Efforts & Challenges in Promoting Public Health | Dr. Vivek Murthy

1. 0:00 – 1:53

   Dr. Vivek Murthy

   1. AHAndrew Huberman0:00

      Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today my guest is Dr. Vivek Murthy. Dr. Vivek Murthy is a medical doctor and acting Surgeon General of the United States. As Surgeon General of the United States, Dr. Murthy oversees more than 6,000 dedicated public health officers whose job is to protect, promote, and advance our nation's public health. Dr. Murthy received his bachelor's degree from Harvard University and his medical degree from the Yale University School of Medicine. Today's discussion covers some of the most important issues in public health, not just within the United States but worldwide, including nutrition and the obesity crisis as well as food additives and why certain food chemicals and additives are allowed in the United States versus in other countries. We also discuss mental health, the youth mental health crisis, the adult mental health crisis, and the global crisis of loneliness and isolation. We also talk about corporate interests, that is whether or not big food and big pharma industries actually impact the research and/or decisions that the US Surgeon General takes in his directives toward public health. And, of course, we discuss some of the major public health events that occurred over the last five years and the current and future landscape of how to restore faith both in public health officials, in public health policy, and science more generally. By the end of today's episode, you not only will have learned a tremendous amount about public health and why you hear the particular public health directives that you do, but also how to better interpret future public health directives. You will also come to learn that as Surgeon General, Dr. Murthy has both an extremely challenging job, but one that he meets with a tremendous amount of both rigor and compassion.

2. 1:53 – 4:35

   Sponsors: Maui Nui & ROKA

   1. AHAndrew Huberman1:53

      Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Maui Nui Venison. Maui Nui Venison is the most nutrient dense and delicious red meat available. I've spoken before on this podcast in solo episodes and with guests about the need to get approximately one gram of high quality protein per pound of body weight each day for optimal nutrition. Now, there are many different ways that one can do that, but a key thing is to make sure that you're not doing that by ingesting excessive calories. Maui Nui Venison has the highest density of quality protein per calorie, and it achieves that in delicious things like ground meats, venison steaks, jerky, and bone broth. I particularly like the ground venison. I make those into venison burgers probably five times a week or more. I also like the jerky for its convenience, especially when I'm traveling or I'm especially busy with work and know that I'm getting an extremely nutrient-dense, high quality source of protein. If you'd like to try Maui Nui Venison, you can go to mauinuivenison.com/huberman and get 20% off your first order. Again, that's mauinuivenison.com/huberman to get 20% off. Today's episode is also brought to us by ROKA. ROKA makes eyeglasses and sunglasses that are of the absolute highest quality. I've spent a lifetime working on the biology of the visual system, and I can tell you that your visual system has to contend with an enormous number of challenges in order for you to be able to see clearly in different environments. ROKA understands the biology of the visual system and has designed their eyeglasses and sunglasses so that you always see with crystal clarity. Originally, their glasses were designed for performance, that is for running and cycling and for sport, and indeed they can still be used for performance. They won't slip off your face if you get sweaty. They're extremely lightweight. But I should mention that ROKA eyeglasses and sunglasses come in some of the aesthetics more typically associated with performance glasses, like those cyborg-style glasses, but they also have a number of styles that you would be perfectly comfortable wearing out to dinner or to work. I wear readers at night or when I drive, and I wear sunglasses during the day if I happen to be driving into bright light or outside and it's just overwhelmingly bright. I do not wear sunglasses when I do my morning sunlight viewing to set my circadian rhythm, and I suggest that you do the same. If you'd like to try ROKA eyeglasses or sunglasses, you can go to ROKA, roka.com and enter the code Huberman to save 20% off your first order. Again, that's ROKA, roka.com and enter the code Huberman at checkout. And now for my discussion with Dr. Vivek

3. 4:35 – 7:44

   Surgeon General Roles

   1. AHAndrew Huberman4:35

      Murthy. Dr. Vivek Murthy, welcome.

   2. VMDr. Vivek Murthy4:38

      Thanks so much, Andrew. And please call me Vivek. I'm informal. (laughs)

   3. AHAndrew Huberman4:41

      Okay, Vivek. My understanding based on my internet search is that the role of the US Surgeon General is to provide scientific information on how to improve health and reduce risk of illness and injury. Do I have that correct?

   4. VMDr. Vivek Murthy4:58

      That is correct.

   5. AHAndrew Huberman4:59

      What are some other roles that you play that perhaps would not come up in a, uh, top, uh, top hit, uh-

   6. VMDr. Vivek Murthy5:08

      (laughs)

   7. AHAndrew Huberman5:08

      ... Google search that, that I ought to be aware of and that our audience ought to be aware of?

   8. VMDr. Vivek Murthy5:13

      Well, here's how I, I generally explain to people. There, there are two primary roles the surgeon general has. One is to engage with the public and make sure that people know about critical public health issues, that they, so they know what they are, how to protect themselves and their families. The second role of the surgeon general is lesser known, but it's equally as important, which is to oversee one of the eight uniformed services in the US government, and that is the United States Public Health Service. Many people are familiar with the Army, the Navy, the Air Force. W- we also have the US Public Health Service, which has 6,000 officers. They include doctors, nurses, physical therapists, pharmacists, public health engineers, a whole range of, uh, of healthcare folks, and their job is to protect our nation from public health threats. So when Ebola, uh, came on the scene in 2014, uh, in, in a major way in West Africa...We sent hundreds of officers to West Africa to set up the Monrovia Medical Unit in Liberia to treat people with Lib- with, uh, with Ebola. Domestically, when there are hurricanes or tornadoes, we dispatch, uh, officers and deploy them to go help strengthen the social- the public health infrastructure, but also to provide direct care. We deployed thousands of officers during COVID. So these officers, uh, I'm incredibly proud of them. Uh, they could be doing lots of stuff, you know, outside government, in the private sector, probably making a whole lot more money and getting to, uh, you know, work a lot less hard, but they're really committed to protecting the public health of the nation. So I have the privilege of overseeing that service as surgeon general, and those, those are th- those are the jobs, uh, that I've signed up for in this role.

   9. AHAndrew Huberman6:48

      Got it. I was not aware of that role. And if I understood correctly, these people, um, these public health officers, um, that presumably are made up of physicians and licensed psychologists and nurses and so forth, um, th- you said they could be making, uh, substantially higher incomes in the private sector, but the work that they're doing with you is their sole career at this point? They're completely devoted to that, or they're doing this as a side hustle?

   10. VMDr. Vivek Murthy7:16

       No, th- they are full-time, uh, eh, government employees and, and members of the Public Health Service. Their day job is often in public health agencies where they're embedded in communities, helping day-to-day to advance public health, and during times of emergency, uh, we deploy them, uh, you know, and, and they're, they're extraordinarily well-trained. Uh, they're experienced at dealing with adversity, but they bring a combination of skill and heart to their work, and you really need both to be effective at public

4. 7:44 – 12:42

   Illness Framework, Enhancing Wellbeing

   1. VMDr. Vivek Murthy7:44

      health.

   2. AHAndrew Huberman7:45

      I'm glad that you mentioned the word emergency because in preparing for our discussion today, it occurred to me that in this, uh, list of roles that, uh, your title assumes, that scientific information on how to improve health comes first. Then you mentioned emergency. So what I'd like to talk about first is health, not-

   3. VMDr. Vivek Murthy8:06

      Mm-hmm.

   4. AHAndrew Huberman8:07

      ... lack of health-

   5. VMDr. Vivek Murthy8:08

      Yeah.

   6. AHAndrew Huberman8:08

      ... but health. Eh, you know, so often we hear about, um, the mental health crisis, but what we're really talking about is the lack of mental health crisis, AKA mental illness. And rarely do we hear, for instance, what constitutes mental health. We hear what constitutes mental illness. Whereas in the domain of physical health, there's a lot of information out there about how to be more physically healthy, cardiovascular exercise, resistance exercise, yoga-type exercise, mobility, et cetera. And of course, some people have physical health ailments, and there's a lot of information in terms of how to deal with that as well. But what I would like to know before we get into the long list of issues that, uh, our nation confronts, um, everything from obesity to food additives to mental health issues, what is going well? In other words, in the last, let's say, five to 10 years, have there been any areas of physical health and mental health improvement in the US at large that we can attribute to some of the public health initiatives, uh, directly?

   7. VMDr. Vivek Murthy9:13

      So that's a really good question, and let me just also say about the very first point you raised, that y- you're absolutely right, that we ha- have operated primarily through an illness frame when we look at health, and in my mind, that's only one half of the equation, right? So when we are talking about physical illness, for example, uh, you know, as a doctor, I learned how to diagnose and treat someone with diabetes or with high blood pressure or with coronary heart disease. But we also know that even if I don't have diabetes or coronary heart disease, uh, or high blood pressure, even if I don't have any diagnosable medical condition, I may not be at an optimal level of physical health, right? I may not be able to, for example, walk around the block without getting short of breath. I may not be able to play with my kids 'cause my physical fitness and stamina is, is insufficient. I may not be able to lift my luggage when I go to the airport, uh, because I don't have enough strength in my body. Yet, I wouldn't have a diagnosable mental illness. So I think it's easier to understand there with physical health that we're not just aiming for lack of illness. We're aiming to optimize o- our physical health. The same is true with mental health, and I think when we talk about mental health, people think we're just... The g- sole goal here is to prevent diagnosable mental illness. That is one goal, to both prevent and to manage, uh, mental illness when it arises. But we also need to recognize there's a whole other half of the spectrum where there are people who may not have diagnosable mental illness, but are not operating optimally in their lives, and that's detracting from their fulfillment, from their functionality, like in, not just at work, but also in their communities and in their families. And so I think part of the conversation that, that I want us to have as a country is about how to optimize mental health and well-being, and that is includes preventing mental illness, but it is much broader and bigger, uh, than that alone.

   8. AHAndrew Huberman11:00

      Great. Yeah, I think it's so important that we recognize that, um, treating disease is critical, obviously, but that there's a lot that can be done to improve one's health even in the absence of any known disease. And, um, and you've got all these officers, these incredible physicians and, uh, nurses and, uh, people at, uh, your disposal. I, I... My hope is that they would also be accessible for and currently carrying out, um, efforts to transmit information to people about, "Hey, here are the things that you can do every day, every week, every month in order to make your life as, as healthy as possible," um, as well as, you know, rushing in under conditions of, you know, um, public health crisis.

   9. VMDr. Vivek Murthy11:45

      Yeah, it's a good, good point, and, and it's certainly, you know, many of our officers do focus on this, uh, broader, uh, rubric around well-being, but it's part of how we need, I think, the, the broader health system and public health system to operate even outside of government, and this, I think, will require significant change and shift i- in how we think about our jobs. Like, when I went to medical school, the vast majority of the focus was on diagnosing and treating illness. Uh, it was much, much less focused on thinking about how to enhance well-being.And, when you ask, talk to people in their lives, it becomes clear that they want to do more than just prevent diagnosable illness. They, they want to be able to walk their, their child down the aisle. They want... And have the endurance to do that. They want to be able to, uh, be independent often, and carry their groceries or carry their luggage. Um, i- i- this is why I think we've got to broaden our focus in, in public health. And, look,

5. 12:42 – 19:50

   Priorities as Surgeon General

   1. VMDr. Vivek Murthy12:42

      w- when I came into this role, um... By the way, I was not expecting (laughs) to serve in government. This was not part of some 5, 10, 30-year plan. Uh, when I was a, a kid, I was interested in medicine, but I always thought I was gonna practice medicine, you know, like my dad did and like my, like the clinic my mom ran. You know, set up, put up a shingle, see patients, and, uh, be a primary care doctor and, and feel good about the work I was doing. But what happened, uh, to me along the way is, uh, you know, I, I trained in medicine, I got interested in technology, spent seven years building a technology company, uh, that was focused on health. I got w- I was w- I became increasingly worried about the way we were delivering healthcare and felt like our healthcare system was broken. People who needed care couldn't get it. It was often too expensive to get care. We were focusing on treatment solely, and not enough on prevention. So I started getting involved in, in advocating for a better healthcare system with doctors around the country. When, despite all that, I still never thought I would work in government. But in 2013, uh, is when President Obama's team had reached out to me and asked if I'd be interested in considering the position of Surgeon General. And s- what was interesting to me about this position is, it's actually very different from most positions, uh, that are appointed by a president in government, in that it's supposed to be an independent position. So my agenda, the issues I choose to take on, are not determined by a president or a party. They're determined by science and the public interest. Uh, and that's what's, what guides me. You know? And that's what e- e- that's what guided me in that first term when I served, and when President Biden asked me to come back and serve as Surgeon General a second time, that's what's guided me here too. Um-

   2. AHAndrew Huberman14:18

      So Biden, um, is not sending you notes saying, "Hey, could you put some effort into, uh, you know, getting messages out about, you know, COVID," or, "Could you put more effort into, um, getting your team over to Maui to deal with the, you know, the, the, you know-"

   3. VMDr. Vivek Murthy14:37

      Yeah.

   4. AHAndrew Huberman14:37

      "... the tragedy there," and which is a long arc tragedy, right? We get the news in a, in a, in a blast of "This happened," and then the next blast comes in about something else, and we forget that there are physical and mental health crises that are ongoing. Um, and, and then I have to imagine then start to overlap with one another. Or is it, so is it your decision, um, where and how to deploy the financial and, and human resources? Like, okay, we're gonna put 10 people on Maui-

   5. VMDr. Vivek Murthy15:04

      Yeah.

   6. AHAndrew Huberman15:05

      We're going to, um, put, uh, you know, five people in the central states, you know, going around talking to, um, major organizations about what they need to do to prepare for this winter.

   7. VMDr. Vivek Murthy15:15

      Mm-hmm.

   8. AHAndrew Huberman15:16

      I- is that how it works? Or-

   9. VMDr. Vivek Murthy15:17

      That's a good question.

   10. AHAndrew Huberman15:17

       ... are you getting memos and, um... In other words, who's your boss?

   11. VMDr. Vivek Murthy15:21

       (laughs)

   12. AHAndrew Huberman15:21

       Everyone has a boss at some level. Mine are, is, are the listeners of, of this podcast, at some level. I work for them. It used to also be my bulldog, Costello.

   13. VMDr. Vivek Murthy15:29

       (laughs) .

   14. AHAndrew Huberman15:29

       Um, but-

   15. VMDr. Vivek Murthy15:30

       My, my boss, my wife, and my two kids who are five and seven. They, I, I do what they tell me to. (laughs)

   16. AHAndrew Huberman15:34

       Got it. Got it. So, um-

   17. VMDr. Vivek Murthy15:37

       But how we make our decisions in the office, actually, it's, it's a bit different, uh, with those two roles. So on, whe- with the second one, with overseeing the Commission Corps, our 6,000 officers, there the, the decisions about how and when we deploy officers are collaborative, right? So w- I, you know, we work with other colleagues throughout the Department of Health and Human Services. We work with people in FEMA, across the administration. But we also work with states. So sometimes states, uh, often, often states will put in a request and say, "Hey, we need support here. Uh, can you help?" So we'll work with colleagues across our department to say, "Okay, well, we can mobilize our Commission Corps officers. What assets can you mobilize?" And then collectively, we will send a team out there. So for example, we have officers, uh, helping in Maui right now, uh, particularly with mental health needs, uh, which are, I worry, only gonna continue to grow, uh, over the weeks and months ahead. On the other side of the house when it comes to deciding which issues we engage with the public on, like in this case, mental health has been a big focus, uh, area for me. On, on that front, while we certainly, you know, are open to suggestions from the public, members of Congress sometimes say, "Hey, can you help the public understand about this issue?" E- you know, a lot of people have ideas and opinions, but the decision about which issues to focus on, those are our offices. Uh, and to me that's important because part of the reason over time I believe the public came to have some degree of, of faith and trust in the office is because they hope that the office was functioning the way you hope your doctor is functioning, which is being an independent source, uh, of information for you, uh, and a source that has your best interest at heart-

   18. AHAndrew Huberman17:09

       Mm-hmm.

   19. VMDr. Vivek Murthy17:09

       ... that's not being pulled aside by political interests or by other agendas, but the primary agenda is, how can I help your health? And so for me, like I, we have to make an independent assessment there and say, "Okay, where is the need, uh, the greatest here? Where can we make the biggest difference?" Sometimes we may not build an initiative on an issue, and that doesn't mean that that issue's not important or that it's not affecting a lot of people, but we have to make hard decisions about where to put limited resources. And so when I was surgeon general the, the first time, one of the big areas I focused on was the opioid crisis, uh, that we were dealing with, as well as the e- e-cigarette use among youth, because we were seeing a dramatic increase, uh, among kids in e-cigarette use that was-

   20. AHAndrew Huberman17:49

       Can, can I just ask you? Sorry to interrupt-

   21. VMDr. Vivek Murthy17:50

       Yeah.

   22. AHAndrew Huberman17:51

       ... but I think it's relevant here. Um, has that increase continued or, uh, e-cigarette use, AKA vaping?

   23. VMDr. Vivek Murthy17:58

       Yeah. So we still see unfortunately there are, there has been some improvements, but we still see way too many kids who are using, uh, vaping devices early on. And part of what we did from our office is recognizing that. We actually issued the first federal report on e-cigarettes in youth. Uh, we called the country's attention to the fact that this is a crisis. We worked with members of Congress, uh, to talk about the kind of action we needed, uh, from a legislative and regulatory perspective, and worked with colleagues at the FDA and in government as well. But there are two things that are really most important in guiding-... our choice about priorities. Uh, one is data. We look at what the nu-numbers actually tell us about the impact these issues are having on the population, as well as the trajectory of rise. If something's getting dramatically worse and people don't realize it, might be an area for us to focus. But the other, uh, critical factor is what I hear from people on the road. And so, I try to spend as much time as I can visiting communities across the country, doing town halls, meeting with, uh, community members, and just trying to, frankly, just listen to what's on their mind. And that's where I actually get a lot of information as well, uh, that te- like, that's actually how I came to focus on the issue of loneliness and isolation. It wasn't 'cause it popped up in a report, uh, as being, uh, the, the leading public health issue in the country. It was because everywhere I was going in 2014, 2015, uh, whether I was talking to college students, talking to retired Americans, talking to parents in rural areas and urban areas, I kept hearing these stories about people who felt like they were all on their own, or they felt invisible, or they felt if they disappeared tomorrow, no one would even care, or they felt like they just didn't belong. And it's heartbreaking to hear that from anyone. It's particularly heartbreaking to hear it from kids, uh, who you hope are entering life and looking forward to what comes, uh, but many kids weren't feeling that way.

6. 19:50 – 28:24

   Public Health Message Distribution

   1. AHAndrew Huberman19:50

      That is very useful context. And I, we will get back to the isolation, um, crisis. Um, such an important initiative that, um, I, I just will thank you now for having put out the, the message on social media and elsewhere b- um, about that, um, because I think one of the questions I have, in light of what you just said, is it's clear that you've got your ear to the ground, you're talking to different people. Um, it's also critically important that people hear from you and know, um, not just what's happening, but that you perhaps want to know what, uh, you know, where the issues lie and what the, um, what the actionable steps are that people can take, right? And I think that we now live in a hyperconnected world. Um, so, you know, in fact, I'll just say that one of the reasons I launched this podcast is, in 2020, I was going on podcasts talking about things like maintaining sleep and circadian rhythm and stuff from my lab related to trying to con- um, adjust anxiety under, uh, under conditions where I think everyone was anxious and sleep rhythms were disrupted, et cetera. Um, and I was somewhat surprised that I didn't get a warning on my phone, "Hey, make sure you're getting morning sunlight." You know? Like, I- I'll get a flood warning.

   2. VMDr. Vivek Murthy21:04

      Uh-huh.

   3. AHAndrew Huberman21:05

      You know, I'll get a warning that I might get a warning.

   4. VMDr. Vivek Murthy21:07

      Mm-hmm.

   5. AHAndrew Huberman21:07

      But it's only a test warning.

   6. VMDr. Vivek Murthy21:08

      Uh-huh.

   7. AHAndrew Huberman21:08

      I got three of those yesterday, living here near the coast. But, um, I don't think once during the pandemic did I get a email or a public service announcement saying, "Hey, you know, if you, uh, are going to be indoors a lot, you're going to have to be mindful of maintaining your circadian rhythm, because if you're not..." I mean, we know based on hundreds of studies now that drifts in circadian rhythmicity are a precursor to mental health issues. I mean, i- in fact, there's a new idea that many, not all, suicides, um, are preceded by a period of disrupted sleep, which is, you know, kind of makes sense and, and, um, and it's not, uh, causal, of course. But how come during the pandemic we, each and all as US citizens, did not get an email or a text message saying, "Hey, these are five things that you need to do every day to try and stay as stable as possible in this very uncertain landscape that we're in"?

   8. VMDr. Vivek Murthy22:11

      Well, I mean, it's a really good question. And, and I think it's a, it's a reasonable, uh, ve- and a very good suggestion to say that, "Hey, look, there should be a clear and comprehensive way that we can get messages out to everyone." Um, like, if we were working in a hospital system and there was a safety issue that came up, there would be an email sent to all the hospital staff members saying, "Hey, this is something you need to be aware of," right? So I think it's a reasonable expectation. Uh, practically, if you go back, though, over the last 20, 30 years for on, on a, on health issues, uh, there hasn't been s- sort of an agency or an entity that has sent emails out to everyone. First of all, how to send an email out to everyone in America is not a simple proposition either. Technically, it's challenging. There are some legal issues you'd have to deal with as well, but-

   9. AHAndrew Huberman22:59

      But you could do a night where you go CNN, Fox, NBC, ABC, New York Times, Wall Street. Like, you could hit the right, the, the right wing, the left wing, and everything in between.

   10. VMDr. Vivek Murthy23:08

       So that's, yeah, that's a really interesting suggestion.

   11. AHAndrew Huberman23:10

       Like one, but one, one video.

   12. VMDr. Vivek Murthy23:12

       Yeah.

   13. AHAndrew Huberman23:12

       Just where they all agree like, "Hey, this is important information."

   14. VMDr. Vivek Murthy23:15

       Sure.

   15. AHAndrew Huberman23:15

       So apolitical. Like no-

   16. VMDr. Vivek Murthy23:17

       Yeah, so I would say that that kind of messaging, I would say, through traditional media certainly has happened, you know, and it happened during COVID. Uh, it happened, for example, when, um, you know, in the first year of COVID, I was a private citizen, you know, in the prior, prior administration, but I, you know, I watched both then and at the beginning of the, the Biden administration. Um, many officials would go out in front of cameras and say, "Here are three things you need to do to keep yourself safe, uh, you know, from, from COVID as..." And that was a big question people had, "How do I keep myself safe?" "Okay, here are three things you can do." A couple of challenges I would say here is that, number one, even if you hit all the major network, uh, and, and cable news shows, you're still not reaching everyone, right? Because we're living in a, in a society where increasingly people are not watching TV, right? They're getting their news from other sources. Um, the other thing, uh, that's important to know is that attention shifts quickly, you know, uh, in traditional media also from issue to issue. And so, you might get a clip, you know, out at a certain, uh, day, or you might get on all the Sunday shows, for example, but the next day, you know, that message isn't necessarily there. You know, it's, it's gone and people's attention has also switched off too. So there were, I mean, I can count...... and, you know, we've logged probably thousands of interviews at this point that we've done with mainstream media with sort of cl- you know, concise messages about three things you can do to protect yourself, et cetera. And, you know, I'm glad we did those. We gotta do them. But I think one of the things we, they don't, we don't have right now i- in the country, and this is an, um, I think a bit of an health infrastructure challenge, is we actually don't have a quick, efficient way to reach everyone in the country with a, a health message. Just like what you said, you know, what are, if you wanted to get that message about three things to protect yourself from, let's say, COVID, or three things to do to, you know, support your health and wellbeing during a time of crisis-

   17. AHAndrew Huberman25:07

       Or during a time of health.

   18. VMDr. Vivek Murthy25:08

       Mm-hmm.

   19. AHAndrew Huberman25:08

       I mean, a- again, like not just the flood warning, but the-

   20. VMDr. Vivek Murthy25:10

       Yes.

   21. AHAndrew Huberman25:11

       ... the, the daily... 'Cause I, I do think that most of mental and physical health-

   22. VMDr. Vivek Murthy25:15

       Mm-hmm.

   23. AHAndrew Huberman25:15

       ... is the result of daily practices-

   24. VMDr. Vivek Murthy25:17

       Mm-hmm.

   25. AHAndrew Huberman25:17

       ... that are, you know, they build on e- themselves, sort of like compound and-

   26. VMDr. Vivek Murthy25:21

       Absolutely. Yeah.

   27. AHAndrew Huberman25:21

       ... compounded investments. And then, of course, there are acute challenges and chronic challenges that-

   28. VMDr. Vivek Murthy25:25

       Yeah.

   29. AHAndrew Huberman25:25

       ... people face. But-

   30. VMDr. Vivek Murthy25:26

       There are.
7. 28:24 – 33:04

   Diagnosis vs. Optimizing Health

   1. VMDr. Vivek Murthy28:24

      we do now. I think part of what this reflects is a broader challenge, like in government but also in society more broadly, which is that we have valued historically prevention and health communication very little. We put the mass majority of our resources into treatment strategies, into getting medications to people, into diagnosis. And that's very important. Don't get me wrong. But we are now seeing with mental health, this is one example, that if we only focus on expanding treatment and deepening our well of knowledge there and we don't do anything to help people stay well, that we just can't keep up, right? And if-

   2. AHAndrew Huberman29:05

      Right. Because one problem feeds the other.

   3. VMDr. Vivek Murthy29:07

      Exactly.

   4. AHAndrew Huberman29:07

      Like the kids that are stay... Listen, I ... If I were to have grown up in today's era, I'd be on my phone and tablet late at night-

   5. VMDr. Vivek Murthy29:13

      Uh-huh.

   6. AHAndrew Huberman29:13

      ... 'cause I was up reading magazines-

   7. VMDr. Vivek Murthy29:14

      Sure. Yeah.

   8. AHAndrew Huberman29:14

      ... and talking to friends on the phone late at night, right?

   9. VMDr. Vivek Murthy29:16

      (laughs)

   10. AHAndrew Huberman29:16

       So it's not a criticism, but, but, you know, disruptions in sleep, disruptions in circadian rhythm, disruptions... lack of physical activity, poor nutrition, social, social isolation, I mean, these are all piling the sand much higher on this, uh, in this other side of what you do in terms of... And here I'm obviously, uh, stating the obvious. E- you know, so it's just gonna create a mountain of issues on the other side, which presumably has a larger budget is what I'm sensing, but doesn't... Um, but there's no way that budget is large enough to deal with that. I mean, if somebody's kid, for instance, is, um, trying to address the issue of whether or not to go on pre- prescription medications and/or, by the way folks, and/or change their dietary intake because they feel they might have ADHD, for instance, I mean, what are they gonna do? They're gonna google. They're gonna listen to podcasts. They're, they, they should be able to write first to your organization and say, "You know, what does the highest level stringency data say about these issues?" And AI should be able to tell them accurately.

   11. VMDr. Vivek Murthy30:21

       Yeah.

   12. AHAndrew Huberman30:21

       Eh, uh, and maybe you have somebody chime in for them.

   13. VMDr. Vivek Murthy30:24

       Mm-hmm.

   14. AHAndrew Huberman30:24

       I mean, we all pay taxes. I pay federal and state taxes. Um-

   15. VMDr. Vivek Murthy30:30

       Me too. (laughs)

   16. AHAndrew Huberman30:30

       ... a- and, and, and to some extent happily so.

   17. VMDr. Vivek Murthy30:33

       Yeah.

   18. AHAndrew Huberman30:33

       Right? Um, because it pays for public works and, and many, many important things, police officers, firefighters, et cetera. But if you don't have a channel to communicate with people about what they and their kids and their relatives can do, then-Like, to some extent, it feels like it- it's, um, it's a cul-de-sac. And it's like, how- how- how in the world can we get healthy again, or healthier, as a- as a country?

   19. VMDr. Vivek Murthy31:03

       The part that keeps me up at night is, and what are some of the hardest decisions I have to make in the office, are putting aside issues that we know deserve a lot more time and attention, uh, but we just really don't have the resources to deal with, you know? The issues that we have dealt with, I am certainly proud of my team that we've worked hard to try to raise awareness of the issues we have taken on, whether it's around, you know, social media and youth and mental health, or whether it's around isolation or clinical- clinician burnout, or other issues like that. But the truth is, uh, that there's more that needs to be done, more issues that need to be tackled, and we have to get to a place where we can, uh, you know, talk about what I think of as the core pillars of- of a healthy life, right, which are sleep, our nutrition, our physical activity, our social relationships. Like, these are all vital elements to living a healthy life. Right now, we're not teaching kids about this in school, right? But if you think about education, uh, and school as a- a- a place and a force that should prep- prep kids for the rest of their lives, it should lay a foundation for a healthy life going forward. These absolutely are important elements for kids to learn about. I- I think it's as important for kids to learn about how to build and maintain healthy relationships in their life as it is, frankly, for them to learn how to read and write. And I know that's a strong statement to make, but it is true in terms of its contribution to their- their happiness, their fulfillment, their health, and their success.

   20. AHAndrew Huberman32:29

       Yeah. I- I- I could not agree more. Uh, we have a series that's out now with a psychiatrist, Paul Conti, about mental health, not mental illness, about self-inquiry and how to use self-inquiry and practices that do not require, uh, a therapist in order to bolster mental- mental health. Um, of course therapists can be very useful, but not everyone has access.

   21. VMDr. Vivek Murthy32:50

       Right.

   22. AHAndrew Huberman32:51

       And not everyone feels comfortable, uh, doing that. Um, but we are but one channel. I mean, you are the governing body for this. Um, you're the army, uh, navy, and marines, so to speak, of- of health.

8. 33:04 – 34:01

   Sponsor: AG1

   1. AHAndrew Huberman33:04

      As many of you know, I've been taking AG1 daily since 2012, so I'm delighted that they're sponsoring the podcast. AG1 is a vitamin mineral probiotic drink that's designed to meet all of your foundational nutrition needs. Now, of course, I try to get enough servings of vitamins and minerals through whole food sources that include vegetables and fruits every day, but oftentimes, I simply can't get enough servings. But with AG1, I'm sure to get enough vitamins and minerals and the probiotics that I need, and it also contains adaptogens to help buffer stress. Simply put, I always feel better when I take AG1. I have more focus and energy and I sleep better, and it also happens to taste great. For all these reasons, whenever I'm asked, "If you could take just one supplement, what would it be?" I answer, "AG1." If you'd like to try AG1, go to drinkag1.com/huberman to claim a special offer. They'll give you five free travel packs plus a year supply of vitamin D3K2. Again, that's drinkag1.com/huberman.

9. 34:01 – 39:11

   Food Additives, Highly Processed Foods, Food Availability

   1. AHAndrew Huberman34:01

      There's lots more to explore there. Um, we may have to do, uh, several, uh, of these together, but, um, to touch on all of them. But maybe we could, um, talk about a few of the things that, um, our listeners asked about when-

   2. VMDr. Vivek Murthy34:16

      Sure.

   3. AHAndrew Huberman34:16

      ... I solicited for questions. And I got more than 10,000 responses across social media in a very short amount of time, but there was some redundancy.

   4. VMDr. Vivek Murthy34:25

      Mm-hmm.

   5. AHAndrew Huberman34:25

      Um, one of the things that I'm very curious-

   6. VMDr. Vivek Murthy34:27

      Can I just stay on that point though, Andrew?

   7. AHAndrew Huberman34:28

      Yeah, please.

   8. VMDr. Vivek Murthy34:29

      One, I'm really glad that you asked, uh, folks to submit questions, and I was really excited to see how many people actually wrote in. Uh, but I think it's also just a testament to how you've done such an incredible job building a- a- a channel to- to the public to let people know, uh, about these topics that, you know, that are so vital to our health and wellbeing, whether it's sleep or physical activity or mental health. Uh, and so I just want to thank you for all the work you're doing trying to help people understand more about health. And clearly the fact that folks are engaging, they're sending questions in, they're sending comments to you means that you're building a relationship there with a lot of folks. So just kudos to you for doing that.

   9. AHAndrew Huberman35:04

      Well, thank you. The- the audience of the Huberman Lab Podcast is- is the only reason we do it.

   10. VMDr. Vivek Murthy35:10

       Mm-hmm.

   11. AHAndrew Huberman35:10

       I mean, I love learning and teaching, but, um, that's the truth. So they are the podcast, um, the podcast is them. Um, so thank you for that. Uh, there were a lot of questions, and I also wonder about why is it that many food additives and preservatives and dyes and things of that sort, that are not allowed in Europe are allowed in US food products?

   12. VMDr. Vivek Murthy35:39

       Hmm. It's a really good question, and decisions around food and food safety in particular are made by the Food and Drug Administration, so that's the FDA. Uh, it's not, it's a separate, uh, agent, independent agency. It's not one that our office, uh, is involved in- in sort of directing in any way. Uh, and so we're not involved in those decisions and don't have insight into how, uh, they're making their- drawing their conclusions, but, uh, they do it in- in a process just that's, you know, guided by scientists like they do and with medications, with devices, et cetera. With that said, you know, I am concerned that dietary practices, the food that many Americans are consuming, are in fact not supporting their health and wellbeing, and in many ways are detracting from it. Uh, when we look at highly processed foods, one of the concerns I have there is we often see sodium content is very high. We see the sugar content, uh, is very high. And, you know, there are certainly additives in there as well, uh, that I think we, I would love to have more data on the actual health impacts o- of those. But the bottom line is that a significant portion of our diet, uh, is comprised of highly processed foods in America.... and, and that worries me. The als- other piece of this that worries me are just h- how much r- you know, refined sugars are being added to so much of our foods. And most people think that sugars are only added to things like desserts, et cetera, but you look at spaghetti sauces-

   13. AHAndrew Huberman37:10

       Salad dressings.

   14. VMDr. Vivek Murthy37:11

       ... salad dressings. A lot of these things which we think of as savory products have, have sugar added to them as well, and so we are consuming, I think, unhealthy levels of sugar in our diet. We're consuming a fair amount of additives, given the processed food composition in our diet, and I think part of the reason this is happening, and I wanna be very clear, I don't fault individuals out there for the composition of their diet necessarily, because we have also made certain decisions in our country about, uh, what we subsidize, about what's cheaper and more expensive for people, and the cheapest foods, unfortunately, are often the most unhealthy foods, the most highly processed foods. Uh, if you are somebody who lives in the low-income neighborhood, a number of these neighborhoods don't even have grocery stores in them, which is a, you know, a tragedy because you can't get fresh produce, et cetera. A lot of times you're shopping, your grocery shopping may be done at a local convenience store, uh, at a 7-Eleven or at, you know, somewhere else that may not have, like, the array of, of fresh fruits and vegetables that you and your family need, uh, for better health.

   15. AHAndrew Huberman38:18

       I don't even think they have vegetables. I think they have, they'll occasionally have some lemons or apples or oranges and bananas, but when I walk into a convenience store, what I see is a pharmacy.

   16. VMDr. Vivek Murthy38:29

       Mm-hmm.

   17. AHAndrew Huberman38:29

       I really do. I see alcohol, caffeine, energy drinks that have a number of different things in them designed to stimulate different neuromodulators-

   18. VMDr. Vivek Murthy38:36

       Mm-hmm.

   19. AHAndrew Huberman38:36

       ... like dopamine and serotonin. I see nicotine products.

   20. VMDr. Vivek Murthy38:40

       Mm-hmm.

   21. AHAndrew Huberman38:41

       I see high-sugar, high- highly processed foods.

   22. VMDr. Vivek Murthy38:43

       Yeah.

   23. AHAndrew Huberman38:43

       And keep in mind, I was a teenager. I mean, I drank my Slurpees.

   24. VMDr. Vivek Murthy38:47

       Yeah.

   25. AHAndrew Huberman38:47

       I had my Butterfingers, you know? I wasn't, you know, Bart Simpson-like in my love of-

   26. VMDr. Vivek Murthy38:52

       (laughs)

   27. AHAndrew Huberman38:52

       ... Butterfingers, but I liked them, but th- but it was, it was a smaller fraction of, of what we ate, and when we were at home, those foods were either not available or we weren't, we certainly weren't allowed to eat them in, um, ad libitum, you know?

   28. VMDr. Vivek Murthy39:05

       Yeah.

   29. AHAndrew Huberman39:05

       Um, okay, so what's clear to me is that the FDA makes decisions about what is safe, what's not safe,

10. 39:11 – 49:53

    Difficulties Addressing Health Issues & Highly Processed Foods

    1. AHAndrew Huberman39:11

       but for instance, okay, this last year, there were several papers published in high-quality journals showing that if people eat just high, just sweet and savory foods combined, that neural circuits in the brain rewire through process of neuroplasticity that drives increased appetite and changes the response to healthier food so that they don't taste as, as satiating.

    2. VMDr. Vivek Murthy39:37

       Mm-hmm.

    3. AHAndrew Huberman39:37

       Okay. That's sort of a duh to a lot of people, but I think it was an important set of findings because it said the brain actually changes in response to the, um, the very, uh, rich, flavorful foods that are associated with, with highly processed or even moderately processed foods. Okay? I mean, um, that's just a couple of studies. Um, there was nothing in those studies that said, "If you eat these foods, you're going to develop cancer."

    4. VMDr. Vivek Murthy40:04

       Mm-hmm.

    5. AHAndrew Huberman40:05

       But, you know, at some point, one has to, as a citizen, a taxpaying citizen, (laughs) speaking on behalf of many other taxpaying citizens, I have to sort of take a step back and say, "H- how long do we wait?"

    6. VMDr. Vivek Murthy40:14

       Mm-hmm.

    7. AHAndrew Huberman40:15

       Right? Do we have to get a randomized clinical trial about the, you know, the, you know, the 500,000 sick kids that grow into sick adults-

    8. VMDr. Vivek Murthy40:24

       Mm-hmm.

    9. AHAndrew Huberman40:25

       ... um, and then run a trial where they go on a- an elimination diet where they're eating only unprocessed vegan or unprocessed meat and vegetable or unprocessed, you know, starch and vegetable f-... I mean, at, I mean, w- then we're talking about a 30-year health crisis before we-

    10. VMDr. Vivek Murthy40:39

        Yeah.

    11. AHAndrew Huberman40:39

        ... intervene. Why not... I mean, if I were in charge, which I'm not, and clearly I wouldn't survive in a government organization-

    12. VMDr. Vivek Murthy40:46

        (laughs)

    13. AHAndrew Huberman40:46

        ... because, um... Well, I've got the uniform down.

    14. VMDr. Vivek Murthy40:48

        (laughs)

    15. AHAndrew Huberman40:48

        Um, I always wear the same thing, but, um... A uniform, but, uh, I wouldn't because I would want to say, wait, you know, why not err on the side of caution?

    16. VMDr. Vivek Murthy40:57

        Mm-hmm.

    17. AHAndrew Huberman40:58

        Why not send out this AI-generated text message that tells everybody in all the languages that Americans speak and can understand, "Hey, you get to make choices about what you eat, but you should be aware that, um, making your diet comprised of more than 15 to 20% of these foods is potentially going to lead to serious issues down the road, and those serious issues are extremely serious."

    18. VMDr. Vivek Murthy41:20

        Mm-hmm.

    19. AHAndrew Huberman41:20

        I mean, the obesity crisis is really a crisis of both body and brain metabolic-

    20. VMDr. Vivek Murthy41:24

        Mm-hmm.

    21. AHAndrew Huberman41:25

        ... challenge, um, that we can talk about. So, you know, who sets the thresholds? You know, in other words, why is it that in this country, we have to wait until people start to get really sick and dying and really struggling before something is done in the direction of their health? And I'm not blaming you.

    22. VMDr. Vivek Murthy41:42

        Yeah.

    23. AHAndrew Huberman41:42

        I just want to understand because, um-

    24. VMDr. Vivek Murthy41:44

        No, it's... Good question.

    25. AHAndrew Huberman41:45

        ... the, the wealthy people I know care a lot about their food sources and they pay a lot of attention to it, and why aren't we allowing everyone the opportunity to make better choices?

    26. VMDr. Vivek Murthy41:56

        So this is, uh, the right question, and, and this is something I, I think about a lot because I- I'm conscious about what I eat, but I also talk to folks around the country and realize a lot of people don't have either the information, uh, or the resources to actually purchase healthy food, right? And to know, like, what's gonna be good for them and for their families. This is why, you know, I mentioned we have a list of issues that, you know, we would work on, you know, if we had more, more resources. This is actually one of them because, to me, one of the most common questions people ask is, "What should I eat?" That's simple, but it's, it's vexing, it's complicated, and it's incredibly confusing if you go online and just try to search for information, and it's a classic example of where it's important to have an objective scientific authority that can come in and speak on broad principles around diet, that can talk about what we know and don't know. So the, here's the important thing, I think a lot of times-People may see something as, uh, you know, on the market, they might read a list of ingredients, they don't recognize half of them 'cause they're additives. But they figure, "Well, if it's there, then it must have been studied for 30, 40 years and there must be no harmful consequences," right? But sometimes things are, are put out there because we have short-term data that says that they're okay, and there might be, uh, but there may be a need for more long-term data. Helping people understand what do we know, what do we not know is important so that people can make decisions for themselves based on how much risk they want to take. The other thing, though, that concerns me here, Andrew, is I... Look, I, I, I have... I'll tell you, I have a bias here and my bias is that I am worried, uh, about the, you know, additives and other products we have in food that don't have long-term data, uh, that's clear in terms of health risk. And so because of that, like, my bias is generally to think, how can we get people, uh, you know, minimally or less processed foods and how can we get them more fruits and vegetables? How can we make sure that they have that more available to them? But we've got to not only make the information available, but we have to make it accessible from a cost perspective. If you don't have a grocery store in your community, if vegetables, uh, and fruits cost 3X what other foods do, that's gonna be a problem, right, to change diet. The other thing we have to keep in mind is that, you know, food companies, you know, a lot of them do a, a great job of actually trying to get healthy, nutritious food out to people, you know, and kudos to them. But I worry also that there's an incentive also, uh, to just try to sell more and more and more of your product. And one of the ways to do that is to try to hack, uh, the body to kind of figure out, okay, well, what kind of synthetic additives could I put together here or what kind of, uh, combination of nutrients could I put together that will get people coming back for more and more and more?

    27. AHAndrew Huberman44:32

        And we saw this in the nicotine industry.

    28. VMDr. Vivek Murthy44:35

        You saw it in the nicotine industry. You also, I would say another, in parallels, you see it in social media as well where the business model of the social media platforms is built on volume of use, right? How much time am I spending on the platforms? It's not quality of time, it's quantity of time, right? So if that's the business model, then you're going to design your platform to maximize how much time someone spends on them, regardless of whether it's detracting from sleep, detracting from in-person interaction, detracting from anything else that's healthy, regardless of whether that may be causing certain harms, right? Like, the business model dictates, you know, uh, in many ways how these things are designed. And that applies, I think, to food as well. So which is why I think it's im- incumbent upon us to be particularly cautious, uh, with highly processed foods, foods that, foods that have additives, and to understand, how is this impacting our brain? How is that impacting our satiety? Uh, how is it, um, leading potentially to greater ingestion that is healthy and leading to things like obesity, which have a whole host of other medical conditions from cancer to arthritis to diabetes aso- and heart disease associated with it? Those are the questions as a, as a citizen, as a father of two young kids who's trying to bring them up with a healthy lifestyle. Those are the questions that I would want to know the answers to, and it's one of the reasons I think these kind of objective reports are so important for the public.

    29. AHAndrew Huberman45:54

        I'm starting to see the, the scope of the problem and the mechanics involved in trying to alleviate these issues are complex. I, I, I, I see that. Um-

    30. VMDr. Vivek Murthy46:04

        There, there also, one other thing that's important to do though, is you need to have authorities that can speak to these issues that are insulated from political retribution, right? So, and to explain this, like I-
11. 49:53 – 54:41

    Retribution, Integrity & Public Trust

    1. AHAndrew Huberman49:53

    2. VMDr. Vivek Murthy49:53

       Ye-

    3. AHAndrew Huberman49:53

       ... fr- frankly.

    4. VMDr. Vivek Murthy49:53

       And I'll tell you, look, sometimes people ask, "Hey, why don't you just go out and say a couple of the statements that you just said? Wouldn't that be fine?" Like, why are, why is time needed to prep something like that? Why are resource needed, et cetera? Here's actually why. Like, I know in today's day and age it's easy to just go and like rattle off, off, you know, off the cuff statements or shoot from the hip, et cetera.

    5. AHAndrew Huberman50:10

       You're welcome on my social media channels any time.

    6. VMDr. Vivek Murthy50:12

       (laughs)

    7. AHAndrew Huberman50:13

       A- really.

    8. VMDr. Vivek Murthy50:13

       Well-

    9. AHAndrew Huberman50:13

       To, to get the word out to millions of people.

    10. VMDr. Vivek Murthy50:15

        No, I appreciate that and I-

    11. AHAndrew Huberman50:16

        Any time.

    12. VMDr. Vivek Murthy50:16

        ... may take you up on that.

    13. AHAndrew Huberman50:17

        Mm-hmm.

    14. VMDr. Vivek Murthy50:17

        But I'll tell you that one of the reason, one of the things we always do, recognizing that when we put out statements, that people, people wa- they, they trust it's coming from a scientific authority and that it's been vetted, right? So we put the effort and time into vetting this thoroughly. We check sources, we look at the data, we talk to experts, we think about how to communicate this in the right way. That's the work, the behind the scenes work-

    15. AHAndrew Huberman50:40

        Sure.

    16. VMDr. Vivek Murthy50:41

        ... uh, that we do before we put out sort of reports and, and initiatives, because we want people to ha- have confidence, you know, in, in what they're hearing. We also know that when we put out initiatives, that other people build on them, philanthropists, you know, and, and foundations will then think about, "Should I fund work in this area?" Uh, you know, s- uh, schools and workplaces will think about shifting some of their practice. Policymakers will also think about legislation, uh, that they may, uh, want to design based on that. So we want to make sure it, it's really solid. But the point I was making when I said also that we have to make sure that not just our office but, uh, uh, folks who are, you know, in public health and who are in medicine who are trying to speak to the public about their health, that they're protected from, uh, retribution and taxes, this is what I meant, which is that saying things about diet, saying things about tobacco, these can be challenging for some folks because there are industries built around these, right, which may not always like what you have to say, uh, if it hurts their business model, uh, or their bottom line. And they may then lean on, um, political leaders, elected leaders, others, to then try to silence you or, or shut you up. And I'll tell you, I've experienced this, uh, in the past, you know, the, when I was Surgeon General during my first term, I had issued two, uh, g- key reports. One was on alcohol, drugs and health, about the addiction crisis, uh, and the other was about the e-cigarette crisis among youth. I will tell you that there were plenty of people who were very unhappy that I was issuing the first federal report on e-cigarettes. Um, folks who felt that, "Hey, um, this is gonna make folks unhappy, it's gonna create political pressure, uh, it's gonna create a l- a lot of problems." Uh, similarly with alcohol, drugs and health, there are many folks who said, "Hey, if you do this, you're really gonna upset the alcohol industry. Do you really need to have alcohol in the report? Why don't you just focus on other drugs? Um, why don't you take alcohol out of the title?" You know, all of these i- sort of, uh, you know, c- concerns were raised.

    17. AHAndrew Huberman52:35

        W- who was telling you this? Who, so, so-

    18. VMDr. Vivek Murthy52:36

        So I d-

    19. AHAndrew Huberman52:36

        ... these are people who get paid by the alcohol industry?

    20. VMDr. Vivek Murthy52:39

        No, these are people in government who are reading the tea leaves and who, who are supportive of the work we're doing, but are saying, "Hey, like, you're gonna really upset a lot of people in the industry."

    21. AHAndrew Huberman52:47

        And so what?

    22. VMDr. Vivek Murthy52:48

        And-

    23. AHAndrew Huberman52:48

        You're also gonna help a lot of people.

    24. VMDr. Vivek Murthy52:49

        Yeah, well, this is what it comes down to. They say, "Well, and if you upset folks, then they're gonna try to fire you, they're gonna try to do all these things." To which honestly, like, my, my response to a lot of these, and the reason we just put them out anyway was because I said, "Well, the worst thing that can happen is I get fired and that's okay." You know, if I, if I go out knowing I did the right thing here, then I'm fine with that. I'm not looking to build a lifelong career in government. I'm not doing this job to like, you know, get to the next thing on the ladder or like, uh, this is about serving for the time I can, I want to be able to go to sleep at night, look myself in the mirror, and know I did so with integrity. Um, so that was an easy decision for me. But, but my point is that, like, we have to be thoughtful that, uh, in these issues that there are gonna be headwinds, right? I'm sure in your case, for example, you've probably gotten pushback from folks about talking about certain things that may have rankled, uh, folks who may have had an interest in those issues and that's okay. You keep talking about them as, as you should and I'm grateful for that. Um, but this is esp- especially important at a time where I think public trust in our institutions more broadly and in science and in medicine have taken a hit over the last few years. And I think it's a time where we have to be even more vigilant, uh, those of us in medicine and public health, to make sure that what we do is based on data, that we're transparent a- about why we're saying what we're saying, that we are also clear about what we know and what we don't know, so that if recommendations change over time, people recognize that this isn't necessarily flip-flopping. You should change your recommendations if the data changes, uh, if the circumstances change. So, uh, anyway, this is all part of the work that we've got to do. But to me, this is a really important part of the work, the integrity behind our work in public health is not just about the issue we're taking on today, it's about the trust that we need to rebuild, uh, in the field more broadly.

    25. AHAndrew Huberman54:40

        So

12. 54:41 – 58:32

    Company Opposition

    1. AHAndrew Huberman54:41

       if I understand correctly, if you were to, for instance, uh, put out a call that says, "Look, you know, there are food additives that are allowed in the US that are not allowed in Europe, that may be a risk. We don't have enough data at present to say to avoid these things, but here's a kind of a yellow zone." You know, your green-... known to be safe, red, clearly known to be unsafe, yellow, we just don't know yet-

    2. VMDr. Vivek Murthy55:04

       Mm-hmm.

    3. AHAndrew Huberman55:04

       ... not enough data. Um, "So here's what my recommendation would be for my children."

    4. VMDr. Vivek Murthy55:09

       Yeah.

    5. AHAndrew Huberman55:10

       It's a free country, you know. Um, there are people that'll argue it, it's not, but at least at the level of which foods you want to buy with your own-

    6. VMDr. Vivek Murthy55:16

       Mm-hmm.

    7. AHAndrew Huberman55:18

       ... budget, um, it's, it's a free country. So, uh, you're saying that, um, you get messages that warnings about certain things could lead to pushback, but if... I have to imagine that there's something, and I'm not a conspiracy theorist (laughs) , but there has to be... Either the people that are saying, "Look, there could be problems-"

    8. VMDr. Vivek Murthy55:37

       Mm-hmm.

    9. AHAndrew Huberman55:37

       ... are just f- friction averse, they're just don't like anyone to be angry at anyone, or, um, there, there must be some incentive for things to remain quiet. I mean-

    10. VMDr. Vivek Murthy55:50

        Yeah.

    11. AHAndrew Huberman55:50

        ... I mean, certainly the government has not had problems saying, uh, to do things or to not do things that had, uh, that upset companies or shut down companies or, or elevated companies and their success. So I, I'm conf- I'd like to know more about-

    12. VMDr. Vivek Murthy56:04

        Yeah.

    13. AHAndrew Huberman56:05

        ... the back contour of this. Um-

    14. VMDr. Vivek Murthy56:06

        Well, look, I, I think, and this is not too dissimilar from, I think, what happens in, you know, other industries, but it's, you know, whenever you, you do something in, whether it's in the private sector and government, people weigh what, "What are the pros, cons? What's the pushback I'm gonna get? How do I deal with that pushback?" Right? Uh, and pushback isn't always a bad thing, right? If you get pushback from the public, people, "Hey, that doesn't make sense to me," et cetera, that's, you should listen to that and, and use it to inform your approach.

    15. AHAndrew Huberman56:28

        But that's the public whose, your job is to serve. I'm talking about pushback from companies is, is different.

    16. VMDr. Vivek Murthy56:32

        Right. So when pushback comes from people who have a financial interest, uh, in the product that you may be commenting on, then you, you got to be... You need to know about that, number one, so that you know how to, how to mitigate it. And while people may take different approaches to this, m- my approach, as a public official and surgeon general, has been to say, at the end of the day, like, I'm happy to, to hear from anyone in terms of their concerns or pushback, but at the end of the day, what's gonna guide my decisions about what we- issues we take on, what decisions we make, and what we say to the public is gonna be what isn't driven by science and the public interest. And if that means it's politically inconvenient, that's okay. If that means that, you know, something happens, you know, it's my job, that's okay too. You know? Like, we... Look, the bottom line is life is short. We don't know how much time we have here. We may as well make the time we have count. We may as well do the things, uh, that, that are right and that are gonna serve people. That's my simple philosophy my parents taught me when I was growing up. So that's sort of the approach I, I bring to this, and that's why if we were to do, let's say, uh, an initiative on diet, uh, I have no doubt that some of the things that we would say would be perturbing, uh, to folks who had a financial interest in the industry, because I don't think that the current setup of the industry is serving the public well. Uh, I, I think we have made unhealthy foods cheap. That's a problem. We've made healthy foods expensive. That's a problem. We've put health, from a dietary perspective, out of reach for millions of Americans. That is a fundamental problem. And we've also disempowered people w- with, uh, by not giving them the information that they need to make decisions. So even if you have resources, I guarantee there are people listening to this podcast and many more people out there who go to the grocery store and just feel confused. Like, "What on earth should I buy? What's healthy? What's okay anymore?" Um, it's just hard to know. And so, I think we've done a disservice by not doing more to help the public understand and access, uh, healthy foods. And again, it's why it's an issue that, you know, that, that w- it was on our list of issues that we would want to work on, because I think that the public health need here is, is immense.

13. 58:32 – 59:50

    Sponsor: LMNT

    1. VMDr. Vivek Murthy58:32

    2. AHAndrew Huberman58:32

       I'd like to just take a brief break and thank one of our sponsors, which is LMNT. LMNT is an electrolyte drink that has everything you need and nothing you don't. That means plenty of salt, sodium, magnesium, and potassium, the so-called electrolytes, and no sugar. Now, salt, magnesium, and potassium are critical to the function of all the cells in your body, in particular to the function of your nerve cells, also called neurons. Now, people, of course, have varying levels of requirements for sodium. So people with hypertension or pre-hypertension probably shouldn't increase their sodium. However, many people are surprised to find that by increasing their sodium intake, they're able to function better cognitively and physically, and that's because a lot of people, especially people who are following low carbohydrate or even moderate carbohydrate and really clean diets, oftentimes they're excreting a lot of water and electrolytes along with it, and simply by increasing their electrolyte intake using LMNT, they just feel better and function better. I typically drink LMNT first thing in the morning when I wake up in order to hydrate my body and make sure I have enough electrolytes and while I do any kind of physical training, and certainly I drink LMNT in my water when I'm in the sauna and after going in the sauna, because that causes quite a lot of sweating. If you'd like to try LMNT, you can go to Drink LMNT, that's L-M-N-T.com/huberman, to claim a free LMNT sample pack with your purchase. Again, that's Drink LMNT, L-M-N-T.com/huberman.

14. 59:50 – 1:07:01

    Public Health Communication, Masks & COVID-19, Public Trust

    1. AHAndrew Huberman59:50

       I have a question about trust in big institutions and public health initiatives in general. Um, the question is about masks. Um, early in the pandemic, as I recall, we were told that masks were not necessary, then we were told they are necessary. And I think for a lot of people, that flip in messaging, um, landed like a parent telling their teenage kid to always wear a seatbelt, but then you look into the front seat and Mom and Dad aren't wearing seatbelts. And a- anyone who's been around teenagers or has been one, you make that mistake once, you're not making it again.

    2. VMDr. Vivek Murthy1:00:29

       Mm-hmm.

    3. AHAndrew Huberman1:00:29

       And you may never recover from that particular (laughs) example.

    4. VMDr. Vivek Murthy1:00:33

       Mm-hmm.

    5. AHAndrew Huberman1:00:33

       In other words, the public felt like there was a switch of messaging.

    6. VMDr. Vivek Murthy1:00:38

       Mm-hmm.

    7. AHAndrew Huberman1:00:38

       But what I don't recall happening was a, like a, "Hey, we got that one wrong."

    8. VMDr. Vivek Murthy1:00:44

       Mm.

    9. AHAndrew Huberman1:00:44

       "So sorry."

    10. VMDr. Vivek Murthy1:00:45

        Mm-hmm.

    11. AHAndrew Huberman1:00:46

        "On us."

    12. VMDr. Vivek Murthy1:00:47

        Mm-hmm.

    13. AHAndrew Huberman1:00:47

        "You know what? The new data say blank."

    14. VMDr. Vivek Murthy1:00:50

        Mm-hmm.

    15. AHAndrew Huberman1:00:50

        What I recall was a message of "don't" and then "do."

    16. VMDr. Vivek Murthy1:00:55

        Mm-hmm.

    17. AHAndrew Huberman1:00:55

        But there wasn't a lot of, um, kind of acknowledgement of, of how challenging the situation was.

    18. VMDr. Vivek Murthy1:01:00

        Mm-hmm.

    19. AHAndrew Huberman1:01:00

        It was just a lot of top-down mandates-And in my opinion, and this is just my opinion, I think that led to a pretty rapid distrust of subsequent messages-

    20. VMDr. Vivek Murthy1:01:11

        Mm-hmm.

    21. AHAndrew Huberman1:01:12

        ... from which we still haven't really recovered.

    22. VMDr. Vivek Murthy1:01:13

        Mm-hmm.

    23. AHAndrew Huberman1:01:14

        Um, and so why do you think it's so challenging for public-facing officials to just say, "Look, doing the best we can at the moment. Screwed up before. Changing the message now. It may change again."

    24. VMDr. Vivek Murthy1:01:29

        Mm-hmm.

    25. AHAndrew Huberman1:01:30

        "We're navigating this in, in real time. It's dynamic."

    26. VMDr. Vivek Murthy1:01:33

        Yeah.

    27. AHAndrew Huberman1:01:33

        "Please stay with us," because, uh, you know, goes without saying, there's been a huge chasm around this-

    28. VMDr. Vivek Murthy1:01:38

        Sure.

    29. AHAndrew Huberman1:01:38

        ... and related issues.

    30. VMDr. Vivek Murthy1:01:40

        Yeah, no, look, this- it's an important question, and look, I- I'm always- I wanna be thoughtful about, um, you know, how I comment on what was done in the first year of the pandemic. I was- I was a citizen. I was outside government, and I don't know what was happening inside government in terms of the, uh, the decisions that were made, made there. But I do know sometimes from my experience in Ebola and in Zika, during those, uh, experiences we had as a country, that in the, you know, in the fog of war when everything's coming at you, sometimes it's hard to make the right decision all the time, right? So I- I want to give some of those folks who were there, uh, you know, in the first year of the pandemic, you know, some benefit of the doubt. But I do think that the important thing, uh, the principle I- I certainly try to follow but one that I think that, uh, and you know, we can all do better. I can do better certainly, too. Uh, but I think an important principle for us in public health communication has to be that we're clear, that we're transparent about what we know and what we don't know, uh, and that we explain the why to people. So if we're telling someone to do something, why? Is it because there's a lot of data behind it? Is it because it's a sort of expert agreement best practice? 'Cause sometimes as, you know, in- in medicine, sometimes when we don't have enough data to guide us on a- on a therapeutic approach but when the problem is imminent, then sometimes experts will get together and put together expert informed guidelines to say, "Okay, look, based on our best judgment and the limited data we have, here's what we would recommend. And as the data evolves, we will change, you know, and- and modify those recommendations." We do that with hypertension, right? We evolve and update recommendations. We do that with lipids. Um, here too, I think that has to be a key part of the approach. I think one of the challenges that I saw many public health officials encounter was even when they went out with comprehensive messages like that, uh, which are hard to fit into a sound bite or into simple posts on social media, um, often a lot of that wasn't covered. What gets covered is the top line. You know, this is what's really being recommended, that's what's being required, et cetera. All the explanation is lost, it's missing, right? And I think we also are living in a time where people are reading headlines. Like, they're living busy lives, right? They're not necessarily, you know, always hearing all of the nuance, you know, that's being explained. Um, but I think that that's a challenge, right? Is like, I know many public officials struggled with how do you deliver nuanced information, uh, at a time when there isn't a clear black and white answer to things? But I think the last piece around this is, um, I think something I was taught early in medical school is to approach your patients with humility, recognizing that even though you have more training than they do, uh, you don't- aren't living their life. You don't necessarily know what they're going through, and you shouldn't assume, um, things about them, right? And so approaching with humility means that, um, you've gotta recognize that not everyone's gonna be able to follow your guidance, and if they aren't able to, that doesn't mean you criticize them. Uh, it also means recognizing that people may have ideas or suggestions for you that may actually improve your recommendations or how you communicate. And so I- I, these are the principles I think that are important in public communication, but I think that both the challenge of translating nuanced arguments into what's actually covered, that was tough for many public health officials. I think the other thing honestly, just on a human level that became hard for many of them, and I- I'm thinking particularly about local and state public health officials who are on the front lines that I talk to a lot, was they ended up getting attacked a lot a- and abused a lot during the pandemic, and I don't just mean like attacked online. I mean people showing up at their houses, people harassing their children, uh, people threatening their safety. Um, and- and this was often people who were upset about some of the requirements that were being put down from local departments of health. And you can understand, look, COVID was as- as stressful a time as we've seen recently. People lost their jobs. People were losing loved ones. I mean, talk about a stressful time. But I think at a human level, public health officials who were exposed to that kind of abuse and who started to worry about their children's safety, um, many of them stepped out of the arena and said, "Is this really worth it to put my family at risk?" Um, and that was hard because we lost a lot of good public health people in that respect. So I think in addition to having sort of these core principles of public health communication in place, I think what we also need to restore is an environment where we... O- of frankly humility and civility, wh- where we don't attack people, you know, who maybe have different views or are coming out with recommendations that, um, you know, are not palatable, uh, to us. And- uh, and I think it's also incumbent upon our leaders in society to not stoke that kind of resentment a- and violence as well, 'cause that happened during the pandemic as COVID got increasingly politicized. And you know, while that may have been at times done for political reasons here or there, the people who suffered were both the public health leaders who were trying to do the right thing for their communities and the public themselves who weren't able to have a clear direct channel, uh, to, and a dialogue with their public health officials, uh, because a lot of that ended up getting closed off.
15. 1:07:01 – 1:10:45

    Masks, Humility; Building Public Trust

    1. VMDr. Vivek Murthy1:07:01

       Andrew, the one thing just to say about the- the humility piece, and I'll give you an example here of where I think this could have and should have been done better.... is in an effort, for example, around masks, uh, to recommend that people m- wear masks. And one i- important thing just to know is that when it comes to, like, schools requiring masks, like, those are decisions that are made on local levels, right? The federal government doesn't mandate masks in schools. Uh, it doesn't have the authority to do that. So, those are local, local decisions. But at the end of the day, there were people who did not want their children to wear masks, right, for a variety of reasons. Uh, some worried about their develop- social development. Some worried that it was adding stress to their kids. Like, people had m- different reasons why they may or may not have wanted their children to wear masks. And o- one of the things I think that was not helpful was that when there were k- parents who made the decision they didn't want their kids to wear masks, um, I think some of them received a lot of criticism, uh, without people necessarily stopping to understand why they may have been making that decision. Because I'll say, as a parent whose children were i- in school, you know, my kids are five and seven, and, um, in the first year of the pandemic they were doing preschool virtually, which was a- a nightmare. It was incredibly hard for us. Even when they got back to school in the, the fall of, uh, 2021, um, it was a really tough, like, adjustment for them. And I could understand, like, some of the concerns that parents, uh, were having, wondering about, hey, how are these precautions affecting my child's experience and social development? So, on the whole, this recommendation may still be, uh, hey, improve ventilation in your classrooms, recommend masking, recommend testing, et cetera. But those recommendations, I think, have to be made in a way that acknowledges, like, the humanity of people who are- may have a different point of view or may make a different decision, uh, for their child. And I know that when s- loca- localities made the decision, in many cases, to require, uh, schools and their, you know, kids in their district to wear a mask, that put some parents who didn't want that, that put them in a hard place, right? And, but I think that our failure to actually have an open, honest, respectful conversation about this, where we didn't feel like we were, uh, each being attacked, you know, as parents for our decisions, or as community members for the decisions we were making, I think that not only hindered, uh, I think, the response, but I think it actually contributed to this division, this sense of Black and whiteness that, hey, it's m- us against them. And then suddenly, if I was against one measure, then I was against all of them, you know? Or if I was for one measure, I was for all of them, because we just started segregating into sides, uh, and this became a, a polarized, uh, you know, experience at a time where, really, it should've been a crisis that brought us together, a- as messy as it was. Um, and that, honestly, Andrew, is what I worry about most for the next pandemic, right? Like, I think we've learned a lot from this pandemic about, uh, how to manufacture vaccines and de- and e- how to develop them quickly, uh, how to distribute them, uh, efficiently. Uh, and, you know, we had one o- one a- was one of the, I think, most historic and e- and effective vaccine distribution efforts in this country, even though, you know, certainly could have been better, but it was historic by, by all measures. Um, we've learned a lot about how to do vaccines, therapeutics, uh, a lot of the nuts and bolts o- of a, a pandemic response well. But I worry what we are still struggling with is how we build trust, how we communicate with the public, and how we stay together as a country in the face of adversity. Uh, 'cause if we're gonna- if we're divided the way we were during COVID, during the next pandemic or the, the next, uh, you know, for- uh, threat that may come from a foreign adversary, m- that's a huge national security issue for us. And so, tha- that, that's what keeps me up at night when I think about the next pandemic that may come.

16. 1:10:45 – 1:17:41

    Rebuilding Relationship to Public, Vaccines

    1. VMDr. Vivek Murthy1:10:46

    2. AHAndrew Huberman1:10:46

       Um, two questions related to what you just said. First of all, um, as it relates to vaccines, in my opinion, um, and I think the opinion of many people out there, that the response to the next pandemic, um, will be heavily contingent on at least some sort of acknowledgement that there are people who at least feel that there have been vaccine injuries, right?

    3. VMDr. Vivek Murthy1:11:12

       Mm-hmm.

    4. AHAndrew Huberman1:11:12

       To simply say, um, "Okay, the previous t- round with COVID went this way."

    5. VMDr. Vivek Murthy1:11:18

       Mm-hmm.

    6. AHAndrew Huberman1:11:19

       "And now, there's now virus X."

    7. VMDr. Vivek Murthy1:11:22

       Mm. Mm-hmm.

    8. AHAndrew Huberman1:11:22

       Right? Let's hope not. You know, God forbid, but sounds like it's coming at some point.

    9. VMDr. Vivek Murthy1:11:26

       Mm-hmm.

    10. AHAndrew Huberman1:11:27

        And people are going to think to the last time.

    11. VMDr. Vivek Murthy1:11:29

        Mm-hmm.

    12. AHAndrew Huberman1:11:30

        And they're going to, uh, i- immediately say, "Well, the last time we were told to, you know, uh, take a vaccine, some people had a good experience with that. Other people didn't."

    13. VMDr. Vivek Murthy1:11:40

        Mm-hmm. Mm-hmm.

    14. AHAndrew Huberman1:11:41

        And it, in this empathy model of acknowledging and, you know, you know, y- letting your moral compass guide in understanding the why behind what people are, are, are doing and how they're reacting, it seems to me that now would be the time to at least, uh, try and understand where they're coming from-

    15. VMDr. Vivek Murthy1:11:58

        Mm-hmm.

    16. AHAndrew Huberman1:11:58

        ... even if one disagrees, maybe even especially if one disagrees.

    17. VMDr. Vivek Murthy1:12:02

        Yeah. Mm-hmm.

    18. AHAndrew Huberman1:12:02

        And try and get people aligned now before the next pandemic. It-

    19. VMDr. Vivek Murthy1:12:08

        Yeah.

    20. AHAndrew Huberman1:12:08

        And, um, so what efforts are being made, if any, to try and acknowledge, um, that some people really do feel as if they were harmed?

    21. VMDr. Vivek Murthy1:12:17

        Mm-hmm.

    22. AHAndrew Huberman1:12:17

        I- I'm not saying that they were or not.

    23. VMDr. Vivek Murthy1:12:19

        Mm-hmm.

    24. AHAndrew Huberman1:12:19

        But clearly, there are people who feel that they or people they know were harmed.

    25. VMDr. Vivek Murthy1:12:24

        Mm-hmm.

    26. AHAndrew Huberman1:12:25

        I- is there an effort to present them with data, to have discussions with them-

    27. VMDr. Vivek Murthy1:12:31

        Mm-hmm.

    28. AHAndrew Huberman1:12:31

        ... to try and get people aligned so that the next time around, uh, we can be more of a unified front, whatever the necessary response happens to be?

    29. VMDr. Vivek Murthy1:12:38

        Yeah. No, it's a really important question. And, and to me, I always go back to sort of first principles from practicing medicine, right, which is if there is a medicine you give a patient, and even if it helps 99.99% of patients, but this one particular patient happened to be harmed, uh, by it, you go in, you acknowledge it, you talk about it, and you f- together chart out a path for how you wanna move forward. And, uh, the path forward might be, yes, let's get rid of that medication, but let's use an alternative. Let's try it. Or we can't use that medication anymore. Here are the risks you may sustain, but we'll find other ways to protect you, right? So, that's what we would do in medicine, right? That's what I've done with patients over the years. I think here too, similarly, when-I think when it comes to tracking, uh, adverse events from vaccines, this is an area where the CDC and the FDA track and collaborate. Uh, and tracking means not just, not only collecting reports from the public and from clinicians when they see, uh, an effect that may be related to a vaccine, but it also involves analyzing those to see were they correlated or where there's actual causation there, right? Because, um, y- you know, if I, if today, for example, uh, I felt unwell, uh, and I traced back what happened yesterday and it turns out, hey, I ate this burrito that was out in the, the sun for way too long. Um, the question is, am I feeling sick because of the burrito or did the burrito just happen to be, you know, uh, you know, something that happened, but it's independent of how I'm feeling. Um, maybe it turns out somebody was actually sick, uh, with a GI bug, you know, around me and that's the reason, uh, that I'm feeling the way I am today. So the analysis that needs to be done on cases that are reported, uh, is important and it's something that the CDC and the FDA do together. Now that analysis I think is, i- essential to communicate clearly to the public. Um, and whenever I engage with folks in the public, which we do often, and people will talk to me about their experiences with vaccines, I do think it's important to acknowledge what people have gone through. Um, like some people, for example, like when I got, uh, vaccinated for COVID, for example, I, I felt like I had mild flu-like symptoms for a couple of days, you know? It wasn't great. I would have preferred I didn't, you know, have those feelings. Like, you know, and, uh, and then I felt better a couple of days later and then I moved on. But, you know, I acknowledged it didn't feel good, you know, to, to feel that way. There are other people who may have had, um, experiences where they felt that they had more serious, uh, you know, side effects, and there may be a question of was that related to the vaccine or not. So I think we have to both hear and acknowledge those. Uh, I certainly try to do that. I know oth- probably, I think it's important to keep doing that across all of government, but I also think it's important for us to, to help people understand the process that we have to go through to understand whether those are related or not. If you go online on the CDC's, uh, site where they collect a lot of this information and you just purely look at reports that are given of potential adverse effects, that, y- you can't sort of take that and say, "Ah, those are all related to the vaccine. Look at this rate of harm. It's extraordinarily high." Because we don't actually do that with any other vaccine or medicine, right?

Episode duration: 2:33:48