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Because of an accident of history, we think of our teeth as being wholly separate from the rest of our bodies. They even have different doctors. But teeth really are the entryway to the body, and the state of oral health in America says a lot about our inequities in general. Abdul talks to Mary Otto, journalist and author of Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America. Abdul also offers his perspective on the current COVID-19 surge and the new Omicron variant.

Transcript

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Dr. Abdul El-Sayed: Omicron, a new variant of concern that could be more transmissible than Delta has emerged in South Africa and has been identified in at least 12 countries. Meanwhile, COVID-19 is surging in much of the Midwest as Americans emerge from the Thanksgiving holiday. A federal jury held three of the country’s largest retail pharmacy chains, CVS, Walgreens and Walmart, culpable in the nation’s opioid epidemic. This is America Dissected. I’m your host, Dr. Abdul El-Sayed.

Look, I always wanted to be a doctor. OK, maybe not always. When I was really young, I actually wanted to be a dentist. When you’re a healthy kid, like I was privileged enough to be, trips to the doctor are, well, uneventful. They listen to your lungs, tap your knees and then tell you to lose some weight. Or at least they told me to lose some weight. Sometimes they give you a shot or two, which—don’t tell anyone—I used to resist with all my might. I am not a vaccine resister anymore! But I still don’t like the sight of a needle in my arm. But the dentist? That’s where the action was. They had all these cool contraptions to make my teeth healthier. They’d give my teeth a whole cleaning, leaving my mouth tasting like bubble gum. Every once in a while, I’d have to get a cavity filled. It wasn’t great and it did involve some shots, but I couldn’t see the needle, and at least I felt like something was really happening. I always felt better for having gone to the dentist, and I wanted to do that for other people. But the fact that I even got to go to the dentist was itself an incredible privilege. For millions of kids, a trip to the dentist is a privilege they go without, by circumstance of wealth, access, or insurance. Meanwhile, some people pay millions for just the right smile. Lo and behold, I am not a dentist. And if you ask Twitter some days, I’m not even a doctor. But I am a public health nerd. So today I wanted to understand what teeth can teach us about American health care and health inequities. To begin, it’s kind of absurd that there are two completely different graduate programs for caring for teeth and caring for the rest of the body. It’s part of a broader trend in health care, where we pretend like the head isn’t actually part of the body, that mental health, dental health, and vision or hearing, aren’t actually part of your overall well-being. It’s as if we decapitate the body in our health care system. And when you decapitate anything, it usually doesn’t live very long. Hah! Twitter, I know enough to know that. It’s yet another broken piece of our health care system, but the system’s consequences of that decapitation are profound. We’re still having a debate over whether or not we should provide seniors with dental benefits. Meanwhile, despite support for children’s dental services through Medicaid, the reimbursements are so low that it’s rare to find dentists that even accept it. That leaves millions of children and their teeth out in the cold. Our guest today has been thinking about teeth for decades as a health care journalist. Mary Otto is an independent journalist and author of the book “Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America.” She joined me to talk about what teeth can teach us about health in America, after the break.

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Mary Otto: OK, here we go. It’s on, should be working.

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

Mary Otto: Sure, absolutely. My name is Mary Otto and I’m an independent journalist based in Washington, D.C., and write about health care and social issues.

Dr. Abdul El-Sayed, narrating: Mary Otto has covered health and social policy for years, writing for The Washington Post and now the American Association of Health Journalists, where she serves as the oral health topic leader. In 2017, she wrote “Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America”, which went on to become an NPR best book.

Dr. Abdul El-Sayed: So I have to jump in first of all, and just ask, when I was a kid I used have this fascination with teeth and I actually started out wanting to be a dentist and I didn’t quite make it there, ended up studying medicine, but I always thought that the dentists really, you know, I could appreciate the value of the health care that I got when I went to the dentist office, right? As a child, going to a pediatrician’s office, you don’t really know what they’re actually doing. They ask you a series of questions, they tap on your knee and that’s that, right? And then you leave with a shot. Whereas at the dentist, I was like, Man, I’m getting a full workup here, there’s like a lot of things happening. I can’t quite see it, but I can hear it and I can feel it. And so I always felt like I got, I got my money’s worth at the dentist, so to speak. But I was one of the only people I knew who had such a fascination with the teeth. And I feel like I found a kindred spirit. Can you tell me how you got interested in teeth to the point where you decided to write a book called Teeth?

Mary Otto: Thank you so much. Yeah. Well, actually, it was a sad story. Tragic, actually. I was working at The Washington Post covering social issues back in 2007, and I was standing at this hospital bedside of a 12-year old boy named Diamanti Driver. And it turned out he was dying of complications from tooth decay. You know which you think is such a simple thing? You know, when you were a little boy, you just mentioned going to the dentist, having the dentist help you and care for you. Well, not all children get into the dentist I would learn as I started to understand what happened to Diamanti. Doctors told his mom that bacteria from an abscess tooth had spread to his brain. And he was, after, you know, his mom had taken him to a community hospital, he had a headache and an infection, and they realized that this had, this abscess had turned into a systemic crisis. So he was rushed to Children’s Hospital where I met him and he had, you know, $250,000 worth of care, a couple of brain surgeries, all kinds of heroic procedures were used to try to save him from what could have been just a routine visit to a dentist. But it turned out that was care that Diamanti and his brothers hadn’t received growing up in this affluent state of Maryland, not too far from the U.S. Capitol, but in a pocket of, you know, poverty and a pocket where there was a shortage of care for Medicaid children. And it turned out hundreds of thousands of Medicaid kids across Maryland weren’t getting that routine care. And across the country, millions of Medicaid children weren’t getting this dental care, which is, they’re entitled to under the Medicaid law. But there was a shortage of providers, particularly in poor and minority communities like where Diamanti was living and in rural places—just extreme barriers to getting those routine visits that you enjoyed as a child, and so many of us did, that could have prevented this tragic death.

Dr. Abdul El-Sayed: Yeah, you talk about that, that awful case in the book. And you talk about in the context of this fact that we don’t adequately provide dental care to people across this country, be it because of poverty or geographic disparities in access to dental care, or the fractured nature of our health care system. And I want to get into a lot of those, but really at core here, it’s like we decapitate the body when we talk about health care, right? We cut off all of the kinds of services that we offer in the head, whether it’s mental health care, or dental health care, or vision care, or hearing care. And when that happens, it’s really detrimental to our provision of health care more generally, because of course, there’s not like the head is not part of the body. In fact, if you decapitate a body, you’ve destroyed the body and the head. And I want to ask you, I mean, where did we get along doing that in health care? Why is it that there’s a different kind of doctor who provides care for the mouth than the rest of the body?

Mary Otto: That was the question I was asking to myself too. And I [unclear] but I found the answer like, just about 30 miles from where Diamante lived his life, in Baltimore. And it turned out that in 1840, there is this event that’s remembered in the annals of dental and medical history as the “Historic Rebuff” and in that year, it was an interesting time in medicine. Specialties were growing up, different kinds of devices were being invented to examine different parts of the body, and medicine was in this interesting [unclear] place, you know, of growing specialization and scientific methods. And it turns out these two serious—but at that time dentists were informally trained under this kind of preceptorship system that kind of dated back to the Middle Ages. You know, the apprenticeship systems, you know, the dentist, if somebody wanted to be a dentist, would apprentice himself—usually himself—to a experienced provider and obtain whatever skills that provider could pass along. And a lot of extractions, you know, in those days, some kinds of painkilling, palliative kinds of patent medicines were developed, but mostly extractions and some restorations. But anyway, these two men who were self-educated and trained under that old system Horace Hayden and Chapin Harris, decided you know, they’d seen death like Diamanti’s, you see before antibiotics, those septic deaths were unfortunately common. And they realized that dentistry was an important facet of health care, and they had also imported books from Europe and understood that there was more going on with dental science in other parts of the world than was currently being examined in the United States. And they approached the physicians at the Maryland College of Medicine and asked if they might institute a dental course within the medical school. And as the story goes, the physicians sent them away with this admonition that study of dentistry was of little consequence. But these two gentlemen were very serious, and they decided to set up their own dental school. And it’s remembered to this day as the world’s first college of dentistry. Chapin Harris wrote the college textbook. You know, they use their own anatomical specimens and did their lectures and started kind of encoded a curriculum of other dental schools opened around the country based on that model. Chapin Harris and Horace Hayden that same year also instituted a dental professional society and a peer-reviewed dental journal to exchange scientific information. And so this discipline of dentistry, the profession of dentistry, traces its birth back to 1840 and those events. But a whole separate system of care sort of evolved from that educational system and that professional, you know, that professional system, they grew up from those events. Even today, we as patients seek our care often in separate places than our medical care. Our medical and dental records are kept separately, often using different coding languages, and our care is financed separately. Our federal government treats our care separately and so do our insurance providers, usually. So there’s this, like you said, our heads are attached to our bodies, but our medical, our health care system just doesn’t reflect that basic fact.

Dr. Abdul El-Sayed: This rebuff and once again, you have another fundamental issue with our health care system that really starts with doctors feeling like they are, they are better than than the people they treat or other folks who work on issues that they don’t include in their practice. And, you know, part of where that traces, right, and where these two things come together again is, as you mentioned, the payment system. And you have a system of insurance that develops around providing medical care, but of course, if you don’t consider dentistry as part of medical care, then there’s going to be a completely different pathway by which insurance for dental care moves. Can you walk us through some of the decisions around thinking about that? I mean, one debate that we’re having right now is whether or not dental care should be included in Medicare coverage, right, a decision that was made back in the ’60s when Medicare was passed. How has the sort of bifurcation, the Great Rebuff, ended up shaping the differences in access to medical care versus dental care?

Mary Otto: Well, it’s interesting. Yeah, you’re right, the conversation around including dental care in Medicare is, has been going on, you know, it’s come to the surface, it’s one of those conversations that’s been going on for decades. And it has moments where it comes up, you know, just like so many important issues something comes to a head, you know, and it has its moment again. It’s a question that is so important because oral health has consequences for our overall health throughout our lifetimes. And on a biological level, we depend upon our teeth. You know, for simple things like eating and speaking and our, and functioning in society. We’re judged by our teeth in funny ways that we might not be judged for other health status issues. It’s odd, but it sort of reflects back on the idea that dental care has been considered kind of a fringe benefit over the years. But more successful people have access to care. People who have more challenges often don’t. So people with poor oral health are stigmatized, and it has a way of kind of fulfilling that cycle of disenfranchisement. If you’re missing a tooth, you may be passed over for a job, you may not be able to advance socially in the way that someone with the perfect American smile can. For seniors, it’s important because we’re managing thanks to, you know, the access to care that we do have and water fluoridation and other public health measures that we are holding on to our teeth into our retirement years, but we often lose our dental benefits when we retire, those of us who are lucky enough to have dental benefits through our workplaces. And currently 50 million of us Americans depend upon Medicare for a whole host of important life-saving, health-saving benefits under Medicare. But Medicare has never included dental benefits. It was opposed, you know, at the time by the organized dentistry, you know, dental—there’s always been this tension between what we have is a private practice, fee-for-service system that offers dental care. Providers tend to think of themselves not only as health care providers, but as small business people. And there’s this tension between private practitioners and public health goals. I’m sure you’ve seen it in other facets of health care that you, that you cover. So there was this pushback against government, you know, regulations that might come, benefits that might not be high enough for the providers to accept, and that tension has arisen again in the current climate. The American Dental Association has urged its members to push back against the dental benefit in Part B of Medicare that’s being considered and is supporting a smaller plan aimed at serving lower-income beneficiaries. But the public health leaders and oral health advocates and elder advocates who’ve been working to get dental included in Medicare over the years see this as an emblematic struggle to provide whole patient care, you know, part of that larger picture.

Dr. Abdul El-Sayed, narrating: We’ll be back with more with Mary Otto after this break.

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Dr. Abdul El-Sayed, narrating: We’re back with more of my conversation with Mary Otto.

Dr. Abdul El-Sayed: It is a really important microcosm for a broader debate that we’ve had in our society for a really long time about the provision of care generally. This mirrors debates about the provision of universal health insurance in our country and about whether or not health care writ large is a public good or a private benefit. And unfortunately, in our country for too long, we’ve always assented to this idea that it is a private benefit, largely because the beneficiaries of the private benefit, right, the folks who make the most money off of the system want to keep it that way. And part of what happened, health care mirrors this issue, is that you end up having dental care included in Medicaid—which is the government health care program funded by the federal government operated by state governments—you have it included in Medicaid and yet, because the reimbursements are so low, the inclusion of the benefit doesn’t necessarily mean that you’re going to get dental care access to low-income folks in urban communities or low-income folks in rural communities. Can you speak to what that then means for the kind of disparities in oral care that we saw? The story that you shared about Diamanti was is emblematic of that, but what are the broader consequences of our failure to provide dental care for the lowest income Americans?

Mary Otto: Well, we were talking about it a little bit just now. The social stigma, the loss of functionality. Oh! Another important point to make about Medicaid, which covers, you know, tens of millions of lower-income Americans, and has expanded under the Affordable Care Act, children are entitled to dental benefits, a full range of dental benefits under Medicaid. But for adults, it’s left up to the state to determine whether they cover dental benefits and to the extent they cover dental benefits. So there’s kind of a patchwork of dental benefits for adults over our country. And unfortunately, because they are considered an optional part of the system, they tend to be among the first things that states cut during times of financial austerity, just when people need this type of care the most, you know? So they’re irregular, as well as being sort of considered a benefit for the poor. A minority of dentists participate in Medicaid, so there is a shortage of providers. There’s some interesting workforce innovations going on, kind of a push in some states to begin training mid-level providers—some people compare them to the nurse practitioners and physicians assistants in the medical world—to work as part of dentist-headed teams and go out into communities and public health settings to just expand the reach of care to these populations who need dental care but may not have a dentist nearby, you know? But that’s another controversial thing that it’s continued tension between professional autonomy and the marketplace for services, and public health needs. But in the meantime, hundreds of thousands of Americans each year show up in emergency rooms with these untreated dental infections and other a traumatic problems that can’t really be resolved in an emergency room, yet they don’t have a dental home to go to. You know, seniors suffer poor nutrition and isolation due to their, you know, unmet dental needs. And of course, children struggle in school. Working folks have trouble sleeping and functioning because of the pain. It’s a tough situation.

Dr. Abdul El-Sayed: One of the things that you really get to and really capture in your book is that teeth really are the gateway to the rest of the body. And not only are they so important in our function, i.e. the fact that they just don’t cause you pain so you can sleep, but then also your ability to chew and your ability to speak—but then they’re also such a marker of privilege and social class. And the ability for someone who wants to get a job in any sort of client-facing role is somewhat related to their ability to present a particular face and that starts with the teeth. You cover in the book the advent and frankly, the continued boom of cosmetic dentistry. Can you talk about how that that industry has grown and what’s fueling it?

Mary Otto: That’s, again, it’s so interesting to look at the history, you know? I, you know, like even Chapin Harris back in 1840, he was, you know, obviously a serious clinical dentist, but he was also an admirer of teeth. Just like teeth are beautiful, you know, and when you look at them, they’re a wonderful, you know, aspect of our faces. He called, he credited them with giving beauty and symmetry to the face. It was also in that very same year I found out the first U.S. patent was awarded for a camera, and it was awarded to a dentist named Alexander Walcott. And the photographic negative was invented that year, too. And photographs, they held up a new kind of mirror to, you know, to us. And the mass production of photographs created new standards of beauty and kind of standardized people’s expectation of beauty. And then motion pictures, you know, they came along, you know, later in that century and early in the 20th century, helped kindle this obsession with the smile. You know, and when people started talking in the movies in the, you know, depression era—Charles Pincus, this dentist who just started a dental practice in Hollywood and he was like, probably on the brink of, you know, financial ruin, he went to the movies and he looked up on the silver screen and these are these new movie stars who had, they didn’t have the best teeth. You know, they were like, what, we would wouldn’t consider their smiles Hollywood smiles today. And he invented these little snap-on veneers—he called them Hollywood veneers—that and the movie stars wanted them. You know, Shirley Temple turned out to be one of his clients, and, you know, we never saw her lose her baby teeth. You know, she had this perfect set a little pearly whites, you know, throughout her childhood and adolescence, thanks to Dr. Pincus. But anyway, it was kind of an illusion of perfection, but people kind of grasp it. And you can see it in our advertising today. You know, the cosmetic dental boom really took off in the 1980s and ’90s thanks to, you know, these new bonding products and veneers and medical credit cards too, so people can pay for their smiles, you know, on an installment plan more or less. So, you know, even today, you know, brides will go and get her, get their perfect dental, you know, teeth for their wedding albums. And so there’s still that kind of connection between the image and, you know, cosmetic dentistry.

Dr. Abdul El-Sayed: And you can imagine what the rise of almost perpetual imagery, considering the advent of the selfie and Instagram, what that then means for the pressure to have a perfect set of teeth. All of this sort of paints this profound picture of inequity. You have people who are literally dying without basic dental treatment and others who are spending hundreds of thousands of dollars to get the perfect teeth. How do we think about what needs to happen to fix and right-size access to dental care? What are the recommendations as someone who’s covered this space for decades? What do we need to be doing differently to make sure that we have a certain level of equity in access to a great pair, a great set of teeth?

Mary Otto: It’s been estimated that about a third of Americans have experienced significant barriers getting dental care, routine dental care, accessing that separate system that generally provides our dental care in this country, whether it’s through geographical, financial reasons, shortage of providers in their communities—there’s a severe shortage of minority providers. And our system is still geared toward those private practice offices that aren’t found in a lot of the communities where care is needed there. You know, tens of millions of Americans live in what are federally designated as “dental provider shortage areas.” You know, this has been an issue for a long time. In fact, a document I’ve gone back to over and over, over the years that I’ve been trying to understand the issues around this is this 2000 report by U.S. Surgeon General David Satcher. It was called “Oral Health in America.” And Dr. Satcher was not a dentist. He was a physician. He was the surgeon general of the United States. He’s African-American. It’s turned out he’d grown up in the Jim Crow South and in a severe shortage area. He really had never had routine dental care himself as a child. But he reframed dental disease as oral disease, and oral disease as a public health crisis. And in this report, he warned that from cavities to gum disease, oral cancers, there was a silent epidemic of oral disease in America. And he said those who suffer the worst oral health are found among the poor of all ages, with poor children and poor older Americans particularly vulnerable. And his report ended with this call to action, and it was an appeal for increased research, you know, removing barriers to care and raising awareness about oral health—not just among regular people, but, you know, among lawmakers and health care providers who may have never experienced a shortage of care themselves but needed to understand, you know, there’s a silent epidemic going on all around them. And he asked that, and a new kind of American health care system that he said, it meets the oral health needs of all Americans and integrates oral health effectively into overall health, our understanding of it and the way we obtain it and provide it. So that’s still going on. You know, progress has been slow.  But it’s interesting, like there’s signs of progress, at least on some fronts. Like with the Affordable Care Act, there was money in the Affordable Care Act for community health centers and federally-qualified health centers to provide like dental and mental health care in these needy communities that they served, you know, to add them to the menu of primary care that they offer to the people in these places. And they’ve actually made some progress in that regard. They’ve even figured out how to integrate dental and mental health records into people’s medical records. And they’ve done, you know, they do those warm handoffs where maybe somebody comes in for a checkup for some other purpose and they said, Hey, have you ever met our hygienist? She’s in today, she could just say, hi, just say hi to her. And people, if they haven’t had adequate care over the years, they might be afraid, ashamed. Maybe the only time they’ve been to a dentist is for some very painful extraction, you know, in the most, you know, awful circumstances. But to build a relationship with an oral health provider who can, you know, get them into treatment and help them develop a treatment plan and get them into a state of health—it’s been shown that it doesn’t only help the adults in the family, but it helps them get their children into care, and it raises oral health literacy, you know, in communities that need it.

Dr. Abdul El-Sayed: Yeah, I really appreciate that point. So, you know, when I ran the health department in Detroit, one of the pieces of the department that I appreciated most was we ran a dental clinic for children, mainly Medicaid-eligible children. And one of the things I came to appreciate is that there is a almost a self-reinforcing spiral of sorts when people are under cared for, because the only times they get care, they’re getting multiple extractions in a single visit, which means that their association with the dentist visit is a terrible one because it’s really painful. And so they want to avoid dental visits. And you know, the real answer to that is regular ongoing visits that are not as traumatic as having multiple teeth removed, to care for the teeth that you have, which means that the interactions are that much more positive. And you know, I think about my own interactions with the dentist. I wish I could tell you I never had a tooth or a cavity filled. That wasn’t true, but it didn’t happen every time I went to the dentist. And you know, you think about a child coming in and every time they come in, it’s either to get a tooth extracted or a cavity filled, and that’s not a fun way to visit the dentist. And it’s also a reminder that we have in our country a very broken culture of health care generally. And it gets back to this question of what is health care? Is health care something, just another industry that a set of corporations or even small businesses can make money off of? Or is it something that we ought to provide to everybody equitably? And the fact that we’ve answered in the former and not the latter means that too many people in our society go without basic services. And we miss that, right, every day because we don’t necessarily pay attention to it, of course, until it’s disastrous, like a child dying of a preventable tooth infection. And so in some respects, right, so long as we continue to have a system that is as broken and as noncontiguous as the one that we have, where we both divide the teeth from the rest of the body and we differentiate who gets care based on how much money they make based on what insurance they have, we’re going to continue to suffer these disparities and in the lowest income, mainly marginalized, most often Black and brown, American folks are going to suffer the back end of it. Mary, I really appreciate you taking the time to share your your reporting and your book with us. I hope that folks will check it out. It’s called “Teeth” and it’s a remarkably thoughtful look at the ways that teeth interact with so much of society and all of these challenges that we face, and what they tell us both about American inequity and American health care. Mary Otto, thank you so much for taking the time to join us.

Mary Otto: Thank you so much, Abdul. So great to be with you.

Dr. Abdul El-Sayed: It was our privilege.

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. Just as we were settling into that post-Thanksgiving Turkey nap, this news hit us:.

[speaker] In South Africa, scientists identifying a troubling new variant of the virus that is dominating infections here.

[news clip] The new Omicron variant of the coronavirus could be more contagious than previous strains, and it’s probably already in the US.

Dr. Abdul El-Sayed: I know what you’re thinking: Not again, please, not again. Let me offer some perspective here. The new variant, which the WHO named Omicron—which I’ll admit I had no idea how to pronounce before this—emerged in the Gauteng region of South Africa and was first identified among young people. Here’s the bad news: from what we understand, it has several key mutations on its spike protein, which is the piece of the virus that sticks to ourselves, and some of these mutations are similar to Delta and some to Beta, leading scientists to think that it might be more transmissible and also more resistant to vaccines than any variant yet. Toward that end, it’s enriched itself, meaning it’s outcompeted other variants to become a greater proportion of overall infections faster than any variant we’ve yet seen. There’s also evidence of second infections and breakthrough cases in vaccinated individuals. Look, that’s the bad news. So let’s take a deep breath. All of this is circumstantial. We’re still waiting for the science on this. So there’s a lot we don’t know for sure. Vaccine manufacturers are actively testing their vaccine-mediated immune response to Omicron. Here’s the key thing to remember about that: this is still SARS-CoV-2. It’s still the same spike protein. And even if Omicron makes our vaccines less effective, it won’t make them ineffective. Let me repeat that: even if Omicron makes vaccines less effective, it won’t make them ineffective. And here’s some good news, or at least not bad news: there’s some initial indication—though again, circumstantial—that Omicron may cause less severe symptoms than other variants. While this is flimsy, considering the first cases have been among young people who don’t generally have a severe symptoms as seniors, it’d be great news if that held up. In fact, from what we understand about the 1918 flu pandemic, it ended after a more transmissible but less severe variant emerged that suppressed more severe variants because of how efficiently it spread. Though it made a lot more people sick, it didn’t make them as sick. Stopping infections isn’t our only goal after all. It’s stopping severe symptomatic illness and death, which are more important. But it’s going to be a few weeks before the science gives us more answers on all these big questions: the transmissibility, the vaccine escape, and the severity. So let’s not jump to any conclusions just yet. Meanwhile, the U.S. has issued a travel ban for non-citizens from several southern African countries. I’ve got a few issues with this. The first is that Omicron is already in 12 countries and counting. And honestly, as of this taping, while we haven’t yet identified it in the US, chances are that if it’s not here yet, it will be soon. And while travel bans can be an effective tool in COVID containment, this ban is kind of nonsensical. I’m rather sure that Omicron, whatever his other capacities, doesn’t have the capacity to discriminate by passport. Banning non-citizens alone will only assure that citizens hurry on home, possibly bringing the variant home with them. I’m not saying that we should ban citizens, I’m saying that it’s either a full ban or no ban. This partial ban seems more about PR than public health. Oh, and there’s another thing: only about 35% of South Africans are vaccinated. While there is available supply of vaccine in South Africa, that supply was late in coming, giving vaccine disinformation time to spread faster than the vaccines themselves. Had there been ample vaccine access earlier, perhaps more folks would have made the right decision before they read that viral disinformation chain post from their cousin’s uncle’s best friend’s former dog owner’s ex-wife. Meanwhile, millions in other countries in southern Africa are going without vaccines because there aren’t any of them. Moderna, for its part, tested its vaccine in southern Africa, where it has donated exactly zero doses. So what does all this mean for you here in the US? Get that booster if you haven’t already. If Omicron does in fact render our vaccines less effective, then you want the most effective protection you can get, and that’s with the third dose. Oh, and don’t forget to mask up, vac up, and wash up. And those things? They can protect you from the most pressing COVID issues you’re facing right now, which is the new surge of Delta cases, particularly in Midwest states like mine. Though the vaccines are holding down the level of hospitalizations and deaths below what you’d expect at this level of cases, hospitals are starting to fill up. Oh, and did I mention you should get your booster if you haven’t already?

In other news, a federal jury in Cleveland found that three major retail pharmacy chains, CVS, Walmart and Walgreens, played a role in perpetuating the opioid epidemic. Their conclusion hinged on a public nuisance argument, meaning that in turning a blind eye to the obvious consequences of the drugs they were handing patients, retail chains were part of perpetuating a public nuisance and should be liable for their actions. The suit, brought by two counties in Ohio, sets a major precedent in holding corporations who profited off the opioid epidemic accountable.

That’s it for today. On our way out, please do rate, review, and share our show. It really does help. And if you’re looking for a great gift for that special science-loving someone or even yourself, I hope you’ll drop by the Crooked store for some America dissected drip. We’ve got our logo mugs and T-shirts, our Science Always Wins T-shirts, sweatshirts, and dad caps. And our Safe and Effective tees.

Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivier Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. The 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.