Transcript
Speaker: Welcome to the Healthcare Theory Podcast. I'm your host, Nikhil Reddy, and every week we interview the entrepreneurs and thought leaders behind the future of healthcare care to see what's gone wrong with our system and how we can fix it.
Speaker: Today's guest is Dr. Tom Frieden, the former director of the CDC and one of the most influential public health leaders of our time. He started his career as a disease detective at the CDC, stopped the tuberculosis outbreak in Newbrook City, and then eventually helped work in India, serve as New York City's health commissioner under Mayor Bloomberg,
Speaker: led fights for smoke-free bars, restaurants, and really from there led a whole career blending the idea of clinical science and public health and policy.
Speaker: He became the director of the CDC under President Obama, and today he leads Resolve to Save Lives, which works in over 60 countries. And his new book, what we get into today, it really encapsulates more than just the CDC. It encapsulates the core ethos of public health,
Speaker: and It's called The Formula for Better Health, How to Save Millions of Lives, Including Your Own. In it, he lays out a simple framework, see, believe, create. and Today, we get to trace that formula throughout his career career from New York with Mayor Bloomberg to India to the CDC and far beyond that.
Speaker: So let's get into it. I can't wait. Hi, Dr. Frieden. It's great to have you and welcome to the Healthcare care Theory. Great to be here. I'm looking forward to the conversation. And I'm looking forward to it too. I think that it's really interesting. Your career spans so many different areas. And maybe because of that, I want to start at the beginning, which is also where your book starts.
Speaker: um You grew up in New York. Your father was a cardiologist. You trained as a doctor yourself. But at some point, I found it interesting that you made a choice that most doctors never really make, which is to leave clinical medicine for public health. There's some solemnity similarities, but at the time it was unusual. And honestly, it still is today.
Speaker: And it's a decision that basically ended up shaping everything that came after, from New York to India to the CDC. So I'd love to know what pulled you in that direction, what drew you to the CDC, and especially the Epidemic Intelligence Service in particular?
Speaker: Well, I tell in the book the story of ah taking a hike with my father in the Blue Ridge Mountains of Virginia. And um my father was the biggest influence on my life. He was a wonderful cardiologist. He was struggling with Parkinson's disease at the time. And he commented that I seemed to like policy or political issues. And I seemed to like ah science also. And that when you put those two things together, you got public health.
Speaker: And I had never heard the term public health before. I didn't know what it was. And then I still remember when the CDC cracked the case of the Legionella outbreak ah in Philadelphia. And it was front page news in the papers. And my father commented, that's CDC. they're They're a good organization.
Speaker: And so I was interested in the Epidemic Intelligence Service. There were a series of short stories collected as books called The Medical Detectives by Bertrand Ruscha. And it talked about epidemiologists, both at the CDC and also at the New York City Health Department. And they were exciting. You know, they're kind of Sherlock Holmes type stories. How do you how do you solve this case? How do you crack the case? But a detective can save a murder.
Speaker: ah A medical detective might be able to save literally millions of lives. yeah that that That's really striking to me because you think about a detective, it sounds exciting, but medicine really works in the same way. You have a problem and you have to diagnose it.
Speaker: And sure, it's it's maybe one big case that multiplies it across an entire population, but that problem solving is still quite similar where you get to do that detective work. And in the book you describe this one scenario, a drug resistant tuberculosis crisis in new York City happened in the early 90s and at the time no one really was tracking it. So I saw that you had to use the city's health code to require labs to hand over their specimens, you compared the DNA to figure out how was spreading, And you have to get really creative about where the data come from came from. And in the end, that work probably saved thousands of lives.
Speaker: But you can tell the story maybe much better than I can. What did you find? How did you crack the case? So, you know, if you're a detective, you're looking for a hot tip. If you're a medical detective, you're also looking for a hot tip. And the hot tip came from a wonderful doctor named Dr. Karen Brudney. And she was treating patients at Harlem Hospital. She had written a couple of really scathing articles about how bad the city's tuberculosis control activities were. And I had known her from some global work that we had both done. And she called me up and she said, you know,
Speaker: I think we're seeing an increase in drug-resistant tuberculosis. And I didn't know, is that a false impression? A lot of times you can get anecdotes that it's a false impression, or is it a hot tip about something real?
Speaker: turned out that the CDC, with budget cuts in the 1980s, had stopped doing tracking of drug-resistant tuberculosis nationally. They hadn't seen any increase. They were out of money. So they stopped tracking.
Speaker: And... um The New York City Health Department ah did some testing in its lab, pretty good quality, but there was no concept of whether patients had drug-resistant strains and who and how they got it. So we had to mandate, using the health code, that patients all laboratories report the results of all drug resistance testing and that all laboratories provide a sample from one month. It was April of 1991.
Speaker: So any patient who was in a health facility, had a sputum test or any um body fluid test that grew tuberculosis, that lab was required by law to asc send us either that sample or a sub-sample of that, so we could get it tested at the CDC.
Speaker: And that testing rapidly confirmed Dr. Brudney's hunch, drug-resistant tuberculosis had exploded. But it didn't answer the question why. What had happened? Was it just bad treatment? Was it spreading? And at that point, genomic epidemiology was just starting.
Speaker: And we were able to have the laboratory at CDC chop up these specimens and see were they in clusters. And that found a lot of clusters, but that didn't tell anything because all these fancy tools only work if you got people thinking about them. So Karen Brudney, the alert clinician, and then we had epidemiologists And we had data systems to track. And I remember we had an enormous piece of paper. It was like nine feet long by six feet high. And we we tracked each cluster and each patient within each cluster. And we tracked...
Speaker: did they overlap at the jail? Because we had jail records. Did they overlap at homeless shelters? Because we had homeless shelter records. Did they overlap at hospitals? Because we had hospitals. And you had to look at, okay, what was the the time that they were definitely infectious or possibly infectious? And what was the time when they were definitely not infected?
Speaker: And when did they first become infected? So with that really detailed analysis, we were able to see that this was The result of massive spread within hospitals.
Speaker: Hospitals were the amplification point for multi-drug resistant tuberculosis, particularly among people living with HIV. And that led us to be able to rapidly control the outbreak.
Speaker: And I find that so interesting because from my conversations, data can really be both a privilege and a burden. It's a privilege to have it, but there are so many different ways to slice the data that finding the right answer might actually be harder with more. And you and your team still managed to do that and crack the case back in the 90s.
Speaker: And this really wants me to get into India, where you spent the next set of your career there. Because it's almost the same problem, but on a completely different scale. It's still tuberculosis and...
Speaker: You're on loan from the CDC, but now it's millions of cases across an entire country. And instead of like a nine-foot wall chart, you're working with a system that barely had the data infrastructure to tell you what was going on.
Speaker: In the book, you describe colleagues who would call up health secretaries, catch the next plane out, and make the case in person. And a lot of that work wasn't really analyzing the data. was persuading people.
Speaker: So maybe talk me through that move. do You helped get TB under control in New York. But what made you go to India? Why did it matter to you? and Maybe walk me through that switch from what that kind of work was going from New York to India all the way across the world.
Speaker: So I had been working in New York City for five years and because of great outreach workers and doctors and a team, ah we had controlled the outbreak. It was done.
Speaker: And i had written an article in the American Journal of Public Health called Tuberculosis Controlled and Social Change, where I had outlined that, yeah, tuberculosis reflects social conditions, nutrition, housing, poverty,
Speaker: but it's also treatable. And ah there's there was one theme of thinking that said, oh, you know, we really need to fix housing.
Speaker: Otherwise, there's no point in and doing this work for ah tuberculosis control. ah And I said, you know, we can do both.
Speaker: We can both work to change the conditions that lead to tuberculosis and treat tuberculosis. And ah the head of the World Health Organization Tuberculosis Program read that article, said, I want to hire this guy flew to New York City and recruited me um the only article I've ever written that got me a job, um but it was kind of a dream job. The Indian government had ah requested funding development credit that was repayable to the World Bank. And so they were creating this program to do good quality tuberculosis. And I got to know, well, I had already gotten to know Dr. Carol Stieblow,
Speaker: who was really the the brains behind tuberculosis control, an amazing person who had helped me enormously in New York City. He had been to India and he had started um phase one programs there.
Speaker: um And there there's a history here. um One of the prior... ah Director Generals of the World Health Organization, Hulfton Mahler, ah pointed out that India has done enormously high-quality tuberculosis research. And Dr. Mahler said, the whole world benefits from Indian tuberculosis research.
Speaker: The whole world except India. And um with really dynamic Indian leaders, the government was able to expand the program. They have remarkable commitment to tuberculosis control now. But what Stiebelow had established in terms of your question about information systems with 3 million patients, Stiebelow had established what I still believe is probably the best information system in all of public health and all of health. Because it's very simple, very clear, and it gives you everything you need to know and nothing you don't need to know. And it's on paper.
Speaker: So just with this system of registers, laboratory register, patient register, and patient cards, you can manage a program well and supervise it very effectively.
Speaker: And what I found when I moved to India is I didn't know much about global tuberculosis control, even though I'd been working on it for ah many years in the U.S. And I had to learn a lot from the patients, from the nurses, from the doctors, from all of the health workers.
Speaker: And I think Carol Stobo's insight there is really interesting. In New York, you were mostly playing detective, and in India, you were still identifying problems, yes, but at least half the challenge and maybe much more was execution. It was acting on those insights at enormous scale.
Speaker: And New York was one city, and fixing it meant maybe reforming or shutting down a handful of hospitals, but India is a massive system that was much harder to change. And yeah like New York, it got a lot better, and it's it's still improving today.
Speaker: So, Michael Bloomberg then from there became mayor in 2002, and he brought you back as health commissioner. And that started a pretty exciting run. You smoked free bars, restaurants, a higher cigarette tax, the trans fat ban.
Speaker: You went far beyond the tuberculosis work that i defined your early career, but some of those fights, especially the smoking ban, were pretty brutal politically. And you were up against tobacco and soda, industries worth of hundreds of billions of dollars.
Speaker: And how did you really decide like which battles were worth taking on and which weren't? Was that a political decision? I'd love if you could walk me through coming from your experience in a single domain like tuberculosis, what did that look like from the inside?
Speaker: Well, there were a few that we won and some that we lost. um i I told Mayor Bloomberg when he he contacted me in India and asked if I wanted to apply for the job.
Speaker: And I basically downloaded the ah vital registration data from New York City to see, because I had been really immersed in tuberculosis control for over a decade and not really paying attention to much else. I was working one hundred plus hours a week on tuberculosis. So, but again, things were kind of on in train for steady improvements in India, um not solved, but in train and nine 11 had happened. And I was born in New York city. i did my medical training there. I spent most of my career there and I felt that there's something I can do to support the city as it rebuilds and recovers from this, I should do it.
Speaker: And the New York City Health Department is a fantastic health department, so it's an enormous honor to to run it. But when I looked at the data, it was clear that tobacco was the number one killer in New York City.
Speaker: And we knew what to do about it. It just wasn't being done. You tax it, you make smoke-free places, you run hard-hitting ads, you help smokers quit. And so I basically said if he's interested in to his staff, if he's interested in taking on tobacco, I'm interested in coming back.
Speaker: And ah I didn't know ah Mayor Bloomberg at that point, um but he has a public health school named after him and he really does get public health. So ah it was it was a great opportunity.
Speaker: And he was willing to support us with some really tough battles. He got the tax raised, cigarette tax raised by $1.42 per pack. That was the most, the highest impact on reducing smoking and then making all restaurants and bars smoke free. That was a massive fight because city council had to approve it um and um required really Bloomberg going to the mat because there was some real objections that were basically paid for by the tobacco industry.
Speaker: ah And he was able to overcome them. um We saw also we were able to ban artificial trans fat through the Board of Health. This is a regulatory body that's appointed by the mayor that the health commissioner chairs. We tried to raise the soda tax and we failed.
Speaker: And this was really a lesson to me that even with a governor and a mayor pushing for it, the soda industry was so powerful that it didn't pass. And it hasn't passed in any state in the US, but there are more than 40 cities and countries around the world that have increased taxes on soda. And the case for soda taxes is very strong. If you look at the calorie increase in the US, the largest single component of it is sugary drinks. They have no nutritional value.
Speaker: And taxing them dramatically reduces consumption. And in some preliminary data, there's a suggestion that it reduces the risk of childhood obesity. So New York City was the chance with a mayor who understood and supported public health to make a lot of progress. And life expectancy increased by three years. In the years, we also greatly improved the care of people living with HIV, focusing on ensuring that there was accountability for supporting people who wanted to get treated. It wasn't about um mandating anything of patients. It was about making sure that patients had access to the best quality care.
Speaker: Yeah, like I can only see that. And I think maybe it's the perfect time to bring this up because we've hinted at your book a few times and so much of what we're talking about right now maps to the book's central framework, which is see, believe and create.
Speaker: And see seems to be everything in New York. You have to figure out where the data is coming from, find the real problem, play detective. And seeing is a lot harder than just looking out the window because you really have to know what to look for. so it's not really just seeing, it's finding, searching, discovering.
Speaker: And then there's also Create. And New York showed how hard this is. I'm sure India did too. You're up against some multinational corporations with huge incentives and politicians who maybe even share some of those incentives.
Speaker: But what I really love is Believe because it puts you right in the middle. The idea that people have to actually believe change is possible. Belief sounds like an afterthought to most people when they think of about policy, but it's probably much more nuanced than it sounds. And clearly runs through your own career, having those convictions very early on from working with Karen Bredney in New York in the early 90s all the way to India.
Speaker: So conviction is important. um But walk me through. This is really what I've learned in decades of public health practice, that there is an approach, a formula that has saved millions of lives.
Speaker: And that same formula can save millions more. And it's even relevant for personal health. When we see problems clearly, believe that change is possible and build systems for a healthier future, we can prevent millions of deaths. That's the framework.
Speaker: See, believe, create. And see isn't just about tracking things. It's also seeing the pathway to progress and seeing whether or not we're on it. um It's also about seeing why we so often don't take steps that are in our best interests, why public health is so hard to get support for, understanding the inaccurate perceptions, because seeing includes seeing why we're blind, seeing what we're blind to, seeing where our perceptions may not be accurate.
Speaker: Seeing the invisible is really the public health superpower. But the next step is understand shatter the illusion of inevitability, to believe that change is possible. And it's it's really important. um There's been a lot of progress in health over the past decades, and seeing that progress should give us confidence of further progress. There's a misconception that things are getting worse, and yes, some things are getting worse, but overall,
Speaker: We have better tools than ever in human history. We are healthier than ever in human history. And that's not saying mission accomplished, we've done enough. That's saying if we've made this much progress, we can make even more. And you can strengthen that belief in progress by having phased further progress and by cultivating optimism. And finally, create. Create is the hardest of the three. It's hard enough to see the invisible and believe the impossible, but what's really hard is to overcome the barriers and create a healthier future. And that means organizing well, communicating well, simplifying the approach, and most importantly, and the hardest part of the hardest part is overcoming barriers because there are always going to be barriers to public health progress.
Speaker: And think the barriers part really strikes out to me because despite there always being barriers, the framework you've instilled here really requires you to believe there's maybe less than there is or to believe they can be overcome.
Speaker: And I think that's really the belief part of the framework that strikes me most um because it sounds soft at first, like just believe things, like have hope. We've all heard that before, but in this framework, it's actually quite interesting and load-bearing because In the book, you describe Bill Foggi, who led the smallpox eradication effort, and you call him the resident con man. he He wasn't selling snake oil, but he was doing something vital that only worked if lots of people believed it could work.
Speaker: And I think that's why belief is so hard, is that humans have a strong recency bias. We forget what went wrong with the past, but we also forget what went right.
Speaker: So when things look bad like today, we always assume they've ah we assume they've always been bad and they always will be. Which brings me to the next chapter when President Obama nominated you as a CDC director. You'd already worked in New York, you'd worked in India, you'd worked on tuberculosis for many years.
Speaker: um But the CDC is ah is a different animal. It's a federal agency with... Arguably more influenced than regulatory authority. It has to work with Congress, the White House, every state health department.
Speaker: So maybe tell me, what was your mindset going into this? What did you think the job actually was? And what were the barriers actually going Especially looking back. The New York City Health Department job has authority than the CDC director job.
Speaker: In fact, I had literally 10 times more flexible funding as New York City Health Commissioner than as CDC Director. Um... CDC is not a regulatory agency. It has very few areas where it regulates. there There are few, and those are controversial, increasingly controversial. But fundamentally, the role of CDC is to work 24-7 to protect Americans from threats, whether those are natural or man-made, whether they're infectious or non-infectious, whether they come from the U.S. or anywhere in the world.
Speaker: And if the CDC is weaker, we are at higher risk. um CDC has many, many fantastic staff. If you've got a question about essentially anything in healthcare, care you pick up a medical textbook and open it to a random page, you will find someone at CDC who's spent the last 10 or 20 years of their life going deeply into that issue and can tell you, you know, this is real, this is not, this is what we know, this is what we don't know.
Speaker: um I was, as we discussed earlier, I was an epidemic intelligence service officer at the CDC. So I was somewhat familiar with the organization and I had been on loan from the CDC to the New York City Health Department as a director of TB control and then to India with the World Bank and World Health Organization. So I'd worked for CDC for over a dozen years, but I had never actually been based in Atlanta. I didn't even know where the entrance was one night when i yeah when I got there. remember my first day I met people at the entrance and there was a guard there. And as I was going up in the elevator, the guard said to me, people are scared, sir. And I said, I'm scared.
Speaker: it's It's a big job. It's a hard job. ah and It has limited authority. either over the CDC itself, because the center directors and the division directors have a lot of authority and the budget is very stove piped. So each unit has its own budget ah and Congress is the decider of all of those. And then when it came to the state health departments, you know, health is a federal affair in the U.S. And so the state health departments have, you
Speaker: have the authority there and the CDC can advise, can support, ah but, but it's really up to the States to act. So I, I found it very different from, from what New York city was where I could, I could really say, i i have some accountability for preventable deaths in New York city at the CDC. Lots of people have that accountability and it's very diffused.
Speaker: And that's really interesting because when most people think of the CDC, they think of a huge, longstanding institution and assume it has the regulatory power power to match that the same way the FDA might.
Speaker: But it sounds like it's a lot closer to the Surgeon General as well, watching what's happening, informing people, making sure things are safe more than like an exact regulatory body in some ways. It's a little bit of both.
Speaker: But by the time you got there, i mean you spent many years like watching public health struggle with what you call the Cassandra curse, where you can see a threat clearly, but you don't or you can't get anyone to act until the disaster is already visible. So it's a real paradox. If you fix it, um you're not credited. And if you don't, then it's like always been there in the first place. But can you please explain your view on the Cassandra curse and how did it shape what you prioritized early on in your career as a CDC director?
Speaker: Cassandra ah is a mythological priestess from ah ancient Greece, and she was blessed with foresight. She could foresee the future, but cursed that nobody would believe her warnings. And until recently, public health has been like Cassandra. that we've been able to I can tell you that a billion people will be killed by tobacco in this century. I can tell you in what countries they will die, in what years, from what conditions. But we haven't been able to prevent those tragedies.
Speaker: So I got to thinking and did an analysis for the book on why. Why does the Cassandra curse exist? And fundamentally, it's about inaccurate perceptions, inaccurate perceptions of ourselves, of the world, and of the future.
Speaker: Of ourselves, we may think we are creatures of unfettered free will, but a lot of what we do is socially determined in ways that we don't readily see. Of our world, ah there are economic drivers of behavior that we also may not be aware of. And of the future, there's something called hyperbolic discounting or shortchanging the future. i think about this in terms of my patients. I remember one very, very kind older woman who had smoked and she had emphysema.
Speaker: And um she had and a death from emphysema is a terrible death because you're gasping for air at every moment. ah And if you give someone extra oxygen, they stop breathing and die. So it's really a bad death. And she was so regretful and remorseful about her former smoking. And so I realized that as a clinician, part of our role is to kind of be the advocate for someone's future self.
Speaker: ah Because we shortchange that future. And in the same way, public health is the advocate for a healthy society. There's another really important driver of the Cassandra curse, and it relates to why public health is so hard.
Speaker: It's what's called the prevention paradox. And this is an inaccurate perception really of the world. The prevention paradox, a great thinker named Jeffrey Rose noted that the biggest gains and harms in society come from small changes across large populations rather than large changes across small populations.
Speaker: Take artificial trans fat. ah Resolve to Save Lives, the organization I lead, has partnered with countries ah that have banned trans fat for more than 4 billion people. This will prevent an estimated 9 million deaths in the future. Not one of those 9 million people will know that this action saved their life.
Speaker: So it's been really good for a lot of people, a little bit, but you can't point to that um in a way that is easy. And what that means is, from an economic standpoint, that public health will usually or almost always have provide diffuse benefits but have concentrated costs.
Speaker: So whether those costs are for the soda industry or the alcohol industry or the trans fat industry or the tobacco industry, um the cost the costs are very apparent and the companies that have to pay those costs will lobby governments hard against it. But the benefits are very diffuse. Some of those people who will not die haven't even been born yet. So they can't advocate for themselves.
Speaker: That's why public health needs to organize the winners and losers, analyze the deciders and influencers, ah um marshal together the advocates and partners, and figure out the right timing for public health progress.
Speaker: And i almost want to push on that a little because Ebola feels like a counter example in the news. It had all the makings of a Cassandra moment, but in the book, you talk about Martin Meltzer's model, which showed that without action, cases that could keep doubling and reach more than a million people. And that projection actually helped move people. That threat was concentrated, urgent, easy to picture.
Speaker: And the worst case never happened, not because the model was wrong, because the model was right, because of the intervention, which is its own Cassandra problem in in some ways. Like when the CDC does its job right, it often gets less credit and not more because the disaster never arrives.
Speaker: um Chronic disease is even harder. Those threats are already there and they're mostly invisible and they can take decades to do their damage. um So when you get discount that far into the future, it really feels never that urgent.
Speaker: But after leaving the CDC in 2017, you founded Resolve to Save Lives um and you've had a long career with plenty of 100 hour work weeks, sometimes for months on end. And this was something new. um And reading the book, it's It's like the whole organization is see, believe, create, put into practice at a a somewhat global scale. I know 717 is a big part of that framework, but is that a fair way to describe it?
Speaker: How would you characterize Resolve to save lives and and and why did you even start it in the first place? So um Resolve to Save Lives exists to partner with communities and countries to scale up solutions to the world's deadliest problems.
Speaker: Our North Star is how can we save the most lives? That's why we are Resolve to Save Lives. So we've worked on cardiovascular health, and we've worked on epidemic prevention, those are both things that can kill 10 million people a year. Nothing else other than nuclear war, which we don't have the capacity to prevent at our organization, can do that.
Speaker: And um we've found that ah by supporting countries ah with really the approach of see, believe, create. So document a problem, document the pathway forward, which we refer to as the technical package, rather than do everything for everyone, do what's going to make the most difference with a very focused set of interventions and and then strengthen the confidence of future progress by having phased implementation, and then create a healthier future with an organized, simple, well-communicated approach that analyzes the landscape and overcomes the barriers.
Speaker: And to me, it's been enormously satisfying. We have a fantastic team. We've worked in more than 60 countries. We're fortunate that we've had um philanthropists who have supported our work. And um we're very grateful for the countries that we work alongside of.
Speaker: We are guests in these countries and are where we have country teams that are entirely from within the country. We don't put internationals in country. And um we've been able to learn from and with countries. You mentioned the 717 initiative. This is in our epidemics unit that we proposed five years ago, little over five years ago, that every outbreak is assessed by whether it was detected in seven days, reported to public health in one day, and all essential control measures in place in seven days. There are now more than 90 countries around the world either using or considering using that
Speaker: approach. And what we found is it's a way of having steady improvement. It's not a fault-finding mechanism. It's a fix-finding mechanism. Find a problem, fix a problem. Figure out what went right, what went wrong in the last outbreak. Use reality as your drill.
Speaker: And this is a very useful approach, but it's an example of something that we didn't come up with alone. We worked with frontline health workers and leaders in Uganda and DRC and Nigeria and Ethiopia and together developed this approach. So what we're able to do sometimes is kind of cross-pollinate between the the great work that goes on in different countries to come up with an approach that will then be further refined to work really well in different contexts.
Speaker: i and I agree. I think that's exactly where it has to start. You need people at every level, institutions, governments, communities, individuals. um And the hard part is getting all of those levels moving together at scale, which is why I really admire what Resolve to Save Lives has done so far.
Speaker: um After reading the book, it ends on a very optimistic note, but a quietly concerning one too. Over the last few years, public health has come right into the lives of everyday people through COVID, and the CDC's role has changed a lot. and There's so much more we can get into, but I'm honestly...
Speaker: both hopeful and excited about the future. And I really appreciate you taking the time to walk through your story, Dr. Frieden. There's much more we can get into, but I think your career is the best illustration of why the See, Believe, Create framework really works. And your book goes through all of this in such great detail that we couldn't even get into today.
Speaker: You need all three and and two isn't enough, but one certainly isn't. um And from New York to India, you can really see why. So thank you again for joining me today. Thank you. And you know, people have said that the book is a message of hope, and I'm glad for that. But I think even more, it's a message of how.
Speaker: We've made enormous progress in the past. We can make even more progress in the future. There is, predict in the book, that within, if not my lifetime, my children's lifetime, heart attacks and stroke, which are the world's leading cause of death now, will be a brand of thing that's possible. A healthier future in well with the future.
Speaker: can find us on Spotify, Apple Music, YouTube, any streaming platform you can imagine. We'll also be posting more short form educational content on Instagram and TikTok. And if you really want to learn more about what's gone wrong with healthcare care and how you can help, check out our blog at thehealthcaretheory.org.
Speaker: Repeat, thehealthcaretheory.org. Again, i appreciate you tuning in and I hope to see you again soon.
