The MeidasTouch Podcast - Meidas Health, Episode 2: Dr. Gupta and Former FDA Commissioner Dr. Robert Califf

Episode Date: April 6, 2025

In this second episode of Meidas Health, two of the nation's preeminent health leaders join forces for a compelling conversation on the impact of ongoing HHS budget cuts on the nation’s health. Dr. Robert Califf, the recent former Commissioner of the U.S. Food and Drug Administration under President Biden, joins Dr. Vin Gupta, host of Meidas Health, for an action-oriented discussion detailing the many ways these continued cuts to federal health agencies threaten the health and overall well-being of all Americans. Learn more about your ad choices. Visit megaphone.fm/adchoices

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free of charge bet mgm operates pursuant to an operating agreement with iGaming ontario hey mightest mighty it's great to see you again i wanted to share a few words ahead of episode two which i'm so excited to be sharing with you. It's a conversation with recent former FDA commissioner, Dr. Robert Califf. He is one of our nation's leading health officials. He was FDA commissioner under President Barack Obama, and most recently under President Biden. And he's somebody that, where there are very few candidates that could get through a Senate confirmation with bipartisan support. He's one of the few that did it. And so that's why it's really important for him, in my opinion, to be

heard from at this moment. When the FDA is being hollowed out, we're seeing all these cuts to HHS more broadly, to NIH, to CDC, to the committees and the personnel that are guiding our health information, communicating with the American public. They're pretty much all gone. Or there are people that we know have loyalties to the politics of the incumbent secretary, RFK Jr., not necessarily to the science and to the profession where the loyalties should be. And so I wanted to tee up and give you a sense of what to expect with me and Dr. Califf in conversation. We're going to talk about, say, 35 minutes or so. And we're trying to make it real. And I was trying to elicit from him and his expertise, why are these HHS cuts? It may seem self-evident to us, but why are these cuts so impactful to all Americans, to families across the country, to people that may not be thinking about these

issues the way maybe some of us are thinking about them every single day. Why does this impact everybody? And how does it impact everybody from food safety, drug safety, especially as we're moving to secure more foods and more drugs from imported sources? It's important to note that a lot of these HHS and FDA cuts are going to impact personnel and committees overseeing food and drug safety, especially from imported sources. That's number one. Number two, he is effectively, RFK Jr. has eliminated the expertise and the personnel that communicates with the American public on vital health issues. So who's going to do it now? We don't know. You've probably seen

esteemed longtime experts like Dr. Peter Marks, who oversaw our vaccine approvals over the last many, many decades, including throughout the COVID-19 pandemic. He basically resigned in protest and was recently came out saying that he was asked by the RFK Jr. team to come up and present data that was favorable to them on the measles vaccine and somehow linking the measles vaccine to autism. This is from recent reporting from the New York Times and other sources that he was asked to produce that information, obviously, in his own telling, that information does not exist. So he was being asked to invent false information. I think it's important as we see inevitably more and more headlines on these topics and other budget cuts to understand well beyond the headlines, why does this impact all of

you, all of us? Why does it impact if you have children? Why does it impact your children? In an apolitical way, how does it impact maybe grandma and grandpa? How does it impact your healthcare access? We have to start talking about these issues. And when we see enormous budgetary cuts for NIH funding and basic science research, that is impactful when I see that, or maybe when you see that, and you can understand the ramifications. But we have to dig multiple levels deeper and understand and communicate why does that impact every single American, again, who may not be in the healthcare field. And it's important to note that those NIH cuts

on basic science research, research that, by the way, is long-term in nature. You know, Wagovi and Ozempic, you hear all about those drugs because they're all the rage now. They are incredibly, incredibly important. I think they're going to reshape the American healthcare landscape. They're going to hopefully portend a new and different and healthier life for people that have access to them. But it's important to note that 20 years ago, the foundational research that led ultimately to the development of Vigovy, Ozempic, and similar classes of drugs, those new weight loss drugs, was funded by the National Institutes of Health.

Long before any pharmaceutical company saw that research and said, yes, I can do something interesting with that research and maybe make a revolutionary medication. It's important to keep that in mind, that the arc of innovation to get the next amazing medical therapeutic or medical breakthrough can take decades. And by the way, there's no government out there that's going to step in and fill our gap, the gap that we're

creating, that Musk and Trump are creating with their budgetary cuts. There's no private sector company that has the patience or willingness to take on that level of risk. Because remember, it's high risk, but potential high reward, but that risk can be felt over decades. There is no other entity out there that's going to be able to replace the United States government, the National Institutes of Health when it comes to ensuring that your children, that all of us, as we age, have access to necessary medications to fill critical medical white spaces. And I think it's important that every single time we hear about the next headline, because we will all be bombarded with these issues

and these headlines, not just now, but over the next weeks and months, to break it down and distill it as to why this matters to every patient across the country, to every single family. Because that's the through line, I guarantee you, that our leading health officials and those in power are hoping we do not make and keep connecting the dots. They're hoping we don't

do that. Because I'm not sure many of them understand the impacts of what they're doing to their family members. You know, this is not an apolitical, this is not in some way, some sort of partisan issue here, access to basic therapeutics that can fill big white spaces like the treatment of Alzheimer's. That impacts Republicans and Democrats. That impacts potentially mom or dad, whether you're a Republican or whether you're a Democrat. And I'm not sure they understand that. Or if they do, one wonders what's really driving a lot of their decision-making because

they're not making decisions in the best interests of their loved ones. And so as we have this conversation with Dr. Califf, please keep that in mind. That's the goal here. I'm going to be inviting on other leading government officials, both in power right now at the state level,

former officials who've guided policy for our country at the national level. We're going to be having these types of conversations to try to make it as real as possible and to keep you informed. I'll also ensure that we cover the news of the day. If there are issues that are happening that need correction, we're going to be doing rapid response corrections on this podcast. So we're going to be doing those as necessary as things pop up. And then my goal to you is to bring you the nation's leading experts to hold to account what's happening

in Washington so that we all have a voice. Okay. I'll see you on the other side with Dr. Califf. Thank you. Hello, everybody. Excited to welcome you to episode two of Midas Health. This is our effort to put good information, good public health information out to the masses, to all of you, especially at a time in which I think it's very obvious to say that is lacking from the highest levels of government. I am honored to have somebody I consider a close mentor and a friend, the recent former FDA commissioner, Dr. Robert Califf, who's joining us en route back to his home in North Carolina. Dr. Califf, thank you for being here, especially amid the times. We're really honored, sir. Well, Ben, it's great to be with you. And almost the inaugural

episode, that's really an honor. So looking forward to our discussion. Well, Dr. Califf, I'm going to give you the floor here, just your comments and reaction to the last week and what you're seeing at FDA and more broadly. Well, I'll be interested in what your main questions are that you think might be of greatest use to the audience, but a brief overview. I think as almost everybody knows now, there was a massive purge of the federal workforce within health and human services, including the FDA. Remember that we had already lost a number of people if they had diversity, equity, or inclusion in their job description. They were basically fired on the first day. And then there were a series of firings if you were a

probationary employee, which in federal terms means that you're less than two years into either your first employment with the government or you've been promoted and you're less than two years into that promotion. And basically, if you're in that category, then there was a significant number of people let go. But then this week, 3,500 FDA employees were fired. It was done, as the first two were, in an almost brutal way that really shows lack of concern for the human beings who were involved. In this case, it sounds like the message went out at 5 to 15 a.m., but many people had already had their privileges disconnected, so they didn't get the message, and people showed up for work

and then couldn't get in. So you end up with a very public scene where you have some people in a line of people who had been fired and other people in the line that's trying to get through security. So there are sort of two big aspects to this. One is the way we treat our fellow human beings in a situation of employment. For most people in the public, though, nothing they can do about that. The question is, what's the impact? And many of us are extremely worried that we now don't have enough people with enough institutional knowledge

to conduct the business that we all rely on. The development and evaluation of medical products, the inspections that keep our food safe, the success we've had in reducing deaths from tobacco, which is still underway, all the things that the FDA does. services. So if we take a problem like the H5N1 pandemic potential with that bird flu virus, that requires a lot of coordination between the FDA, which regulates the milk, the USDA that regulates the cows and the chickens, and the CDC that regulates the farm workers who are most primarily affected. And many of the people that were working on that problem were fired. And it was done in a way which gave them no chance to hand off their responsibilities. You know, it's sort of like you're a basketball coach. I'm a big basketball fan, as you know, and it's March Madness.

I am a blue devil, I have to say. But can you imagine that you put in a substitution and you don't have an assignment for the new guy coming in? And the guy coming out doesn't relay what was going on on the court. It's just makes no sense. Well, Dr. Kale, first of all, we should have done disclosures on your basketball affiliations for those that no longer want to listen. I hope that's not many. And congratulations to your Blue Devils. What a run.

Exciting weekend ahead. I do want to, you know, I noticed you posted on LinkedIn and other social channels something to the effect that the FDA, as we've known it this week, you had posted this, is now finished. And when you talk about the impact of these cuts, I understand it's just having living and breathing health and health policy, but I'm wondering if you can make it real for our listeners who maybe aren't thinking about medical device safety and food safety. Even if there's a self-evident quality to some of these cuts and their impact, how is this going to impact the life of an everyday American?

Well, I think there are many analogies that are all kind of similar for something like this, and maybe pothole repair is an easy example to grasp. If you decide, I want to cut the city budget, the expenses, you could say, we're not going to fix any potholes for the next couple of years. And right away, you don't notice anything different. But then over time, the risk of something bad happening goes up incrementally over time,

and eventually someone's going to hit a pothole and something bad is going to happen and so i mean we have industries that in america that and globally that supply america that produce pretty good products um and so you wouldn't see something right away that the for the average person, but there will be harm done by products that are deficient that didn't get inspected on time or safety reports that go out. One place that was cut substantially was the communications part of government. Someone's got to actually notify people when there's a safety problem. The company has a role, but I don't think we want the companies taking full

accountability for that. That's problems there is part of what led to the FDA being in place in the first place. But a place, just to mention one group I'm particularly worried about where who could see really big losses from expectations would be people with rare disease. You're very aware, Vin, that we're on the threshold of treatments and cures for hundreds of thousands of diseases that were previously completely untreatable because of gene editing and other ways to affect the human genome. This is not possible until just now. But it's very complicated, and it's a risky development process

that needs a lot of interaction with the FDA. And we're already seeing, for example, investors backing off because of the uncertainty as to whether there's enough staff left at FDA to work with the industry to develop these treatments. So, I mean, this is not a matter like many of the diseases you and I deal with in our, I'm a cardiologist. We have a lot of treatments already. We're talking about people with no other treatment. It's just one extreme example. I do want to ask a follow-up on that and then zoom back out to just broader food and drug safety. So when you mentioned rare diseases, I noticed there's optimism around an experimental Alzheimer's treatment that I'm sure you saw

some lay press around about last week, that for those with a genetic predisposition to Alzheimer's, this treatment for all our listeners out there delayed the onset of Alzheimer's for a very high risk group that was almost guaranteed to develop symptoms by at least a decade, if not more. And that the funding for this trial has been stopped in its tracks. And so who knows what happens to patients that are reliant on this medication. Obviously, it's sort of pre-FDA, but it's an example of what's at risk here in terms of the treatments in our toolkit for providers across the country.

Five, ten years down the line for something that is unmet when it comes to treatments for Alzheimer's. Not necessarily a rare disease, but I think something that could ring home to a lot of people. I'm curious, do you feel like there is public understanding of what these cuts mean when it comes to treatments and novel therapeutics? Or is that message not getting or is that the consequences of what's happening this week? Is that not landing at scale? I think you're probably a better judge of that than I am. But my perception is it's just hard to connect the dots here for the average person.

It's got a lot of other things to worry about in life. And this is not the kind of thing, at least not right now, where, you know, like your garbage is not picked up. You're going to know that right away. Or, you know, your Social Security check doesn't come. That's been in the – that's a – you know, those are immediate things. or your Social Security check doesn't come. Those are immediate things. This is really the infrastructure that's built an environment where we have access to safe and effective products and safe food, and we're seeing a reduction in the toll of tobacco.

This is being undercut as we speak. And I worry that the lingo that's being used makes it even more difficult because I can say for sure anyone who's worked in federal government can think of a lot of ways to make it better. And it was certainly my experience in my two terms as commissioner that the workforce wanted to make it better. And so you can say waste, fraud, and abuse, but that's not what we're talking about here for the most part. We're really talking about the core functions of the government that enable the ecosystem to produce these products that we all depend on. Dr. Cale, do you feel,

based on the cuts and sort of the gravity of the cuts and the loss of personnel, what I imagine is, I would imagine morale is not high. And amongst those that remain at FTA across these key functions, food quality and safety, vaccine approvals. I mean, we're seeing all these headlines come out. And I think even I sometimes wonder what's actually happening. What does this really mean? Can you speak to, or just very directly, do you feel like, can Americans trust the, and do you feel like we have the mechanisms and personnel in place now still through FTA where we can trust our food supply and our imported drug supply that it's gone through the necessary scrutiny and rigor to be safe if we put it in our bodies?

Well, I'd say generally yes right now. And it's a matter of what happens after this. You know, we with a civil service, which has maintained this infrastructure, which I believe is so important. The analogy I'm using for people to grasp sort of allegorically is Humpty Dumpty. And you'll notice if you read Project 2035, the goal right now has been to essentially destroy the federal government as it existed. And then in an unspecified way, there's going to be some building back up. So let's give the new FDA commissioner a chance before we condemn it. But I think we all need to keep a very close eye on it because

you're certainly right. Even the remaining employees don't know day to day if they're going to get fired. And they're spoken about so disrespectfully when anyone who's worked in the government knows these people are working hard and very dedicated to the mission. So the sort of language that's being used, I think, is not helping the public grasp what's going on. Can we spend a moment on that, too? Because it strikes me that for those that remain, obviously, you were the leader of this organization twice, both under former President Obama and most recently under former President Biden. You know them well. There's been a lot of high profile departures. It strikes me as a clinician, you know, with a few roles across healthcare, that if I knew that my job was maybe potentially at risk, it would fundamentally make me want to consider proactively switching jobs.

Certainly I would lose any sense of connectivity to the organization. So I'm wondering even for those that remain, if you can speak to the risk of brain drain and just talent leaving, not wanting to come back, just the difficulty it is of retention and recruitment into a place like FTA. Because I do think that some of those things don't get talked about enough. Well, the brain drain is already occurring. It has occurred to a large extent. Many of the most

experienced, knowledgeable people have left already, either because they were fired or because they saw the handwriting on the wall and sought other jobs. And these people are highly employable. At least they have been up until now because the skills to understand, let's say, drug development or what the factors are in safe or nutritious food. These are highly qualified people. So, of course, right now, those that are being fired are having a hard time finding a job because universities are also not hiring, and the industry is getting filled up with people. So there's going to be a problem in the short term. But there's no question that losing institutional knowledge,

the understanding of how things work, where the risks are. I mean, Ben, one thing I feel like I have to say over and over, if we just take drugs, nine out of 10 drugs that get into human clinical trials don't make it to market either because they have an unexpected toxicity or because they engage the target the drug is going after, but it doesn't have the benefit that was expected. And to know that, you have to do these very complicated clinical trials. I think a better way to describe them is human experiments, which is what they are, people volunteering to put their lives on the line. Now, you referred to put their lives on the line. Now, you referred to one, but it's one of many clinical trials.

Imagine that you volunteered for a human experiment, you're in the middle of it, and the government decides to just stop funding it out of the blue with one day's notice. You may be on an experimental drug, you're getting medical care related to this. It's really a lot of evidence that sort of software engineering is being used to do this with anonymous emails from people who actually

don't have content knowledge about what's going on. But that's why now that we have a new confirmed commissioner, I'm hopeful that he will sort of put things back in order and build it up. But we've really got to keep an eye on this. he will sort of put things back in order and build it up.

But we've really got to keep an eye on this. Ben, could I mention one other thing that I think is really important right now? We have a secretary of health and human services who's written that viruses and bacteria don't cause illness and who is suing the government to make it almost impossible to distribute vaccines. Some of the very basics that our public health system depends on are being undermined by the Secretary of Health and Human Services, which I hard to imagine that could have even happened. Now, there's a slogan, Make America Healthy Again. I hope, like me, that you think that's a really good idea. And it actually really is true that our food system, while safe from viral and bacterial infections, it's not nutritious. The easiest thing to do for Americans

when it comes to buying food is to buy stuff which is not healthy. Totally on board on better nutrition and exercise, but you can't treat measles with cod liver oil. Right. You just, and, but yet that is, so imagine you're coming to work at the fda and you're working on vaccines you know let's take the hpv vaccine the um uh it's almost eliminated cervical cancer in uh women let's say you're working on that and your boss's boss is saying, can't trust this stuff. It may not work. It's an individual decision.

But it's a very difficult work environment, almost like you feel like you can't tell the truth because if you do, you're going against your boss and your boss's boss. Well, just hearing you speak, I have to ask. I agree with you that we have to give Dr. Macri, the new FDA commissioner, an opportunity. I will say just me, independent of you, looking at early signals, I worry whether or not he's going to have the independence to push back. And, you know, seeing Dr. Peter Marks, who is a legend, just like yourself, and has made his career at FDA on one of the lead vaccine safety experts leave, and it seems like with the

permission of Dr. Macri, that worries me on what that heralds. And I'm wondering how you take Dr. Peter Marks leaving and how we should take that recent news coupled with the fact that these advisory committees on important vaccine decision-making, especially before Dr. Macri even joined, looked like those were delayed. I'm wondering how much, one, independence you feel like the FDA commissioner can have in this environment, and then two, what these early signals herald, if anything. I mean, as you know, Ben, there's a long history of the independence of these federal agencies to do their jobs, and it's sort of at two levels. The commissioner is a political appointment, and I was one of those. So you understand that you come in

reflecting the values of the president. It's a presidential appointment with senatorial confirmation. But then the decisions about individual products are not made by the commissioner. That's only happened a couple of times in the history of the FDA. Those decisions are made by full-time civil

servants, but all but two of those people at that top level that have accountability for those decisions have been fired. And so now there are going to be appointments made. Well, and here's a place where, you know, I wouldn't expect an average member of the public to, I mean, it's complicated to get involved in this. I think those of us who are professionally involved need to really be keeping a close eye on this. Are we going to appoint people with deep knowledge of, let's say, drug approval, device safety, food safety? Are they going to be appointed into these roles or will they be people who have a political allegiance to a particular agenda?

And I think there's a lot of reason to believe it's going to be the latter and people have to keep a close eye on that. I didn't realize the, that's news to me that all but two of the senior level officials that once reported into you now have been let go. That is a stunning number. And you're right,

a lot of institutional knowledge that bridged presidential administrations. I think it's important to recognize in the case of, say, Dr. Peter Marks, he bridged presidential administrations. I think it's important to recognize in the case of, say, Dr. Peter Marks, he bridged presidential administrations. And regardless of whatever the prevailing politics may be in the White House, he was still there for many, many administrations. That's where I'm sure some of the... Yeah, I mean, all the people in those jobs, they don't come and go with administrations. They are part of civil service. Can people trust vaccines and their safety profile moving forward?

Or do we have to go to Canada to get our flu shot? Will it be as accurate and as useful as the last vaccine developed under your leadership for, say, seasonal flu? I'm wondering when you hear those questions, I'm sure you get some version directly to yourself, some riffing on those same themes. What's your response? And can you reassure us? And if not, what should we be vigilant for? You know, what I'd say is I'm not very sure that this administration is going to look carefully at vaccine safety. And I think there will be a lot more studies done. I'm more worried about the other side of the coin. When there's a benefit, are the vaccines going to be promoted? And, you know, as you all know, I think for the average person,

it may be worthwhile thinking in terms of two dimensions. There are vaccines like measles and polio, where unless over 90, 95% of the population is vaccinated, you're putting everybody at risk, not just your child or yourself, but your neighbors, children themselves. There are others like COVID and flu, which don't eliminate the virus,

but they reduce the risk of dying or being hospitalized and reduce transmission somewhat, but not the huge effect. It's those ones that eliminate the virus completely where the big worry is now, because we had gotten rid of polio and measles. Now measles is back. And if we don't get more vaccination done, we're going to have polio back. But it's also true that vaccine biology has really advanced and the availability of messenger RNA vaccines gives us the ability to knock out a lot of other diseases much more effectively. But if you fundamentally don't believe vaccines are beneficial, it's going to put a big drag on the system.

And here's where one nice thing that's developed across countries is, you know, we have the EMA in Europe, and we have the Canadian regulators, and we have a growing number of sophisticated Asian regulators. And if the U.S. government is falling behind, I think we'll be able to look to other countries and see what they're doing and put pressure on to make sure that we keep up. So I'm less worried about safety. We'll hear all about safety in great detail, I'm sure. And I'm not opposed to that. All interventions have risks.

I'm a cardiologist. You're an intensivist. You know that a lot of things that we do that have a net benefit in some people, it causes harm. And you try to reduce that as much as you can, but you can't eliminate it. And for everybody listening right now, I think Dr. Caleb brings up a really important point. One, on measles, for all of those tracking, we already have one of the worst outbreaks we've seen in recent memory. Case counts here have exceeded the last several years. And this seems like this is

only going to get worse before it gets better. A reminder, if you're talking to those that might be exposed to measles, if they're pregnant, for whatever reason, unvaccinated, don't know their status, one shot of the measles vaccine is 93% effective at preventing infection, two shots, 97% effective. Protection is in nearly every case lifelong, unlike what we've heard from the new health secretary. And it's important to keep in mind antibodies are detectable even within a few days. So if you've been exposed and short of pregnancy,

which is a different sort of edge case, if you've been exposed and don't know your status or are unvaccinated, getting vaccinated is indicated is the best thing you can do. If you're pregnant, exposed, and you don't know your status or know you're unvaccinated, immediately speak to your obstetrician or

gynecologist because we might give you a different type of therapy called IVIG, but something to keep in mind. Or if you know somebody that might be at risk, those are things just to keep in mind. Dr. Kale, I know that you're in an airport and we only have limited time with you. I do want to zoom out a bit. And just when we think about HHS cuts more broadly, the impact that this is going to have on our talent pool, good jobs across biomedicine. And frankly, what this means, again, I mean, I really want to laser in on things that impact the everyday America that may not be thinking about things

that you and I think about often. Wondering if you can zoom out 10 years from now and assuming that what's happening today with these cuts across NIH, research funding cuts, impacts on committees and expertise across FDA that oversees quality and safety across a range of products. What does that mean for the American patient 10 years from now when it comes to access to treatments that might save their life for

a cancer or say a chronic cardiometabolic disease or something in between. Can you make that real for us? What's the real patient impact here five, 10 years from now? Well, when you talk about broader HHS, it's a bit different, I think, than the FDA in that some of the impacts are very immediate. People that were getting access to helpful medical care at community centers where the funding was cut, massive cuts to the public health infrastructure that many of our most vulnerable people are very dependent on. You know, I am unretired from Duke University again, so I'm looking at universities. A lot of the people entering graduate school had their acceptances revoked because there's no money to pay them because the funding has been dramatically cut for training programs. This means we'll have fewer scientists,

fewer knowledgeable people, much higher risk that things will slip through the system that are unsafe when it comes to drugs and devices, higher risk of unsafe food. Now, all this is contingent on, you know, what happens now. Are things going to be rebuilt? And, you know, at some point they will have to be rebuilt. I've learned 100% of Americans know the first verse of Humpty Dumpty, that the king's horses and men couldn't put him back together again. But if you look at Wikipedia, there's a fifth verse where he is put back together. And so, you know, I cling to a hope that whether it happens soon or later, it will be felt back. But if it's not, we're going to see some drastic public health losses.

And as you well know, this is occurring at a time when we have the worst life expectancy of any large high-income country. And that gap is widening. And I want to be clear here because the rhetoric gets, I think, a bit confused. I'm totally in agreement that we need to fix our diet and exercise more. Those are essential. That's a good thing that this administration is focused on. But to blame that on medical products, which are often life-saving and beneficial, just doesn't make any sense. And to take away the safety net for so many people, there's a quote I still love, life is a sexually transmitted disease with 100% mortality. What I mean by that, even if we succeed

and make America healthy again, eventually people get sick and die. So we're going to need traditional medical care, hopefully delivered better no matter what we do. But that's all in peril right now. You know, just listening to you speak, I do want to emphasize, first of all, couldn't agree more. And I think it's important for people to remember both on this concept of making America healthy again. It's hard to do that if we're seeing in parallel deep potential cuts. It seems like we're signaling deep cuts to Medicaid, other ways in which people are accessing

fundamental health care for prevention and then ultimately wellness. You can't do one thing without the other. And just encouraging people to eat healthier and exercise more. Well, we've been doing that for a very long period of time. And bridging again, administrations. It strikes me that taking away durable health care access for the most vulnerable is going to solve anybody's aims here. So that's one. And then two, to your point on brain drain to the impact that cuts across NIH will have on innovation, new therapeutics,

and there's clinicians across the country that have seen that and have been very alarmed for what that means for our patients. You know, it's important to remember that, you know, I don't have to remind you, obviously, Dr. Califf, but for everybody listening listening that the foundational research into medications like Wagovi and Ozempic, all the rage right now, you know, for good reason. They're incredible therapeutics.

The weight loss for diabetes. NIH funded 20 plus years ago by the American taxpayer at a time when I don't know if we expected to see the end result, this incredible new set of drugs that could fundamentally reshape our... Again, that's part of our toolkit, but these tools would not be available to us were not for investments made 20 plus years ago when this current reality we live in was not visible. So I think it's important to keep in mind we can't be short-term when we think about how we advance American health care and what's best for our patients. Sorry, please. Yeah, two other aspects to mention.

First, not to be too heavy on the basketball analogies, but we have been the envy of the world, our system of innovation, new products, technology. FDA is the premier regulatory agency in the world. And when you come into a team which is ranked number one, you'd better really make it better if you're going to disrupt things. It's not a kind of thing where we're at the bottom of the league there. Now, health care delivery, we could have a whole other discussion about the issues there. We're not number one in the world there, and it needs to get fixed. But messing with this part of it is very treacherous because we're the best.

And other countries, it's amazing. You mentioned the brain drain. Every other high-income country, including China and Canada and Europe, they're advertising for our best PhDs saying, come to our countries. You'll have funding and the freedom to operate. And China is full bore ahead, trying to race ahead of the U.S. in control of biotechnology and devices. So this is not a time to take the foot off the gas in that regard. Yeah, and I think that's one of the important things.

Sorry, Josh. One other aspect that's a bit technical, but you mentioned it. We've been encouraging people to eat better forever. And we know that the things that are proven to work are pretty simple, like more fruits and vegetables, et cetera. But if you want to fix the underlying structure of the food system so that it's easier to buy healthy food at a lower cost. That involves a lot of restructuring of the incentives we have in the system, which are thereby long. So that means you've got to actually develop federal rules

and have a bureaucracy that, you know, you have to put the rule together. You have to justify it in terms of a very detailed analysis. You put it out for notice and comment for a year. The industries that are affected often will object and take you to court. So there are a lot of lawyers that have to be involved. I think this is worth doing because if we started with the farms and grew healthier food and had a system that distributed fresher food to what we all are familiar with, the deserts that exist right

now where there's no fresh food that can be bought, that would have a huge impact on health. But the slogans are not going to fix this. It's going to need to be fixed by putting a different system in place, which involves lawyers and people who know what they're doing when it comes to writing the rules. I can tell you from experience, you know, we're the last country left in a high-income group without graphic warnings on cigarette packages. And we did a beautiful job of that during my first term, in my opinion.

But the tobacco industry took us to court and got it nullified. And we lost five or six years. And we're just getting back to being able to now put graphic warnings on. And these graphic warnings have a huge impact in helping people stop smoking. Every other company does it. So there's a lot of reason to have people know what they're doing in the federal government, even if you think the direction that we've been going has not been the right direction up until now. Yeah. You know, just to put a fine point on that as a pulmonologist, as Dr. Cale has just mentioned, graphic warning labels on cigarettes,

arguably one of the most effective public health communication tools to have ever existed. It has been shown independently to cause behavior change and to help people to quit smoking because it's so blatant. It's such a great communication tool. And to Dr. Cale's point, we used it and unfortunately it went away and now it's hopefully coming back. Also, just a finer point to Dr. Gayle's point, we used it and unfortunately it went away and now it's hopefully coming back. Also just a finer point, then Dr. Gayle, if I'm going to kick it to you for your closing comments here. I do think it's really important for people to realize that as we talk about the impact of brain drain, the fact that who is even amongst those remaining in government, morale is low. Your job is, if any of us were in a situation where we didn't know if we're going to get our jobs cut tomorrow, just givenPhD students, a very different trajectory potentially

on how they want to take their career given the long-term impacts this is going to have. And to your point, others will step in and we're no longer going to have American IP on the next generation of therapeutics because it's going to go offshore. And that's going to have real impacts for our ability to access some of these medications

as affordably as we could, hopefully. And then also for national security, especially as we saw during the pandemic, it's nice to be producing as much of this seminal research knowledge and ultimately the therapeutics within the continental United States if we can. And that's all at risk. Dr. Cale, just in the last, gosh, 48 hours, we're seeing the impacts of some of these cuts and what it means for communication, health communication to the American public. And New York Times reported just yesterday that the HHS cuts are going to directly impact the teams communicating vital public health information to the masses, to the public. I am wondering what that means, how you as an expert and leading government official, how you are advising people to get their public health information moving forward. What are trusted resources?

How do we cope? Ben, I hope we'll have a chance on another day to have a detailed discussion about this, because my short answer is, we're going to have to put together a parallel system of information, the sources we used to depend on. I mean, if you're being told that measles vaccine, you know, you really got to consider the risks, and it's not highly recommended to take cod liver oil instead. That's really bad, and I hope those kind of things will get fixed as we go along, now that we have more leaders like at NIH and FDA in place, but we got to keep an eye on that. I think the professionals like you are very important,

and we need networks of medical students, faculty, clinicians of all types to band together and create a network of more reliable information. I look forward to talking with you more about that in the future, but the work is underway. This is not to create dogma it's not to say here's the answer to everything science has differences of opinion and those can be discussed but there are some things that are proven by clinical trials that we know are right and these are really the basics of public health. Beautifully said. And it's interesting because I know this is for another conversation another day, but there's so many things that we have at our disposal now, thanks to your very successful term,

your most recent term as FDA commissioner, like say more ways to lose weight, these new class of weight loss drugs. For which exactly to your point, Dr. Kale, if I have this conversation with patients often, there's still things that we just don't totally know. In what cases can we deprescribe those medications? I don't think we totally know that answer. Does everybody need to be on these medications for a certain prescribed period of time? Again, I don't know if we know the answer for everybody, which is why you were a vocal advocate for things like post-launch patient registries for which we can study these critical questions on medications, vaccines, other medical devices that you appropriately allowed people to access, but for which every single question may not have had a firm answer because science is evolving and we're learning in real time. And I say that because this notion that, and I've seen the current health secretary often

say this, sort of latch onto an area of uncertainty because everything in medicine, there's an imperfection there. We don't know everything. And we acknowledge that. But some people like him will leverage any sort of ounce of uncertainty and say that some of us are withholding information and that couldn't be the furthest thing from the truth. But I'm glad you brought that up. And I appreciate your focus on post-launch patient registries so that people can get access to therapeutics, but maybe we're still learning as we go when it comes to sort of key questions like indications for use or how long somebody needs to be on a medication. Really, really important. Also, just want to say for cod liver oil, I'm trying to weave in some of the things that I know often get asked by a lot of folks. We're actually seeing people take excess doses of vitamin A, either through cod liver oil,

which has a lot of vitamin A, or directly as a supplement. And that's causing toxicity. And they're listening to those that want to misinform, taking these supplements in an unregulated, unsafe way with clear impacts on the body. And so, again, something really important that you're calling out, which is networks that are digital, that are omni-channel, putting better information out there is really important, which is why I just want to thank you, Dr. Cale. If I know you're traveling, you're so gracious to join us. The whole intent of Midas Health is to work with Midas Touch Network, which is one of the widest reaching digital media platforms in the country.

And we're doing exactly what you said. And this is a first effort and we're going to evolve it over time to reach people in different ways. And we're hoping to build a network of partners to do that. So Dr. Caleb, I just want to say thank you for your years of service to the country. Thank you for being on with us this morning. And I hope this is just the first of many episodes with you. But thank you, sir. I hope so, too. It's been great working with you over the years and look forward to working together more in the future. Sorry about all the background noise, but be getting boarding soon. So please take care. Thanks, Dr. Califf. Talk to you soon. Can't get enough Midas?

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