Barbell Shrugged - Body of Knowledge  — Chapter 9  —  Human Healthcare w/ Linda Resonstock

Episode Date: June 8, 2018

In chapter 9, we are joined by Linda Rosenstock to talk about healthcare and the various factors that influence it. Linda has 20 years of experience in clinical medicine, she was appointed by the Clinton and Obama administrations to advise on issues in public health, and she served as the dean of the UCLA School of Public Health for 12 years. Enjoy! - Kenny and Andy   ------------------------------------------------------------------------------ Show notes: http://www.shruggedcollective.com/bok_chapter9 ------------------------------------------------------------------------------   ► Subscribe to Shrugged Collective's Channel Here http://bit.ly/BarbellShruggedSubscribe 📲 🎧 Listen to the audio version on the Apple Podcast App or Stitcher for Android Here- http://bit.ly/BarbellShruggedApple http://bit.ly/BarbellShruggedStitcher Shrugged Collective is a network of fitness, health and performance shows that help people achieve their physical and mental health goals.  Usually in the gym, but outside as well. In 2012 they posted their first Barbell Shrugged podcast and have been putting out weekly free videos and podcasts ever since. Along the way we've created successful online coaching programs including The Shrugged Strength Challenge, The Muscle Gain Challenge, FLIGHT, Barbell Shredded, and Barbell Bikini. We're also dedicated to helping affiliate gym owners grow their businesses and better serve their members by providing owners tools and resources like the Barbell Business Podcast. Find Shrugged Collective and their flagship show Barbell Shrugged here: SUBSCRIBE ON ITUNES ► http://bit.ly/ShruggedCollectiveiTunes WEBSITE ► https://www.ShruggedCollective.com INSTAGRAM ► https://instagram.com/shruggedcollective FACEBOOK ► https://facebook.com/barbellshruggedp... TWITTER ► http://twitter.com/barbellshrugged

Hey there ladies and gentlemen, this is Doug from Barbell Shrugged. I just want to let you know that we now offer 11 of our top training programs as a part of a single membership site that we're calling the Program Vault. We used to launch training programs every few months and people were always bummed that they couldn't sign up at any time. You had to be around for the launch. The launch was only 4 or 5 days. If you missed it, then you had to wait 6 months or a year depending on what training program we were offering next.

It was kind of a hassle, even when people signed up for training programs to switch to a different program when they got to the end of their current program or they just happen to be in a new phase of training they hit their their past goal and now they have new goals and new goals require different training programs so inevitably it was a pain in the ass for people to switch programs so we took all that feedback and we decided to just put all of our programs together on this thing we now call the program vault that way all shrugged athletes could have access to all the workouts that we have and move from program to program as they saw fit for themselves makes sense so there's 11 programs three of them are long-term very comprehensive programs where there's you know a warm-up and there's mobility and there's nutrition added in there all the workouts are there there's a cool down there's there's stuff

to do on your off days they're super super comprehensive and those programs last for over 18 months if you want to stick around for that long and there's also eight short-term programs these programs are three months long and these are basically add-on programs so if you are already doing classes at a gym and you don't want to stop doing your classes but you want to work on one particular thing maybe you want to like work on your shoulder health or you want to work on your conditioning like your your aerobic capacity or maybe you just want to work on your squatting strength or your pull-up strength or something like that then we have these short-term add-on programs that are

super low volume but they're just like an extra you know two or three exercises at the end of your workout to help work on whatever those very specific goals are that you have. So the three long-term programs are flight weightlifting. That's a very weightlifting specific training program. It builds you from someone who's more like beginner intermediate at weightlifting and builds you up to be a more technical professional style weightlifter you know over the course of 12 or 18 months we also have muscle gain challenge if you just want to put on muscle mass and you want a higher volume training program this in my opinion is more of an intermediate program if you don't have good technique on the olympic lifts yet you're going to kind of be throwing right to the wolves so to speak. It doesn't ramp you up like flight does.

Flight has very specific progressions for weightlifting to let you learn all the technique over time. Muscle gain challenge kind of just throws you right into it. So ideally, you already have some experience with Olympic weightlifting before you start the muscle gain challenge. And there's a very high emphasis, of course, with the muscle gain challenge on gaining muscle. So that means you've got to eat a lot of food. and there's a very high emphasis, of course, with the Muscle Gain Challenge on gaining muscle, so that means you've got to eat a lot of food, so there's a lot of emphasis on how much to eat, what to eat, and your recovery as a part of that program,

so that way you can get bigger and stronger. Also, we have Strug Strength Challenge, which is more of a traditional kind of CrossFit-ish program. If you do CrossFit classes at a CrossFit gym, you probably do some strength movements at the very beginning of class. Maybe you do front squats for five sets of five, and then you do a Metcon that's, you know, 20 or 25 minutes or whatever it happens to be. That's more typical of the shrugged strength challenge where strength is the goal, but certainly conditioning is a key part of that as well. It has more of a strength bias than kind of a regular generalized CrossFit-y type program.

So the eight short-term training programs, again, these are about three months long and they're kind of an add-on program. So the first one is boulders for shoulders. That's a shoulder health and stability program, health, mobility, and stability program. That doesn't mean you're going to be doing a whole lot of jerks and overhead presses necessarily. This is again an add-on program so you're going to be doing a lot of assistance work for your shoulders, your thoracic spine, etc. That way you can have the healthiest shoulders possible. There's the aerobic monster program which is adding in a bunch of extra mostly aerobic conditioning. You're going to be on the airdyne a lot, you're going to be on the rower a lot, you're going to be doing a lot of monostructural stuff. So you know if, if you already have your regular workout, you do strength, you do your Metcon,

and then, you know, as a very overly simplistic example, you do, you know, 20 minutes of rowing, or you do 30 on 30 off for 10 rounds, or you're doing a hard 30 and an easy 30, or whatever it is. Just a little bit extra aerobic work. There's the squat the house program where, you know, we add in two leg exercises three days a week. So you might squat and then do some lunges or something like that. Depending on what your regular classes are like, you might already be doing a lot of squatting. But if you're not currently able to do a lot of squatting and you want to do some more squatting and you just want to add that onto your current training, then Squat the House is a great program.

Anaerobic Assault, that is a high intensity interval style program where you're doing very fast metcons so you might be doing airdyne sprints you know 30 seconds on 100 full speed and then and then take a three minute break and do it again or even you know five touch and go deadlifts followed by you know 10 burpees rest two minutes and then do it again but you're doing it all 100% full speed, really teaching you how to kick it into high gear and move very, very quickly when you're doing your Metcons. There's my first pull-up, which is not going to give you a whole lot of actually doing pull-ups. This is a program for people that can't do a pull-up yet. So there's a lot of assistance

work for pull-ups, and there's a lot of extra assistance work for just all the muscle groups involved in doing pull-ups. Everything from doing extra extra lat work extra scapular attraction rhomboid lower trap work extra bicep work etc to help get you to the point where you can do your first pull-up there's a strongman accessory program where you can be doing yoke walks picking up stones pulling heavy sleds and things like that and then there's two more programs that are kind of a little bit higher volume. You could do them on your own if you wanted to. And you also can combine these.

You could do Aerobic Monster and Aerobic Assault and My First Pull-Up all together if you wanted to, if you just wanted to add extra volume. But the last two, Open Prep, is exactly what it sounds like. It just gets you ready for the CrossFit Open or other similar competitions. You'll be doing a lot of Metcons. And the last one is Barbell Beginner to Meet. It's prepping you for your first

Olympic weightlifting competition. Each program is scheduled between three and five days per week. There's videos explaining all the programming. There's demos. There's technique explanations for everything. And then also you have access to the private Shrugged Collective Facebook group.

That way you can get advice from ourselves. We'll be in there hanging out. Our guests from our shows. We also have a bunch of athletes, coaches, and strength experts that are friends of ours that are in there too

to help you out. If you're interested, since I've been talking long enough, you can go to shruggedcollective.com backslash vault for all the information. Again, that is shruggedcollective.com backslash B-A-U-L-T.

That spells vault. Go there, check it out. If you have any questions, email help at barbellshrugged.com and enjoy the show. Mike Bledsoe here, CEO of the Shrugged Collective. If you haven't already noticed, we've got a lot of new cool stuff going on. You hit shruggedcollective.com. You'll see some great content that we won't be catching if you're only listening to the podcast. Hit the website and see the new look

and feel. This week, we get to introduce you to two new shows. Today, we bring you Body of Knowledge. This show has been created by a couple of guys you already know, Dr. Andy Galpin and Kenny Kane. They've had their own project and I love that we get to share it with you here. As we're expanding and improving the shows, we have partnered with amazing companies that we believe in. We talk and hang out with the people who run these businesses and know why they do what they do. Not all products are created equal, even if it looks like it on the surface. We've done the research and have been in the industry long enough to see what really works and what will make the biggest difference for you long term.

With that being said, one of my favorite companies, Thrive Market, has a special offer for you. You get $60 of free organic groceries plus free shipping and a 30-day trial. Go to thrivemarket.com slash body. This is how it works. Users will get $20 off their first three orders of $49 or more, plus free shipping. No code is necessary because the discount will be applied at checkout. Many of you will be going to the store this week anyway, so hit up Thrive Market today. Thrivemarket.com slash body.

Enjoy the show. Can we start again? Yeah. Where's the future of this understanding going? Don't know. Why? Anyways. We are not a singular thing. Anyways. practices that every human should be striving for. It's candy madness.

Scream if you like candy. I don't know where that came from. I wasn't listening. I was just thinking about that. So additionally, Linda, you are a puppy lover. And I've been told by your husband, you are currently collecting a lot of dogs and you're running a kennel at your house.

Is that correct? Well, we have four dogs. It depends what you think. Yeah. We like them. The problem is that we negotiated for an additional two. From what your husband says, I don't know if that's necessarily a negotiation. It's you making a determination.

Actually, it was friends of us. We were traveling together. We were in India. He wanted to buy some rugs. It was very clear that I was not ready to buy anymore. And the agreed upon, the consensus of the group was for every two rugs he bought, I got another puppy. And guess how many rugs he bought? So are the rugs for the puppies to pee on?

No, no, no. Well, you know. Not our dogs. I think I could use you in my house josh and andy spent a lot of time with me and char and they're like thor is nuts he's like i mean he's just like rambo but i'm like yeah if you've ever spent time at either of their places with their dogs their dogs are insane like josh's dog flow is on crack and ghostface killer and and the other puppy will if you go to their house will when you walk in, there's so much dog energy.

But it seems to be fueled by amphetamines and not by kibbles and bits. And so the dogs spin around the room so much so that they'll move a several hundred pound couch just by jumping on it and running circles around it. So we brought in a trainer for our last dog, who's a puppy. He's a chocolate Labrador puppy. We have two other dogs, and a chocolate Lab. And hardest dog we've ever had to train. Sweet as could be. Jump.

Got to be a year. Wouldn't stop jumping. We thought we knew how to do this. Finally brought a trainer, and the trainer came into the house, and the other three dogs were there. And everything else seemed perfectly normal. And the trainer said, is it always like this we said yeah she said this is chaos this is unacceptable what she said you can't just train

this dog you need to train all of your dogs so we fired the trainer we're gonna change our minds no way so we're here with Dr. Linda Rosenstock, who was appointed by President Clinton to serve as the director for the National Institute for Occupational Safety and Health. Additionally, she was appointed by President Obama to the advisory group on prevention, health promotion, integration for public health. And last, and again, listeners, this is a very hyphenated introduction to her rather vast biography, but she served for 12 years as the Dean of UCLA's School of Public Health. Which to give you guys some context, that's about three to four times longer than most deans last. So Linda, we, meaning Josh, Andy, and myself, sincerely appreciate you spending these moments with us today. I was telling them earlier that I can't get a 30-minute meeting with my dean. So the fact that you've come in here for this many hours,

it's a true blessing. A big part of our conversation thus far has been that there's certain elements of the health and fitness community that believe that there's these giant conspiracies that are manipulating all the choices that we make. And one of the things that we've sort of started to understand is that addressing massive pathologies is a complicated problem. So the three of us get to sit in our little podcasting booth right here and pontificate about ways that we think might be able to solve these giant health crises. But you're somebody who's been in the trenches and that unto itself is at a scale that I know from me personally, the rec group that I affect is really just a few hundred people. The science, unfortunately, we've laughed about this before. Andy's writing very revelatory papers right now as they represent what the human body, specifically muscle, is capable of.

Yet six people might read them. Two of those people happen to be in the room right now, Brian McKenzie and myself. Hey, I read the abstracts of Andy's papers. Thank you, Josh. Okay. Just the abstracts. Seven people read Andy's papers. That's more than what Natasha does.

And we've identified that there's a lot of people in this space that are generally intending to do well, but have a variety of information that they're filtering from their own biases. What we realize is all that gets very convoluted. And it's hard for us to take a few steps back and go, what are the major influences on this thing? So having done that for several decades in a number of capacities, I know Andy is very excited to kind of like dive into this with you as is Josh. But what are some of the big considerations when you're looking at creating public health policy? Because that in and of itself, I mean, I don't even know how to frame the question with enough specificity for us to wrap our heads around it. But what are the considerations when you're framing public health contextually and then policymaking from it? Well, I think the first thing you said, which is really important, is that we all have biases,

and everyone comes to every topic with a set of biases. And I think one of the jobs we, you know, as Andy tries to do, if you're in the academic world, you try to get people to at least agree on what we think the fact base is. You know, we may have disagreements. There's always uncertainties in science, but there are some things that are pretty well established. And so if you can agree on the general science or evidence base in an ideal world, if politics weren't around, which of course doesn't exist, then that evidence would drive policy solutions. Because really what public health is about is, as you said, looking at lots of people, not just looking at one person at a time, but thousands or tens of thousands or millions of people at a time and saying, well, what do we know that works or doesn't work? But what happens, of course, is the biases we bring to the table may put that filter on what we look at. So first of all, some people describe public health in different ways. So I

want to just, for the sake of the people listening, let's talk about what public health is. For those of us who are very self-congratulatory about the work we do in public health, we say, well, in medicine, and I do medicine, in medicine, you save lives one at a time, but in public health we save lives millions at a time. So that's a pretty self-congratulatory concept. But the idea is that in our health care system, we are very much a sickness system. We're very much looking at people who already are ill. We're treating them. It's costing us a lot of money. The outcomes are very uncertain for a lot of things we treat. And in an ideal

world in public health, we're trying to say, what do we know at a community level or a population level where a lot of work about prevention and forestalling things or anticipating things and changing what might happen might work. So if you look at our health system, something I'd like to call the 97-3 problem, 97% of our three plus trillion dollars a year is spent on sickness health. We're taking care of people who are already sick and spending a lot of money on them. Not that they don't deserve it. Only 3% is going to prevention activities or public health activities, perhaps even less. And that's an imbalance because we actually know if you invest in prevention, and we can talk about that a little more, if you invest, you actually

have evidence, good science-based, that you get good outcomes. So all the things you're talking about, fitness, healthy living, healthy eating, if you look at all the things that cause people to be sick, we know that the health care system itself and our biology only explains 20% or 30%. There's a lot of other factors going on. The environment we live in, the education, the housing we have, income inequality increasingly becomes clear as something that actually affects mortality for our population. We identified that recently. So I just think the opportunity of where you push the levers is very different between the public health approach compared to the sickness system approach. And of course, in an ideal world, those two should work together.

You don't want to leave one thing out versus the other. With the 97.3, is that an issue then of reallocating that percentage more towards prevention, or is it a change in absolute numbers? Well, that's a fair question. I think for sure we can rebalance within, because the advantage, the outcome, the value of investing and shifting within would have a greater health benefit if you did it. The other thing is we happen to know that a lot of the money we spend in our sick health care system is actually not having the outcome we want. And people have looked at this. There is a really good science base that looks at,

well, what are the opportunities costs? Well, estimated recently that $50-plus billion a year is lost every year in the United States because of lost prevention opportunities. And an additional $150 billion a year is spent on doing the wrong thing, over-treating people. We sometimes think about under-treating people, but we over-treat people in health or our sickness care as well. Can you explain what lost prevention opportunity means?

Well, it means if we know, for example, that screening for high blood pressure or providing family planning options for people has a measurable health outcome, optimal spacing between pregnancies and the latter and the like. If you don't do that to the degree you should, you're missing. It's money lost because down the line things happen that you could have otherwise prevented. Okay. So then the follow-up. This is an idea I've heard and I've been playing with before, and I would love for you to tell me this is nonsense or totally or this is sci-fi. But is there a need or is there a future for actually a separation

from the government's perspective in terms of that 97.3 where we just say, okay, look, governmentally we are now only going to cover disease treatment and management, and we will then outsource or create a separate system for disease prevention, studying of, in other words, okay, the government or physicians are now in charge of treating me when I get sick, but we are going to appoint somebody else to stop it from happening in the first place. Is that not going to happen? Do you think it should happen? What's your position? Yeah, I sort of think that sort of, we already have some version of that. So we have to talk about what the government does and what

the outside the government sector, but let's talk a little bit about, it's gotten a lot of attention lately, the Affordable Care Act, now commonly known as Obamacare. One of the most extraordinary things about this piece of legislation is not just that it did successfully provide, with problems, by the way, but provided access for, you know, 20 million people, roughly, to health insurance that they didn't have. And it didn't stop the cost of health care going out, but it flattened the rate of rise so it wasn't going out as fast. It did that with some problems for people. But the other thing it did is it introduced for the first time in national legislation an attention to prevention. They basically said prevention makes sense. They had put instructions in place across the government to say let's think about health in all policies.

So if we do something in education, let's make sure we're doing something that's going to be healthy for people. Let's make sure we have sidewalks if we're setting up streets so people can get exercise, because we're all very privileged here and get the exercise we need. But in other parts of society, we don't get to do that. So in that sense, a lot of things happened with prevention. They provided first dollar coverage for people to get preventive services. You know, a lot of people talk about the contraception mandate, which is a misnomer, but that was basically saying enormously good evidence that if you provide that service to women, you will improve their health and the health of their children. But it also provided first dollar coverage for colonoscopies and other kinds of prevention benefits and the like.

So I think a lot of strides were made in that in terms of putting a new light and a positive light on public health and prevention. But it's not to say that government can do all things. Government is just the public policy piece. Well, while you're on this topic, we've got a lovely slide that you brought us here. And it's a beautiful equation. And I know as a listener of many audio podcasts myself, I love when people talk about equations on audio. Just kidding. But yours is actually very easy to understand. So could you walk us through what the equation is and then actually give us some context of what that means? You like that equation because there's not a single number in it.

Yes, that's the best kind of math. And the students I teach love it for that very same reason. It's also I only got three words and that's the whole equation. So it's pretty easy to remember. But it's just a way of framing things. And I think in health, it's really important that we think about how we frame things. So the framework is this. Science plus politics equals policy. That's a simple equation. What does it mean? Well, we started talking about it a little bit before. Science just means evidence, okay? If we have evidence, for example, or science,

to show that if people have health insurance, they're going to do better, they're going to live longer, they're going to come to the doctor earlier, and they're going to do better in their health, even in our sickness health care system, then take politics out of it. The evidence would say the policy is you give people as much health care as you can possibly provide. So evidence-based policy in that sense.

If the problem is people who have health insurance do better than people who don't, a policy solution or multiple solutions would be trying to provide that to them. Now, obviously, in our current time, politics gets in the middle, as it always does, and people have different points of view about what to do. And they think it's right for government to intervene, or they think it's not right for government to intervene. But the Affordable Care Act was an evidence-based policy approach to the issue of insurance. Let me give you another example besides health care that we think about. This is an environmental one. Let me give you another example besides health care that we think about. This is an environmental one. Let's talk about climate change. Climate change, probably one of

the things for which there's unequivocally strong, enormous science that it's happening, that it's real, that it's very much human-related. And there's great evidence of things we can do to start to mitigate it. And obviously, we know that politics will get in the middle of maybe thwarting the evidence-based policy. So that's, it's a framework. And what it means is when you can pretty much agree about the science, even though you may have different biases about what you do with it, then you can analyze what the policy steps should be. And you can analyze, what do you mean by politics? Well, we mean by who who's doing what why and how who is the executive branch the congress interest groups you know pharmaceutical

companies insurance companies crossfit gym owners you know you name it those are the interest groups right and they're all entitled to sit at the table, and they all have different roles. Some of their motives may be economic motives. They may have the public good as a motive. They may have ideological reasons that are motivating. You just name the list of motives, and then, depending on what happens and how they align, they may either advance or block policy. You know what it's funny, listening to that equation, science plus politics equals policy, makes me think of one that's really very relevant to this entire volume as we've sort of

been discussing things. And to use your framework for a platform for the conversation that we've been having, and I realize that as I'm looking at this equation that you've put together, is evidence plus human beings equals fitness. Now, human beings being all the different people that can influence the fitness space, sometimes very intentionally dedicated to the pursuit of money and or ego, standing on top of something to make one's notoriety bigger and sell a lot of memberships or whatever it may be. Sometimes that's very well intended. The application of this evidence in science is sometimes very, as we see it, as it drives Andy nuts as an exercise physiologist, because he sees some fitness people really manipulating things that are

evidential base and going, okay, now you're really stretching it as far as like what we understand these things to be. But it's something that is really interesting as you described this massive nature of policy for us in the podcast so far, it's been about this sort of fitness industry and how those things overlap. What are the things that you're looking at when you're breaking this conversation down? What are the influences that you're navigating when a president appoints you to figure this stuff out? Well, let me first say that I think your analogous use of this equation or the framework works

perfectly well. Because really what it's trying to do is say, you know, for better or worse, we have evidence or science. And then we have people get involved in that and deal with it different ways. And in the ideal world, if the science is perfect, which it rarely is, then it's a little easier to tease out motivations. You can say, well, if the science is perfect, but someone's recommending to do something totally different, then maybe they're economically driven and not driven by the public good. So I think it helps you do it. Now, of course, when there's less certainty, and in my view, and if you look at nutrition, for example, there's a lot of uncertainty.

And there's been a lot of crazy policy. We swing from left to right. We stay low fat. And then all of a sudden, everyone starts gaining weight because they're substituting other things. So it really does matter how good the evidence is for where you're going to go. When it comes to something I've been really involved with for a long time, which is worker health and safety, again, same things apply. For some things, we have great information. We know just what might work to make things better. And for other things we don't.

When it comes to ergonomics, which is a problem. What is ergonomics? It just means you fit the world to the person rather than the person to the world. So you don't do the wrong kind of lifting. You figure out how to lift correctly. You figure out how to have the right posture when you're all day long on your computer and things like that. We have a lot of information about what can be done. But at a national level, there were some very large companies who completely supported the idea that you would try to have a regulation or government guidance about how best to reduce those injuries. And

there were others who simply didn't want to have the risk of the cost that might go along with those. And then you've got to understand what does the evidence tell you? Why might there be people blocking it? And what can you do to do with that? So it's like life. You sort of try to sit down and talk with people of different points of view and try to get a consensus. That's something we did pretty much when I was in government and we did pretty well and got industry and labor to work together a lot of the time, not perfectly. And I think that's what happens in the situation of dealing with people who come to the fitness world differently. Hopefully you get people to have the common ground. And if you can't have a common ground, you call.

You just call it what it is. I've sat in faculty meetings when you've got 30 tenured faculty trying to make a decision about what the name of a class is. And it's four hours and no one can agree. And you leave the room, everyone hates everyone and nothing at all happened how the hell does this happen when these conversations are about something really really important and you've got 300 people and state reps and and all these other people how do you make these decisions like how does actually anything at the government level ever get done well you know interesting that you should say that because i think right now we're sort of looking at government and maybe in a slightly more negative view than we sometimes do. But I have great awe for what you can get done in government.

I actually, for good or bad, by the way. So I do think we have a pact with society where government can help set up public policy. I mean, industry can do its own private policy, but government is the author of public policy. That can be recommendations. It can be guidelines. It can be laws. It can be, you know, other things, but it means that we can put a tax on cigarettes and we know that's going to reduce consumption. That works. So then you have to see if you can get enough people to go along with that process. So I guess my view is we've done really well in so many areas, and it's very easy to talk about the things we've failed at doing. I actually think we should embrace the players, the who we call in this equation,

who's doing what and why. And sometimes we find that things aren't as partisan as they look, and sometimes they are very partisan on a Democratic-Republican sort of basis. We have to understand that we have to educate the public because the public has a lot to say about what happens. I want to drill down really hard on one thing real fast. Whether it's the stuff with OSHA or the government stuff or as your dean role, it's really a similar question. But is there anything specific, any tactic you use, or any strategy you have? How do you get these people to agree that maybe you're all agreeing on the science, but their politics are different in terms of they just see the answer is different. They want to go about it differently. And how do you still walk out of that

room with some policy? Well, first of all, I mean, you don't have to get everyone to agree. I mean, that's the way we live in our democracy. So you sometimes just have to get enough people to agree. And if it's getting it through Congress, depending on whether you're using the arcane rules of whether you're going to need a simple majority or a 60-person majority, it's going to change the conversation you're going to have. So there's that. The other thing is that in general, there's enormous inertia. So you're absolutely

right. I think you're suggesting it's really hard to get things done. It's really hard to get things done because the status quo tends to prevail unless you do something to change it up. How do you manage the people though? Because whenever you put somebody in those rooms, and especially if they have, they are the ones bringing the science it was their life's work or is their job to bring this information up and they've got a real vested and by vested i don't necessarily mean financial but i mean a personal or uh they really believe in themselves interest and you effectively then they're the ones that lose the vote how do you manage that emotion how do you we're still on the team going forward as a leader how do you do that emotion? We're still on the team going forward. As a leader, how do you do that? Let me try to give you an example that I think is relevant in today's world.

I really had the privilege to chair for what was then called the Institute of Medicine. It's now called the National Academy of Medicine. It's an independent government-chartered organization that basically is supposed to bring independent expert opinions to government to help them make a decision. And I was asked, out of coming out of the Affordable Care Act, to chair a group that was called Preventive Services for Women, Filling the Gaps. And we had 16 experts on our committee, and we knew that we had to go through all the science and review all the science and say well what are the things that aren't going to be covered for first dollar coverage for

preventive services for women right and we had to work quickly because we were under a mandate to do that we had people who felt very strongly about the issues but it just turns out getting agreement on science was actually relatively easy because most of the science was pretty clear. I've given an example earlier. I'll come to it again because it got a lot of attention. If you look at the evidence that providing family planning services without a cost barrier is really good for the health of women and their children, healthier babies, a long-term life course of being healthier, women healthier pregnancies, avoids unintended pregnancies, and therefore in turn abortions, all the things that people

would all agree on. The evidence and the economic evidence for doing that is enormous. So that was one of the first things on our list. But then the policy had derived from saying that was a gap was the administration had to make a decision. Did they accept our recommendations? We had eight recommendations. And the administration decided that the expert panel had come up with the right science and accepted them all. And in fact, within two weeks, they became law. It was really quite an extraordinary effort but you at that point had the mandate an election had been won you had the ability to do it to say this is the best evidence we can provide to fill in the gaps here about what women should get now fast forward

seven years and you have a different administration and many of the same things we were recommending are being attacked and trying to be withdrawn. That's politics with a big P. Yeah. But it wasn't a problem of getting people around the table to agree about what made sense. Did you have to be strategic about when you tried to go after an agenda knowing with that inertia problem, saying like,

oh, we've got an idea, we're in consensus, but maybe we have to hold this one back because we're not at a point where we'd be willing to accept a change right now and evident in other words we can hit there's sometimes when you get hit with evidence but if you're not ready for change it's not going to matter did you hold anything back at all or a certain purpose you know the nice thing um and again i don't want to be a pollyanna about how science works because we can have fierce fights about whether we agree on the science or not. But I'm talking about things where 99% of scientists would agree about

things. Let's use that as an example. Climate change is one, family planning is another, there are other things like that. If you get agreement, then you can say that's where the science ends. That's what the evidence would show us and then we recognize that other things intervene to change whether people are going to do the right thing if i think it's the right thing or do a different thing but that's no longer the role of scientists we can advocate for what we think the evidence is but we recognize that other people come along there's congress there are state legislatures there is county you know you name whatever government domain you're working in, and people will have a different approach to what to do. But I'm a great believer in using your best science, recognizing the limitations of the science and what you know,

and then advocating for the best policy based on the science you have. And then you try to work the players to get to what you think is the right outcome. And I think those are all very good roles for scientists to play as long as they are recognizing that there are limitations to what they can do. Is there any one example you can think of where your opinion on something changed because new evidence was presented? Oh, gosh, yes. Fantastic. All the time.

Give me 10. I can't give you 10 because I'm so young. I always have it right. No. I've only been wrong twice ever, and I'll tell you both. I think I gave the example of nutrition. I mean, I think we've all accepted national guidelines until we realized, oh, my God, we had no idea what we were recommending. And I would argue right now, even as we're looking at the issue about the total calorie versus the kind of calorie issue, I think we know so much less than

we pretend to know. I think there's a lot of unknown about there. So I think the best advice I would give to an individual or to a group would be, we know people very differently with what calorie restriction they do best with and don't try to be dogmatic, telling everybody that it's low carb or everyone at something else and try to figure out what's going to work best for the individual group people you have. Boy, that sounds familiar. Yeah. We, you know, it's funny as you're talking. And again, for those of you listening, Brian McKenzie's in the room with us, coauthor with Dr. Andy Gallop. And, and I can't help but to think between the three of us, you've got a scientist, Brian is at this point, like one of the highest level, let's just

call him a tinkerer. So he is one that he tinkles a lot. He can not take help, but to challenge everything from modalities of coaching to presumptions of science and is constantly challenging, thinking, tweaking, and playing with these things. And then myself, I identify more as a coach, applying some of the stuff that Brian is going to take care of, some of the evidence and science that Andy's going to produce. And I go, okay, well, I've got 250 people here that I'm going to try to like apply some of these principles to the best that I can. And I can't help but to notice that there is not only in policy of like what is healthy, but then also the real application. So we opened the show with this 97.3 thing, which identifies, look, there is basically 3 trillion bucks going to sickness. And 3% of that is going to some considerations of prevention. Meanwhile, there's a whole sub-industry with people that are pushing scientific boundaries, Brian being one of these

people who historically will just flip an opinion on its head. That trickles down, gets to me and some other coaches, and we try to apply some of that the best we can. But that, Linda, is a small chunk of the population. And what I sense sense being a business owner in the fitness space, is that there's a growing gap, like my population cares, and they care intensely about their health and well being. That being said, we've got the greatest degree of sickness that modern society has seen. So there's this, to me, what it feels like is a growing gap. And I'm wondering, is there like research right now being done on the sort of effectiveness of coordinating care between people like ourselves, health and fitness coaches, and primary care doctors and the patient

like that, that's to me where the principal gap is starting to really present itself because I'll talk to some clients and they'll say, I went to see my GP and this is what they recommended. And I'll sit there and I will always say, I am not a doctor, but I'm having a hard time being 30 years into this going, I can't agree. And it's hard as a business owner, as a coach to go, look, I didn't go through medical school. I can't stand on the platform that the doctor, but I also know that the doctor's under a different set of pressures than I am. I actually think you were honest thing that I think it's worth our talking about a little bit, which is, in my view, would be the multidisciplinary roles that people have in teaching the respect for people who come from different disciplines. Because I do think what you've just described between the physician mentality, and we can talk a little bit about the stereotypical persona, and someone who comes outside the discipline, and you may find a real

disconnect. And I think it's worth talking about how do individuals navigate that gap? How does society navigate that gap? Yeah. I mean, I feel like we're addressing this really, really well. If we look at the principal biomarkers of our general population, and Brian can dive in on this as well, people are generally well under our stewardship. I'm not going to say take my recommendation, but I can look at somebody's blood panel and go, you know what, we might want to tweak one or two things. Go and retest this in three months. And by and large, we're going to see an improvement in that biomarker. And that's just by exposure to not just the technology, but the information that I have access to right now.

And my own personal, you know, curiosity about that, but also study of that because I'm seeing success. I'm seeing general success. I see a lot of bullshit with myself. Sorry. Like I'll be culpable for that. Like I sell a bunch of nonsense. You know, and I'm trying to do less of that, and part of that process is this show. And I'm trying to get to a practice of saying to people, look, you come to me. I'm going to do my damn best with the information that I got. I'm not going to be right. This thing is going to get flipped on its head.

But based on where you're at and what I know, we can move this thing in a good direction. And there's enough consistency with that where we can just see that repeatedly. And it's anecdotal, but it is consistent. Well, I think what you're talking about, Kenny, there are two pieces to that that I think are relevant for me. One is that for everything we're talking about, we need feedback loops. You know, we can say in an ideal world, the science is great and this is the right policy. But the whole key to the public policy process is you go back and test it and say, well, did your policy make a difference? Did it work?

And we're often talking about groups of people. You know, if you put the cigarette tax into people, smoke less. If you do X, Y, or Z, is the world better? I think in the medical health care world, we have an issue with the second piece, which is we have a tradition, and I'm guilty of that as well, where physicians feel that they're often at the top of the hierarchy. They are stereotypically not good listeners to people who come from different points of view or different disciplines or different worldviews. And I think we're getting better, but we need to educate all of our providers, physicians, non-physicians, and others. And we need to understand that people do bring different things to the table. And so a physician may say, as happened, as you know, in the case of my husband who had a bad outcome from a surgery that you'll

never play tennis again. And you said nonsense. And luckily you were right and the physician was wrong. And we need to have, there needs to be a comfortable place where there can be different points of view where you're not doing harm, but you're trying different things. It turns out you're right because you can go back and prove it and test it. And you're going to have that example other times.

So I think we need to have better respect for these things. And incidentally, that was very experimental on my part. I went with some theoretical principles, but we happened to do well. I'm fascinated by this whole thing. And it's like the quietest I've been in, I don't know, a week and a half. That said, you know,

it's taken me like 17 years or so to get to a point to where I'm actually, where people can, and I'll flip this on its head in a second, where PhDs or MDs actually take me seriously because of the work that I'm doing. That said, why did that even matter in the first place? Okay. But with your job and what we've been talking about and what you've been responsible for, it's like, okay, we've been wrong at times and we've done this stuff. So when evidence and things like this happens at that level,

this is where I think the frustration in our world exists. And it's not towards you or the policy, you know, it becomes the government has a problem. And the problem is, is that the evidence is showing differently and we're not getting the doctors and the people who are actually creating this layer that is saying, no, your husband's not going to play tennis.

And Kenny's going, oh, yeah, you are. You're going to. And I've said the same thing hundreds if not thousands of times as well. And it's how are we not figuring out a layer or a way to go, you know what? We got to change this now because people are eating incorrectly or people are doing something incorrectly and we're giving these people too much power and them thinking that they have too much power. They understand medicine. They don't understand anything outside really that medicine. I think my question is, is what's the, what's the process for

when, Hey, Oh crap. Like we made a mistake here and we've been looking at this incorrectly. Or, you know what, there's new evidence here and we've got to get this out, you know. Well, I think it's exactly what we need. And I do think it comes from a basic ability to sort of look and recognize what people do and don't know. You're absolutely right about physician training. It largely deals with the sickness system of health care and doesn't deal with these other issues. I've always been a believer, and certainly in workplace health and safety, it was necessary. You couldn't, as a physician, even if you were really smart, figure it out if you didn't have an industrial hygienist

who knew what went on in the workplace and what the measurements were and what the exposures were and if you didn't have a social worker or a nurse or an employee advocate. And you needed a whole different team to go in and make a difference and we need to think more about teams and it is a little bit about respect i i have less question about the government because i think a lot of times the government's just you know it's a big big word it's not really the government it's just people not listening to each other. And I just want to reiterate, and I'm not harping on MDs or PhDs, that I mean, I'm alive and probably sitting here because of Western medicine and the way it's operated.

And that's been a hard lesson for me, actually, my career because of being, doing what I do and thinking, oh, these guys have the problem or these, you know, these ladies have the problem. Like they're, they're telling people the wrong, no, that's not it at all. It's I'm, I'm just trying to kind of say, Hey, we need filters here and, and we need the egos to be in check and including mine, including, you know, ours. And, and, but from what I'm hearing, it's like, there's just, we're, we're sitting in the private sector basically to a large degree to where it's like, Hey, we've got this whole thing, this group of people who really don't need these things like healthcare. Like I don't need healthcare provided by the government. I don't.

And I'm not probably ever going to need it. And as long as I can afford to take care of myself, I'm going to stay active. I'm going to do the things that i understand to be healthy right so that fits into kind of that layer of the private sector where then we've got the people who can't or don't or want the help or need the help because they're just not going to do it or they don't have the means of doing it well you're sort of opening a big question just for the sake of people listening we We talked a little bit about this big bill, and we do pay more money than most of our comparable countries of our size and level of development and don't get as good outcomes. But about half of the health care bill is paid by the government. It's not the government doing it. You know, Congress hates to admit that they

have government-run health care. I mean, that's how they stay healthy or not. But so my point of view is more that if I think about the government, it's a little bit like how we talk about framing things. So if I come as a public health person, a phrase that we would use is we believe in the savvy state. Well, what's a savvy state mean? It means that we believe in certain conditions, certainly when it comes to promoting public health, that the government, local, state, federal, has a role to play to set policy to keep our air clean and water good and other things.

And we all value and we all benefit from that. So the savvy state is government when done right, protects all of us. The same people could take those issues, and they call it the nanny state. You know, they come along and say, same exact set of policies, same exact government dimension, but hey, we don't want government. Of course, if you took away their clean air, their clean water, their ability to other things, they might feel differently. But that's just a framing issue of the same thing. And I think what you were suggesting, Brian, which I absolutely agree with, is to get out of the, I know better than you do, and I can't be wrong. And the lovely thing to me about science, which I'm a great believer in, is in its truest form, it should be something for

which there's always addition, new information, ability to recognize you're wrong, ability to talk about how it's changed. And I've tried to use extreme examples where the science is really settled, because then you kind of see an easier situation to talk about politics. But in fact, we know a lot of the times it's completely unsettled, and that we have to recognize that as well. There's probably far more cases of the latter than the former. Exactly. I really believe the better we educate the public about issues, the better we'll all be. And unfortunately, the public is often not as well educated as we'd like. I mean, one of my favorite examples, because it's very topical right now, we talked about framing. You know that the Affordable Care

Act got in place in 2010. It did many good things. I'm a great critic of things that need to be improved, cost too much money for a lot of people who got priced out of the market and the like from really getting care, but certainly broadened health insurance. But, you know, that Affordable Care Act, by the opposition of people who didn't want it, didn't believe in government involvement, started to be called Obamacare. We know that. We know that President Obama eventually said, let me disarm this argument. I kind of like Obamacare.

It's a nice name. So I'll call it Obamacare, too. So we have identical things, just the same thing called by different names, Obamacare versus the Affordable Care Act. Well, in February of 2017, we have a new administration and certainly had come in with a lot of people opposing the Affordable Care Act. And what do we know? That if you call it Obamacare, 47% of the public is downright dead against it. And if you call it the Affordable Care Act, same exact thing. Only 39% of the public is downright against it. So we know just by what you name it, giving it a different name causes opinion.

So it's really important that people at least have a level playing field of information. Five by five or five, three, one. Yeah. Okay. Same exact thing. Different name. yeah okay same exact thing different name um if we gave you unlimited budget unlimited power but we said you get to make one one policy change one rule one law you get to take one law away whatever it happened to be what would be the first thing most impactful change you would make you

know i think we've slowly but surely we're getting better. Major social legislation came in, Medicare, it really did provide a health safety net for seniors. It's not ideal, but it's really done a pretty good job. We had drug coverage that came along. So that's under Democrat and Republican administrations. And then we have the Affordable Care Act. So I guess if I could wave my wand, I would try to get rid of the silliness of just getting rid of it because it's called Obamacare and we need to make changes, but taking it away and going back to where we were, I think will be a huge disservice to people. It's costing, you know, healthcare costs are going up, but they're never been going up as this lower rate as they are now going up. So it's already done that. It wasn't even designed to do that. So there are lots of things we can do. So to me, the most important thing is we have extraordinary evidence that providing people access to good insurance with

good preventive services proves on a population level to be good for the nation's health. And I'd love to see us continue on that course. You've been a part of two presidential administrations, right? Now, the current knock, Brian, you sort of alluded to this too, about whenever we take coaches and people from our network and we start talking about public policy, the immediate thing is to think, well, it's all being controlled by big pharma, by big industry, et cetera. What do those conversations behind public policy really look like? In other words, how much influence do those things really have? Are they even a part of the conversation? Are they a huge part of the conversation? Fill us in on what's really going on.

Well, again, this is where we all have our biases. So we all can bring different points of view to the table. There's no question that if you compare our health care system to others, that some sectors of our health care system have disproportionate influence in what's happening. It's not always intuitive what way. Right now, the insurance companies have done extremely well under the Affordable Care Act. They've had 20 more million people with insurance, and largely they were covering them, not all of them. So that worked out pretty well for them. So they're now not aligned against the Affordable Care Act. So you can't always predict where it's going to go. But yes, there is influence in that. I like to think of health

as a public good. I think of it the same way I think of education. I think there are certain things we as a society should do because it's not just good for the people we're serving, but it's good for all of us. So to the degree we could have more evidence-based health policy than we now do, I'd welcome that. But as I said, I think we've made great progress. So I don't want to throw out the baby or the bathwater. I'm going to carry on with that point. And to be clear, you were appointed by President Obama to serve on an advisory group on prevention, health promotion, and integrative public health. So what were some of the principal components of that recommendation group? So that group, which is a presidential commission, was formed out of the Affordable Care Act. It

really came from this new emphasis on public health and prevention. And one of our main roles was basically to advise the government on what's called the National Prevention Strategy. The National Prevention Strategy hasn't gotten a lot of attention. Other things have, but it basically said, let's work across the government, recognizing that virtually every sector affects health. It's not just health per se. And within the health system, we have things. And so the environment affects people's health. Housing affects people's health. Level of education affects people's health. We know that that's something we always call the multiple determinants of health. It's not just about health care. Right. Nutrition and exercise

are just a portion of health. Exactly. Yeah, right. And so that's that. And then within that, part of the National Prevention Strategy identified, well, what are the things that have been done that have been most successful for improving health? This is a very evidence-based exercise. And they came up with seven items that if we could continue working on those, we would continue to improve health. Tobacco-free living. Tobacco has been one of the biggest scourges for health ever. We've done better, but we need to continue to do better. Now we have new forms of tobacco problems.

Drug abuse and excessive alcohol use, enormous problem. Look at the opiate epidemic. So that's just another issue. But things in your wheelhouse, healthy eating was number three. Active living was number four. A recognition that even though we don't have all the details, we know that living well and having a health and wellness approach to life actually is a payoff. And then the others included reproduction and sexual health, which I've talked about, injury and violence-free living. Because right now we're sort of neck and neck between gun violence and opiate deaths are really up there as remarkable killers of particularly our young. And finally, mental and emotional well-being were priorities. Priorities because they were problems that were

causing big issues for a large segment of the population and for which we had strategies that we knew if we started to implement them, we could do better. That's sort of an example of what we as an advisory group had influence on in trying to support and disseminate and work with cabinet ministers from across the government, as well as our own experts and working with community leaders to try to identify and come up with ways to deal with these issues. It's funny how on this level, things get simplified into very basic ideas. Each one of those seven things is not horribly sophisticated to understand, yet the work to get to that point where you can agree on seven things that you're going to advise and

implement strategies. Is there currently antagonism with those seven recommendations? I don't think so. Again, within the public health expert community, there'd be general agreement because this comes from a pretty evidence-based analysis. How you deal with it, of course, there are differences of opinion. So the Surgeon General who was just terminated by President Trump came from our group. He was one of our members as an expert in public health. He's a physician. And he really, as do I, believes that gun violence is a public health

problem and that you have public health measures you could use to decrease that. So we might all agree that gun violence is a big problem. It would be silly not to agree to that. What steps you do and the role of the government to do that would be people have different opinions about. Can we talk a little bit about the classic, it's like a philosophical dilemma, but it gets implemented in reality a lot of ways. The freedom versus equality problem where the old thought experiment is if you were going to be born into a society, would you want it to be mostly free or mostly equal? Because those are two different odds with each other. And so when you think about something like tobacco use being bad for people, well, people using tobacco is very good for tobacco companies and people who

profit from that, just as people using opioids and paying for them is very good for pharmaceutical companies. So there's this sort of dance between how much freedom and personal choice and room do we have versus responsibility for preventing suffering and maximizing health and minimizing risk. risk and i just curious what your thoughts are in terms of balancing kind of the market forces versus the policy governmental forces to minimize certain things or to try to improve it is you know it certainly is a balance and then i'll go back to that phrase you know it's part of that perspective is do you believe in a savvy state where you make wise choices that you get general societal agreement on. For example, people who ride motorcycles or ride bicycles, helmets are protective against injury, severe damage to the brain and the like. And when that happens, you may say, well, that's an individual freedom of choice, but we all pay for the people who get sick. It's not like society doesn't pay. So if you look net, there's a net cost to not putting in the steps that we know work. So in that sense, I think most of us from a public health perspective would say that's a very

wise public health strategy. It's a minimal infringement on freedom to say you wear your bicycle helmet and you're going to do better off if you have an accident. And of course, we know areas where there may be less agreement. But I think you have to think about the cost to whom and the profit to whom. And for every upside for an industry, if there's a large societal cost, then we're all paying for it. Uninsurance isn't a victimless crime. If someone doesn't have insurance and they come late to the game and are sicker and die more readily than someone who has insurance, we still all pick up the bill when that person shows up in the emergency room. So then you can say, well, I can argue from my perspective, doing steps to assure as much coverage as possible is not only justice or a

social goodness, but it's also an economic benefit to all of us to do that. I mean, this is a tough one because we've got this, we've kind of constructed this society and this culture around freedom, and it's often a card played to personally benefit a lot of people. So with the contraception example, what's the argument made against the contraception mandate? It's religious freedom, in air quotes, because people are claiming that you're infringing upon their freedom to express their religious views. But if you really look at that, you're infringing upon their freedom to restrict their employees' access to something that goes against their beliefs.

So this argument of my personal freedom gets used a lot. I mean, we all agreed a long time ago that it's not okay to exercise your personal freedom and steal from people and kill them. Right. But, you know, it's a continuum of where do you draw that line of personal freedom to infringe upon other people's rights or actions or behaviors. And I love this from, this is a Noam Chomsky thing from one of his documentaries. He makes the point about economic theory that all of economic theory is built on the rational consumer model, which is consumers make informed, rational choices about everything. But the entire

advertising industry is based on people making uninformed, irrational choices, right? Like if advertising were informed and rational, you wouldn't have trucks flying off of cliffs and blowing up to sell Fords. So like this, this savvy state rational consumer thing, like I rationally and in a savvy state of mind can agree to that. But the evidence of behavior as it pertains to influence of advertising and marketing is overwhelmingly in the direction of non savvy and non rational in a lot of areas. And you look at the fitness industry and the health and preventative wellness industry in general, and I would argue that it is way dominated by irrational, uninformed choices. The majority of fitness and gyms and physicality is not CrossFit and functional wellness and Brian and Kenny tinkering with people. It's people

paying for gym memberships that they never use yeah agreed so i well there's there's there's something there too josh i mean that was really well said and i think everybody in the room just went well that was well said but to take that a little bit further and linda you just brought this up there's the idea of the commons so when personal freedom goes into an expense that we currently don't recognize in our economic system, like Linda points out, well, okay, somebody's picking up the tab. But then beyond that, it drains other sort of resources as well. Yeah. And I think the thing that I'm touching on humanity, the thing that I'm touching on is this, this argument of

freedom gets used when people get restricted or people are prevented from hurting other people for personal gain so you know if you if you stop me from selling you cigarettes i'm going to say you're infringing on my freedom to sell cigarettes but really what you're doing is preventing a global or communal cost to lots of people for an action that benefits fewer people. And there's a really broad continuum of this freedom of this personal freedom versus the commons. And that conversation is not framed very well, usually politically, because all you hear is the rhetoric of personal freedom or nanny state or these things

that that are often kind of perverted when it and then and then you can't use the phraseology of communal or communist or things like that because of the entire mccarthy era of like oh if you're considered a communist or you use the word or the current era or the current i mean it's but that's that's again momentum from a cold war that was waged against an ideal of communism so we latch on to these terms and these these these things that we we turn into dogma that is personal freedom is now it's now our silver bullet for oh i get to do whatever i want so i you know josh i think you're absolutely right and it's partly the american mentality a little bit of this frontier and the freedom and it can be uh it can be understood but it can also be misused and it's

misused uh there was a i see davis some of you remember was a great entertainer and a human rights activist you know he came up with something like, you know, I understand your right to be you, but it shouldn't take away from my right to be me. And I think that sense of balance, which is what was going on with the contraception issue and the Religious Freedom Act was, and I didn't agree with the way the courts ultimately decided that, it was a very split and politicized court,

but the idea was that in allowing that opinion to hold, where besides the silliness to some of us that a corporation could actually have religious beliefs, which some of us find laughable, because it's just, it's a entity that doesn't exist to make money. I mean, that's all it is, is what a corporation is. But that aside, the idea was that that was literally trumping the employees. So a few were able to determine the choice of others. So it depends who's eyeing freedom. You know, I do think we have to look at the United States. And I always like to do international comparisons because I think you can learn from them.

We do some things better and some things worse. You know, there are only two countries on the planet that allow direct-to-consumer advertising about pharmaceuticals. So we all take, for example, I mean, those horrible ads on TV where they say, take this medicine, it's going to make you feel great,

but it may kill you, you'll die, you'll have allergies and all this stuff. You know, that's the thing they put in as the disclaimer. 700 more side effects than cause. So there are only two countries that have done it,

New Zealand and the United States. It is a marketing strategy that basically, I believe, miseducates the public to then go demand things that are often not appropriate for them. And it's a very hard system to break. That's a governmental decision. Most developed countries would never allow that. That's really interesting. And to a point that we had made earlier in the show, which was the fitness space operates really well in that environment. That is to say, hey, look, there's this thing wrong with you. We're going to make you feel kind of crappy for a second, but I'm your savior. Come on down. Give me some cash.

Let's do this thing. Oh, wait, you didn't turn up? No problem. My pocketbook's still getting fatter. Plus, I've got a methodology and a large fan base to kind of stack up some credibility on. The cynicism in my head is blowing up right now. When you say that, I'm sure I'm wrong here, so I'm going to try to calm down for a second. But the two countries allow direct-to-consumer pharmaceutical advertisement. That only strikes me as something horribly, horribly bad. but the two countries allow direct-to-consumer pharmaceutical advertisement. That only strikes me as something horribly, horribly bad. Like, I can't see a positive outcome there.

So, one, am I wrong? Is there something beneficial about that? And if I'm right, why is that not? That, to me, sounds like, number one, like, bing, bing, bing, lobbyism, money. The only reason this is around is because someone's paying pocketbooks. Like, please tell me I'm wrong here and there's something I'm missing. Well, I'd love to tell you you're wrong, but you just asked a question a little while ago andy and the question was does the pharmaceutical industry what's the

role and unfortunately i think they have a disproportionate role for their economic well-being relative to the public health's well-being how do you not get this removed from public office well you can start to map where the pharmaceutical industries are and where your elected officials are and guess what what? This crosses both Democrat and Republican boundaries. So you get a bipartisan support for a very significant lobbying. All right. So, Linda, in addition to having two presidential appointments and continuing to work to understand preventative health practices, not just domestically, but internationally, you got started studying psychology back at Brandeis. Yeah. Yeah. And then you carried on to Johns Hopkins and graduated from the School of Medicine there with an MPH and then...

Which is a master's in public health. And an MD, correct? Right. Yeah. So you started off in psychology and then went to public health and MD. But walk me through that transition. Where did your interest go? Why did you decide to go to public health and why was it medical school?

Well, the first thing I'll do, and I try to be honest when I talk to others about this, is serendipity played an enormous role. I'm not a planner. I barely plan a year ahead. I certainly am not a five- or ten-year plan person. Good thing somebody who's been appointed by two presidents to run government things is not a planner. Isn't that great?

Fantastic. Yeah, you've got to be flexible. I like it. So the first thing to know, which is truth-telling, which I'm a great believer in, is that when I was a senior in college, I applied for seven jobs as a teacher in elementary school and got rejected from each one. Stop it. And that's absolutely true. Now, there was a teacher, but it wasn't that I was incompetent. That's equivalent of Michael Jordan not making his high school basketball team.

Are you kidding me? No, so this is a true story. Linda, not good enough to be an elementary school teacher, but how about being an MD at Johns Hopkins? So that, you know, I was in a certain era where it was less common for women to be thinking about these, what was then traditionally male jobs. So that's just the reality of the 1970s. So I just ended up by chance working on doing, not completely by chance, but largely by chance, doing pre-medical work and coming back to the U.S. from Canada where I was one of only two people in our class of 120 who actually got a combined degree in public health and medicine because I understood. So you did those at the same time? Yeah. Oh.

So I understood, though, that these were different pieces of the pie. You know, we talked a little bit earlier about the separateness. I always like to talk about the linkages between public health and medicine. They really shouldn't be pulled apart because we're individuals in a public health system. We're the ones who benefit from public health actions and regulations and systems like that. At the same time, we're individuals in the healthcare system. And the idea is to get the balance right and the proportion right of our effort, but not to try to tear them apart. And I think I've always professionally really lived at the interface between clinical medicine and public health,

and I think it's a sweet spot that I really value. That's something that seems to embody your life work, right? Because knowing as a former teacher, there's a soft side to every teacher that I know their heart. That's one of the reasons why I continue to coach because one of my first jobs out of college was being a teacher. And there's something about that, that the intent is to help others. Is that more than anything, more than the accolades, more than having a president appoint you to a position? Is that the thing that fundamentally drives you?

So I think what really has fundamentally driven me, for right or wrong, in terms of whether I got it right or wrong, was this idea that you make the world a better place. I think it's a core value that you're going to live it better than it is and try to create the public good. And public health does it differently than medicine. I got great rewards personally. There was nothing that was more fulfilling to me than the 20 years I spent in active patient care.

What you take away as a physician taking care of other people is so much more than I think you give. On the other hand, you can feel the impact in much larger numbers when you're dealing in public health because you know you're affecting more than the few individuals you can touch. And is that why you decided to go from private to public policy? I actually always think of policy as, you know, again, linkages. I don't feel I went from one to the other. I think I just was working in that domain. So when I started out in the university where I was doing clinical

medicine with largely frail older seniors, but I also developed a specialty in worker health and safety. I was dealing with very young, often healthy people who got injured on the job or sick on the job. It was in that domain of dealing with those folks that I realized, you know, doctors have a way of thinking about things if you see a problem. And I think in fitness the same thing happens. You start with awareness of the problem. You then diagnose it and say, okay, I think that's what it is. And then you treat it.

And then if you're really good at what you do, you put in this feedback loop we were talking about. You go back and you do the notification follow through. So if you're in a worker health you do, you put in this feedback loop we were talking about. You go back and you do the notification follow-through. So if you're in a worker health and safety or a public health person, you say, okay, I'm aware, I diagnose, I treat, but now let me see what happened. And when it came to workers, I meant you better go to the workplace because if one person's sick from asbestos-related lung disease, there are going to be others who are there as well, and the responsibility was to go back and try to take care of the environment for other people not just the individual you saw so that's a nice feedback loop and i think that's what we should do every time we put policy in place and try to see if we're actually making the problem better that we're trying to address linda that's interesting

that you uh spent 20 years working with people. I know that that's one of the reasons why I continue to do what I do. Was there a point as you transitioned into public health and more the political nature of influencing that where that feedback loop wasn't fed in the same way? And did that ever at any point start to wear you down or get to you? Well, you know, I think if I had been left to my own devices, I would have kept doing clinical medicine throughout, but I frankly got to a point where I was moving from one place where I had a large patient panel in Seattle, Washington, where I was working. Go UW.

Absolutely. And then I moved to Washington, D.C. with this responsibility for a large federal agency. And, you know, we had 1,500 employees. We were in six cities. I just simply couldn't do that job and keep up clinical work or start a new clinical enterprise. So I gave it up reluctantly because I was doing something else that question, I miss it. It would be too hard for me to go back and retrain it to the level I want to do it, but I do think it was something that, again, was very rewarding, but also let me ask better questions about what was going on in people's lives by having that kind of intimate contact. What did it take for you to make that decision to make that change? Well, it was basically being given the opportunity through the Clinton administration to take a job where I thought I could really make a bigger difference, which was running the National Institute for Occupational Safety and Health. I'm curious about your personal

sort of value system as it pertains to, because you mentioned that you don't plan very much into the future. You kind of react and you do things. So what are some of your, your values and decision-making criteria that go into those things? Because I think a lot of people are motivated by specialization and creating value and being well-paid for things. There's a tendency to, I'm going to become the best at this one tiny thing, and then I'm going to be paid well for it. So what, what kind of went into you having a broader experience set and, and believing more in integration and balance and things like that? You know, if I, if I look back now, cause that's what we're asking to do, I would say I'm basically a generalist at heart. I always have been. I really like

looking at broadly at things. I do occasionally take the deeper dive. But when I practiced medicine, I was a primary care or general internal medicine physician. When I did public health, yes, I worked on worker health and safety, but that's very broad. And now I do public health across the board. So I've not been someone who tended to specialize as much as others. And I think maybe because I'm not a planner, I don't know that I react, but I love new opportunities and new challenges and learning new things. And by keeping being a generalist, you're sort of

forced to kind of keep digesting newer, different kind of material. To tie up what you just said, it sounds like having a broad general approach and broad interests paired with opportunism and not being intimidated by or generally seeking opportunities is what has led to a lot of your success and having such broad impact and things. So if like our listeners are trying to figure out their own, their own path or their own, their own thing, it seems like generalism and opportunity are two things that have brought you to where you are. I think that's, that's a fair summary. And I, and the reason I shared the somewhat embarrassing story of not getting a single teaching job for

second grade is that I also think for all of us, and I have young kids as well who are just starting out in their career paths, and I think millennials know this instinctively, the idea that you're going to be stuck where you start is no longer the terrible idea, and the idea of being open to change and different things is something we should all embrace, and it's, I think, going to a fact of of work for the next few decades anyway yeah so a couple things that really resonate with our values for the show and josh was just asking about sort of your value system things that drive us are this concept of improving the quality of life for people so largely the intent of sharing this stuff

is intended for those that can help others because we kind of believe that there's a small army that's brewing that has the capacity to help the health and wellness of the people that they're in charge of. So we believe that there's a lot of listeners out there that are well-intended, well-informed generalists who are trying to, like you say,

absorb a lot of information in the scope of helping others. One layer deeper, and this is something that is going to hopefully link up and tie up something that we were talking about earlier in the show is we also believe in this idea of human connection because we're seeing a lot of practices that inherently disconnect people from either leaders, teachers, or educators, or Sherpas, let's just say, and shrink this down to the health and wellness space. And we feel that those groups are the ones that can help the pathologies and sicknesses that we've identified and that you have on a very massive scale tried to help with. Now, as you look at the broad scope of what has become a large, very scaled body of work, how do you see the have been and have been currently influence and work with. There's people like Brian McKenzie, Andy Galpin and myself, our producer, Josh, who are,

you know, helping to get information out there. But how do you see this gap getting closed with what we've identified, meaning like some of the general GPs are having some gap with being able to communicate information that helps people live healthy. There's people in the space that can do that. And then there's large gaps where health insurance and a lot of other influences are starting to sort of make this all get very disparate very quickly. So what do you see being some of the key elements to sort of close this thing? How do you, how do we start to become increasingly more healthy versus increasingly more sick? Well, complex question. I know. And in some sense, I think we can go back even to what I think were the better definitions of health. I mean, the World Health Organization in the 50s started talking about

what is health, and they started saying, well, it's physical and mental and social well-being and not just the absence of disease. So this broader concept that health is more than just the sickness system we've been talking about. And for me, as we've chatted, it's not just separating off the public health or the active living, healthy eating piece from the sickness. It's sort of the more holistic view of the integration of those aspects. And I think the biggest challenge is the education for ourselves as professionals and for others to recognize the value of team building because what happens is we do often operate in our distinct disciplines.

So the physician thinks he or she knows all about all aspects of health when that's just simply not true, doesn't have the same experience, doesn't have the same training, and needs to then seek out others to come in and help. And I think that involves a sort of change of mindset. I think it's happened to some degree. It's happened with calling in physical medicine or rehabilitation medicine. That's the beginning of recognition that your specialty training may not take you far enough. But that's just the beginning, because we know beyond those disciplines come other folks who have a lot to contribute. So I just applaud what you're doing. And as long as you do it with the best-based evidence, with the

best interests of your clients at heart, I think that's going to be part of the solution. It's funny that you say that, given your experience. Again, this is a huge piece that we've been talking about a lot throughout this first volume. That ability, I mean, you brought up the word teamwork and human connection is an essential piece of that. And I think, again, just to repeat what we've already repeated innumerable times is that this stuff gets very spread out very quickly and it takes people away from each other rather than bringing people together. So if you're a practitioner, a Sherpa, I mean, the idea here is go out and help people. If you're somebody that is in need of

greater health, maybe finding a Sherpa teacher, a tribe to belong to can be things that are helpful. That's certainly my invested and very convenient takeaway from this conversation. Most of us at this point are aware smoking is bad for us, right? We all know we need to exercise and eat better. And these are public health crises for sure. But there's something that most of us acknowledge. Now, we have a lot of differences of opinion in terms of the politics of how we put a policy together. We've covered a lot of that.

But my last question really is, is there any other thing that you see that is a potential cause or something we should be concerned of public health-wise that we're not paying attention to? Maybe that's technology. Maybe that's something else.

Anything jumping out in your mind like, hey, we should be paying attention to this? So I think the thing that you had asked earlier about what didn't I know, and there are lots of things I've learned. One of the things as a teacher of public health is we always talked about these things about other sectors, education and economics, socioeconomic status, all affecting health. But traditionally, we always said it was just poverty wasn't good for health, and you can understand why that would be. But now what we're learning with new evidence is living in societies with income inequality,

whether you're at the top of the income ladder or the bottom. It's always worse when you're at the bottom, but living in societies with income inequality is bad for everyone. And, in fact, people at the top of the ladder in unequal societies don't do as well as people in the top of the ladder in more equal societies. So the public health lesson is we're all better off in more cohesive societies where there's, and we don't know exactly why that is. It may be some sense of justice or fairness. It may be that we disinvest in other societal systems that improve health. But I think in the United States, we should be very worried that for the first time

now we're seeing loss in longevity gains for certain segments of the population, including largely rural, middle class whites in the United States. There's something going on there, and we don't know exactly what it is, and it's big. It's the health risk of abundance in the face of inequality. Exactly. It's in the face of inequality that is an issue. It's one we're starting to tease out. People were calling these despair deaths. This is part of the opiate crisis, but it's not merely that.

There is more going on, and when that happens, as we've looked at other societies, it tends to be a harbinger of other things not going on in society. So that should be something that concerns us all, and I believe that we're now accumulating enough evidence to suggest that policies that mitigate income inequality will actually improve everyone's health. So on behalf of Andy and Josh, we'd like to thank Brian McKenzie for stopping in. You can easily find him on the socials at I Am Unscared. Also Brian McKenzie on Twitter. He, along with Dr. Galpin, have written a book. It's called Unplugged, and you are going to be able to order it on Amazon this summer. It can be a rather, I would say, pretty influential book.

I'm hoping it is, at least, as it challenges technology, as it influences our exercise habits. So I'm certainly looking forward to getting an advanced copy and I highly recommend everybody take a look at that book. Additionally, you can find us on Instagram at The Body of Knowledge. You can also go to our website, thebodyofknowledge.com, where you're going to be finding more information this summer as it relates to many of our guests. As a reminder, this is the last chapter of volume one, but we're releasing an epilogue next week where we're going to reflect a little bit on where we've been, but we're also going to reveal where we might be taking this thing. I think I can speak for the rest of you here on the team that this first volume has been a

tremendous amount of fun. We've had a great time doing it. And I'm really excited next week to sit back and reflect on what we did. But for now, we have some ask for you, for you listeners. If you found some joy or some value

from any of the things, it would be very, very helpful for us for you to do a couple of things. Number one, provide us with feedback, whether you want to email Josh at info at the body of knowledge, go to our website, reviews you all if you've listened to podcasts, you know how important it is for us as hosts to have likes and reviews on iTunes. So if you could leave a short note, that'd be very helpful. If you've enjoyed anything along the way of volume 1, please, please reach out to us.

And more importantly, if we've actually inspired you to make some change, we desperately, I want to hear that story. Just really bad. It makes Kenny and I cry. It's, we drink wine and tea. But no, seriously, like we really do. That's what makes it worth it, all this.

So please, if you found some change at all here, please let us know. Listen, more than anything, we're trying to expand this conversation rather than shrink it down so much so that it's a battle of who's most right. I believe that we've been kind of sharing that viewpoint and hopefully that's hitting some of you with some resonance. The basic idea is that this conversation is intended to grow all of us to the point where we understand that we're in a habitat that changes quite often and we can grow with that or not. So as always, ride your woolly mammoths and keep your shimmies shined. love you guys so does andy galpin

and so does josh emory and we are the body of knowledge peace looks like you enjoyed the show make sure to go over to itunes go to shrug collective give us a five-star review positive comment only and make sure to go over to thrivemarket.com body to order your groceries this week