The David Pakman Show - 12/19/23: Republican not sure about women voting, Rudy Giuliani sued AGAIN

Episode Date: December 19, 2023

-- On the Show: -- Anupam Jena, physician, economist, professor at Harvard, and host of the Freakonomics, MD podcast, joins David to discuss his new book "Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health" -- Republican Congressman Guy Reschenthaler collapses under simple questioning about the Joe Biden impeachment inquiry from Democratic Congressman Joe Neguse -- Rudy Giuliani is sued a second time by the same plaintiffs from the recent $148 million verdict because he continues to attack them publicly -- Jason Whitlock, a right winger who happens to be black, says that it wasn't really necessary for women to vote -- Former Republican Congresswoman Liz Cheney tells the Fox News audience to ditch Donald Trump during a recent interview -- Failed former President Donald Trump reaches a new high in 2024 Republican presidential primary polling -- Donald Trump is confused and treasonous at his recent rally in Reno, Nevada -- Voicemail caller wonders whether lead in water lines could be responsible for the high levels of mental illness in the United States -- On the Bonus Show: 118th Congress has few laws to show in its first year, Clarence Thomas faces more backlash over SCOTUS salary complaints, the Senate hearing room sex tape scandal, much more... 🔊 Babbel: Get 55% off your subscription at https://babbel.com/pakman 💪 Athletic Greens is offering FREE year-supply of Vitamin D at https://athleticgreens.com/pakman 💻 Stay protected! Try our sponsor Aura FREE for 2 weeks at https://aura.com/pakman 💻 Get Private Internet Access for 83% OFF + 4 months free at https://www.piavpn.com/David 🖼️ Aura Frames: Use code PAKMAN for $30 off at https://auraframes.com/pakman 👍 Manscaped: Use code PAKMAN for 20% off & free shipping at https://manscaped.com 🥂 ZBiotics: Use code PAKMAN for 15% OFF at https://sponsr.is/zbiotics_pakman -- Become a Supporter: http://www.davidpakman.com/membership -- Subscribe on YouTube: http://www.youtube.com/thedavidpakmanshow -- Subscribe to Pakman Live: https://www.youtube.com/pakmanlive -- Follow us on Twitter: http://twitter.com/davidpakmanshow -- Like us on Facebook: http://www.facebook.com/davidpakmanshow -- Leave us a message at The David Pakman Show Voicemail Line (219)-2DAVIDP

Speaker 1 Sometimes the simplest questions can actually give us the greatest amount of information about whatever we're trying to figure out. And in this case, I'm going to show you an example of that where Democratic Congressman Joe Neguse is speaking to Republican Congressman Guy Reschenthaler. And this is all in the context of the building desire for the impeachment of President Joe Biden by Republicans. They've officially launched an impeachment inquiry strictly along party lines, including many Republicans who just years ago when it came to Trump said we should never have a single party impeachment. We should

never see one party in one party alone abuse the impeachment power when there is no bipartisanship whatsoever. And now they are doing exactly that. Not a single Republican voting the other day to move forward and formalize this impeachment inquiry against Joe Biden. And yet they love throwing around words like bribery, criminality of high crimes and misdemeanors. And yet when they are asked the simplest questions, do you have any evidence? Well, we're looking for the evidence. What crime are you investigating? That's why we need the inquiry, etc. It all collapses.

Take a look at this super simple question asked of Republican Congressman Guy Reschenthaler by Joe Neguse. What is it you suspect he did that you're investigating? Sort of like if police say, hey, you you can't leave. You're being detained. Oh, on suspicion of what crime? Well, we suspect you may have participated in a burglary. And if they can't articulate what crime you're suspected of, other than in very specific cases, you can't be legally detained. Take a look at this video. Keep that in mind to the core. I think the question I'm asking you is, OK, what what is the specific constitutional

crime that you're investigating? Well, we're having an inquiry so we can do an investigation and control the production of witnesses. And what is the crime you're investigating? And documents high crimes, misdemeanors and bribery. What high crime and misdemeanor are you investigating? Look, I will once I get time, I will explain what we're looking at. They've had years to explain, years to explain and they criminal bribery. Oh, well, who was the who did the bribing or who was bribed? Well, I don't know the details.

And I will make the equivalency. No, I'm just asking you for the last impeachment. OK, so what I'm trying to say, Mr. Reschenthaler, and again, I say this because I served as a prosecutor during the last impeachment. One of the things about prosecuting is you need a crime. Let me let me explain to you a few things. When we prosecute, we have something to prosecute for. But Mr. Reschenthaler. A former President Trump, there was a specific high crime that he was impeached for on a bipartisan basis. 13 Republicans agreed. During 2019, when President Trump was impeached, there were two very specific offenses he was impeached for.

And I can't get an answer. I don't think members of the Oversight Committee could get an answer or the Ways and Means Committee or the Judiciary Committee. I don't think there is an answer. There's not. And of course, it's unsurprising because according to even Fox News correspondents, House Republicans have been unable to make any kind of connection to a constitutional high crime and misdemeanor and President Biden. So I don't, I would say this, to make the argument that there is some similarity between, and I don't know if this is what you're suggesting, I hope it's not, between the various facts that you've focused and zeroed in on with respect to President Biden and President Trump's conduct.

On January 6th, I just it very clear to me the American people would reject that argument out. Yeah, they don't even know what argument they're making. That's the thing. Joe Neguse is acting as if they're making some specific argument. They're really not. And this is called phishing. Sometimes police do it right. What crime am I being detained under suspicion of? We don't know yet. Oh, so then why am I detained? You're right. Traffic stops. You've got to provide ID. You've got to stay there a reasonable amount of

time until the officers. But if you're just approached randomly and you are now detained on suspicion of what crime and they don't care what this would sound like if they had something. It would be well. After Joe Biden became president, he removed a regulation that affected only two Ukrainian companies, both of which had Hunter Biden in their employ and Hunter Biden kicked back some of the money to Joe. And here are the receipts. That would be a specific allegation. They don't have that. They go, well, Biden benefited. Joe Biden benefited from helping Hunter Biden and then getting kickbacks. Any proof? No, we need the inquiry in order to look for that proof. Well, so then why is it that you believe that's the case, given that you've been looking

into this sort of thing for years now? The timeline is all jumbled. It's it's, you know, a verbal inkblot when they try to explain it. Joe Biden did this as president, but the dates are when he wasn't president. Well, but he was running and he was VP. No, he wasn't VP at the same time that he was running. The timeline is jumbled. The facts are nonexistent. The evidence is imaginary. But if they could at least articulate something, then we could very easily say, oh, there is or is not evidence evidence to support that because they know they don't have evidence. They will never articulate it as specifically as Joe Neguse tried to get Guy Rushin Thaler to do. It's fishing. They have nothing. And at the end of the day, maybe they have nothing because Biden didn't do anything wrong.

Speaking of people who did things wrong, Rudy Giuliani is getting sued again by the same people who were just awarded a hundred and forty eight million dollar defamation verdict. Rudy appears completely unable to control himself. Take a look at this. Former Georgia election workers sue Rudy Giuliani again, asking judge to permanently stop him from lying about them. These are the same people. It's not other people. Ruby. This is CNN. Ruby Freeman and Shea Moss, the two Georgia election workers who won nearly one hundred and fifty million dollar verdict against Rudy on Friday, have sued him again, asking a federal judge to permanently prohibit Rudy from lying about them. This lawsuit comes as Giuliani continues to make false

statements about their work as absentee ballot counters in 2020. This is the new lawsuit. It says, quote, defendant Giuliani continues to spread the very same lies for which he has already been held liable. Defendant Giuliani's statements, coupled with his refusal to agree to refrain from continuing to make such statements, make clear that he intends to persist in his campaign of targeted defamation and harassment. It must stop. So this this is now a new lawsuit. He lied about them again within 15 minutes of that hundred and forty eight million dollar verdict. Now, he can't pay one hundred and forty eight million regardless. This we know his finances are not such that he can do that. I don't know that we know that Rudy Giuliani is broke, but he's not exactly flourishing financially at this point in time. Maybe Rudy's view is I I can't pay any of

this stuff. The only punishment they could give me is jail time, which maybe will come at a certain point if he's held in contempt. I'll just keep talking about them, saying exactly the same stuff that was found to be libelous. He's now saying it outside of the very courtroom where a jury said, oh, you owe damages because of the things that you've said. He went on Newsmax also, and he was interviewed by Rob Schmidt and asked again, do you believe the things you said are true? He goes, oh, yeah, they'll sue me again. But the things I said are absolutely true. And indeed, they are suing him again. Then it. Do you do you like that? Do you like that? What about your your your your your allegations, your initial allegations? You still believe them to be true? Yeah, well,

of course, they'll sue me again for it when I say that. But yeah, I do. But they want me to. They want me to lie. They basically they are suing me in order to lie to them. I'm sorry, I can't do it. He's just too honest to ever tell a lie. No problem running around the country lying about how Trump won in the aftermath of 2020.

Speaker 4 If if I showed you the evidence right now, and I think you've played it on your air, people would see that what I said was absolutely true and their support for it. And the most important thing is doesn't have to be absolutely true. Has to be supportable. They have to prove that I was deliberately lying, which I wasn't. I had all this material that I based it on. So I never got a chance to make that defense to the jury. Speaker 1 Rudy is insisting he has tons of evidence. He wasn't allowed to present the evidence to the jury. He's not allowed to present the evidence on Newsmax. One lawyer wrote to me and said,

you know, David, this Newsmax interview is interesting because we are now post judgment. Newsmax is potentially liable here by allowing Rudy. But first of all, by setting Rudy up with these softball questions and then by allowing Rudy a platform to uncontested insist that the defamatory statements were true. This is not there's been no judgment. Maybe it's true. Maybe it's not.

Rudy Rudy Giuliani statements have already been found to be defamatory by a jury. And one hundred and forty eight million dollar verdict has been indicated here for the argument that this lawyer is making, who wrote to me, is that for Newsmax to now air this stuff unchallenged opens them up to a defamation lawsuit as well. Now, I mean, I said this yesterday, but I'm going to say it again, because if you look at the YouTube comments, you look at the X excretions on X. It used to be Twitter. Now it's X. You see what people are saying about what we're talking about here. They're insisting that Democrats have criminalized speech. First of all, this has nothing to do with

Democrats or Republicans. Many if you look at all of these different defamation cases, Fox News and all these different ones that we've been talking about, the judges are a mix of partisan backgrounds. Some of them are right wingers. There is no criminal aspect to this. Defamation is almost always a civil matter. The reason we're talking about one hundred and forty eight million dollars rather than three years in prison for Rudy is because we are talking about civil matters, not criminal. So no one has criminalized speech. This isn't a criminal issue. It's not Democrats.

And importantly, there are limits to so-called free speech. Democrats didn't invent them. Defamation law has existed for a very long time in the United States. And much like their now supposed concern about the conditions of pretrial detention in the United States. Why do they care about that? Because there's a bunch of Trumpist rioters sitting in jail waiting for trial. They never cared about the conditions of pretrial detention before. Now they suddenly do. They never cared about defamation law before.

Now they suddenly do because so many of their ilk are regularly making defamatory statements. What ultimately happens with Rudy? Do they get any money out of him? Does he end up being held in contempt for not paying? I have absolutely no idea. But Rudy sued again and he seems unable to learn from mistake after mistake after mistake. And the big mistake obviously was attaching his cart to the horse known as Donald Trump. Not exactly a powerful stallion, but a horse nonetheless, at least figuratively. That was really quite a mistake.

Let's take a very quick break. We have a whole bunch of different things from all over the country to talk about today. So glad you're here. Quick break. We'll be right back. No matter your genetics or lifestyle choices as humans, we all share some basic foundational nutritional needs and properly replenishing your nutrients daily is important for gut health, stress management, immune system. And that's where our sponsor AG1 comes in. AG1 is a foundational nutrition supplement. It supports your body's universal needs with something that you can easily absorb and utilize. So instead of a multivitamin or fumbling around with 10 different vitamin bottles, I've just replaced all of it with one scoop of AG one.

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It takes just a few seconds to use the aura free trial to find that out. That's a u r a.com slash Pacman. The link is in the podcast notes. In case anyone was wondering, David, is your program funded by some rich Democratic donors or something like that? The answer is no, it is not. It is actually funded funded by some rich Democratic donors or something like that? The answer is no, it is not. It is actually funded directly by people in our audience.

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We have members only town hall events, all these great things. And it happens at join Pacman dot com. It's very cheap. We're talking about a few dollars a month, but you can cut that price down if you want by using the coupon code two million to celebrate reaching this two million subscriber milestone on YouTube, which is an extraordinarily exciting thing. Consider, consider nobody's obligated here. Nobody's under duress. Consider getting a membership if you like what we're doing. I'm going to play a video for you from this T.P. action turning point USA event that's been going on the last few days in Phoenix, Arizona. And I'm going to show you this clip because it is so relevant and emblematic to what the

American right wing has become at this time. We used to have debates between left and right about things like should the top tax rate be where it is? Should it be higher or should it be lower? That was a big debate at one point between left and right. Or, for example, to what degree should United States use foreign policy to try to spread what we believe is the best system of government around the world. That was a debate that was had. We now have such a disconnect where the debate is on the left.

Hey, maybe the top tax rate should be higher. And on the right, maybe women shouldn't have the right to vote. I'm not kidding. Take a look at this video. This is the blazes. Jason Whitlock. He's a black man. And that's relevant here because he went on stage and said, you know, it's not really necessary for women to vote. Maybe just one vote per household like it used to be when only men could vote or whatever. You know, maybe we don't need all these different groups voting. And it's particularly disturbing when his group, black folks, were once denied the right to

vote. And then once they were three fifths of a vote. And this is where the right is. And anybody playing the both sides game needs to have a rude awakening. This is what the right has become. Take a look at this. And so they have recreated this history that, oh, God, it was all just sexism. And we didn't have the right to vote until Susan B. Anthony and the women's suffrage movement. And I will defend life before suffrage because of both used to represent the family when we were a culture that really what he means is when only men could vote, each family got one vote as represented by the one man in the household. Value family and really understood the natural order that God intended. Man serving God, woman following man who serves God, man and woman developing and nurturing

children. You only needed one vote per household because that vote was about the entire family as they have destroyed our family structure and made this all an individual pursuit. Women getting to vote themselves as part of the destruction of the family and toxic individualism. Quite an argument, huh? Quite an argument. Now everybody has to have a vote and everybody has an agenda that a lot of times has nothing to do with family. The risks and the sacrifices that men made for the advancement of this country and for the benefit of all of us. These are the stakes in 2024. Now, of course, we could say to Jason

Whitlock, why stop there? Maybe go back to when only landowners could vote. Should everybody's vote count as one? There was a time when black folks vote counted as three fifth. We could go back to other things if the point here is not everyone needs a vote. Let's figure out who the real stakeholders are. But those are disgusting conversations to have. This is what is on the ballot in twenty twenty four. They aren't hiding it. So anyone who is playing the well, you know, I mean, people on the left are making their

arguments for what they think makes sense and people on the right are making their arguments for what I think makes sense. A third of this country wants an overtly Christian version of Sharia law to become a dictatorship and they believe they are more entitled than anyone else, especially those who disagree with them to dictate how this country is going to function. So for those who are saying, I don't love Biden, I might just stay home. This is what's on the ballot. You might not like Biden, but Biden wants to improve access to health care. Biden has done more student loan forgiveness than any president in history.

Joe Biden is overseeing to whatever degree presidents are responsible or not. Joe Biden is overseeing an extraordinary economy. Have you seen what's happening with unemployment, inflation in the stock market lately? Has anybody seen what's going on? And then on the right, they're arguing about was it good for women to get the right to vote or not? I don't know. Should abortion even be legal at all or and if not, who should go to jail? Should it be the women or the doctors or the fetuses or everybody who should go to jail? Right. This is what is at stake right now.

It is lunacy. What is taking place? And the right is welcoming this stuff with open arms. There are a handful of Republicans prominent who seem to be sane. MAGA doesn't want to hear from them. We're going to hear from one next. Liz Cheney appeared yesterday on Fox News, former Republican congresswoman Liz Cheney. By the way, I know that, you know, the sins of your father are not your own. Dick Cheney, her father as vice president, participating in one of the greatest expansions of surveillance, warrantless surveillance on

Americans starting multiple wars that didn't make sense. You know, Dick Cheney disaster. Liz Cheney agreed, at least at the time, with much of what he was doing. So Liz Cheney is no is no angel, but she had what is considered the audacity today to say, oh, yeah, Joe Biden won. And if you lost, you shouldn't try to steal the presidency. Liz Cheney went on Fox News last night and she tried to urge Fox News viewers, which is not an easy crowd to convince, to ditch Trump. Brett Baier correctly mentions to her the polling is really good for Trump. We're going to look at that polling in a bit.

Good for Liz Cheney. I don't think she's going to get very far with this audience. Take a listen. If you look at the polls, he is up 63 percent to his nearest rival, 12%. In Iowa, the Des Moines Register, 51%. You keep on going down state by state. What is not getting across if your message is so urgent on these other channels and other places? What is not happening to the electorate to see that? Well, I think you're actually seeing some movement.

There have been other polls out today that show some movement among some of the other candidates. And look, what I would say to Fox viewers, and I worked here for many years, as you know, and the race today presents a number of candidates, Republican candidates, who will abide by the Constitution. And you can have the policies that we all want, the policies, some of which Donald Trump put into place, some of which he didn't. We can have conservative policies without having to torch the Constitution. And so what I would urge people watching today who are going to be voting in those caucuses or in those primaries, vote for somebody else. Well, they don't want to hear it. And we're

going to prove it with numbers in a moment. She's making perfect sense. It's a beautiful message for Fox News viewers. They don't care. Do it. And we're going to prove it with numbers in a moment. She's making perfect sense. It's a beautiful message for Fox News viewers. They don't care. Do not vote for the person who already tried to seize power. You lost your primary to Harriet Hagman two to one. And she said Liz Cheney has never been in touch with your average person. In 2019, AP said, of Liz Cheney says Democrats for over two years have peddled falsehoods and made one scurrilous claim after another involving Trump and Russia. Cheney says in the statement, it's time for

Democrats to put aside their partisan agenda of attacking Trump and focus on real issues. What do you say to critics who say, listen, all of this, even after you look at January 6th, all of this is about going after Donald Trump and that his policies, if you look at January 6th, all of this is about going after Donald Trump and that his policies, if you look back to his four years, are something that they want. So there are voters who obviously feel that way. Yeah, so I would say a couple things. First of all, I won my primary by 70% of the vote.

I could have done that again if I was willing to lie about what Donald Trump did. I wasn't willing to do that. I voted against that impeachment that you're talking about. The first impeachment I voted against it. But this was different when you have a president of the United States. All right. So you get it.

She's pointing out the obvious, destructive and corrosive nature of what has happened. And she's saying Republicans shouldn't support it. She's basically wrong about the polling movement. It is true that there's a new poll in New Hampshire that shows Trump in first place, but not by that much. But he's still in first place in New Hampshire. And what we are going to look at next is despite the obvious red flags about another Trump presidency, the guy is leading by more than ever. I have stunning numbers to show you. Donald Trump has reached a new record high in polling for the 2024 Republican primary. This do not adjust your television. The purple line at the top of your

screen is indeed at the highest point since this primary began. Donald Trump is now polling 62.9, call it 63 percent in the Republican primary. He is the one benefiting from other Republicans falling off here. Pence bails, Tim Scott bails, et cetera. Trump is polling 63 percent and everybody else is sharing the remaining 37 percent. By the way, DeSantis and Nikki Haley are now essentially tied. They've been they've been tied going back now about 10 days, right around 12. By the by the time this is over, as I've said, I believe Nikki Haley will do better than Ron DeSantis.

These are stunning numbers. This is a guy in Trump who says he is going to be a dictator. And I don't mean, oh, I'll be a dictator on day one. I mean, if you just listen to the things he's promising in terms of weaponizing the Justice Department against his political enemies, going after media outlets that he doesn't like, et cetera. This is a guy who has 91 felony counts against him in four criminal trials and is going to spend much of 2024 maybe going to rallies, but going between multiple criminal trials of his where any

sort of sentence would be a de facto death sentence for Donald Trump. And he has more support than ever. Now, there's another element to the polling that I think is important to mention. And many of you write to me about it. And I have no interest in hiding this from you. If you look at general election polling today, which says if the nominees were Trump and Biden, who would you vote for? A lot of it looks very bad for Joe Biden. I'll give you some examples. Oh, David, you're hiding the polling. I'm not hiding the polling. Here is the polling.

Harris X poll when it's Biden versus Trump. It has Trump plus six. When you include the additional third party candidates, it goes to Trump plus eight. That's a bad number for Joe Biden, without a doubt. When you look at the YouGov economist poll, they have it tied. When you look at the Ipsos Reuters poll, it's Trump plus two in a head to head matchup and Trump plus five when you include Robert F. Kennedy Jr.. So there are some not good polls for Joe Biden here. I would continue to urge caution. And the reason I'm urging caution is we don't even have official nominees yet. We don't yet know what the state of the economy will

be in November. But if it's like it is now, it's generally speaking, an environment in which incumbent presidents get themselves reelected. We don't know what's going to be the situation with Trump criminally and legally at that time. And in many of these head to head polls, for example, in the YouGov economist poll, it's Biden 43, Trump 43. That adds up to 86. That's 14 percent of the electorate that is elsewhere. OK, so there may be a time to panic for now.

Let's make sure we're registered. Let's make sure we plan to vote. Let's be talking to everybody we know who has a good head on their shoulders about the importance of voting, because if they don't, it will eventually come back and lead to what we saw in 2016. Trump gets three Supreme Court picks, abortions gone, etc. OK, let's be clear about the consequences. It is not time to panic. It is time to vote. And we'll have more time to talk about that for sure. Using the Internet without a VPN can open you up to all sorts of issues.

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MD. Really great having you on. I appreciate it. Thank you for having me. So maybe to start with, you know, so many of your episodes will take a specific question, a medical question or an aspect of medicine and do sort of a deep dive into it to make the first kind of topic general. Are we getting better at getting definitive answers when it comes to a lot of these questions in the following sense? It seems as though even

when we talk about randomized controlled trials, long term studies, longitudinal studies of trials that have been done. There's always this feeling that, OK, is the result we're getting influenced by randomness, a factor we're not considering when it comes to diet questions? Is it the addition of something or the elimination of something else that we're maybe not correctly tracking? You know, you hear this about eggs or coffee or whatever the case may be. You had a great episode on colonoscopy. What what are we getting better in your mind at really getting answers? We can be very confident about with a lot of these what's best for human health or are

we not really there yet in your mind? So I'd say we're not really there yet. And I think we're getting better in a lot of respects, and we're getting worse in some other respects, or at least staying status quo. So the places where we're getting better is where we actually have high quality evidence. So you use the words randomized controlled trial. It's when you take a bunch of people who have a medical condition and you randomize half of them to get a treatment and half to get another treatment or maybe nothing at all. And that allows you to say with some certainty whether or not this treatment works. Does it have a cause and effect relationship with the outcome we care about? So those types of data are very good. We try to make most of our decisions based on that kind of information.

But what you hear about in the news, what we read about in medical journals is often not that kind of information. Rather, it's what we call observational data. It's relationships that we're just observing based on who is using a treatment, who is drinking coffee, who is drinking red wine, and people who aren't. And those kinds of data, I think, are very much at risk of leading us down the wrong path. And probably the most, I mean, the best example of that kind of work is in nutrition. So what are the effects of moderate amounts of red wine, moderate amounts of alcohol, dietary things? That kind of literature is, I think, very suspicious in my in my own view.

There are movements that are taking over social media platforms at this point when it comes to nutrition and the connection to health and longevity. There's been, you know, the carnivore diet people. There's the seed oils are inflammatory and you should never have canola oil. And if you have only olive oil first press, ideally you're going to live 10 years longer. And then there's usually some blowback where it's, Hey, you know, it's based on like a Petri dish study. It seems that in humans, canola oil may actually be anti-inflammatory. And then there's, there's like a counter to that.

Is there, what's your advice in terms of minimizing the noise and increasing the signal when it comes to all of these fads and trends that we start to see? You know, I would I don't personally put a lot of weight on those kinds of studies. I mean, I think basic things like eating a somewhat healthy diet, fruits, vegetables, proteins, some carbs, and a healthy amount of exercise and activity. Those things I think are very reasonable, and there's good general evidence for those sorts of things. It's really in the fringes, but I won't even call them fringes because it dominates what we hear about, where I think the evidence is really not very strong. And so long as you're trying to

do those two things right, like generally eat healthy, generally be active. That's where I think we have good evidence everywhere else. It's really not something I put a lot of weight on. There seem to be sort of two movements that have a bit of attention right now when it comes to health and longevity. On the one hand, there's the movement that's about adding stuff. It's what about starting to take NAD? What about taking metformin? What about over overloading on blueberries because of their supposed effect? Right. So it's the ad. You need to find things to add. Another movement is about we actually want to not necessarily take away, but maybe simplify. Right. Let's let's just keep out certain things, keep out ultra processed foods,

avoid a sedentary lifestyle, et cetera. I don't I'm not asking as if you have a definitive answer and it's hard to predict these things. But from what you follow, do you believe that the path to a predictably better health span, as we might call it, is going to come from finding stuff to add or simply from avoiding things that are damaging? Well, first, let me say I got a couple of supplements I'd like to share. No, I'm just I think it's probably a little bit of both. And you had a really interesting insight just a moment ago. When you add something, you're sometimes subtracting it as well. So you can't separate whether it was the addition of something versus the subtract to subtract aren't sort of the sexy things. I'd

say, you know, you want to subtract high-fat, high-calorie foods. That's a natural thing to subtract. Not completely, but to some extent. Adding things like exercise probably matters. You know, there's a lot of studies that look at the relationship between walking and exercise and outcomes, and there certainly is some causal effect of exercise, but it's probably not to the level that we see in some studies because people who have time and the ability and the interest to exercise are doing a lot of things differently for the health. Right. And you can't figure out whether it's the exercise versus everything else that they're doing. So I'd say there's probably a little bit of both going on, adding and subtracting.

I want to talk a little bit about the role of, I don't know if we would call it chance or odds or sort of coincidence in this entire conversation. I think everybody has heard stories of exercised every day, ran a 5K once a month, ate a perfect diet, whatever perfect is in the mind of whoever's kind of analyzing this. And yet something happened to them, rare disease or early death or whatever the case may be. What is in your mind, especially since you're both a doctor, but also an economist who might answer some of these questions at a population level, what should be the role of chance and randomness in thinking about a lot of what we do as individuals with regard to health and

also with regard to health policy? Good question. I think there's two answers. First of all, is that none of the things that we think help us are necessarily cures. So even something like a vaccine, a vaccine, which for, you know, a good vaccine, which we think might help prevent disease, it might not completely prevent disease, but it will reduce the likelihood that we die from it or that we get hospitalized from it. But it doesn't completely prevent us from the exposure and some consequences of it. And the same thing is true, like you just said, of immense amounts of exercise and a really healthy diet. It will improve your probability of living a longer, healthier life, but it doesn't guarantee that for all the sort of reasons that you described.

Some would be totally random, like getting hit by a car, maybe a genetic predisposition to something. Those things are kind of out of our control, but they do help. The second thing is, and in the book, Random Acts of Medicine, we talk a lot about how chance affects our lives, but it also teaches us something. So, for example, we've been talking about diet. There was a really interesting study that I talked about on the podcast as well, where these researchers looked at this policy towards sugar intake in the United Kingdom around World War II, I think it was. And basically, there was a rationing of sugar for some period of time for war purposes. And what they found was that these cohorts of people who were born around that period of rationing, they got exposed to less sugar early in their life. Two, they were less likely to use large amounts of sugar later

in their life, in part because they hadn't probably built that interest in sugar from an early age. And then three, they had less problems with things like diabetes and other inflammatory medical problems later in life. So that's a nice way that chance allows us to understand something about what works and doesn't work in our healthcare. By the way, when we look at something like that, do you feel that that sort of study actually accounts for all of the factors that would influence such a determination? Or is even a study like that missing some of the things that might be crucial to know to be able to say, hey, here's what's actually better to do?

Great question. So I think that kind of study is better than one where we just look at people who eat a lot of sugar and people who don't, because those people are different in so many ways that you can't possibly control for all of the things that you might be able to observe and all the things that you can observe. What I like about the kind of study that I just described, which is, we call that a natural experiment, is that you can directly look and see whether the cohorts of individuals who are just by, you know, by when they are, then the only difference between them is that one group was exposed to limited amounts of sugar and the other one wasn't. The other group wasn't again, arguably by chance. But even those kinds of studies are perfect because you might pick up other differences between the groups, in which case you would be worried about saying

something about cause and effect. Speaker 1 Thinking now with your medical knowledge, but as an economist, what are the sorts of large sort of interventions or campaigns that are most effective? And when we think about things like, well, we could ban sodas of a certain size, right? Or we could have money into an anti-smoking awareness campaign. Or what about making vaccines free at the point of injection rather than whatever. Right. Include any sort of population level intervention that could be done. What sorts of things do we know have the biggest impact? That's a great question. So I would say the following.

I think the things that have the biggest impact are the things that make it easier for us to do what we want to do. And I'll give you two examples of that. So the first is we've been talking about diet and exercise and health. There are these new medications that many of your listeners have probably heard about that are being used for diabetes, but also for weight loss. Now it turns out losing weight is really, really hard to do. So if there's a medical technology that allows you to do something that is otherwise really hard to do, that's very valuable. And there's obviously a lot of interest in people to use that. What are the long-term effects and outcomes?

That's harder to know. But that sort of technology, I think think is very valuable because it reduces the barriers to achieving what we want to achieve. The second example would be related to cost. So we spend a lot of time in health policy thinking about what are the costs of care. Insurance reduces the cost of care. Making drugs free, making vaccines free reduce the cost of care. But what we know from a lot of studies is that even when you make something free for somebody, they're still not that likely to use it. So there's a famous study about heart attack patients, which showed that even when heart attack patients were given medications for free, 50% of the time they weren't taking the medications

that they're supposed to take after a heart attack. So that tells you it's not the cost of the drug that's the barrier. Maybe it's the feeling that I have a medical condition and there's a stigma that you internalize there. Maybe it's the cost or the time cost of going to the pharmacy to fill the prescription, the mental energy required to remember to take the prescription. So anything that reduces those barriers, I think, is much more substantively impactful to improve health than focusing on the dollar cost of whatever intervention we're talking about. Yeah. If we continue thinking a little bit about health care through an economic lens, there's sort of a unique reality about health care services when it comes to demand, which is extreme inelasticity in a sense. And the discussion I've had with my audience before is before I started having appendicitis,

I was completely insensitive to the cost of an appendectomy with regard to my interest in it, whether it was 30 grand, a thousand bucks or even free. I didn't need one. So I had absolutely no interest in it whatsoever. At the point at which I started experiencing pain and ended up at the hospital and I was told you're having appendicitis. At that point, I was also in a position that is very unlike most markets and supply and

demand, which was now I don't even care what the cost is. I need an appendectomy and I need it very, very soon. This seems unique to medicine and to health care. And thus, it seems logical that we would evaluate the health care industry and market and health insurance differently. There are those who want to say it's just supply and demand and we should basically open the door and think about it like cell phones or airline tickets. And there are others, including people like me, who say, no, no, our policy needs to be different because of this difference in in fundamentally how it works. Can you talk a little bit about that and

what sorts of considerations are important when you have this sort of inelastic demand situation? Yeah, I think, you I think both groups are right. And you focused on a very natural situation, which is where there really is no option but to treat it. So if someone has a life-threatening heart attack, they're going to want to get care at really any price. But it is the case that if you have chest pain, you're at home, you have chest pain, your likelihood of going to the emergency department might depend on how generous your

insurance coverage is. So you may not even go or you may delay going until the point that your chest pain is so severe that you're like, I have no other option. So I think you're both right. So at the point where you're in dire straits, you're in need of a medical intervention, people will tend to be less sensitive about the cause. But at other points, they might be more sensitive.

And we see this, for example, for chronic disease medications. For some chronic disease medications, people tend to be more elastic. In other medications, like cancer medications, they may tend to be more elastic. In other medications, like cancer medications, they may tend to be less elastic with respect to price because in that moment, they prioritize so much getting treatment. And so from a public health perspective and a what should health insurance companies be required to do sort of perspective, what's the approach? I mean, I know that this is a big question and a complex issue, but what sort of principles should be applied when we think about that? Great question. So I think, you know, it really depends on a few things. One is,

what are the interventions that we think work, how much they cost, and what are the barriers people to using them? So there is a movement in health insurance to try to make certain medications free to individuals. And the reason why is because they think that, A, the medications are valuable to the person, it'll improve their health, but it might also be the case that if you make it free to someone, they'll take it and that might lower the other costs of care. So, for example, you're less likely to be hospitalized if your chronic disease is better managed managed so that there is a movement towards making a lot of things free and if you do think about it right it's not like a bag of doritos or a car right nobody you know anybody who's taking a medication they're taking it because they feel like they need to take it not because they enjoy

they derive some utility from taking it so your your points that I would totally agree with. The other thing that's a little bit different about insurance is that there is this recognition now that one reason why insurance companies might charge co-payments out-of-pocket costs to people is because they might want to use that as a form of selection. A health insurance company wants to, from a financial perspective, try to attract healthier enrollees because they cost that insurance company less. One way to do that is to say, all right, well, if you have this medical condition that's costly, we're going to charge higher out-of-pocket costs for that. And by doing that, they would dissuade those types of enrollees who may have higher costs from choosing that insurance plan.

Now, from a societal perspective, that's not what we would want, but I could see how that kind of thing might unfold. Speaker 1 100 percent. And I guess that would be the argument to say the profit motive should be removed altogether, which is a whole other conversation in terms of approach. And we would have to it's a different conversation, but that would be an argument to say when it comes to cell phones, that's fine. When it comes to health, some would say we should be removing that motivation altogether. Yeah. Yeah.

I mean, I think that, you know, people will differ on that because it is the case, I think, that sort of the search for profits may improve quality. And there's a lot of thinking around that overall in economics and also in medicine. But I think the bigger thing I would think about is like, you know, what is it that's going to improve patient care, right? And I think it is the case that for at the point of care, making things affordable, maybe even costless to patients, you might even consider contemplating paying people to take medications because of the other barriers that we talked about. Like, it's just you don't want to take a medication because you don't feel like taking it or it's hard to get to the pharmacy, whatever it may be.

Those sorts of things, I think, are worth considering as well. We've been speaking with Dr. Anupam Jena, who is the co-author of Random Acts of Medicine and also host of the Freakonomics MD podcast. Really appreciate your time and insights today. Thank you for having me. One of our sponsors today is Manscaped. They make excellent products. You've got the Lawnmower 5.0 Ultra. This is Manscaped's fifth generation body trimmer and groin trimmer. You've got two next gen blade heads, your standard trimmer blade for taking off a little bit of hair, the foil blade for taking off a bunch of hair. All of

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A visibly confused Donald Trump had another cultist rally that went treasonous in Reno, Nevada the other day. We're going to look at some moments from this and consider the incredible nature of the crowd that loves these absolutely un-American and again, borderline treasonous ideas from the failed former president. Donald Trump told this crowd of cultists in Reno that Joe Biden launched an invasion against the United States and says that what Joe Biden did, I guess, through border policy is as if Joe Biden went to the military and said, please attack the United States.

What? Our border had never been stronger, but then Crooked Joe came in and he launched an invasion against our country. This is an invasion. This is like a military invasion. It is like a military invasion. This is like a military invasion. It is like a military invasion. You know, presidents, past presidents, they can criticize what current presidents do. They often don't. George W. Bush said Obama's president now. It's not about coming in and

criticizing. I know how hard the job is, et cetera. That's a position that one can take. But if you are going to criticize current presidents, you should maybe do it in a way that's not borderline treasonous in the way that Donald Trump is doing. The president launched a military invasion against our own country. What on earth is this guy talking about? Trump continuing to refer to criminals and authoritarians in a positive light, again, bragging that he's been indicted more than the great Al Capone. I don't know. I hear different stories that anybody ever hear of the great Alphonse Capone, Al Capone,

great, great head of the mafia. Right. Mean Scarface. He got a scar that went from here to here and he didn't mind at all, but he was a rough guy. Now I heard he was in. This is crazy, by the way. This is a crazy if you're wondering what is this about? It's just bonkers stuff that it wants. A couple of people told me a few times more, but I was indicted four times and Al Capone, Alphonse, you know, if he had dinner with you and if he didn't like the way you smiled at dinner, he would kill you. You'd be dead by the time you walked out of the nice restaurant, you would be dead. He got indicted

once. I got indicted four times over bull. I got indicted. There you go. It was just complete and total B.S.. Trump now unable to deny that the unemployment numbers genuinely are pretty damn good. His new one is saying that the unemployment numbers when he was president were real. But now you can't trust the jobs numbers. This is a classic move. Denounce the same statistics you relied on when they were convenient as fake when they are no longer convenient. Unbelievable. We're going to cover them. Biggest tax increase in history. When we had we had the biggest

tax decrease ever, ever. By the way, that's a lie. Think of it ever in history of our country. The biggest tax cut, the biggest tax decrease in the history of our country, the biggest tax cut, the biggest tax decrease in the history of our country, the biggest regulation cuts in the history of our country, the best job numbers in the history of our country, the real job numbers, not the fake job numbers that they did. There you go. The jobs numbers now are fake, unable to contend with the fact that unemployment hasn't been this low for this sustained period in 50 years.

Trump is now relegated to saying the jobs numbers are fake. Of course, we've heard this before from these loony right wingers. This is the same way we've measured unemployment for decades and decades. There's nothing special going on right now. There's no particular trick that's being played. Unemployment is just genuinely that low. Trump then bragging about things that can be done with a telephone. And this is when he went into sort of like visibly confused word salad mode. Wouldn't take him back. I got a thing called a telephone. You can do a lot with a telephone.

Right. You can do a lot. I did it with France. They were going to put taxes on American companies. Yep. And thanks to George Santos, who invent invented long distance calling, Trump is even able to call Europe these days. Trump said that Americans who disagree with him politically are more dangerous than the authoritarian leaders around the world. This is the authoritarian dictatorial stuff. You have a different opinion about politics than me. You're just as dangerous as a dictator. This is what we're up against. Fighting against some really vicious people within our country. We have vicious people outside, but I believe truly that the people inside of our country are far worse because we can handle with the right president, in particular, president.

We can handle China, Russia. We can handle North Korea, Kim Jong Un. Right. Right. We can't handle all of these people who disagree with me in the United States, but we can handle dictators around the world, which, by the way, Trump completely failed to handle when he was talking about how to fix the Affordable Care Act. Trump says he did almost fix it last time.

But John McCain, the late Senator John McCain, prevented Trump from fixing it. Not my recollection of what happened. We're going to make it much less expensive for people with much better health care. And we're going to get that done. We almost got it done. But John McCain voted against it. That was a bad day. Remember that thumbs down after campaigning for 10 years?

Thumbs down, everybody. Let's put your thumb down campaign for 10 years on it. And then he put his thumb down. You know, my recollection was that what Trump and Republicans proposed was going to lead to tens of millions of Americans losing health care coverage. That was what the analyses of that plan determined. And then in August of 2020, after silence for years on the matter, Trump told Chris Wallace on Fox News in two weeks,

we will have a new health care plan signed into law. We never heard about it again. And then lastly, kind of capping the xenophobic part of the speech, Trump randomly saying Barack Hussein Obama apropos of nothing coming up to me saying that the Obama administration, has anybody ever heard of Barack Hussein Obama? Remember Rush? Barack Hussein. Remember Rush Limbaugh?

He would talk about Barack Hussein Obama. Oh, yeah. It was so clever when Rush would do the rush, gave him the Presidential Medal of Freedom. He is missed greatly. Yeah. Remember when we just would randomly say who's saying the crowd loves this stuff? The crowd loves it. The crowd wants more Trump. He's got 63% support now in the Republican primary. We must vote to stop that from becoming four more years. That's the bottom line. That's what's at stake. We have a voicemail number. That number is 2 1 9 2 David P. We've been talking a lot about the mental health crisis in the United States. Here's a caller suggesting maybe one element of it. Take a listen to this.

Hello. I just have one quick question. You spend a lot of time talking about widespread mental illness in our country. Yes. And I'm wondering how much you think that has to do with lead in the water. Just from our basically old lead line services and such. Yep. This is not a wild conspiracy theory. You all know that I am very quick to say, hey, this is a conspiracy theory. That's a conspiracy theory. There's no evidence.

There is evidence linking lead exposure, especially in childhood, to mental health issues later in life. There are studies that show that if you're exposed to lead early in life, you can have reduced cognitive function, behavioral issues in children. It extends into adulthood. It can manifest as mental illness. The mechanism that we believe is the one through which this happens is that lead impacts the NMDA receptor in the brain, which affects development, learning and cognitive function. When that receptor is damaged by lead exposure, it then leads to these problems

that in adulthood manifest as mental illness. In childhood, they can manifest as behavioral issues. And so that's a real thing. Now, the next question is, do we still have lead pipes? There is still some lead in our water systems. The EPA is working to get rid of it. But there are an estimated, you know, the number I found is nine million. It might be a smaller number by now, but there are millions of lead service lines. So in your home, presumably there's no more lead. But some of the service lines do have lead. And part of Joe Biden's infrastructure bill actually puts in 15 billion dollars to remove these lead service lines, which is an important thing. So this is important. If you're worried

about this, I recently read something about how despite there being lots of municipal water systems that are lead free somewhere in there, there could still be lead. And so I bought these water testing strips strips. You stick it in the water for five seconds and take it out and then you match up colors. And it was great to see that there is no lead in my water system. But if anybody's curious about this, you can test this super cheap. I think a pack of like 100 of these test strips was under under five dollars or something like that. So just do it. Figure figure out whether there is lead and if there is something that that you can deal with.

We've got a great bonus show for you today. And by the way, lead lead service lines are not the reason for mental illness in the United States. The caller is simply not wrong that that is something that is still an issue in the United States. We've got a great bonus show for you today. Sign up and join Pacman dot com. Look forward to seeing you then.