Earlier this month, the Department of

Health and Human Services under the

leadership of Robert F. Kennedy Jr.

announced it would be cutting nearly

$500 million in funding for mRNA vaccine

development.

>> Experts say the announcement was riddled

with false and misleading claims about

the proven effectiveness of the

vaccines.

>> HHS has determined that mRNA technology

poses more risk than benefits for these

respiratory viruses. And it's not just

mRNA vaccines.

>> The Trump budget proposal cuts more than

$33 billion from Health and Human

Services.

>> Includes cutting nearly 40% I'm going to

say that again. 40% of federal funding

allocated to the National Cancer

Institute. That's nearly $3 billion.

>> His cuts to scientific funding and

grants and institutions broadly have

thrown just a huge amount of possibly

life-saving research into chaos.

Is any of this is all of this really

going to make America healthy again? I

doubt it. Obviously, I doubt it. But

what it does do is reveal what Make

America Healthy Again was really is

really about. I feel about that movement

the way I felt about the Department of

Government Efficiency. I'm fundamentally

sympathetic to what it is promising to

do. A Department of Government

efficiency, an effort to make America

healthy again. These are good ideas.

Somebody should actually try them. But

Maha, like Doge, isn't even attempting

to do what is promised in the name. So

what is it attempting to do? What are

its actual ideas? How did a pandemic

that was largely ended by vaccines lead

to this policy regime? How did the

president who presided over Operation

Warp Speed, that was Donald Trump's

great success, how did he become the

president who appointed RFK Jr. to lead

our most important health institution.

How is it possible that 5 years after

the co pandemic, experts now say that we

are less prepared for the next pandemic

than we were for the last one? My

colleague David Wallace Wells has done

incredible reporting both on the

pandemic in the sort of fastmoving

scientific and social moment that was

and since on how it has deformed our

politics and our society. Rachel Bard is

a physician and a writer who's been

trying to think through where Maha is

and where it and its critics might find

common ground. As always, my email is

Kleinshow at ny times.com.

[Music]

>> Rachel Bard, David Wallace Wells.

Welcome to the show.

>> Thanks for having me.

>> Great to be here.

>> So David, I want to start with you.

There's a quote from Michael Lewis, the

writer, where he says, "The problem with

pandemics is that people want to forget

them." So, we're four plus years on from

CO's onset. What have we forgotten?

>> I would say the biggest thing is the

death. 1.5 million Americans died, 30

million people globally, tens of

millions,

probably some number in the millions who

are disabled by experience with CO. And

we now look back on the experience

focused on all of these secondary

questions. Whether we close schools too

long, whether we mask toddlers, exactly

what kind of sterilizing immunity

vaccines could deliver. And those are

all important questions. We should be

asking them in any good retrospective.

But I think fundamentally almost all of

us have basically forgotten or are

overlooking the basic medical trauma

that we live through which was direct to

people who were got sick and died and

indirect in that it produced in us a

kind of panic reaction um which really

deranged our entire society. We want to

believe that it was all a fantasy that

it was all pushed on us. Liberals want

to blame it on Donald Trump.

Conservatives want to blame it on Dr.

Fouchy. But we're so eager to get away

from the central lesson about our own

fragility, our own vulnerability as

individuals and as a society that we're

playing a blame game rather than really

reckoning and grieving with what we went

through.

>> Rachel, I assume as a doctor, you had a

quite different pandemic than me and

David did.

>> I did.

>> So the same question to you. What have

we forgotten?

>> So in March of 2020, I was a physician

on Riker's Island. I was working in the

New York City jail system. There was a

point in March of 2020 when Riker's

Island had the highest CO known COVID

prevalence in the world. Um,

jails are like cruise ships but worse.

They are locked spaces that are dense

with bodies. There's a huge amount of

excess human contact and there's very

very little that you can do to um to

change that in that environment. So, it

was incredibly scary. Um, and if you

were involved in policy discussions at

that time as a healthcare provider, you

were making a lot of educated guesses

under really difficult, very urgent

circumstances that involved a lot of

trade-offs. So, an example is in our

context, we advocated strongly for

everybody who Riker's Island is a jail,

not a prison. Most people who are being

held there are in pre-trial detention.

So, they're in the innocent until proven

guilty phase. they're being held at the

discretion of the court. We advocated

really strongly to say everybody who

doesn't need to be held during this time

should leave. We should decant this

system so that there are fewer bodies in

these spaces together.

There are obviously lots and lots of

policy trade-offs in making a decision

like that. Right? So the degree of

uncertainty and the sense of urgency

around decision-m at that time was so

extreme and you had to pick the variable

that you were going to preference over

other also very urgent concerns

>> and it was full of so much fear too. I

mean the fear was pervasive and I think

one of the real features of that early

period was about how many people were

just so worried.

>> Yeah. And I mean all of my colleagues

like we would you know I would go I was

working 100 hours a week. We would go in

to see patients in the jails and go home

and everybody would strip their clothes

right before they went into the house. I

sent my family away because I was like

I'm going to get it and I don't want you

guys to be here.

>> So you talked about the way we haven't

looked back in any systematic way.

Right. There's been no equivalent to the

9/11 commission for co but there has

been a lot of research going back and

trying to think through what did we do

that worked what did we do that didn't

work um what would you say David that

research has found

>> well I think when you look globally it's

important to acknowledge that basically

no country avoided the pandemic no

country won this war um there were

degrees of victory and degrees of defeat

and generally speaking the most

important factor for our country's um

outcome was the age structure of the

population since old people were so much

more vulnerable. But when it comes to

policy, what we could actually control,

it was a matter of how many people got

infected before they got vaccinated.

Basically, like full stop. By the time

the clinical data was released from the

vaccines that told us that they were

going to be safe and rolled out soon in

November, something like 10% of the

American public had gotten CO. By the

time shots were really going to arms in

January, it was something like 20 or

25%. And that is the main determinant of

our outcome because those shots

basically cut individual risk by a

factor of 10. And um you could manage

that outcome by speeding up vaccination

which we did by historical standards in

a miraculous way. The Maderna vaccine

was designed in two days, fully designed

before the first confirmed case in the

US. Fully designed before China even

confirmed that there was humanto human

transmission of this disease. This

vaccine was designed. It was

manufactured within a couple of months.

It took a little bit longer to get out

to the public, but even by even so the

by historical standards, this was

incredible getting it into people's arms

before the end of the year. We didn't

get pick up as dramatic as um as across

Europe, but we did relatively well by

the end of 2021. 95% of seniors were

vaccinated. And then there's the other

side, which is how many people got the

disease before that happened. And you

can control that in a variety of

different ways or try to control that in

a variety of different ways. And

there's, as you suggest, a lot of debate

um and back and forth about what

policies worked and what policies

didn't. If you look at Russia, Russia

did nothing to stop the spread of the

disease, and their death toll was twice

as high as the US's. In other countries,

they did a much better job of um

controlling transmission in 2020. Canada

had half as many deaths in the end as

the US did. We need to take seriously

the idea that while there were some

things that sort of worked and some

things that sort of didn't, um all of

this was variable and if we had had a

slightly more aggressive transmission of

the disease, we would have had a much

much higher death toll. Uh but but I do

want to push at least on part of that,

which is to say that different places

did do different things in terms of the

um prevaccine policies. I remember being

involved in these debates at the time

and the level of fury say liberals fell

to what Florida or Texas was doing was

huge, right? It was deeply

irresponsible.

When I look at the the research

afterwards, you know, when they do all

the things they do to try to control for

deaths and the age distribution of the

population and all the other things we

know, it's surprising to me how

different places look. So Massachusetts

and Florida kind of both look pretty

good. California and Texas both look

pretty bad and it doesn't sort of fit

the policies or the narratives we had

before. How do you think about that?

like what else aside from vaccination

mattered here?

>> Um, when you do comparative stuff about

the states, I actually think the

policies were less different in that

period than you're suggesting, but you

know, there was not a big difference

between red states and blue states,

school closure. Schools were closed at

roughly the same time all across the

country. There was some variation in how

they reopened, but that was really

starting in the fall. Um and when you

think about you know social distancing

guidelines um retail policies and even

if you look at you know the behavior of

individuals that can be tracked through

um on on phones there wasn't much of a

difference between the way that people

behaved. So we had a kind of a discourse

fight. We had Republicans and

conservatives who were saying we need to

reopen. We need to get back to our

lives. And we had liberals who were

yelling no we can't do anything. We

can't let a single person die. We need

to get all the way to zero COVID. That

was happening in social media. It was

happening to some degree in our

politics. but that the level of lived

experience actually there was

considerably less variation in um

behavior behavioral response to the

pandemic than we think um and often

remember misremember and that means that

any comparison there is a little bit

complicated in New York we had a a huge

initial spike that was you know

anomalous that transformed our um our co

experience other states didn't have that

certain places encountered the disease

for the first when they were for the

first time when they were doing pretty

aggressive of lockdowns. Other states

didn't really see it when those policies

were in place and encountered it much

later and so the signal is pretty

idiosyncratic. So is that your sense

also Rachel that in some ways our

retrospective on how divided we are, our

sort of memory of it is actually

different than what was happening at the

time when there was a lot more unity and

red states and blue states kind of

looked alike and a Trump administration,

you know, accelerated the vaccines and

had their own lockdown uh proposals. I

think um I I think so the data that

David cites around sort of how we

actually know how people behaved versus

just what the policies were is correct.

The place where you start to see blue

states and red states divide right is

postvax not prevax. Post vaccine what

you see is that blue states do much

better than red states and that's

because vaccine delivery was more

successful in those states in part

because there was higher trust in the

vaccine at that point and that I think

is that's the vaccitency didn't start

the day the vaccine came out into the

community right vacancy reflected months

prior of um sort of stewing mistrust and

resentment and anger amongst people who

felt as though they were being asked to

do things that were interrupting their

lives.

>> And just to be really clear about how

this what this meant, in the 9 months

between August 2021 and April May 2022,

many more Americans died of COVID than

died in the nine month the first nine

months of the pandemic. So by the time

that we were all over it, by the time we

were all, you know, all the seniors were

vaccinated, um, by the time that we were

all screaming and and, you know, and and

trying to move on, um, actually there

were many more American deaths in that

period than in than in the previous

period. And, you know, that complicates

a lot of our simplistic, moralistic

narratives.

>> And why was that?

because especially middle-aged people

didn't get vaccinated and some pocket of

vulnerable elderly people also didn't

get vaccinated and when Delta came and

omocrron came it was much more punishing

to the American public than it had been

in the UK or in Europe. Why did vax

hesitancy become a more right-wing

redcco-coded phenomenon? So the Trump

administration drives operation warp

speed. uh Republican governors across

the nation are broadly very pro-

vaccine. This seemed like a very classic

shared policy, a policy that both

parties are bought into. I also remember

if you go back a couple years before co

vac hesitancy is understood as a crunchy

liberal hippie thing. Uh a thing that is

happening, you know, among people who

only shop in the parts of the health

food store that have bins of dry goods.

>> Yes.

>> And then again it becomes very

right-wing coded. Why?

>> I think because vacc hesitancy is in the

COVID and postcoid context gets

polarized as part of an

anti-establishment, anti-institutional,

anti-expert

sentiment that is stewing on the right.

And vaccines are part of that and they

aren't necessarily the focal point.

They're they're one of the flash points.

But one of the sort of main underpinning

ideas is this concern about um about big

pharma, right? And this idea that

government and pharma are sort of in

cahoots to make you sicker for profit.

What's interesting about operation warp

speed is that right from the beginning

we knew the companies involved and we

were celebrating this public private

partnership to rush this to market.

Right. And that was obviously a colossal

accomplishment in terms of actually

getting the vax produced and out into

the community and also could not have

been a better setup for playing into

antivax anxieties.

>> But shouldn't that have set the left up

to be skeptical? I just have always

found this to be an interesting wrinkle

and I agree with you. It has something

to do with like attitudes towards the

establishment. It's just this is all

happening under Donald Trump.

>> I think it's attitudes toward the

establishment. I also think it's

fundamentally about tensions between

um like liberty and autonomy and

collective safety.

>> And I think that the the participating

in COVID mitigation strategies

voluntarily became this way of

demonstrating solidarity, right? And of

putting the collective above yourself,

right? There was like, you know, the

beginning when we said you have to

you're not doing this for you you you're

doing it to flatten the curve for other

people. You're trying to protect other

people. That messaging I think speaks to

left-wing values in a way that really

connected for for liberals and felt

hard I think for people who felt as

though it was infringing upon their

freedom and so it flipped.

>> I mean I would say that it made

right-wingers actually kind of excited

to demonstrate their risk tolerance that

they were sort of showing themselves to

be independent you know um adventurers

in the world and not so not liberal

safetists. One thing that I always felt

confused of politics here is that the

relationship between the vaccines and

the pandemic changed pretty fast that

the initial vaccines actually did

prevent transmission.

And so the idea that the vaccine was a

collective decision where we're trying

to achieve herd immunity made some

sense. If you could get it high enough,

you could maybe stamp this thing out.

And then the virus mutated around the

vaccines and you had, you know, omocrron

and delta waves or delta and omocrron

waves and the vaccine really became much

more a form of individual protection.

It felt like the politics had trouble

keeping up with that and people felt

like they were sold a bill of goods. It

wasn't true. And so ideas about vaccine

mandates that maybe maybe made sense at

one point made less sense later on for a

bunch of different reasons, but one

being that the the vaccines had changed.

How did you how do you think about that

playing into this? Well, I think that at

a sort of historical level, the story

that you describe played out, you know,

the vaccines were somewhat oversold. Um,

there was in terms of providing

long-lasting sterilizing immunity that

had not been tested in the trials, they

could it could have been tested, but it

was not tested. And so, when they were

introduced, we didn't really know how

long or how long the protection would

last, and we didn't know how perfectly

it would protect against transmission.

Um, I don't think the people making, you

know, those pronouncements, the public

health officials, um, were hysterically

overpromising, but they probably gave

the impression a little too strongly

that we knew that this was going to be

the endgame for the pandemic.

Interestingly, many of the people who

were making that case most strongly are

now RFK's deputies in the public health

administration. You have Jay Baracharia,

Marty Mccari, Venet Prasad. These are

people who in early 2021 were like, get

those shots and it's over for you. You

don't have to worry about visiting your

grandma. you don't have to wear a mask.

Forget it. It's over. Because their

primary impulse was on moving past the

pandemic. I wish the public health

officials had been a little more humble

um and especially were more open to

breakthrough infections and indeed

breakthrough deaths when they arrived in

the spring and summer of 2021.

>> It it would never have been the the

expectation that vaccines were going to

prevent every death from CO ever. That

would have been unprecedented.

But it was not people's expectations I

think were not effectively managed in a

way that let them think okay some people

are still going to die from this

probably this is a very serious virus

there are people who are going to be

vulnerable and they might get it you

can't protect every single person you

can't prevent every single death there

was very little expectation management

there was very very few goals actually

articulated I think that could guide the

public in a way that would make them say

Okay, I actually understand that, you

know, this has made it safer for me.

It's not guaranteeing safety to everyone

I ever interact with for the rest of my

life. Right? The other thing that I

would say that I try to say when I talk

about this is that bodily autonomy is a

big deal. And so there was all of this

sort of creeping infringement on

autonomy that happened before the

vaccine came along. Then the vaccine

came down. It came down with mandates

that applied to people who were in

low-risisk groups right across the

board. And those people were doing their

own research and they were thinking

like, I don't think I need this. You're

going to make me do this. You're going

to fire me from my job or whatever it

is. And it's it's I think it's a little

reductionist to think about that is

selfish alone. I think it's actually

quite a big deal to ask people to accept

things being put into their body that

they don't want. And vaccines are one of

the places where that plays out.

>> I mean, you're we're we're living in

this risk landscape. We're worried about

how infections are going to come into

our bodies. and change our lives. Bodily

autonomy is in certain ways a kind of

rational response. I'm not not going to

let anything in. But I think it's also

the case that we saw during the pandemic

the cottification of you know the

equation of liberals with establishment

values and institutional values in part

because of of Donald Trump and the sort

of growing safety which I think is a

psychological psychologically reasonable

thing that people did in the face of

risk but which turned an awful lot of

people on the other side off quite

dramatically. I think the thing that I

would say about the pandemic is that I

don't think of it so much as a catalyst

for these dynamics as so much as an

accelerant. So there were already all of

these um tensions about collective

safety versus uh individual autonomy and

freedom that were emerging in medicine

right where we didn't have good clear

evidence-based frameworks for resolving

them. I'm thinking about trans care for

minors is one of these, right? Aid and

dying is one of these. Reproductive

rights, which has come to a head much

more post 2020, but was, you know,

barreling towards that Supreme Court

case.

Um, vaccines already were a total flash

point in some communities. And the

veilance of who's on which side in those

various debates, who's on the freedom

side, who's on the collective safety

anxiety side, who thinks you should have

more regulation, who thinks you should

have less regulation, it flips between

to issue to issue, right? So the idea

that um that co created those dynamics,

I think, is not quite right. I think

what it did is it accelerated people's

sense of uh intensity about them, but it

wasn't the pandemic didn't start it.

Well, the the way I've come to think

about this, so my first book is on

political polarization.

And one thing I always say about this

that people always get the term

political polarization wrong. They seem

to think it means something like

political disagreement. But it's

actually how well sorted

>> the two or multiple coalitions are by

different ideas. So in American

politics, we are very well sorted around

the idea of abortion. If you are

pro-life, you are probably a Republican.

If you are pro-choice, you are probably

a Democrat. And that has gotten much

more true over time. This was a set of

ideas

that was not well sorted between the

parties. RFK Jr. was a Democrat. He had

been considered for a high-up

environmental cabinet level post in the

Obama administration. He spoke at the

2004 Democratic National Convention. As

we were talking about earlier, there was

a deep strain of vaccine hesitancy of um

body purity on the left in the the sort

of the hippie left that I grew up near,

right? Like when in my household you

could not have food with synthetic dyes

in it. Like that was how like I could

not have colorful cereal growing up,

right? And that was a sort of I

understood that as a kind of liberal

thing.

And what the pandemic does in a very in

a way that I think you can imagine

having gone the other way, but it sorts

the parties around the set of issues and

you see people leave one party and join

the other over them. And you watch

individuals who were very mixed in their

views sort themselves. Trump decided to

be on the side of the vaccine hesitant

even though it was his best policy ever

that helped accelerate the vaccines. RFK

Jr. joined the Trump coalition despite

having been a lifelong Democrat. You

had, I think, people also move the other

way out of kind of fury um over what

they felt was increasingly anti-science

coalition, although that had begun

happening over climate change quite a

bit before. And so these ideas were

always there in the electorate, but they

didn't have clear expression in the

parties. And now this has become a

pretty central cleavage in our politics.

>> Yeah. When you ask people about their

confidence in vaccines, Republicans

confidence is lower and it's going down

relative to Democrats. That's true. And

at the same time, more than 90% of

parents get their kids vaccinated still,

right? So we are polarized again I think

a little bit in the discourse and in the

politics around this more than people

actually are polarized in their lives

about it. And that that's different and

interesting and important to me because

it makes me think that those

um

those folks are still sort of up for

grabs more than we talk about them as

being.

>> Yeah. And I think it's it's important to

sort of rightsize the scale of the

problem here. The US did much worse than

our peer countries, but we did get 95%

of American seniors vaccinated in 2021,

which means the people who were by far

the most vulnerable to this disease

overwhelmingly got the shots. And the

fights that we were talking about

before, the discourse fights were often

among people who were not in the most

vulnerable groups. It was the

middle-aged than the young. And really,

ultimately, those people were facing a

different kind of risk landscape, had

different considerations to make. And

you know, I'm 43 years old. I was vaxed.

I got a couple boosters before I stopped

doing that. I think that was wise. Um,

but if someone who was in my same

position decided not to, I would have at

the time I think understood and I know

some people who did this so I had these

conversations with them. I would have

understood that if they were accepting a

much higher um if you know if they were

choosing to go unvaccinated the main

burden being imposed was on them. Okay,

but I think this picks up on something

really important Rachel said, which is

the way this activated differing

frameworks of morality around the

collective and then around individual

autonomy.

That conversation you just described

hypothetically are actually happening

with you and your friends. That is not

how liberal politics was working in that

period. what sort of emerged around

masking, around vaccines, and I think

for very reasonable reasons, but was a

extremely aggressive push

towards a sense of collective

responsibility backed up by social

dynamics particularly online um of

shaming and then in some cases backed up

by state power. I think about the like

overwhelming assault say on Joe Rogan

and like this is when the left really

loses Joe Rogan over the fact that you

know in their view and I don't think

wrongly he's spreading vaccine

misinformation on show but these also

categories of misinformation

disinformation infohazards right it's

not just like you're not being

responsible but you become a kind of

hazard to the collective

>> and that really radicalized a bunch of

people who felt themselves on the

receiving end of it I'm not saying it

was totally without merit

But I think it has really reshaped our

politics in the aftermath.

>> And I think you can see the same pattern

applying to the management of

disinformation, misinformation, which

was essentially a hygienic effort by

liberals to like decontaminate the

space. I mean, it was a symbolically

consonant um approach that we took to

limit bad information and promote good

information. But I think that the the

pattern that you're describing where

liberals went in one direction and

conservatives went in another direction.

I think conservatives went really far in

one direction and liberals went a little

bit in the same direction. Like

Republicans were more about individual

management of risk, navigating the world

according to your own um values, not

worrying nearly enough as much about the

collective well-being and liberals were

much more safety and collective in their

approach. But I see a lot of increasing

self-interest, mercenary thinking, loss

of solidarity on the left, too. When I

think about how, you know, angry people

were um that, you know, in 2021 that

certain people in red states weren't

getting vaccinated, there's a kind of

like let me live my life, don't make

don't burden me with your bad choices

logic. You know, in in 2015, 2017, 2019,

we saw all of these solidaristic

movements on the left which were built

on the idea that we should protect the

most vulnerable, attend to the most

vulnerable. And I don't think that

that's the central organizing principle

of American liberals today. I think

we've taken a path that is also towards

a more inquisitive um you know aaricious

um individualistic path. And that just

gets to me to the big fundamental story

here, which is like this is about our

psychological response to a rampaging

disease that none of us felt prepared

for. and that our psychological,

cultural, emotional responses are less

about what advice Anthony Fouchy gave in

the spring of 2021 and less about

exactly how successful Joe Biden was in

promoting vaccine mandates and much more

about the fact that we are all we

quivered in fear in 2020 almost all of

us. And then we tried to make sense of

that experience in somewhat different

ways, but almost always in ways that

pushed us towards um prioritizing our

own well-being and the well-being of our

nuclear units and um walked away even

the most solidaristic of us made us walk

away from the solidarity that had guided

so much liberal politics through the

2010s. Do you buy that?

>> I'm thinking about it. I I'm wondering I

I think I buy it up to a point in 2020.

The other thing that happened, right,

was George Floyd and that summer of

protest and liberal public health

establishment figures said, "It's okay

to go out and protest after we've said

you had to be home all this time." Now,

Anthony Fouchy didn't say that, but

people said that on Twitter. That was

part of sort of the discourse at the

time. And it really angered

conservatives who sort of thought that

they had been being good team players by

staying home even when they didn't want

to or kept their businesses closed or

not been in church.

um that that was I think a pretty bad

pivotal moment and

the idea of there there were sort of a

lot of opportunities for liberals to

demonstrate outwardly to each other that

they cared about one another that they

were committed to the cause. Wearing

masks I think became this like gesture

of solidarity well past the point when

masks were really indicated even when

people weren't necessarily doing them

out of anxiety for their own risk or

others. They were doing them to show

that they cared about other people's

risk.

Um and

>> and in a way that was a really inspiring

performance. I mean putting aside its

efficacy which you know we could talk

about just the fact that so many people

not just in the US but around the world

were like I'm going to upend my life.

I'm going to you know my kids are not

going to go to school. I'm not going to

go to work. I'm not going to see my

girlfriend. You know all these things

>> out of some combination of fear and

concern for one another. Kind of an

unprecedented in you know in my

imagination unprecedented gesture. You

know, I'm still mulling the point you

made a minute ago about whether or not

both parties moved in an individualistic

direction and that there were these big

solidar solidaristic movements on the

the left that that began to to fade.

And when you first said it, my instinct

was it was wrong. And as I think about

it, I think it's right.

>> But I think that it's right for possibly

a different reason, which is I wouldn't

say that the left has gotten more

avaricious. Um that's not my sense of

sort of where liberal policy is going or

>> at the political level. No, I meant sort

of personal.

>> Yeah.

>> But I think there's a sense that that

politics failed

that you look around particularly after

2024,

>> but you look around at the way kind of

communal shaming worked. You look at the

way people look back on the pandemic.

You look at um the backlash now to what

gets called wokeness. Um me too. And

whatever you believe about the

underlying arguments being made that the

effort to shame your way to a better

world was a political failure. Not a

small political failure, but a political

failure that has empowered the absolute

worst people, the people you feared the

most. Like a murderer's row of who you

did not want to have power in the year

2021.

and the move, I'm not sure if I would

call it towards individualism, but away

from

this heavily enforced solidarity of both

action and language.

Um, very very uh aggressive on speech

and infohazards

that that that was part of what went

wrong.

>> I I want to make a distinction between

what I think you are describing, which I

would call orthodoxy and solidarity. So

I don't think that those things are

quite the same and I would say that

>> although often conflated

>> often conflated absolutely and I think

what you're and and in that moment

perhaps conflated right but I think what

you're describing is orthodoxy that was

deployed like as a tool to sort of to

get everybody on board with not just

pandemic mitigation but also a political

program like a you know um to enforce

police each other's speech everything

you're saying that does feel very

different to me from what I consider to

be solidarity which is a positive vision

for what it's like when people come

together and work with one another on

behalf of each other but also the

vulnerable and I think that the failure

of solidarity is a failure of leadership

and I feel less so about the orthodoxy

question. I think that might be right.

And I'm not, I think, as negative on all

the impulses here as I'm probably

sounding, but I but I am trying to think

through why things changed and and sort

of some of the intuition of this whole

episode is that 2020 still deforms our

politics in very profound ways. And I

think the distinction you draw here

between solidarity and orthodoxy is a

really good one. But the way you

understand solidarity and probably the

way I understand solidarity is as a

positively motivated pro-social concern

for others. But what many were doing in

this period and often what you have to

do in politics on some level is enforce

that same concern on people who don't

share it. And one thing that I think

happened in this period that is still

very present in our politics, although

in strange ways, is that the left became

extremely comfortable with the

deployment of state power on behalf of

institutions and so on. Um, in a way

that really radicalized the other side.

And the other side didn't become

libertarian. In a strange way, they

became authoritarian.

But but there was something here about

the relationship between cultural and

political power that I think really

reshuffled the parties in in important

ways and was very very radicalizing

for people who ended up on the other

side of it.

>> So I think orthodoxy is enforced and

solidarity is built and those that's a

really important distinction and for

solidarity to be built you need

leadership. I remember very distinctly

this moment in March of 2020 thinking

like, "Oh my god, this is the worst

month of my career." And we're on the

precipice of a new world and a bunch of

right the government was throwing money

at people. I was like, "Maybe we're

going to get singlepayer out of this."

Right? There was this moment I was

almost hopeful and then it all fell

apart. And and I think

um that that reflects a lack of

attention to the political sentiment and

the emotional sort of um uh the Daniel

Offrey, the doctor describes emotional

epidemiology, which is basically like

the vibe, right? Like there was sort of

a lack of attention to the vibe in the

way that leaders were thinking about

making their decisions. There was very

little attention to the emotional

experience.

Who was the best communicator during

that time? It was Andrew Cuomo. And when

you think about Andrew Cuomo's

slideshow,

>> New Yorker thing to say.

>> Well, you should watch the videos

because they're real good. Because

they're just Andrew Cuomo sitting there

beside a PowerPoint and the PowerPoint

says, "I hate this or I'm tired of this.

We're all over it." He sat every single

day and spoke directly to people in his

state and spent a a significant portion

of each day's press conference talking

about how difficult this was, how

valuable it was that people were

participating in it. This is not an

Andrew Cuomo endorsement on any level,

but I do think he did this one thing

very very well. And we had an absence of

similar leadership elsewhere or

communication from leadership elsewhere.

And so that solidarity curdled into

something else.

>> And I actually think it's important just

to be really clear that like, you know,

May May 4th, I think Anthony Fouch's on

TV saying we can't do this forever. We

got to go back to our lives. He's

publicly saying we should get kids back

in school. He may not be doing

everything that he can do to get kids

back in school. But the policies that we

live through in the summer and fall of

2020 are often remembered as imposed

from on high by liberals and maybe even

by Fouchy himself. Of course, like

Donald Trump was the president then.

Many states were controlled by

Republicans. Most of the decisions that

we're talking about were imposed by

governors or mayors. There are some

people who got some tickets here and

there. Um but we basically gave guidance

and then enforced that guidance through

social pressure and that meant that the

enforcement mechanism was social rather

than state power. I was just looking

this morning you know France in their

lockdown they deployed 100,000 officers

to police people's movement around the

country. The US did not do that. So the

to me the the thing that happened was

less about liberals um becoming

comfortable with deploying state power

and more about liberals becoming

comfortable shaming each other.

>> Yeah. Although I do think these things

combined. I It's so funny because I'm I

think I'm sort of ventiloquizing an

argument I only 50% agree with. But I do

think it's very important.

>> So much of this played out on the level

of speech and what you could and

couldn't say. And it is true that the

primary power deployed there was social.

It's not true that the only power

deployed there was social. Like if you

go listen to what appears to have

radicalized Mark Zuckerberg, it has to

do with going back and forth with the

Biden administration um on what could

and could not be said, right? There was

a lot of efforts to criminalize certain

kinds of arguments um making them things

you cannot have on social media as

disinformation. Right? There's a real

effort to get Spotify to to to cancel

its contract with Joe Rogan. And I agree

with you, we didn't deploy a gigantic

police force. But one thing I take

seriously from just a lot of interviews

I have done with people who were not big

Trump people in 2016 or 2020 and were by

2024 is that they were incredibly

radicalized by debates over speech. I

find this incredibly ironic because and

grim because the Trump administration is

policing speech and using state power

>> so much more than anything

>> to punish speech in a way the B

administration never would have even

considered right so it's like you have

summoned the thing that you feared I

mean I think the lab leak story is a

really interesting one here um in 2020

you had surveys showing something like

one-third of Americans already believe

that the virus came out of a lab then we

got you know the famous proximal argens

paper which was the the first effort by

the sort of epidemiological

establishment to sort of um you know

really um say that we know where this

came from and it came from nature. Um

you had this sort of coordinated action

by epidemiologists um to sort of manage

that message through the media. um to

the extent that there was a an effort to

really control speech on the co on the

lab leak it was in that period um the

spring of 2020 by May of 2020 49% of

Americans believe that co had escaped

from a lab so this period of a couple of

months which is the most intense control

of the narrative that was ever

undertaken actually we saw an explosion

of um you know support for the lab leak

theory and that I think is the basic

dynamic with a lot of this stuff it

wasn't that speech was truly controlled.

A lot of the people who built their

social media followings most

aggressively during the pandemic were

>> Look, if it was truly controlled, you

couldn't have had the backlash.

>> Right.

>> Right. That's always the irony of these

things. It's it it could it could

actually be so enraging to people and be

so so politically damaging because they

weren't doing I think what the Trump

administration is increasingly thinking

of doing,

>> right? like you actually could just be

Joe Rogan with your $100 million Spotify

contract having vaccine, you know,

weirdos on your uh podcast,

>> but it radicalized people.

>> It it was the end it it was the sort of

final um

experiment, I think, in the liberal

elite trying to moderate content in a

way that would keep people in line with

a particular program. So, and and it

failed utterly, right? So like RFK's

Instagram was taken down and it

absolutely only served to make him

stronger because the suppression

>> affirmed everything he said about what

they don't want you to know. Right. And

that happened over and over again. And

>> that I think is really significant

because it sort of signaled I think the

end of an era of expert authority that

like we're not going back to.

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But I want to hold on RFK Jr. because

his trajectory is genuinely interesting.

He goes from being a Democrat in

extremely good standing, right? An Air

America host for those who remember that

somewhat ill- fated exercise

to whatever he is now. And in this

period he is held in even as he is still

a Democrat and runs for president as a

Democrat

he is held in extreme illreute by

mainstream Democrats and liberals.

Did he change? Did liberalism change?

What what is your sense of

what happened here? Did he become much

kookier over time or was this kind of

always how he was, but it was on things

that maybe liberals felt more

comfortable with a more conspiratorial

view on?

>> I think that our FK Jr. his entire

career since 1985 has been about

fighting contamination. The thing that

this guy really really cares about is

pollution. So his he finishes law school

and sort of his first real job after law

school is um working for the River

Keepers, right? trying to keep the

trying to um suing polluters, people who

are polluting the Hudson River. And his

whole career from then on is all about

fighting contaminations. It's fighting

contamination in the water, in the air,

from factory farms. And as time goes on,

he sort of widens his aperture and picks

up issues where contamination is a

factor in other contexts.

So vaccines, his antivaccine activism, I

think, is best understood as another

strain of his like obsessive

anti-contamination

thing. He doesn't like when toxins or

chemicals are introduced into what he

thinks should be pure and natural bodies

or environments.

In that sense, I think he's actually

been very consistent for like 40 years.

and the pandemic was uh provided a ton

of opportunity for that kind of thinking

to take purchase, right? He's also

always been conspiratorial. That's been

true forever. So, he's always been very

sort of anti-cor like again in a way

that was dubtailed with democratic

ideas, but very anti-corporate, always

about suing corporations for things. um

that also becomes relevant with vaccines

and then gets accelerated during co

that's also very consistent. He's also

always been very politically ambitious.

You're right. So he was considered for

EPA under Obama in 2009. He was on the

short list to replace Hillary Clinton

for um for her Senate seat when she was

made secretary of state.

>> He had thought about running for

Congress earlier than that, like maybe

in 2000.

like Trump, he is a person who by virtue

of his family and his privilege and

everything else has always led a life

that sort of had a public service

element to it, has always been public

and has always been thinking about

running for office. And so I think that

what happened is the pandemic put his

issues at the forefront of the American

consciousness.

He built a much bigger follower

following than he'd ever had before.

He's incredibly adept at using mass

communication tools now in a way that

very few politicians are in a way that's

frankly very similar to Trump I think

and he sees his opportunity to run.

There's another I like your framework of

him as being concerned about

contamination. There's another framework

that's helped me think about him and and

Maha more generally. So I'm a big fan of

this book um by a writer named Charles

Man and the book is called Wizards and

Prophets or Wizards versus Prophets.

Great book

>> and the book is tracking this divide in

ways we think about environmentalism and

solving environmental problems and man

basically argues that there are wizards

who want to solve them technologically.

His big example is Norman Borlo who is

the father of the green revolution in

agriculture and there are prophets who

their argument is mankind has grown

beyond uh its wisdom. Um it is out of

alignment with the natural world. It

needs to rediscover limits. We are going

to destroy everything. We're going to

destroy ourselves. And and the only path

forward is a in a way going backwards

like going backwards to a more holistic

human form of um of of living in this

place and at this time.

RFK Jr. is a prophet like in everything

he has ever done. The guy aside from

social media is very very very skeptical

of technology. He, you know, thinks

climate change is a huge problem, but

he's part of the left that hates nuclear

energy, for instance.

In him and in Maha more generally,

something that I see repeatedly is an

intuition that trying to solve problems

of modernity with the tools of modernity

is just going to create more problems.

People believe correctly a lot has gone

wrong in our population level health.

They blame possibly correctly modernity

but also commercial decisions by by

companies and capitalism and their set

of ideas around it are about going um

you know back to a more uh natural form

of living of eating of moving. This is

canonically a leftwing set of views,

right? This is small as beautiful

environmentalism

and there's a lot of appeal in it. But

but you spent a lot of time thinking

about Maha. How does that track for you?

>> I think that's largely correct. I you

know, so the first thing I think to say

about Maha is Maha didn't exist until

last summer, right? Maha the neither the

term which was hastily right like

something that he slapped on his website

after he joined the Trump coalition um

or the coalition frankly like under the

MA banner and sort of loosely around

Kennedy's candidacy there are lots and

lots of different subgroups there are

small farmers and there are parents who

are antiaxers for various reasons and

there are people who are really

interested in nutrition policy and there

are people who are worried about

pollution. So, it's a complex network of

people who sort of like loosely see in

him somebody who wants to focus on a set

of issues that have been left out of the

political discourse for a very long

time. When we talk about health care,

traditionally in politics, we talk about

healthcare access. We don't actually

talk about health and bodies. He is

obsessed with health and bodies. That's

what he talks about. He talks about the

chronic disease epidemic as the major

problem facing the future of America.

Right? And that that really speaks to a

group of people who sort of form around

him. Some of them I think share what I

would call sort of the degorous

tendencies that you're talking about. Um

but not everybody does and that's a

political challenge for him frankly. He

has a lot of different constituencies to

respond to right now. Um and a lot of

different bosses because of his

relationship with MAGA and he's in a

really complicated crossressured place.

Well, I I want to pick up on one other

part of this before we even get into

what he's been doing, but but something

that pulls together, as you say, a lot

of different people into one coalition

is also, I think, a sense of being

deeply failed by institutions.

>> Yes.

>> And I think this set of feelings is very

very legitimate and also very

complicated. Um, but anyone who has I

have in my family people with, you know,

autoimmune diseases that we just don't

understand and cannot effectively treat.

And it's very frustrating and enraging.

And it's not like chronic health issues

were not a part of political discourse

before RFK Jr. became uh HHS secretary.

Like I covered Obamacare. We talked

about chronic health issues all the

time. they made preventive care

functionally free or heavily heavily

subsidized under under the the terms of

that law. But it it was always done in

both I think you know liberal politics

which is very connected to sort of

scientific institutions and doctors and

others and conservative politics which

is much more uh entwined with

corporations.

It was always done with a lot of respect

for institutions in a sense that these

are just hard problems. Modernity is

tough. And one thing that I think yokes

together a lot of the maha world. Um not

always in a way that holds together but

nevertheless is there is one a true

level of fury about it. Not the

technocrats disappointment or pledge to

work on incremental solutions but an

actual level of like horror that people

who are touched by these diseases

actually feel. And second, a profound

skepticism

of mainstream institutions, be they

for-profit, be they governmental, in a

sense that a lot of our problems are the

result of some form of corruption and

villain, right? That there was a

fundamental level of being willing to

say rightly or wrongly, you are being

failed. You are being screwed. The fact

that everybody's so sick and you know

and so many Americans are obese and have

type two diabetes and and all these

things are happening is not your fault.

It's their fault.

>> I remember talking about preventative

care in the Obamacare conversations as

who's going to have access to these

things that we all agree we all want.

What MA does is it fundamentally does it

doesn't just question institutions. It

questions medicine itself. So it it says

>> or ma you know sort of maha advocates

RFK Jr. himself says it's not just that

you've been g you know you have this

diabetes because you've been fed the

wrong food and

um you know and and

the the system has put you in this

position where you don't move your body

and whatever he says you can solve that

problem a different way than they're

telling you and we have a better way for

you to do it and they've been telling

you the wrong way and the way that

they've been telling you has been making

profit for other people and keeping you

sick and that's very different I think

debates at the level of what should we

actually be doing to our bodies, not

should we have access to the care that

we all sort of agree we need. That's

really new, I think.

>> How do you take Maha? Like, how would

you edit this sort of emergent sense of

it?

>> I think that they perceive a lot of real

problems about our world and our health.

And I think they have a very narrow,

often confused, even diluted approach to

what the solution set should be. I mean

I think at a core you know kind of

reptilian level I do think it is about

um primarily about defending one's body

from the invasions of the outside world

contamination as you were saying and

empowering individuals to navigate that

risk landscape on their own and I think

you know that is a lesson that many

people took out of the pandemic that we

were told what to do and the the problem

was imposed on us in certain ways and

the solution was imposed on us in other

ways. and we really just wanted to

navigate that landscape on our own. Um,

but I also think that it's the wrong

lesson to take from the pandemic because

um, a disease that spreads through a

population in unpredictable ways

requires health solidarity beyond what

Americans showed themselves really

capable of in 2020 and 2021. And I've

been saying lately, you know, I could

imagine RFK in an alternate universe

where he had ended up at EPA and like

Vic Ramaswami ending up running HHS.

That actually doesn't seem like a very

bad outcome um you know for either of

these impulses. You could imagine you

know some streamlining of drug approval

and you know um a kind of abundance

approach to drug production in a vivic

um HHS. And you can see possibly

somewhat conspiratorial but nevertheless

directionally correct um policy change

at EPA where we're trying to do

something to get um more pollutants and

contaminants out of our food system. But

I think when we're talking about all of

this, it's it's illustrative to me of

the bigger story here, which is like

we're we're asking ourselves, how did

this man of the of the left um end up on

the right? And I think the real obvious

answer is just the pandemic. like that

is when we're talking about these things

scrambling and flipping um it was the

experience of the disease our experience

of fear through that that really changed

so much of the veilance of all of these

questions.

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>> I enjoy the counterfactual you just

posed where VC Ramaswami is at um HHS

and because he has a biotech background

and uh RFK Jr. is at EPA. And here's why

it could never have worked. And I think

this is I I do think this is really

important for understanding what Maha

has become and why what is happening is

in my view extremely extremely bad which

is

Trump is transactional and coalitional.

RFK Jr. could not be put to EPA where he

would want to do something about climate

change and probably make it through the

Senate and then like get anything done

because Trump gets a huge amount of

money from oil companies and there are a

lot of people making transactions with

Donald Trump who do not want RFK

Junior's set of views at EPA. So what

has he actually been doing at HHS? What

has Trump been doing? And you see huge

holdups in NIH grant making holding up

$1.5 billion in funding. You see the

evisceration of cancer research funding.

You see the evisceration of mRNA vaccine

research funding

>> because this fits two things. It fits

RFK Jr.'s view of the world where he's

very skeptical of the scientific

institutions very skeptical of these

kinds of pharmaceutical interventions.

And it fits the part of the Republican

party that just hates government and

wants to slash it. Needs the money it

will save by slashing it to give tax

cuts to rich people. Right? Ark Jr. used

to be very much about healthcare access

and believed in it. But in fact they are

gutting Medicaid as part of the big

beautiful bill. One of the great

tragedies of all this is Trump in his

first term in my view had functionally

won good policy which was operation warp

speed. When you look back at the

pandemic data one thing worked which is

vaccines.

And what they've done in office is not

outlaw school closures in the future.

It's cut into vaccine research. It's

like we are taking the one thing that

really worked and disassembling it to

the best they can. Co was in many ways a

very modern kind of pandemic. It was

accelerated by international travel and

all the things we know. the vaccines

were a very modern solution and

particularly how fast they worked and

and some of the new forms of them like

mRNA vaccines like RFK Jr. is not super

excited about GLP1s. He's very worried

about obesity but not super excited

about GLP1s even though that is the most

effective uh treatment we have ever

found on obesity by many many many

miles. It's like I can imagine

>> a version of MA I'd be excited about. I

feel about it the way I always felt

about Doge, which is like good idea.

Somebody should actually try it. But

we're being governed by, you know, these

profits of naturalism. And they make

some good points, but they're trying to

take out all the technological solutions

that we've been building and that

actually, you know, are the sort of

countermeasures to

problems and threats we face that yes

are part of technological society. You

like don't get to undo it.

>> I do perceive him as extremely

politically crossressured in a bunch of

different ways. It is not a natural

marriage. the Maha Maga coalition and

it's not guaranteed to him that he keeps

that job. So NAH cuts a lot of that is

Doge, right?

>> Doge Doge did a lot of the sort the

agency cuts and the NAHH cuts and the

research cuts in it sort of

characteristically ridiculously sloppy

way. So you got all these cuts in cancer

and all these cuts in Alzheimer research

and all this stuff that like wasn't

remotely intentional, right? It doesn't

actually reflect very much about

anyone's worldview other than we can

break it and worry about it later. And

that that's not an RFK thing really so

much as a Elon thing. And therefore,

>> but a thing RFK has defended,

>> but a thing that he'll defend because

he's an incredibly canny, ambitious

political actor. I I think he is playing

a pretty long game. He wants to keep

that job. He does not want to be kicked

out of the nest. And I think he probably

potentially wants to run in 28. So he

takes the doge cuts. He supports OBB. He

writes a a editorial in May in the Times

supporting Medicaid work requirements,

something that he never could have done

10 years ago, right? And he has to

deliver wins for his coalition early.

And so he's doing all of this like

tickytacky stuff, right? He's like

getting corporations to voluntarily take

their the food dye out of their ice

cream or whatever. And then he's like,

you know, appearing at press conferences

saying like, "Thank God now your ice

cream is saved from that food dye." He

it's not that he thinks that he has done

something amazing there. He's just he's

just trying to rack up a couple of wins

that satisfy his coalition. And then the

last thing I would disc that is him,

right? Cutting $500 million.

>> So that's what I was going to say, which

is that I think absolutely

his antivax stuff is very very sincere,

but even on vaccine policy, I think he's

quite crossressured. So the mRNA the in

the antivax universe there is a real

distinction between people who are sort

of what I'll call traditionally antiax

who are like moms worried about the MMR

causing autism right people who were

antivaxed before the pandemic and then

people who are specifically obsessed

with the COVID vaccine and with mRNA who

have this whole like um set of theories

about what mRNA mRNA as a technology did

to people the idea that the covid vac

killed all these people all this

He has to deliver wins to his antivax

base. He is actually, I think, trying to

do things in some ways that split the

baby a little bit. He is really going

hard on COVID boosters. He's cut the

mRNA, which is very much a win for his

base. They're thrilled about it. And at

the same time, he quietly approved flu

vaccines for the fall last week. his new

ACIP if you approved RSV shots for the

next year for babies.

When he took mRNA away, he said it's

because we don't think it works well

enough and we want to go back to other

models of vaccination. We're going to

we're going to come up with other

vaccines that will work better for

respiratory diseases. He didn't say we

don't need vaccines at all. That's not

to defend any of those choices, right?

That's not to say that any of those

things were good decisions or to suggest

that he's not himself very sincere in

his antivax aspirations. But I think

he's in a complicated place where he

can't actually wholesale get rid of

vaccination

access in this country because I don't

think that that's what Trump wants. I

think if we have hundreds of dead kids

from measles next year, that's a problem

for RFK and he's aware of it.

>> So I agree with that to the extent that

he's crossressured and can't maybe do

everything he would like to do. But I

think that the the thing that I am

getting at the the sadness of all this

to me that the thing that they are

really exercising a lot of state power

to do

whatever the coalition dynamics are is

gutting scientific and medical research

um firing huge amounts of people on that

and

taking away from the development of

future drugs and treatments. So we're in

a very promising place. Um we were doing

a lot towards a vaccine for HIV, right?

The mRNA where you know Maha is very

worried about the rise in cancers. The

mRNA vaccine research we were doing um

and that was really that is really

showing promise is around a bunch of

different cancers. Uh my partner is kept

alive by medical technology, right? If

she didn't have insulin, right, that's

that.

Um, but they have used the actual power

of the state to kneecap a huge amount of

basic research.

>> Totally.

>> It's not like they have outlawed the

advertising of sugary cereals and

processed foods to kids. They've not

outlawed processed foods. They've not

mandated exercise. They have done some

jaw boning of corporations on food dies,

which I'm for. I don't think there

should be food dies in everything. I

don't think it's valuable.

You know, there's a lot I would love if

the Trump administration or any

administration would do on ways in which

profit deforms

what my kids are exposed to, what I'm

exposed to. Like, I wish my kids never

saw Paw Patrol

on a package of gummies in the

supermarket ever. Like, I just don't

think that should be legal. Um, like I

would use state power to like curb a lot

of advertising towards kids, right? And

I think things like that would actually

help. But instead, what we're getting is

this attack on wizardry, right? We're

getting an attack on the technological

foundations

of um of how we might treat diseases

that are everywhere right now. We don't

know what treatments we will not have

because of this. It is hard to blame

anybody for a medic a medicine that

doesn't exist until 5 years later than

it might otherwise have because you

never knew you could have had it. Like

that seems David to be where we're

going.

>> Yeah. Yeah. And I think it's interesting

to think about, you know, the way that

the Trump coalition shifted since 2016.

One of the major changes is that we have

a new techright component and many of

those figures do want radical

technological change and want to see the

government not kneecapping that, but

getting out of the way of that progress.

And you know, we we've talked around

this a bit um already, but you know, the

the truth is that America is in a much

worse place health-wise than all of our

peer countries. um even though we're

richer um you know even though our our

medicine is quite advanced you know

something like 500,000 700,000 Americans

are dying every year um above the levels

that would be dying if we matched our

peer country's mortality rates these are

huge huge um amounts of suffering and

ill health that we're staring at and we

are throwing away the tools that we have

um to help us there

>> I mean the the thing that makes the most

concrete difference in or is likely to

make the concrete difference in health

outcomes for Americans is the one big

beautiful bill, right? Like the most

important thing that has happened is the

Medicaid cuts and the SNAP cuts. Um and

that I think is

uh his his turn there. Um his sort of

like relinquishing of any concern for

entitlements. like Medicaid, you know,

supporting Medicaid work requirements,

getting up and doing press conferences

in which he's talking about taking away

um the ability to use SNAP money to buy

junk food, right? Like as he's also

supporting a bill that is effectively

going to make children go hungry in this

country. That's the most concrete thing

that this administration has done on

health. Yeah. This year, you know, um

the technological stuff is really

devastating. The research stuff is

really devastating. It's not totally

unprecedented. George W. Bush put a

pause on stem cell research which was a

huge issue when he came into office.

Absolutely delayed discoveries

potentially right in a in a major way.

And at the same time stem cell research

did continue in the private sector and

then was resumed in 2009. So I do think

it is devastating on no level do I think

that anything that they are doing at HHS

is good. And I don't think it means

certain doom for our ability to continue

to do meaningful biomedical research in

this country or to resume um biomedical

research that's supported by the federal

government in the future. I

>> I agree that it's not doom, right?

There's a I think a big difference

between um things we could have gotten

that we won't or won't until later and

and and doom. So I don't want to be too

much of a doomsayer. I guess though it

it opens this question. I said a few

minutes ago that, you know, Maha is a

good idea. Somebody should try it.

What would it look like to try it?

Taking seriously David's point a second

ago that we are sicker than our peer

countries. Taking seriously everything

we know about chronic illness in

America, which is devastating and

endemic, and taking seriously that

cancers are rising among young people.

taking seriously that there is that

there are unusual forms of pollution all

around us including microplastics which

we don't really understand what they do

to the human body.

I often think that maha is like the

wrong answer to the right question.

How would you think about beginning to

formulate the the right answer to that

question rather than just

counterpolarizing

you know into a defense of the

institutions or policies as they exist.

>> Um I think that there are a few

different things. So, I think to to

hammer home about entitlements again,

first I think you could do Medicare for

all who want it, right? If you're not

going to be able to do Medicare for all,

you could do Medicare for all who want

it and you could expand healthcare

access in this country. You could do

more generous entitlements rather than

less. That would go a huge distance,

right? Chronic disease in this country

is a colossal issue. It is not born

equally amongst classes. People who are

poor have a much greater disease burden.

you could do things that he sort of said

he wanted to do which is invest in both

on the research side trying to

understand

the role of some of these contaminants

in the in in human health. We have

questions about chemical additives. We

have there are lots of things we

actually don't understand that well that

we could use a lot more research on um

and he could invest in that. You could

totally change the way that you pay for

healthcare in this country and this is

something that they sort of maybe are

doing. they are looking at reimbursement

schemes. So that right now we um we

relatively overimburse procedures versus

talking, right? You get paid much much

more to go do a colonoscopy than you do

to go talk to your primary care doctor

for the same amount of time or the

doctors get paid much more. And it

incentivizes certain kind types of care

being used more often than others. And

it also just makes it very hard to meet

the demand for certain types of care.

So, we make it easier to prescribe uh

anti-depressants than it is to find a

therapist who can see you and who can be

paid for that time. You could totally

change the way that you think about

reimbursing all of these

non-farmacologic interventions in ways

that would incentivize their use.

There's lots of good evidence for doing

that. We don't do that right now in the

system. And then, you know, I think the

question about how how to manage this

breakdown in trust is also really

interesting. I think it's critical that

we don't counterpolarize. I think we're

really in danger of doing that and we

have to be very very careful about it. I

don't think that on any level Democrats

want to be the party that's defending

pharma, right? Like that's a huge huge

trap for us.

>> I'm curious what you'd add to that.

>> Well, I think one really important thing

is that, you know, RFK is really driving

liberals away from public health um

guidance too and that's quite damaging.

You know, the repopulation of his

vaccine advisory panel. I don't think

many liberals are going to trust the

advice of that panel going forward. I

think that that is quite damaging. I

think the, you know, the changes to the

vaccine compensation program he proposes

are, you know, quite problematic. Um,

but I would I would sort of emphasize

your point, which is that, you know, on

a lot of these um questions, why are why

are Americans less healthy? We don't

know all of the answers in total detail,

but we know the broad strokes. We know

that we're a more violent society. We

know that we have, you know, more guns.

We know that we drink and do drugs more.

We know that our diets are unhealthy. we

know that we don't exercise enough. You

know, these are not questions that we

don't know the answers to. The problem

is, you know, how do we manage to

encourage good behavior, discourage bad

behavior, and support it um through

funding and public policy? And I, you

know,

I don't know that the answers there are

obvious and I don't know how much

progress even an ideal figure in RFK's

position would have because we are so in

all of these areas um fighting against

one another, animated by resentment

towards elites and institutions um

trying to navigate and find new ways

around um old guidance towards new um

new wisdom. It just feels to me like,

you know, we're we're in a bit of a

free-for-all brawl and that we are in a

we are in a phase when we are going to

be repolarizing and repolarizing and

repolarizing.

>> Well, one one way I hope we don't

repolarize is part of the abundance book

out of Derek Thompson. I mean, we have

two chapters in that book that is

fundamentally about the

bureaucratization of science. The amount

of time that goes into NIH grant

writing, it's like 40% of um the

researchers time. Derek has this good

line. Derek Thompson in the book was

like it's like we gave like all the

researchers chronic fatigue syndrome,

right? We're making them spend all this

time on paperwork.

>> They are really doing a lot of damage to

the NIH, to the FDA,

>> to these institutions that are in many

ways remarkable and are also flawed. And

one of my concerns is the, you know,

rallying around the institution as it

was. But there's also going to be this

question of what could it be?

And during the pandemic,

there were some marvels, right? As you

said, how quickly the mRNA the mRNA

vaccine was developed. And there's

questions of could the process by which

it was approved have been faster? Should

we have had more things like human

challenge trials? Um there was fury I

think correctly about the wide

availability of rapid testing in Europe

that it took us a long time to approve

it here.

>> Yeah.

>> And so there's also that side of it,

right? I mean I actually think we should

embrace um a huge amount of what you

know Maha at least claims to embrace

around nutrition and and health and

other things. But I also think that the

reality is one way you cure diseases is

through technological treatments for

them. And

I would like to see a Democratic party

that took more seriously that we could

get a lot more out of the NIH, the CDC,