Tylenol Needs A Tylenol

Toled all, welcome to the resistance. This is America Dissected. I'm your host, Dr. Abdul El-Sayed. And I'm your co-host, Dr. Caitlin Jettelina. And recording this on Wednesday, September 24th at 11 a.m. Eastern Time. Before we go on, I wanted to share some news about the show. For the past five years, I've had the privilege of bringing this show to you. It started as a limited run season, expanded as the worst pandemic in modern history mushroomed into a years-long ordeal that took millions of lives. Since, we've been bringing you conversations at the edge of health and society. Throughout, I've tried to bring you the best, most evidence-based information available from a perspective of empathy and hope. For the last five months, that same combination of truth, empathy, and hope, they've driven me all over my state. I've been to 57 cities across our state and done over 100 town halls, roundtables, and meet and greets as I strive to serve. The work is as arduous and grueling as it is gratifying and engaging. But it just doesn't leave much time. I find myself at a crossroads. And so it's with a heavy heart that I wanted to share some news. We're going to be hitting pause on the podcast starting next month. We'll be having two more episodes for the next two weeks and then one final episode, our live show from APHA in November. We'll be doing a bit of a retrospective for our penultimate show. So if you want to send us a voice memo of what this show is meant to you, please send to info at incisionmedia.com. I look forward to hearing from you. Oh, Abdul, this breaks my heart. I don't want this to end. I know it's the end of an era, but I will tell you that the best chapter was the final chapter. You know, unlike several multi-season TV shows, I feel like, you know, we ended with a pop. So I'm grateful to have been joined by you for this last season. It's been a lot of fun. I couldn't imagine a better person to tear through this absurd moment in public health and health care with. So thank you for joining us. Truly absurd. Yes. Thanks for having me along for the ride. I'm going to miss you. I'm going to miss the show. I'm going to miss all of the listeners. I'm going to miss interacting with you all out in the world. Then I think the work goes on obviously, obviously. If you want more of this kind of hard-hitting content that takes on the most important issues in public health today, there is a great substack I've heard of, Caitlin. It's called your local epidemiologist, which I highly recommend people subscribe to. I will also say you're not getting rid of me that easily, I'm told. We'll be around. And look, if things go the way, if things go the way, I hope that they go, then I'm looking forward to working together. And who knows, it's just a pause. We're not, we may not be done yet. So let's, let's see where things go. Let's see where things go. And right now it's. a crazy time. I mean, things just continue moving on. And I think also, um, a indication that there's a lot of work to be done out there. Um, so I'm thankful for you, Abdul, for doing a lot of the work and everyone else listening to. Yeah, absolutely. And I'm, I'm sorry for letting folks down because like, who knew it was going to get this crazy? Uh, which takes us to our first story of the day. Um,

All right. On my bingo card, I did not have Donald Trump begging people not to take Tylenol, saying literally, and I quote, fight like hell not to take it. This was, of course, the, go ahead. It was just wild. That press conference, I mean, Trump is wild, you know, going always off script and stuff, but this was next level. It was pretty crazy. Yeah, nuts. You know, this was the long-anticipated outcome of the autism report, which they had teased that they were going to drop, you know, three, four months ago. And we reported on some of the top lines last episode, namely the unsubstantiated claim that acidia menifine use causes autism. And, well, let's just play you some of what transpired. But with Tylenol, don't take it. Don't take it. You have a little child, little fragile child, and you get a vat of 80 different vaccines, I guess. So. Ideally, a woman won't take Tylenol. And on the vaccines, it would be good instead of one visit where they pump the baby loaded up with stuff. You'll do it over a period of four times. The number of, like, so I was watching in real time, the number of falsehoods that were coming out like a fire hose was incredibly overwhelming. I mean, just in that clip, it was. vaccines. It was vaccine schedule. It was the number of vaccines. It was Tylenol. It was babies. It versus pregnancy. It was, it is, it's impossible to keep up with. And, you know, like throughout the whole thing, I was like, that's wrong, that's wrong, that's wrong. But when I stepped back and after that. I got so many text messages from my friends, my mom friends, of like, holy crap, I took Tylenol during pregnancy. Is this going to be, it's just the amount of guilt and the amount of fear is just from this irresponsible press conference was what really hit me as a fellow mom. Like this is just unacceptable from the federal government. And. It's false blame and false hope. And they want to treat this like it's a victimless thing, right? They're just putting a warning out there. But there are a cost to this. There are real cost to this. There are a lot of people now who are scouring their mind about whether or not they might have used to Tylenol. when they were pregnant and maybe, just maybe, that explains this thing and they're beating themselves up over it, right, re-traumatizing themselves about all of the things that they should have or could have done. And then there's this false hope, right? All I got to do is just avoid taking Tylenol and I'm pregnant and everything's going to be okay. And none of those things are true and there are real victims out there. And then, Kalim, you made this point last time, but like, you're telling people to sit with potentially treatable inflammation, which itself has consequences.

on evidence that is cherry-picked and poorly interpreted. And that itself is going to have consequences down the line. And guess what? A fever also can cause autism. A fever during pregnancy. I mean, you can't just go with a precautionary principle here. Exactly what you're saying, Abdul. Like, there are consequences. And parents deserve clear, level-headed. evidenced in order to weigh the benefits with the risks. And clearly the evidence shows the benefits outweigh the risk. This press presser sounded like the risks far outweighed the benefits. And that is just incredibly irresponsible. Abdul, I was also noticed, like I noticed a lot of things that weren't said during this. One of them was that this was happening. at the White House and Trump was there, which was really interesting to me because I'll be curious about your thoughts, but one is that I think, not I think. Trump is friends with the Wright family and the rights who are founders of Autism Speaks. And in the beginning of Autism Speaks, they flirted with this vaccine theory. They've since not. They even came out with a announcement two days ago that this was just not where the evidence leads us. I think, too, it's deeply personal to Trump. The other thing is, I don't know if you've been following the polls, but... There was a recent poll out that Robert F. Kennedy Jr. is losing a lot of ground. Maha is losing a lot of ground, particularly with independence. And so. Trump making this announcement at the White House, he didn't have to. But to me, it tells me or is a sign that maybe he's trying to save the Maha movement because it is struggling. And that means this administration thinks that only Trump can rescue it. So I don't know, the in-between lines was even more interesting to me than the actual word salads that came out to. Yeah, I chalk it up to the fact that this guy thinks that he's actually omnipotent. I think he thinks that he can just make. falsehood's true by saying them. And I think the level of narcissism, I think the level of delusion has just gotten to a point where he wants to get the accolade for solving things he cannot solve. And, you know, it's like, as I say, power corrupts and absolute power corrupts, absolutely. Like, this is somebody who's tried to ascribe to himself absolute power. And it's not just this. And so to me, it's like, this is just one substrate for this, like, profound narcissism to try and.

to try and take up. There's this, you know, this is going to get nerdy here, but like this is what we do in the pod. So there's this kind of being that's called a saprophite. And it eats and digests external to itself, right? Like it spills its digestive juices on things and then sucks up the nutrients. And I feel like saprophites are probably the best model for like Trump narcissism and politics. No, they're usually fungi, right? Oh, okay. And. And so, like, this is what he does. He, like, spills his nasty digestive juice on things. And then he politicizes them. He forces people to take sides. He creates a whole bunch of misinformation. And then he draws power out of it because he forces people into their corners. And folks who've already come with him are sort of in this position of being like, well, if I leave him now, I have to apologize for all the things I did. So maybe I'll just keep going. But, like, he's a political sacrifice. And this is him. trying to just drop his juices on other things. I don't think it goes much further than the way that delusion and power meld together. Because even Robert F. Kennedy Jr.., it seems, from the reporting, was kind of being like, yo, yo, let's hold our horses a little bit. Like, maybe let's not go all this far. Which is wild. It is wild that that's Robert F. Kennedy Jr.. But you're right. That was reporting from Politico that Trump is insisting to go further and broader and faster. So we'll see where this takes us. But. Yeah. Yeah. So let's take on some of the claims one by one, Caitlin, shall we? So one is that babies are pumped with a vat of vaccines like you'd give a horse. Caitlin, do we pump babies? I mean, it's been two years since I had my last one. I don't know if things have changed, but I don't remember the moment where they brought in like the horse juice and pumped my baby full of it. I think I would have had some issues. So does this happen? Caitlin, is this a thing that happens? No. No, it is not a thing that happens. There was, they, um, Trump kept repeating this, uh, statistic that it's, I don't know, what more than 80 vaccines that kids get. And that's just incorrect. I think by the age of two, it's 25 doses, not different vaccines. Um, and, you know, are. vaccine technology has gotten better and better. So even though we do get more doses than we did and our kids did in the 70s and 80s, they actually get exposure to less antigens. We're getting way smarter with our vaccines. And so no, this, this is not how this, yeah, no. Yeah. The other one, break the shot, yeah, number two, break the shots up, do it four or five visits. There's no downside. It can only be good. Yeah, no. That's, I mean, there's, that's false. You know, there's reasons why we have this vaccine schedule, right? It's like a seatbelt. You don't want to wait four or five years to buckle up your child. I don't know if that's the best analogy, but I think that there's.

We test the dosing intervals. They're chosen empirically and tested in clinical trials. And there are very much reasons why we give these vaccines younger because their little immune systems get overwhelmed when they see these terrible viruses like measles. So incorrect. Yeah. And the thing I want folks to understand is that. In a lot of communities, it's not so easy to just have another visit with your pediatrician. So if you break it up into more visits, the probability that you actually get your full courses lower. And there's costs associated with going to those visits. And then to your point, you're offering a longer window within which folks are potentially exposed. So, you know, if the whole point here is to protect you from disease because your immune system has been tipped off regarding what you might see. You want folks to be tipped off as soon as they possibly can, right? You want their immune system to be tipped off as soon as they possibly can. So it can only be good is just not consistent with the truth. So the other one, Caitlin, there is no autism in the Amish community. I don't even know where this comes from. There's no reason for no autism in the Amish community. I mean, 85% of autism is explained by genetics. So maybe they have less genetic. predisposition or maybe different environmental exposures, but I haven't seen the data, but I would say that I have a very hard time believing that there's no autism in Amish communities. What's your read? Yeah. Yeah, there are definitely people who are Amish who have been diagnosed with autism. Like, this is easily disprovable. Now, if you wanted to say there might be less, maybe, but also famously. Folks in the Amish community don't have as ready access to health care resources. Yeah. That's a thing. So if you have to get a diagnosis to have a diagnosis of autism, maybe it's the fact that folks are less likely to get diagnosis because they're less likely to have the means of diagnosis. I don't know. I'm just an epidemiologist. I don't know. No one doesn't matter. Maybe, you know, like, I mean, like, if we're doing health care policy by vibes, it's just like they don't know. Like, they have autism diabetes. It's just a feel like that about the diagnosis. I don't know. This is the last one. You got to fight like hell. Toughen it out. He literally said toughen it out. I was like, you do not tell me as a mother that goes through birth. Like, first of all, Tyrone was. One, the only pain and fever reliever that is considered safe during pregnancy right now, taking that away, you have no other option. Also, treating fevers during pregnancy is important. It's associated with these increased birth defects, right? Including an increased risk of autism. So, no, women shouldn't be toughing it out. We have the tools. I think the message is, you know, that...

use Tylenol as needed for fever or significant pain. Using less is better, but this is where we are. He's, I don't, I don't, I just get angry about that toughen it out. What do you think, Abdul? Yeah. I mean, it's a backhand to women all over this country, and it is dangerous. I mean, just fundamentally. It is. Here's what's funny. So, you know, Bill Cassidy, who, I don't know, just like nine months ago was in a good place to stop all this bullshit from ever happening, had the most understated tweet I've ever seen, okay? I'm going to read it and I quote, I understand and applaud President Trump's desire to address this issue and to support HHS. HHS should release the new data that it has to support this claim. The preponderance of evidence shows that this is not the case. He's just trying to play both sides, man. But I do want to highlight this, that like there was no report. There was no new data. There was no new studies. There was the politicians, the politically appointed leaders in HHS came to these conclusions using the same evidence that hundreds of scientists have been looking at for the past decades. So. I want that to also be very clear was there's no new evidence. So you're right. They're basing this on vibes and going against the scientific consensus. Public health by vibes. Public health by vibes.

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So the public health community obviously was incensed, and you had a number of folks come out to push back on this. I want to sort of just think a little bit about where this goes, because obviously, you know, if you're hearing it from your mom friends, this went far and wide. How do you feel like public health should respond, and how do you grade the response so far? I will say I was really impressed with public health, particularly content creators out on social media, pre-bunking. this report, right? So Washington Post over the weekend said this report is coming out on Monday. And really quickly, a lot of scientific content creators started pre-bunking this, right? Started seating what to expect in this report, what was true, what was not true, what were the kernels of truth. And I thought they did an incredible job. And guess what? We're completely correct when that report came out. I mean... Robert F. Kennedy Jr.'s moves are highly predictable if we've been watching him the past 20 years, like a lot of us scientists have. I think going forward, I would really like people to... approach this with a lot of empathy towards moms and that we as moms go and parents right go through so such crazy chaotic information landscape it's really hard to know who is right and who is wrong and so at least how i've been approaching it and maybe this isn't the right way, but this is how I feel, is walking people through the evidence, right? Walking them through what it really does say, walking them through how to weigh benefits versus risks, and being very clear in answering questions. I think that's what I've been seeing. I hope more of it comes out. I was also really happy to see the major autism foundations come out very strong, as well as ACOG and AAP. They're filling very big gaps while this federal government is in disarray, and I think we need... those foundations to really take the lead and we help support them in the way they think it should be dealt with right now. Yeah, I think that's right. I want to say that, you know, there's something implicit in all of this framing, which is that folks living with autism, you know, they're living their lives. And this is implicitly stigmatizing to a lot of people. And I think it's really important that folks with autism get to dictate and get to engage with the impact of these kinds of decisions on their lives and their livelihoods and their ability to be and do what societies want for everybody. I also think you've got to give people really a lot of credit for just being smart and getting them out of the weeds on this, right? Because there's a way that complicated things can be oversimplified in dangerous ways like this.

But also getting people to step back and say it's actually not that complicated. Like if we think that Tylenol use is the cause of autism diagnosis. And also autism diagnosis is up threefold over the past 25 years. Do we think that there was a threefold increase in Tylenol use during pregnancy? Do we really think that that's what drove it? And I think it becomes patently ridiculous on its own terms. And it empowers people to be like, actually, yeah, that's a fair point. Yeah. And I think more of that kind of simplicity around. breaking this down, I think is really valuable as well. Yeah, I'm glad you said that because I did in the newsletter. I'm like, but you're right. There's this, I included two graphs, right? A exponential increase in autism spectrum disorder rate, but a decrease in women, the percent of women who take Tylenol during pregnancy over time. That math just doesn't add up. Right. This is just another sign that Tylenol is not leading to a dramatic rise in autism. And you're right. I think people deserve to be walked through this, too, if they have questions instead of being brushed off. So let's move on to what should have been the biggest news this week, which is the outcomes of the advisory committee on immunization practices meeting or ASIP meeting. We got new recommendations from ASIP and therefore the CDC on vaccine policy. Kaelin, let's start with MMRV, which is MMR, measles, mumps, rebella, plus varicella, which is chickenpox. What were some of the biggest takeaways that you noted? Right. So the final decision that they basically made was they removed MMRV as an option for a child's first dose. Just to back up, usually kids get dose one of MMR. plus V or MMRV at 12 to 18 months, and then they get a second dose around four to five years. And so they took that option away, the MMRV for kids. My level of concern of this really, like there's no evidence to really back this move up, but my level of concern is. you know, pretty low because a lot of kids don't get this vaccine in the first place. About 15% of pediatricians stock the combination vaccine for the first doses. So there will be a little disruption, I think, switching supply chains, clinic workflows. This all takes time. And it could, that lag could mean temporary gaps in vaccination. But overall, I think the population level impact is likely going to be small. All right. Next up, hepatitis B. Caitlin. What happened there?

Yeah, so ACAP last week discussed delaying the hepatitis B birth dose. So you usually get this at infancy within 24 hours until 30 days of age. This is actually far better than what was initially reported, which was delaying it by four years. Still a step backward. And this wasn't based on like any new scientific evidence. So if you can see the theme throughout this episode is that these changes are not following the scientific evidence. Now, interesting. So, and they went through, oh my gosh, so many falsehoods during this meeting. But interestingly, what happened was they ran out of time from this meeting on Thursday and said they were going to table the vote for Friday. Friday came along and they said that they're not voting on this for reasons not explained. This is really highly unusual to have a vote planned to talk about the evidence, talk about the science, and then just not do anything about it. It does honestly make me nervous for what's ahead. I think that there's, I mean, two options here. One is they saw the signals that they shouldn't be touching Hep B, given the, you know, Bill Cassidy hearing earlier that week. Or they do want to do it for four years. And it could be worse than this 30-day implication. They're going to be meeting in October again. And I... 99% sure they'll be talking about Hep B then, so we'll see what's up their sleeves. So for now, no changes. But I will say, I am already hearing that this is confusing newborn nurseries just from the headlines and from all the hoopla of last week. So, yeah, we'll see. More to come. And I do want to just explain a little bit about why. you don't want to delay Hep B vaccine because one of the principal forms of, um, One of the principal forms of infection actually happens from infected moms to babies, right? And so you do want to make sure you're protecting babies as soon as you possibly can rather than waiting because you miss that potential window to do it. So let's see what comes of there. Last, of course, one we've been talking about for a very long time is COVID. What happened there? This was wild. Basically, so the end decision was that ACIP recommends a COVID vaccine for everyone over six months. This is actually broader than the FDA license, which means that the CDC is recommending off-label use. It is less wide than the professional organizations, but, I mean, pretty darn broad. Now,

What is interesting to me was that, and I wrote about this, but the entire meeting. The ACIP members that are been handpicked from Robert F. Kennedy Jr.. continue to make a case that the COVID vaccines were more risk than benefit. And some points were raised that I thought were reasonable, right? Disease is becoming less severe for some groups. And then there was also just, again, a firehood of falsehood throughout this entire meeting. Like. They don't prevent infection, so it's not worthwhile, which is false. There's DNA contamination of the vaccines, which is false. I mean, they just kept going, the COVID vaccines caused cancer and autoimmune disease and excess dust, which is false. And we started tallying over at WILE, and there's more than 50 falsehoods, they said, around the COVID vaccine during this meeting. However, they ultimately voted. the opposite in that they ultimately voted on a very broad COVID-19 recommendation. I think what's happening, and there's lots of hypotheses around this, is that Robert F. Kennedy Jr. is feeling the heat, that he's going to want to take away people's choices and restrict access. People in the U.S. actually want vaccines. They want to have a choice. And I think that this 180 change was incredibly political. from grassroots pushback, political pressure, state actions, strong internal voices that really curbed the most extreme proposals. So, you know, this was a win in my mind. And I think it's a win because of the pushback, because people are speaking out that they want access to vaccines and choice. Yeah, there's a couple of overriding features that I think are important to understand here. The first is there's a foundational premise that they're trying to argue. which is that the dangers outweigh the benefit. Like, that's the foundation of the attempt to change all of this. And... That argument is really hard to unsubstantiate, right? Because their argument is, well, there's risks, but the benefits are low because the risk of disease is low. Well, the risk of disease is low because people take enough vaccines. And the minute you undercut vaccine access, that's going to change. So they're making a microscale argument that itself doesn't work in the long term. And I think all of us who push back on this have to remind. ourselves, that these are real diseases. These diseases have taken

hundreds of thousands, if not millions of lives through the course of human history. And there is a reason we continue to protect ourselves from them, right? And I just think that like that broader point about the consequences of these diseases has to get pushed. And then the other thing is, to your point, Caitlin, about the politics of this. It's really interesting because I think these ASIP members are in this weird place. On the one hand, they have to think a bit about how they got to... this and they have to please Robert F. Kennedy Jr.. And on the other, I think all of them are also thinking about their own politics and their own challenges. Because now you're going along with this. And a lot of these folks do have some modicum of respect within some communities that if they go along with some of this and as crazy as it's gone, I think they get pinched. And what's really interesting to me is watching the... reaction to what Donald Trump said in the White House on future ASIP meetings. Yeah. Right? Because because they're now thinking, okay, wait, like, I'm being asked to sign on to that, right? Because he just set the high watermark for crazy. So now I'm being asked to sign on to that. And if I'm going to be used, right, for that, that is really, really worrisome to me. So I'm really interested in the, in the back end of like, when ACE meets again following the Trump conversation. They're like, okay, so. Does it look like I'm now becoming a stooge for Donald Trump, not just Robert F. Kennedy Jr.? And that is, that has implications for people in their own lives. I think that's a really interesting point you're bringing up, Abdul, because. Certainly beyond COVID vaccines, right? If they're actually like starting to chip away at these routine childhood vaccines, because nearly all the ACIP members are there because they're long time COVID contrarians, right? They're still defending hydroxychloroquine. They're still defending ivermectrin long after they are proven ineffective. So their views are built over the pandemic mainly. And it'll be very interesting to see how they react to other childhood vaccines that I don't think they necessarily anticipated getting into the ring and through the arena about. So, yeah, and yeah, we'll see. I mean, the October meeting is what? God, three weeks again or something ridiculous. Like, I can't. But. But it won't be COVID vaccines, right? It's going to be other routine childhood vaccinations. I think probably happy, I'm guessing, HPV to, we'll see where this takes us. Yeah. Real quick, before we go, we are through the end of the summer, Caitlin. We have just passed the autumnal equinox so fall is officially with us, although you wouldn't know it because you live in San Diego. I did put a sweater on. Good for you. Wow. Yeah, great.

You're jealous. If there's an upside to pausing this, I don't have to be living through Michigan, January, and February while you're just being like, oh my God, it was a little bit chilly. I wore a sweater. Do you believe it hit 68 degrees? I'm going to still text you, Abdul. I'll text you. Don't be worried. You're going to text me pictures of the beach. Yeah, exactly. I literally lost a pinky to the frozen tundra, Caitlin. But yes, okay. I'm glad. I'm happy for you. All right. So what do we make about this COVID summer peak? It seems like the peak is over. I'm all right? Yeah, here's your weather report, right? COVID summer wave has peaked. Looks like it's decreasing in all areas of the nation and coming down pretty quickly. Peak was about as high as last winter this summer. I'll be very curious to see what this winter has in store. Winter surge now. Yeah, when COVID waves usually begin in mid-November. But right now, it's coming down. Some good news. Thanks, COVID. Good news. Our common cold is increasing, though, if we want to go through the weather report. So if you're sick, it's most likely the calm and cold right now, followed by COVID-19. Boo. And that is your weather report of the day. Thank you, Caitlin. Now back to the news. All right, Abdullah, who did you talk to this week? One of my favorite people. Yes, I got to talk to Dr. Dimitri Daskalakis. He's the former director of the National Center for Immunization Respiratory Diseases at the CDC. We talked to him just after that insane. press conference, and we got his perspective on everything from his resignation to the lead up to that. And then what he makes of this moment in what folks in public health need to be talking about and saying to be able to win back public confidence and support in a moment like this. I know that you guys have some history, Caitlin. I mean, we worked at CDC together. He was under Mandy. He also worked with the Impox responsive at the White House. So, yeah, our circles overlap a lot. I have so much respect for him and so much respect for working at CDC the past nine months and trying to toughen it out. But I think we all. reach a red line of our value system. And I think it was a smart move to come out. And he did it with Grace and with, you know, a lot of education on what's actually happening behind the scenes. Well, it was a great conversation. And I really appreciate our whole folks will stick around. Caitlin, we'll see you again next week. All right. Sounds good. Bye, guys. Bye, everyone.

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All right. Can you introduce yourself with the tape? Sure. My name is Dimitri Daskalakis. Dr. Dimitri, we really appreciate you joining us. And there are not very many people who work up to the kind of job that you had at the CDC and then willingly walk away from it. It took a lot of courage. Can you walk us through your decision making and the choice that you made to leave last month? Sure. So I was working as the director for the National Center for Immunization and Respiratory Diseases. That's one of the three infectious disease centers at CDC. The last eight months have been extremely complicated with the new administration, which has been musty issue, but more the issue, the installation of Robert F. Kennedy Jr.. as the Secretary of Health for the Department of Health and Human Services, the last eight months have really been deaf by a thousand cuts. So I think big things that happen to the agency, including massive firings of people that really reduced its ability to function. But mainly for me, the things that led to my resignation were around the vaccine and vaccine policy space. The first thing that made me very concerned was when Secretary Robert F. Kennedy Jr. announced new guidelines for COVID vaccine for children and pregnant women via Twitter without having any consultation. with any CDC scientists. So we learned about it on Twitter, and we're told that we had to implement a change in the vaccine schedule based on the brief video that he had shot with Dr. Bottacharia and Dr. McCarray. So can I ask you just a question on that? So you heard about it via Twitter. Was there any discussion that this was coming, any ask for a brief beforehand to get the best available CDC data? Was there anything that that gave you a sense that your input would have been valued? Well, quite clearly our input was not valued, and that was not a priority. So we had no idea this was coming. And, you know, we were not asked for briefings. I've never met the secretary. That's very atypical. I've met secretaries before him because of the fact that we had to brief them about things of public health consequence. Never met the secretary. Had offered briefings on measles, on COVID, on vaccines. Have never been taken up on that. So through the whole measles outbreak that was raging in Texas, never once asked for a briefing from you who were very important in that response. Yeah. I mean.

I know my way around a measles outbreak. I also ran a large event in New York City in 2018 and 2019. And I'm just one of the people who is a sort of expert in the measles space. We offered these. We offered the briefings. Every time I saw his senior staff, I said it would be great if we could please brief him about these key issues in public health. He's never met anybody from the National Center for Immunization and Respiratory Diseases. He's never met anyone who's briefed him with actual knowledge on measles or on vaccines. So he's getting his information from somewhere, but it's not from CDC. So no input from you to him. What about from him to you? The man has never communicated with me directly. And, you know, the only input that I've seen has been through directive. And you talked a little bit about the gutting of the infrastructure. Tell us a little bit about that. Was that the doge cuts or was that the cuts that came after or the combination of the two of them? Yeah. I mean, I think there were lots of different strategies that had been used to dismantle CDC. So the first is, I think, the doge cuts. And that was really based on... you know, searches for key terms. So in my center, my former center, the only branch that was cut was the only branch that had the name equity in its name. And so other places that had things like HIV, sexual health, chronic disease, like those were not as lucky. And so the cuts were a lot deeper and a lot broader. And they were really focused on, you know, simple word searches to identify, you know, items that may be too woke or that were buzzwords for the administration. And so that was round one. The second round was, you know, adding. sort of mechanisms for people to leave on their own accord by making it really unpleasant to be at CDC. And I know I think that we've seen this as a quote from the head of OMB, who said that his mission was to make it hard for civil servants to come to work and to traumatize them every day. Mission accomplished. And so there was the delayed resignation program where people were able to pick or choose to leave early. It's the Elon Musk buyout that we'd heard about at the beginning. And then other folks were given other retirement options. And so the effect is that holes have been created at CDC.

that don't have any rhyme or reason. So it was with no like global intent or vision. It's just little bits and pieces are deleted. So it kind of doesn't work at all anymore. Yeah. So tell us a little bit about, so you had said that there was a first strike and then there were two other strikes. What were some of the other things? Yeah. So the first strike was that COVID guidance coming out. So not only did we only hear about it on Twitter, but we also requested what's the background science that sort of went behind the decision and the Health and Human Services Department declined sending that to CDC. So to this day, no one at CDC who's a CDC scientist who knows anything about COVID has ever seen the justification for this change. The second thing that happened was... what occurred with the advisory committee for immunization practices or ACIP. There were a couple of different cuts that led to my decision. The very first thing that happened was he fired, Secretary Robert F. Kennedy Jr. fired the 17 scientists who had been on this advisory committee. before he landed. And he cited political reasons that he didn't, he didn't think that they, that, that, that the administration could put their stamp on the, uh, on the committee. And therefore he wanted to remove the 17 disimpassioned actually not politically appointed scientists from there. And in fact, then replace them with people who were, um, for lack of a better term. exactly aligned to his ideology, pretty much ideology clones from the perspective of the anti-back's sentiments that he has expressed. So that happened, but I didn't leave yet. The next thing was that they put together the documents that really defined the role of ACIP, the advisory committee, and its work groups. And the documents they created, they didn't take any feedback. from scientists and they didn't take any feedback from CDC lawyers. And what they produced was something that in effect made an anti-bax advisory committee member. the overlord of the work group. And so in this example, it was COVID. And so that person was given like full power over what the agenda was going to be, what materials were to be presented, and the membership of that work group. Cutting out the agency except for perfunctory provision of data and other support. So that was number two. And then number three, the final straw. It was when I saw that now, you know, we had no ability to influence vaccine policy in any meaningful way. My hope was that because we had Dr. Susan Menares there and she was a really strong scientist, that we would have a strong scientific advocate to make sure that we could have the diplomacy needed to maybe allow us to have science get into the mix as opposed to just ideology. And, you know, when we learned that...

When DeMauri, who was the other doctor and Dan Jernigan and I all learned that she was going to get fired, we had to quit because we had, you know, no more scientific leadership. We knew that this was becoming an ideology machine. And then subsequently, we resigned. And everything that we thought was going to happen, in fact, did happen. I want to ask you, I want to talk a little bit about what did happen, but first, tell me a little bit about the mood inside the building. I'll tell you, my first time at the CDC was when I was a newly minted health official in 2015 and I, you know, walked through. They toured me through the, you know, incredible emergency response center and the labs and everything. And there's so much of the CDC does behind. closed doors that we don't necessarily pay attention to any day most of the time, not because they're not transparent, but because these aren't things that we need to pay attention to because the CDC's got them taken care of. And, you know, we're in a moment right now where there is another active Ebola outbreak at any time you could have a new novel infectious pathogen that makes its way. What? How should we be thinking about the CDC's current capacity to actually do the things that the CDC has been protecting us from or do the work that CDC has been doing to protect us from diseases we don't even have to pay attention to all day, every day? Yeah, I would be highly concerned that CDC is not in the place to be able to mount a large response. So I think, you brought up Ebola, given the inability of CDC staff to communicate effectively to WHO, The future of withdrawal from WHO and then, you know, the complex diplomacy created by such a movement has meant that visibility globally has decreased as has the sort of diplomatic and public health diplomacy needed to be able to work on the ground. So I think we have less visibility in infections globally and also less of a diplomatic end to be able to actually provide what CDC is best at providing, which is expertise, as well as boots. on the ground on some occasion. So, you know, I think that it is fair to say that with a very chaotic health and human services that does not have a cohesive vision for CDC, cuts that have gone across the agency in random ways that will... impede the ability for the agency to respond, and then also policy that is destabilizing at the core science necessary for response, CDC, I think, is not in a position to be a robust responder as it had been in the past. Which is harrowing because you never know when the next. Pathogen is going to emerge. I want to ask you also, right, to get to what we all witnessed earlier this week, there was a disaster of a press conference with Robert F. Kennedy Jr. and Trump rolling out, A, the outcomes of this big...

the promise that they made to identify the cause of autism by September, and then rolling out ASIP recommendations. I want to ask you, right, because it's almost anybody who's been watching this knows that this was the logical conclusion from the jump, right? Anybody who wants to find a particular answer can go find that answer. It's just not really an answer. It's a proposition. What do you make of what we all saw yesterday? Like when you were watching this as somebody who... used to work within the most lauded public health agency in the world. What did you make of it? Like, what was your first reaction? You know, not to be snide, but my first reaction was, I told you so. And so that's, this is why I left. And so I think we saw sort of in the vaccine space that conspiracy theories and unproven data were presented. on a CDC stage at the advisory committee for immunization practices as if though it was gospel truth. And that provided a sort of platform for mis and disinformation to then demonstrate that there was no faith in that advisory committee for making reasonable recommendations for vaccine policy and for the health of Americans. Flash forward a couple of days, and we saw the exact same thing. There were assertions made about the etiology of the cause for autism. It was based on little or no data. There was nothing really new that they were discussing. They seemingly lift up some of the press statements of some of the authors of a study to sort of support their finding that acetaminopin may be related to autism. But that exact press statement says, that no causality is actually defined by the study. So it's all like Orwellian double speak, where you have, you know, people who are saying, like, we have identified the cause or a cause of autism. They talked about acetaminopin. They didn't show their work. They didn't show the data. They didn't talk about the process. Like one paper, two papers does not a conclusion make. It takes a lot more to sort of weave all of the data together in its totality to have the confidence to say that something is causal. So, you know, what I saw was not confidence. What I saw was hubris and the desire to actually achieve a deadline for science as opposed to actually do good science. So I think that that's what I saw. And I also saw this crazy moment where even though vaccines were not to be the focus of this, somehow they managed to slip in vaccines and the childhood schedule with absolutely not a lick of data, no justification for saying anything about that vaccine schedule.

And that's a preview because they've already decided what they're going to do with the schedule. Everything is going to get rubber stamped because the decision has been made by the secretary. And because of his poor briefing to the president, I think the president doesn't have the right information that he needs to make informed decisions. Yeah. America Dissected is brought to you by the American Public Health Association. APHA is excited to welcome you to the 2025 annual meeting and Expo taking place November 2nd through 5th in Washington, D.C. APHA's annual meeting attracts thousands of public health professionals and partners from around the world and across a variety of disciplines each year. This year's theme is making the public health a national priority. With countless sessions, networking opportunities, and unique experiences lined up, you'll leave with new tools, insights, and connections to advance your work. Don't miss the live taping of America Dissected while you're on site. And don't miss the chance to be part of the world's largest gathering of public health professionals. Secure your spot at APHA.org slash annual meeting. Listeners of this podcast get a 10% off discount using code D-I-S-S-E-C-T-E-D-25. It was kind of wild to watch. I mean, the thing that was the most wild to me was just that there were so many people there. And not at any point did anybody step up and be like, dude, what the effort are you saying? Like, this is insane. Some of the comments that Trump made to me were just like, how can anyone let him say this when it's just so obviously false? And look, there is real danger in oversimplifying a problem, right? Because it offers both false hope and false blame. And those two things are really dangerous. There are people out there who are listening and trust somebody like Robert F. Kennedy Jr.. and Donald Trump because they put their political priors ahead of a logical engagement with the data who are thinking back through their course of their pregnancy and asking whether or not they might have taken talent all, as if that's going to explain an outcome that existed, that happened with their child. And, you know, the challenge with this is that. When you start to use ideology to remand science, it's not like this is a victimless crime, right? And that's the thing I just want folks to understand is that like there are real victims here. And there are a lot of folks out there. who somebody listening to this pod might think, oh, well, serves your right for listening. But people are afraid, and not everybody has access to all the information that we'd want for them. And let's be clear, these people have huge megaphones and they're using them on purpose to pretend like they can declare victory on a problem that is way more complicated than being able to deliver an answer to in five months when a lot of really smart, capable people have been trying to answer them for literally five decades. I want to ask you, right, because we all... We're in the situation right now, I think, for all of us who work in this field.

feeling very helpless, feeling very disempowered. What is your advice to people who want to be exponents for the truth and for the scientific process? Like, where do we go from here? Yeah. No, I think the first thing is to just speak up. I think that that's important. And I know, like, having done it myself, having done it with two other colleagues, it is scary because it does really put a target on you. And so I think that... You know, my trauma-informed advice is, you know, you have to do what's right for you. But where you can, it's important to make sure that you speak up. If you're a doctor, a nurse, if you work in public health, if you're helping set local policy or helping, you know, support work on the ground, it's really important to sort of be clear to people, you know, that you're not aligned to a rhetoric and an ideology that's not based in science. You know, I think in public health, the answer is always do your work, and your work is going to be what shines through to prove that the right way to do this is in a way that is both informed by science and the community. So, you know, it's persevere. It is take care of yourself because it is your civic duty to do so. In fact, you know, I went to the funeral, the memorial service of the officer who was shot when CDC had 500 rounds shot at it, again, because of misinformation that has been promoted, frankly, by Robert F. Kennedy Jr.. And one of the things that the officer said while eulogizing Officer Rose was to remind everyone to take care of themselves because it's their civic duty. And, you know, we are the police. We are the defenders of public health. And so just like my police colleagues said in DeKalb County when they memorialized Officer Rose, it is also our necessary duty to take care of ourselves while we try our best to push against the noise. I want to ask you, you know, as you think about broader public health, it's, you know, I think we as a field tend to self-flagellate a little too much and blame ourselves for things we couldn't necessarily control. But what are the lessons in this, right? I think there's lessons for us, I think, as communicators, as scientists, as public servants. In your mind, what are the lessons? Like if you could go back to Dimitri circa, you know, 20 or maybe 2015 even, what would you be telling yourself about how to engage the future that's coming on? Yeah, I mean, I feel like I learned a couple of really important lessons in the work that I've done in public health. And it's that there's really three core elements that you need to be able to prevent either chronic or acute infectious diseases and other public health threats. The first is that you need like a local base community engagement to really understand what people need.

The second is that you need to have political will. And all of that then lifts up science that's implementable to do what's right to keep people healthy. I think that one of the important lessons is that the public health official, your job is to try to maintain all those three things, to maintain the integrity of science, to make sure that you identify resources and are a good steward of resources, to make sure that the science is the best, to make sure that you stay engaged with the community because that is where the ground truth is. The people that you serve are always right in terms of what they need. And then the hardest part is to work as hard as you can. to maintain political will. And so one of the hard parts is that if there is no political will to maintain, we have a major problem. And then what needs to happen is that public health needs to focus on lifting up the locals in the community to be able to sort of support the science and the work. So that's an important lesson that I learned. And the second one that I really think is humility. I think that we definitely... everybody made mistakes during the COVID pandemic. And I think that there was inherently a hubris in some of the way that we communicated science and communicated the sort of infallibility of vaccine. I think that those things have then created opportunity for people who have had decades of strategy to try to undo public health, to be able to sort of find those cracks in the wall. make them bigger, and then ultimately, you know, do what we're seeing now, which is, you know, the decay of a public health system. So, yeah, I think that we need to be humble. And we need to admit that some of the things that we did during the pandemic, the confidence with which we approached vaccines, the confidence with which we approach guidance may now be something that we need to be more careful about in the future and always start with, this is what we know today and this may change tomorrow. Yeah, I really appreciate that. You said something which I want to pause on for a second, which is around political will, right? On the one hand, we have a bit of a schizophrenic relationship. On the one side, we're like, public health is not political. And on the other, we're starting to watch as the political process is destroying public health. And the choices we make about the investments we put into, the well-being of the public, anything that has to do with where we put our public investment is political. So how do you think about public health moving forward in this moment? How should public health think about engaging with the political process? Obviously, you always put the science first, but that also means that you've got to build coalition and think a little bit about who partners are. How are you thinking about that in this moment?

I mean, I used to agree with you. I mean, I think that very specifically when I talked about my three components that you need to think about to have successful public health, you know, the politics and the science are separate, but the politics lifts the science up into feasibility. And so, you know, you need to work to sort of build coalitions and, you know, think about what people are telling you. I mean, I'll give you a great example. You know, way before this administration came in, before there was even Robert F. Kennedy Jr. as a. glimmer in someone's eye. As a health secretary, CDC had been doing work around vaccine messaging. And it was very clear that saying things like vaccines are safe and effective period was no longer what people needed to hear. And that instead, we had to approach vaccines more around a risk calculus. Like the risk of this vaccine is much lower than the risk of the infection. The benefit is far greater. And so... you know, that builds coalition because you meet people where they are. And I think that that's like one of the things that, you know, public health is, should, we'll get better at and at its baseline does, which is it's kind of like artificial intelligence. It's like AI. If you train the system with data, it eventually gets to evolve in a way where the output is even more effective. So the more input that we have, the more community engagement, the more connection to elected officials and to policymakers, the more we're able to do that, the better we can train the system to have an output that's more useful to people. My example is, I would have done anything to sit with the secretary to understand his perspective. Because that would have helped me figure out how to do better in achieving good public health within his mission. I read his books before he came. I listened to every hearing where he was testifying for his confirmation. I listened to his welcome address at HHS, hungry for the information that I need to train the system so my output could be even more effective. Unfortunately, you know, A, not being given the opportunity to interact in a meaningful way, and B, understanding that he's coming with a mission that is really not aligned to public health has made it very hard. At this, it will be hard forever. There will be a change. I'm not sure when. But, you know, when that time comes and we have leaders who are more interested in interacting, the goal of public health is going to be to build that. coalition and build that relationship so that we can really lift the science up and do good work for the community. Well, we really appreciate you being the next point of that, and we appreciate your leadership and your courage. Our guest today is Dr. Dimitri Daskalakis. He's the former director of the National Center for Immunization and Respiratory Diseases. We really appreciate you joining us, sharing your perspective, your wisdom, and looking forward to working alongside you toward a healthier future. Thank you so much for having me.

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