Sawbones: A Marital Tour of Misguided Medicine - Sawbones: John Green and Good.Store

Episode Date: October 29, 2024

Dr. Sydnee and Justin are joined by John Green to talk about the still-prevalent disease of tuberculosis and how his company Good.Store is using coffee and tea to eradicate it in one African country.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. Alright, this one is about some books. One, two, one, two, three, four.

Two, three, we came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert.

We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert.

We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. We came across a farm in the middle of the desert. Hello everybody and welcome to Saw Bones, a marital tour of Misguided Medicine. I'm your co-host Justin McElroy. What's that? No Sydney? Well, she's just not here for the intro. She's in the actual episode.

She just didn't do this part. We got a really exciting episode for you. We got John Green as our interview guest. He's going to be talking to us about this massive TB initiative he has going right now, and how you, by buying the products that you love, can help get involved. It's a great conversation.

I look forward to sharing it with you right now. Our guest today on Sawbones, as we probably said, is John Green, here to talk about Good.store. Is that the preferred Good.store? That's what you said in a recent video, so I wanna make sure that's the preferred nomenclature. I love it. Yeah, we go with Good.store.

Good.store, that gets the URL right in the company name, which I love that. Yeah, yeah. So Good.store is our coffee, tea, and sock company where all the money goes to support better tuberculosis care. And we're going to talk about tuberculosis today, my favorite disease. I mean, my least favorite disease. Sydney struggles with that too.

She's got favorite viruses, favorite really dangerous stuff. Yeah, well, everybody always asks a common question when you're a doctor, is what made you want to be a doctor? And I always say, ooh, hemorrhag common question when you're a doctor is what made you wanna be a doctor? And I always say, ooh, hemorrhagic fevers, I just love them. And that's not a good, most people don't take that well. So I understand, I empathize. I don't love a hemorrhagic fever myself.

And I don't love tuberculosis either, I really dislike it. And I think it's my unique dislike of it that makes it so interesting to me. When did it really tick you off the most, John? When did TB really get on your bad side? So I didn't even know that tuberculosis was still a thing. I thought it was like the thing that killed John Keats, like past tense disease, until 2019

when I was at a TB hospital in Sierra Leone. And I met this kid who has the same name as my son, Henry. And he was just one of these kids who just pulls you around the hospital and, like, chats to you, and, um, even if you don't mutually understand each other all the time, he's just, like, there for you, like, walking you through everything, telling you what the deal is with tuberculosis, showing you the microscopes that they're looking at the slides in and everything and at the end of it

I was like whose kid is that is that like a doctor's kid or something and they were like no that's one of the drug resistant TB patients were really worried about and in the end Henry would go through like Six years of treatment total he would take over 25,000 pills over the course of his treatment for tuberculosis, but he did get cured and today He's a student at the University of Sierra Leone. Fantastic. Unfortunately, he's studying human resources management. Oh, that's a bummer, you hate to hear it.

Yeah. You hate to hear it. Yeah, other than that, he's doing great. No, he's doing awesome. So what was it about this disease specifically, you kind of joked about it being your favorite disease, but is there anything else about it that's staying? I do, as a layman myself who has talked about TB

a good amount on this show, there's still like a residual old West romance to TB, if that's fair, I don't know. Absolutely. It's almost like there's two diseases, and y'all have talked about this to some extent on the show before, but like before the era of tuberculosis,

this era of consumption, which lasted really until 1882, you had this disease that was really romanticized. There was the Old West disease, there was a beautiful disease that kind of made you sexy and also a little bit of an artistic genius. And like, um, one of my, uh, one of my favorite lines about TB is some friends of, um of Victor Hugo telling him that he would have been a great novelist if only he'd contracted consumption. And that was the disease that was this inherited condition that came along with other aspects

of a personality that made you such a genius and so beautiful and everything. And then in 1882 we discovered, oh, actually, this is an infectious disease caused by a bacterium and it immediately becomes a disease of filth, a disease of poverty, a disease that's associated, that's stigmatized instead of romanticized. And, and that shift fascinates me, but then also TB remains the deadliest infectious disease in the world, even though it's been curable since the 1950s, which is insane, right? Like it is insane to live in a world where the deadliest infectious disease in the world, even though it's been curable since the 1950s, which is insane.

It is insane to live in a world where the deadliest disease is curable. It's also an interesting example, Sid, of how, like, we've talked about a lot, how important it is, the framing of a disease, like, how we think about it, how we talk about it. I know you were doing an awareness campaign recently about this, John, about TB, and I feel like the way we think about it, how we talk about it. I know you were doing an awareness campaign recently about this, John, about TB. And I feel like the way we think about a disease is really important.

And I think that's true. It's something I encounter a lot in medical education, the way that I was taught about diseases and the way that we continue to talk about them, at least in the US, I went to a US medical school. TB was, I'm sure we did a chapter on it and then we skated past it because for the most part, we weren't expected to encounter it

or I guess to think about it or worry about it very much. The first case of tuberculosis that I, and since then I've seen more in the US, but the first case that I actually helped manage, I was working overseas in a village, Equendene in Malawi and they put a chest x-ray up and said, all right, doctor, what's that? And they knew what they were doing to me.

And I said, oh, oh, it looks like cancer. I thought it was a malignancy. And they all said, yeah, that's what all the Americans say. No, this is tuberculosis. And that was the first time I'd ever really seen a chest x-ray to even know what I was looking at. But I do. I think that there are certain diseases that even in medical school, they're like, but you don't need to think about this, which is kind of our privilege showing through our education.

Yeah, and to some extent, you know, the TB person in Indiana sends out pens to all the doctors that say think of TB, because, you know, there are 10,000 cases in the US every year. And like you said, you've seen some of it. But that's nothing compared to what it is in a place like Malawi, which is one of the epicenters of the global TB crisis, where you see chest x-rays that are terrifying on a pretty regular basis.

It's funny you should mention that you thought it was a malignancy, because one of my TB friends, Dr. Jen Furin, described for me once that she, you know, from a chest x-ray was having trouble telling if it was TB or cancer and that it proved to be TB. And when she told the patient, the patient started crying and Dr. Furin said, why are you upset? We can cure this.

And the patient said it's so much more humiliating than having cancer. Like, that's how stigmatized TB is in many poor countries. And I think we underestimate the degree to which stigma can be its own. I encounter this not so much with my current patient population with tuberculosis, although I do see that because most of my patients now have HIV or are at risk for HIV.

So that's a lot of the care that I do now. And it's the same thing. Transportation and cost of medications, there's so many things that we are overcoming because of where I live and where I practice. But that last barrier of stigma is still, I don't have the tools or all of the ways to overcome just that to get people the medicine that they need. Well, in HIV, the kind of twin pandemics of HIV and TB, for those who don't know, people with HIV have, untreated HIV at least, have vastly reduced immune systems.

Their immune systems aren't as effective and then tuberculosis can kind of much easier take hold. Like a lot of people have been infected with TB like between a quarter and a third of all humans right now are and have been infected with TB but like the vast majority of us will never get sick because we have an effective immune system to kind of control that infection. But with people with HIV that can change really quickly and really catastrophically. And so we often talk about like the twin pandemics because the HIV

pandemic really reignited the tuberculosis, the ongoing, the old ancient tuberculosis pandemic. Um, and yeah, that's really, that's stigma is the hardest thing to, I don't know how to manage it either. I don't know how to get past a social order that just rejects people. You know, there's, um, at the TB hospital in Sierra Leone, one of the nurses told me that the hardest part of her job is bearing the patients for the families

who won't come get their loved ones because they're scared, they're that scared of TB. I really feel bad about complaining about Best Buy now. In hindsight, that was not a bad place to work at all. I don't know why I even had any complaints. I feel the same way about Steak and Shake, man. I mean, right? Like, that's a tough day in the office for me,

is like, no, he bought Netflix, you know? I had a griot. I had a brutal graveyard shift at Steak and Shake, but I don't get to complain to nurses and doctors. It doesn't stop Justin. Oh, no, no, no. It's important, because that my- As a doctor, he complains to me all the time.

I'm really relieved to hear that. I'm really relieved to hear that, because I don't think I could. My wife is an art curator, so I feel like I can complain to her, but I don't feel like I could complain to you. I feel like I'd be like, what was rough about the office today? Oh, man, it was so hard coming up with jokes with my brothers.

It's, you know what, John, you're right. And the perseverance it takes for me to feel bad for myself day in and day out. It's impressive. It's beautiful, man. It's beautiful. Thank you, man. Thank you. It's a game-recognized game. When you're, you know, you talk about that starting point of saying like, this is a problem.

And I think that, especially in the U.S., in our medical system, which is so fundamentally broken, I think it's really hard to look at this giant system and say, okay, there is a massive problem. What size bite of this elephant am I gonna, right? So I'm really interested in that. And I'm sure that is an absolute moving target. And probably one of the biggest questions

for Good.store is like what problems, what are we attacking? So how did you sort of like land on Lesotho for this like specific initiative and... Yeah. Yeah. So we started out tackling maternal health, trying to tackle maternal health in Sierra Leone. And that was actually, or that has been in an ongoing way, really encouraging because Sierra Leone in 2017, one out of every 17 women were dying in pregnancy or childbirth. It was an astonishing, astonishing number. And that's been reduced by like 65% just in the last seven years. Now, obviously it has tremendously far to go, right?

Like with it's still hundreds of times too high. Um, but we're seeing, you know seeing this maternal center of excellence open up, partly funded by Good.store, that's gonna really transform. It's the first NICU that's gonna be, for most of the early-onians, the first really good maternal care center where you can expect a safe, clean OR,

where there's a good blood bank, all that stuff that you really need to save people's lives when they're giving birth. That's opening up next year. We're really excited about that. And then, but then good.store kept growing, uh, especially the coffee and tea kept growing and we reached, so we reached out to friends in global health and we said, what would you do, you know, if you had a couple million dollars a year. And they said we would invest in comprehensive tuberculosis care because this because it is curable, right?

So you can end a chain of transmission by by curing the person who's sick and offering preventative therapy to their close contacts. Like that ends that that line of infection and you could that's how we basically reduce TB to almost zero in the United States. Now there is still quite a lot of TB in the US, but like compared to what it was 50 years ago, it's been reduced by over 99%. So, or at least 75 years ago,

from before the antibiotic era. So I really think like we know how to do this, we've just assumed that we can't do it in poor countries, and it's time in a place like Lesotho, which is a relatively small country, you know, it has a population of about two million. It also has the highest TB rate in the world. It's time to say to in a place like Lesotho, like, like this is not acceptable and we don't have to accept this world.

And so that's, that's kind of what we're trying to do with our silly coffee. Is there a temptation to just like crush one that's very local to you? Just like I'm going to make a museum for me. Or you know, like something that's a little more local, I guess would be the question. There is a temptation sometimes. Because I think the advantage of local work, and y'all know this from your work,

is that you're in the community every day. Right? Right. And so you know the needs of the community in a way you don't know the needs of a community in Lesotho or Sierra Leone. The advantage to working in a country, if you trust experts, the advantage to working in a country like Lesotho or Sierra Leone is that you can make a huge difference. And you can make a huge difference with like what is a ton of money, you know, I think good

stores given away $8 million in the last three years, it's a lot of money, but like it's also not a lot of money, right? Like it's not a lot of money compared to building Elon Musk trying to go to Mars or whatever. Yeah he should fix this stuff. He's so busy though he's so busy fixing other things. And by fixing I mean breaking. Yeah he's got to pay people to vote. settles those pointless arguments that you and your friends have. Should you put ketchup on a hot dog? Or liquid, foam, or bar soap? And our 500th episode of We Got This With Mark and Hal is available now. It is supersized and a ton of fun. Yeah, we've got guests coming back from the entire 500 episode run of our show. Some of your favorite Max Fun stars, some of your favorite regular out in other places in the world stars too, some really fun surprises, and every single one of them had a topic for

us to cover. You can listen to it right now on MaximumFun.org or wherever you get your podcasts. Hello, sleepyheads. Sleeping with Celebrities is your podcast pillow pal. We talk to remarkable people about unremarkable topics, all to help you slow down your brain and drift off to sleep. For instance, the remarkable actor Alan Tudyk. You hand somebody a yardstick after they've shopped at your general store.

The store's name is constantly in your heart because yardsticks become part of the family. Sleeping with Celebrities, hosted by me, John Moe, on MaximumFun.org or wherever you get your podcasts. Night night. So, when you're looking at like different products and what that lineup is gonna be, I know that Awesome Coffee Club, which I was a proud member, card-carrying member, is now Keats & Co. Is that correct? Yeah, we rebranded.

We rebranded from the Awesome Coffee Club to Keats & Co. Because we wanted to get a little more TB-focused, a little fancier. This is the fancy, okay, so this is the thing. Keats & Co. sounds fancy. This is the thing, John. As fellow brothers in entertainment, you and I both come from a long proud heritage of being uncomfortable giving anything a cool name.

Yes. I think that we are, by definition, we're pretty hardwired to not try to sound like we're ever being cool. So like, it's a good sock. You get it. They're good socks. Just get them or don't. We do good. Yeah. Just get them or don't. I think that's a key part of our marketing play as well. It's an awesome coffee club. It's like, you get it. They're good. Just get them or don't. We do good. Yeah, just get them or don't. I think that's a key part of our marketing play as well. Yeah, but we rebranded to Keats and Co. in an attempt to be more mature, but it's still the same coffee, still the same price. And the thing that...

The major thing that changed is that our packaging got fancy, but I'm so uncomfortable being fancy, just like you. Like, there's that aging, I don't know. Some people say he's such an annoying, cringe millennial. And I'm like, oh my god, thank you so much. Because I'm pretty sure I'm a cringe Gen Xer. Yeah. I'm right on the line there.

Yeah, I'm right on the line. Y'all are a little younger than me, so I think you're safe. I'm 43. I'm an old, old man. I'm 47, buddy. It's impossible John It's I know too. Thank you When I noticed when you're the growth you talked about the growth of

Good dot store and and and the numbers that are continuing to build It's such an anti like the model of the company is so different and it's so like. Oh yeah, I should have mentioned that, that we give all of our profit to charity. So it's like Newman's own, like we don't keep any of the money. Right, now, I am astounded that you just

did a Newman's own poll and you're worried about being mistaken for a millennial. There's just no planet. There's no reality in which this salad dressing referencing man is a millennial. You know just no planet. There's no reality in which this salad dressing referencing man is a millennial. You know Newman's own. Yeah, the young people's salad dressing, but they've given away hundreds of millions of dollars.

They've done a ton of great work. This is not to detract from Newman's own a lot of great products. Check my fridge. I'm hearing you diss Newman's own's delicious Oreo knockoffs, which are called Newman's O's. I like Fig Newman's. Fig Newman's. Fig Newman's, they didn Oreo knockoffs, which are called Newman's O's. I like Fig Newman's. Fig Newman's.

Fig Newman's, they didn't even wanna make them. They just came up with a name and they're like, got to, got to. I like the salsa, that's my favorite. If we're plugging Newman's Own products. Okay, great, now who are we here for exactly? Right, exactly. So the question, my question is,

how do you balance a, like, this is a question nonprofits have to deal with constantly, but this is not that exact model, right? How do you grow a business or balance growing a business with like doing the mission? It's hard too because, well, part of the reason it's hard is because we have to invest in advertising and marketing and every dollar you invest in advertising feels like a dollar that's not going to somebody

in Lesotho. Our advertising has to really be efficient because otherwise I feel sick to my stomach that I'm giving Instagram money and not getting enough money in return. That's part of what's difficult about it. I also think we try to treat it as a regular business. It's just a regular business that's trying to do something different in the world than accumulate wealth into two hands

that already have plenty of it. Right. Yeah, so that's the other thing, is that like this is pretty easy for us to do because Hank and I already got paid. Right. Yeah, it's a luxury to be able to do this. I think that that's, you know,

it's so interesting to hear you say that, John, because I feel like when we do charitable stuff, I really don't ever find it laudable. Like, I really don't think of it. I don't, I don't. I legitimately, and that sounds like a fake thing, but I don't, I don't, especially when I feel like I'm just redirecting an overabundance of generosity.

I have said that for a long time, because the majority of work that I do, well, up until soon, but up until now, the majority of work I do medically has been volunteer, so I don't get paid for any of the work. And anytime I'm applauded for that, I always feel like there are a lot of people, there are a lot of physicians I know who would also,

it is a privilege to an extent. It does feel like a luxury to get to just practice this thing I love in its kind of purest form, just do it for the sake of wanting to do it. It is kind of a luxury, I understand that. Yeah, and a lot of people would do that if they could. And the other thing is that there's a different kind of generosity involved.

I remember my first trip to Sierra Leone, there was this community health worker. Community health workers are really the backbone of a rural healthcare system in a lot of ways. And these are the people who go out in their neighborhoods, visit with patients, those living with HIV, those living with tuberculosis, living, you know, people who are pregnant so that they can, you know, check in on them and get the maternal care as they need it.

Like that's, that's the backbone of how a healthcare system like Sierra Leone's can, can, can get healthier and stronger. And I was visiting with this, but they don't get paid well. I mean, a lot of them don't get paid at all, but, but they don't get paid well, even if they get paid. And I was walking around with this healthcare worker, Ruth, and she was visiting with a patient who was, hadn't taken her TB meds that day, because she said she tried to take the first one,

you have to take like 10 pills a day or 15 pills a day a lot of times. She tried to take the first one and she just threw it up immediately because she hadn't any food that day and she didn't have any money for food. And Ruth gave her like the equivalent of $2, just like gave it to her. And that is so much more generous than any amount of money that I will ever give because it materially affects Ruth's life. And I think that's really worth remembering.

I'm a little over celebrating rich people and naming buildings after them for their generosity when they are not any less rich functionally. Right. Yes. And I think what you just talked about with community health workers, that kind of work that again, I think we, even the way that I was trained in a US medical school, we don't think about that as being applicable to our healthcare system.

That's so true. But that exact work is what we are trying to build in my community right here where I practice because I live in a part of the country that is rural, where a lot of people are living in poverty, where a lot of people have no transportation, reduced access to everything, including education on these issues.

There's a huge amount of stigma. And this is exactly the, I am sitting in rooms with people saying, maybe we need something like a community health worker. Maybe we need something like that to go door to door and figure out what people's needs are and help them meet them. We're trying to retrofit that back here,

because it is applicable here. Well, Sydney, I think that's so important. And I think it's really important to understand that we tend to think of philanthropy as a one-way street, as a one-way exchange of resources and information. That we are trying to make the Sierra Leonean or the Lesothoan healthcare system stronger. But in fact, we have so much to learn

from the Sierra Leonean healthcare system, from how nurses and doctors and community health workers work with extremely limited resources to get different kinds of care to their patients than we're getting to ours in the United States. And especially in a healthcare system that, as you said, is so fundamentally broken, those kind of interventions can make a huge, huge difference. So that's cool to hear and it's really cool to think of this as an exchange of expertises and

knowledges and learning rather than like a one-way street of resource distribution. Yeah, it's wild to hear about you talk about the things that you used in like techniques that you learned in Malawi that you have had to like adapt for street medicine like at Harmony Health. I also, I want to talk about how you helped take on Big Pharma. Yeah, in a small way. Well, still.

That's the only way to do it. That's very exciting and tackled the problem of evergreening, which I don't know if we've ever really talked about on our show or that our listeners are very familiar with. Yeah, patent evergreening is an incredible strategy that pharmaceutical companies use to extend their patents basically forever. So they'll say, well, this patent is expiring, but there's this aspect of the drug delivery that we actually patented

later. You know, at Doctors Without Borders, they compare it to you patent the pen and then eight years later you patent the pen and then eight years later, you patent the pen cap and you say like, oh, the pen doesn't work as well without a cap, so we're gonna have another, we're gonna have it for another eight years and then turns out eight years after that, you patented a slightly better pen cap and now that's the pen cap.

It's exactly what they've been doing with Mickey. Now they got the lines and the gloves. Exactly, they got Mickey. Now the ears are a little tilted. Yeah, yeah. It's exactly what they're doing with Mickey. And so Johnson and Johnson is trying. It's like you were saying that, John, it is exactly. It is, it is. It's exactly what they're doing with Mickey and so Johnson Johnson's right. You were saying that John is exactly it is

Exactly. Yeah They do it they do it with novels too They want me to recopyright my novels so that like 74 years from now They they can still make money from them and I'm like, oh y'all they will be so out of print But anyway, hey by the way John eight years till we get James Bond By the way, if you want to collab with me on a James Bond novel, and I can't have anything but the name James Bond and I think he could be a spy.

I'm interested. 2034, maybe, look for it. No, no, no, no shaken nuts turned martinis, but he can be. No guns, no guns. No Q, no Q, no, he's. He can't be British. He's a low, low-insurance salesman in Muncie. Bond, James Bond, pleasure. Yeah, yeah, and he can only drink gin. I love it. I'm in. I'm in. Let's do it. But

yeah, so this is a big strategy that pharmaceutical companies use, and Johnson & Johnson was trying to use it for their TB drug, bedaquiline, which is this incredible drug that has revolutionized our ability to cure multidrug-resistant tuberculosis and taken the amount of time that it takes to cure it, the amount of money that it takes to cure it and brought it way down. But unfortunately, bedaquiline was still really expensive because it was under patent. And there were all these Indian drug manufacturers ready to go to make versions of it that were 60% or 70% cheaper, would expand

access to millions more people over the next decade. And Johnson & Johnson was really reluctant to release their patents, but then under significant pressure from us and a lot of other people. I think this had been in the works for a long time. And to credit Johnson & Johnson, I think that they were really serious about this. They pretty much fully released the patent. Um, and these days you can buy but Aquiline for 70% less than you could even two years ago. Um, and then the other company that we've taken on, which is a more challenging

relationship, I would say, um, a more fraught complex relationship is with the company, Danaher that makes the best tuberculosis test in the world. So they make this incredible test where after two hours you can know not just if somebody has tuberculosis, but also whether or not their tuberculosis is resistant to common antibiotics that we use, the first line antibiotics we use. And that's a game changer to be able to know that

from the outset. That would save somebody like Henry years and years of bad treatment. But the tests are so expensive that it's been really difficult. So we got those tests reduced in price by about 21%, which is a significant step, but we feel like there's some more work to do on that front. That isn't it. I mean, that's an incredible triumph though with Johnson & Johnson to do that. And then I think that the point of care tests like that, those sort of rapid tests, I don't think that's well understood how critical those are,

not just diagnostically, but to the access of care that follows up. We use a ton of rapid HIV tests. Do you use like, do you use GeneXpert? That's the company that Dan and her runs. Ours are Insty. Oh yeah, yeah, yeah. Yeah, but I think there's another group in town

that uses those, but yes, we use the Insty and having that and knowing that I can, I have the patient right there, five minutes later, I have a pretty confirmed diagnosis, we'll send him off for blood work if we need to, and I can offer them care instantly. I usually have the meds, I can do it right there. They're so much more likely to access that care

if I can do it in one place. They can get started right there, they're so much more likely to access that care if I can do it in one place. They can get started right away. And also, there's not that... The delay, I mean, the delay doesn't just delay care in ways that can be catastrophic because you can lose people. It's so easy to lose people to follow up or that's... Even that phrase kind of bothers me. that's even that phrase kind of bothers me. But, um, but also, also just psychologically, it's really hard to go three, three, five days, whatever, um, worrying, worrying about whether or not you're going to get diagnosed with something and to be able to be with a doctor or to be able to like, you know, have your questions answered immediately.

Like that makes a big difference. It does. It does. It's huge. And we're, I mean, we're trained that that's what we're supposed to do, but they're always, especially with tuberculosis, I mean, there's this lag where a lot of times we're doing the collect three morning sputums to do AFB smears, and so it's at least three days if you can get them at the right time,

and then you've gotta get a pathologist to read them. I mean, it was a very arduous process, even in the US. Yeah, still diagnosing tuberculosis is way too hard and harder than it should be. And a big part of that is because Dan and her won't make their prices more reasonable. Is it, man, I think at this point in history,

and you can say this at any time, but I think we're definitely seeing a lot of the evils of capitalism laid really, really bare. I mean, to like an obvious extent where like, even a layman can look and be like, that doesn't seem right. How do you, I think of you as a pretty inspirational, humane thinker, John, how do you square for yourself

as someone who wants to stay like, I don't know, engaged with the human race? How do you square the systemic evil with that individual, just like human to human thing? Because I still have the belief deep down that if you get individual people one-on-one, you can usually talk to them, at least begin to talk some sense,

but I feel like they're working against a pretty evil system. Yeah, and a lot of individuals are left out by those systems and those systems oppress a lot of individuals. And then they lift others up and the ones who are lifted up may not even sense that they're part of a system, you know, they may not even be aware of the system. Uh, they just, they, they don't, you don't know that, you don't know that you have a tailwind until you turn around, right? Like, and.

But I think the place where I find hope, to be honest with you, is that human built systems have, have, have human built solutions and they aren't easy. They aren't uncomplicated. It's, it's, it's extremely, I mean, Sydney knows this better than either of us, but like it's extremely slow.

It's human to human work. It happens at the scale of one individual speaking to one individual. But we can, over time, build systems that include more people. And we can find ways to reform our systems to make them better. And they will still be wildly inadequate, right? Like, I think the ACA made healthcare more accessible to people, and yet still, it was wildly inadequate. And we still live in a healthcare system that is hugely, hugely inequitable.

And so I find hope in the idea that human-built systems have human-built solutions, human-built problems have human-built solutions. And ultimately in 2024, like tuberculosis isn't really caused by a bacteria anymore, because we know how to kill the bacteria, we know how to deal with the bacteria, tuberculosis is caused by us, like we're the cause of it. And that's very discouraging and very worrying. But that also means that we can be the cure. And that wasn't the case for people 200 years ago, they weren't in a situation where they could be the cure by changing the way that they distribute resources and changing the way that they allocate different cures to different people.

And now we are in that world. And I think that's, it's bad news in the sense that it's frustrating to live in a world where we are the problem, but it's also good news because it means that we know what the cure is. And that's why good.store uses the tagline, if you shop anywhere else, you're the problem. And I just wanna say that if I see you drinking any coffee

that didn't come from Keith's and Co, you are basically on the side of calculus. Like I hope I'm not like overstating the point that is. You're selling our coffee so much harder than I would. I really just saw this as an opportunity to come on my favorite podcast. You're really out there promo-ing me. Well, John, I'm just so happy to have you,

and it is one of those rare times where I can promote a brand that actually does good. I've done so much free work for brands that haven't given me a dime and are honestly actively evil. Me too, me too. Not even like sort of evil, but just like, it's foot, like that's part of their gag. That's part of their thing.

Yeah, that's part of their gag. You can't feel good about anyone who's eaten pizza rolls because of you. I'm probably wearing Harvey's underwear like right now. Yeah, I might add a pizza roll because of you actually. I might add a pizza bagel here and there. You're welcome. Mine is Diet Dr. Pepper. Like I'm a very public fan of Diet Dr. Pepper. Seth Sidney's too. Mine is Diet Dr. Pepper. I'm a very public fan of Diet Dr. Pepper.

And I think- Set Sydney's too. I love Diet Dr. Pepper. Can you? Can you too? But it definitely makes the world worse. Oh yeah. Will you talk about, have you tried Diet Dr. Pepper Zero Sugar? Yeah. It's better, right?

No. No. Okay, both of you too now. No. It's worse. It's not worse. It's worse. Justin made me do like a blind taste test to see if I would admit if I drank them both.

And then he said, now don't tell me what's what, tell me what's better. And I know one, like I'm not gonna know Diet Dr. Pepper. It was a tough test. It wasn't a good scientific test, I agree. It was better. I mean, it's Diet Dr. Pepper is better. It just tastes better.

And the other thing about Diet Dr. Pepper, and people think I'm crazy when I say this, but it tastes differently depending on where you drink it. So sometimes I'll go outside to have a crisp Diet Dr Pepper because the outside air brings out the cherry flavor a little bit more. But then sometimes I want to be inside. You air it. Exactly. Sometimes I want to be inside and taste more of the plum. Well, let's not. Oh, don't drink that Diet Dr. Pepper yet.

I just opened that a few hours ago. You have to let it breathe. Breathe. We can't even get into the can versus the plastic bottle. I can't even. The can versus the decanter. It's the oldest debate. Yeah, what is the better?

Yeah. John, is there anything else you'd like to say about tuberculosis? Yeah, well, I appreciate y'all's coverage of TB so much over the course of this podcast. It's like the least grisly thing you talk about. So I appreciate you guys occasionally going into non-grisly spaces. But I also appreciate the grizzle, man.

My son and I loved your amputation episode. Henry was just like, this is great. I was like, yeah, buddy. And he was like, they pull the meat over the bone. And I was like, that's right, that's right, buddy. I'm so glad he enjoyed it. See, I, Justin always, as we're recording, he plays the role of the audience for me sometimes,

in that I'm watching his face, and as I'm talking, I'm thinking too far to pull it back, pull it back, pull it back, because I never, I don't have that line. You don't have that line? No, they beat it out of you in medical school. No. John, thanks for joining us.

Good.store, get your coffee, get your socks, get your soap, get your tea. Don't, I mean, get your coffee, get your soap, get your... Come on, come on. Hey, let me know if you wanna do a line of energy drinks, because I feel like that's the partnership. Let me know about a smaller, much smaller, less important problem that I can fix with Justin's raw energy.

Justin's six hour energy? Beat them at their own game. Thanks for having me. Thank you. Beat them at their own game. Thanks for having me. Thank you. All right! Maximum Fun, a workaround network of artist-owned shows, supported directly by you.