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June 21, 2025 - Conspirituality

36:41

Brief: MAHA Mass Casualty Horizon

What dangers does an RFK Jr HHS pose to Americans, really? Derek dives into science writer's Laurie Garrett's work, who spoke to the dangers we're facing today in 1994—and who has raised an alarm about the consequences of destroying public health ever since. Show Notes The Coming Plague — Laurie Garrett Betrayal of Trust — Laurie Garrett Laurie Garrett on This Week in Virology Learn more about your ad choices. Visit megaphone.fm/adchoices

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	I'm Nomi Frye.
	I'm Vincent Cunningham.
	I'm Alex Schwartz, and we are Critics at Large, a podcast from The New Yorker.
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	Do you feel like life just keeps getting more out of control?
	Like, do you regularly come across something that is terrifying or enraging, but you don't even understand what's happening?
	Are you frequently wondering if what you're coming across is even real?
	Well, there's a show that definitely can't make things better, but it can at least explain why we are all losing our minds.
	On Panic World, internet culture writer Ryan Broderick from The Garbage Day newsletter breaks down how the internet warps our minds We'll let you laugh at the chaos running the world.
	Whether it's the Tide Pod Challenge, what happened to Kanye, or the secret playbook to Kill Me Too, Panic World gives you answers to the questions you wish you didn't need to ask.
	Check out Panic World wherever you get your podcasts.
	The problem that we face ultimately is that public health is a very timid profession.
	Very timid.
	It rests on an army of skilled personnel who, for the most part, have thankless jobs that involve protecting hundreds of thousands of people at once.
	So it's really quite extraordinary.
	An MD in their life.
	Let's say a cardiac surgeon in his or her life might save, I don't know, 500 lives, maybe 10,000 lives.
	They have a super high productivity medical setting.
	A person with only a master's degree in public health that knows how to do their job with water sanitation may save hundreds of millions of lives in their lifetime.
	But we skew the power and the funding and the respect towards that cardiac surgeon, not towards the poor schmuck that sits in the windowless office making sure that every time I drink from my tap, this is safe.
	Maybe we need more odes to schmucks.
	Maybe the reason that wellness influencers are actually so healthy is,
	You just heard science journalist Lori Garrett, and she was talking to the podcast This Week in Virology on June 27th, 2021.
	And throughout her decades of work, Garrett was talking to the podcast This Week in Virology on June 27th, 2021.
	Garrett has warned that humanity is on the brink of a global health catastrophe.
	Now, you might be surprised to learn that the causes are not food dyes, seed oils, or vaccines.
	Rather, having devoted her life to studying and writing about public health, Garrett recognized that widening disparities between industrialized and developing nations and the unequal distribution of public health and disease prevention benefits are the drivers of public health crises.
	She describes the threat as a river of microbes and threatening pathogens that can only be kept at bay with a global, robust public health infrastructure.
	And such a task doesn't only rely on scientific processes.
	She includes politics, sociology, economics, religion, philosophy, and psychology.
	which we're going to get to near the end of this episode, all as factors in creating that infrastructure.
	I've been reading Garrett for a few years, and I want to unpack some of her ideas today, especially in the context of what's going on in America.
	Now, Garrett writes that globalization, though it does bring economic and cultural opportunities in tow, Interestingly, she writes that panic itself has become a new terrorist tool, maybe we can say a domestic terrorist tool, and it can potentially lead to a societal breakdown.
	Throughout her work, she notes that things like biological terrorism such as using anthrax or smallpox as weapons capable of killing millions of people would be far more complex to combat than chemical or explosive attacks.
	What if that terror is actually coming from within right now?
	What if the smallpox attack isn't from a foreign agent?
	But a far more dangerous enemy, the leaders of the American public health apparatus.
	Considering they are now beholden to deranged conspiracy theories, what if they let smallpox spread unchecked due to their decades of anti-vax fear-mongering?
	We sort of have a use case going on right now with measles.
	I know it's not a pandemic, but it's kind of signaling what's to come.
	I'm not even sure that Garrett could have foreseen an RFK Jr. leading the HHS when she wrote her two books.
	You have The Coming Plague, Newly Emerging Diseases in a World Out of Balance.
	That's from 1994.
	And you have Betrayal of Trust, The Collapse of Global Public Health.
	And that's from the year 2000.
	Her personal focus has been Ebola.
	She was awarded a Pulitzer Prize in 1996 for a series of articles she wrote chronicling an outbreak in Zaire.
	Her work took on new relevance in 2020 with COVID-19.
	I first learned about Lori's work in 2017 when I read a book called Warnings, Finding Cassandras to Stop Catastrophes, and that was written by Richard Clark and R.P. Eddy.
	You may have remembered, if you're a long-time listener, that I interviewed R.P. very early on in Conspirituality.
	I talked to him for my old podcast, Earthrise, in 2017 or 2018 after the book came out.
	And I specifically asked him back onto Conspirituality to discuss the chapter on pandemics and Lori's work.
	Now again, that's 2017.
	Her work is 1994, and in 2020, we're seeing all of this manifest.
	There's a quote from Warnings that's pertinent to today's episode as well.
	Garrett, quote, laments that in public health you never get credit for correctly predicting an outbreak because implementing effective countermeasures blunts the impact of the disease, leading critics to believe that you exaggerated the threats.
	I say this often.
	These fucking wellness influencers talk about preventive medicine all the time and then they try to sell you a whole range of things that we don't know whether the fuck they're preventive or not.
	But we have preventive medicine that we know works.
	We have vaccines.
	We have fluoridated water.
	Everything that actually has been shown to work, they are against because that takes money out of their bottom line.
	And isn't that ironic that the fact that likely they're healthy are due to those measures and now they're shitting on them?
	That is, in a nutshell, why I have so many problems with what influencers do.
	I meet people all the time or people DM me asking about supplements.
	I have nothing inherently against supplements.
	As I've said often, I take a few of them that have been shown anecdotally to work for me for what I need them to do.
	It's the health promises.
	It's the demonization of the healthcare system.
	The wrong demonization.
	Not the fact that it's for profit.
	Not the fact that we can't get socialized medicine in America, which is a really big problem with our healthcare system.
	They target doctors, they target nurses, they target researchers, they target vaccinologists.
	They focus on all the wrong things.
	Lori Garrett has spent her life focusing on the right thing, the invisible thing, the schmucks.
	The public health system.
	But public health is boring.
	If it's working, you don't know it's there.
	That's because it's predictive and proactive.
	The things that the fucking wellness influencers claim that they are.
	But those are qualities that humans are generally terrible at.
	If we predicted better, we wouldn't have a gambling industry.
	It wouldn't be so lucrative.
	If we were more proactive, We as animals are much more suited for reactivity.
	And we usually write narratives that suit our beliefs only after the fact.
	Public health as a discipline, as a practice, it's an attempt to write those narratives before tragedy strikes so that we never have to experience them in the first place.
	And yet.
	Tragedy appears imminent right now.
	I was on QAnon Anonymous, long-time listener.
	There's a lot of crossover between our podcasts.
	They've been on our podcast.
	We've been on theirs.
	But Travis asked me to come on to discuss RFK Jr. recently.
	So I was on about two weeks ago.
	And Matthew, my colleague here at Conspirituality, he heard the episode.
	And he was kind of surprised that I made a prediction at the end.
	The hosts ask me what I thought an RFK Jr.
	HHS would lead to.
	I'm generally conservative when it comes to predictions, but honestly, this one doesn't seem like much of a prediction at all.
	If you spend decades belittling and demonizing evidence-based medicine while you're monetizing the fruits of your misinformation, and then...
	What the fuck else is going to happen but tragedy?
	Matthew suggested I explore this topic in a little more depth, and when I thought about it, Laurie Garrett's work immediately came to mind.
	This Conspirituality Brief is called Maha Mass Casualty Horizon.
	That's Matthew's term.
	I kept it.
	I love it.
	And I'm going to pull from Lori's two books because I want to better understand the warning signs of coming plagues and how a country should prepare for imminent disaster.
	And I'm going to give you a spoiler alert right now.
	Robert F. Kennedy Jr. and his entire Maha coalition is doing the exact opposite of that.
	Still, we should know how to prepare.
	As always, you can find us on Instagram and threads at ConspiritualityPod.
	We are all individually on Blue Sky.
	And if you have the means to support us as independent media creators who spend way too much time listening to these and doing this work, that would be wonderful.
	We're on Patreon and Apple Podcasts.
	Let's get into it.
	You know, I have to say, I thought maybe I was nuts.
	You know, maybe it was just me being alarmist or something that I was seeing trends in the virus world that looked distressing.
	And that, because I was surrounded by the messaging that was the opposite, that, you know, it's all about cancer now.
	There's no reason to worry about these infectious diseases, but I had lived in Africa.
	We had seen up close and personal on multiple treks all over sub-Saharan Africa what measles was doing.
	All these things that we thought were no big deal back in the USA were ravaging populations, especially children.
	And that there was this whole background of mortality that was never diagnosed.
	What was that virus?
	What was that bacterium?
	Nobody knew.
	Nobody bothered to look and nobody had the capacity and the laboratories to do the work because all the money was skewed to other parts of the planet.
	That part about not paying attention to infectious diseases, she's talking about her fieldwork in the 1990s.
	Does that ring a bell?
	Kennedy wants to stop or pause infectious disease research to focus on chronic diseases.
	Never seeming to understand that sometimes infectious diseases become chronic diseases.
	That last part that Garrett was talking about, about the rich versus developing nations, that plays a big role when you think about health broadly, when you think about global health especially, because it's not like we live in silos.
	We interact with one another on a global level.
	And so if we're not taking care of the people most in need, that will come to affect us in some capacity.
	And that's our first warning sign.
	I'm going to talk about a few of the signs and talk about how they relate, although a bit obvious if you've been paying attention to what Maha is doing.
	But the widening health disparities and neglect.
	is her first warning sign.
	And that is the widening gap between the health and well-being between richer and poorer nations and the unequal distribution of public health benefits.
	They often signal a crisis like Ebola, which she writes about in part of her first book, which became its own series for which she won a Pulitzer.
	I looked into the data Comparing today to 1994.
	And some health disparities between richer and poorer nations have actually narrowed, which is a good thing.
	Those two disparities are child mortality and life expectancy.
	Significant gaps still persist and in many cases inequities within countries are widening.
	But what makes it worse is that global progress has not been sufficient enough to meet the targets for creating health equity.
	And in those, it seems to be getting worse.
	As of 2021, low-income countries still face child mortality rates more than 10 times higher than higher-income nations.
	And 94% of maternal deaths still occur in low and low-middle-income countries.
	And even within those countries, it's the disadvantaged groups that are at much higher risk.
	What has gotten worse?
	Well, in terms of life expectancy, people who are born in countries with the lowest life expectancy, even though it's narrowed a bit, They still live, on average, 33 fewer years than the highest.
	So you have to remember when Kennedy comes on and says, America, life, health, expectancy, it's not great.
	It's dropped, and that is true, and it has corrected a bit since COVID.
	He's comparing it only to developed nations.
	That's a caveat he never really likes to discuss because he doesn't discuss economics or finances or the social determinants ever at all.
	Healthy life expectancy rates.
	So that's how healthy are you throughout the range of expected rates that you have.
	They've also widened.
	And the social determinants within countries are growing worse.
	And this very much includes America as well.
	Next up, she writes that a big warning sign is infrastructure collapse and deterioration.
	She points to the collapse of public health systems in former Soviet socialist republics.
	Tuberculosis came back and was exacerbated by economic instability and poor diet and alcohol consumption.
	She writes, and this is, again, back in 1994, that the American public health system struggles due to inadequate regulatory staff for food and water safety.
	And public health programs, she writes, are, quote, allowed to wither in an age of anti-governmentalism.
	Again, I can't express this is 1994.
	As I'm reading this book, Now, if you consider infrastructure collapse, let's look at what's going on right now.
	So the 2026 budget request that Trump is trying to ram through Congress right now, I recently covered on my bonus episode, Jay Bhattacharya, and the way he tried to wiggle his way out of the proposed budget for the NIH.
	Well, this is what's happening.
	The CDC is facing a proposed cut of 44% from $9.2 to $5.2 billion.
	The NIH would see a 40% reduction from $47 to $27 billion.
	Overall, the HHS would be cut by 34%.
	Now, direct federal support for public health has already been cut by $11 billion.
	There's been 20,000 jobs that have been lost because of the public health.
	Specifically, this budget proposes deep reductions or eliminations for a number of public health programs.
	That address HIV and AIDS, tuberculosis, malaria, maternal and child health, family planning, nutrition, that fucking thing that that's all they talk about, but they're actually cutting nutrition programs, and global health security.
	Oh, back to nutrition for a moment.
	The food pyramid hasn't been around since 2011.
	You have Macri going on TV talking about how they're going to get rid of the food pyramid when it's been gone for 14 fucking years.
	Do they not think that people have Google or whatever chatbot you use for your search now to figure these things out?
	MyPlate has been in existence since then.
	And what Kennedy is proposing is basically just my plate.
	So, great job.
	Doing a lot of really good work here.
	This, as bad as it is under Kennedy, it reflects a long-term trend.
	Because over these past two decades...
	So we weren't investing in public health before, and now we're barely investing in it.
	That is a huge warning sign that Garrett warned about.
	A few other warning signs Garrett warns about are lack of preparedness and expertise because officials often downplay outbreaks.
	When have we seen that happen recently?
	There's a lack of expertise at the agencies.
	Hello?
	There's an insufficient stockpile of vaccines.
	A major weakness she points to is the decline in commitment to tropical diseases research and control in North America and Europe.
	And guess what?
	Looking over the current proposed budget for 2026, the amount of tropical disease research continues to decline.
	Finally, Garrett talks about social and political factors and...
	She writes about the vague and often contradictory nature of information from overseas, which she says hinders effective responses.
	We did see some of that during COVID.
	The lack of trust in government and health authorities, which she writes in 1994, that it fuels panic and conspiracy theories.
	Do you think so?
	Bigotry and community resistance which blinds health leaders to the urgency of problems like perhaps measles.
	Garrett specifically writes about how homosexuals and drug users were demonized during the AIDS epidemic.
	We're seeing that sort of mindset happen with That link is pretty clear to me.
	And finally, she writes about how societies follow a pattern of denial, fear, and then repression when they're faced with epidemics.
	Going back a bit to the demonization aspect, I want to look into Garrett's keen observations about society at large, which she wrote about in The Coming Plague.
	With the initial emergence of the microbe, she found evidence of denial in all tiers of society, and the tendency was to actually ignore the microbial threat, the disease, the virus, or only to assume that they, which she notes as some distinct subpopulation of the society, were really at risk.
	The microbes exploited such denial and it spread rapidly while humans made no attempts through either their personal or collective behaviors to block any of the avenues of transmission of the organisms.
	The second social epidemic, she notes, is fear.
	A biological epidemic suddenly shocks society out of its state of denial and then that led to a state of group terror.
	She writes about this in 14th century Europe, and specifically she notes that the timescale was very quick.
	Plague-infested rats arrive on town on a Tuesday, and then humans begin dying Thursday or Friday, and that led to a widespread panic by the middle of the following week.
	Now, what's the biggest threat?
	She writes about the problems with microbial adaptation, specifically the number of drug-resistant strains of viruses that our antibiotics can no longer counter.
	I started writing about this 15 years ago, and the fact that we're actually in worse shape now is even of greater concern.
	I don't have the exact numbers in front of me.
	Because as I'm reading through my notes for this episode, I just was reminded that in the 1960s and 70s, there was a lot of public investment in antibiotics.
	So you would have multiples coming out every year to help to combat any sorts of diseases.
	Now, because there's not a lot of money in Creating new antibiotics?
	Pharmaceutical companies just don't do it anymore.
	Now, this could be solved if our government actually invested in and either had the scientists work on it themselves or paid pharmaceutical companies to develop antibiotics.
	For Garrett, this is one of the biggest problems.
	We have preventable diseases, but we're not I don't expect Kennedy's HHS to make these sorts of investments because they've been fomenting distrust in pharmaceuticals as it is, except, of course, when it suits them.
	So if it's ivermectin, if it's hydroxychloroquine, if it's testosterone replacement theory, if for some of them it's Botox, all those pharmaceuticals How do nations prepare for plagues?
	As Garrett talked about in This Week in Virology, she was really hesitant to make predictions.
	But at some point, she realized that people kept asking her to do it and given her...
	She thinks that being prepared first and foremost is achievable, but you need political will.
	And her recommendations for that are multifaceted.
	So again, the global public health infrastructure It makes sense to try to get ahead of things.
	Now, considering Trump left the WHO, fuck all that because that ain't happening, but that is a top Garrett's prescriptive list.
	She also talks about a holistic approach.
	I mentioned this earlier.
	Health is not just about health.
	It's not just about exercise.
	It's not just about the food you put into your body.
	You have to consider environmentalism.
	You have to consider ecology.
	You have to consider economic development, cultural anthropology, parasitology, virology.
	She includes a list of dozens of things that have to be considered under the broader rubric of public health.
	Next up, vigilance and surveillance.
	You have to pay attention on a global level.
	The better your disease surveillance is, the more effective the infrastructure will be.
	Rapid response and stockpiling.
	This includes antibiotics, vaccines, and general medical supplies.
	Interagency coordination and trust.
	The U.S. ain't doing too good on that with other countries right now, but that is still quite necessary.
	Here's one she writes about public education and trust.
	Yeah, okay.
	And then she actually writes about addressing root causes.
	So, prevention of diseases means confronting homelessness.
	Confronting inadequate social services.
	And when I say confronting, I also mean working on them, spending money on them.
	Drug abuse is an issue.
	Anything that can help foster disease.
	She also notes that it means addressing human rights violation, poverty, and general human behavior because these all play a role in disease emergence.
	Last little story here.
	She specifically writes about the warning signs that she saw in US cities during the tuberculosis epidemic.
	I forgot about this because it was a long time ago, but in the late 80s, early 1990s, we had an epidemic of tuberculosis.
	The warning signs that she said were there for everyone to see included rising homelessness, fiscal reductions in social services, Complacency in the public health sector, rampant drug abuse, and increases in a number of other infectious diseases.
	The emergence of novel strains of drug-resistant tuberculosis was there for us to see, but as she writes, the warning fell on unhearing ears.
	Now, more recently, there was a notable tuberculosis outbreak in Kansas in 2024 with 67 active cases and 79 latent cases in the Kansas City area.
	Two people died from that.
	Now, that is not a huge outbreak, but again, given all the pieces we've been talking about today, we're seeing the warning signs shoved right in front of our face.
	Finally, in her work, She specifically writes about America's strengths and weaknesses.
	Again, this is 30 years ago, but I want to give it some oxygen and then think about how that plays into how we're faring now.
	We have a history of public health pioneers, people who really changed the course of history and understanding of science.
	That's a good thing.
	Really strong, globally renowned institutions like the CDC and the US Army Medical Research Institute.
	Those are good things.
	We'll see how long they last.
	We have an ability to mobilize resources in times of emergency.
	Sometimes, she notes specifically how reluctant the Reagan administration was to move on the AIDS crisis.
	Once it did start to move, it can happen quickly.
	We do see this.
	Sometimes when emergencies happen.
	The U.S. has demonstrated the capacity for rapid strategy development and implementation at local levels.
	She specifically notes that New York City had a response to the India plague scare that had preceded this book by a few years.
	And finally, the adoption of advanced scientific tools like PCR tests.
	Obviously, PCR tests played a huge role in COVID-19.
	On the good side, we are capable of these things.
	We'll see how they go in this HHS.
	Now, the weakness is, and these will definitely ring a bell, the anti-governmental sentiment and political interference.
	So you have the public perception of government and then you have the parties that are always fighting and refusing to work together.
	A lack of comprehensive national systems for disease detection and surveillance, which she says makes us pretty defenseless against nuclear weapons.
	I find this so fucking telling.
	Kennedy is threatening to remove federal funding from universities that do not train doctors in nutrition.
	But physicians aren't being trained in things that are far more important.
	And it's not that nutrition training isn't important.
	And as a number of doctors that I follow said, their programs do have nutrition training already in them.
	But I don't know how strong their infectious diseases and public health training is.
	I'm guessing not that strong.
	Garrett writes about weak links between medicine and public health broadly, which I think is really, really important to understand as well.
	We have a vulnerability to external threats.
	We mentioned tropical diseases a little bit earlier.
	We don't pay enough attention to them, at least at this moment.
	Yeah, you think so?
	For all the complaining that Maha does about the way that pharmaceutical companies operate and how they pay for clinical funding, which are then published in journals, yeah, it is a problem.
	The problem stems from the fact that the US government doesn't invest enough in that research and that we have a for-profit healthcare system.
	That's the fucking root cause.
	So if you start to solve that, all the problems you complain about, they magically go away.
	Garrett notes that in terms of bioterrorism, the U.S. is far, far short in detection and preparedness.
	That's not great.
	She writes about the risk of public health losing public trust.
	I'm just going to leave that right there.
	She admirably writes about the racial disparities in health outcomes because they've only gotten worse in the last 30 years.
	The aging scientific workforce and key public health labs, and that combined with budget freezes, is helping to take away our expertise.
	And finally, the overall healthcare financing system, which denies access to care for the vulnerable.
	And there's also...
	Again, the very thing that Maha screams about all the time but they don't actually invest in because they're so myopically focused on this inane, insane ideology, this cult of individualized health.
	That is not how public health operates.
	If you want a robust, healthy nation, you start with public health and it trickles down, I'll use their term, to the individual.
	And if we don't focus our energies there, things are never going to get better and we are not going to get healthier again or ever.
	And when tragedy strikes, when the mass casualty horizon is here, you just know that RFK Jr. and all his fucking cronies and all those Maha wellness influencers, they're going to find everything but themselves to blame.
	We still really don't want to talk about modes of transmission of disease that make us uncomfortable and force us to think about.
	Larger social issues.
	Look at COVID.
	Who really wants to get down and dirty about why African Americans are at special risk?

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