Former CDC Director on Rebuilding Public Health and Trust in America with Dr. Tom Frieden - Transcript
Tom Friedman
We've got a a deep hole to dig out of in public health. What I realized about a decade ago is there isn't a good understanding of what public health is, why it's important, and how it could save a lot of lives, including yours.
Dr. Mark Hyman
How do we start to restore public trust in public health? Doctor. Tom Frieden serves as the director of the Center for Disease Control and Prevention of the CDC and the commissioner of the New York City Health Department. He's a physician who's advanced training in internal medicine, infectious disease, public health, and epidemiology. And he currently runs Resolve to Save Lives, a nonprofit that addresses the world's deadliest health threats.
Tom Friedman
A 100,000,000 Americans don't have a primary care doctor. That's ridiculous. $4,000,000,000,000 in health care and we can't give this basic thing to a third of the people in this country, that's absurd.
Dr. Mark Hyman
The scary data is that fourteen percent of adults and fourteen percent of children are biologically addicted to food, which is actually more people than are addicted to alcohol. So this is a big problem because people can stop smoking, but they can't stop eating. Where are the big problems and what are the policies that need to happen and what do we do for ourselves?
Tom Friedman
When it comes to public health specifically, I think there are three things we've got to do. One is.
Dr. Mark Hyman
Well, Tom, it's an honor for me to have you on the podcast because I have been a huge fan for actually decades. Before you were CDC head in in 2009 to 2017 when you were the New York health commissioner, and you were taking arrows in the back for trying to get trans fat out of food supply before the FDA said it was a non safe substance to eat or non grass. You were talking about ways of reducing hypertension through sodium restriction. You were working on trying to limit sizes of sodas and soda taxes, and we're really, you know, reaching really a lot of resistance. And the food industry is so powerful, and we were just chatting about our mutual friend Paul Farmer who really addressed what he called structural violence.
You know, we're trying to do public health, we're trying to do personal health, we're trying to be a doctor in an office seeing patients, but you're up against this structural system, the social economic and political conditions that drive disease. Big food, big ag, big pharma, the medical industrial complex, whatever you want to call it, is a real thing. And, you know, we were chatting about how soda taxes, you know, are can be very helpful, but I'm gonna say how the hunger groups are all funded by big food. And, of course, they're gonna be against any restrictions on SNAP or soda or anything else or soda taxes. So we're in this situation where, you were one of the first pioneers in public health to start talking about these issues and then doing something about it.
And I read this. I don't know how this actually did the math works out, but you've helped reduce trans fat consumption for almost 4,000,000,000 people, which is about how many people were on the earth when we you and I were first born. You know? So really planetary medicine. And I'm just I'm just so tickled and honored to have you on here to talk about your new book, The Formula for Better Health, How to Save Millions of Lives, including your own.
I think the public health, personal health has has not been properly integrated. I think this is really a huge problem in in medicine where there's, like, public health and epidemiology. There's some people who are trying to do things on a public health level, and there's the doctors in their office doing it on a personal health level. And there's not a lot of synergy or communication or thinking about how do we actually solve these problems holistically. And you you do that.
And it's a lot of what your book's about, it took ten years to write, which is very impressive. I I'm I think to have that much dedication, that much focus to getting it right, and telling a new narrative about how to think differently about public health is really ultimately what this is about. So I'm just thrilled to have you here.
Tom Friedman
Well, thank you so much, Mark. It's very nice of you to say. And and that the honest truth is I have been lucky. I've been lucky because I've had great mentors. I've been lucky because I happen to have opportunities to do jobs where I could make a big difference, and I've learned a lot.
And what I realized about a decade ago is there isn't a good understanding of what public health is, why it's important, and how it could save a lot of lives, including yours. So I I really struggled to to get clear on both explaining what I knew and learning more. Because when I got into some of this stuff, I realized, wait. I don't understand why that happens, or what is the latest data show, or why don't we look at it this way? So I try to sort that out in the book.
Dr. Mark Hyman
I think it's important that we're having this conversation now because in the earlier part of your career when you were the commissioner of health for New York City, and then when you were the CDC director for eight years, we were in a period of time where there was still public trust in medicine and public health. With the COVID pandemic, for a lot of reasons, and various echo chambers, and propaganda, and, you know, the whole mismatch of kind of the culture around how to think about what was the truth or not the truth, and things we learned after we're told that weren't weren't true. There's a whole feeling now that there's a mistrust in public health, and yet it's really important. I don't know you probably as an empty knowledge know this guy, but when I went to the University of Ottawa Medical School, one of my professors was John Last, who wrote the textbook on public health.
Tom Friedman
Dictionary of
Dr. Mark Hyman
public He's like the dictionary of public health. Was one of my early inspirations, and I did a public health expedition in Nepal when I was in medical school looking at public health of small rural communities up in the Himalayas. So, I mean, I went there because I wanted to go trekking actually, but it was a good I got credits for it, but it was amazing. And how do we start to restore public trust in public health and address some of the big issues now? Because, yes, the pandemic was a big deal, but chronic illness kills far more people, and it's almost entirely preventable.
And the things that we're facing now didn't exist a hundred and fifty years ago. Diabetes, obesity, heart disease. They were like, it's like seeing someone with polio now. Oh my god. There's this come with polio.
There's a couple of Russians to this case. I've never seen one. Or measles, you know, although that's increasing. But, like, it's just it's it's these are we're not necessarily in inevitable conditions of being human beings, and they are related to our public health. The reality is is that we haven't really come to terms as a society with the massive impact of our epidemic of chronic disease.
And whether you like it or not, or whether you believe it or not, like, the at least, the very least, the whole movement has been like, hey. We have a problem, Houston. You know? Like like, what are we doing about it?
Tom Friedman
So I think, you know, to your question, what what can we do to regain trust in public health? I think it's a a specific question about a broader one, which is how can we get back to recognizing that even though we may disagree on a lot of things, there there is something that's the common good. There are win wins in society, not just win loses. And there are things that we could do together that will help all of us. But when it comes to public health specifically, I think there are three things we've gotta do.
One is we have to listen better. We have to communicate better, but communication starts with listening. And listening means understanding, yeah, people are really frustrated. They're scared. They don't know who to trust, what to trust.
There's a lot of suspicion. There's a lot of lack of access to 100,000,000 Americans don't have a primary care doctor. That's ridiculous. $4,000,000,000,000 in health care, and we can't give this basic thing to a third of the people in this country? That's absurd.
The second thing I think we have to do is to make small wins, things that make a difference that people can see in their own lives. And the third thing is stay away from mandates. Only require things when it's absolutely essential. Right? And and I think with those three things, we can step by step build back trust, but it's going to take a long time because trust gets broken in instant, and it gets put back
Dr. Mark Hyman
Slowly. Yes. It's lost in buckets, and it's gained in trips. Exactly. I just double clicked on something you said.
You said, you know, one of the challenges of public health is these dictums and mandates, which were a big part of COVID. What's your view on what happened there in terms of the mandates around vaccines, around masks, around distancing, around lockdowns, around school closures, and all the stuff that we now recognize may have been really bad public health decisions.
Tom Friedman
I rec I discussed this in some detail in the book, actually, though it's not mostly about COVID. The the fact is that take them one by one. Right? So I I before I was health commissioner, I worked on tuberculosis for more than a decade. First in New York City, where we stopped the big outbreak, the biggest outbreak The US has ever had of multidrug resistant tuberculosis.
Then in India, where I supported the government to implement a program that saved millions of lives. And in tuberculosis in New York City, we had a few patients, small number, one maybe one or two percent, who just wouldn't take their medicines. And so we had to mandate them to take their medicines. And if that didn't work, we locked them up, not in a jail, but in a hospital. We couldn't force them to take the medicines, but they had to stay until they were cured.
So they eventually took their medicines, and they got cured.
Dr. Mark Hyman
Because they were harmed to themselves or others?
Tom Friedman
And others. Right? So your right to swing your fist doesn't extend to my nose, And your right not to take your anti tuberculosis medications doesn't extend to coughing, untreatable, multidrug resistant On subway into my lungs. Right?
Dr. Mark Hyman
On a subway near
Tom Friedman
I think everyone can understand that, get with the program. We did it with full concern for patient rights. We individualized the assessment. We only did it when nothing else would have worked, and it worked. We cured just about everybody who had been not cured, some of them, for many years.
So if that's not controversial, why is wearing a mask controversial? And let's just take them the three things that got mandated, masks, closures, and vaccines. Masks, you really have to look at the situation. Let's suppose you're walking into a ward of a hospital for kids with leukemia on cancer You think it's a requirement, right, to wear a mask. That's not an unreasonable thing.
Dr. Mark Hyman
Because these kids' immune systems are suppressed, they're gonna get
Tom Friedman
If you look at East Asia, people wear masks all the time, and they're death rate No.
Dr. Mark Hyman
I used to live in China. I was like, why? Everyone but it's because of the pollution.
Tom Friedman
Well, not just. It even goes before that. It actually goes back to SARS one in the nineties and to flu, where it's pretty clear that societies that use more masking have less flu. I said this in 2010 when I was CDC director. Nothing to do with COVID.
COVID hadn't come out yet. But, you know, if we had a culture where if you're not feeling so good, you wear a mask, we'd all be healthier. When it comes to masks, at one extreme, you have the leukemia ward. Right? At the other extreme, you have outdoors where it really doesn't make sense to mandate anyone wear a mask.
Jogging with a mask on. Right? Right. Masks actually were a way at one point to open more of the economy faster, but they got so politicized that it was difficult. I was on a focus group where a guy said, I have cancer.
I'm on treatment. But if anyone wears a mask, I don't trust anything they say. I I I happened to be on a flight the day the mask mandate was lifted, and the pilot got on the intercom, and he said, please respect whatever mass decision the people around you have made. It was a beautiful comment. Right?
Look. It's like wildfires or ozone. We like to know what our risk is. And if it's a high ozone place and you're got asthma or COPD, you may wanna not go out or you may wanna wear a mask. Same thing for COVID.
If it's raining COVID hard and you're immunosuppressed, or you got a big talk next week you wanna give for a meeting or a wedding you wanna go to, you don't wanna have COVID, maybe you wanna wear a mask.
Dr. Mark Hyman
Sure. I mean, it's a nuance for sure decision that is based on your medical history, your conditions, who you are, what you're around. But as a mandate,
Tom Friedman
you're thinking it's a bad idea. Closures are much more complicated. Closures look. When we didn't have a vaccine, and hospitals were slammed, and patients were dying, and we didn't have enough space in the morgue, actually closures worked to tamp down spread temporarily. They're not gonna we can't hunker down forever.
But that was done wrong in terms of when, where, for how long, what, and involvement of communities in that decision. And finally, on vaccines, what really changed was what we understood. When the if you remember, when the first studies came out, it looked like they prevented spread, that they were so good, you didn't get COVID, you didn't spread it to anyone. That's a vaccine where there's a case for a mandate. But then it became clear, no.
Actually, they mostly just protect you. So then it becomes more like a motorcycle helmet mandate. Maybe it makes sense. Maybe it doesn't. Every community could should decide.
But clearly, mandates were one of the things that, you know, both administrations got wrong. Communication is something that both administrations got wrong.
Dr. Mark Hyman
And we're What's the communication that was the problem?
Tom Friedman
Well, if you go back to February 2020, COVID's just coming out. Nancy Messonnier from the CDC says, this could be really bad, but we need to be humble. We don't know. We may not have planned for everything, but disruption to everyday life may be severe. The Trump administration didn't like that.
CDC wasn't heard from again for all of 2020, and you didn't have the the the good public health messaging, which was at the start of every sentence, we don't know everything. Based on what we know now, this is what we're gonna do. It's likely gonna change.
Dr. Mark Hyman
We treated Americans as if they were dumb and and not able to understand nuance or anything like that.
Tom Friedman
I mean And then and then in the Biden administration, frankly, I didn't agree with having the CDC speak from the White House. Because that means if you didn't vote for president Biden, you didn't believe what the CDC was saying. So you really need to separate the technical from the political. They need to be aligned, but they need to be separated so you don't feel that that person with the white coat is doing something that a politician told them to say. So I I think we've got a a deep hole to dig out of in public health.
Dr. Mark Hyman
And the vaccine, you wanna touch on that? Because I think, you know, people that was the biggest thing for people was, like, you know, my body I'm, you know, medical free the medical freedom movement. I'm a sovereign. How do you dare you tell me what to stick in my body?
Tom Friedman
Here, I say, give people information. Encourage them to talk to their doctor or clinician. The data is very clear that the vaccine reduces severe illness. Boosters reduce severe illness. But it's like the flu vaccine.
I wasn't there were some in public health who were like, oh my goodness. We don't have enough people vaccinated. It's like, I go back long enough so that almost nobody was getting the flu vaccine every year. Little by little, people got more confidence in it, more faith in it. They saw that it reduced risk.
Is it perfect? No. It's you know, compared to other vaccines, the flu vaccine is a lousy vaccine. It's safe, but it's only thirty to sixty percent effective. So it's not great, but it's the best protection we have against flu.
So you
Dr. Mark Hyman
don't have reduces your flu by seventy five percent. We should have a vitamin D mandate. And same thing with COVID. We didn't have the data was there from Israel and other countries where if your level was over 50, there were no deaths.
Tom Friedman
Tricky.
Dr. Mark Hyman
Tricky
Tom Friedman
tricky tricky topic. Tricky topic.
Dr. Mark Hyman
Okay. Well, let's go. I wanna
Tom Friedman
hear Here's here's I wanna step back a little bit because what what I do in the book is I talk about a formula, see, believe, create, a way of systematically working to protect our own health and the health of our family and our community. And in the see, I talk about in one of the aspects of seeing the invisible, because that's the superpower of of public health, seeing the the invisible, seeing the pathway to progress. And part of that is really good technical rigor. And I distinguish between things that are essentially certain, things that are probable, things that are possible, and things that are theories. Yeah.
Now the theories may be right, but we may not have the evidence, or they may have been disproven. But I think when we give people personal health advice, we should stick with the things that have definite proof and that are a big deal for their own health. And I think there are a limited number of those things.
Dr. Mark Hyman
And low risk.
Tom Friedman
That's right. Most of them are pretty easy to do.
Dr. Mark Hyman
Vitamin D is, like, is almost as low risk as you can get.
Tom Friedman
Well, it's fat soluble, so you can have too much. For sure.
Dr. Mark Hyman
But I have
Tom Friedman
to be careful
Dr. Mark Hyman
when dosing it the right way. And, yeah, you can overdose, but, like, you have to take a lot.
Tom Friedman
I did actually some of the initial studies on vitamin A because there was a measles outbreak in New York City when I was an epidemic intelligence service officer, and we had acute and convalescent sera. And so I could get the vitamin a levels of all of the patients with measles, and I showed that when they were acutely ill, they all came down. Vitamin a is acute phase reactant.
Dr. Mark Hyman
You know, that lowers.
Tom Friedman
Goes way down when you're sick and have fever, and then it comes back up a couple weeks later. The studies show that, you know, some moderate benefit of treatment in in kids under the age of two in The US globally where stewards are much more tenuous, there's a mortality benefit for treating kids with measles with vitamin A, but obviously, vaccine is the most effective. Way to prevent it. Vitamin d is tricky because our our measurement is complicated. There are certain things, Mark, I think we're gonna learn so much more in the future about lipids, about vitamin D, the way we measure it now, what we measure, what the different types show.
They're they're really different. I'm I mean, take lipids where I went into it in some detail when I was at CDC. We say LDL bad, HDL good.
Dr. Mark Hyman
Not so simple.
Tom Friedman
Not so simple. Right? LDL is like hundreds or thousands of different types of molecules. Same with HDL. And some HDLs are unhealthy, and some LDLs are healthy.
So we'll learn more, but we know enough to take certain actions now.
Dr. Mark Hyman
Moving on from the from the swamp of vaccines, I kinda wanna I wanna zoom out and and talk about what's happening in America right now because and increasing globally, which is that we have this chronic disease epidemic that you spent a lot of time thinking about that you wrote this book about. And this is a global book. It's not just about America, the formula for better health, how to save millions, I would say billions of lives, and including your own. We haven't really taken a serious look at those interventions that are gonna make the biggest difference. And there's now a movement, and David Kessler is gonna come on podcast this afternoon after you, who's who's really taking a stand for making ultra processed food an issue that we have to face, and particularly the refined starches and sugars as as the biggest driver of the chronic disease epidemic.
But there's other things, like, obviously, the sodium potassium ratios and hypertension, which is also related to some degree to insulin resistance. And and and small fact that for those of you who are listening, when you eat sugar, your insulin level goes up. When your insulin goes up, you retain salt or sodium, so you retain fluid, so you get high blood pressure. This is just a known medical fact. I'm not sure if you're aware of that, but it's it's pretty straightforward.
So one of the best ways to lower blood pressure is to not only limit salt, but to limit sugar as a way to actually reduce your your retention of sodium. And I've seen this over and over and over again, and it's probably the quickest, fast way to lower blood pressure. And and America's really suffering from this epidemic of metabolic disease, prediabetes, diabetes, obesity, and that leads to heart disease, cancer, dementia, and obviously diabetes. So it's is this a big problem? And and I'd love you to sort of summarize, you know, the things that you talk about in the book that that I think we should all be aware of as as Americans and as as a global population of, you know, where are the big problems?
Where should we be pushing? And what are the policies that need to happen? Can they happen? And what do we do for ourselves?
Tom Friedman
Well, let's focus on chronic disease. And the formula for better health is see, believe, create. Three steps. See the invisible. Believe that what seems like it's gonna be there forever can actually be changed.
And then work systematically to create a healthier future.
Dr. Mark Hyman
I love that. See, believe, create.
Tom Friedman
And for each of these, there's a
Dr. Mark Hyman
personal Take part of it anytime.
Tom Friedman
There's a personal part of it, and there's a societal part of it. Can I take two examples and take you through this Go whole for All Let's take Zero show? Tobacco, and let's take sugar. Alright. And we think about the societal and the personal.
See the invisible. So when I became health commissioner in New York City, we had no data on how many people smoked in New York City. It didn't exist. So we had to start a survey, rigorous, systematic, standardized survey, and it came back. Twenty two percent of adults smoked.
Wow. And it hadn't changed in a decade.
Dr. Mark Hyman
So we And this was in the eighties?
Tom Friedman
This was in no. Nineties. Actually, February, 02/2002, I became city's became a New York City health commissioner. We didn't know. Right?
And public health really is like Cassandra. Cassandra was this Greek mythological priestess who could see the future, but she was cursed. Nobody believed her predictions, so they didn't change their behavior. We can break that Cassandra curse if we see the invisible, believe we can change it, and create a healthier future. So we knew that twenty two percent of of New Yorkers smoked.
That was one point two million people at that point. That meant we knew at least four hundred thousand New Yorkers were gonna die from smoking related causes. About a third of them from cancer, about a third from heart disease, and about a third from lung disease and other things. So these were four hundred thousand people about to go over the cliff. And the other thing we could see is what works.
What works to stop smoking? Now, when I got to CDC, I found out some of the things the tobacco industry does to keep people smoking. It is amazing, and I describe it in the book.
Dr. Mark Hyman
Oh, tell us the secrets.
Tom Friedman
It's amazing. You know, it started with the CDC tobacco lab ordered what's called a smoking machine, which actually exists, which the tobacco industry used to say how much healthier their cigarettes were. And so the first clue that there was some bad stuff happening was that the tobacco industry tried to block the sale of the tobacco smoking machine to the CDC. But the company said, hey. We wanna sell it, so they sell sold it.
First thing they found is that each cigarette had holes in the filter. Now when you smoke a cigarette, you cover those holes. And so when you cover the holes, all the smoke comes right into your lungs. But the smoking machine didn't cover those holes. So they got all this what's called sidestream air coming in, diluting the cigarette smoke and reducing how much they said.
But that was
Dr. Mark Hyman
just kind of a rigged machine.
Tom Friedman
Rigged machine. But they figured out how to fix that, but that was just the beginning. Then they found that if you look at the amount of nicotine, there's the most nicotine at the tip of the cigarette. Why? Because after you know how chain smokers stub out the cigarette when it's halfway smoked?
That's because they need to get another hit of nicotine. But that was just the beginning. Then they realized that they were alkalinizing the tobacco because if you alkalinize with urea or other things
Dr. Mark Hyman
painful to smoke.
Tom Friedman
Actually, it increase it potentiates absorption. So you absorb it faster. Then they found that they're adding sugars because that increases binding to the lung receptors. And things like menthol, not only make it smoother, but they may increase actually the number of nicotine receptors in the brain.
Dr. Mark Hyman
And they they were studying this. So they knew this. This isn't like, oh, oops. We we see No.
Tom Friedman
This is all in there. Design. All by design. So with this design, a single smoke a single puff of a cigarette will deliver more free nicotine or crack nicotine to your brain than an injection, an intravenous injection of nicotine. So, you know, these are invisible things that are changing how people behave.
And the more you see them, the more you can do something about them. The path to progress is another thing we can see. And what the path to progress was, tax cigarettes. It's the single most effective thing you can do to to help people quit smoking. Most people wanna quit.
And price is really important. And there's a actually But
Dr. Mark Hyman
a pack used to be like a dollar. Now it's $10. Right? So, like, that's it's not like a little tax. It's a big tax.
Tom Friedman
And the bigger the tax, the bigger the impact. And the impact we saw because we had this survey now. We taxed cigarettes another buck 42 a pack. In the next year, big reduction in smoking. After ten years of no reduction, a significant reduction.
What's the next effective thing you can do? My next most effective thing you can do is go smoke free in all your restaurants and bars. We did that. It was a massive political fight. Yeah.
In the next year, came way down again.
Dr. Mark Hyman
And just to give you some kudos, just so you all understand, now you can't smoke on a plane, you can't smoke in a restaurant, you can't smoke in
Tom Friedman
a hotel. That was you. Well, some of that was me. It was really advocates doing this all over the country, all over the world, but we
Dr. Mark Hyman
can take a little
Tom Friedman
Wouldn't have happened without Mike Bloomberg, to be frank. He went to the mat on this. Yeah. The next year, I thought, you know, okay. We started that downward trend.
It'll continue. But because we could see the invisible, because we had a tracking system in place, we found out that actually the decrease had stalled, and it was scary. Here it was. You know, I had come back from India to take this job. Had taken on tobacco as the highest priority, and we were failing.
So I looked at the data, and the next most effective thing you can do is run hard hitting ads. So I'm not sure that would work. It's expensive. $10,000,000 to do that. You could run a bunch of clinics for that, hire a bunch of staff.
We did it. We had the data. Big further reduction, especially in the groups we targeted most with the ad.
Dr. Mark Hyman
Yeah. I mean, the limp cigarette and the Marlboro Man's mouth, that really worked. You know?
Tom Friedman
You know what? Interesting. What works is very interesting, because we studied it. We we studied it. What works is showing disability and disfigurement.
If you tell people you're gonna die, like, everyone's gonna die.
Dr. Mark Hyman
Show your black lung Yul Brynner and his black lungs in
Tom Friedman
the If you can if you but and and when I was at CDC, we did the tips from former smokers campaign, and I got to know Terry, a wonderful woman from North Carolina. She had been a cheerleader in high school. She'd worked on a tobacco farm. She had started smoking two packs of cigarettes a day. She was funny.
She was vivacious. And she got cancer at a young age, in her in her forties. She ended up getting surgery, chemotherapy, tracheotomy, and she we had these tips from former smokers. And, you know, she was so effective. She helped more smokers quit, saved more lives than most doctors ever will.
But on the on the tobacco side, yeah, individuals may blame themselves. Oh, why can't I quit? But that's happening because advertising is marketing.
Dr. Mark Hyman
Not easy. Right. But so you did you did you did the the restricting where you can smoke, and you did taxes, and you did
Tom Friedman
Hard hitting ads. Hard hitting ads. And we did cessation, where we helped people quit with nicotine patches.
Dr. Mark Hyman
But was that was that what created the most shelter? Was it the fact that it wasn't regulation, it wasn't legislation, it was litigation that finally brought tobacco to its knees and to a class action shoot, and this was, I think, under David Kessler, actually
Tom Friedman
got the Litigation did a lot. So litigation revealed the discovery. The The discovery. The these sleazy tactics of the industry, the lies. And that opened the door and made it easier to do things like tax cigarettes and go smoke free.
So there is an interplay bet
Dr. Mark Hyman
But but it but you know, and most people listening know that in the seventies, a lot of these big tobacco companies saw the decline in smoking, and they started buying the food companies. RGR Nabisco, you know, you know, what was it? Crafts Reynolds Craft or something. It was like Philip Morris Craft. It was like, there were these big tobacco companies who started buying these companies, and I don't know whether it's intentionally or not, and Michael Moss talks about his book, Salt Sugar Burn Fat, how the food industry scientists created, you know, tasting labs where they hired craving experts to find the bliss point of food to create literally heavy users, quote unquote, all their own language, internal language in the industry.
And and so it almost seems the same way that they were deliberately designing food to keep us biologically addicted. And and the scary data is that fourteen percent of adults and fourteen percent of children are biologically addicted to food, which is actually more people than are addicted to alcohol. Alcohol is fourteen percent of adults, but not kids. So this is a big problem. And then many other people fall in the, like, kind of semi addicted craving, can't stop eating sugar carb kind of category because of how it affects the brain.
So the the the question I have for you is you you were about to sort of talk about sugar. This is a this is even a bigger problem because people can stop smoking, but they can't stop eating. And and yet 60% of the food we're eating is ultra processed food. Probably 75% of that is sugar and starch and other weird derivatives of sugar and starch that David Kessler points out in his petition to the FDA on defining ultra processed food. And how do we navigate that?
Because, you know, you've got, you know, hunger groups saying, oh, it's regressive and dangerous to restrict access to this to the poor. We're just providing convenient, safe food. We're gonna damage the food supply. You're gonna make people be unable to afford good food. This is this is a huge service to America, blah blah blah.
And there and that it's you know, you basically you know, your fault if you're overweight. Like, everything in moderation, it's all about calories in, calories out. And not all calories are created equal. They have different effects on your hormones, your brain chemistry, your metabolism. And so how do we navigate this?
Because to me, this is their biggest global crisis right now, and the global burden of disease study showed clearly that, you know, a 195 countries, food was the biggest killer. More than smoking, more than war, more than anything else. So, you know, you've you've tackled these big problems. You've been inside government. You've you've you've won some big wins.
We're we now have an administration that seems alert to this, and people in the administration seem talk talking about it. Are they going about it the right way? What do we need to be doing? Because I don't think this is an individual problem. You know, yes, as a as a one on one doctor, I can coach my patients, and I can help them understand what's going on, and I can put them in a group and have have group support, and I can move the needle in a couple of people.
But on a public health level, this is just getting worse and worse.
Tom Friedman
So I think you're absolutely right.
Dr. Mark Hyman
When you and I graduated medical school, there was not a single state with an obesity rate over twenty percent. Now there's none one hundred and thirty, and most are 40.
Tom Friedman
Well, my father was a cardiologist, and I shadowed him in his practice for a month, and he was a wonderful physician. And, you know, there was essentially no obesity. It's very rare, and I'll talk about that a little bit. But I wanna just, as we transition from tobacco to nutrition, not only has industry that's gotten rich off of making people sick learned from tobacco and applied it to food, But we in society, in public health and medicine, as individuals, we need to learn those lessons also. What worked to reduce tobacco?
Now we have to say the tobacco epidemic is not over. It still kills more Americans than any other preventable cause, half a million a year. There's still a lot of people smoking. It's come way down, but the the war isn't over on tobacco. But we've learned a lot.
Dr. Mark Hyman
But food kills more. Right?
Tom Friedman
Well, let's go into nutrition. I got asked actually, it was by one of my kids. I got asked when he was about four or five years old. He said, daddy, which is worser? Sugar or salt?
And, you know, it's a hard question, But after a couple of decades of thinking about it, it's salt. Salt is worse. Salt kills more people than sugar. Now they're both bad. There's no reason to fight, you know, this, that.
But but let's start with salt because this is an area where we can make a really big difference, but half a century of urging people to eat less salt has done nothing. Nothing. In fact, globally
Dr. Mark Hyman
because it's in every processed food. You can't eat anything without it. You go to a restaurant, you buy something in the grocery store.
Tom Friedman
It's Astonishingly high. Astonishingly high.
Dr. Mark Hyman
It's not the salt you add at your dinner table.
Tom Friedman
That's right. That's right.
Dr. Mark Hyman
It's the salt added by corporations.
Tom Friedman
And and it's almost impossible. Well, it's not impossible. It's very, very difficult for an individual to reduce their salt level.
Dr. Mark Hyman
Unless they stop eating ultra processed food. That will help. Or don't eat out at fast food restaurants.
Tom Friedman
But, you know, how practical are some of the things that we're That's the problem. Recommending for people like, Jim Salas said to me when I was health commissioner. He said something that made a big impact. I was trying to increase physical activity. Didn't know how in the population.
And he said, you'll never get more than 5% of people going to a gym regularly. I thought, oh, that's a really good point. Right? So if we wanna affect society as a whole, we have to think about scalable intervention. I talk about how to how to get scale in the book.
But when we look globally at policies that have worked to reduce sodium, there are really only two. One of them is to promote potassium enriched low sodium salts, and this is a great life hack. This is probably, you know, one of the best life hacks you can have. You can just change the brand of salt you use at home, and you can reduce your risk of a heart attack, stroke, or early death But that's only if you need home cooked food. That's only because you're
Dr. Mark Hyman
eating everything that America is like I get it. A factory.
Tom Friedman
Hey. You know, we don't have to solve all problems to solve some problem.
Dr. Mark Hyman
Yeah. Yeah.
Tom Friedman
Yeah. So it's something. Right? It's something you can do. Yeah.
In terms of public policy, the policies that we saw coming out of Latin America, Chile, Argentina, Mexico, Colombia, where they put a black stop sign that says too much salt, too much sugar, too much fat. You can debate the fat, or too many calories. These make dramatic changes because they improve both the options and the choices. The companies don't want a black mark on their food, so they reformulate really quick. Like, thirty, forty, 50% of foods after saying, we couldn't possibly reformulate the day after it becomes required.
Oh, we reformulate it. And the second thing is it it changes the choices that people make, and you can tie that policy to things like, hey. If it's got a mark, you can't advertise it on TV. You can't sell it in public places. We're gonna tax it.
So the public policy approach, like with tobacco, taxation, smoke free places, the equivalent in food.
Dr. Mark Hyman
Why advertising like there's no tobacco ads in magazines and television. Right?
Tom Friedman
Or, you know, you can't have tobacco on public property. Why can you have junk food on public properties? So I think on sodium, it's really difficult as individuals. But for those who are really health conscious, you could do things like, just for once, count the sodium and potassium that you consume in a twenty four hour period. Because the strongest predictor of heart health is consuming more potassium than sodium.
We mostly consume about three times more sodium than potassium. But if we cut way back on sodium and you get used to it. You know what? I've cut sodium out of my diet. I eat hardly any salt.
And and food that comes in restaurants, I can't eat it. It tastes like brine. You know? I mean, who wants to eat that?
Dr. Mark Hyman
Yeah. Like yeah. You know, it's interesting you say this, but, you know, because I looked at some of the the Leo Cordain and other works on the paleolithic diets, and Melvin Conner, and and, you know, they published in New England Journal. It was really fascinating to read that work. And one of the key highlights of that was that the sodium potassium ratio has flipped since since our hunter gatherer days.
Tom Friedman
Yes.
Dr. Mark Hyman
10 to one potassium to sodium, and it's now almost the opposite in terms of 10 to one sodium to potassium. And and potassium comes from eating vegetables and fruit. And so, like, you can make a potassium soup. I have, like, a whole recipe in my book called the ultra broth, which essentially is throwing a lot of root vegetables, a lot of onions, so, like, just a bunch of, you know, veggies in there, and you cook it down and drink the broth, it's just full of potassium. And I think, you know, that that's really the other benefit.
It's not just eating low sodium. It's actually increasing your potassium intake. You know? And that's why fruits and vegetables are part of the DASH diet and all this because they have more potassium, but they work.
Tom Friedman
So the the inter salt study that was done by Jerry Stamler and his colleagues, and and Jerry and my father did research together on sodium in the 1950. Oh, wow. That's So he just passed away at a 103. He was very active, still writing articles at 100.
Dr. Mark Hyman
Great. I'm counting on that. I'm counting on that. You and me, Tom.
Tom Friedman
Let's hope. Now what they studied in Intersalt was 32 communities in 28 countries, and they identified four communities that were basically pre industrial communities, and they had no age related increase in blood pressure. They were 90 over 60 at age 16 and 90 over 60 at age 60. And, yeah, there were other things, but the amount of sodium they consumed was about a tenth what we consume. And they didn't have any symptoms of low sodium.
We really have so much sodium in our diets, and it's so unhealthy. The more we can replace it and, again, it's going to be the public policies that make a difference. Telling people to eat healthier, you know, we have fifty years of failure doing that. Now there are things that are important. One of the things I go
Dr. Mark Hyman
into The public health thing with the salt, though. Like, what what are we talking about here?
Tom Friedman
Those labels.
Dr. Mark Hyman
The labels.
Tom Friedman
Promote low sodium potassium enriched salt, not just at home, but but in industrial food and restaurant food as well. What we we
Dr. Mark Hyman
heard limited can you can you regulate to limit it on ultra processed food or in restaurants? Say you can't have more than 2,500 grams of sodium in, like, know, one tablespoon.
Tom Friedman
What the what the Latin America model is that works very well is if it's above this level, it gets a warning label. And then that encourages reformulation. You can also set maximums. You can track things. But it's hard to reduce sodium as individuals and as a society, and it means taking on industry.
Like, they make money. Look. Salt is really cheap, and salt in Makes hardbored taste good. Yes. Exactly.
And if you put it in your chicken you know, a lot the chicken you buy in the store Oh my god. Is in brine. I know. Guess what that is? That's salt and water, and you're selling it by weight.
Yeah. So what am I selling? I'm buying salt water for, you know That's right. A couple bucks a pound. Yeah.
That's right.
Dr. Mark Hyman
Well, that that's my point about the sugar, because when you increase insulin, you increase sodium retention, and that causes food retention, and that insures your blood pressure. Like, I'm 65. My blood pressure is one zero five or one ten over 70, and I eat tons of salt. Like, I don't eat processed food. I don't I go out to restaurants sometimes, but, like, I'm very careful.
But, you know, I don't worry about how much salt I add in the food I'm cooking at home. Right? It's just it's not an issue because the rest of my salt intake is so low. Well, I
Tom Friedman
think for what I find with people that I counsel on nutrition is rather than deny yourself stuff you love, find stuff that's healthy and eat more of it. Right? So, like, high potassium food, sweet potatoes, salmon, tomatoes, mushrooms. I mean, this is stuff that tastes good, avocados, bananas, yogurt, pistachios.
Dr. Mark Hyman
You like my diet. Right.
Tom Friedman
So so, like, instead of deny yourself stuff, then find stuff that's healthy that you like to do. Same for physical activity. Now you wanna talk sugar.
Dr. Mark Hyman
Wait. Before before you do that, I wanna I was just salt thing is important, and I think it's gonna relate to the sugar conversation too. Because what you're what you know, people may not really hear that you said is that in South America, across the board, in most countries there, they've had radical sweeping policy changes that have been studied, that have profound impact. And you worked with Bloomberg and and Johns Hopkins in helping with some of their public health stuff, and and they've been very involved in these policies in South America. And there were a number of things that were collectively done that are incredibly hard to do here, and I'd love to hear your opinion about how that would get done.
Soda tax of 18%, restricting food marketing to kids between six and 10PM, getting all the crap out of schools, having no infant formula advertising, having these warning labels on the front of the packages that have the the stop signs with black. This is gonna kill you, basically. These are all policies that, you know, work, and they've been demonstrated work. And, you know, in this country, trying to change food labeling, trying to restrict food advertising, trying to do any of these things is is almost impossible, because you've got the First Amendment. You've got the industry lobby that's bigger than almost any other lobby in the food and ag industry lobby.
How do you how do you think about this here? Because because globally, it seems like people are catching on, especially because those countries are putting the bill out for the health care.
Tom Friedman
Well, my organization, Resolve to Save Lives, works on nutrition issues around the world. We have supported more than 50 countries to ban artificial trans fat that will, as you said, protect 4,000,000,000 people, prevent nine million deaths from heart attacks, and the other nutritional measures that will reduce heart attacks are reducing sodium and improving the healthfulness of foods. It always involves taking on industry because there are very powerful economic interests, And I talk about in the book how how you do that. Right? You can't just wring your hands and say, oh, we don't have the political will.
That's sloppy thinking. Who are the winners? Who are the losers? Who are the deciders? Who are the influencers?
Who are the advocates and champions? What are the partnerships that's gonna work? Look. Coke and Pepsi hate each other. Right?
But they work together to block tobacco taxes and reform in health policy. So we can work with groups that we may not agree with on everything, but we agree with on some things.
Dr. Mark Hyman
American Beverage Association, they both belong to that. It used to be called the American Soda Pop Association. It's terrible.
Tom Friedman
Thinking about, you know, what can be done when at the local level, at the state level, at the national level, where there's a window of opportunity. Soda taxes are a really important example. Like, soda taxes work. And I use it as a case study in the book because we tried them in New York City and New York State, and we got shot down. I had written an article in 2,009 ounces of prevention, posing a penny an ounce tax.
And, you know, for a while, president Obama thought about it, and his budget director thought about it. And then the industry came down like a ton of bricks, and he never heard about it again. But since that time, the Bloomberg Foundation has supported cities all over The US and countries all over the world to implement soda taxes. We found a beverage association publication that said soda taxes were the biggest threat to their industry that ever occurred, and they are because they really reduce consumption. And one of the aspects of the formula for better health is believing we can make progress.
And part of that believing is showing that what is existing now is not normal. Like, the amount of soda people consume now is nothing like what people consumed when we grew up. It's become as cheap or cheaper than water and consumed in huge quantities. When I was at CDC, we used the the the best study there is, and hence, to
Dr. Mark Hyman
see That's the national health and nutrition examination survey. It's done by the government regularly on tens of thousand people to look at all their health issues and biomarkers and It's really rigorous.
Tom Friedman
It's really rigorous. And and what that showed was that we actually hadn't reduced our physical activity that much in The US in the last couple decades, but we've increased our calorie consumption by about 300 calories per person per day, and about half of that is from soda.
Dr. Mark Hyman
And the other probably have is ultra processed food. You know, we have 500 more calories of food on in the market than we did in the seventies because of the increase in corn production and the way crops, subsidies, and supports change from the FDR policies under Earl Butts to the policies under Nixon that made it, you know, incentivized to grow as much food as you can and get paid for it even if it goes to waste or it's, you know, used in to make us eat more. So I think, you know, the the the the thing you mentioned, for example, about the soda tax in New York, and I'm sure you're aware of this, But the NAACP and Hispanic Federation were funded by Coca Cola and Pepsi to actually
Tom Friedman
I know.
Dr. Mark Hyman
Oppose those taxes. So you've got the people who are the most affected. These these populations that are underserved, that are genetically susceptible, that are suffering disproportionate rates of diabetes and obesity and kidney failure, and the list goes on, they're the ones who are the victims of this, and they're co opted. This is the dirty tactics that they use. You mentioned astroturfing.
There's co opting of of of of professional societies. I mean, the American Heart Association got mad at me because I said, you know, they get a $192,000,000 from, you know, industry, which they do, and a big portion of that is from the food industry. And they're like, oh, well, not and they're like trying to defend themselves. I'm like, look. You're taking money from these guys.
And and so you've got, you know, front groups like the American Council on Science and Health that confuse everybody with saying pesticides, trans fats, and, you know, sugar and high fructose corn syrup are all healthy for you. You know? Tobacco's great. Right? And you've got and you've got science being funded by industry, 12 times the rate of as as regulars, nutrition science by the government.
And so you've got all these areas that are that are almost circling the wagon, and it's not, like, subtle. You mentioned soda taxes. Yeah. They work. And you're right.
They're a threat. And that's why in California, when the soda tax craze was going on and Berkeley started, and then every little town started doing soda taxes, the industry got together, and they they basically put a ballot petition, which had nothing to do with anything, saying if if you wanna pass any state or local law, you need a two thirds majority, which is insane. And so that would have frozen the entire governor in California, and they went to governor Jerry Brown, otherwise known as governor Moonbeam, the most left probably governor in history, and said, if you don't put a semi permanent lockdown on any further soda taxes, we're gonna pass this ballot, and you're screwed. Like, that's what they're doing. And how do you fight that?
I think we learn from the
Tom Friedman
past, and this is the essence of the formula. See the invisible, including the reasons we don't change. Why does the Cassandra curse exist? See the path to
Dr. Mark Hyman
save us.
Tom Friedman
Curse is what? The Cassandra curse. Cassandra could see the future, but she was cursed. No one believed the tragedies that would happen, and so they didn't change their behavior, and they didn't prevent those tragedies. K.
So the Cassandra curse is something that we may know that our smoking is gonna kill us, but we don't stop. We may know that eating something unhealthy is gonna kill us, but we're gonna eat it anyway. Why does that occur? And it has to do with our perceptions, our perceptions of ourselves, our world, our future, and there are ways to counteract that. But then see what really works.
Like, there's a lot of stuff that's performative. Like, high I'm sorry, but high fructose corn syrup versus regular sugar. Right?
Dr. Mark Hyman
It's almost a wash.
Tom Friedman
Calorie. I can't tell you whether one tastes better or not. That's not my area of expertise. But nutritionally, this is performative nonsense.
Dr. Mark Hyman
I mean, there there are subtle differences in terms of free fructose and its effect on And
Tom Friedman
liver disease potential. Yeah. Yeah. There there are some things that are maybes, but compare that with soda tax or front of pack warnings to empower consumers to know what's healthy and what's not at the glance. These are there's no no comparison.
Dr. Mark Hyman
That's what
Tom Friedman
I said.
Dr. Mark Hyman
I got I got interviewed on a show, I think, News Nation about the the Coke switch to sugar, making it more available here. And I'm like, well, to quote Sarah Palin, you put lipstick on a pig, it's still it's still a pig. You know? So you put sugar in a Coke, it's still Well put.
Tom Friedman
To make progress, this is you know, public health is never easy. One of the I'll get a little technical here. One of the drivers of the Cassandra Cush, one of the reasons we don't take action on things that might kill us, is a public health concept from Jeffrey Rose called the prevention paradox. And what the prevention paradox says is basically harm or benefit that's a little bit for a lot of people will cause more good or more harm than harm or benefit to a small number. That's a very technical way of saying, basically, things that do a little bit of good for a lot of people will do much more good than things that do a lot of good for a few people.
And yet, when we pass regulations, laws, new policies, or programs, the the losers in that, the tobacco industry, the food industry, that's a very concentrated loss. That's a few groups. They're organized. They're powerful. The people who benefit don't know they're gonna benefit.
That's a very diffuse benefit. And so the prevention principle, the the prevention paradox tells us that the biggest changes come from the smallest changes. Mhmm. And there's a political corollary of that, which is that there's going to be a systematic opposition that's very powerful to public health action. So how do you get around it?
You first analyze who are the winners, who are the losers, and you figure out, okay, who's gonna win from well, insurers would win if we have less obesity. Employers would win if we have less obesity. And and map it out.
Dr. Mark Hyman
And who's gonna win? Insurers win because they make more money by increasing their premiums, and they just keep going up and up and up. And they don't really care. Because the more sick you are, the more they can raise the premiums, the more money they make, and they get a percent that's fixed. It seems like a rig game.
Well, life insurers do better. Yeah. Life insurers, for sure. And that's why John Hancock, by the way, has got their vitality program, why they're actually giving function. My comp my company is a preventive health health data platform services of lab testing for proactive preventive care to their members.
It's it's it's interesting.
Tom Friedman
There was a long term partnership between MetLife and the New York City health department to promote health. But you also think about who are the deciders, who are the influencers. And sometimes someone comes in with a commitment to do something, and it becomes possible. You think about pragmatism and timing. Like, what can be gotten through when at what level?
Maybe we can't get soda taxes through at the state level, but we can get them through in some cities. Maybe Philadelphia did it.
Dr. Mark Hyman
And you But the first time they tried, Coke gave $10,000,000 to the Children's Hospital, and they and they buckled, and they backed down.
Tom Friedman
And, you know, one of the reason one another driver of the I get all like No. No. I'm gonna it's fun because It allows me to get a little little wonky here. But another another driver of the Cassandra curse is something called hyperbolic discounting, which means we shortchange the future. And we will if if something's gonna happen to me tomorrow, I'll take action to avoid it.
If it's gonna happen in a year or ten years, I'm not gonna avoid it. I use this for my scheduling, Mark. I decide when I get an invitation, and it's six months. I used to go to these things and say, why did I agree to do this? And then I
Dr. Mark Hyman
learned the only one who feels that way.
Tom Friedman
So here's here's
Dr. Mark Hyman
the hack.
Tom Friedman
Here's the hack.
Dr. Mark Hyman
Nothing on my calendar in six months. Sure. Why not?
Tom Friedman
Here's the hack. When I learned about hyperbolic discounting, I said, alright. I'm gonna pretend it's tomorrow. Would I wanna do it tomorrow? If I say no, I don't accept the invitation.
Dr. Mark Hyman
That might be the the biggest benefit I've ever get gotten from having someone on my podcast. Because my wife always talks about future forecasting. I'm like, what's my future self gonna want on that day? And I'm like, she's like, no. You're not gonna wanna do that.
I promise you.
Tom Friedman
So the same is true for health. If we can imagine the future and the reason I bring it up with Philadelphia is the way to counteract hyperbolic discounting, that shortchanging the future, is to give yourself short term benefits. And what Philadelphia said is, hey. We're gonna use this soda tax to fund pre k
Dr. Mark Hyman
Yeah.
Tom Friedman
Childcare. And and then you have an immediate benefit as well as long term benefit. So there are ways to counteract the gazendocrats, and you have to look for those moments of opportunity where you can make progress. Advocates can make a huge difference in these things. You know, never doubt that advocates can make a huge difference in whether it's tobacco or food policy.
Dr. Mark Hyman
Well, that's Margaret Mead. Right? Never doubt that a small group of committed people can change the world. In fact, it's the only thing that ever has. So and you're one of those.
That's nice of you to say.
Tom Friedman
But, you know, I've I've learned from great advocates, and I I tell a story in the book about Matt Myers. He's a very effective tobacco control advocate. At one point, the state of Vermont was debating whether or not to go smoke free, and there was one vote in the assembly that would determine whether they succeeded. And so Matt went to the assemblyman, and he said, assemblyman, here are two ads. The first one thanks you for protecting Vermont's children.
The second holds you responsible for the cancer and heart disease and suffering and death of Vermont's children. One of these is definitely running tomorrow. You get to choose which one by how you vote today.
Dr. Mark Hyman
That sounds like the godfather. I made him an offer you can't refuse. Right? I mean, those tactics can work. But, you know, what's what's interesting to me is I've been and, like, as you have been you know, pounding this drum for decades.
And first went to the White House in 02/2005, and started to try to advocate in these ways. And in 02/2009, was very involved in trying to change policies around the Affordable Care Act for prevention and health, and food as medicine. And, you know, it's it's it's been such a slow process. And and for us, you know, we've been doing this a long time, but the the there seems like to be this interesting moment now where it's not, like, invisible anymore. And you talk about making the invisible visible.
The cultural movement around, I think, what happened with COVID, medical freedom, and that translating to make America healthy again, right or wrong, is is a moment of awakening. And and so the question I wanna point to you you you pointed a lot of things that need to be done, like sodium potassium ratios, reducing ultra processed food, smoking, you know, other simple public health measures. If you were king, if, you know, right now, President Trump, the Supreme Court, and Congress said, you have a magic wand, and you what could be realistically done over the next eight years to dramatically impact this chronic disease epidemic that's killing most of Americans? That six out of ten people have a chronic illness, that ninety three percent are metabolic and healthy, on their way to diabetes, that, you know, cancer rates are going up, autoimmune rates are going up, mental health crisis is increasing. You know, we're just we're just in a spiral, like a death spiral.
So if you were if you were king, really, and had that magic wand because you you've been in doing this for so long. I I would love to hear your insights about how to navigate this, because there's a lot of people watching trying to do good. But Bernard Lown once said, the well meaning are often ill doing. The well meaning are often ill doing. So we don't want ill doing.
We want the well meaning
Tom Friedman
to do good. Right? My father and Bernie Lam were friends, so
Dr. Mark Hyman
it's always nice to hear you. Knew him. I was actually I was actually part of the international physician for the French nuclear war group back in the eighties when he was Evgeny Chazov won the Nobel Prize with the with the organization. So I don't know I can say I won the Nobel Prize because I was a member, but the organization won the prize. So And I I don't put
Tom Friedman
it on my resume. I I think you have to start with what are the things that we can do with public policy? What are the things that we can do on the clinical front? And what are the things that individuals have to do? So if you really had the levers of power, you would take strong action on tobacco, alcohol, because these are proven killers, and we have proven means to prevent them that we're not implementing.
Taxation, restrictions on sales and marketing, some of the liability laws on alcohol. So these are really big, and they're underappreciated as continuing sources of illness and death. On the nutrition front, the two most well studied, best proven, high impact policies would be tax soda and potentially other sugary foods and implement a kind of front of pack warning system that's clear. And, you know, it's interesting. We've studied this.
There are various systems like Nutriscore, ABC, traffic lights. They don't work. They don't work. The only thing that actually substantially reduces consumption is this black stop sign. Because people spend at most six seconds making a decision of what to buy in the supermarket, and it's just gotta say yes or no.
I don't know what a traffic light means. Maybe red is good. I should stop there and like
Dr. Mark Hyman
it. Right? You're you have something called the keep it simple. It's my mother said, keep it simple, stupid. The kiss method.
Tom Friedman
Absolutely.
Dr. Mark Hyman
Yep. Black warning. Stop sign. Don't eat this.
Tom Friedman
Chapter six, simplicity. Simplicity is the ultimate sophistication. Leonardo da Vinci, you have to keep it simple. So on nutrition policy, you would absolutely tax sugar. You'd absolutely put in front of pack warning.
But I I do wanna talk about health care because sometimes I think
Dr. Mark Hyman
And and, dude, but just go go before we jump on that. So front of package labeling is now under review at the FDA. And the Biden administration put forth a rule, which I thought was kinda lame, that basically put a front of package label for sodium, saturated fat, and sugar, and basically rated them high, medium, low. I don't think that was very helpful and very confusing. And, you know, nutrition fact labels are just you need a PhD to understand them anyway.
No. I mean, they were in advance from nothing, but it was they're not really what we should have. Is there a pathway to do that legally that we have with our current laws around free freedom of speech, and, you know, they have supreme court, and all the ways all the ways that the industry's gonna fight PAC. It's gonna be tough. It's David and Goliath here.
Where's the where's the stone
Tom Friedman
in the gonna be tough. It's touch and go of whether you could get through the supreme court a mandate to to put even factual stuff on the front of PAC. So you'd rather say too much salt or excess sodium, excess sugar. But because high, medium, low will confuse people. Like, maybe high is good.
Right? Oh, good. We we we studied this when it came to calorie labeling on menu boards. A lot of college here is like, oh, more calories. I want that.
Yeah. Exactly. Right? What's politically and legally possible in this country is is a challenge. Yeah.
Because this idea that corporations are people, and they have free speech rights, and you can't make them say things that they don't wanna say even if it's the truth, that's that's challenge.
Dr. Mark Hyman
So repeal Citizens United is is what we
Tom Friedman
gotta do. Well, I don't I don't get into politics. I'm a doctor. But but I do wanna talk about health care because I think sometimes what I hear coming out of some of the folks is it's either or. And we can walk and chew gum at the same time.
Right? We can prevent a lot of disease and treat as well. And we can walk and chew gum. We can prevent illness and disease and also treat. And I think it's it's a false dichotomy to say, oh, we're over medicalizing.
I do agree that there are some things like ADD meds where there's too much use. But there's underuse of medicines for conditions that are asymptomatic. Like high blood pressure. High blood pressure, high lipids, hepatitis C infection, you know, things that you don't feel, things that are invisible that might kill you. And when it comes to blood pressure, the data is really strong.
Lower is better, down to one twenty over eighty. Reduce your risk of dementia, not only heart attack, stroke, early death, kidney failure, but also your cognitive
Dr. Mark Hyman
Even lower. Like, I mean, he was where's the lower limit?
Tom Friedman
One fifteen. One fifteen. 15. The elegant studies that that the group in Oxford has done all around the world, starting at one fifteen over seventy five, your risk of a heart attack, stroke, or death doubles with every 20 increase.
Dr. Mark Hyman
It's a continuum. And I think people don't realize that. It's not like one forty over ninety, and it was like, oh, one twenty over eighty. But, no, it's like one ten over probably one fifteen over seventy something.
Tom Friedman
So if you were gonna remake our health context and health system, you'd not only do the prevention stuff, you'd give people a primary care doctor. You'd change the way we fund health care so it's more like Kaiser Permanente, where the payer and the provider have the same interest of keeping you healthy. Right now, they have different interests. You know, most doctors in America, they want their patients to have their blood pressure controlled, but we don't even get that right half the time because it doesn't pay. And if you don't control the blood pressure, heart attack, and stroke, that pays.
Now no doctor wants their patient to have a heart attack or stroke, not one. But that's the way our system is structured, so that's what happened. Were you near
Dr. Mark Hyman
a commissioner when they did the whole diabetes initiative, and they they basically identified there were eight hundred thousand diabetics in New York, and they put in a whole nutrition curriculum, and they got people free nutrition consults and lifestyle change programs, and it was dramatically effective. But the program had to be shut down because the hospitals were freaking out because they were getting $200 for a nutrition consult and not $6,000 for a toe amputation. And this was a whole series of New York Times that sort of outlined this. It was it was maybe it wasn't during your tenure, but I was like, oh. I had a
Tom Friedman
much less successful diabetes effort. Yeah. I I oversaw the public hospitals and focused on diabetes as the chair of quality assurance there. I we made h b a one c mandatorily reportable. We tracked all a one c's over nine.
We reached out to all doctors and all patients with a one c's over nine, and we made zero progress. And what I learned about diabetes after years of failure was diabetes is not a sugar disease, as you know perfectly well. It's a metabolic disease. And if you got diabetes, the thing that's gonna kill you first is your blood pressure. The thing that is easiest to correct is your lipids.
And the thing that's gonna do you the least good and be hardest to control is your sugar. Doesn't mean we shouldn't try. But if you think of comprehensive care of someone with diabetes, get their blood pressure down below one thirty, maybe even lower, Get them on statins, maybe other lipid lowering drugs. Increase physical activity because physical activity is the closest thing to a wonder drug. And then do your best to control their sugar because that will make a difference.
But the health gain of sugar control in a person with diabetes is way less than the health gain of blood pressure control or lipid control. Don't get me wrong. I want to do everything to have their sugar
Dr. Mark Hyman
you're saying that because I can't remember the name of the study, but there was a series of studies that were published maybe a decade or so ago where they looked at really aggressive interventions, lowering blood sugar, lowering blood pressure, lowering lipids. And the more aggressive they were, the worse the outcomes were.
Tom Friedman
But that was the sugar driving that.
Dr. Mark Hyman
Just the accord study. It was it was
Tom Friedman
The sugar was driving that, and this is the challenge. Now we have some better meds.
Dr. Mark Hyman
Because they were my theory was that they weren't actually dealing with the fundamental metabolic disease, and that they were just masking the symptoms. And then underneath it, inflammation was still raging. And, yes, you can get lipids to come down, and you can get blood pressure to come down. But if you've got this visceral fat that's spewing out cytokines and inflammation, you know, you're still going to get
Tom Friedman
There's probably there's probably some truth to that. I but it's also the case that just leave the sugar aside, the benefit from blood pressure control and lipid control, and now the SGLT two inhibitors, the phlozins, are is really big. There's a big mortality benefit and morbidity benefit from that. Sugar is much more complicated. The the you know, once you get past metformin, what else you do to reduce sugar?
The SGLT2s do a little bit of sugar reduction, not a whole lot. But really think we get diabetes wrong. It is not a sugar disease, and we need to treat the whole patient. And that means you know, another part of the book is burden times amenability. Right?
How big is the problem and how amenable it is? The highest burden is your blood pressure, and the most amenable is your lipids. So get those two things in really good control. And then absolutely, I I talk in the book about the six keys to healthier living, and it's blood pressure, lipids, physical activity, getting enough sleep, avoiding toxins, and, of course, healthy nutrition.
Dr. Mark Hyman
Those are those are fundamental. And they're you know, they're things that some we we have control over, but, you know, you talk about air pollution and lead in the book, and, you know, we're increasingly seeing, you know, the harms of particulate air pollution from industry that is affecting us across the spectrum of disease, from heart disease to cancer to metabolic health. And we're also seeing, despite the fact that we remove lead from paint and from gasoline, which was great, that there's still a huge lead burden. And I see this clinically in my practice. Like, I have a patient I'm treating now who I mean, it did my I have often an affluent clientele, and they are drinking out of crystal glasses and crystal wine glasses.
And I once went into this shop in town to buy some wine glasses, and they were like, well, there's a $5 ones, and there's a $50 ones. I'm like, why is this $50? They said, oh, it's Riedel crystal. I'm like, well, what does that mean? He says, well, it has lead in it.
It makes the wine taste better. I'm like, what? And so all these people eating off these fancy glazed plates and crystal this, and it's it's stunning how what a burden there is.
Tom Friedman
There are a lot of toxins in the world. My group, Resolve to Save Lives, is beginning work to address the global problem of lead poisoning, and it's massive. No. It's not subtle. It is massive, and it's still We burn coal.
Medics. Yeah. It's in Lipstick. Pollution. It's in all sorts of stuff.
And we think that Resolve to Save Lives can support governments to implement programs that will prevent literally millions of deaths and lots of people from being terribly lead poisoned. You know, just to talk about lead for a minute because it's in the book. Alice Hamilton was the first female professor at Harvard University. She created the field of occupational health in The US, worker health. And she was really, really effective at working with factories and getting the lead out so workers wouldn't get poisoned.
And in 1924, there was an industrial accident in New Jersey, and more than forty workers were made severely ill or killed by a lead poisoning incident, an acute poisoning incident. And then there were hearings about, is it a good idea or not to put lead in gasoline? And Alice Alice Hamilton said, I am not one of those who believe that this leaded gasoline can ever be made safe. Sure. You can control the factory, but how are you going to control the whole community and country?
And just imagine, this was a Cassandra warning. You know? Cassandra '25, exactly a hundred years ago. And, you know, Cassandra could see the future, but she was cursed. Nobody listened to her.
So just imagine. Just put yourself for a minute. Close your eyes. Put yourself in a world where in 1925, we had listened. We had said to industry, no.
You can't do that. Generations of Americans would have grown up with less heart attacks, less high blood pressure, less violence, smarter, making more, more creative, more harmonious, lower health care costs, less ADHD. In the lead free America that listened to Alice Hamilton, it's a more harmonious, productive, creative society. In our world, we have massive amounts of avoidable suffering, illness, disability, and death. The when we were growing up, the average level of lead was 15.
Dr. Mark Hyman
I know. In people's blood. In people's blood. Yeah. So so you're expecting that just because I and now I know what that means.
40 used to be the cutoff. Then it was 20. Now it's 10. And there's papers that show that even down Three
Tom Friedman
and a half. Down to three
Dr. Mark Hyman
and a down to one, you're seeing Yeah. Clinical effects on cognitive function in kids. Even down to one. This is exactly
Tom Friedman
And thirty nine percent of Americans have a level of over two. This is exactly what the prevention paradox shows, that these few people who had really high levels, like we had a terrible incident in Nigeria with seizures, four hundred kids died from acute lead poisoning, that's dramatic, but the bigger harm is lots of people having a low level of toxicity. But and it's gonna take public action to get rid of that. And and at Result to Save Lives, we're we're really engaged in trying to do this globally because you can talk about it, but we like to support societies to do something about it.
Dr. Mark Hyman
Yeah. I mean, this is the issue of toxins. This is, again, one of those invisible threats. Right? And it's it's also, again, a big industrial issue because we live in an industrialized world, and we can't switch that off because we're all benefiting from it.
And and yet it's impacting our health. So from a public health perspective, you know, you've now you know, you've got, on the one hand, Bobby Kennedy talking about I mean, he was an environmental lawyer. He's the one who got the Hudson River cleaned up from the PCBs that g dumped in there and got them to pay over a billion dollars in, you know, reparations to fix it. You know, he's been fighting these fights for a long time on the environmental front, but, you know, now he's on the focus on the food and health issues, but the EPA doesn't wanna hear about the environmental issues. They don't wanna hear about glyphosate.
They don't wanna hear about atrazine. Mean, senator Grassley and a whole cohort of senators and congressmen wrote a letter to the MAHA commission saying, hey, guys. Pesticides are safe. Like, don't make a big deal about this. It's all hippie propaganda.
Like, forget about it. Focus on other stuff. And and I know in the back rooms, it was a big battle. It was a huge battle. You know, Lee Zeldin and, you know, the USDA secretary, Brooke Rollins, and Bobby Kennedy.
It was a it was a it was a despite. And so this is all industry, and, you know, we've got we've gotta face that. And as a society, how do we get Americans to wake up and say, no more? Like, just enough is enough.
Tom Friedman
See, believe, create. See, believe, create. See the harms that these toxins are causing. See the reason we're not taking action. See the pathway to progress to getting rid of them.
Believe we can make a difference. We got lead out of paint. We got lead out of gasoline. We got a lot of toxins out of our environment. It's not that we haven't made any progress.
Dr. Mark Hyman
Well, now we're increasing culprits.
Tom Friedman
We have new ones. You know, we have nanoparticles, which are really scary.
Dr. Mark Hyman
Microplastics. Yeah.
Tom Friedman
Microplastics, endocrine disruptors. The microbiome, probably the greatest unknown in our society is like, what is actually inside of us? Right? And how do we change that and improve it other than some simple things like more fiber? But and then create a healthier future by analyzing who wins, who loses, figuring out those windows of opportunity where you can make progress on a specific issue.
I'm really discouraged that the current administration rolled back the PFAS law. Yeah. Right? Half of our water has PFAS. Those are forever chemicals.
Forever and everywhere. Right? They're forever and everywhere. You know, we really can make a lot of progress. There are things that seem like they're inevitable, but they're not.
We've made progress before. Smallpox is gone. Yeah. Right? Typhoid is gone.
And I think if we take the right actions, heart attacks and strokes can be gone as well.
Dr. Mark Hyman
But nobody's making millions of dollars from typhoid or smallpox. Right? People are making trillions of dollars from the food industry. It's the single biggest industry on the planet, employs more people than anybody else on the planet. Everybody eats.
It's like $1,516,000,000,000,000 dollars. It's a massive
Tom Friedman
I made that point. I got into trouble making that point.
Dr. Mark Hyman
I'm like, you
Tom Friedman
know When I became health commissioner in New York City, had been working on tuberculosis for a decade. And I said, for the last decade, my enemy has been a microbe, mycobacterium tuberculosis. Now it's a really low life form, the tobacco executive. And I got a letter from Philip Morris. I still have it.
It says this is a form of hate speech Yeah. Because no human being should be described as less than human. And, you know, I had to admit they were right. So ever since then, I don't use that phrase. I just say that they're mass murderers.
Dr. Mark Hyman
Society. Mass murderers. That's good.
Tom Friedman
They haven't written again. That's good.
Dr. Mark Hyman
That's good. I I got a letter from the corn refiners of America berating me for actually talking about high fructose corn syrup. It was really interesting. And it was really hysterical because then the sugar association called me up and said, hey. Would you testify on our behalf?
Because you know, I'm like, no. Get off we'll pay a half a million dollars. No. Go away. Literally.
Literally. I'm like
Tom Friedman
When I was CDC director, we got a directive from congress to study the marketing of unhealthy food to children along with three other agents CDC and three other agencies. And then the food industry spent, according to reports, at least a $175,000,000 lobbying congress, and we got another letter from congress saying, you will not write that report.
Dr. Mark Hyman
Yeah. It's it's crazy. So congress told the CDC not to write a scientific report because of hun 100 plus million dollars that the industry spent to
Tom Friedman
They they, you know, they couched it in other language, but that's essentially what it was. We had one year where the budget bill had in it a writer that said the CDC can't recommend that people consume less sodium. You have to study it, but the group that studies it can't be anyone who knows anything about
Dr. Mark Hyman
sodium. You can't make this stuff up. Well, what you just said is really important because, you know, the the continuous trope of industry is, you know, we don't know. There's not enough science. We need more science.
We need to study this. We can't make any decisions. Just like the tobacco industry. Right. That's exactly what talking That's why I'm bringing it up.
So what do you say to that?
Tom Friedman
There are certain things that we're certain of, and for those, we need to take action. And I agree. There are others that we're not so sure. Mhmm. But PFAS isn't good for you.
Right? Sugar isn't good for you.
Dr. Mark Hyman
And I wanted to say this I wanna say to Senator Grassley, here's a glass of Atrazine. Just enjoy. You know? Here's a glass. You can you can have a combo package with the glyphosate and the atrazine.
You enjoy those, senator Grassley. I'm like I mean, I get he's from Iowa, and he's gotta protect the farmers, but the farmers are also not happy. The farmers are, you know, struggling. There are more suicides than farmers than any other subpopulation in America. They're they're making incredibly small amounts of money or losing money.
They're they're not actually healthy because they're affected by all the chemicals they're using, and their diseases and Parkinson's is the number one, you know, group that has Parkinson's disease. And and they wanna change. They wanna do different practices, but they're stuck.
Tom Friedman
If you think this
Dr. Mark Hyman
is Sorry. I get all I get all hyped up.
Tom Friedman
Well, I'll tell you. If you think this is bad in The US, we work globally.
Dr. Mark Hyman
Oh, it's terrible. Yeah.
Tom Friedman
Yeah. What the industry does globally is even worse. Made it in America, we're gonna ship it overseas. Right? Well, they pay off the government very openly.
They buy out the news media and put stuff in as if it's news articles. They pay farmers to grow stuff so that there will be a lobby against reducing tobacco or alcohol or or sugar consumption. Even if they're not gonna buy that, they have contract farmers who are not making any money from that and are getting really sick from tobacco and other products. But, you know, I remain optimistic because, ultimately, one of the things we can see, one of the things that we can reveal is what industry is really doing, what the profit motive is doing. And and you see some, you know, accusations about different groups.
Well, what's really happening is, yeah, there's a lot of money behind pushing stuff that's very unhealthy, tobacco, alcohol, unsafe food, unsafe chemicals in our environment, and people wanna be healthy. I And don't think that's a Democratic or Republican issue. I don't think it's a right or left issue. It's about health or sickness. It's about fact or fiction.
Dr. Mark Hyman
It's so important. I mean, we have a lot of work to do. A lot of work to do. And I think, you know, your message in your book, the formula for better health, which definitely should be on everybody's reading list, and you can get a copy now wherever it's out, is, you know, we can't ignore this anymore. And and it's it's gotten to a point where, you know, we we have to take this on as a society just as we took on slavery, as we took I mean, when you think about slavery, maybe it's a bad analogy, but, you know, the entire economy was based on slavery, and then it stopped.
And then the different forms of sort of quasi slavery, they persisted afterwards, but it was basically stopped. And America went on, and industry recalibrated, and we figured it out. You know? And I feel like it's kind of that moment where we're being enslaved by the food system that is producing foods that are killing us en masse, and and it's almost an invisible problem.
Tom Friedman
One of the aspects of the formula is to strengthen our belief in the possibility of change. And I think one way we do that is by recognizing the progress that we've made in the past, whether it's progress in tobacco or progress in other areas getting some toxins out of our environment. I think sometimes public health folks and and and others are really reluctant to recognize past progress because they think it's a way of saying mission accomplished, foot off the accelerator, everything's fine. No. I think it should give you more impetus, more energy to do more.
Another way to strengthen belief is to make small steps. What concerns me about some of the stuff going on today is that a lot of the diagnosis is pretty good. Yeah. We have a big problem with nutrition. We have a big problem with obesity.
But the prescription is tell people to eat healthy or, you know, switch to regular sugar instead of high fructose more. Or or even the food additives. You know, it's good to get them out, but this is not going to move the needle. The things that will move the needle are the policy levers, whether it's on soda tax or clear warning labels or low sodium activities or getting unhealthy food off public property, including food government and schools and other areas. So I think making steady progress is really important.
We don't just throw up our hands and say, oh, there's nothing we can do about it. There is something we can do about it.
Dr. Mark Hyman
I one of the greatest things that could happen, and I love your opinion on this, is we spend the government itself is the single biggest funder of of health care. And and through all the different programs, the Department of Defense, the VA, Medicare, medic I mean, it's called I mean, health service across everything. They're they're funding 40% of the population's health care in some way or another, and they're paying almost $2,000,000,000,000 of the almost $5,000,000,000,000 health care bill every year. If we took 1,000,000,000 of that trillion dollars and we did rigorous research showing the harms of ultra processed food, the harms of sugar and starch in a way that that could change minds and change you know, make the evidence so clear kinda like with tobacco, I feel like that could start to to kinda be a force that could start to shift the policies. Because right now, it's like, oh, there's lack of evidence.
I mean, even the the dietary guidelines committee, when they looked at ultra processed food data, they were like, well, you can't really say it affects weight. There's one study here, one study there, not enough evidence, blah blah blah. And the what I always say, and I stole this from somebody, I forget who, is the absence of evidence is not the evidence of absence. And and I think this is where we can lean in as a government to start to fund at a at a scale that we're funding a lot of other things that are way downstream from these problems.
Tom Friedman
So I would say two things about that. First is there are certain things that we do know already. Right? We know that we should be consuming less sodium, less sugar, and we know some of the ways we could implement programs that would make that happen. More fiber, more fruit and vegetables.
We don't need a new study to show us that. The second thing is if you're thinking about The US health care system, I really think we should focus on primary health care. A 100,000,000 Americans don't have primary health care. And it's really important, whether it's to interpret the evidence for you or to give you good care or to make sure you get the care you need. There's a lot of good care that Americans don't get, and it's not driven by pharma.
You know? Just to be clear, neither I nor my group have ever taken money from pharma nor will we ever, but and the medicines we recommend are all generic, low cost. But there's just no excuse for this country having a less than 50% blood pressure control rate, and that's to one forty, let alone one thirty or even lower. And that's a lot of suffering. More than a half a million deaths a year in this country.
About forty percent of them, people 70, because their blood pressures aren't controlled. We need to do much better at what we know how to do. And, yeah, let's learn more about other things as well.
Dr. Mark Hyman
It's personal for me too. My grandma had high blood pressure, and she had a stroke. You know? I feel like with this with this huge inflection point now in health. In America, globally, kind of the the cat's out of the bag, the invisible has become visible, and I think there's political will to change things here and around the world.
I see it increasingly happen. You you and I are about the same age, it's been slow, but it's sort of like having slow, slow, slow, then all at once. It feels like that moment. I don't know if it'll be a passing moment, but it it feels like it's really important. And I think your work in the formula for better health and the the framework of how to save millions of lives in your own, including your own, is really important.
And and there's some simple things that you talk about in your book that are foundational, that we say over and over, but that are real. One of the things I thought was interesting that you brought up in your book that we didn't talk about was b twelve as a intervention, not lowering salt, not lowering sugar. It's something you add. And also, was surprised to see that you wrote about it in a way that said even if your levels are, quote, normal, there may be a benefit to increasing the amount. So can you just talk a little bit about that?
Because I think that was a that was a little bit of an for me.
Tom Friedman
Yeah. There are some lab tests that are not perfect. We still have a lot to learn about lipids, vitamin d, and b twelve. Even the very sophisticated lab tests for it can miss subtle deficiency.
Dr. Mark Hyman
You mean meth methylmalonic acid? Yes. Yes. Which is a big word, but it's sort of a way of looking at metabolite of b twelve. And if b twelve is adequate, it's lower.
And if it's not adequate, it's higher.
Tom Friedman
I think of two, you know, ways two vectors, if you will. How certain are we about something? How big is the benefit? And how hard is it to do? So when it comes to vitamin b twelve, to take that as an example, I'm not sure that taking vitamin b twelve will help, but it's not gonna hurt.
It costs, you know, pennies a pill. And it might help, and it might even help a lot. And you really have no way to know if you're deficient. Help what? It might help reduce dementia.
Because b twelve issues. May. May as well. Just like you know, potassium also, low potassium is associated with fatigue. So you get enough potassium, you're you may feel more energetic.
You'll certainly live longer, but you may feel more energetic for those years as well. There's this misconception that healthy stuff makes you feel bad, that you have to deny yourself pleasures. It's just the opposite.
Dr. Mark Hyman
I'm a hedonist. Trust me. I like all the pleasures.
Tom Friedman
Hate is an example of something. I take it every day, because it might help, can't hurt, relatively reasonable, straightforward. I have to say, you know, one of the brands I was using, I got back from a long trip. I traveled around the world a lot, and it smelled off. It's like, woah.
That's a bad form of quality control, so I don't use that brand anymore. But remember, congress has prevented the FDA from regulating additives and vitamins, and that's a real problem. So we have no way of knowing which company is more reliable.
Dr. Mark Hyman
Yeah. Yeah. It's true. Yeah. And by the way, a lot of people will take b twelve, and then the doctor will check for eleven.
They'll see they're really high, and they'll go, oh, you're toxic from b twelve. It's a water soluble vitamin, and you're trying if you take it without folic or folic acid or folate, you can get problems.
Tom Friedman
You can yeah. You can mask an anemia. Yeah. But but it's basically another you know, it's not just about diet. When the CDC discovered that folate deficiency causes birth defects, really severe neural tube birth defects, and got a mandate for some of our flour to be fortified, that prevents about a thousand severe birth defects a year, saves hundreds of millions of dollars.
And you don't have to change. No. That's the that's the sweet spot of public health.
Dr. Mark Hyman
Oh my god. But, Tom, Tom, I I I 100% agree with you. And I had a conversation with someone in government recently, which was like, you know, we want to really reduce the amount of refined flour. The dietary guidelines, it has to be something that we can't just say eat half of your grains as whole grains. Like, having half of your grain intake as ultra processed, highly pulverized, high glycemic, metabolically chaotic white flour is not a good idea.
And they're like, well, there's, like, all these unintended consequences because people get their folic acid in flour. And I'm like, that that yeah. Yes. We we we impoverished our food, so we had to enrich it, but let's figure out a different solution. Because, like, saying we can't say to reduce our flour intake because there's vitamins in it that were put in after the fact doesn't make sense.
Tom Friedman
And here's a really important point, and and it's something that that happened on my watch that wasn't right. Right? So don't try voluntary measures with the food industry. They don't work. No.
Of course not.
Dr. Mark Hyman
Oh, we're gonna lower our calorie. We're gonna
Tom Friedman
lower your We we worked with the corn masa flour producers, and for whatever reason, it was a voluntary action. No difference. Yeah. There's a large part of the population consumes corn masa flour. Hispanics, they continue to have folate deficiency.
They continue to have birth defects from it. That needs to be mandatory. So if you wanna make a change, force it to happen.
Dr. Mark Hyman
Yeah. A 100%. You're talking about primary care, and I'm a family doctor. I'm a primary care doctor. I trained in Santa Rosa Hospital.
There were only family doctors. Did community medicine. Worked in a small town in Idaho with 3,500 people, family doctor. There was one drunk surgeon, a few family doctors, did everything. I get primary care.
I work in inner city hospitals. I understand it. And and what's true is that, yes, people need access to good quality primary care, but we're gonna be a 100 and, I think, 32,000 physicians short by 2030 in America. And that's concerning. And globally, it's even more, a shortage of physicians, nurses, health care providers.
And we're we're at this interesting moment in in the sort of intersection between technology, AI, and medicine and health care where it seems as though early the early indicators are that actually AI can do as good or better a job in assessing and treating people than actual primary care doctors or even specialists for that matter. So it it can never be done independent of health care, I don't think. It's not just like you throw AI in medicine and then forget about it. But but I I do think that there's this moment where we can start to reimagine how we deliver care at scale. I mean, telemedicine should be approved.
I don't know why we we rolled it back after COVID. It's only because the boards of registration medicine wanna make money in each state. There's no reason that your body changes from moving from, like, Arizona to Colorado or New York to New Jersey. It's like unlike the law, which changes, your body doesn't change. And and and second, like, we we could deploy at scale a tech solution that is has embedded within protections, but still guides people for a lot of the issues that they have and and provides almost better quality answers.
And I know I'm, you know, I'm a 40 well, I don't know how many years now. Like a forty something three year I don't know. I'm not good at math, but a lot of years of that being a doctor. And and, you know, I feel like I'm well trained and well experienced, and there's still so much I don't know. And so when I see a patient now, I'm like, I just I don't think I can remember da da da da.
And I kinda look it up, and I'm like, wow. I just got so much smarter about how to take care of this patient. And it's really it's not making this even for me, but it's actually like like a it's like a it's like a rocket booster on my medical practice.
Tom Friedman
I think there are three things we have to do to really transform health care to make it work for people. One is change the financial model so that primary care pays. Right now, a primary care doctor who does wonderful work for twenty years will make less than half what a surgeon who graduated yesterday makes.
Dr. Mark Hyman
A 100%.
Tom Friedman
That's ridiculous.
Dr. Mark Hyman
Oh, it's crazy.
Tom Friedman
That's ridiculous. And so we need to change so that primary care pays, and it pays to keep you healthy. That's what works at Kaiser Permanente. If they keep you healthy, they make more money. In the rest of the health care system, if you have a heart attack or stroke, they make more money.
We have to change that. The second thing is teams. Nurses kind of talking
Dr. Mark Hyman
about either accountable care organizations, single payer system.
Tom Friedman
Single payer is a nonstarter in this country, but some way of making everyone
Dr. Mark Hyman
Value based health care.
Tom Friedman
You know, a lot of stuff that says it's value based isn't value based. It's changing the incentive. Another approach is what's called total cost of care, which says if you drive down the costs, you're gonna share in some of those
Dr. Mark Hyman
The shared savings model.
Tom Friedman
Yeah. So that that's a but you have to guard against cheating. It's complicated stuff. So fix the financial model is one. Second is teams.
Nurses, nurse practitioners, social workers, outreach workers. Really important. And that includes telemedicine.
Dr. Mark Hyman
A million community health workers. Absolutely. A lot to help our country.
Tom Friedman
It includes telemedicine. I think very little good came out of COVID, but telemedicine really did make a leap forward, and we need to use it because it gives people access. And, you know, one other team member is AI. AI is I gotta say, it blows me away. It is awesome.
There are topics that I know cold, and it knows them better.
Dr. Mark Hyman
A 100. I'm like, wow. I thought I was pretty good at that. Yeah. And I'm like and
Tom Friedman
it's you know, the the open evidence is really impressive. I use it every single day. And, you know, the only problem is if it's a you know, I'm checking on somebody who's being treated by another doctor, and it knows better. It's very awkward to say, you know, actually,
Dr. Mark Hyman
your dose is wrong
Tom Friedman
of that. So I I do think that this will make it possible to give better care to more people for less money, but we still need to fix the finances and to have a whole team to do it. Because the nurse is gonna be better at talking to the patients. The nurse practitioner is gonna go to places the doctor is not gonna go to. You do need some hands on care.
But I do think AI is not just awesomely good. It gets better every day in a way that's just astonishing.
Dr. Mark Hyman
I love this conversation. I could go on for hours. I just wanna sort of sum up what you're saying, which is the core of your message, which is changing health in America and globally really com is comprised of three things. One is addressing the public health crises, addressing the care model, and empowering the individual.
Tom Friedman
Yes.
Dr. Mark Hyman
And and I would also say the individual can also work to change the policy because they're the ones who are members who listened to. The reason RFK got confirmed was because senator Cassidy had 200,000 phone calls to his office because people spoke up. So people have more power than they think with their voice and their vote, and they can vote with their fork and their voice and their every way that you can vote is important. And I think that's kind of in a message that's empowering. I think we can we can kind of agree on that.
Tom Friedman
You know, it's it's actually how I what I discuss at the toward the end of the book about personal politics. If you just take the the four or five healthiest habits, less than five percent of Americans have them. Less than five percent of our kids are gonna have them. And it's not just about willpower. We can encourage you to be healthier and eat healthier, but it's in your self interest to get policies changed, whether it's at a community, walkable streets and bicycle paths, they work, whether it's at the state level trying to get tobacco and alcohol and soda taxes through, whether it's at the national level to regulate some of the things that really would make a difference and get menthol out of cigarettes.
The personal has a lot to do with not just what you can do in your own life, but what you can do in your community so that you, your family, and all of us can live a longer healthier life.
Dr. Mark Hyman
I think there might be one more piece to your your puzzle. It's like a three legged soul, can make it four legged, is litigation. Because that's worked. It worked for GE in the Hudson River. It worked for it's worked for glyphosate.
It's worked for tobacco. I think, you know It's one of the tools.
Tom Friedman
It's one
Dr. Mark Hyman
of tools that we can
Tom Friedman
use to to push for progress. There are other tools as well, building coalitions, building movements, communicating effectively, showing where there's progress, and using that progress to encourage other groups to make similar progress, documenting harms that are happening. We have to keep in mind that there really is a common good, that it's not all win lose. There are some win win things. If we improve health for everyone, we'll have a more productive society.
If other countries are less likely to have disease outbreaks, we'll have more customers. We'll have cheaper goods. We'll have better ability to thrive.
Dr. Mark Hyman
Yeah. Health is a good it's a good metric for the world at so many levels. So, Tom, thank you for your life's work, for being an inspiration to me early on as I look to how do we get out of this mess that I'm seeing in my clinic because I realized I couldn't cure diabetes in my clinic, and for staying at it. And and with your resolve to save lives for continuing, you know, people can support it. It's a nonprofit.
I think your work is really important, and everybody should get your book, The Formula for Better Health, How to Save Millions of Lives, including your own. Thank you so much for coming to Austin and being on the podcast and giving me the chance to meet one of my heroes. So thank you.
Tom Friedman
So nice of you, Mark. It's great conversation. I've learned from it. And just to be clear, I don't make a penny from the book. Any proceeds will go to groups we work with around the world to advance health products.
Dr. Mark Hyman
Okay. So we'll buy 10 books then.
Tom Friedman
Thank you so much.
Dr. Mark Hyman
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