back, like, what does a nose do for us? I mean I, sound should sound obvious, but like, what is it that a nose is is in the process of doing everyday? Because it’s a lot more than just bringing in air. 

Sarah Zhang: Yeah, no, that’s a great question because I definitely took noses for granted. You know, I was like, eyes, mouth, ears. They all do very important things. But nose, just a tube that brings in air, right? It’s like just–

Dr. Abdul El-Sayed: Right. 

Sarah Zhang: –a hole in your face. Um. Actually, what the nose does, it’s like basically a constantly functioning 24 seven Hvac system on your face. And as one sort of one nose doctor I talked to described it to me. He says, you know, imagine the air you’re breathing in. It’s maybe 70 degrees. It’s maybe, oh, 30% humidity. By the time it reaches the end of your nose, which is three or four inches, the air is 100% humidity and, you know, 95 degrees. Just imagine how much work that nose had to do in the space of three or four inches. Uh. So the point of a nose is to it, basically it readies air, it cleanses air, it warms air, humidifies air. So it’s ready for your lungs. If you’re breathing dry, cold, dirty air directly into your lungs, your lung cells would not be very happy. You would also have a lot of gunk in your lungs. So the point of the nose is to uh keep your lungs happy, uh not just to bring in the air, but to prepare it for your lungs. 

Dr. Abdul El-Sayed: Mm hmm. And and and, like, that’s really impressive. It’s like an impressive thing that that that this thing uh on our face does beyond just, like you said, just being a tube uh for air. What role does the nose also play in um in keeping us healthy? 

Sarah Zhang: Yeah, um this is something that I thought was really interesting. Um. I alluded to the nasal cycle a bit earlier, which we can get into in more detail. But just very briefly, the nasal cycle is that you actually have um, [laugh] as one nose scientist put it to me, you actually have two noses. So we all we all know that we have two nostrils, right? But we think of ourselves as having one nose. Uh. But each nostril actually kind of is really its own separate organ. They they are not directly connected to each other. That’s why you can uh be congested in one side of your nose, but not the other, because they’re basically functioning independently and they actually work in tandem and kind of work in sync. So the nasal cycle is this um cycle that is always present. Uh.  In most people basically, one side of your nose is working harder than the other. The other [?]. What that means is that one side of your nose is always a little bit congested and the other side is fully open. And that’s because the inside of your nose is lined with this like erectile tissue, which, as one knows doctor described, is similar to the erectile tissue in the penis. So it fills with blood and it swells. And that’s why you feel congested. 

Dr. Abdul El-Sayed: So wait, so like so so congestion is basically just a nasal, a one sided nasal erection. 

Sarah Zhang: Yes, exactly. [laugh]

Dr. Abdul El-Sayed: And–

Sarah Zhang: And I recently learned that um uh Freud was very interested in the nose for uh some of these reasons. 

Dr. Abdul El-Sayed: He would have been. 

Sarah Zhang: Which I did not know which I did not know, writing the article. So that was delightful to find out. Um. Yes. So you have this eractile tissue in your nose. Um. I I always thought when I got congested it’s because my nose was filled with mucus. And it’s true. The mucus does make it worse. But maybe you’ve experienced this as well. Sometimes you can blow your nose and blow your nose and there’s like nothing coming out and you still feel congested. Uh. That’s because that one side of your nose is really, really swollen. It’s the blood vessels have um that’s filled with blood. And that’s why it’s, you know, literally stuffed up you there’s nothing you can do that you can can’t blow it open. 

Dr. Abdul El-Sayed: Hmm. 

Sarah Zhang: Um. 

Dr. Abdul El-Sayed: So I want to stop there for a second because it’s a really–

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: –important point. It’s, you know, one of the central takeaways. And, you know, I went to whole ass medical school and I didn’t I didn’t I don’t remember any lecture about congestion, even though it’s something that almost all of us experience. 

Sarah Zhang: Yes. 

Dr. Abdul El-Sayed: Almost all winter long. It may be because I don’t remember a lot about a lot of things I learned in med school, but I don’t remember learning about this. So the issue here is that when you are congested, yes, there is a bunch of mucus that’s being produced by the glands in your nose that produce mucus. Fine. But the bigger issue is that this nasal erection is literally stopping your nose up from being able to suck in air because it’s literally taking up space in the small cavern of your nose. That’s what you’re saying? 

Sarah Zhang: Yeah, exactly. Right. Like, if you think if the inside of your nose as this straw, um the straw has basically kind of swollen and now the straw is totally blocked. So, yes, I’m glad to hear you say that you went to medical school and did not know this because I did not know this and I was like, what? I’ve just been going through my entire life, misunderstanding why my nose is congested. You know, like I’ve lived like, what, 30 something years of my life. With like no idea this is what was happening. 

Dr. Abdul El-Sayed: It’s one of those things that you’d think, at least in med school, they’d teach you this, but like to your point, this is an interesting point and I’m taking us on a side tangent here, but I think it’s important. One of the big mistakes that we make in health care is that we don’t pay enough attention to the things that are annoying but not deadly. Right? You’re not going to die of congestion, right? That’s just–

Sarah Zhang: Right. 

Dr. Abdul El-Sayed: –not a thing that that’ll happen unless somebody like you get really congested and somebody like plugs up your mouth, which is basically choking you and and you know, so that it’s not going to happen. You can always breathe through your mouth. And so we don’t pay it as much attention because it’s not deadly, but it’s something that people have to spend a lot of time being frustrated about. And your point is a really good one. You know, how many times have you blown your nose, gotten absolutely everything you possibly could get out of there and you still can’t breathe and no one explains this to you. Right. And it’s just a it’s like a really frustrating thing. And I feel like I need to go to Columbia University and just say, listen, give me my money back because I haven’t been able to explain this until I read it in an article in The Atlantic. Like because because a journalist went and sourced like the single person who actually has the answer to this. I just I kind of feel robbed. And but it’s a it’s a broader point about what we pay attention to. And I think we would do well to spend a little bit more time paying attention to the little [?] that that happen in people’s lives, that are a unifying experience that we probably should be paying a little bit more attention to. Because to your point, right, you started thinking about this because you were covering an FDA meeting about uh Phenylephrine, which is a drug that works because it basically closes down these erectile tissues in the nose. Right. And so when you spray Phenylephrine in your nose, it’s extremely effective. Like you actually feel it. 

Sarah Zhang: Right. 

Dr. Abdul El-Sayed: Like extremely quickly because it acts at the level of the of the of the venules to close those venules down, to stop them from being stuffed up so that you can breathe evenly. Here’s the problem, though, is that we’ve been giving them to people orally for years thinking that they’re going to have some sort of effect, which makes absolutely zero sense because we know that these operate at the level of the venules. But when you eat them, you are literally introducing them into your stomach, into a super acidic environment where the acid is going to denature that uh molecule to the point where it’s not going to have any effect systemically. And that should make like that should make sense to almost everyone. But like how many millions of dollars have been wasted on money that people spent thinking that they were going to get some relief for a medication. The basic mechanism of action of which would obviously not work if you took it in your mouth. But like, here we are. Right, here we are. And–

Sarah Zhang: Yeah, yeah. It took years, years. It was obvious years ago that this these drugs didn’t work, and yet they were sold on the shelves for, you know, everyone bought them. 

Dr. Abdul El-Sayed: Yeah. It’s like. It’s insane. Anyway, I appreciate um you bringing this truth to us. So like as we think about this, right, so we have two noses on our face who operate as HVAC systems for uh our lungs to make sure that the air we are breathing is somewhat filtered, is warmed and is humidified. And then every once in a while, when we get sick, they have like, erections that we we kind of don’t understand and don’t want them to have and block us up from being able to breathe. So how does this change um the way that we should be thinking about treatment and um how we should be advising people about what to do in this part of the year that is cursed by the by the viral activity of small children. 

Sarah Zhang: Yeah. Well, first of all, don’t buy Phenylephrine. [laughing]

Dr. Abdul El-Sayed: At least not oral Phenylephrine right?

Sarah Zhang: I think I think. Yes. No. Don’t buy oral Phenylephrine. I think a lot of stores have started to pull it off the shelves. So um, you know, maybe you won’t make that mistake. Uh. Funny enough, the week after that article, I got sick and asked my husband to buy some decongestants. And he I specifically told him that he needed to make sure he has his ID so he’d get the Sudafed that worked that you have to get from behind the counter. And, you know, I feel like this proved that he doesn’t listen to me because he got me the Sudafed, the Sudafed PE, that Sudafed Phenylephrine. I was like, no, I literally just told you this. I just wrote an article about this. I can’t believe you got this wrong. Um. So I think, you know, on one hand, it’s just like, what are the drugs that actually work, right? So don’t get oral oral phenylephrine, get um pseudoephrine, um which is the the one that you need to show your ID for. And the reason for that is because that um it has been used as an ingredient to make meth, though though sort of the sidebar, um the way meth is produced now actually rarely uses this ingredient. So [?]–

Dr. Abdul El-Sayed: Also, just don’t make meth with it. Like, you know, just use it for the purpose it’s intended, right? So if you’re going to like–

Sarah Zhang: Yes. 

Dr. Abdul El-Sayed: Just don’t make meth. Like that’s, you know. 

Sarah Zhang: Yeah, that’s probably good public health advice [?] yeah. 

Dr. Abdul El-Sayed: That was like a fair message for our podcast. Like please don’t make meth. [laugh] 

Sarah Zhang: I agree. That’s good medical advice. Uh. The other the other um just from doctors I’ve talked to and you probably know this as well, is that the other um group of drugs that work really well are sprays. So sprays like Afrin, um which is not phenylephrine, that’s a different drug, but it also works pretty well to kind of um basically it works the same way, right? It’s a it’s a drug that makes those blood vessels in your nose constrict so it’s no longer erect. So so your nose becomes open. Um. The other thing that I was really surprised to learn is that you can also control the uh swelling on one side of your nose at a time, which I which made sense once I thought about it. So uh maybe you and maybe the listeners have had this experience where you are congested on one side of your nose at night and you’re trying to sleep and one side is blocked um and you turn around and that side is clears up after a few minutes. So I had always thought that this was like mucus moving from one side of my nose to another because of gravity. But actually what’s happening is that this is a reflex we all have. If you push really hard under your left armpit, your right nose will open and vice versa. If you push really hard under your right armpit, your left nose will open. Um there in yoga people sometimes use a yoga crutch on one side or the um under their arms on one side or the other to control their breathing. Um. I’ve also maybe people have come across this. There’s this online hack we’re supposed to like put a bottle on under one side of your arm and, like, press really hard on the bottle, and that’s supposed to open up one side of the nose. Um. So this is a real reflex uh there the hypothesis of why it exists is that like you know, what it does is if you’re lying on your left side, it opens the right side of your nose, right? So your right side of your nose is like further away from the ground. It’s less likely to be obstructed. Maybe this is helping you breathe when you’re lying down. Um. That’s a hypothesis. We don’t really exactly know why this exists, but, you know, next time you’re congested or you feel one side of your nose um you know unable to breathe, try pressing really hard under your armpit on the other side. I will say I tried this um and I was not wowed by the results. It’s not like flipping a switch, right? It’s not like immediately your nose will open. Um. But if you like wait five minutes, it will happen. Um. It definitely works when I’m lying in bed and going back and forth. But the problem is then like the other side gets congested. So you still have to turn back around. [music break]

[AD BREAK] 

Dr. Abdul El-Sayed: So this is another one of those facts for which I need to get my money back for for my medical education, because who knew that there was an armpit nasal erection reflex? Like because that’s basically what we’re–

Sarah Zhang: Yes! 

Dr. Abdul El-Sayed: –saying is like, you can massage one side of your armpit to to stop the erection in the other side of your nose. And I you know, like I. Here’s the hard part about a lot of these things is that oftentimes we’re left trying to hypothesize an answer or some evolutionary link between the ways our body is connected to itself. That seems to make sense. And I guess the you know, this notion of making sure that the other side of your nose is open when you’re laying on one side, you know, that is a good plausible answer because when else is your armpit stimulated, I guess, right? 

Sarah Zhang: Yeah, exactly. 

Dr. Abdul El-Sayed: But like it’s still I just feel like there’s there’s a little bit more research that we need to understand uh how this operates. The other really interesting point that you made was that, you know, so often we assume that um modern hypothesis driven, empirical evidence driven medicine has the best answers to things or has elucidated this. Uh. It would be really interesting to understand when is it that we first fully understood this uh neuro dynamic connection between armpits and  uh and noses. But like, you know, you’re talking about a yoga tradition that is substantially older than our ability to collect, you know, any sort of systematic evidence that had had this sort of insight and understanding well before. And anybody who listens to the show knows that I um, I sometimes look askance at uh at some of the alternative healing um that folks will monetize, in large part because it doesn’t have substantiation in in in evidence. But this is one of those important moments where you’re saying, well, look, like first of all, yoga is a long, long, long historical tradition. And then two, right like there is a way to bring your scientific mind to these questions and to ask if someone’s trying to make a dollar on you. Right so this is not the same thing as uh you name the, you know, the Goop product that uh Gwyneth Paltrow was trying to um to sell you uh to make to make money. This is, you know, a long historical tradition. And I think there’s a lot we can learn by trying to apply um evidence driven approaches to asking, you know, what the links are in some of these older than um science traditions. Um. As far as you know, has has anyone uh made good use of of sort of a, an approach to thinking about about congestion, that um that involves manipulating the underarm? Like is there a well tried and true approach to dealing with your like cold and flu symptoms that involves um, you know, surreptitiously massaging your underarm in public? [laughter]

Sarah Zhang: Well, you could try the bottle method that I just uh mentioned. 

Dr. Abdul El-Sayed: The bottle, there we go. 

Sarah Zhang: Um I yeah. I think the thing of the problem is that even though it does help one side of a nose or the other, right. It doesn’t really open both sides of the nose. So you might end up with, you know, congestion not on the side that you started with, but on the other side. Um.

Dr. Abdul El-Sayed: So here’s my question–

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: –about that, though. Couldn’t you just do both at the same time? 

Sarah Zhang: Oh, that’s a good question. I wonder what would happen then. I don’t know. 

Dr. Abdul El-Sayed: All of a sudden your head explodes.

Sarah Zhang: Yes. I don’t know. [laughter] Um. You know, I’m not I’m certainly not an expert in traditional traditional Indian medicine. And I’m really glad you kind of highlighted that, because there is a really long tradition of being very attentive to your breathing and to breathing from on one you know through one nostril or the other. And I um unfortunately is someone who just like I’m incapable of like really thinking about this for all that long. So I have not tried it myself. Um uh. But yeah, it is a really huge part of um, you know, this another like tradition, another like medical tradition. And I think it would be I hope there’s more study about it. And you know, when I was writing this article, I was trying to look a little bit more to see like whether there had been any sort of formalized um uh descriptions of it and there really haven’t. And I wish there were. I think I would love to learn more about it as well. 

Dr. Abdul El-Sayed: As you reported this, um did you ever stop and sort of wonder like, why isn’t this better known? 

Sarah Zhang: Yes, [laugh] I was like, how did I not know about this before? Um. You know, I think we all just kind of take the nose for granted. Right. Um. It’s funny because as as we were talking about cold medications, there is such an industry to sell us products to deal with colds. Right. You I can think about all the Kleenex commercials I’ve seen, all the cold medication commercials I’ve seen. Um. But the here’s this like very simple principle of how our noses work that none of us really know about. Like what what even causes congestion? Most of us probably don’t have the right answer. At least I didn’t. 

Dr. Abdul El-Sayed: No, I didn’t either. Our health care system is really good at doing two things. It’s really good at waiting until you have a disease to start talking about solutions. And then it’s really good at presenting you solutions that require you to part ways with dollar bills. Right. And one of the things that comes with that tends to be a um a disengagement with more traditional approaches because there’s just not there’s not much money to be made out of that. And look I, you know, everyone talks about a cure for the common cold would would sell you know wildly. Sure. Fine. It probably would. But um that’s only if if it’s something that you can sell and um not something that you can sort of manipulate in your own body or engage with. And look, there are medications that deal with, you know, one sided uh nasal erections and they do a pretty decent job of it. The problem is we’ve been selling them folks um the other stuff for a very long time. And so the hard part is we don’t do much uh work on things that um, A.) are not are not deadly, but are um broadly annoying for a lot of people. And then we don’t do a lot of work really making sure that um we get information out about about these things. And it’s a big reason why I wanted to talk to you about your reporting on this piece, because it was just so astounding to me that this thing that so many of us experience, so few of us actually have any knowledge about, including, you know, many of us who who had medical training. Um. And uh this was a really you know important, insightful um perspective on how to understand this, you know, human condition that so many of us uh face. I too have kids that are really young, I too deal with uh nasal congestion for most of the year. Um. And uh I too, at times would sit there, blow my nose and wonder why it is that this is not working if I’m getting all the stuff out of my nose. Uh. And here we are, you know, with a with a better understanding of the basic anatomy and physiology of the nose, um with a better understanding of like, what to do about it. I I want to ask you, so as someone who sort of covers this space, are there other like questions like this that you feel like we’re really missing, things that you’ve come across, which is like, we should know a lot more about this than we actually do?

Sarah Zhang: Uh well we’re doing the nose. Last time we did the eye. [laugh] Maybe we gotta move to the mouth.

Dr. Abdul El-Sayed: We’re about to get to the mouth. 

Sarah Zhang: Or the ear. [laughter] You know, I’m sure there are um I don’t know what they are yet because I haven’t written the article yet. But if you hear of anything, let me know. [laugh]

Dr. Abdul El-Sayed: One that I that that I that I um I have a friend of mine who has alopecia and he is losing his eyebrows and uh and he’s like, you know, I, I rely a lot more on headbands than I used to. 

Sarah Zhang: Oh. 

Dr. Abdul El-Sayed: I was like what do you mean by that? He’s like, well eyebrows spend they actually keep a lot of your forehead sweat out of your eyes. 

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: And one of the things he’s like, you know, he like, he like worked out a lot when he was a kid and kind of stopped for a while and had since the alopecia had started to take his eyebrows, got back into it and started to realize that like, he was getting stinging in his eyes because of the sweat into his eyes. [laughter] And so these are like these these parts of your body that you’re just like, I never really thought like, you know I I I–

Sarah Zhang: Yeah. What’s the point of eyebrows?  

Dr. Abdul El-Sayed: I appreciate that eyebrows look a certain way, but like, I never thought about eyebrows– 

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: –as a as like literally a like a um like a a uh a window pane almost for your eyes. Right? They just they keep, they keep the sweat right out. So, um you know, there’s a lot of parts of this that that we sometimes don’t appreciate simply because they don’t tend to be universal or ubiquitous experiences of losing them. And also um that uh that they tend to be like small annoyances. Right. Getting getting sweat in your eyes when you’re working out is one of those things that’s not going to kill you. Right? But it would be pretty annoying if it was your experience. Um. So I–

Sarah Zhang: Well, here’s another one. What about fingernails? Right. So I you know, usually we all have our fingernails, but um you maybe have experienced this. Anyone who has young kids who may experience the [?] you can get hand, foot and mouth, which is a disease that can sometimes cause you to lose your fingernails or your toenails. So I fortunately did not lose my nails, but my my daughter did. 

Dr. Abdul El-Sayed: Oh. 

Sarah Zhang: So she had a couple of toenails that fell out. And that made me think like, what is the point of nails? And I was like, well, yeah, I guess if I didn’t have a nail then my finger would probably get injured all the time. 

Dr. Abdul El-Sayed: Yeah, that’s a good point. It’s a really good point. I also think that there’s some there’s something about our um our past experiences as uh much more we’ll just say direct carnivores. Uh. And you know, if you, if you kind of think about the the role that that fingernails play on like big cats or um or big dogs. 

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: Right? They’re pretty important for hunting.

Sarah Zhang: I’ve got a cat right next to me with very sharp claws so–

Dr. Abdul El-Sayed: And. 

Sarah Zhang: We’re aware. 

Dr. Abdul El-Sayed: Yeah, yeah. And so it’s like this interesting thing, but, you know, at the same time, right, Like, you think about um you think about uh herbivores and the, the hooves that they have, right. And they all got them too. And, you know, they’re not using them for hunting. But you’re right. Like you can imagine also, especially on your toenails, like that, can you imagine how bad stubbing your toe would be if you didn’t have toenails? 

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: That’s a really right like this notion of like, protection is a really interesting one. 

Sarah Zhang: Yeah. 

Dr. Abdul El-Sayed: Uh. Yeah. No, I mean, there’s, there’s so much in our, in our anatomy and physiology we just don’t pay much attention to until um either something goes wrong with it or uh, or we don’t have it. Right? Um. Or something causes us some sort of frustration. I had to have my appendix taken out uh a couple of years ago, and I remember a lecture in med school on this. Is like we don’t really know why we have appendices. Um. We think it had to do with, you know, in the past when we ate relatively undigested uh foods, we would um eat rocks. Those the rocks would go into the appendix and then those rocks would help um digest uh much more um fibrous foods. But like clearly, we don’t do that anymore because, you know, many, many, many uh centuries ago we realized that if you cook your food, you have to spend way less time chewing it or digesting it. Um. So here we are. But uh so that’s the other part of it is like things that used to have that may have had obvious uses for our distant, distant, distant ancestors um our our modern way of life, have now abrogated the need for. Uh. And we’re we’re we’re only now trying to make sense of them. Um. We really appreciate your reporting, Sarah, and uh for you taking the time to join us to teach us a bit more uh about the large organ in the middle of our face, literally, um that we only really pay attention to, despite it’s yeoman’s work for us uh when it gets stuffed up because apparently it’s having erections. Uh and um and appreciate you writing. Our guest today was Sarah Zhang. She is uh a staff writer at The Atlantic um and wrote a fantastic piece about congestion. Sarah, thank you for taking the time to join us today. 

Sarah Zhang: Well, thank you. Pleasure to talk to you about noses. 

Dr. Abdul El-Sayed: Oh, I’m still waiting for our teeth conversation. I think it’s going to be a good one. So.

Sarah Zhang: [laugh] I think that will be too. [music break] 

Dr. Abdul El-Sayed, narrating: And as usual, here’s what I’m watching right now. Just when you thought the assault against basic health care in the form of the effort to repeal and replace the Affordable Care Act might finally stop. We got this. 

[clip of unspecified news reporter] Donald Trump revived his threat to repeal Obamacare this past weekend. On social media on Saturday, the 2024 Republican front runner wrote that he is seriously looking at alternatives to the Affordable Care Act if he were to win next year’s presidential election. 

Dr. Abdul El-Sayed, narrating: Yeah, so they’re bringing that back. I want to be clear about something. The ACA is among the most important pieces of health legislation to ever pass through Congress. While I’d certainly have loved it go further to do more and go deeper into the dysfunction of our healthcare system like, say, Medicare for All, repealing the ACA now would be a travesty. I serve Wayne County, Michigan, one of the poorest counties in the entire state. It’s the county with some of the largest Black and Brown communities in the country, and 30% of our population has health care coverage through Medicaid. And without the expansion of Medicaid, some quarter million people in my county alone would not have health care. And those are just some of the stakes of ostensibly repealing the ACA. So if the ACA had done nothing but expand Medicaid, it would have been critical for the lives of tens of millions of Americans. And make no mistake, repealing it would rip health care away from them. And here’s the other thing. As we discussed last week in a podcast we taped in 2019, it’s amazing how little things have changed. There is absolutely no plan to replace it. See, the ACA was the Republican plan developed by the conservative Heritage Foundation in 1989. I share this to remind us just how much is at stake in the elections in 2024. Last week, the Supreme Court heard arguments in a case regarding the opioid settlement with Purdue Pharmaceuticals and their owners, the Sackler family. While the settlement requires the Sacklers to invest $6 billion dollars of their personal fortune into a fund for survivors, it does so in exchange for immunity from future litigation, meaning they get to keep many billions of dollars they made off their opioid business. The suit brought by the Department of Justice’s trustee program, which adjudicates the bankruptcy process, argues that the settlement is a misuse of that process. It wasn’t intended to protect folks who aren’t in bankruptcy, which is, of course, what the Sacklers would explicitly be protected from. But the settlement is supported by 97% of affected folks. And if the Supreme Court were to upend it, both stakeholders and Purdue Pharma argue that it could result in a far less equitable distribution of relief dollars. In essence, it would result in what attorneys call a race to the courthouse, where folks who sue first get way more than folks who come after them. The case highlights a broader set of uncomfortable tensions at play. How do you hold the folks who profiteered off the opioid epidemic accountable while also making sure that the billions they made actually go to the people who suffered the consequences? We’ll keep you posted. Finally, the Biden administration issued a new executive order on prescription drug and healthcare costs that could upend the way we think about drug patents. The order would give the government what’s called march-in rights for prescription drugs that result from federal research dollars. Those march-in rights allow the government to hand patent rights over to other manufacturers, if the prices of those drugs are too high. To understand how important this is, remember that the vast majority of prescription drugs benefited from some form of taxpayer funded research and development. That means that virtually all prescription drugs would be theoretically eligible for this kind of intervention. Giving the government march-in rights over high cost prescription drugs will have two big implications for those prices. The first is the obvious one. That for medications that are too expensive, the federal government could march-in and hand over the manufacturers patent. Second is the knock on effect. The fact that the order is now in place will force manufacturers to think twice about how high they set prices in the first place. The order did some other important things too. It launched a government wide inquiry into, quote, “corporate greed in health care.” That inquiry will specifically focus on the impact of private equity and consolidation. Two hobby horses on the show. Though these kinds of executive orders tend to be a bit more for show than for substance, they’re still an important start. That’s it for today. On your way out. Don’t forget to rate and review. It really does go a long way. And if you love the show and want to rep us, drop by the Crooked store for some America Dissected merch. And don’t forget to follow us at Crooked Media and me at @AbdulElSayed, no dash on Instagram, TikTok and Twitter. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producers are Tara Terpstra and Emma Illick-Frank. Charlotte Landes mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer and me. Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s 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. The views expressed in this podcast reflect those of the host and his guests and not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services. [music break]