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Puberty is awkward. But that’s, in part, because we continue to feed the stigma around it. Now, puberty is happening earlier for girls, a trend accelerated by the pandemic. Abdul reflects on what that means for public health. He speaks with Jessica Winter, an editor at the New Yorker, who wrote about this trend to understand why it’s happening and how we can make the experience easier.

TRANSCRIPT

Dr. Abdul El-Sayed, narrating: [music break] Two more major manufacturers of insulin slashed their prices. The best evidence yet about the origins of the pandemic suggests it may have emerged from raccoon dogs in the Wuhan wet market. A new poll of doctors shows that they feel woefully underprepared to treat long COVID. This is America Dissected. I’m your host, Doctor Abdul El-Sayed. [music break] Over the last couple of years, Pediatric endocrinologists have observed an unusual surge in the number of referrals of girls with early puberty. In fact, a recent study found that the number of girls with precocious puberty almost doubled between 2016 and 2021. In this trend, it’s been observed all over the world with similar studies and findings in Turkey, Germany, and South Korea. What’s going on? Why are girls hitting puberty younger and younger? Well, that’s the topic of our episode today. We’ll get into all the causes that have led to this acceleration. Hint we’ll be talking about the pandemic again and all of the ways we can make this experience easier. But before we get to all that, let’s take a step back. I remember watching that quote, “Miracle of Life” video in my seventh grade health class with about 50 other mortified tweens as we watched grainy footage of a child being born. Our science teacher, the stand in health teacher, was one of the coolest teachers in school. Dude looked just like Matthew Broderick, which gave him an easy air with students of the 1990s. Usually collected and self-confident, he just kind of looked at the ground while the video was playing. I mean, I don’t blame the man talking about one of the most awkward topics with a collection of awkward pre-teens going through that awkward phase all at the same time. That can’t be easy, but it’s so profoundly important. Nearly all of us experience puberty and the concomitant changes that come with it in some form or another. But the experience remains so profoundly shrouded by stigma that we really need more straightforward, empowering conversations about it. I’ll be honest, though. I’ve got to check my blind spots on this one. I’m a cis straight dude who was pretty athletic through my childhood. That means I had we’ll call it puberty privilege. That’s not to say that it wasn’t awkward as all get up, but for the most part it meant that over the course of one summer, I could run faster, jump higher, lift more. And my voice turned into this smooth baritone you tune into every week. There was, of course, the awkward management of a whole slew of more vivid emotions. But even if it was awkward, I can’t say it was terrible. There were the you’re a man now speeches from men trying to awkwardly teach me masculine scripts. And sometimes that meant being expected to hide my emotions behind a certain stoicism. That didn’t really change with puberty it’d been there all along. So I had puberty privilege. My version of it didn’t involve newfound monthly bleeding from my genitals. I can’t imagine what my response to that would have been at that age. It also didn’t come with being forced to grow up too soon as people with more physical power than me objectified my body. As so often happens to post pubescent girls who are catcalled or worse, by grown men. And puberty never forced me to contend with my gender identity or sexual orientation, as it does for LGBTQ youth. I got to tell you why I’m so concerned about this, though. It’s precisely because of those blind spots. As a parent, it’s always those aspects of your kids experiences that you understand least that keep you up most at night. You can either pretend like you understand or actually seek to understand. And puberty is one of those things I’m trying to get a jump on, because as you probably know by now, I have two daughters. My girls are still a long way away from this, I hope. But as with all things parenting, parenting has a way of absolutely obliterating time. It feels like just yesterday that my eldest, now five, was born. And, well, given the data, I might not have as much time as I thought I might. 

[clip of unspecified news reporter] New studies are finding that some girls are hitting puberty earlier and earlier. 

[clip of unspecified news reporter 2] During the past few decades, little girls have been going through puberty at a younger age. Studies show every decade it starts around three months earlier. But during the pandemic, the age change was dramatic. 

Dr. Abdul El-Sayed, narrating: Puberty is happening a lot earlier now than it ever has. The pandemic accelerated this trend, and early puberty just makes all the hard parts even harder. It gives parents, teachers, and other caring adults less time to have the necessary conversations. And it forces those conversations with a child that’s less emotionally or cognitively mature. It also exposes the child to the worst of how society treats young women far earlier. All of this should move us to be a lot more proactive about the way we engage the subject of puberty, along with destigmatizing things like periods and protecting women and girls from the objectification that is far too normal in many places. We also have to prepare these kids for the changes in their bodies that they’ll experience. I first learned about this trend toward earlier puberty in girls from an article in The New Yorker, written by our guest today, Jessica Winter. I wanted to invite her on the podcast to share what she learned in her reporting and think with me about everything that ought to change from sex ed to the conversations we have about puberty in our own homes. Here’s my conversation with Jessica Winter. 

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

Jessica Winter: Sure. My name is Jessica Winter, and I work at The New Yorker, where I write about family and early education. 

Dr. Abdul El-Sayed: So I want to ask, you know, what got you um interested in writing about early puberty in girls? 

Jessica Winter: So I had heard kind of anecdotally that this was in the air, that this was more and more of a concern among moms that I knew about their girls. And I had also seen this kind of raft of really sensational seeming headlines that uh they read to the effect of screen time causes puberty [laugh] or, you know, excessive screen time triggers early puberty. And I thought, well, that can’t be true. That sounds strange. So I just started drilling into that a little bit and looking at what these studies were actually saying and how credible it was. And I realized that there is a lot of research out there and that early puberty uh spiking during the pandemic was a real thing. And there’s a growing body of research um showing that it’s happening and hypothesizing about why it’s happening. 

Dr. Abdul El-Sayed: You know, it’s interesting, right, because puberty is something that by definition every adult um goes through some form of. And it’s also one of those life defining events that happens in a relatively awkward part of your life, in part because of the circularity of puberty being awkward and people being awkward about puberty. [laugh] Um. And and so, you know, in particular it ends up being one of these deeply stigmatized experiences that people go through in a particularly vulnerable time of their life. And yet we don’t really do much work to destigmatize it. And obviously, I’ve only ever experienced one type of puberty. And that’s that’s, you know, cis male puberty. Um. And the experience, I can imagine um is very, very different for boys than for girls. For boys, the experience of puberty is, you know, aside from smelling kind of funny and your skin getting weird, it’s kind of great. You go from not being able to run very fast to being able to run a lot faster. You go from not being able to do many push ups or pull ups to being able to do a lot more. Um uh. And, you know, you start experiencing a set of sort of realizations in the world that are themselves, um if awkward, you know, they they open your eyes to a lot of things. Um. And I can imagine uh the reason that that all of this is generally a good experience is because you don’t start bleeding from uh your genitalia. And I can imagine male puberty would be a lot more traumatic if that was the case. And yet for half of this world, um we still don’t do a good job explaining, preparing, engaging people with that. And so we leave, you know, young people in a very vulnerable situation in their lives, um shamed and stigmatized for doing the completely normal thing of going through puberty. Um. Why do you think we allow this to persist, this this awkwardness of this experience? Um. And why haven’t we destigmatized it, taken away the shame from it? Uh. Empowered a conversation through it. And I know there are a lot of great organizations that do it. It’s just, you know, we’re still not there yet. Um. Why do you think that is? 

Jessica Winter: Well, first of all, I had never thought about this in these terms until I heard you articulating it, that when boys go through puberty, they’re becoming what they’re supposed to be. They’re becoming a man stronger, faster, better every day. Right. And I think for a lot of girls, not every girl, but I think for a lot of girls, when they go through puberty, they’re they’re being taken away or that what they were supposed to be or the best version of themselves, I guess, is ending. And it’s something to be mourned. It’s a lost innocence. Right? We never frame it that way with boys. With boys, it’s a triumph. And with girls, it’s if approached in the wrong way, it’s a loss. Um. It’s innocence lost. And I had just never framed it as an either or until I heard you describing it that way. I think that a lot of this is um socially prescribed. Obviously, um when we’re looking at early puberty, maybe 75% or more of of girls whose parents bring them to clinics and say, I think something’s up with with a puberty starting too early. But 75% of those kids are girls and about 25% are boys. And I didn’t report on boys in my piece for The New Yorker, so I can’t really talk with much authority on it. But I can say that experts wonder if early puberty in boys is under-diagnosed. And that’s because it’s not externally visible and it’s not seen as a problem. So early puberty in girls is defined as the development of breast tissue. That’s the first stage of it. The counterpart, the analogous um stage in boys, is that um their testes and their penis start to grow. And a lot of boys don’t really notice that this is happening. They don’t know when it’s supposed to be happening. Their parents don’t notice. And obviously no one can see it happening. For girls, the counterpart is they’re developing breasts and that is obvious to other people. And so it becomes a quote unquote problem when it can be seen. Um. And I think that’s really interesting. That this is a problem for one rather than the other because it’s externally uh legible. Um. I think a lot of the stigma of early development in girls in particular is unfortunately at least ostensibly backed up by research. There are absolutely endless studies of widely varying quality and depth that correlate early puberty with every adverse consequence under the sun. Like an edited list would be obesity, type two diabetes, breast cancer, heart disease, depression, anxiety, body dysmorphia, eating disorders, antisocial behavior, bad grades, substance abuse on and on and on. So in addition to what we were talking about earlier, about the sense of innocence lost, um there is all of this research supposedly out there um tying early puberty to all of these bad outcomes. Um. A lot of these studies are small or they’re based on questionnaires. Um. Some of these outcomes, like the percentage of risk, is very, very small when you look at it. Um. And so a lot of it in broad strokes feels really alarmist to me. You know, the the ways that we try to clinically back up the stigma feels a little bit alarmist. And so I think that the most useful takeaway from this particular body of literature about all the bad outcomes of early puberty is that a lot of these consequences are contextual. They have to do with the adults and the peers in this girl’s life. There is nothing innate in the mechanism of early puberty that makes the kid, you know, break bad or something. Like a good example is depression. There is a strong causal relationship established in research that girls who go through puberty earlier are at a higher risk for clinical depression. And so I think a parent is completely within their rights to worry that their early developing girl is going to be depressed. But we don’t know why that is right? Is it because of the effects of estrogen on the developing brain, or is it because early puberty is really stressful and kind of sorrowful and in some cases, and that that sadness and stress triggered something in a young girl? You know, we we just don’t know. Um. But I think it’s it’s one more reason that we have to work as as parents, as educators, as a society to destigmatize early puberty and girls and puberty in general. [music break]

[AD BREAK] 

Dr. Abdul El-Sayed: I um I really appreciate that. You know, it’s it’s interesting. When I was when I heard you feed back to me um your perspective on what I had shared. You know, as we think about puberty, it really is it is the most potent moment when we gender someone, right. Because it is the onset of a um an adult form of of gender. Right. And um a more sexualized form of gender. Uh. And, you know, the the degree to which the connotation of gender stereotypes and that this notion that you talked about of like arrival versus departure, um the degree to which that shapes the way you think about um the future, I think is quite profound. Um. You know, and the other part of it is, is, you know, we can’t disentangle this from the notion that, you know, for a lot of people their experience of um of puberty is is not the normative one that we ascribe to two genders. Right. And you can imagine how much more complex it is uh for a child who identifies as non-binary or trans that this moment of this change in biology um takes on, you know, even a different meaning than the ones that have been socially ascribed firmly within the median of of two genders. And then there’s the interaction right across the two. Um. And I, you know, I think about this, I have two daughters and um you know my daughters are very young, five and uh and six weeks. [laugh] Um. But it’s one of those things like as I think about preparing myself as a parent, you know, there are the things that you think you understand about your child’s experience. And then there are the things you know you don’t understand, recognizing that you probably don’t understand much of it simply because, you know, 30 years is a long time between between two shared experiences and the world changes. So, you know, even if your child was a carbon copy of you um growing up 30 years later, their experiences are going to be different than yours. But but this one around, you know, thinking about gender stereotypes and the ways that those change across a life course is one that I’ve really tried to be very cognizant of, um you know, just already in the in the, you know, the compliments or the criticisms that um my older daughter will get. Uh. And you start to think, well, you know, when people say, oh, she’s beautiful, I shudder a little bit, right? Because what are we setting her up to think about herself and the value that she adds? And then how does that change when you know the nature of what is, quote, “beautiful,” um goes from what you expect in a five year old girl uh to what you expect in a 15 or 25 year old woman. Um. And, you know, I think in this case, I can trying to be empathic about it. I can imagine somebody who was going through puberty at nine or ten for whom the conversation about what they are and who they are, um you know, the connotation implied in she’s beautiful changes. Um. I can imagine that to be extremely jarring um and extremely challenging. And I think as a boy, right, there’s never, you know, the kind of the kind of um compliments that you associate traditionally with a boy. Oh, you’re so strong. You’re you’re so brave. Right. Um. Those don’t take on a different connotation pre and post puberty. Right. And in some respects, you’re only more so. Right. And there’s not a um there’s not an objectified sort of version of that in the same way as as you can imagine, for uh for a girl. And then not to mention all of the complexity that that must be experienced by people who don’t identify firmly um in either male or female. And so um I want to sort of jump to just the statistics here. What is the average age of thelarche today and how has that changed? 

Jessica Winter: So our understanding for a long time was that the development of breast tissue happened typically around age 11 and that menstruation began maybe around 13 or so. And the understanding of that schedule came from a long term study that was conducted um from the 1940s until the beginning of the 1970s in England. It was the famous Tanner study. That was what established our understanding of the schedule and it really it still drives our understanding of the schedule today. That understanding, at least in the U.S., began to change in the late nineties, early 2000s when pediatricians started seeing younger and younger girls coming in, having either entered thelarche, the development of breast tissue or menarche, menstruation. Um. By the late 1990s, close to one in five white girls, for example, were entering puberty early, meaning before the age of eight they were developing breast tissue and something like 40 or 45% of Black girls were, for example. And there were a lot of hypotheses about why this was the case and and we can get into that. Um. Nowadays, I believe the average for white and Asian girls is around ten. And for Black girls, it’s around nine. And for Hispanic girls, it’s in between. I think that there’s there’s a fair amount of variance and noise in various studies, but that’s about where we are now. 

Dr. Abdul El-Sayed: I want to get to the pandemic experience in a second, but what were the hypotheses about why there had been a [mouth click] a slow, steady movement upward in the life course? 

Jessica Winter: So there were a lot of hypotheses about this, and they eventually coalesced around three factors. Um. They were BMI, body mass index, uh EDCs, endocrine disrupting chemicals and stress. So we can take those one by one, I guess, in reverse order. So stress, stress results in higher cortisol levels. And cortisol may prematurely activate the pituitary gland and the adrenal gland and get everything going for puberty. 

Dr. Abdul El-Sayed: Just to make sure I understand. So the idea here is that when you have external stressors, your body’s response is, is cortisol uh secretion, which mediates the long term stress response, and that having cortisol on board activates um the hormone centers in the body that then activate puberty. 

Jessica Winter: Absolutely right. The pituitary gland starts secreting gonadotropins in girls. Gonadotropins cause the ovaries to grow and produce estrogen. Estrogen triggers the development of secondary sex characteristics and so forth. 

Dr. Abdul El-Sayed: And one of the things I want people to understand who are listening is that, you know, we often think about hormone centers as being, you know, ovaries or testes, but all of that is mediated centrally in the brain, actually in the hypothalamus. And so, you know, when we talk about the brain body axis, um it is absolutely real. And folks, you know, should understand that. So. 

Jessica Winter: Yeah, and it’s realer than real in early puberty, you know, this is a really good example of how to illustrate that idea. Definitely. So one of the factors was stress. Um. A second factor was EDCs. So these are things like parabens, the preservatives that are used in cosmetics and food and pharmaceuticals, phthalates, which in our plastics and these, as I’m sure your listeners know, scramble the body’s naturally occurring hormones, they possibly confuse the endocrine system in ways that again could contribute to the onset of puberty because of the relationship with uh estrogen. It’s really difficult to study this um because we are swimming in these chemicals all the time. We metabolize them at different times, and at different paces. It’s almost impossible to design a controlled experiment to parse out these effects, but we know that the effects are there. 

Dr. Abdul El-Sayed: And just so um for folks to understand, for us to be able to actually um causally interpret the impact of this, you have to have a contrast group. And because these things are so ubiquitous, you can’t actually generate a contrast of people who’ve never been exposed to parabens or other plastics. It’s just it’s just part of what we live in. And so this very well might be the case and you might be able to say, well, look, there’s this um long term change as we’ve used more and more of these, but that just gets us to the problem, we call it endogeneity. It’s like this is the problem we’re describing. So we really don’t have a contrast group to be able to get a study that shows us definitively a causal effect. And, you know, it sounds really technical in terms of uh what we’re trying to explain, but it keeps us from being able to infer uh the impact at all, even if we think this very well might be it. 

Jessica Winter: Exactly. We can’t escape what we need to compare to another thing. [laugh] Exactly. Um. So there’s EDCs, there’s stress, and then there’s BMI. And the correlation between BMI and early puberty has to do with a hormone called leptin. Leptin is one of the triggers for the pituitary gland to begin producing those gonadotropins. Leptin is produced in the fat tissue, and it raises the body’s estrogen levels. So typically, as estrogen increases, so does fat and so does leptin, and it creates a feedback loop. Weight gain spurs puberty, puberty spurs weight gain. And indeed, a lot of the pediatricians in the nineties and 2000s who were seeing these girls entering early puberty, these girls had BMIs often um above the average. 

Dr. Abdul El-Sayed: And so the pandemic sort of created this one moment in time that helped us to understand a little bit more, because where early puberty had been um creeping backwards in in a life earlier before the pandemic, all of a sudden during the pandemic, we saw this, you know, greatly backward almost um in uh in puberty time. Can you tell us what we saw, what we observed during the pandemic? And then how did scientists use that to better understand early puberty? 

Jessica Winter: Right. So the first signs of this were just referrals to clinics. There were clinics all over the world. It was a global phenomenon that we’re seeing doublings, even triplings of referrals to pediatric endocrinologists for suspected early puberty. There were early studies out of Turkey, Israel, Italy, uh South Korea, India, um as well as in the US. Um. And this was particularly striking because these kids were coming in during pandemic times when a lot of families were maybe setting aside what they might have seen as non-urgent medical care and they were bringing their kids in because they were really concerned. We don’t have exact numbers on how much the average age has dropped. What we do know is that there was this just ocean of referrals. And when researchers started trying to hypothesize about this spike, they could obviously they could extrapolate pretty easily from those three factors that we just discussed and kind of mapped them on to the pandemic. So of the three, EDCs are probably the most indeterminate, but we can guess that maybe kids were eating more processed foods, they have less access to fresh foods, and maybe as a result, their EDC exposure was up. Maybe, who knows? Stress and BMI, I think, are more suggestive. Kids were definitely under intensified stress during the lockdown months of the pandemic. Away from their friends, wrangling with online school, uh family members who were sick or lost their jobs. They might have been in crowded home environments. It was a stressful time. So that seems suggestive. BMI is also easy to extrapolate. Kids were more sedentary. They were stuck at home. They were eating for comfort or boredom. Uh. You know, they were sedentary. And even kids who didn’t gain weight may have had relatively more fat tissue due to a more sedentary lifestyle. Um. But the lockdown months of the pandemic also introduced a fourth factor, which may have previously gone somewhat overlooked um for its relationship to puberty, and that’s melatonin. So melatonin, as I’m sure your listeners know, the sleep regulating hormone that the brain produces in response to darkness. So a drop in melatonin is associated with the onset of puberty. That happens when puberty starts it um it activates one of the the many puberty triggers. It’s called kisspeptin. And during the lockdowns, obviously, many kids got less sleep, more irregular sleep. They stayed up later, they got up later, their circadian rhythms were thrown off and they were, in many cases, spending vastly more time in front of the blue light of screens, which inhibited their ability to secrete melatonin. So that gets us back to the very beginning of the podcast. When I was talking about the sensational headlines, there was a germ of truth to them. There is a relationship between melatonin and puberty. It’s just not as easy as like your kid is watching YouTube and then they entered puberty, right? 

Dr. Abdul El-Sayed: So we have this um collective experience of earlier puberty in girls. Um. I want to ask, were there any communities that you know of or parts of the world where they might not have had the same um early puberty? I know you mentioned studies from Turkey and Israel, so it seems like a sort of a worldwide thing. But are there any communities out there where there hasn’t been a uh increase in early puberty? 

Jessica Winter: I don’t know and that may emerge in the years to come that there were certain communities, certain regions of the world, uh you know, certain climates, certain cultures uh where they evaded this and that that would be really exciting to know if there are those outliers out there. But we just don’t know yet. 

Dr. Abdul El-Sayed: Yeah, you know, it’s funny. Now you’ve got my epidemiologist brain flowing. I’m like, all right, what are the contrasts that we can find? Where are they? Who are they? Where in time do they exist? Um uh.

Jessica Winter: I mean, it’s exciting because we’re so early in this. I mean, this just happened a couple of years ago. It’s a micro generation of kids. I mean, we’re basically talking about kids born between roughly 2010 and 2016. I think so much is going to emerge about these kids in the years and the decades to come. I hope there are longitudinal studies going and going out there because I think they have a lot to teach us. 

Dr. Abdul El-Sayed: Yeah. [music break]

[AD BREAK]

Dr. Abdul El-Sayed: This has been a collective experience um in so many ways. And I’m wondering how this ought to inform the conversation that we have about puberty uh with girls? 

Jessica Winter: Yeah. I mean, I don’t know that there is any one programmatic remedy for the stigma of puberty writ large and the stigma in particular of early puberty in girls and um the strain that’s going to be placed on any, you know, seven or eight year old who’s developing breasts or any fifth grader who suddenly dealing with her period or whatever it might be. I do think anecdotally in conversations with parents, I really do think it’s the case that some general pediatricians in general practice could stand to look at their bedside manner when it comes to the kinds of language that they’re using in these discussions with parents and with kids. Um. I’ve heard some stories that are not mine to tell, but that really indicate that pediatricians, not pediatric endocrinologists, but general practice pediatricians, could be more sensitive and thoughtful about their approach to make sure that kids don’t feel objectified and pathologized, because, as we’ve said, there’s nothing necessarily innately, you know, physically risky or physically wrong with puberty if it happens early. Um. You know, the the the bad effects are mostly in how the world responds to that girl and that and her body. Um. And I think that pediatricians can be reassuring to parents and their concerns without being dismissive of them. I also think that there could be more and I obviously I don’t know what shape this would take, but I do wonder if there could be more of an education campaign in pediatricians offices and health classes about what this new normal is, what it looks like, that puberty is happening earlier and it’s okay and that it’s normal. And I honestly think that there’s a case to be made for earlier sex education in classrooms for this very reason. But given the political climate, I know that’s probably a nonstarter. I think, in terms of what parents can do, like individual parents. I do think that there’s a burden on parents of early developing kids. No one wants to be a helicopter parent, but if you have a nine year old who quote unquote, “looks like a 13 year old,” um it’s going to be on you as a parent to be more vigilant that your nine year old, you know, if at all possible, to be more vigilant that your nine year old is hanging out with other nine year olds and doing nine year old stuff and is not hanging out with 13 year olds, and that her social life cleaves to her chronological age and not to, you know, the age that would be estimated on a bone scan. Right. And that’s not to say that 13 year olds are bad. Um. It means that a nine year old just doesn’t have those four extra years of cognitive and social emotional development to be able to make good choices and risk assessments in certain situations. Um. I also think that there should really be more emphasis and more awareness on the phenomenon known as adultification. Adultification is where Black girls and Black boys are perceived as being older than they really are. They are held to a higher behavioral standard. Their actions are more harshly scrutinized. They’re seen as more culpable. And you see this reflected in school discipline trends, suspension rates, and their encounters with the juvenile justice system. Um. There’s a wealth of sociological data backing up adultification as a real thing. And the the risks um and the, you know, the adverse consequences of adultification are compounded in Black girls because Black girls are more likely to enter puberty earlier. So, you know, they’re dealing with adultification and the stigma of early puberty at the same time. Um. And so this is a great concern to Black families and Black girls. And I again, I don’t have a programmatic solution for this, but I think that the word needs to get out that girls who develop early and especially Black girls who develop early, are just generally misperceived by their society in ways that really harm them. 

Dr. Abdul El-Sayed: Hmm. I really appreciate you raising that last point. And um this is a conversation that we as a society have to engage in. And, you know, especially in the setting where we’re talking about um boys but but even girls, this can be deadly, right? When law enforcement perceives a Black boy um as an adult and uh treats him as such and ascribes to him a level of power and capacity that he may not have as a boy, um that can lead to deadly situations. And you know, the broader point about the racial inequity in early puberty and in the consequences and the objectification that comes with early puberty, and about the way the narrative that society tells you about who you are uh and and you know what your um role is. Uh. I think cannot be uh overstated. There are a couple of things that you think about as well. Um. The way we do sex ed um itself, is a just you know, I shudder to remember my own sex ed experience because it was just super awkward. And um and I think there are, you know, better ways, more thoughtful ways of doing it. And what keeps us from doing it is the stigma and the shame and the awkwardness of it in the first place. And I know that there are some great um uh sex ed teachers out there who really spend a lot of time thinking about how to have this conversation. Um. But, you know, I think there are just modes of learning and teaching nowadays that could potentially make this a bit less of an awkward experience. Um. The other part of it is, you know, getting to the question of menstruation and um and the challenge of period poverty and now you’re talking about uh a 11 year old maybe in the fifth grade um who who needs period products that may not be readily available. And if they do need them, then they’re very stigmatized and um they’re the kind of thing that they don’t want to be caught dead with. And that just creates a really untenable situation for everyone involved. And I think normalizing access to period products any and everywhere um for anyone who needs them uh can be a really important thing um that we do. The final point that I really appreciated you bringing up is the fact that as parents um when you choose not to talk about a thing, you are making an argument. And your child is going to impute that argument even if you don’t explicitly come out and make it. And I think sometimes we forget about that, um that when you say nothing at all, you are saying something. And in choosing to say nothing at all, uh the message you’re sending may be difficult. Now, a lot of times it’s easier to say nothing at all because of the the pain, the discomfort, um the the challenge of knowing what to say. But I do think it’s incumbent on uh all of us, um you know, as adults with kids in our lives, whether you’re a parent or or elsewise, uh to be thoughtful about what you do say and how you do say it, and to be thinking ahead about what you will say. I [laugh] you know, talk to a lot of uh friends who are, you know, with with children a bit older than mine or similar ages. And, you know, there are topics of conversation, they’re like, oh, that’s not a conversation I’m looking forward to having. And if you ever have that experience, then you damn well better spend some time thinking about what you’re going to say and preparing for that conversation, because most of the time you’re going to have to have it. And it’s better that it doesn’t get strung up on you, but that you are prepared to have a challenging conversation. Those are the conversations that, you know, kids remember, I think a lot about, you know, some of these seminal conversations you have with parents or you have with teachers or you have with um siblings, and they’re almost always more impactful for the younger participant. Right? They remember every word, uh even if for you, you know, it might might just be another conversation. I remember, you know, I have several younger siblings and, um you know, they’ll bring up, do you remember when you had this conversation with me? I was like, no, I don’t. I don’t but like well here’s what you said. Um. And I can only imagine that with your children, it’s that much more impactful because I remember the conversations with my parents. Um. I really appreciate you sharing your reporting with us. Um uh I want to ask, you know, as we leave this conversation, if you were to be able to go back and talk to those parents um who got you to think about this uh and brought it to your attention, what would you want to say to them now? I figure you probably wrote it out, but, you know, just in your in your uh in your daily life as uh as Jessica, not not, you know, Jessica Winter, um editor at The New Yorker, what would you want to have been able to say uh in those conversations to them? 

Jessica Winter: Well, I mean, I have said it to some of them. You know, I’ve shared my research and I’ve shared some of the papers that I’ve come across and they’ve read the article, obviously. And it’s it’s a difficult balance. There’s a tension there because on the one hand, you know, your kid’s going to be okay or you hope that they are and you know that they have inner strength and resilience and and that you’re going to be there for them. But on the other hand, there is all this evidence out there that that early puberty um can have all these adverse consequences. And you do have to worry about the outside world and all the influence that it has. So again, it’s getting back to that balance of being reassuring without being dismissive because this is a real concern. But if magically all of society could get together and decide that it wasn’t, it wouldn’t be anymore. And that’s that’s kind of wild about um talking about this. Like it doesn’t have to be this way. But the question of how to change everyone’s mind about it and just see girls through a different lens, I mean, how how do you do that systemically or individually? Um. When you were talking about how mortifying your your sex education experience was, and I think most people’s uh are pretty mortifying. I was thinking about that a lot for my kids when I was researching this piece. My kids are eight and six um and I got all these recommendations for like, great, you know, learning about your body books from various experts that I talked to. And I found a couple that I really liked. And so I just sort of suggestively left them around the house, you know, for my eight year old daughter to kind of stumble on. And she did. And, you know, she read them cover to cover and she had questions. And there was some stuff that was completely over her head and there was some stuff that she really wanted to drill down clinically and and talk about. And that worked out really well for us. I mean, she’s eight. We have a long ways to go, but that is my one piece of advice for people. Find the books that you like and just leave them, leave them around and and you can let your child come to you. And if your child doesn’t come to you, you’re absolutely right, then you’re choosing not to say something. And and that’s a proactive choice. That’s not a passive choice. You are avoiding the conversation and then you have to do something more proactive and more bold and maybe more uncomfortable than what I did was, which was just to, you know, kind of leave breadcrumbs around the house. Um. But these things have to be done and they’re hard and they’re weird and they’re awkward. But again, we can just decide that they’re not, that they’re just our bodies. And bodies are like gross and weird and embarrassing, and we all have them and let’s talk about them. 

Dr. Abdul El-Sayed: I appreciate that insight. You care to share uh which books you recommend? 

Jessica Winter: My absolute favorite and my daughter’s absolute favorite that’s a nice coincidence is a book called The Girl’s Body Book, Everything Girls Need to Know for Growing Up. It’s by Kelli Dunham. And um it’s really fun and charming and a little bit whimsical without being kind of twee or condescending. It’s very easy to understand. It’s very lucidly written. Um. It’s just a joy. And my daughter dips in and out of it. And it’s just been a great tool. And I’m really grateful to have this book in our lives. 

Dr. Abdul El-Sayed: Well, I really appreciate that recommendation and um I may have to uh pick it up as well. Um. Thank you so much for taking the time to share your reporting with us. Our guest today was Jessica Winter. She’s an editor at The New Yorker and uh author of a recent article about early Puberty in Girls. Jessica, thank you so much. 

Jessica Winter: Thank you. It’s my pleasure. [music break]

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. 

[clip of unspecified news reporter] Drugmaker Eli Lilly says it will cap the cost of insulin at $35 a month. 

[clip of unspecified news reporter 2] Drug maker Sanofi is becoming the third major company to cap prices, capping the price of insulin at $35 per month for those with private insurance. 

Dr. Abdul El-Sayed: The fire sale on insulin continues. This week both Novo Nordisk and Sanofi announced that they’ll slash prices for insulin too. Sanofi, a French company, was the last to follow suit following what I could imagine to have been unbearable political pressure. Between Eli Lilly, Novo Nordisk and Sanofi, they account for 90% of the global insulin market. And just like that, in the span of two weeks, the price of insulin in the U.S. is now down over 70%. There are two implications of this move that should teach us a lot about how the pharmaceutical industry works. The first is that contrary to what these manufacturers have been saying for years, they really could still make money on insulin even if they slash the costs. There are two parts to this. The first is basic supply and demand. Think about it, nearly 40% of insulin users ration their insulin. If you lower the price, nearly half your market starts to buy more insulin. But the second just shows how craven these producers have been from the jump. The skyrocketing price of insulin over the past ten years has nothing to do with the cost of manufacturing insulin. It has to do with the way pharmaceutical companies fleece people. It all goes back to financialization, the way that nearly all of American commerce has been controlled by Wall Street. The pharma companies, just like auto companies, banks, and other major corporations, live and die by their stock price. In fact, CEOs are usually paid in stock. But stock prices are a reflection not of how profitable you are today, but how profitable Wall Street thinks you will be. And that has to do with how much profit you’ll make not now, but in the future. But making more profit at a drug company isn’t easy. They can’t just pull new drugs out of a hat. So instead, they just raise their prices on the old ones. It’s a cheap trick to make them look more profitable next year than they were this year, despite adding no more value but raising their stock prices. And they were using drugs like insulin, a drug that people who have diabetes fundamentally absolutely cannot live without to do exactly that. The fact that they could just drop their prices like that shows just how much this was all about greed and nothing else. It also shows one more thing, that when we stand up, when we fight like hell, we can win. This week also brought more news on the origins of the COVID 19 pandemic. 

[clip of unspecified news reporter] The East Asian raccoon dog, a relative of the Fox, may hold the key to the origins of COVID 19. 

[clip of unspecified news reporter 2] A new report on the possible origins of COVID 19, an international team of scientists reportedly finding genetic links tying the pandemic to another animal in Wuhan, China. 

Dr. Abdul El-Sayed: Raccoon dogs. [laugh] Bet most of you didn’t know there was a such thing called a raccoon dog are part of the canine family, but look like raccoons in the face. Hence raccoon dog. They’re often bred for both their fur and also their meat. Researchers found samples from the Wuhan market from January 2020, which contained DNA from the virus co-mingled with raccoon dog DNA, suggesting, though not proving that the virus had infected a raccoon dog at the time. Previously, scientists had suspected that the animal most likely to have passed the virus along would have been a bat, given that previous coronaviruses, like the one that caused the first SARS epidemic, are thought to have emerged from bats. To be sure, it doesn’t directly prove that the virus emerged from raccoon dogs in the market. After all, it’s possible that this finding is just coincidental. Another possibility is that a raccoon dog was secondarily infected from a human with COVID. But it does make the argument that a raccoon dog was the zoonotic host that passed the virus to humans a lot more plausible. Finally, a new poll of doctors showed that they feel woefully underprepared to treat long COVID. The poll, commissioned by our colleagues at the de Beaumont Foundation and Morning Consult, found that 70% of doctors agreed that long COVID was a recognizable diagnosis and that 78% thought it was a real problem. But less than half felt comfortable diagnosing it and nearly three quarters felt uncomfortable treating it. We need more research, folks. That’s it for today. On your way out, don’t forget to rate and review the show. It really does go a long way. Wait, wait, wait, wait, wait. You’re not going to listen to me. I need you please, to go rate and review the show. Thank you. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. We’ve got our logo mugs and t shirts. Our science always wins sweatshirts and caps are available on sale too. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez and me. Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.