Share This Podcast

Abdul dissects the critical role of trust in public health–and how the pandemic challenged it. He interviews Andy Slavitt, a former Obama health official and former member of the Biden COVID-19 Task Force on going from an outside commentator on the pandemic to the White House and what he learned about COVID-19 from inside the belly of the beast.

Transcript

Dr. Abdul El-Sayed: June is Pride Month, and in the midst of celebration for many, conservatives have introduced a slew of anti-tranx bills across the country, a stark reminder of how much further we have to go to reach equality. This Saturday is Juneteenth, a commemoration of the moment that the last enslaved people in this country learned of their freedom.

The FDA has approved a new Alzheimer’s drug, though scientists believe it may not even work and Biogen, its manufacturer has set its price at $56,000 a course, potentially tripling Medicare’s budget for injectable medications. This is America Dissected. I’m your host. Dr. Abdul El-Sayed.

Trust is an odd thing. We often think about trust between individuals, we trust the people we love and care about, the people we work with, the people we rely on in our lives. People have to earn our trust over time and sometimes they break that trust. Earning it back is no easy matter. But we don’t, at least not nearly as often, think about institutional trust—that inherited trust we hold in our government or our doctors or our banks. Institutional trust is a little different. We usually inherit that trust from our parents, or grandparents, from our communities. Think about going to a bank or waiting in line at the secretary of state or DMV, they may not be the most efficient things, but you trust that your money will be there for you, or that your license will come in the mail. Institutional trust is critical in society. I know because I’ve lived in places that don’t have it. If you think our secretary of state’s office is bad, imagine bureaucracy in a low-income country like Egypt. You get there and pull a number, you watch people who come in after you get service before you because they paid a bribe or know the branch operator. You arrive with your paperwork in hand and if you look at the clerk funny, let alone complain over your exasperation at having had to wait for hours, they’ll just close the window. You put in your paperwork and sometimes it’s just lost. Talk to anyone who’s immigrated here from a low-income country and they’ll tell you one of the deepest blessings of living here is that stuff works. That is, of course, until it doesn’t. For too many folks in our country who are Black and brown, it never has. Public health is one of those institutions you don’t usually see operating, it’s happening in the background. Every time you click your seatbelt to get in the car, you trust that it meets a set of safety standards imposed by public health. Every time you go to a restaurant, you trust the food that’s being served to you won’t make you sick because a public health professional has inspected the kitchen and certified it. Every time you open a tube of toothpaste, you trust that it won’t poison you. Every time you take a breath or a drink of water or—you get the picture. We trusted our public health institutions, our government at large, to protect us from the COVID-19 pandemic, and it failed that trust. But here’s the thing: institutions are just collections of individuals working together to accomplish a task. There’s regulations they have to follow, a culture that holds them accountable, a reputation they seek to maintain. But what happens when the individuals who we trust to lead those institutions could care less about them? That was the question we were left to ask ourselves, knowingly or not, in the fall of 2019 as this happened:

[news clip] We’re going to begin here with the outbreak of a mystery virus in China that now has the World Health Organization on edge. At least four people have died and hundreds more are sick, though there are concerns 5x as many people could be infected.

Dr. Abdul El-Sayed: Trump had been elected to, quote, unquote “drain the swamp.” It was a message designed for a candidate who had zero regard for all the parts of government our politics don’t even acknowledge: people who work hard to try to do good by their communities every day. Don’t get me wrong, our politics is broken, but our government was not. As cases began to tick upward, we watched as the people we trusted to act were suddenly interfered with at every turn. They systematically neutered the CDC, stripping it of its most basic responsibility of tabulating and interpreting raw epidemiologic data. They muzzled government leaders who dared to speak up about how serious the pandemic was. They tried to deflect responsibility for their profound mismanagement of the pandemic by blaming it on China, saying it would go away, promoting unscientific treatments like hydroxy-chloroquine and even detergent, and throttling funding to states and localities that wouldn’t go along with their gambit. They talked down masks and talked up conspiracies. Meanwhile, public health officials and agencies all over the country were hounded by loyalists of the president because they chose reality over the stories Trump spun. And all of this, well, it was designed to destroy the last shreds of trust Americans had in their politics, in their government, in one another, and in the institutions we relied upon for centuries. Science was no longer the best way to decide how to beat a once-in-a-century pandemic, the media was just lying to us after all. I could go on. I say all this because my job as a health director in the city of Detroit, as a government official, was one of the hardest but most gratifying I’ve ever had. It was hard because we were constantly struggling to earn and deserve the people’s trust. After all, I was a city official in Detroit. Not more than a decade before I started, Kwame Kilpatrick, the city’s mayor, went to jail on corruption charges. Three years before I started, the city’s finances were taken over by the state as the city was pitched into bankruptcy. There wasn’t much to trust. That job was the most gratifying because when we succeeded, it meant that kids had glasses, could breathe easy in their neighborhoods, could drink the water in their schools. We could earn people’s trust because of the work we did to deserve it. Public health, after all, is a matter of trust. When we fail, we make the preventable, imminent.

Our guest today served in government, too. He was the Acting Director of the Centers for Medicare and Medicaid for President Obama. Through the Trump presidency he developed a loyal online following as he fought to preserve the Affordable Care Act, one of the most important legacies of the administration’s work in health care. As the COVID-19 pandemic took shape, he became an important guide to the pandemic for hundreds of thousands of people. He wrote a book about the pandemic out this week called “Preventable.” And when President Biden was elected, he was tapped to serve on the COVID-19 task force. Andy Slavitt on public service in a pandemic after the break.

[ad break]

Dr. Abdul El-Sayed:  Hey! Uh, you hear me OK?

Andy Slavitt: I can hear you.

Dr. Abdul El-Sayed: We hear you, you hear us: perfect.

Andy Slavitt: All right, yep. So I’ll hit record.

Dr. Abdul El-Sayed: All right, Andy, if you can introduce yourself for the tape.

Andy Slavitt: Yep. Hi! Andy Slavitt. What else can I tell you?

Dr. Abdul El-Sayed: Tell us about, about your past work, and about your book.

Andy Slavitt: Yeah, I was just finishing up as the White House Senior Adviser on the COVID response team, and I’ve written a book called “Preventable,” and it’s about our experience as a country in the first year of the COVID-19 response.

Dr. Abdul El-Sayed, narrating: There are a few people who’ve experienced this pandemic quite like Andy Slavitt. A former Obama official, he had an insider’s perspective on how the federal government ought to be handling a pandemic as it kicked off. But, of course, he was on the outside. And then all that changed when he joined President Biden’s COVID-19 task force. He’s written a new book, “Preventable,” out today, about the pandemic. He joined me to talk about what he learned on both the inside and outside of the pandemic, and what we need to do to prevent the next one.

Dr. Abdul El-Sayed: Your experience in health care is interesting cause you didn’t come by health care on the usual path, and this, this also, this service that you’re coming off of on the Biden administration, it’s not your first rodeo. You served in the Obama administration as the acting head of CMS. What got you interested in health and health care?

Andy Slavitt: You know, I actually got into health care the way a lot of people end up doing it, unfortunately, which is they have a personal experience. In my case, I had a roommate from college who was a dear friend of mine at 31, called me one day and said he had numbness in his arm. And it turned out a couple of days later we learned he had a brain tumor. He had just been married and had twin one-year olds, and four months later, he died.

Dr. Abdul El-Sayed: I’m sorry to hear that.

Andy Slavitt: Oh, thank you. So he, it’s actually was not even as much what happened when he was alive, it was what happened after he died. His widow and their twin one-year olds came, moved across the country and moved in with my wife and I and we helped them get back on their feet. They couldn’t pay their medical bills. They couldn’t pay the medical bills when Jeffry died. And so I basically decided I would try to start an organization that would help people who were facing a very similar situation. This was in the ’90s. This was way before the Affordable Care Act and Children’s Health Insurance Program, and many of the things that have come since. So things were even worse then. Things are still bad for a lot of people now, as you know. But that got me into health care.

Dr. Abdul El-Sayed: And during the Obama administration, you had a hand in helping to move what are billions of dollars around health care. You know, in that time, right, a lot of the fights were about health access—they still are—and health affordability. And I think a pandemic sort of registered relatively low on the scale of things that we talk about when it comes to health care. During your time in the administration, as you think about the work that you did, could you draw a straight line from where we were there, to where we are now?

Andy Slavitt: Well, you’re right in the fact that the country as a whole was very unprepared for it. It felt, I think, that something like a pandemic couldn’t happen here. You know, I think we have this vision of ourselves as being above the world’s problems, which is just simply not true. Viruses are a fact of life. And the fact is that lack of preparation was, in fact, part of what I talk about in the book, that we just simply, it took us too long to actually do the things that people in the rest of the world would do naturally who were more accustomed to this sort of thing. Now, you throw on top of that a government and a president at the time, in President Trump, who really wanted no part of the virus, or the virus response and I think was very used to being able to be in a situation where he could just say something, simply deny something and have it go away. And I think he tried that. And, you know, I spent a lot of time, you know, talking directly to people like Deborah Birx and to Jared Kushner and others, during that time period and I have, all that stuff is in the book. But really, we had a bad situation and on top of it, I think we had a government that just didn’t want to deal with the problem.

Dr. Abdul El-Sayed: One of the things that’s fascinating, right, is that as a former Obama official, you had an inside view into how government works, how government operates, how it’s supposed to process and digest an experience like this one. And you had an inside lane to conversations with a lot of the folks who in a normal world would have been doing that digestion. When did you realize that we were really in trouble in the midst of the pandemic? And what were the sort of conversations that you shared, like with some of these folks, around how things should be done and how things were being done?

Andy Slavitt: Yeah, of course, we did learn for some time that President Trump learned in early January that we were going to be facing a situation where there are mass casualties, and decided not to do anything about it, and decided that he would go to bed every night. Until he was forced to by two things happening: one is the stock market tanking, and the other is the NBA calling the season off. And those things forced the president to stand up and say, OK, we have a problem here. And at that moment, I think Americans had good reason to think that maybe, like the rest of the world, we were going to take this seriously. Unfortunately, that didn’t last. And I think as soon as the stock market went up, that was the day that President Trump was effectively done with the pandemic. And there’s a situation that described in the book that was described to me by many people, where he actually got a copy of the newspaper, which showed the stock market increase, got it reprinted and signed it for his senior staff. And from that point on, it was very difficult to engage him in the fact that people were dying and the fact that this was damaging the country and he was the person in a position to do something about it. So that really put a lot of things by design on the states, which is exactly where he wanted them—on the nation’s governors. So a lot of a lot of the effort that had to go on was to try to take states who are not in a position, whether they have either the budget or the staff or the expertise to fight a pandemic, and put it squarely on their shoulders.

Dr. Abdul El-Sayed: And then you had this odd experience of going back in government to clean up the mess that you watched being made in real time. What did you find? What, was it better or worse, or just about as bad as you thought it would be? And what were, what was on your mind as you and the team started to take on the work of trying to right the ship, and bring down this pandemic?

Andy Slavitt: Well, I think I was brought in precisely because I had dealt with a major national crisis before from inside the government. But I also had a lot of experience outside of the government in health care, in the private sector, and we had to act and move very quickly. Now, I think what we inherited was—without getting too political about it—I think it’s fair to say that the last administration really didn’t view it as their accountability to deliver vaccines into people’s arms. I think they viewed it as their accountability to manufacture vaccines and send them out to states. But when we got there—put yourself back into the shoes we were all in on January 10th, 12th, 13th when were just getting up to speed and getting ready to go into the White House—thousands of people a day were dying, most people couldn’t get a vaccine appointment, most people didn’t know if they were qualified. The people that were more than half of them weren’t sure they even wanted the vaccine because the government had done such a poor job of building trust. And then the vaccines that were getting, that were being sent to states, fewer than half of them were making their way into people’s arms. And there was no, there was no standing inventory, there were enough vaccinators, there weren’t enough vaccination locations—and so we inherited this at a time when every additional day that we didn’t act, thousands more people would die. So we had to treat this very much as a wartime effort and try to basically overwhelm this problem and put together a plan and begin executing very hard the first day.

Dr. Abdul El-Sayed: Mhm. And one of your roles was, was to be a spokesperson, up against a lot of the same forces that frankly created Donald Trump’s presidency and that he’s been so effective—continues to be so effective—at riling up against any semblance of truth or system of trying to understand truth. What was it like trying to speak against a lot of the misconceptions, the misinformation, the all-out assault on science, truth, people like Dr., Fauci? What was that like, and how did you think about trying to engage the public conversation to enable a lot of the work that you just talked about?

Andy Slavitt: It felt like we had a real opportunity to get people to reestablish trust again with government, with the American people. And the way there was, I think, very much guided by how President Biden views the world, which is he said to me: don’t make me, don’t worry about making me look good, give people the information they need, just tell them the truth. And I think believing that the public would be able to handle the truth—whether the news was good or bad—and allowing scientists to speak for themselves—whether or not it was convenient—felt like the underlying principles that we needed to never stray from. And for a lot of people we heard from, it was incredibly refreshing. I remember there was one occasion when I was asked a question at the press conference and I said: look, let me just be very clear, we have a shortage, we have a shortage of vaccines. Let me be very clear that crisis will take weeks or months to resolve. We’re not used to having crises, we’re not used to having shortages here in the U.S. That’s, but people all over the world are. This is an unusual situation. I know it’s frustrating for people, but that will remain the case for a couple of months. Once that, once that shortage is overcome, we will have plenty of vaccines. And I thought that was a very simple, straightforward statement, but I got an overwhelming amount of response from nurses, from people in the country who were waiting to get vaccinated, saying: I finally felt like for the first time in a long, long time, I just got handed the truth. And that gave me so much more confidence that we’re going to solve this problem now, because every time I’ve been lied to, it just sets it back, it sets me back further in terms of whether I think there’s something deeper going on. You just came out and told us the ugliness of the situation, and it was actually, it actually made things better. And it was a real lesson for me.

Dr. Abdul El-Sayed: Mm hmm. You know, this may be a challenging question—I know that you’re just coming off your service—what do you think is the biggest mistake of the Biden era of COVID-19?

Andy Slavitt: You know, I think the thing that I, it’s hard for me, the reason it’s hard for me to answer the question is because I sit here now, I had lunch yesterday with my son, with my mask off, indoors and it’s, and it’s just barely June, and I think many of us felt, particularly when we came in in January, that we were going to be in the situation where we were going to be at this and struggling for a long, long time. We, we had only 300 deaths yesterday, 250, which is a very low level relative to where we’ve been. So I think you can take issue with any individual decision that you made and say: boy, you could have called it this way, you could have called it that way, you know, you can give it a little more vaccine to this state, you could have done—you know, any one of a number of decisions that people could question. But in the end, we had a plan and we built as much redundancy into our plan so that when things went wrong—and things did go wrong, right? Johnson & Johnson’s vaccine was pulled from the market. A lot of things went wrong. And when they went wrong, they didn’t knock us off our plan because we had prepared for them. So I don’t think it was a situation where we had to get every little thing right. I think it was a situation where we had to just, frankly, win. We had no choice but to win. By win, I mean against the virus. I don’t mean against any political force. And because we did that, I’m not going to sit around and second guess the work of anybody on the team making really good battle decisions in the heat of that. But I’m sure others will have, I’m sure others will have criticism.

Dr. Abdul El-Sayed: I wonder, as you think about where we are now and you know, I largely agree with your assessment. I think the effort to vaccinate the country, to distribute those vaccines in an equitable way, to set standards and meet them—even if you took some heat for those standards being somewhat low, but to say here’s our standards and we’ve got to hold ourselves accountable to that, and we’re going to we’re going to speak the truth, whether it’s for or against us, I think that’s been a real boon. And frankly, it’s the reason why, you know, you can sit and have unmasked lunch with your son indoors. And yet there’s still so much work to do. And one of the spaces that I think the challenge still exists is to ask, how do we make sure that, you know, if Joe Biden is sort of seeing this as this FDR moment, right? FDR both ended the Great Depression and he won World War II, and in a lot of ways, he saved a lot of, a lot of lives globally by taking the war on. You know, if you were to say—I don’t like the war analogy as much—but if you were to say the next step of this is our responsibility to the international community, what are the challenges there? What do you think the next steps are, and what will it take for us to meet them?

Andy Slavitt: You’re absolutely right. Gone are the days when “we’re fine, screw the rest of you” is the statement that our country makes. We have several reasons to feel like the job isn’t nearly done, even if we do complete the task here at home in the US—and I think that’s not even completed yet either. One of which is simple humanitarian reason that we should take responsibility as a wealthy nation for making sure that particularly the less developed and middle-income countries have their vaccines and get their vaccines. And that’s going to require billions of dollars of investment, it’s going to require cooperation from the G7 and the G20, it’s going to require creative, clever distribution, and it’s going to require us to nearly double, more than double, the vaccine production we do every year. So none of that, none of those on their own are easy feats. All of them together, are challenges, but they’re challenges that we, if we make a top priority, we can solve for. Now, people also understand that you don’t eradicate a pandemic in one country. It’s a global pandemic. So people now understand that these viruses mutate, that the longer they’re out there, the more they mutate and those great threats abroad, that become threats at home. So this is very much, I think, as we are in the—I don’t know when this records—but it is either in the wake of the G7 meeting or we are just following the G7 meeting, I think more likely. So we are just following the the G7 session, as you saw, there was a significant amount of focus and announcement around this commitment. And we’re going to need every bit of that commitment.

Dr. Abdul El-Sayed: I want to step back and come back to America for a second, because so many of the problems that you worked on during the Obama administration became the backdrop for this pandemic. I mean, the pandemic demonstrated the inequity and frankly, the vulnerability of our health care system as 15 million people lost their health insurance within the first first quarter of this. We watched as millions of people were forced to choose between lives and livelihoods. And I think to the administration’s credit, a lot of the work has been around trying to seal the holes in the social safety net and to rethink a lot of the paradigm about, about poverty in this country and about what the economy ought to deliver for folks. And I think that’s really important. I wonder if you were to go back to yourself in the Obama administration and you could take this experience of this moment back with you, what would you have told yourself circa Obama administration, 2010s, or so?

Andy Slavitt: Sure. You know, it’s funny. There’s a chapter in the book that is titled “The Room Service Pandemic” and it talks about this dichotomy between the fact that we labeled 50% of the people in this country as, quote unquote “essential workers” and we had a number of people that were just fine and protected at home, safely ordering their Amazon, ordering their DoorDash. And then we had millions and millions and millions of people that were growing food, distributing food, packing it in warehouses, distributing it, delivering it at grocery stores—all of whom were at risk—so that, quite frankly, people wouldn’t have to miss a bit of the luxury that they’ve grown accustomed to. These are deep issues in our country that were on display for all who chose to pay attention to them and were willing to bring attention to them. This pandemic did not hit this country evenly. There were people who did quite well during this pandemic, and there were people that made billions and billions of dollars during this pandemic. There was a, there is another chapter in this book about the industry that evolved around this, what I called the sort of free market approach to the pandemic, that this country took at times. And that free market approach victimized, safe to say, hundreds of thousands of lives, because we put certain things above the value of people. Now, this is an issue that goes back generations, generations within families, generations in our country, and generations within our policy community. It was only 50 years ago that we began, with commitment to even provide care for elderly people and low-income people. And step by step, we have moved closer and closer to a dream of taking better care of people, but the truth of the matter is that whether you’re talking about the pandemic or whether you’re talking about the health of a mother who is giving birth, or diabetes, or heart disease, or sickle sickle cell—if you are Black or you are a person of color, you are getting a far worse outcome in the health care system. That was on display during the pandemic, but it wasn’t pandemic-specific. When I was in the administration, I made the health equity, I made a position called “Director of Health Equity” a cabinet-level position at CMS, and I think people were a little confused by that at the time. This was only five, six, seven, eight years ago. But people didn’t really understand what that job meant. They didn’t understand what that does. Now, cut ahead to 2021, the Dr. Marcella Nunez-Smith who leads to Health Equity Task Force out of the White House, it’s one of the most significant things we do. We don’t make a decision or a move without involving Dr. Nunez-Smith and her team. You don’t get through a conversation with President Biden or Vice President Harris without talking about how the different elements of the pandemic are hurting the populations that are hit the hardest. So there is a consciousness, at least in this administration, that is leagues ahead of even where we were a couple of terms ago/ and certainly very, very night and day from where we were with the last administration.

Dr. Abdul El-Sayed: And, and I guess I’m going to, I’m going to ask the same question framed-shifted forward. So you are now leaving your role in the White House and you will be out as a private citizen and someday there’s going to be the next one. And as you think about what it will take to prevent the next one, what are the key things that we need to be doing right now post-pandemic, or at least as we think about coming off the back end of this pandemic, that we need to do to inure ourselves to the risk of the next one, and certainly the risk of the unzipping of society that we saw during this one, for the future?

Andy Slavitt: This question is both so simple and so complex. There is a part of this book that’s very, at the very end, which I call “Exhibit N,” and Exhibit N is the list of everything we would do and should do to prevent ourselves from the next pandemic. The reason is called Exhibit N is because there is no way, no way possible that these things will happen unless we as a country do some things that are even more basic. Which is have a real conversation about whether or not our commitment to one another is strong enough to overcome the personal liberties and the personal wealth and the politics and the way of doing things that have become a big part of our country, quite frankly. You know, we learned some ugly things about ourselves. You know, we learned at key moments, Americans were generations removed from will, be willing to sacrifice even a little bit for one another. You know, I think back to my grandmother who lived through the Great Depression and World War II, which you referred to, she went ten years without drinking a cup of coffee during the Great Depression. If I go a morning without my dark roast at Starbucks, I get whiny. So we have a very different mindset these days, and if being called upon to simply wear a mask for one another, or to in some other way, restrict our own liberty so that we can, we can make people other people’s lives better—if we’re not willing to do that, then I’m hard pressed to say that will do any of the things necessary. And I really hope that we don’t just focus on the basic lessons of let’s make sure we have more masks and more ventilators next time, but that we really focus on the lesson of how do we become a better country and better people to one another, because at our best day at our best game—and I, look I think President Biden has done a good job of calling out people’s best day—this country can do extraordinary things. But we have to really face the truth, that—and I think part of why this is been preventable is not simply because of the president we had, but because we as a country weren’t willing to do the things that were necessary for one another. And I hope we really learn that lesson.

Dr. Abdul El-Sayed: You know, what you’re getting at Andy is, you know, the topic of my notes before our interview today was on trust. And, you know, I grew up between here and Egypt, where the difference in trust is profound. And not just individual trust, but institutional trust, that, you know, you’re going to walk into a bank, you’re going to walk into the secretary of state, and that those institutions are going to do their job by you. And if they don’t, that they’ll at least be accountable or they’ll be somebody to talk to. In Egypt, that doesn’t happen. You know, you look at someone the wrong way and you get booted out of the, out of the equivalent of the DMV. And I worry that we’ve come to a point where there’s just so little public trust, and your experience in government now and under two administrations, and, you know, as a private citizen and as an advocate, what does trust mean to you, and how do we get it back?

Andy Slavitt: Well, there’s no question that we have a number of things which make that more difficult today than ever before. The sort of, if there’s ever a common experience with a common enemy, you would think it would be a virus. And a little bit in this book goes through this, like journey that I went through where at the very beginning of the virus, I really believed that we had the opportunity to have a very unifying response, and a unifying moment as a country. You know, I launched this campaign called “hashtag stayhome” where we talked about sacrificing for one another. People were scared. People were, you know, people were perhaps moving out of their normal comfort zone. And it felt like a real opportunity for us to unite. And it couldn’t have worked out more differently, and I couldn’t have been more incorrect. In the book goes a little bit through the journey of how in the midway point, the president decided he was going to exploit divisions that existed—and by the way, I don’t think that this is endemic to a political party, I think a Mitt Romney would have done things very, very differently than a Donald Trump because political, people can say they’re conservative, people could be liberal, whatever they are, but there is a certain competency and a certain humanity that’s required to lead a country through a pandemic. A certain human empathy to just, to basically mourn with people. And care. And encourage other people to care. And we didn’t have that. Now, it’s not so easy for Joe Biden, as you know, to get people who voted for Donald Trump to even admit that he’s the president, let alone to follow anything out of his mouth. So these are deeper problems that we have. I don’t think they’re going away very easily. I think they’ve existed since certainly since the founding of the country. And it’s hard to deny them anymore.

Dr. Abdul El-Sayed: Well, we hope that we’ll get there. And I think the work is going to continue. Really grateful for you and your service and your new book. That’s Andy Slavitt. He’s the author of the new book Preventable, and he is the former senior adviser to the COVID-19 Task Force and formerly the Acting Director of the Centers for Medicare and Medicaid Services. Andy, thank you so much for joining us today.

Andy Slavitt: So great to be here. Thank you.

Dr. Abdul El-Sayed: As usual, here’s what I’m watching right now: it’s June and Pride Month is in full swing. This month for many in the LGBTQIA community is one of celebration and commemoration. But celebrations are being interrupted by the dread of legislation introduced in Republican legislatures to strip away the hard-fought rights of the trans community. Right now, 31 bills have been introduced across the country to restrict health care access among trans people seeking gender-affirming care. It’s ironic that a party that decries medical tyranny in the form of flimsy cloth masks thinks that it can get between a person and their doctor. To add insult to injury, an additional 66 bills have been introduced to restrict trans youth from school sports. Seriously? Let the kids play. Trans rights are human rights. In this pride month, remember that those rights are not a foregone conclusion in this country and that we must keep up the fight for equal dignity, equal protection and equal rights under the law.

Juneteenth is also coming up on Saturday. The holiday, also known as Freedom Day, Liberation Day and Emancipation Day, commemorates the day in 1865 when enslaved people in Texas learned that they had been emancipated when Union Army General Gordon Granger announced General Order Number 3, carrying out President Lincoln’s Emancipation Proclamation in Texas. Like Pride, Juneteenth is a celebration and commemoration of liberty and freedom. But it’s also a reminder of how far we have yet to go to achieve true equality. As we’ve discussed with Professor Ibram Kendi and Representative Cori Bush before him, profound disparities in our country continue. They remind us that structural racism robs millions of Americans of the most basic right one can have: the right to health. We will not have succeeded until every child gets to breathe clean air and drink clean water, every senior has access to quality health care in her community, every family can live in a safe, healthy home. The work continues. Nevertheless, happy Juneteenth and happy Pride to you all.

Last week, the FDA approved a new drug for Alzheimer’s disease called Aduhelm. Alzheimer’s is a terrible disease, stealing people’s minds and their memories, relationships, and connections to the world around them. It’s critical that we keep pressing to produce medications that can slow or even reverse its course, but this ain’t it. In clinical trials Aduhelm, at best, reduced symptoms by a fraction of a point on an 18 point scale. This after Biogen, its manufacturer, halted two trials that showed it didn’t work, and then reviewed one with a fine tooth comb to come up with this result. The FDA’s own advisory panel voted almost unanimously, with one abstention, not to approve it. And yet the FDA approved it anyway. And then Biogen set the price for a one year course at $56,000 a course! The drug could wind up single-handedly tripling Medicare’s budget for injectable prescription drugs. Biogen is gaming the science and the public’s desperation for a breakthrough on Alzheimer’s disease to nickel and dime us all.

That’s it for today. If you like our pod, tell everyone by rating and reviewing it, it really helps people find us. So please do your part. Oh, and just in time for the holiday weekend, we’ve got new merch. We’ve got two new lines: T-shirts with our new cover art, and a new T-shirt with a simple message “safe and effective, like the vaccine.” We’ve still got our Science Always Wins  merch too. Check it all out at the Crooked store.

Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters of show. Production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. The theme song is by Taka Asuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, and me: Dr. Abdul El-Sayed, your host. Thanks for listening.