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It’s early August–it’s hot and sunny. And for many people, it’s sunburn season. But the long-term consequences of sun exposure can be a lot worse than just a sunburn. Americans have fewer and worse sunscreen options than their counterparts abroad–and those options mean fewer people will wear it. Abdul speaks with Amanda Mull, staff writer at the Atlantic, about the bureaucratic issue standing in the way.

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Dr. Abdul El-Sayed, narrating: The Biden administration declares monkeypox a public health emergency. Voters in Kansas overwhelmingly rejected a ballot measure to eliminate the right to a safe, legal abortion. And the Senate moves Medicare one step closer to finally being able to negotiate the price of prescription drugs. This is America Dissected, I’m your host, Dr. Abdul El-Sayed. [music break] Just a warning here. I’m about to wax poetic about the greatest state in our nation, Michigan. I know, I know. You all are probably sick and tired of my cheerleading, but you’re here anyway, and I promise I’m going to get to something important. Michigan summers are honestly the best. The best. The weather is consistently between 75 and 85. We’ve got the best lakes in the world. We’ve got amazing parks all over the state. And the sun hangs in the sky until, like 9 o’clock. There’s a reason people write songs about summers in Michigan. And that sun. Well, that sun will do it to you. For most of my life, I didn’t really use sunscreen. My family is Egyptian. I always used to joke that the copper hue my skin turns in the summer was actually my natural skin color. But my grandfather, who sold vegetables under the Egyptian sun his whole life, developed skin cancer toward the end of his life. And my father has permanent sun damage on his neck from his time photographing tourists on the Mediterranean. And as I’m, yes, getting older, I’m getting some serious crow’s feet. So every day I put on my sunscreen in the morning. But honestly, sunscreen isn’t great. It goes on chalky and it makes my skin look weirdly splotchy. I’ve tried tinted sunscreens, but they’re super expensive, and then it stains your clothing when anyone touches your face. In truth, dermatologists recommend that we wear at least SPF 30 sunscreen every day and that we reapply sunscreen every 2 hours when we’re outdoors, which is something very few people actually do. Our bodies need an ounce of sunscreen, enough to fill a shot of espresso, every application. But most of us only use 20 to 50% as much as we really need, and we barely reapply as needed. And that’s for folks who are most likely to get sunburns. For more melanated people who aren’t as likely to get acute sun injury in the form of a burn. Many of us simply don’t wear sunscreen at all. But the long term consequences, like the skin cancer my grandfather got, or the sun damage my dad did, are even more important to prevent. Adding insult to injury, the current sunscreens are simply more aesthetically awkward for folks with darker skin. Why isn’t sunscreen better? Well, it turns out that it is, just not in America. Increasingly, Americans are buying better options from abroad online. These sunscreens differ in a critical way. The filler, the main substance inside the sunscreen is different. In many cases, they’re safer, more effective and cheaper than the ones we have in America. But we don’t have them because well, bureaucracy. I recently learned a ton about sunscreen thanks to a piece Amanda Mull, our guest today, wrote for the Atlantic. In it, she breaks down how sunscreen in the United States came to be, well, just not as great as it is in other high income countries. It’s a story of tough FDA regulation and decisions about what sunscreen actually is. Is it a drug or a cosmetic? And how those hurdles have kept the best sunscreens out of our hands. And as we’re deep into the hottest, sunniest days of the summer, I wanted to share it with you all. Here’s my conversation with Amanda Mull: 

Dr. Abdul El-Sayed: Uh, All Good. Let’s go. Um, can you introduce yourself for the tape? 

Amanda Mull: Yes. Um, my name is Amanda Mull. I’m a staff writer at The Atlantic, um where I cover health and consumerism. 

Dr. Abdul El-Sayed: I have to ask, um. I put on sunscreen every day, uh and the only reason I do it is because I learned like a year ago that this was a good thing to do. Um I’m starting to generate some, like, really intense crow’s feet. Uh so I started putting it on and I never really paid attention to it before that I happened to have the privilege of being rather melanated, so I never really burn. What got you interested in writing about sunscreen? 

Amanda Mull: Um, well, in part, I’m just a very pale person. So sunscreen has been a big part of my life since I would say approximately since I was a teenager or in college. I’m 36 now, so I feel like over the course of my life, I have seen the sort of public discourse on sunscreen change a lot. Um, When I was a kid, I come from a family of very fair skinned, sort of like northern European derived people, and so we all burn. Uh, But when I was a kid, I grew up in Georgia, a lot of sun, a lot of outdoor time, and we just never really put on sunscreen like it wasn’t really present. And my mom is like a, an anxious person. So I know that if she had been told to, she would have. Um, but it just didn’t really exist in the, in the nineties. Like sunscreen existed, but the culture of sunscreen that we have now did not. And then over the course of my lifetime, the the sort of uh necessity of wearing sunscreen has been like a bigger and bigger message in public health, especially for people with my kind of skin tone. And you see it uh popping up a lot more in cosmetics, in, um you know, skin care products and other things. And and so the, how that has changed over time was always fascinating to me. And then in the past couple of years, um this sort of move toward uh a lot of people anyway, this move toward looking overseas for sunscreen and the sort of uh folk wisdom that has gone around, um especially among women on the internet, that what is available overseas is better and that there’s some like regulatory reason that we can’t get like the really good stuff in the United States, is fascinating to me. And so with, you know, skin cancer rates are uh climbing all the time. It is the most common cancer in the United States. And with that facts, it seems really odd to me that there were just like sunscreens that we apparently can’t have that people really like and people use in much of the rest of the world. So I uh have had this topic like in my back pocket forever, for like four years. It was on my pitch list when I started at the Atlantic in 2018 about just wanting to look into this eventually. 

Dr. Abdul El-Sayed: Ah and a pesky uh, pesky pandemic probably got in the way. I um. I have to say, when I when I told folks that we were going to do an episode on this, I was ushered into a whole sunscreen discourse that I didn’t know existed. And people have a lot of opinions about sunscreen. And, you know, that makes sense. It’s something that uh you wear every day. It’s something that is about as intimate as it gets. It literally goes on your face and on your body everywhere. And um, and it’s one of those things that uh that if it fails you or it doesn’t work the way you’re supposed, it’s supposed to, it can have negative consequences. So it makes sense. It’s, it’s something, though, that uh, that you know, I just I didn’t I didn’t realize existed. And I’m grateful for you writing the piece because I really learned a lot about it. I want to just start by asking, how often do people actually follow the recommended sunscreen usage? 

Amanda Mull: Well, that varies a lot. It varies depending on age. It varies depending on skin color. Um, it varies depending on uh other cultural factors. But in general, the the rate of adherence to like ideal sunscreen usage behaviors is not great. Even people who uh have a lot of opinions about sunscreen, who really believe in using it, um the amount of time we’re supposed to be wearing sunscreen, and the amount of sunscreen we’re supposed to be using and reapplying, etc., etc., is it just makes it a real behavioral problem in addition to a sort of like chemical uh problem? So adherence to ideal sunscreen behaviors is is very, very low. Um, And then you have a lot of people who are sort of in the middle who will put on some sunscreen if they know that they’re going to the beach or going to sit in the, you know, unprotected grandstands at a baseball stadium for 4 hours or however long baseball takes now, um the constantly expanding game or do something else that is going to put them in direct sunlight for a long time. People um generally, even people who dislike sunscreen, don’t want to get burned um because sunburns, like they’re aesthetically uh inopportune. They’re a little embarrassing. You have to explain to people why you’re so pink um and they hurt, they uh peel, they you know, nobody wants that. So people are generally willing to take like a first line of defense against that. But then you end up at the beach and you have to reapply. You’re sweating, you’re in the ocean, you’re rubbing yourself off with a towel and you have to reapply. And reapplying is annoying. And, you know, you get into um a situation where even people with good intentions often don’t live up to their uh to their uh goals as far as sunscreen goes. 

Dr. Abdul El-Sayed: And you’re making a really important point here, which is that sunscreen protects you against both an acute injury and a chronic long term, potentially devastating outcome. And, you know, it speaks to a certain psychological quirk that exists in all of us, which is that we’re way better at avoiding something that can happen immediately after something uh we fail to prevent, even if it’s far less serious than something that happens in the long term. I mean, this is a pretty analogous to uh to climate change. Uh, We are um sucking yet more fossil fuel out of the ground. Uh, And even though we’re all burning up because of climate related heat waves, we’re all trying to find more oil because gas is really expensive. [laugh]

Amanda Mull: Right, right.

Dr. Abdul El-Sayed: And um and so sunscreen sort of offers that perfect, that perfect foil here. The interesting part of this, though, um and one that I really wanted to get into is that part of the problem is that usage itself is um not great. Can you tell us a little bit about why American sunscreen sucks? 

Amanda Mull: Yeah. Part of the usage issue in the United States at least is a problem with the products themselves. Because you can uh you can give people all the information about what they should be doing. You can give them compelling reasons to do it. Uh, But if they don’t have tools that also encourage that behavior, then a lot of times you’re just going to see people fail to do the things, even if they intend to do them. And sunscreen in the United States is in some ways worse than uh what is available in the rest of the world. That has to do with the chemical composition of U.S. sunscreen. Sunscreen works by using um a combination of filters to either block or absorb uh UVA and UVB rays before they’re able to penetrate your skin. Um, those are the rays that give you cancer and also those that damage your skin and give you wrinkles, discoloration, things like that. And the United States has 16 currently approved, FDA approved filters for use in any kind of sunscreen, and a new one hasn’t been approved since the 1990s. Um. 

Dr. Abdul El-Sayed: Wow. 

Amanda Mull: So and the reason for that is because the FDA regulates sunscreen like an over-the-counter drug. So in order to be used in sunscreens, an ingredient has to get GRASE approval, which is um Generally Regarded as Safe and Effective, which is a very high standard of proof that something can be used uh widely in lots of different types of products and lots of different formulations by lots of different people without any medical oversight. There is like very good reason that there is a high burden of safety and efficacy information for things to get grace approval under the FDA. Um, And it’s why you can buy like off brand Tylenol and off brand Ibuprofen and know that it’s going to be safe and effective in the same way that Advil or name brand Tylenol will be. So it, that approval process provides some real benefits to people in the United States. For sunscreen. It has sort of. Sunscreen manufacturers have found a little bit of a corner in this sort of regulatory structure that it’s difficult to get out of because the FDA requires a really, really high burden of proof for safety and efficacy for this type of approval. It costs a lot of money to get these ingredients uh approved as actives in the United States. [siren in background] So you have to produce a lot of studies, a lot of data, a lot of information in like very specific forms. And a company has to uh do that. A company has to produce these these studies, and that costs that company a lot of money. And then if they do get approval, they don’t have a competitive advantage with that ingredient. 

Dr. Abdul El-Sayed: Mmm. 

Amanda Mull: But because it’s a GRASE approval, anybody can use it. So you’re asking um some company to sort of out of the goodness of their hearts, foot the bill for this and then let all their competitors profit from it. 

Dr. Abdul El-Sayed: There’s like a classic collective action problem here where uh it’s like you want a park bench and you’re asking one company to build the park bench so that every other company can sit on it. 

Amanda Mull: Yes. 

Dr. Abdul El-Sayed: Uh, And so we end up with a situation where that local disincentive, that economic disincentive leaves us, in effect, without all of these other choices. Which is ironic, because as as consumers in the United States of America, the one thing that uh we assume to be our birthright, for better or worse, usually for worse, is that we think we should have all the choices all the time. And– 

Amanda Mull: Right. 

Dr. Abdul El-Sayed: And here we are without many of the choices all the time. 

Amanda Mull: Right. Yeah. It’s a very strange thing um. It’s a situation that doesn’t happen a lot in the United States, as you said, because in general, I would say that the FDA is more tolerant of potential chemical safety hazards to consumers than um than regulatory regimes in the U.S. or Australia or Asia generally tends to be. Um, But because of this particular uh very high standard for this particular type of authorization, it’s just very, very hard to generate the very specific types and forms of data that the FDA wants. At the same time, a lot of data in real world data, too, which is which is great for this type of product because it’s going to be used widely and without medical oversight. A lot of data exists about the safety and efficacy of these products because um some of these filters have been used, in use for five or ten years in the European Union, in um Asia, in Australia, who regulate their uh sunscreen ingredients a little bit differently and with varying levels of safety and efficacy information required. A country like Australia still requires a lot and they have um almost twice the number of filters that we do available for use. 

Dr. Abdul El-Sayed: Mmm. 

Amanda Mull: And what filters do, what these newer filters do in sunscreens is make them uh more aesthetically elegant products. They’re less greasy, they’re less chalky, they’re easier to put on. They uh you don’t feel like you’re wearing something gross on your skin. They sort of melt into your skin in a way that makes compliance, or even if it’s not like perfect compliance, but better compliance a lot easier on a behavioral front, especially for people who have uh darker skin. 

Dr. Abdul El-Sayed: Mmm. 

Amanda Mull: A lot of good sunscreens now have uh if you’re using something that has physical uh U.V. blockers in it are going to have like a whitish cast. And so for anybody but the whitest people out there, um this is going to be like aesthetically, not okay. You’re going to– 

Dr. Abdul El-Sayed: Yeah. 

Amanda Mull: You’re going to look wild. And if you look wild, then you’re not going to put it on, even if it’s like the healthy thing to do. 

Dr. Abdul El-Sayed: Mm. 

Amanda Mull: So these new types of filters are, you know, generally outside of the U.S. considered to be extremely effective, very safe. They uh have some chemical properties that make them easier to make into like wearable, enjoyable sunscreens. 

Dr. Abdul El-Sayed: Is there any indication that they are less safe or effective? 

Amanda Mull: Not that I’ve been able to find. The European Union in particular, as well as Australia, keeps very good records of this type of thing of consumer safety issues. And um what we see is that especially for the you know five most promising new filters out there, there is good evidence that not only are they safe, but they’re safer probably than some of the ones that we currently have approval for, um because they are uh they seem to be less likely to be systemically absorbed. 

Dr. Abdul El-Sayed: Mm. 

Amanda Mull: So if you have a lower absorption rate systemically, then you naturally have a lower– 

Dr. Abdul El-Sayed: Lower toxicity. 

Amanda Mull: Right. Right. So you’ve got a lot of um a lot of lab data on that from overseas. You’ve got a lot of real world data on it. And all the experts I spoke to for the story were very adamant that they think that uh that these are safe. 

Dr. Abdul El-Sayed: Is there any indication that people in these other countries where they have these other fillers are more likely to use their sunscreen as recommended? 

Amanda Mull: It sort of goes up and down because like I said earlier, the sunscreen usage has a lot of sort of like cultural factors to it and not just um chemical factors. Um, in Asia, sunscreen usage is uh extremely high, very, very popular. Part of that is because of beauty standards that encourage people to stay pale. So you’ve got like cultural factors that happen on top of uh on top of efficacy factors. But yes, in general, these sunscreens are extremely popular in the countries uh where they’re sold. They are tend to be like the default products that people that people use um instead of the types of things that we have in the United States. [music break]

[AD BREAK] 

Dr. Abdul El-Sayed: Are Americans uh getting wise to these other products? Are you finding people maybe going off uh off our usual um buying habits to, to get these on on websites, etc.? 

Amanda Mull: Yes, there is like a real market in the United States for these sunscreens. There’s like a couple of reasons for that. Some of it is because, you know, when Americans travel in uh in Europe, in Canada, in Mexico, anywhere else in the world, you’re you know, if you’re on vacation, you’re probably there when it’s sunny out um and you’re buying local sunscreen probably, and realizing that like, oh, this rules like this– [laugh]

Dr. Abdul El-Sayed: Mmm. 

Amanda Mull: This is so much better than what I had back home. And then realizing you can’t get it back home and like trying to find it on the internet. So there’s, there’s that aspect of it, of people just encountering these products and then sort of word of mouth moving around about like, oh, this is better. Try to get some of this off Amazon if you can. And then there has been an explosion in the past 5 to 10 years in the United States of Asian beauty products and in Asia sunscreen is a big part of the um skincare routine process. 

Dr. Abdul El-Sayed: Mm hmm. 

Amanda Mull: Um, So you get along with all these other skin care products that are coming in from Asia. You get people writing about like, oh, also a big part of this is sunscreen, but you can’t technically buy it in the United States. But there are some third party sellers on Amazon. Here’s a link. So you get a lot of information that way and a lot of people who are introduced to these products that way. And then just like word of mouth on social media, a lot of the ones that are available internationally are made by, you know, multinational beauty conglomerates that people know. L’Oreal makes a lot of the different brands that are available in the, in Europe, and they make versions of those products that are just not quite as good for the U.S. market. 

Dr. Abdul El-Sayed: Hmm. 

Amanda Mull: And then in Asia, one of the most popular ones is made by Bioré, which is a company that a lot of American consumers will know as the makers of the little drugstore strips that you put on your nose and then you pull them– 

Dr. Abdul El-Sayed: Blackhead remover. 

Amanda Mull: Yes. You rip all the gunk out of your pores. Um, that’s a Japanese company and they sell lots of different products in lots of different countries. And they sell a really popular, really inexpensive drugstore sunscreen in Japan, that is extremely popular on Amazon and that feels like a skincare product. You don’t notice it under your makeup um. And that has you know, you can buy on Amazon for like 11, 12 bucks for like a pretty good sized tube. 

Dr. Abdul El-Sayed: So given that we’re in the situation where adherence to sunscreen recommendations is low, that uh skin cancer rates are high, that there are products that we know from real world data to be safe and effective out there that Americans can access that could help solve both the behavioral problem and the long term health care problem. And we know that there’s a, uh you know, an annoying bureaucratic circumstance that’s in the way. Has there been any effort by the FDA or uh even Congress to address this problem? 

Amanda Mull: Yes, I think that there’s like pretty widespread uh frustration outside of the FDA about this like gridlock that we find ourselves in. Um, In 2014, Congress actually passed a law uh trying to uh loosen up the approval process specifically for sunscreen ingredients. What that bill failed to do was make the data requirements any different. [laugh] So you end up uh sort of uh with some other parts of the process. 

Dr. Abdul El-Sayed: With a non-solution solution? 

Amanda Mull: Yeah, some of the other parts of the process are a little easier. But as long as the FDA wants like a very specific, very large amount of certain types of data and like won’t work with manufacturers on that, then you are still in a position where you can’t get these uh get these ingredients into the United States. 

Dr. Abdul El-Sayed: And have any of the, any of the companies come together and said, listen, we’ll just let’s just in a shared process, in a shared way, put together this application and then share the benefits on the back end. 

Amanda Mull: You know, not that I know of. There are advocacy organizations that are mostly uh set up trying to get the FDA to like budge on this. But I don’t think uh, at least to my knowledge, during my research, I didn’t find any uh sort of like corporate teamwork on this. But it would make a lot of sense, like if they if they could just, like get together, especially like the big multinationals, like L’Oréal is a huge company. They could uh get together with a couple of other, you know, an Asian multinational and and put this data together, I think if they if they really wanted to. But I think that they are more I think that the horse they’re betting on in this race is getting the FDA to sort of uh back off a little bit. 

Dr. Abdul El-Sayed: And the irony is that, you know, you would have some increase in arguably that this is this is why we’re even talking about this is you’d have some increase in sunscreen purchase because more people would use it. But I think a lot of these companies say, well, we sell what we sell as it is anyway. So, you know, what’s what’s the point in selling something else? The other question is also whether or not these alternatives are more expensive to manufacture. Is there a reason why, you know, American companies are happy to sell these old fillers. Are they less expensive to make? Do we know? 

Amanda Mull: Some of them are like a little bit more expensive to manufacturer. Some of them are more technologically advanced. I don’t think for uh for most of them, I don’t think there’s a huge difference. 

Dr. Abdul El-Sayed: Hmm. 

Amanda Mull: But I think that what you said is correct. There’s just like a little bit of a level of complacency with like, you know, we’re selling a lot of uh sunscreen in the United States as it is. Um, You know, L’Oréal’s company, La Roche-Posay sells a lot of sunscreen in the United States, partially on the strength of the reputation of its European products. 

Dr. Abdul El-Sayed: Hmm. 

Amanda Mull: And if American consumers are going to keep buying that and like sunscreen, you know, purchase rates are up, people are buying more and more of it. So if you got healthy sales in the United States with like slightly different products or slightly worse products, then, you know, I think that if you’re just a numbers guy at one of these companies looking at this saying, okay, we’re, our sales are fine, um our the marginal increase of our sales is not worth this fight. And ultimately, you know, the people who lose from that are people who need to be wearing good uh state of the art, highly protective sunscreen. 

Dr. Abdul El-Sayed: I uh, not not that um we advocate uh contraband product here at America Dissected but I presume you’ve tried some of these different uh these different products. Are there any that you found um that you really liked? 

Amanda Mull: Yeah, I’ve tried a couple of them, specifically the Bioré one that uh is sold in Japan and that is like pretty widely available um on Amazon from like third party sellers. 

Dr. Abdul El-Sayed: Mmm. 

Amanda Mull: If you look for it. I really love that one. It goes on like like a dream. It’s great. Um, It’s not super expensive. Part of what, sort of, I find galling about all of this is that like in the United States, the quality of products and the sort of elegance of the formulas has gotten better in the last ten years. But that’s mostly because of the other ingredients in sunscreens, and that’s mostly at the very, very top of the market. So, I have a sunscreen from Glossier, that uh which is an American brand, that is that works very similarly to the Bioré one. The Bioré one costs like $11 or $12 even as contraband. Um, The Glossier one costs more than twice that, um for a smaller amount. So– 

Dr. Abdul El-Sayed: Hmm. 

Amanda Mull: You’ve got like more elegant products in the United States than there ever have been, but they’re almost all at the very, very top of the market. So you’ve got rich people who can access the stuff and people who are just going into the drugstore to get something simple just have to deal with stuff that’s not as good. 

Dr. Abdul El-Sayed: Yeah. And given uh what we know about the distribution of wealth in this country. Lower income people tend also to be more likely to be Brown and Black. And we talked about the implications of chalky white sunscreen on Brown and Black skin. Is that the um disincentive for use is higher because it looks real awkward when you kind of come out as like brown and pasty? And people are like, I don’t know what to make of your face right now. At least that’s been my experience when I wear, when I wear sunscreen at the beach. Um, And so it becomes even more of a disincentive to wear it. And oftentimes, given the historical consequences of our policy choices, um a lot of folks are priced out of these markets for sunscreens that are protective, both in the short and long term, uh who tend to be the folks who who who from an aesthetic standpoint need the most. 

Amanda Mull: Right. 

Dr. Abdul El-Sayed: When you think about this situation, how often is a sort of bureaucratic challenge like this uh getting in the way of markets for health kinds of products in ways that we don’t we don’t always see? 

Amanda Mull: You know, it’s hard to say because there are like also opposite very valid critiques of certain types of FDA regulation. Like, I personally wish that the FDA cracked down a lot more on like the supplement industry. 

Dr. Abdul El-Sayed: Mm hmm. 

Amanda Mull: Uh, I think that um there are some areas in which they’re they’re far too passive um and far too uh permissive of what companies uh want to tell consumers and what they want to put in their products. We’ve got like a regulatory regime that does like some things very, very well. And uh and like I said, I think that there are some real advantages to this, sort of uh like very high, uh high standard GRASE certification. 

Dr. Abdul El-Sayed: Mm hmm. 

Amanda Mull: Um that is a real benefit to consumers. But when you look at it and it begins to prevent, like, good new products from from entering the marketplace and from reaching people who could use them, then I think that there’s probably a reason to retool some of that structure, but not necessarily retool the um the sort of significant burden that companies have to meet in order to make claims about their products. Um, but in this situation, I just think that we have set a structure that does not allow people to meet that burden, even though there’s good evidence and there is probably like a middle ground between this and between what we let like supplement manufacturers get away with that would be uh of a major benefit to U.S. consumers overall. 

Dr. Abdul El-Sayed: Yeah, I really appreciate that point because a lot of folks don’t appreciate that the vitamins that they take every day or other supplements, that those are not regulated by the FDA. And you are ingesting those. Those are all going inside your body, not just on the outside of your body. And um and yet we have this situation where uh we have um sunscreen, which is of known benefit, demonstrated benefit against both short and long term outcomes uh that is regulated in this particular way. And, you know, the the the cost benefit uh in terms of sunscreen is is really quite high. I mean, I really appreciate you um taking the time to educate us about sunscreen and uh and to share uh what you learned about the kinds of sunscreens that are on offer here in the United States versus abroad, and um some of the bureaucratic uh obstacles to getting that done. And I hope that um, you know, that folks, good folks who listen to this, whether at the FDA or elsewhere, think a little bit about trying to address this problem um so that folks are more likely to use sunscreen that they need. And we can do something about our skin cancer epidemic in this country. Our guest today was Amanda Mull. She is a staff writer at The Atlantic. And you can check out her most recent work on sunscreen. Amanda, thank you again. 

Amanda Mull: Thank you for having me. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. Monkeypox cases are skyrocketing around the country, reaching 6600 known cases across the U.S. That’s prompted the Biden administration to declare a public health emergency around monkeypox. In addition, the White House has named a monkeypox coordinator in Robert Fenton, a regional FEMA administrator, and he’ll be supported by Dr. Demetre Daskalakis who runs HIV AIDS Prevention at the CDC. I think this is the right step, considering just how shambolic the monkeypox response has been to this point. It’s been hampered by a lack of communication, coordination, and urgency. Here’s New York City health commissioner and our former guest, Dr. Ashwin Vasan, on what a federal state emergency can do:

[clip of Dr. Ashwin Vasan] The federal declaration of a public health emergency is much welcomed because it allows us to pull down much needed resources to mount the kind of fast, efficient, equitable, and effective public health response that people have come to expect of us. 

Dr. Abdul El-Sayed, narrating: My hope is that they can finally take on some of the admittedly shambolic response that has existed for some time. Recent reporting from The New York Times found that though the U.S. currently owns about 16.5 million doses, they are currently frozen in plastic bags outside Copenhagen at the facility of a manufacturer called Bavarian Nordic. And that’s because sloppiness among federal administrators, orders weren’t placed until well after other countries had placed theirs, meaning the highly technical process of putting those doses in vials has been delayed. This comes after administrators let 20 million doses in the national stockpile expire. Right now, the federal government is distributing about 1.1 million doses, but most public health officials believe that that’s about a third as many as we need. Even the distribution has been questionable, according to a senior public health official I spoke to, the CDC is allocating vaccines based on HIV burden, given that the two diseases are more likely to infect the same community of what public health officials call men who have sex with men. But this is a new disease, whereas HIV has been around for decades. New diseases tend to start in big cities, like the ones currently hit hardest by monkeypox. Like New York City, before they penetrate inwards. And yet this approach, well, it leaves those cities without the doses that they need to stop them from penetrating. It’s like the CDC is already planning for it to penetrate rather than trying to nip it off in the bud. All of this, well, it highlights just how critical it is that the administration gets its act together. Appointing coordinators and calling a state of emergency should sharpen the response, facilitating more streamlined testing and tracing processes, improving vaccine distribution, and expanding outreach efforts. 

[clip of unnamed newscaster] Resounding victory for abortion rights advocates and a potential warning sign for Republicans in the deep red state of Kansas. 

Dr. Abdul El-Sayed, narrating: Voters in Kansas overwhelmingly rejected a ballot measure to eliminate the right to a safe, legal abortion in their state. This is a big effing deal, particularly considering the history of anti-abortion extremism in the state. In 1991, an extremist organization called Operation Rescue blockaded three abortion clinics in Wichita. The same city in 2009, an extremist shot and killed an abortion provider while he was ushering at his church. But voters understand the difference between opposing abortion and opposing the right to an abortion. And by an 18 point margin, they preserve the right to an abortion, the right to choose. One county, Leavenworth, supported Trump by 59%, then rejected this referendum by the same exact margin. All of that suggests that even in deep red states, the fall of Roe is extremely unpopular and that Americans have come to understand that abortion well, it’s health care. For their part, the administration issued another executive order last week. While Biden is hitting the right notes, the executive order well leaves a little to be desired. It calls for more study on what the federal government can do to protect abortion rights. It remains far short of the declaration of emergency or clearing the way to provide safe legal abortions on federal lands that activists and organizers are demanding. But that doesn’t mean that the administration didn’t get some wins last week. 

[clip of Vice President Kamala Harris] And the bill, as amended, is passed. 

Dr. Abdul El-Sayed, narrating: In a marathon session, the Senate passed the Inflation Reduction Act, the climate tax and prescription drug bill that Senator Manchin finally got on board with a few weeks back. First, this also is a big deal between the nearly $400 million dollars it spends on climate to the corporate minimum tax it establishes to, yes, finally allowing Medicare, the country’s biggest health insurer for people over 65 and with some disabilities, to negotiate prescription drugs. That well, that should reduce prescription drug prices for millions of seniors. It’ll also cap out-of-pocket insulin costs at $35 a month for them. Finally, the bill extends ACA subsidies created during the pandemic through 2025 that 13 million Americans rely upon. The bill will move to the House, where it’s expected to pass later this week and move on to President Biden for a signature. That’s it for today. On your way out. Don’t forget, please rate and review the show. It really does go a long way. Also, if you love the show and want to rep us [?] will drop by the Crooked store for some America Dissected merch. We’ve got our logo mugs and T-shirts. Our Science Always Wins sweatshirts and dad caps are available on sale. And our Safe and Effective Tees are on sale for $20 off while supplies last. [music break]

Dr. Abdul El-Sayed, narrating: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Tara Terpstra. Veronica Simonetti mixes and masters the show. Production support from Ari Schwartz, Inez Maza, and Ella Price. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez, and me, Dr. Abdul El-Sayed. Your host. Thanks for listening.