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Joined now by Dr. Anand Parikh.
He is Chief Medical Advisor for the Bipartisan Policy Center, formerly Deputy Assistant HHS Secretary for Health under George W. Bush and Obama administrations.
Dr. Parikh, welcome to the program.
Thank you.
Great to be here.
Tell us about the mission at the Bipartisan Policy Center and what you do there as chief medical advisor.
Yeah, so the Bipartisan Policy Center is a nonprofit organization founded in 2007 by four former Senate Majority Leaders, really to try to take the best points from both sides to promote health, security, and opportunity.
So we engage individuals on both sides of the aisle.
We tackle pressing issues, particularly ones that Congress is about to face, and we come up with expert analysis and recommendations for Congress.
I provide both the clinical as well as the public health expertise for the organization.
So really on the healthcare side as chief medical advisor.
You wrote a book called Prevention First, Policymaking for a Healthier America.
The second edition is out now.
This sounds kind of obvious, but why has prevention not been a priority?
Why has American healthcare focused on the cures and the medications instead of preventing the illness in the first place?
Yeah, and that's important as well.
But, you know, maybe we live in a pretty reactive town here in Washington, D.C., where there's a crisis, it seems like, almost every single day or week.
Prevention demands you be proactive.
So it's a whole different mindset there.
In my experience, I've also seen policymakers not always understand the evidence behind prevention.
And if you don't, then you can certainly have misconceptions.
You can think of prevention as the nanny state.
Secondly, as you said, we have a sick care system still in our country.
We're trying to change that, but the incentives, how you make money, harder to make money on preventing illness than treating illness.
So those incentives need to change.
And then I've also noticed we don't really have a grassroots movement in this country really pushing prevention.
But at the end of the day, you know, my book, the chief thesis there, is that prevention ought to be our nation's top health policy priority.
And that's really because the majority of what afflicts us is actually preventable, and the majority of healthcare costs are also preventable.
President-elect Trump has picked RFK Jr. to head HHS.
Can you, you work there under several administrations.
Tell us about the extent of the agencies and the programs that would fall under his purview if he's confirmed.
Yeah, vast number of programs, hundreds of programs, 10 large agencies.
A lot of the three-letter acronyms that the public is familiar with, the FDA, Food and Drug Administration, the NIH, National Institutes of Health, the CDC, Centers for Disease Control and Prevention, Medicare, and Medicaid.
Those are just a couple of examples.
But 80,000 employees, majority of which are career civil servants, as you would expect.
So really a massive organization there that RFK is currently nominated to lead.
A couple of issues that RFK Jr. has brought up, and one of them that I want to ask you about is fluoride in the drinking water.
This is an AP report with this headline.
U.S. government report says fluoride at twice the recommended limit is linked to lower IQ in kids.
Break this down for us.
How do we know what is considered too high?
What's twice the recommended, like what do we know about the levels of fluoride in the drinking water now, what effect they might be having, and what they should be?
Yeah, so this is one of public health's greatest achievements in the 20th century, ensuring that our water has fluoride.
It's had tremendous impact in preventing oral cavities and promoting oral health.
The question now is: do we still need that fluoridation in our water, given that we can get fluoride from other sources?
And there are an array of studies out there.
Some are suggesting at higher doses than what we currently get in water, there can be potentially neurodevelopmental impacts, particularly in infants.
And I think that that's really the scientific issue here, where I think we want our scientific agencies like NIH and CDC and EPA to take a look at this.
But right now, our water is currently safe.
The dose of fluoride in the water is absolutely fine, and it is, as intended, reducing oral cavities and improving oral health.
And so, I mean, if that were to be taken out, what can we expect to see either among dental health or also these IQs and the allegation that these are lowering IQs in children?
Yeah, so again, the majority of these studies are using doses much higher than are currently what we drink in the water.
In terms of other jurisdictions around the country or in other countries that have said, you know what, we're not going to fluoridate anymore, many have seen increases in oral cavity infections, increased hospitalizations, health care costs as well.
So I think this is a study.
It's a complex issue that deserves, I would say, more study, probably not a day one knee-jerk blanket recommendation that we ought to stop fluoridating our country's water.
But those decisions are actually done at the local and state level.
They are not done at the federal level.
That is correct.
So if the federal government were to say, stop putting fluoride in the water, would anything happen?
Or would it just be a matter of people just saying, well, maybe this is dangerous.
Maybe we should ask our local officials to make a change.
Absolutely.
I think that's exactly what would happen.
And again, you wouldn't see that uniformity that we see.
And we don't see complete uniformity right now in the United States.
But yeah, you'd see jurisdictions then approaching it in many different ways.
And I think what we'd rather want is let's get the best scientists together and let's see where we're at.
Let's study this.
We are talking about health policy with Dr. Anand Paraik of the Bipartisan Policy Center.
If you'd like to join us, you can do so.
Our lines are bipartisan.
So Democrats, 202-748-8000.
Republicans, 202748-8001.
And Independents, 202-748-8002.
You can start calling in now.
I want to ask you about vaccines because Mr. Kennedy has been a skeptic on vaccines.
What's your take on that?
Yeah, I mean, I think this is going to come up in the confirmation hearings.
And I think you're going to hear it from both sides.
And I suspect there are going to be some threshold questions.
You know, do vaccines cause autism?
No.
Have childhood vaccines saved millions of lives?
Yes.
And Mr. Kennedy is going to have to be unequivocal on those statements.
And if not, I think he's going to get pushback again on both sides.
So first, he's got to say the correct things that are science-backed.
But then senators have to believe him because he's got a track record and a history of making these types of statements.
So I think it's going to be really interesting.
Let's see how the confirmation hearing goes.
I think it's perfectly fine for him to say, you know what, we spend a lot in terms of vaccine procurement and development.
Do we need to spend more on vaccine safety?
Are there some research questions there?
Do we need to better coordinate our vaccine surveillance systems?
I think all of those are fine points.
But if he starts questioning the basics in terms of what we know from a science perspective, I think he's going to have a hard time on both sides of the aisle.
The Kaiser Family Foundation reports that childhood vaccination rates continue to decline as Trump heads for a second term.
Why do you think childhood vaccination rates are falling?
You know, I think it's unfortunately some spillover effect from the COVID pandemic, and we know that that was a pandemic that was very much polarized.
But we're seeing, particularly for vaccines like measles, mumps, and rubella, in 14 states across the country, less than 90% of childhood kids taking these vaccines.
Why that matters is we are seeing more and more outbreaks across the country.
And science tells us that you need kind of about 95% of a vaccination rate to ensure there's herd immunity in a community.
So there are many people who can't be vaccinated.
So to protect them, it's important to keep that vaccination rate high.
I want to ask you about the COVID vaccine that has been on a lot of people's minds.
Dr. Deborah Burks served as the White House coronavirus response coordinator in the first Trump administration.
She was asked about concerns about RFK Jr.'s comments about that vaccine.
And here she is, and I'll have you respond to it.
So it's not good enough for us to just say vaccines don't cause autism.
It's us finding what is the cause of autism.
Well, I believe Burks would absolutely agree that it is ridiculous that there isn't a lot of research and established causation of autism.
But what he has said in the past is that autism is caused by vaccines.
And there's no scientific basis for that conclusion, as I understand it.
That's correct.
And so that's why when he talks about transparency, I'm actually excited that in a Senate hearing, he would bring forward his data and the questions that come from the senators would bring forth their data.
What I know for sure is he's a very smart man who can bring his data and his evidence base forward and we can have a discussion that many Americans believe already is a problem.
So, until we can have that transparency and that open discussion from both sides, I know the members have incredible staffers who will bring great questions from their constituents.
And that hearing would be a way for Americans to really see the data that you're talking about.
That we can't see that causation right now, but what is causing it?
And so, you're absolutely right.
Addressing what the cause is will be critical.
And I think what has confused people is we weren't clear about what COVID vaccines do and don't.
And so, now people are questioning, well, what do my childhood vaccines do and don't?
And they don't understand that some of the vaccines that their children are getting protect them from both disease and create herd immunity.
And some of them that they get are just for their child, like H flu and pneumovax to prevent their child from getting very serious illness.
What do you think, Dr. Parikh?
Yeah, no, I agree with Dr. Burks, agree with that dialogue.
You know, during the pandemic, we were learning as we were going.
And as the science changed, I don't think we always communicated well with the public to keep them up to speed.
They heard missed messages, and I think that that affected public trust.
But these are important things, and I think all of the topics that were raised really need to come out in this confirmation hearing.
HHS is a massive, massive department.
Can't really pick and choose what you work on.
You got to work on both chronic diseases and infectious diseases.
And so, let's see how Mr. Kennedy does.
One more question, and then we'll go to calls, and that's about drinking raw milk.
That's something that Mr. Kennedy has brought up.
Can you explain why do we pasteurize milk?
What are the risks?
What are the benefits of pasteurized versus raw milk?
Well, the main benefit is to reduce the risk of infectious disease transmission that could potentially occur in the milk.
Pasteurization heats the milk to such a degree that you're really reducing the potential of a microbe or an infectious disease to be transmitted.
Right now, that's important given the H5N1 avian influenza outbreak, particularly in dairy cattle, and therefore, the public health recommendations are that you not drink unpasteurized raw milk.
Are there any benefits, health benefits to raw milk that we might be missing out on by pasteurizing?
Yeah, it's a great question, and it's not an area that I'm an expert in, but particularly on the infectious disease side, it is pretty important.
All right, and here is Mary.
You're up first in Wisconsin on the line for Republicans.
Good morning.
Good morning.
This is Mary.
And, you know, that prefrontal cortex, the part of the brain that's the last to mature, is in the late 20s for boys and girls.
And prior to that development, the only thing important for them is peer relationships and societal acceptance.
And the part that seems to mature in the late 20s is responsible for decision-making.
They're trying to give puberty blockers to kids in their teens and early teens.
And those kids will get to their late 20s and say, why did you do this to me?
So we are taking it sort of an abuse society, taking advantage of kids to change their sex when they really don't even can't make that decision on their own.
So we should, as parents, all be informed about that so that we can help our children grow and be beautiful human beings that God wants us to be.
Dr. Perrick, what do you know about puberty blockers?
Yeah, well, I think this broader issue of gender identity is also going to come up during the confirmation hearings of RFK, and it was an issue during the presidential election as well.
And, you know, there are issues related to science.
There are issues related to families and culture here.
So there are an array of complicated issues here where I think we'll have discussion.
And certainly, in a Trump Health and Human Services, you're going to have different policies than you had during the Biden administration as well in terms of flexibilities and what is allowed and what's not allowed.
Here's Richard in Oceanside, California, Democrat.
Hi, Richard.
Hi, Mimi.
Thank you for taking my call and being there today.
You look great.
So does Dr. Anand.
And for Dr. Anand, I would have this question.
We're talking about fluoride in the water.
We're talking about pasteurization of milk.
We're talking about vaccinations.
And it amazes me, for instance, on the vaccinations.
I know a fellow up the street from me, 30 years Marine Corps veteran.
When you go in the military, they vaccinate you left, they vaccinate you right, and then they make you do a thousand push-ups, figuratively speaking.
It hurts like the devil.
Well, he believes against vaccinations now.
And I asked him, I said, how did you survive 30 years in foreign countries where it lives malaria, typhoid, and everything else imaginable?
And you were vaccinated up to yin when you went in.
How can you not believe in vaccinations anymore?
People have changed.
Well, fluoride in the water.
I don't know what years I started doing fluoride, but I was born in 1947.
And I had a lot of cavities when I was a kid.
My teeth are a mess, but I still got enough to chew a little bit.
And my entire family lost their teeth, the older people that were born back in the 20s and stuff.
I'm the only one of the whole crowd who's got any teeth left at all.
And there's a lot of them.
So there's a lot of us people around here that remember these things.
And they used to teach in the schools about such matters, fluoridization, pasteurization.
I wonder now, Doc, do they teach this stuff anymore in the schools to little kids about Louis Pasteur and his miracle about fluoride in the water and so on?
All right.
What do you think, Dr. Perrick?
Yeah, you know, I hope so.
And I wish that's the case because I think we've forgotten a lot.
You know, we take public health for granted.
It's saving our lives, has saved our lives.
In the last century, public health is credited for raising our life expectancy by 25 out of the 30 years.
So all of these things, whether it's vaccines, illnesses that we don't see anymore, fluoride in the water, preventing or enhancing oral health, these are all very, very important things.
And I think education is absolutely critical.
And now with science changing as well, I think we have to keep up with the science.
So it's always important to do research, but always important to remember where we came from and why all of this is so important.
Axios is reporting that a quarter of Americans suffer from chronic pain.
Why is that?
What's causing that?
An array of conditions cause chronic pain.
Some primary, others secondary based on, let's say, you're in a motor vehicle accident.
Let's say you have a particular neuropathy like you have in diabetes.
So there are many, many different reasons why people suffer chronic pain.
Some estimates are about 100 million Americans actually suffer chronic pain.
And there's been also a lot of focus on how do you best treat this chronic pain, trying to ensure that individuals also don't just get prescribed opioids, for example, willy-nilly, given the risk we know of addiction there.
So a really important public health challenge faced by millions of Americans.
Let's talk to Jennifer in Evans, Georgia, Independent Line.
Jennifer, you're next.
Hi, yes.
I have a question for Dr. Perrick with his book, which I think is really timely at this point.
You talk about how preventative health will help our health care industry, and you're tying it.
If Robert Kennedy is the health and human services head or whatever, what would be the three things you would like to see him do when it comes to the American diet?
Because my belief is that it's the American diet that is causing a lot of this economic issue and the health issue, and we could save a lot of money if all Americans tomorrow decided to go on a healthy diet, we would save a lot of money.
We're spending, we talk about inflation, and when you look at the cost of inflation in terms of food, most of the inflation is higher in things like fats and processed meats.
Inflation for fresh produce and unprocessed meats is much lower.
We eat so much more than we need to.
And all these statistics say that like 30% of Americans are overweight, 42% are obese.
Children born today have a 50% chance of being diabetic.
So your book, I think, is important in covering that, how it could help us from a health care cost perspective, but an overall economic perspective.
What would be the three things that you would suggest to Robert Kennedy to get implemented right away, policy-wise?
Yeah, thanks so much for that question.
And I think it's really important to note for the public that poor diet now is the leading risk factor for mortality in the United States.
It surpassed cigarette smoking in 2019.
So I agree, probably the most important, arguably, health policy issue that we're facing.
So to your question, what are a couple of specific policy issues?
Number one, I think we need more healthy food financing initiatives.
We need to ensure that the healthy food is not the most expensive food.
We need to make sure, for example, in underserved areas, we can get grocery stores in those areas.
We need to also continue working with the industry to significantly reduce what I call the hyper-palatable ingredients in the food supply.
So the added sugars, the sodiums, the saturated fats, really driving the chronic disease epidemic in this country.
I think we need to look at agricultural subsidies as well, particularly with Congress looking at farm bill reauthorization next year.
They were supposed to do it this year, didn't get it done.
And then we ought to look at tax policy also.
Why is it that marketing of unhealthy food to children leads to tax breaks?
Should we be perhaps taxing certain types of food?
So I think there are an array of policy issues there that the next HHS secretary, whether it's RFK or not, take a look at because it's a really, really important health policy issue.
Dr. Parak, Carol in Boston, Massachusetts sent us a text on the shortage of primary care physicians, which is something you talk about in your book.
She says that many don't have PCPs.
How can we better incentivize doctors to become primary care physicians?
For example, should medical schools take the initiative to reduce tuition for those committing to the practice for at least 10 years after graduation?
Yeah, I think there are lots of important solutions we should think about: loan repayments, scholarships, other ways to reduce debt, ways to reduce tuition.
You know, 50 years ago in this country, a half of physicians were primary care physicians like myself.
Now, today, it is less than a quarter.
The reason why that matters is that primary care is the one health care service that's been associated with better health, lower costs, and greater life expectancy.
So, we're certainly in a crisis today where we have a primary care shortage.
Reimbursement policies don't support the team-based care that primary care could provide.
You can imagine a reimagined primary care system ensuring that Americans get their clinical preventive services, that they get their medications for opioid use disorder, that they are providing care for individuals who have both physical and mental health conditions.
That's what really primary care can do.
And that's why I think, although then obesity, I would put primary care there.
Those two issues, really fundamental to both a high-functioning healthcare system as well as saving lives in this country.
Let's talk to John in Memphis, Tennessee, Democrat.
Good morning, Meghan.
Morning.
I'm concerned about that fluoride in the water.
I'm 80 years old, and a lot of my friends have died from brain cancer, stomach cancer, and bladder cancer, and all them different cancers, I think, due to the fluoride water we have here in Memphis, I believe.
And I was concerned about that also.
But the main thing I'm concerned about, you know, kind of like to me, we got the fox guard, the chicken house, the hen house.
And, you know, we look and the fox are eating chicken, and that's where I see it.
You see?
And, you know.
John, are you worried about fluoride in the water causing cancer?
Was that your initial question?
Okay, let's get you an answer.
Yeah, so I have not seen any scientific evidence for fluoride causing cancer.
I think what we're talking about here, particularly in infants, and I think a couple of studies had reported lower IQ scores and neurodevelopmental harms for individuals who are consuming higher doses of fluoride than you normally would get in the water supply.
That being said, I do think that this is an area that ought to be looked at.
We ought to get the scientists together, assess the NIH research, the CDC surveillance, the EPA efforts here, and really chart a path forward to better understand from a policy perspective, what's the best recommendation to make to states and localities.
You mentioned getting the doctors and the scientists together to really study this, but the Pew Research Center talks about public trust in scientists and views on their role in policymaking going down, especially if you break that up among party, that Republicans have a much lower trust in scientists and Democrats having a higher degree of trust in scientists.
Talk about that and what impacts you're seeing.
Yeah, you know, that's really concerning.
I will say sort of the silver lining, I think, in Pew's latest poll for the first time since the pandemic, those numbers have come up, and particularly for Republicans, which I think is really important.
So we don't have that divergence by party.
But look, I think it's really, really important that there be trust in science, in public health.
And also it goes sort of both ways.
So how can scientists and public health officials and medical professionals, how can they better connect to the public?
How can they make sure they're communicating in the right way, that they're demonstrating empathy, that when the science changes, they're able to communicate that.
These are all, I think, really important lessons that we've all learned over the last few years.
Here's Cliff in Tulsa, Oklahoma, Independent Line.
Yeah, I'm just wondering if we're going to be able to get Robert Kinsey past Big Pharma.
They're the ones that don't like his books and don't like his opinions.
But then again, about Yvonne Musk, I've watched the cost per pound for Charlotte, you know, for lunches go from 60,000 pounds down to 25,000 pounds.
So I personally don't like Yvonne Musk, but he has a way of cutting costs and making a profit out of it.
But I'm all for RFK getting involved and stirring things up with Big Pharma.
What do you think?
Yeah, I suspect that's also going to be a topic in the confirmation hearing.
There are a lot of issues to talk about there, from the costs of pharmaceutical drugs to how much we rely on pharmaceutical drugs for conditions that couldn't be prevented in the first place.
So certainly I think that this is going to come up.
It's probably not the only sector that is going to be watching the confirmation hearing closely.
I think the agricultural sector, pharmaceutical sector, there are many sectors there that have special interests that are going to be watching to see what he has to say.
Wally in Naples, Florida wants to go back to the fluoride issue and asks, will toothpaste and mouthwash with fluoride work good enough to protect our teeth?
Florida is in the process of eliminating it now.
Yeah, you know, and I think many would argue that certainly because we can get fluoride from different parts of society now, that maybe we don't need it in our water.
And I think, again, this is one of the things that we need to look at very closely.
Other countries in the world do it differently.
Communities in the United States do it differently as well.
But we haven't really had really concerted analysis and science here.
Before we make sort of knee-jerk recommendations, let's take a look at this.
It's a complicated issue, and then we can go from there.
Let's talk to Robert in Far Rockaway, New York, Democrat.
Hello.
Good morning.
I have a question.
Where does fluoride come from?
I mean, what's its source?
And isn't it labeled in its original potato as a hazardous material?
I mean, it's a natural element, and it is critical for particularly, again, for oral health, and it has been shown to improve oral health, reduce cavities, and providing fluoride to the population through the water supply for decades now has been shown to be a really effective way, again, to improve oral health.
So I think that's really the bottom line here.
And also, at what dose should there still be fluoride, if any, in the water, given what we just talked about, that you can potentially get fluoride now from various different sources.
John in Massachusetts, Independent Line.
Good morning, John.
This is what happens when you have doctors and corporations on the payroll.
They don't tell you real history.
The real history is that fluoride was created from a derivative of oil processing.
Okay, the goulash during the days of the Bolsheviks used to use this to calm down the prisoners, dumb them down.
This is government corporate fascism, basically what it is.
Let's get a response to that, Dr. Barrick.
Yeah, you know, I don't know really what to say to that.
I don't know that background that the caller is discussing.
I can tell you that what we know from the science is that community fluoridation, providing fluoride in the water for decades, has improved oral health in the United States.
I think it's perfectly valid to assess whether that fluoridation is now still required given some of the studies that we've seen, particularly related to infants and neurodevelopmental health.
Again, those doses were higher than what are currently supplied.
So I don't want anyone thinking right now that the water is unsafe.
But let's study this.
Let's look at this and let's provide recommendations to states and localities.
This is on X from Tillman who says, after the COVID-19 period, we won't trust the, quote, science for a long time.
Don't need a mask, wear cloth, wear to, get N95.
Kids need to get the shot, wait, it may give them myocarditis.
Give them a shot even if the kids had COVID-19 already.
Yeah, so the thing about COVID and the pandemic is we were learning as we were responding.
And I think as the science changed, I do not think that officials did as well as they could in explaining to the public that Here's what we knew, here's what we know now, and this is what we think the best recommendation is.
At times we were too definitive, and then when the science did change, the recommendations did change, then people were rightfully so skeptical.
So, you know, there are a lot of lessons related to the COVID-19 pandemic.