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The Collapse of Trust in Public Health | U.S. Surgeon General Dr. Richard Carmona
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Today's guest is Dr. Richard Carmona, the 17th Surgeon General of the United States, a trauma surgeon, public health leader, former hospital executive, and decorated Army Special Forces medic.
In this episode, we explore how Dr. Carmona’s early life, military service, and medical career shaped his understanding of healthcare as far more than what happens inside a hospital. He discusses building Arizona’s regional trauma system, turning around a public hospital, and why prevention, health literacy, and trust are central to improving outcomes. We also dive into the politicization of public health, from tobacco and vaccines to the growing confusion around scientific institutions today. Dr. Carmona explains why the Surgeon General’s role should be nonpartisan, grounded in science, and focused on helping the public make better health decisions. At its core, this conversation is about what happens when science, politics, and trust collide, and what it will take to rebuild confidence in American healthcare.
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Transcript
Introduction and Career Overview
00:00:00
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.
00:00:14
Speaker
On today's episode, I'm speaking with Dr. Richard Carmona, who, in my opinion, has one of the most remarkable careers in American health care.
From Harlem to Surgeon General
00:00:22
Speaker
He grew up in Harlem, dropped out of high school, and enlisting in the army, he became a special forces medic in Vietnam. And later on, he went to become a trauma surgeon, ran a regional hospital and became a hospital executive, and eventually was nominated to be the 17th Surgeon General of the United States under the Bush administration.
00:00:40
Speaker
and his career spans almost every layer of healthcare. He's delivered here on the front lines, he's built trauma systems, run public hospitals, and has shaped health policy at a national level. So in this episode, we not only go through his career, but we talk about how his early life shaped his understanding of poverty and access to healthcare, and why public health, especially now, depends so much on trust, prevention,
00:01:04
Speaker
health literacy, and how the politicization of science and the role of the Surgeon General has really can misconstrued the way public health policy is supposed to be delivered. So this is a core conversation about why health care is not just medicine.
Influence of Early Experiences on Healthcare Perspective
00:01:18
Speaker
It's far more political and systemic than that. So hi, Dr. Carmona. Thank you so much for coming on today and welcome to the Health Care Theory. Thanks. Happy to be with you.
00:01:29
Speaker
Of course. And before we get into your background a little bit, i noticed that in your bio, public health was almost marked as a second career in the in the beginning. You were working at MPH at night while you were still doing work because you realized most of what you were seeing was preventable. So you were kind of balancing being a clinician, working public health. But I'd love if you could tell me a little bit about your early workings in the healthcare system, what drew you to healthcare, and what eventually...
Military Service and Medical Passion
00:01:54
Speaker
sparked an interest in public health that made you span both being a doctor, but also publicly a health leader and executive. I know it's a lot of things to bounce at once. So what really drew you there? Oh, we can. I think I can condense it for you.
00:02:06
Speaker
um Probably my some of my best education to understand the complexity of what we call today the social determinants of health. We're just being a poor kid.
00:02:17
Speaker
I was born in New York City in Harlem. My parents were immigrants and we were very poor. lived in a tenement, um homeless a couple of times, ah relied on aunts and uncles and friends to help us.
00:02:32
Speaker
And um I would say I had a happy childhood. i mean, we were poor, but all the kids on my block were poor. We played stickball. We swam in the Harlem River, and which I tell people that's why I'm so healthy. I've been exposed to every pathogen known to mankind.
00:02:47
Speaker
But we were poor, happy kids growing up in Harlem. um I didn't spend enough time in school. I became a truant and I dropped out of high school when I was 17, but I hadn't advanced much past my sophomore year.
00:03:02
Speaker
And I enlisted in the army because it was a way out. And it was a good decision. i mean, it would have been better to stay in school. My mother, nobody in my family had ever graduated from high school.
00:03:13
Speaker
So my mom's goal was she wanted to ah go to, she spoke English and Spanish and and other languages, but but primarily English and Spanish. And she used to say, I just want to live long enough to go to a graduation. She only meant high school and none of us, none of the four children graduated from high school.
00:03:31
Speaker
But the block I lived on, I didn't know anybody that finished high school. So With that in mind, at 17, I enlisted in the Army largely because I met a veteran, i got an Army ah officer in Special Forces who I heard, thought about the studies, the things he told me.
Medical Training and Trauma System Development
00:03:49
Speaker
And he said, well, if you're thinking about it, go talk to the recruiter. He gave me a card. I went up to the recruiting station and talked and I took some some tests. And they said, hey, you'll be great, you know, sign here and you can join.
00:04:01
Speaker
But then they saw I was only 17. And he said, well, you have to get your mom's signature or your dad's. My mom wouldn't sign. him My father was a World War II veteran. My mom wouldn't sign because she said, I don't want you to go because all of you young boys are going over there fighting that Vietnam War.
00:04:17
Speaker
And her opinion was it was needless, number one. And two, she said, you could die. So I don't want you to go. So I signed up, but I couldn't leave till my 18th birthday.
00:04:28
Speaker
And then, you know, she forgave me. And I, you know, I saw it as my way out. And, you know, she wrote me regularly. My father was there sometimes. He was a nice man, real nice man. But, you know, he had a life in the streets and and and maybe it wasn't the the typical father that you'd expect. My mom was really the one that kept the family together and was the matriarch and even like a patriarch, if you will, a father as well.
00:04:53
Speaker
And my father was there, you know, sometimes, but um I learned a lot on how to be a father when I had children based on the absence of my father when I was, you know, younger.
00:05:05
Speaker
So that' I went in the army and I, because of no education, but yet I did pretty well on my test. Most of the time, young guys like me were just trained to be what they call infantrymen. And I trained as an infantryman, that's the person who fights the war. You learn how to shoot the weapons and learn tactics.
00:05:21
Speaker
And then I volunteered to go to jump school to be a paratrooper. And my intention when I went in the Army was to go to Special Forces because the so officer I had spoken to from the neighborhood was in Special Forces.
00:05:34
Speaker
So the recruiter said, you can, but we can't guarantee that to you. You have to pass all of these other things and then you can volunteer. So after i jump school, i that's being a paratrooper, so doing the parachutist.
00:05:45
Speaker
I volunteered for Special Forces. I took the tests. I qualified. I went to Fort Bragg and spent another year training in Special Forces. And I ended up being a Special Forces Weapons Specialist and a Medical Specialist, which is where I got my love for medicine.
00:05:58
Speaker
But even when I wasn't going to school, I was always enamored with science. i would go to library and read books on science, on pharmacy, pharmacology. I still have them because I i just was curious how things worked.
00:06:12
Speaker
And um I love being a combat medic. He went to Vietnam. I did well there. I was wounded, but I survived. But I got to see some of the most horrific things you've ever seen. and And it elevated my insight into the complexities of society and why governments will fight and kill each other because they have differences. And it matured me a great deal.
00:06:37
Speaker
And when I came home from Vietnam, my high school counselors had written me when I was in Vietnam. They kept encouraging me to to college, but I couldn't go to college because I didn't have SATs or no GPA and no transcripts.
00:06:52
Speaker
So they arranged for me to go into Bronx Community College where they had an open enrollment program for Vietnam veterans. That's how I got into college, in an open enrollment program. and if you do well for the first year, then you matriculate. So I did.
00:07:05
Speaker
And then I went to a number of, i went to Bronx community. I went to the city college itself. So there's a big campus with lots of different schools, but they're all under the City University of New York.
00:07:17
Speaker
And then I worked in a lot of different jobs as a paramedic early on in the days of paramedicine. Also ah teaching things that I learned in the military tactics, scuba diving, parachuting.
00:07:30
Speaker
So I was able to make a living. My wife also worked when I got married. And then I decided to move to California because a lot of my, what we call battle buddies, the guys I was in combat with were in California. I moved out there and because of my special forces training, I was able to take the nursing exam.
00:07:46
Speaker
So I got my registered nursing license. So I worked nice as a nurse and went to college during the day and I taught and did a bunch of other things. And then eventually, um, finished toward the end of my my college at at the California State University.
00:08:02
Speaker
I applied to medical school. I'd done well in college, did well in my MCATs. And so I got accepted to a number of medical schools. And I was fortunate it to go to University of California, San
Transforming Public Healthcare in Arizona
00:08:13
Speaker
Francisco.
00:08:14
Speaker
And I went there and did very well there. Was the happiest kid in the class, you know couldn't believe it. you know And I ended, i and it's Skip my last year. I finished in three instead of four.
00:08:28
Speaker
I graduated number one in my class and then trained for seven more years in general vascular surgery, trauma, critical care, and did some basic science and NIH fellowship. And i was just, I trained to be a professor and that's what I was planning, planning to do.
00:08:43
Speaker
And in, uh, 85, when I was done, uh, I was recruited to many places, but I came to Arizona because They did not have a trauma emergency medical system and they were looking for a director to set it up.
00:08:56
Speaker
And my bosses at the University of California who were world leaders said, you should go there because with your background, you can build a new program. I thought I'd only stay for two years and that was 40 years ago.
00:09:08
Speaker
And so I promoted up to where I am now as a a distinguished laureate professor in surgery, public health and in pharmacy. And so I teach, I do a lot of health policy now. I don't operate anymore.
00:09:21
Speaker
I sit on a number of public boards. And prior to this administration, I was still actively involved with health policy and global health policy. Of course, the challenge today is it's all being dismantled before us.
00:09:35
Speaker
So I'll stop with that. And if you have any specific questions, let me know. But that's the thumbnail sketch of my life. Yeah. And i I was a police officer as well in there. I forgot. I ran a SWAT team. I was a homicide detective for a number of years.
00:09:47
Speaker
And a lot of that were the tactics I learned in the military that I was able to translate into law enforcement. Yeah, it's actually very interesting. and Thank you so much for the background. I mean, when you think about careers, it often feels like there is some logical explanation behind it. But oftentimes, you just go through things and end up like following what you're pursuing as you go through it. But first of all, i think it's great that your mom got to see you go through probably two graduations. It seems like med school, undergrad, so that worked out. But also, um i really find it interesting like how you made that switch to medicine. I mean, you have this institutional background, working in the military in Vietnam, or also in police in the police force running a SWAT team. So you've seen how to lead teams, how these institutions work, and now you're bringing that towards healthcare as a doctor.
00:10:29
Speaker
So I want to get into a little bit about Arizona. i mean, you had the first certified regional trauma system in the area. And you're starting a network, a program from scratch. It's building a network, these protocols, standards. You're building culture too.
00:10:43
Speaker
And I'd love if you could walk me through that. I mean, you have this blend of being a great surgeon, a great physician, but also you understood institutions. How did you go about building this system? What was that like? And what were the kind of the constraints you were dealing with at the time? yeah Well, first, you need a willing community with the elected and appointed officials who wanted to have this.
00:11:02
Speaker
And they were below the standard because the standard then was a city this size and a region this size needed a place to take seriously injured people. Because right now, literature then, and even today, the literature shows that if you just randomly take people to a hospital with serious injuries, the morbidity and mortality goes up, no matter how good the hospital is, because you have to have a whole team.
00:11:24
Speaker
So I studied the environment and I recognized what I needed to do. I spent a lot of time going to community meetings, meeting with community health leaders, elected officials.
00:11:35
Speaker
because I recognized I needed to get not only the elected officials to buy in, but the business leaders, academic leaders, and so on. So the university was involved, the big private hospital was involved, the rural areas, had a huge geographic area, almost 40,000 square miles with about 80 miles running along the Mexican border. So we had an international flavor as well as just large geography, and a state which is about a third or a little more of a third Hispanic, and lot of immigration coming from the South,
00:12:05
Speaker
So it was a but a unique opportunity to try to do something that was innovative and necessary so reduce to reduce the morbidity and mortality in this given area because they did not have the highest level of care that was necessary.
00:12:17
Speaker
So that's what I was charged to do. After the first year, we
Challenges as Surgeon General and Political Influence
00:12:20
Speaker
got certification from the American College of Surgeons committed Committee on Trauma. Many of the hospitals in Arizona had been saying they were trauma centers, but they weren't certified. When you when you open yourself up to certification with the American College of Surgeons,
00:12:34
Speaker
you get a third party coming in and verifying that you have attained those standards. And that's what I did. Many of my professors at University of California that trained me were part of the College of Surgeons and they helped me set up the program.
00:12:49
Speaker
So I did that. And after the first year, we had our certification. We had two hospitals that were level one centers, University Medical Center and Tucson Medical Center. And then we had a huge catchment area with dozens of other small hospitals and clinics that fed us patients.
00:13:04
Speaker
established an 800 number so doctors could get instantaneous consults if they needed them. So that we built we built a network that it wasn't us and them, it was they were part of a comprehensive integrative network and all of us focused on reducing morbidity and mortality from trauma. And then we got into prevention as well.
00:13:21
Speaker
After doing that for a number of years and great support from the community, I ended up in our public hospital, what then was called Keno Hospital. It was a oh what you would, it was the the closest tertiary care center to the Mexican border, but still 50 miles north.
00:13:41
Speaker
And ah it was gonna close, and I petitioned the Board of Supervisors not to close it because it was essential for poor people living on the south side of town. Plus, before I came, it was a de facto trauma center.
00:13:56
Speaker
And so they thought they needed to close it because it was losing money. i made the argument they weren't losing money It was simply because these were underserved populations and there was a cost of doing business.
00:14:08
Speaker
So they respected me. I respected them, but there was ah like a little bit of a contentious debate. So they said to me, well, if you want to keep it open, then you you take it. So I became the CEO. I came to CEO of the hospital.
00:14:21
Speaker
And in two years, I stratified it. I diversified the revenue stream. I bought in paying customers, HMOs. I put in an occupational health clinic on the South side. We partnered with professional baseball who did spring training and we put a sports medicine clinic in.
00:14:37
Speaker
So it was at two years, we were a revenue positive. And before that, it wasn't that they were losing money. It was that they were taking care of people who had no money. And that's what public health hospitals did.
00:14:48
Speaker
But I turned it around and then my thesis, my thesis before I became Surgeon General, when I went back on active duty, my master's thesis i went to that's right I went to school at night to get my master's while I was working because I needed more and more knowledge about the business of medicine and and public health.
00:15:05
Speaker
So I did that at night and then I had to write a thesis. So my thesis was amalgamating the public hospital, the Keno Hospital, into the University of Arizona system.
00:15:16
Speaker
It had a business plan and everything. And there was a lot of contentiousness that people wanted to be independent, but none of it was germane to the discussion of being part of a larger enterprise that ultimately would serve the people better.
00:15:29
Speaker
And so, when i nothing was done for about a year, but when I was Surgeon General, I got a call from the county manager and he said, You still have that report you did? i said, yeah, I submitted it to you guys. He says, well, we're going to go ahead. We've talked to the university and we're going to combine and make it one system where that will be a feeder hospital.
00:15:49
Speaker
And what I said was that the county hospital should not be doing high tech tertiary care surgery because they don't do enough of it. Make it a primary care hospital and use the university to do tertiary care.
00:16:02
Speaker
And at the same time I moved, I got a bond money to move the public health department from downtown to where it should be. And we built out a public health campus that included the medical examiner. so all of the big assets for the county now were on one campus.
00:16:17
Speaker
So that, and that came to fruition from my master's thesis, but it I didn't appreciate it till I was surgeon general and they started doing it afterwards.
00:16:28
Speaker
So that's kind of my history here. And then and I promoted up eventually to become a professor, got involved with a lot of national organizations, stayed involved with law enforcement. Started a program called tactical emergency medical support for for special operations teams.
00:16:43
Speaker
And um after my four years as Surgeon General, I came back home and resumed the job. And only thing I added differently was I, now with my business acumen, got involved in in being on public boards.
00:16:57
Speaker
Clorox Corporation, McKesson Corporation, Herbalife, and did a lot of work with private equity, venture capital, and startups as well. So a part of something I never trained for, but that I, got interested in.
00:17:08
Speaker
And I was there at the right time with the, the if you will, the the the intersection of science and venture capital, private equity and business. And everybody was looking for people to help them sort out, you know, what are the next medical advances, how they can come to market, how they can be monetized.
00:17:26
Speaker
So it was fun for me and I still do that as well.
Modern Healthcare Issues and Global Health Role
00:17:29
Speaker
Yeah. And I think like, especially with private equity and venture capital, I mean, the playbook that you had, diversifying revenue streams, bringing HMOs, um targeting and even like integrating with the larger medical systems, I think they've become more common now. But I imagine back then that was a pretty novel approach and something that private equity and larger systems have adopted en masse. But it's kind of takes it's it's a big risk in doing so. So um I would love to hear, though, back then when you're trying to implement these new revenue streams, like what why wasn't it done before? I guess it was a kind of a trivial question. But is it because institutions are a little bit hesitant to change? Was it something else? Or
00:18:04
Speaker
What how did you yeah, why were you new new sorry, why were you needed to take a step further, I guess?
00:18:12
Speaker
I guess as an attending physician, I saw the weaknesses in the system. And I was engaged with the Board of Supervisors ultimately had the authority for the public hospital.
00:18:23
Speaker
And I recognize how important they were in taking care of the underserved population, which was largely Hispanic and Native American, also some Angles, but largely and Native American and and and some of the and the Hispanic population.
00:18:37
Speaker
And I just thought it would be a tragedy to close that hospital. Where would the people go? And I made the case to the board of supervisors. i said, look, you're elected officials. If you close that hospital, the the the care that these poor people need is not going to go away.
00:18:52
Speaker
It's going to show up in the private sector and it's going to be uncompensated care. And all those people that i'll vote for you guys are not going to be happy. So I think that helped to The economic incentive and the voting incentive helped them to understand that this should be stay open.
00:19:09
Speaker
And then that was why I wrote the my thesis to be how to combine this into a single system that would be more cost effective. And then making partnerships with people who could pay.
00:19:21
Speaker
Private corporations, the professional baseball, and you know started a sports medicine clinic. We bought in um occupational medicine to take care of all the small businesses in the area.
00:19:33
Speaker
So because of that, we were able to generate revenue streams for people who were poor. We made sure that they were all signed up if they were eligible for Medicare and Medicaid access, which is, you know, the Arizona health care cost containment system, which is but essentially Medicaid.
00:19:48
Speaker
And so we we maximize the revenue streams by the private sector and at state and federal government. And then we then we were we were in the black. Okay. But then the other side was, I spent a lot of time putting programs in place for prevention.
00:20:04
Speaker
So everything, you know sleeping, eating, reducing risks, seat belts, helmets, yeah all of that. And over time we saw cost of care go down. but But it was to me, I was very proud of being able to build an integrated system that was fair to all the people in the area and not leave anybody behind.
00:20:22
Speaker
So that's that's, you know, i maybe I just saw the problems that other people didn't see, I don't know. But ah I was fortunate to have my upbringing and know the indignities of not being able to get timely healthcare and going to bed with toothaches because you can't afford a a dentist and um not always knowing if you're gonna have dinner at night, you know?
00:20:46
Speaker
And so I i guess I, you know I was very sympathetic and empathetic to people that were struggling, that just needed a little help to you know get their lives in order.
00:20:58
Speaker
So I think it was all those things. I think part of it is just is having a different perspective. A lot of people who run these facilities or these large health systems have been in that area, have been leaders for so long that it's almost hard to envision a new change. But then empathy is also a huge part too, and just being willing to take that stand. So then in 2004, as you became Surgeon General, um i i saw that you called health literacy one of the common, a common currency for success. And you said pretty bluntly that as America's a little bit of a health illiterate society.
00:21:29
Speaker
And I think that line has aged like uncomfortably well, unfortunately. And I mean, can you speak to that? What were your main priorities in pursuing as in terms of being a U.S. U.S. Surgeon General over the term of your career? What were you hoping to change? What recognized early on, I would,
00:21:45
Speaker
You know, I was never satisfied. I was always curious and asking, you know, what's around the corner? What else do I need to know? And one of the things I saw was that in the very diverse populations that we serve, there were many barriers, language and culture being many of them.
00:22:06
Speaker
These are good people. It's just that they don't speak the language. They don't understand the culture. they haven They don't have higher education. So I did spend a lot of time on health literacy and cultural competence because that is how we translate the science we have to a regular person.
00:22:26
Speaker
And what do you want to do with that? You you translate complex science in a health literate, culturally competent manner to a population or people to do one thing only, effect sustainable behavioral change.
00:22:37
Speaker
Wear your helmet, wear your seatbelt, eat better food, take care of each other, get sleep, you know, whatever it is that you're trying to deal with, people first have to understand you. And then if they trust you, they'll go along.
00:22:48
Speaker
So working to have trust, being that I understood Spanish and came from that kind of a background, I think it gave me a leg up. The being that the people I think saw that I really cared, I didn't have to be there.
00:23:02
Speaker
I wasn't there because I'm making a lot of money. I was there because there was a mission to try and do something better for the community. So I think it was all of all of those things but mostly understanding as Surgeon General and and and that health literacy is one of those barriers that you can't expect people to execute on what you're saying if they don't understand what you're talking about.
00:23:27
Speaker
So that's why I spent the time there. And as I said, in the southern part of where my jurisdiction was with the county hospital and then the bigger system, when we combined with the university, um there was Spanish was probably spoken more than English in many of the communities because of their immigrant communities.
00:23:48
Speaker
So I think that that was needed to be able to translate the things I needed the people to understand. I also started an institute which was part of Canyon Ranch, which is ah ah ah a destination resort.
00:24:02
Speaker
And the owners were kind enough to let me use the intellectual property and I got people to volunteer. And we took all of the great content they had here and we put it into 35 hour curriculum and we took it into all, a lot of poor neighborhoods in the South Bronx, part of where I spent my time as a kid and other Appalachia, Indian reservation.
00:24:22
Speaker
And what we did was we gave them a Canyon Ranch experience for free and basically taught them the elements of optimizing health and wellness. And then we tracked it and we looked at biomarkers, without biomarkers we looked at markers of you watching hypertension, watching glycemic levels, sugar, you know things like that.
00:24:42
Speaker
And we tracked the populations. And when I set up the Institute, I said, we have to have it validated. So I called my friends at CDC and and NIH. We got people to you know read the papers we were publishing so that we'd get validation. And it was very successful in in targeting underserved communities with the intellectual property that you find at a world-class ah health resort and bringing it to those communities.
Advice for Future Healthcare Professionals
00:25:08
Speaker
So that was a lot of fun for me as well. Again, always appreciative of what I achieved, but never forgetting that it was my obligation pay it back. Yeah. I think a long longitudinal study like that's really interesting. i It's just...
00:25:21
Speaker
hard I guess for doctors and people to, and doctors are so important today because they're the ones that can reorient care. People don't really know what they're spending their healthcare on, which is why you see a lot of excess excess spending, not really because people are making the wrong decisions, but because they don't have the knowledge to make their own decisions either, which is a difficult scenario to be put in. And I know you spoke on something singular similar, more at the institutional level, um is that like as a surgeon general you have the both the privilege but also the burden of telling inconvenient truths which is difficult and i think that even though people as us can be hard to understand our health so can institutions and presidents they can also misunderstand what's going on in health care or health more broadly so how do you deliver this unpopular evidence or new science in a way that people can actually hear and understand while still keeping your own credibility intact it's kind of a fine line to balance but i can imagine it's one that you have to try to cross many times throughout your career?
00:26:16
Speaker
It's a great question. And oh every surgeon general has been plagued with this problem. In 2007, Surgeon General Koop, who was before me and Surgeon General Satcher, three of us testified to Congress about the politicization of the office, for those very reasons.
00:26:35
Speaker
our argument was the surgeon general should never be partisan. The surgeon general should speak truth to power based on the best science. Then the elected officials are the ones that get to make policy and convert that.
00:26:47
Speaker
lot of times the surgeon general gets but you know blamed because there's no policy. we don't We don't have authority for policy. We have authority to inform. Okay. And the challenge of course is when you have leaders that don't want to hear the scientific truth because they have something else driving them.
00:27:04
Speaker
Look at the problems we're having today with the ideologically driven vaccinations. Vaccinations are probably arguably the most important advancement in the history of mankind. Okay, we don't have black plagues anymore wiping out whole continents and populations.
00:27:18
Speaker
We don't have polio. Beasles, mumps, rubella are kept under control. Wupikov. And yet we have people that are denying the vaccinations for whatever their ideology is. Okay. From the very top, right at secretary's office.
00:27:33
Speaker
So it makes it very difficult because now the public doesn't know who to trust. And if they don't trust you, they're not going to follow your directions. So for a while, my colleagues and i what we've done is to say, Your best source of information as to should you be vaccinated or not is your primary care doctor.
00:27:50
Speaker
Talk to the doctor that you trust and they will probably tell you to get your vaccination, especially if you're older, especially if you're at higher risk because of comorbidities that you have, you should be vaccinated.
00:28:01
Speaker
So i use vaccination as one of many of the bits of this and disinformation we're struggling with today. I didn't have it that bad. You know, there were politicians that didn't like sometimes what I said. And most of the time, if I ever generated a negative headline is because I disagreed diplomatically with a politician who wanted something else.
00:28:22
Speaker
My lens was always, what is the best science to solve this problem? Recognizing that I don't have the authority, but I will tell it to the people who do have the authority, the elected officials to make the policy.
00:28:33
Speaker
so We see today that in my case, for instance, I worked for President Bush. He was always very supportive of what we did. But you know different groups didn't like this or didn't like that, but that's part of a democracy. As you know, Winston Churchill commented famously that ah democracy was terrible except for every other form of government that we've tried.
00:28:55
Speaker
You know, and that that's so it's expected that we're going to have discre discussions and we are going to have disagreements. But that's what a democracy is for, to be able to settle those disagreements in a nonpartisan way that benefits the public peacefully.
00:29:13
Speaker
And so. ah you know I had some problems and I wrote about them. I testified before Congress about the general politicization of that. And there are many of the people that are embedded in those different places who are Republicans and Democrats, and you know they tend to be very partisan.
00:29:29
Speaker
For me and most of the surgeons, all the surgeon generals I've known, there was not a partisan bone in their body. They basically just said, what's the best science? Okay, now let's give it to the elected officials so we can get policy on this to benefit the people.
00:29:42
Speaker
So with that in mind, we see what we're facing today, where most of the things that are coming out are ideologically driven, not scientifically driven. And that's dangerous.
00:29:53
Speaker
We see the dismantling of our CDC and our and NIH, some of the smartest people in the world. In fact, the world would look at CDC and NIH for guidance as they structured their own countries as it relates to public health preparedness.
00:30:08
Speaker
Now, you know many of those great minds are gone because they were fired simply because somebody didn't like what they said. Somebody didn't like that they were not ideologically aligned more.
00:30:21
Speaker
And that's all detrimental to the health, safety and security of our nation. And I say that specifically for security as well, because biopreparedness, all of the things that I was involved in and other Surgeon Generalists have been involved in, in protecting the nation from making sure We have good health, but also having an infrastructure that could surge when necessary to deal with all hazards, threats, nuclear, biological, chemical, war.
00:30:47
Speaker
There's an infrastructure there. And now that some of the key thought leaders in those areas have been silenced, eliminated, we are we are worse for that right now.
00:30:58
Speaker
Last I'll mention is our epidemiologic intelligence service, which basically provided surveillance for the world of epidemiology. And they're struggling now too. So it's not only the United States that's suffering from mis- and disinformation and ideologically driven in decisions, but it is the rest of the world that depended on us for that information because they didn't have the resources like we do to do those things. So PEPFAR, which was the AIDS program, has been eliminated. USAID, which is the United States Agency for International Development, has been eliminated.
00:31:31
Speaker
And I can go down a list even more. But these are not only detrimental to our country, they're detrimental to the world and our allies that depended on us for yeah and you would actually think that COVID would be a breaking point in terms of people would want to be more educated, see how important public health is, but um I don't think it was necessarily. I had a conversation with Dr. Susan Menares, who ran the CDC, until she was unfortunately i mean almost ousted, and per se. um And it seems like the role of these larger institutions is changing. It's getting yeah more ideological, more politicized, and less about the science, as you almost exactly said.
00:32:08
Speaker
um And I would love to hear, do you think that's this is like a new thing that we're dealing with? I know back in your in your time as Surgeon General, um secondhand smoke, you worked you had a big report on secondhand smoking. And you publicized that the science was clear, the debate was over, and there was resistance. I mean, do you think that resistance is there at the same magnitude as there is today with vaccines and new science? Or do you think it's something's changed? Or how are you looking at today's climate versus then?
00:32:34
Speaker
So let me be clear. the The resistance did not come from my immediate superiors that were elected. The resistance was from the tobacco industry. Okay.
00:32:45
Speaker
But yet they're the ones that pay the money to the elected officials. All right. So if you follow the dollars, you see how people vote. And that's just the truth. And it's on the same on both sides. So I, I testified to Congress.
00:32:59
Speaker
I was in federal court testifying about tobacco and its deleterious effects. And I was very involved in all the tobacco legislation. Nobody ever told me not to do that in government. Nobody. Okay.
00:33:11
Speaker
Except the tobacco industry was furious. They didn't want Okay. But that's the way it is. But because they have a disproportionate influence on elected officials because they pay, you find out you find people sometimes that have opinions that are contrary to science.
00:33:29
Speaker
Let me put it that way. So for for the most part, most of the people I work with were good public servants who wanted to do the right thing for the people. And Occasionally, you run into people that are more ideologically driven or partisan.
00:33:44
Speaker
Okay. What we have today defies any kind of characterization. it it It is just downright crazy, you know, that we have a secretary that came in who said that he was not going to touch the vaccination program. In his confirmation hearing, people were worried that he had many aberrant thoughts. He said, oh, no, we're going to support everything. What did he do?
00:34:09
Speaker
He tore it apart. You know, our ASIP is gone. they head a We had a group of knowledgeable, nonpartisan vaccine scientists who were the ones that I would meet with the Surgeon General to determine what our next vaccine should be.
00:34:23
Speaker
Now you have partisans in there. that's That's not what we need. And then you look at some of the other things. Now, I'll give them credit on some of the other things where you're talking about eating better, you know, this so-called make America healthy again.
00:34:37
Speaker
i don't I don't agree with that. polarization characterizedization of these problems, but should people eat better? Should they be eat farm to table, reduce all of the food that has been adulterated in different ways?
00:34:51
Speaker
For sure, that would be better to do, but can everybody afford to do that? Okay, do they have the education to understand it? So there's a way to do this in the correct way that we could get to the people and inspire them to make these changes rather than confuse them with ideologically driven policy that makes no sense. And it's like, at least for me, it's like you're hearing one thing from the secretary, hearing one thing from your primary care provider. you You're hearing different things everywhere. It's kind of noisy to the point where we see this almost anti-establishment part of health care.
00:35:22
Speaker
People are upset at UnitedHealthcare and delivery companies, but they're also equally confused about what's going on and the actual literacy point of things. And I think that's created a trend where people want to take health care into their own hands.
00:35:33
Speaker
um and almost like consumerizing healthcare. So, GLP-1s, Ozempic, Grigovie, people are obsessed about Adderall too, but I think a huge thing that we're seeing lately is peptides and things like that where people believe that they can do their own science and reading and and kind of assign themselves um what's best for them. And I'd love to hear, like what do you think about that? i mean How do we create guardrails that allow it like i guess public health experts to control what people have access to while not like restricting their freedoms? For example,
00:36:01
Speaker
um Not all peptides are safe, but you can get them illegally and people think that they're safe. It's hard to educate them while still not taking away their freedoms. It's kind of like a weird middle ground you have to play. mean, what do you think about these modern problems where people so think they're getting more educated with the Internet, but oftentimes still are missing some of the fundamental science and endangering their own health as a result?
00:36:24
Speaker
The first thing that has to happen, the public needs to regain its trust in its leadership. Because in the past, a secretary of health, a surgeon general would provide guidance that would filter down to the community, to the doctors, to the nurses.
00:36:41
Speaker
There'd be surgeon general's reports. There'd be calls to action by the surgeon general, all based on science. That's all sidelined now. Okay, because it's coming directly from a secretary who's ideologically driven.
00:36:53
Speaker
And yet I give him credit. Some of the things he's saying are correct. Eat eat healthier for sure. But to politicize all of that and make it partisan doesn't make any sense, is my point. So I think that first you cannot lead if the people don't trust you.
00:37:08
Speaker
And right now the people don't know who to trust because as you pointed out, they're getting so many messages from different people about what should I eat or anything about their health for that matter. Vaccination is just probably the most important one before us right now.
00:37:22
Speaker
We have people not being vaccinated. So what what's the ah what is the outcome for that? If you trained in medicine in the last decade or so before this challenge, you'd never seen a case of measles.
00:37:35
Speaker
Now we have little epidemics all over the place because children aren't being immunized. you And if you think about it, if we continue down this path and more and more people don't get immunized, we'll maybe see polio again.
00:37:48
Speaker
We'll see diseases that we haven't seen before because we've eradicated them. Now, Some people like the secretary and others have said, well, but you have herd immunity. That's, that's that. Let's just let it happen naturally.
00:38:00
Speaker
Herd immunity is a good thing, but when you can accelerate herd immunity with a vaccine, it's even better. And if you wait for natural herd immunity, your cost of care goes up and your mortality and morbidity go up.
00:38:11
Speaker
Okay. It'll happen eventually, but it's going to be at a higher cost. So why not eliminate that cost, keep people healthier longer? Really, that's the simple thing. But when you're ideologically driven and you have telling people that what vaccines cause autism, vaccines cause you know other diseases, no scientific evidence whatsoever.
00:38:30
Speaker
But yet when it comes to people who are in high positions that the public rely on, now they don't know who to trust, which is why myself and others in previously and in senior positions and surgeon generals have said to the people, this is what we think you should do, but Go to the doctor, nurse, practitioner, PA that you work with and talk to them.
00:38:53
Speaker
They will give you the good information. OK, because, again, they they're confused. I've had people say to me, yeah you know, I know you're a surgeon general, but you're saying do this. But that guy who he was your boss is saying do that, you know, and so they get confused. The average person doesn't have the scientific acumen to be able to understand. And they feel, well, why would an elected official lie to me?
00:39:14
Speaker
okay I'm not calling it a lie, but I would say it is ideologically driven and incorrect. Lying is more about purposeful things. But if you believe that, it's wrong. And we know that vaccines work and everybody who's eligible should be vaccinated.
00:39:29
Speaker
And of course, you need to check with your doctor. You may have a disease, you may have a problem, you may have an allergy, we understand that. That's why I always say, if you are eligible, take advantage of it because it not only protects you, it protects everybody around you.
00:39:42
Speaker
And when you go to see your grandmother or your grandfather who happen to have chronic diseases and you are infected, and then you infect them, they could die. And for the seniors, it doesn't always prevent you from getting COVID, for instance, or another disease, but statistically, it probably says you will not have to go to the hospital, be in the ICU, and you will die.
00:40:02
Speaker
So all of those things are important. That's what the science says. Now we have to get back to the a world where our elected officials defer to the experts to be able to deliver the appropriate messages, to incite behavioral change,
00:40:19
Speaker
that results in people making good decisions to reduce morbidity and mortality and equally important, keep the cost of health Yes. And I'd love to, for my last question, love to get to the example of measles. um I spoke with Dr. Seth Berkley, who ran Gavi, also one of the largest kind of one of the largest people in furthering vaccine development. And You can give an interesting example is that when you think about someone today, they don't see measles at all, really. So, of course, they're going to think that what are these vaccines for that I'm injecting my child to? Obviously, they care and love about. And there's some going to be natural hesitancy there.
00:40:50
Speaker
and And unfortunately, as you mentioned, the institutions that are supposed to build up trust in these methodologies are kind of being just removed or displaced a little bit. But for people listening today, like us younger individuals in their 30s, 20s, 40s, who are going into these fields, who don't really have the power to change institutional credibility overnight, but are still going to be in the health care system working as doctors or clinicians, policymakers, lawmakers. what would you What advice would you have for them in terms of increasing health literacy or just changing the way that we, i guess, normal people who are just instead of who don't read science papers and just feel health care, feel what people are saying?
00:41:30
Speaker
What advice would you have for ordinary people who are trying to pursue these paths in terms of reshaping health care for kind of everybody? Well, what we've done in this confusing geopolitical landscape that we have is to recommend people talk to their primary care provider. If you're uncertain, go to your university medical center and look at their website. Look at what the doctors and professors are telling you to do, because that will be apolitical.
00:41:57
Speaker
OK. So there are places out there where you can do that. There's a lot more education being done now in health literacy so that students in all of the health professions are learning how to better communicate to people.
00:42:08
Speaker
Hence, translating the complex science, genomics, genetics, epigenetics, pharmacology, to an average person, a high school graduate that has a family, okay? and having them understand in simple terms what it is they need to do, the action they need to take to keep their families healthy.
00:42:28
Speaker
That's what health literacy is all about. It translates into actionable items that people then can decide to do to keep their family healthy. So raising the bar for health literacy, and it's much better than it used to. When I got involved in, there was not a lot of health literacy.
00:42:45
Speaker
Now it's it's something, and I i latched onto a surgeon general and I've continued. So things are better now, but the public needs to be reminded of places they can go to get truthful, trustworthy information about any disease that they have or how to stay healthy.
00:43:06
Speaker
And there are a lot of organizations. You know, you have the American Medical Association, you have the universities that they live near that have medical schools, schools of nursing, schools of PAs, paramedics.
00:43:18
Speaker
There are people out there that can provide guidance when there are questions especially at a time when our government continues to confuse the people. And usually they were the source of the best information.
00:43:31
Speaker
But now it's it's not that way anymore. When you think about it, we, we, as Surgeon General, I traveled the world representing our country. I met Surgeon General from other countries, health ministers. I worked very closely with the health minister of Mexico for a number of years, who is now the chancellor at UCLA.
00:43:48
Speaker
So I, I got a really good feel for how important our nation was in our scientific acumen. Everybody wanted to know how our, what does our FDA say about this, or our CDC, or NIMH, all these other organizations that are part of our government, because we had risen to be the global standard of excellence in science.
00:44:10
Speaker
Drug development, delivery, everything. Everybody wanted to know, and now they're not sure if they can trust us. So our credibility has dropped because the world sees that in some cases are the the tried and true America that they used to count on 100%. They're not really sure if they can trust us anymore.
00:44:33
Speaker
Not because we don't have the ability to do it, but but because we have lost the opportunity because some of the people and organizations have been muted or eliminated. So that's the problem now.
00:44:45
Speaker
And, you know, We're a country of 340 million, 350 million people, but we have a disproportionate influence on seven, eight billion people in the world because of who we were.
00:44:57
Speaker
Now we've lost some of that credibility. And even on the other side, you look at NATO, you look at the issue of how the world depended on us to try of try and keep the peace. Look at all we did after World War II to help Japan get back on its feet, even though they hurt us, Germany get back on their feet, the Marshall Plan, the World Bank, the United Nations, the World Health Organization, all of those were stood up after the war, Second World War, to create a more stable, healthy world.
00:45:31
Speaker
And now those are being dismantled, and we have a president that's even discrediting some of them. That is very detrimental, not only to the United States, but to world health. i do I definitely agree. I think that we're ceding both on the trust side and the discovery side to other countries. And I think it's not just a personal level, like trust your primary care provider, but it's the entire, it's a problem of the entire country in some way. So I guess...
00:45:57
Speaker
it's going to taken i think it's something that'll take many years to fix and hopefully will be restored in my lifetime but um it requires change at every single level from people to institutions to people leading those institutions so i'm curious to see what will happen but i really appreciate your time again dr kermuda to come on i know it's been um there's so much things going on in healthcare care now but it's really interesting to get your perspective I mean, you've delivered health care, you've led health care systems, um you've seen policy change. Thank you again for the time. i Really enjoyed this discussion today.
00:46:28
Speaker
Thank you. I enjoyed it as well. Thank you very much. Bye bye now.