Science Friday - Successful HIV Treatment, Improving Health Equity, Fusion Energy Record. Feb 18, 2022, Part 1

Episode Date: February 18, 2022

Third Person Cured From HIV, Thanks To Umbilical Cord Stem Cells The third person ever, and the first woman, has been cured of the HIV virus, thanks to a stem cell transplant using umbilical cord blood. While the invasive, risky bone marrow transplant process may not prove the answer for large numbers of people, the use of cord blood may open up pathways to new treatment options for a wider variety of people than the adult stem cells used to cure the two previous patients. Vox staff writer Umair Irfan explains why. Plus how President Biden is using executive orders for decarbonizing new parts of the economy, new research on the climate origins of the mega-drought in the American West, a prediction for even more rapidly rising sea levels from NOAA, and how orangutans—some of them at least—might be able to use tools.   How To Close Gaps In Healthcare Access When a public health crisis strikes, a natural instinct is to turn to a strong leader. The COVID-19 pandemic is a prime example: We want someone who can calm our fears, tell us what to expect, and what steps we can take to make things better. But leadership does not happen overnight—and it will take a brave person to step into the shoes that guide the country through the next stage of the pandemic. Dr. David Satcher is used to adversity. Born into poverty in Anniston, Alabama, Satcher contracted whooping cough at two years old. The town’s only Black doctor, Dr. Jackson, treated Satcher, but did not expect him to live. Overcoming this illness launched him into a lifetime of public health work, with an emphasis on health equity. Satcher speaks to Ira about his work as former assistant secretary for health, surgeon general of the U.S., and director of the Centers for Disease Control under Presidents Bill Clinton and George W. Bush. They also discuss his leadership work at the Morehouse School of Medicine, and his advice for getting the country towards a more equitable healthcare system.   New Energy Record Set By Fusion Reactor The promise of a human-made, sustained, controlled nuclear fusion reaction has always seemed to be “just a few decades away.” But now recent results from JET, the Joint European Torus experiment, have researchers hopeful that practical fusion may indeed be possible as soon as 2035. In the experiment, a high-temperature plasma made of equal parts deuterium and tritium was confined in a magnetic containment vessel known as a tokamak. The run produced 59 megajoules of energy over a fusion “pulse” of five seconds, considerably longer than previous attempts. While the experiment did not produce more energy than it took to produce the extreme conditions needed to induce fusion, researchers took the run as a proof of concept that an upcoming reactor called ITER should be successful. Alain Bécoulet, head of the engineering domain for the ITER project and author of the upcoming book Star Power: ITER and the International Quest for Fusion Energy joins Ira to discuss the recent advance at JET and the prospects for producing a sustained, controlled nuclear fusion reaction—what Bécoulet calls mastering a small piece of the sun.   Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Iroflato. A bit later in the hour, we'll talk about a major advance in nuclear fusion. And Dr. David Satcher recalls his lifelong quest for health equity. But first, a leukemia patient has become the third person ever to be cured of the HIV virus and the first woman. And it's all thanks to a transplant of stem cells from umbilical cord blood. In contrast, the previous two patients were cured with transplants of adult stem cells. What does this mean for the potential of others with HIV to be cured? Box staff writer Umerer Fon is here with more. Welcome back to Science Friday. Hi, Ira. Thanks for having me. Nice to have you. You know, this sounds like such good news. Another person cured of HIV. How is this woman's case different from the other two people we've seen cured? Yeah, you know, this is definitely good news and we should dwell on that,

but this woman was in a fairly unique situation. A provo on the vili at the New York Times wrote about this, And she explained that this woman, yes, had leukemia and was being treated for that, but also she was being treated with umbilical cord blood. And this is a source of stem cells, but these stem cells tend to be a little bit more robust. And one of the other factors that was significant here is that this woman was of mixed race. And so typically when you do these kinds of transplants with bone marrow, you want to try to match the donor and the recipient as closely as possible. But with cord blood, it seems to be that you actually have a little bit more.

flexibility, and this could potentially be something that you can use in a larger group of people than we previously could with other treatments. But as you noted, she had leukemia. She was already being treated for another blood disorder. So it's not like this is a therapy that we could use for other HIV patients. But doctors say that this could potentially, you know, chalk out a path for a more generalized treatment. And when we say people are cured, that means they've survived longer than five years or more? Well, what it means is that they think that the virus is no longer present in their bodies. You know, HIV over the years has become a more treatable illness with antiretroviral drugs, and it's basically become a chronic condition, but the virus itself is

very insidious. It can actually integrate into the host genome, and so even if you knock out all the virus particles, it can still come back in the future. But in this case, it seems like these patients are no longer having even that presence of HIV, that it's no longer present in their systems at all, but that requires basically resetting how their body produces blood cells with these bone marrow transplants. And so it's a very invasive procedure. The past two patients who were treated with us, the two men, they both had some very severe complications. This woman who was recently treated fortunately seems to be in better shape. She left the hospital after about 17 days and seems to be faring a little bit better. And that may be because of the source of stem cells being

cord blood. So you mentioned the invasiveness of bone marrow transplants. Everyone can't do this, right? So can we learn something from these successful cures that might translate to something more accessible in the future? I mean, that's certainly the hope that, you know, eventually we could come up with a way that people who don't have leukemia can be treated for that have HIV. But right now that's still something that's still a little bit far off. But scientists are definitely excited. It is good news to have one other person cured of a disease that was previously thought uncurable. Nice to have some good news for news for a change. Your next story, though, goes in the opposite direction.

Some bad news. The big drought in the American West right now, it turns out, is a pretty bad one. Yeah, that's right. You know, anybody who's lived in the Western United States doesn't need a reminder of this, but water has been in scarce supply. But a couple of recent studies put it into context. And so Gabriel Cannon at The Guardian wrote about a study that looked at the history of drought over the past, you know, two millennia.

And the researchers there reported that this is now the driest spells. that we've seen in at least 1,200 years, and that's referring to the period between 2000 and 2018. And of course, we're already seeing the consequences of that, you know, not just low water levels, but also extreme heat. You know, water in the landscape acts as like a natural air conditioner, and we've seen a lot of heat waves in the western U.S. And this is also a major contributor to wildfire risk.

And one other interesting aspect about the study is they also calculated how much humans have made this worse. And so there's been this advance in this subfield of climate science called Atribute And in this case, they found that about 42% of this drought was made more severe due to human production of greenhouse gases. So it could get even worse then? Yeah, that's the idea is that, you know, if we continue putting more greenhouse gases into the atmosphere, some of these trends will continue to be exacerbated. But drought's a little bit tricky because we know that some parts of the world are going to get drier, but some parts are actually going to get wetter because as air gets warmer, it can hold on to war moisture. And so it's not necessarily a straightforward path that it will necessarily lead to more drought,

but there are a lot of complicated factors at play. And in some cases, we could actually see this sort of whiplash between extreme rainfall and extreme drought. Well, you've brought me to my next subject. Nice segue. From famine to flood, because we're also seeing a more rapid sea level rise on the East Coast and in the Gulf of the U.S. 100 years worth in just 30 years. Yeah, Seth Borenstein at the Associated Press, wrote about this. Noah study that, you know, examined again the history and the future of sea level rise. And they found that, yeah, we'll probably see the whole past 100 years worth of sea level rise

over the next 30 years. So this is about 10 to 12 inches around U.S. coastlines. But some parts are actually going to see a little bit higher sea level rise than others. So the Gulf Coast may see sea level as high as 1.5 feet. And there are a few different reasons for that. You know, water does like to seek its own level, but the planet is round and there are also ocean currents. And so there are parts of the country where you will see higher water levels than others. You also have ground subsidence. And that, of course, has huge consequences. About 40% of the U.S. population lives in a coastal county. Yeah, we're also talking about not just big, big rainfall events. You have the hurricanes and now you have the sea level rise. It's going to be pretty wet. Right. And so, you know,

when you have these events that normally happen like, you know, sea level rise, like, you know, hurricanes pushing water inland, those events are going to be more severe. But it also means that we'll see more nuisance flooding, like flooding on clear days with blue skies, the king tide flooding that you can see in some parts of coastal, the United States already in places like Miami. That's actually going to be more severe over the coming decades. And of course, that's going to be very expensive because there's going to have to be a huge infrastructure ready for this kind of sea level rise. And that doesn't exist yet. That's right. You know, parts of the country are trying to build things like sea walls and channels to help redirect this rising water, but it's a moving target.

As it's accelerating, as this water is moving up faster, you know, cities and coastal regions are trying to adapt and are kind of scrambling to try to make sure that they can mitigate these losses. And in some cases, they have to retreat. You know, it's not going to be worth preserving them at a certain point. It's going to be too costly. And 30 years is not a lot of time to adapt to this kind of thing. No, it's not. You know, what's interesting about both of these studies, this new megadrought and the rapid sea level rise,

this is sort of a recalibration of what we can expect from excessive. extreme climate change. It feels like more than just the usual bad news. Right. You know, as scientists start probing these mechanisms and looking at them in more detail, they keep finding unexpected ways in which they're interacting. And so we generally do see that as scientists look at these things more closely, they find that things like sea level rise are happening at a faster pace than they expected or that aridity and drought are more severe than they realized. And what that means is that there's likely in the future, there may be more unexpected mechanisms that we don't appreciate now that could make the situation worse.

Okay, let's talk about steps that can be taken. The president's big climate bill fell flat last year, but he's back at the effort to decarbonize, but this time with executive orders. What's he trying to do here? Right. You know, since the build back better bill has been stalled in Congress, the White House is trying to look at ways that they can use their executive authorities, the things that are already granted to them under the Constitution to try to get some climate change action underway. And the White House has already done that in several different ways with things like, you know, electric vehicles and federal procurement. But this new executive order this week looks at the industrial sector. And this is something that's, you know, kind of obscure from public view.

These are businesses and industries that make the stuff we use to make stuff, you know, metals, concrete and other kinds of building materials. And they account for about one third of U.S. greenhouse gas emissions. And so what President Biden, wants to do is use the federal government's purchasing power to make sure that the federal government buys materials that are produced with less carbon intensive and in cleaner ways, hopefully setting a signal to the rest of the economy that this is a viable way to actually pursue construction projects and to pursue building materials. But there's other couple investment areas in this as well. One thing is that the White House is doing is they're betting big on hydrogen. They're calling

for about $9 billion in investment on hydrogen fueling stations, but also ways to produce hydrogen in a clean way. Right now we get hydrogen fuel mainly from steam reforming methane, which has carbon footprint. And so what they want to do is try to come up with ways to get hydrogen from water using renewable energy. And one other interesting thing about this executive order is it's also looking at trade as a lever. We're trying to get other countries to clean up their act as well by putting limits on the kinds of metals that we import from other countries. So basically we're going to set sort of a standard for metals and other materials that we import by saying that If you don't, you know, adhere to our environmental rules in producing these materials,

then we will either add a tariff or restrict their import into the country. And that's sort of a way to nudge other countries to do more on climate change as well. Yeah, and this is typical of the government setting, an example, using its big buying power to sort of turn that giant industrial ship in a different direction. Right. It's kind of hard to overstate how big the U.S. federal government is. You know, the military alone is the single largest employer in the world. And so you have all these buildings, infrastructure, vehicles. And just by getting the federal government to set tight standards for itself, it becomes a big purchaser, and that can help lead to economies of scale. But then also, if the government can validate and show that this works and this is cost effective, then other businesses may want to step up and try to clean up their activities as well.

That'll be interesting to see how the hydrogen side plays out here. Is there a downside to using executive orders for climate change measures? Well, as we've seen between the administrations over the past couple years, you know, all it takes is another administration to come in and undo everything with an executive order. So this stuff is not set in stone, but what the Biden administration in the White House is hoping is that there's enough inertia baked in that if they can get these initiatives rolling, they'll have enough benefits that they'll be irreversible. And essentially, it will be much harder politically and feasibly to actually undo some of these changes. And one last story really quick. Orangetans using axes. It sounds like the opening of the film 2001 Space Odyssey.

Yeah, that's right. I read a piece in New Scientist about this by Michael Marshall. So a team of researchers looking at orangutans at a zoo in Norway found that they could actually use tools even without being instructed on how to do so. Now orangutans are a species that live in trees and so they don't typically interact with stone tools on the ground. but these researchers found that if they gave them a box that was tied up with a string and a sharp rock, the orangutans figured out exactly how to use the rock to cut open the string and to get the fruit that was inside. But the one shortcoming they had was they couldn't quite coach the orangutans to make the tools in the first place. So that seems to be a little bit of a bridge too far, but it is interesting that they were able to show initiative in using these tools that they've not encountered before.

Thank you, Umer. My pleasure. Thanks for having me. Omer Irfan, staff writer at Vox. He joined us from Washington, D.C. After the break, a major advance on the road to fusion energy. Stay with us. This is Science Friday. I'm Irafledo. Last week, we mentioned in passing a major advance in fusion research in Europe, a test run at an experimental reactor called Jet that smashed previous records for energy output. This week, we have time to talk about it in depth. What was the breakthrough? What does it mean for future attempts to achieve sustained nuclear fusion, the holy grail of clean nuclear energy

production. Joining me now is Alain Beculé. He's head of the engineering domain at Ider, the next generation fusion test facility under development in France. He's also the author of the upcoming book Star Power, Ider and the International Quest for Fusion Energy coming soon from MIT Press. Welcome to Science Friday. Thank you so much.

Can you tell us what actually happened at Jet? Why are people so excited? So what happened at Jet that was announced last week, but in fact that happened at the end of last year, is effectively a breakthrough in one of the performance indicator of a fusion device, namely the amount of fusion power that is produced for a given duration. 20 years ago or so, Jet had already achieved an important step in this nuclear reaction, let's say performance. Namely, Jet has achieved something like 16 megawatts of fusion generated by these reactions out of 20 megawatts that were injected in order to create the conditions for this reaction.

So basically getting as much power from the nuclear reaction as you need to heat and to create the conditions for these reactions. But this was a very short pulse. So Jet has pursued its research and developments for the years after this record and constantly improved the situation. And last week they reported the fact that now we as a community, they as a machine, are able to create something like 10, 11 megawatts of fusion for five seconds out of something like 30, 40 megawatts that are injected

in order to create the conditions. So the pure performance is slightly lower, but the duration is extremely important because this record means that effectively it works. Effectively, we can create and maintain these conditions. Of course, the machine jet is at the end of what it can do with all the technologies that are presented yet. So the next step will be realized by the ITA machine

that is under construction, but that will be equipped with all the technologies in order to further maintain and develop this kind of performance. Why did it stop after five seconds? So the reason why jet experiment stopped after five seconds is because this device that was built and created 40 years ago or so is not or was not equipped with the proper technologies to sustain longer. You can imagine that you have this very large heat, this very large energy that is created,

and that you have to withstand it. It is exhausted from the plasma outside to the machine. And if the machine is not simply properly designed to be actively cooled and to deal with this extraction of power, then you can only rely on a very short time. And then after that, you have to stop simply. ITER is designed to create this kind of conditions for much, much longer. So it's a matter of really design of the machine.

And so we have to wait for a bigger machine. Yeah, so this bigger machine is under construction. As you said, this next-step machine is called the heater. It's 10 times bigger than yet. It's really at the size of now producing 10 times more power than the power that is used to create the conditions for fusion. So it's an amplifier of power. And the goal that is given to heater will be to amplify this power by a factor of 10

on durations that now, with the proper technology, will reach quarters of an hour, one hour, this kind of durations, so really much more, much longer durations. And also demonstrating that we have all the technologies to operate, to manipulate, to maintain this kind of condition. So it's the pre-reactor. In fact, ITER will be the very last step before being able to build really reactors that will then generate electricity.

and coupled to the network. You know, the joke has been for many decades that no matter when you ask, practical fusion is always 30 years away, right? Yes, right, or 50. We went down from 15 to 30, so it's getting better. Well, when might we see this new giant Ida reactor finished?

If you come to France and visit us, you will see all the building, services, et cetera, all there, and the machine itself, the Tokamak itself, is being assembled. But it's a very large machine. It's a very complex device. So this assembly will last another five years, typically, before it is finished to be ready to start.

And then this machine will start. It's progressive operation, raise in performance, power, and so on. So the target is expected by 2035. And you think that in this new machine, you can actually create a sustained-controlled nuclear fusion for almost an hour. Yes, this is the goal. And it is the way it is designed.

And once that happens, you can then move on to a construction of a practical, functioning, power-producing nuclear fusion reactor. Yes, which is already under design. I mean, our members, all of them, if not almost all of them, have also reactor design activities

in parallel to Italy. So they contribute and they participate to Eater in order to make this demonstration real, and at the same time, they are preparing the first reactors. You must be just jumping up and down waiting for this to be finished at Eater. Indeed, indeed, and I'm not the only one. But no, it's very exciting. And the other very exciting part is the fact that this is international and completely

international and for a very long time. So it's multicultural. It's very, very interesting. The grail here is really that this kind of electricity source, energy source, has a very large attractiveness. This is a nuclear reaction based on very light nuclei. So this is something that is not of the kind of the fission reactors creating a lot of nuclear waste, nuclear problems, etc.

It's an interestingly safe process. Nuclear fusion reactor cannot explode, cannot divert. It can only work or stop. So you have this kind of promises and others that make this research attractive. But it's a very big challenge. We are trying to capture and to master a small piece of the sun. So it's something that is extremely difficult. Mankind today is very attractive.

and very occupied and busy with trying to move to Mars. And I think that everybody understands how difficult it is to go to Mars, to land on Mars, to live on Mars. Fusion is trying to do the same kind of things, but to go on the sun in a sense. So we are trying also to achieve this kind of very, very challenging goal. But if we manage to do that, And there are still, I mean, there are still a lot of things to do to be able to master this.

But if we manage to do that, yes, then we have potentially very interesting, very inexhaustible, in a sense, a source of energy for really for mankind and for quite some time. I'll tell you what, we'll meet back here when you have either finished. Sure, sure. We'll be very happy to talk about it then. And we wish you great luck in trying to capture the sun. That's very kind. Thank you so much. Alain Becule is head of the engineering domain at Eater in France. He's also the author of the upcoming book Star Power, Eter, and the International Quest for Fusion Energy.

When a public health crisis strikes, a natural instinct is to turn to a strong leader. Just think of this COVID pandemic. We want someone who can calm our fears, who can tell us what to expect next, and the steps we can take to make things better. But leadership does not happen overnight, and it can take a brave person to step into the shoes that will guide a country and an idea. My next guest has a long and storied history of public health leadership. His new book, My Quest for Health Equity, Notes on Learning while Leading, is out now on paperback. I'm very pleased to welcome Dr. David Satcher, former Assistant Secretary for Health, former Surgeon General,

Director of the Centers for Disease Control and Prevention, founding director of the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta. Welcome to Science Friday. Good morning, Arroyd. It's great to be with you. Nice to have you. Let's talk about your personal history because in your book, you referred to it many, many times. Your personal history with health equity started very early when you were, what, just a toddler? Yes, I had a very serious experience with Wupinkov before I was two years of age. And I know it was serious because the one black doctor in Anderson who came out to the farm to see me, told my parents that he didn't expect me to survive the week. And so that's the story that they always tell.

It's that I was not expected to live. And my mother feels very proud of that. I felt very proud of the fact that she was able to take care of me through this script to my life. And that doctor who treated you. Dr. Jackson. And that Dr. Jackson, who treated you, left a big impression on you about what you did with your life, correct? Very much so. I never actually met him after I.

I became old enough to know people. So I don't remember the interactions, but by the time I was four years of age, my mother was talking about Dr. Jackson and the fact that he came out there and that he didn't think I was going to live. Did that set you to thinking about becoming a physician yourself? By the time I was six years old, I was telling everybody that I was going to be a doctor like Dr. Jackson. Clearly, because my mother talked so much about Dr. Jackson and the fact that he gave up his off day and came out to the farm and he worked so closely with them. And as a result,

I survived that struggle with Hooping Coopin Coff and Newmone. Let's talk a bit about your educational history because you mentioned in your book how important you believe education is. neither of your parents finished elementary school. They made education a priority for you and your siblings. Tell me about your educational journey as a young black man. Well, it was quite a journey. I had eight siblings and we all went to school and we were told that education was a priority, that we were not going to be kept out of school to work on the farm. We had to do the work after we got home. and before we left for school, we had to do the work on the farm. Each one of us had an assignment, but we couldn't do it at the cost of education.

And you believe that education is key to leadership and getting ahead in life? I do. I think education is one of the greatest opportunities that we have when it comes to the things that determine our future. We now call them the social determinants of help. and certainly education is one of the major social determinants of health. So we were taught to take it seriously. I think it had something to do with the fact that my dad, who never actually finished the first grade, but learned how to read and my mother coached him,

he went on to become superintendent of a Sunday school for 25 years. And he demanded that we, study our lesson and that we'd be able to discuss it every Sunday. So as you can see, my parents were very serious about education. And you talk about the social determinants throughout your book. I want to get to that and a little bit later, but I want to talk about you writing that you, quote, I have been a victim of racism and segregation, and I have had the opportunity to confront racism. You participated in the civil rights movement alongside the, alongside the, the King family. How did that experience shape your idea of what a leader is?

Well, I was greatly inspired and motivated by Martin Luther King Jr. As a student at Morehouse, I had many opportunities to hear him speak. A group of us, about five of us, would actually walk the five miles to Ebenezer Baptist Church, where he was a co-pastor with his father. Now, this was later, and he had done the Montgomery Bus Sport Card, and he was back in Atlanta, and we would go to hear him speak. And I've been quoting him ever since. He was one of the most quotable people I've ever met. And you quote him, and you say he has an unusual ability, quote, to educate, motivate, and mobilize people.

Important talents for leaders to have. Yes. Now, I watched the Montgomery bus boycott from afar. I was in Anniston, Alabama, 100 miles away. But my brother, Robert, Bob, who is three and a half years older than I am, he would come home and talk about the Montgomery bus boycott. He would go to Dexter Avenue Baptist Church on Sunday and hear Dr. King speak. And then he would get out and walk, join the boycott. As you know, that was one of the most. successful civil right intervention that we've ever had in this country. And it was the beginning of Martin Luther King's joining as a leader. This is Science Friday from WNYC Studios. And you say that

civil rights, and now I want to get back to what you mentioned before, health equity, are intertwined. Please explain what you mean by that. Well, health equity is critical. And I say that because health equity is not having equal access. It is getting what you need to be healthy. And certainly, one of the biggest challenges that we face as a people, and that many people still face, is the inability to receive the care that they need. And so I have worked very hard throughout my life and career to find out what is it that people really need to be healthy. And we don't all need the same thing. But we all need the opportunity to make the best of our own health. And that means having access to quality health care, which is so, so rare for so many people in this country.

And how do we get there? How do we get health equity in this country? Well, number one, I think it's really critical for us to understand that health equity is important for the nation, not just for the people who are trying to get in the door. It is interesting, though, that the United States is one of the rare countries that apparently doesn't see health equity as important to the extent that we make sure that everybody has access to it. And so that's an ongoing struggle as we educate more physician, more nurses. more public help leaders, getting people to realize that it is in the nation's best interest

to provide health equity and for people to be able to realize the optimal health status for themselves. We have to take a break, and when we come back, more with Dr. David Satcher about leadership and health equity. This is Science Friday. I'm I'm Iro Flato. We're continuing our conversation with Dr. David Satcher, former. Assistant Secretary for Health, former Surgeon General, Director of the Centers for Disease Control and Prevention, his new book, My Quest for Health Equity, Notes on Learning while Leading, is out now in paperback. Speaking of showing leadership as a physician, you were a pioneer for black physicians,

and for some you may have been the first prolific black government physician they were ever exposed to. Do you feel a responsibility to be a good role model for other people? I do. Yes. I've felt that for a long time. I think being around people like Dr. King and Benjamin Mays, who was president at Morehouse College and others, you're really challenged to think about why are you here? What's your role in life? What's your responsibility? So I do, I've always felt that I'm looking always for the best way to live up to my responsibility to other people. I can't see children not getting access to health care and feel like, you know, I don't have a responsibility. I do.

As long as poverty is a major health problem, public health problem, then we're all responsible. You're right that you carry with you the sayings of Dr. Benjamin Elijah Mays, whom you've talked about at Morehouse. And those sayings include, quote, the tragedy in life does not lie in not reaching your goal. The tragedy lies in having no goal to reach. Wow. Right on Target. You wrote it. Do you feel that you have reached your goal?

No, by no means. I've reached a lot of goals, but not my goal because I think my goal must be. to make health care available to all people, not just in this country. It's really sad to be able to have to say that it's not available to all people in this country. It still often depends upon where you live, where you work, how much money you have. And I think that's an issue. Now, the reason that I have put so much emphasis on public help in my career, even though I've trained and in medicine, pediatrics.

I went into public health because I think the definition of public health fits me. It says that public health is the corporative efforts of people to create the conditions in which people can be healthy. In other words, public health care is not just about getting health care. It's about dealing with the conditions that make people sick in the first place. And you say that to many people, public health means just seeing a good doctor, but you're right that no, it involves good nutrition, a good place to live. There are other environmental factors that contribute much more to public health and just access to a good doctor. No question about it. Public health recognizes that, number one, we are a community. And in this community, we have a responsibility for each other. And we have to find a way to make sure that the conditions,

and I want to repeat that word again because it takes us back to the social determinants of health. Public health is the cooperative efforts to create the conditions in which people can be healthy, the conditions. And some people don't have those conditions from birth to death, they live in conditions that are not conducive to good health.

And so part of what we do together is to try to change those conditions. So it's not just about medical care. It's about creating conditions where people can live healthy lives. Now, as many people remember that as Surgeon General, one of the first things I did was to develop the Surgeon General's prescription. And the things on this prescription are pretty simple. moderate physical activity at least five days a week, 30 minutes a day, eating at least five servings of fruits and vegetables, avoiding toxins, including tobacco.

So those are the kinds of things, responsible sexual behavior, daily participation in relaxing and stress-reducing activities. So I don't believe that health care or good health is just a system responsibility. I think it starts with individuals, but somebody needs to educate individuals. Do you think we're doing an adequate job at that educational process? No, we're not. I mean, it's one of the weaknesses of our system. And I think in the system, we're often rewarded because we don't do a good job.

I guess during the time that I was Surgeon General and really before, people heard me talk about that our system of healthcare created disparities in health. And so the whole issue of eliminating disparities became a big issue starting in 2000 when we released the plan, the Healthy People 2010. But that commitment to closing the gap to eliminating disparities in health was based on the fact that we felt that these were disparities that we have to create. Now, when we talk about COVID-19, it's very clear that there are some people who are going to have an experience with COVID-19 that's different from others. And as a rule, they're going to get COVID-19 more frequently, and they're going to die earlier. They're going to more likely to be hospitalized.

And when you look at it, it's mainly because they had risk factors. Health disparities are risk factors. And so go look at the people who are in the hospital. those who have been there, those who died, and what you find is that they came to this pandemic, if you will, at greater risk than others. So what do you think it will take in terms of leadership, in terms of motivation, in terms of action? What kind of actions are going to be able to change these disparities? Well, number one, I think as a rule, systems in this country operate.

effectively when desired behavior is rewarded. And we certainly need to do a better job of rewarding people who serve valiantly on the front lines of health care to not just keep people alive, but to keep people healthy. When I say reward, I'm not just talking about money, reward people who do a good job on the front line of health care. people who are often completely ignored, neglected, front-line workers who, with a little help, would keep many more people alive. And yet even without that help, they're doing a great job.

So frontline workers, nurses, I, you know, I know that physicians don't like to think of nurses as being at the leadership of the health care system, but nurses really, not just in the hospitals with our COVID patients, but in many other settings, nurses serve valiantly. And they die because of this kind of service that they provide. And we've seen that in this pandemic. What about training physicians to better understand what these other factors of health are? Well, I think that that's sort of where it begins for me. I think I went to medical school already feeling very strongly the obligation that physicians had. And for me, it goes back again to Dr. Jackson,

it goes back to knowing that if physicians were on the front line of care, and they took risk and more and more, we would see people who don't have access to care, getting access to care, quality health care, So I think physicians have a leadership responsibility, and that's not to say that all of the leaders in health care should be physicians, but it says that physicians have a leadership responsibility when it comes to health and health care. One that we haven't always carried out, and that should change. And what do you think of the current state of COVID leadership in this country?

Well, COVID has been one of the major challenges that we face. Now, the question becomes, you know, when there are pandemics, how do we respond as a global community? Because pandemics are not the challenge to any individual country. Pandemics, they don't have boundaries, so they spread rapidly. So we're really fortunate, given the systems that we have in place, We're fortunate that more people have not died from this pandemic and hopefully few people will die in the future. But despite all of our resources as a global community, we're not committed to working together in such a way. We're fighting, but we're not figuring out how to work together to prevent the spread of Delta and Omicron.

And that's what we have to do, that we're going to make sure that we're not suffering from a new pandemic every other year. This is going to take cooperative effort to lead us into a healthier future. You mean, in other words, we need to be spreading vaccinations and health care to other countries as well as our own? Almost definitely. And I commend the administration and others for the extent to which we have made vaccines available to other countries. We can do better, but certainly we have seen our responsibility. We have made vaccines available to countries all over the world, Africa. There's no debate about the fact that we need to make vaccines available. The debate is more, why is it that certain people

won't take them? And that's because we don't trust each other. Wow, that's a big issue you just brought up. Trust. Trust. How do we restore trust? Dr. Satcher. If I had the answer to that, then that's what I would be doing all the time. But I do think it's the appropriate question. How do we restore trust? We have a lot. I mean, we've been entrusted with a lot in terms of resources.

And the question is, then how do we use those resources to make the world a better place where people trust each other can work together? You've spent a whole part of your life or a great part of your younger life and later life trying to solve the distrust problem. The distrust people have for maybe their community leaders, the distrust they have for equity. I mean, distrust is a very difficult concept to overcome, isn't it? It is. I think there are also a lot of reasons for people to trust each other because some good things have happened. In the book, one of the most difficult stories for me to write was that story about my walking out on the OBGYNR rotation

and then being threatened to be put out of school. You know how hard I had worked to get to that point in my life, all through the cotton fields of Alabama and J.O's in Georgia. And yet, that whole thing was threatened when I walked out. You tell this story in your book, and I think this is instructional about your leadership, about how in medical school you walked out of an OBGYN exam because you felt the patients were not being treated appropriately. I couldn't honestly do anything else because I can't say I have to participate in the mistreatment of patients because I want to be a doctor.

I did want to be a doctor, but I couldn't do that. You know what happened after I walked down and was told to go to Cedar Dean the next day and with the implication that I was going to be dismissed from school. Later that day, somebody, and I'm embarrassed that I can't tell you the name of that student, called a meeting of the other students, nine other students. And they decided to walk out also. They decided that if it were inhumane for me to do it, and they agreed that it was, that it was inhumane for them to treat patients that way.

And so by the time I got to the dean the next morning, he said to me, David, do you know what happened this morning? I didn't, and he told me the other students that walked out. Then he told me that the school was going to change the practice. He said, we were right, and the school was going to change. This is Science Friday from WNYC Studios. What do you think that you inspired in those students to walk out with you? Well, if I just assume that because I grew up in poverty, because I've been to jail and prison, fighting for rights, that I'm the only one who feels that way.

So what those students proved, and it could have been just one or two students who provided the leadership, I never analyzed how did it happen. I just know that they came together and decided that if I was going to be put out for walking out, they were going to join me. And I don't know. I just think that we often underestimate people. And I believe that we have to trust people to be their best selves. One final question for you, doctor.

Over the last 10 years, I know you've become involved. You're right in developing the Satcher Health Leadership Institute at the Morehouse School of Medicine. Give me an idea, if you can, of the goal of that institute and your work there. Well, first, I mean, I was concerned that not enough support is being made available for leadership development. This quote tells you a lot. And it is the Satterhead Health Leadership Institute's quote. when we talk about the kind of people that we're trying to help develop, we need people on the one hand who care enough. We believe that caring is the first need that we have for leadership development.

Secondly, people who know enough, and we hope that here at the Sightiel Leadership Institute, we can help to provide people with a base of knowledge that will help them to be better leaders. we need people who have the courage to do enough and that gets back to that experience at Case Western and people taking chances and many of them didn't even know me personally but when they heard the story they said they agreed and finally we need people who will persevere

until the job is done. Perseverance is critical because nothing like this is going to happen overnight. Martin Luther King Jr. knew that. And in fact, he didn't think it would happen in the 40 years that he lived. And so he didn't go into this thinking that one day there was going to be a celebration. He was going to win another Nobel Prize. Now, he went into it knowing that he was probably going to be killed, and he was.

Well, Dr. Satcher, I want to thank you for your life's effort and for taking time to be with us today. And good luck to you. Thank you very much, Howard. Dr. David Satcher, former Assistant Secretary for Health, Surgeon General, Director of the Centers for Disease Control and Prevention in Atlanta, Georgia. His new book, My Quest for Health Equity, Notes on Learning, While Leading, is out now on paperback, and you can read an excerpt from the book on our website, ScienceFriday.com slash health equity. And that's about all the time we have for this hour.

Here's Diana Montano, with some of the folks who helped make this show possible. Thanks, Ira. Kyle Marion Viterbo is our community manager. Danielle Dana is our executive director. Wendy Coonrod is our stewardship manager. And I'm Diana Montana, Experiences manager. Thanks for listening. Thank you, Diana. B.J. Leatherman composed our theme music. And of course, if you missed any part of the program or you would like to hear it again, subscribe to our podcasts. Have a great weekend. I'm Ira Flato.