# Tom Frieden & Eric Topol - Discuss the Formula for Better Health Book

An episode of [Ground Truths](https://invisiblenetwork.ai/podcast/1728526108), 1 Oct 2025, 35 min.

Audio: https://api.substack.com/feed/podcast/174857100/908af721d541f486e83712aec3205aa6.mp3

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## Transcript

[0:00] SPEAKER_01: We are live and folks are joining us.
[0:03] SPEAKER_01: And I'm excited about that because I've got a great friend here today,
[0:07] SPEAKER_01: Dr.
[0:08] SPEAKER_01: Tom Frieden,
[0:08] SPEAKER_01: who was the former director of the CDC.
[0:12] SPEAKER_01: And he has a new book.
[0:14] SPEAKER_01: And it's called the formula, the formula for better health.
[0:17] SPEAKER_01: And that's not at one level.
[0:20] SPEAKER_01: It's at two levels, both at the individual and the population level.
[0:24] SPEAKER_01: So there's a lot to discuss here, Tom.
[0:27] SPEAKER_01: Congratulations.
[0:28] SPEAKER_01: I know the book was formally published yesterday.
[0:30] SPEAKER_01: Is that right?
[0:31] SPEAKER_00: Absolutely.
[0:32] SPEAKER_00: Thank you, Eric.
[0:33] SPEAKER_01: Yeah, no, it's really...
[0:35] SPEAKER_01: Very thoughtful.
[0:37] And we're going to go through some of the really great points
[0:40] in it because you
[0:41] have nailed some of the issues that we are confronting to get
[0:45] us to a much
[0:46] SPEAKER_01: healthier state,
[0:47] SPEAKER_01: both as Americans or globally,
[0:50] SPEAKER_01: and also as a personal health story.
[0:53] SPEAKER_01: Now,
[0:55] one of the things that I thought was so perfect that you delved
[0:58] into was the
[0:59] SPEAKER_01: Cassandra curse.
[1:01] SPEAKER_01: This is kind of a cornerstone of the book.
[1:05] SPEAKER_01: And you take it to a great extent.
[1:08] SPEAKER_01: So maybe you can start with that about the Greek mythology,
[1:14] SPEAKER_01: this curse,
[1:15] SPEAKER_01: and how it all applies to getting us healthier.
[1:19] SPEAKER_00: Thanks so much, Eric.
[1:21] SPEAKER_00: The Cassandra curse,
[1:22] SPEAKER_00: actually the working title for the book,
[1:24] SPEAKER_00: which I've worked on on and off for 10 years,
[1:26] SPEAKER_00: was How to Break Public Health's Cassandra Curse.
[1:30] SPEAKER_00: And then I found out that most people hadn't heard of Cassandra.
[1:33] SPEAKER_00: So that wasn't going to be a very effective book title.
[1:37] Cassandra was a priestess in Greek mythology,
[1:40] and she was blessed with foresight.
[1:42] She could foresee the future and future tragedies that were
[1:45] going to strike.
[1:46] SPEAKER_00: But
[1:47] She was cursed that nobody believed her when she prophesied
[1:51] those future tragedies,
[1:53] SPEAKER_00: and so they all came to pass.
[1:55] And that's been what we've been like in public health and
[2:00] actually as individuals also.
[2:02] SPEAKER_00: And breaking the Cassandra curse is part of the formula.
[2:07] SPEAKER_00: It is really an approach that's been proven that has saved millions,
[2:12] SPEAKER_00: actually literally hundreds of millions of lives,
[2:15] SPEAKER_00: and can save hundreds of millions more.
[2:18] SPEAKER_00: And it's really relevant for individual health as well.
[2:21] SPEAKER_00: And the approach, the formula is C2.
[2:24] SPEAKER_00: believe, create.
[2:26] SPEAKER_00: Three phases.
[2:27] SPEAKER_00: And the Cassandra curse is really part of the C phase.
[2:32] We have to see the invisible threats that are coming at us that
[2:35] are going to kill us.
[2:37] We also have to see the toxins that we can't see in our
[2:40] environment that may be poisoning us.
[2:42] SPEAKER_00: And we also have to see the trends of...
[2:47] You know,
[2:47] like Ebola,
[2:48] when I was running CDC,
[2:49] Ebola was exploding in West Africa.
[2:51] SPEAKER_00: We couldn't get anyone to pay attention.
[2:53] And then a modeler,
[2:55] Martin Meltzer,
[2:55] showed this exponential increase,
[2:58] and then people got it.
[2:59] SPEAKER_00: So you have to see trends.
[3:01] SPEAKER_00: You have to see whether programs are succeeding or failing.
[3:03] And one thing I'm sure we'll talk about in a bit is you have to
[3:07] see the path to
[3:08] SPEAKER_00: progress,
[3:08] SPEAKER_00: the technically rigorous path.
[3:10] SPEAKER_00: But you also have to see why we're blind.
[3:13] SPEAKER_00: Why?
[3:14] SPEAKER_00: why we don't pay attention to those warnings.
[3:17] And the Cassandra curse really indicates that we may know
[3:20] something bad is going to
[3:21] SPEAKER_00: happen,
[3:21] SPEAKER_00: but we don't act on it.
[3:22] SPEAKER_00: And why?
[3:23] And in chapter two of the book,
[3:25] I talk about six of the drivers for the Cassandra curse.
[3:28] SPEAKER_00: And the underlying theme there is that our perceptions are wrong.
[3:32] SPEAKER_00: Our perceptions are inaccurate.
[3:34] We think things about ourselves,
[3:36] about the world,
[3:38] and about the future that
[3:39] SPEAKER_00: that aren't really aligned with reality, and therefore we don't act.
[3:44] SPEAKER_00: I'll give you just one of these six drivers of the Cassandra curse,
[3:47] SPEAKER_00: which is a fancy term called hyperbolic discounting.
[3:50] SPEAKER_00: And what it basically says is we shortchange the future.
[3:54] If every smoker knew that they had a 50-50 chance of dropping
[3:57] dead after the next
[3:58] SPEAKER_00: cigarette,
[3:59] SPEAKER_00: not a whole lot of people will keep smoking.
[4:02] SPEAKER_00: But 50% of smokers, unless they quit, are going to get killed by tobacco.
[4:05] SPEAKER_00: So how then...
[4:08] SPEAKER_00: do we break the Cassandra curse?
[4:10] SPEAKER_00: And for each of the six drivers, I go through a way to break it.
[4:13] In terms of the shortchanging the future,
[4:15] the hyperbolic discounting,
[4:16] it's kind of cool.
[4:18] SPEAKER_00: You can do two things.
[4:20] One,
[4:20] you can use emotion and rationality to think of something far
[4:24] in the future as tomorrow.
[4:26] SPEAKER_00: And two,
[4:27] you can reward yourself or society with short-term gains that
[4:32] compensate for that
[4:34] SPEAKER_00: longer term.
[4:34] SPEAKER_00: So to give you one example of each,
[4:37] SPEAKER_00: in the time management field.
[4:40] SPEAKER_00: If I get a request for something,
[4:42] SPEAKER_00: go to a meeting,
[4:43] SPEAKER_00: give a talk,
[4:45] SPEAKER_00: I used to show up at these talks and think,
[4:47] SPEAKER_00: why did I agree to this?
[4:49] SPEAKER_00: And I realized,
[4:49] SPEAKER_00: well,
[4:49] I agreed to it six or 12 months ago when it seemed like it was
[4:52] never going to
[4:52] SPEAKER_00: happen.
[4:53] So now when I get an invitation,
[4:54] I say,
[4:55] if it were tomorrow,
[4:57] would I do it?
[4:58] SPEAKER_00: And if the answer is yes, then I do it like this wonderful podcast.
[5:01] SPEAKER_00: But
[5:02] SPEAKER_00: Often, the answer is no.
[5:04] SPEAKER_00: If it were tomorrow,
[5:05] SPEAKER_00: I wouldn't want to do it,
[5:06] SPEAKER_00: but I would have said yes if I hadn't asked myself that question.
[5:08] SPEAKER_00: The same is true for health.
[5:10] If we can use our rational brains or use our emotions to think
[5:15] of something as
[5:16] SPEAKER_00: right here before us.
[5:17] On a public policy,
[5:18] to give you an example of this,
[5:20] Philadelphia got a soda tax passed by...
[5:23] SPEAKER_00: including the revenue going for early childhood education.
[5:27] SPEAKER_00: So you give a short-term benefit in addition to the long-term benefit.
[5:31] SPEAKER_00: So a long answer to a short question.
[5:33] SPEAKER_01: Well, no, that's great.
[5:34] I mean,
[5:34] what I want to do is I want to show this graph to everybody,
[5:38] this figure 1.1.
[5:41] SPEAKER_01: Okay, this graph, here we go.
[5:44] SPEAKER_01: You see how that hockey stick takes off right there?
[5:47] SPEAKER_01: No intervention or intervention.
[5:49] SPEAKER_01: This is a famous, from the book, you're in the situation room.
[5:54] SPEAKER_01: You are now trying to convince, talk about a Cassandra curse, right?
[5:58] SPEAKER_01: You're trying to convince it's 2014,
[6:02] SPEAKER_01: Ebola is warming up,
[6:04] SPEAKER_01: people are dying,
[6:06] SPEAKER_01: and nothing is being done.
[6:07] SPEAKER_01: It's being ignored.
[6:09] SPEAKER_01: You can see it.
[6:09] SPEAKER_01: You believe it.
[6:11] SPEAKER_01: You want to create a plan.
[6:14] SPEAKER_01: And you show this figure.
[6:17] SPEAKER_01: Tell us about that experience.
[6:20] SPEAKER_00: Yeah, so it really felt like the Cassandra moment.
[6:24] SPEAKER_00: We couldn't convince people to invest.
[6:27] SPEAKER_00: We couldn't explain how bad it was.
[6:29] SPEAKER_00: I had gone to West Africa or was going in West Africa.
[6:37] I had to meet with folks and say,
[6:40] you know,
[6:41] we're not going to get aid here in time.
[6:43] SPEAKER_00: Cases are doubling every three weeks.
[6:45] And it was really the explanation that there could be a million
[6:49] cases within,
[6:50] SPEAKER_00: by the end of the year,
[6:52] SPEAKER_00: this was May,
[6:53] SPEAKER_00: June,
[6:53] SPEAKER_00: and by January there would be a million cases.
[6:57] SPEAKER_00: What's interesting is that did galvanize action.
[7:00] SPEAKER_00: And Samantha Power talks about that in her book as well,
[7:04] SPEAKER_00: this dramatic table drop in the Situation Room.
[7:06] SPEAKER_00: But there's more to this modeler.
[7:10] SPEAKER_00: Martin Meltzer had done something also very interesting.
[7:13] SPEAKER_00: He had shown us the route to progress.
[7:17] He showed that if we got to at least 70% safe care and at least
[7:21] 70% safe burial,
[7:25] SPEAKER_00: cases would drop just as rapidly.
[7:28] SPEAKER_00: And so part of the C,
[7:30] SPEAKER_00: part of the formula,
[7:31] SPEAKER_00: C,
[7:32] SPEAKER_00: believe,
[7:32] SPEAKER_00: create,
[7:32] SPEAKER_00: is to see the technically rigorous path to progress.
[7:37] SPEAKER_00: And some people criticized Martin's model because,
[7:42] SPEAKER_00: you know,
[7:43] you probably would have changed if things had kept doubling
[7:46] every three weeks.
[7:47] SPEAKER_00: But the point was, without change, that would have happened.
[7:50] SPEAKER_00: But, you know, I'm just going to show, figure that one point
[7:55] SPEAKER_00: too, which is really interesting.
[7:58] SPEAKER_00: What this showed was he was exactly right.
[8:02] If you superimpose what happened on what he said would happen,
[8:06] that's exactly what happened.
[8:07] SPEAKER_00: So I think part of technical rigor is seeing the pathway to progress.
[8:13] SPEAKER_00: And that includes
[8:15] not just RCTs,
[8:16] randomized controlled trials,
[8:18] but includes practice-based evidence.
[8:21] SPEAKER_00: It includes practical experiences.
[8:24] SPEAKER_00: And I think often, look, I'm by training a tuberculosis specialist.
[8:31] randomized control studies started with tuberculosis and we
[8:35] learned how to treat.
[8:36] SPEAKER_00: So I think they're fantastic, but they're just one form of evidence.
[8:39] And they're not necessarily the best form of evidence for
[8:42] everything,
[8:43] only for some things.
[8:44] SPEAKER_00: So when we talk about seeing the pathway to progress,
[8:47] SPEAKER_00: we also have,
[8:48] SPEAKER_00: and this is very relevant for personal health,
[8:50] SPEAKER_00: and I think we have to be really frank about almost certain
[8:56] SPEAKER_00: likely, possible, or just a guess.
[8:59] And for a lot of things that are relevant for personal or
[9:03] societal health,
[9:04] you really have to think of which of those categories it fits
[9:07] into if you're going
[9:08] to see the pathway to progress and then figure out how to
[9:12] believe you can make more
[9:13] SPEAKER_00: progress and systematically scale up.
[9:16] SPEAKER_00: Yes.
[9:17] Well,
[9:17] you know,
[9:18] you show so many great examples and you really hit hard on this
[9:23] scene.
[9:24] SPEAKER_01: You have to see, you have to
[9:25] SPEAKER_01: acknowledge the future, the invisibility feature.
[9:29] Like,
[9:29] for example,
[9:30] you go back to 1925 with putting lead in gasoline with Alice
[9:34] Hamilton.
[9:35] SPEAKER_01: and how we went 50 years,
[9:37] SPEAKER_01: 50 years before not only were children having mental development issues,
[9:43] SPEAKER_01: adults with heart disease.
[9:45] SPEAKER_01: I did discuss this with Bruce Lamphere in a prior.
[9:48] SPEAKER_01: I read, I listened to that.
[9:49] SPEAKER_01: Kidney stroke, all this stuff.
[9:52] SPEAKER_01: And it took all that time for the Cassandra curse to be broken.
[9:55] SPEAKER_01: It's amazing.
[9:56] SPEAKER_01: And of course, you take us through the TB in New York City, the
[10:01] SPEAKER_01: TB resistant in the early 1990s.
[10:03] SPEAKER_01: So many great examples.
[10:04] And as you said,
[10:05] it's not just randomized trials and modeling,
[10:08] natural experiments.
[10:09] SPEAKER_01: I mean, still so many people won't get a shingles vaccine.
[10:13] SPEAKER_01: And we see the data consist in three big natural experiments in
[10:18] SPEAKER_01: Wales,
[10:18] SPEAKER_01: the U.S.,
[10:19] SPEAKER_01: and Australia,
[10:20] SPEAKER_01: that shows like 20-some percent reduction of Alzheimer's and dementia,
[10:25] SPEAKER_01: which would be a phenomenal drug,
[10:26] SPEAKER_01: but they don't see the benefit.
[10:29] SPEAKER_01: I mean, this is part of our health problem.
[10:31] SPEAKER_00: Is that true?
[10:32] SPEAKER_00: Yeah.
[10:33] SPEAKER_00: You know, I think there's, you know, frankly, so much hype
[10:37] so much sloppy thinking and so much grifting in the personal
[10:42] wellness space that
[10:44] SPEAKER_00: the simple stuff gets lost.
[10:46] SPEAKER_00: And part of the, you know, see is hard enough.
[10:49] SPEAKER_00: Believing things that may seem inevitable can be changed is also hard,
[10:54] SPEAKER_00: but we've made a lot of progress.
[10:55] SPEAKER_00: We can make phased further progress.
[10:57] SPEAKER_00: We can cultivate optimism.
[10:59] But the hardest part of the formula is to create a healthier
[11:02] future because there
[11:03] SPEAKER_00: are always going to be challenges.
[11:05] SPEAKER_00: You have to prioritize.
[11:06] SPEAKER_00: You have to
[11:08] We deal with this a lot in our work at my organization,
[11:11] Resolve to Save Lives.
[11:12] SPEAKER_00: We work in countries around the world.
[11:14] SPEAKER_00: And,
[11:15] SPEAKER_00: you know,
[11:15] SPEAKER_00: people want to do everything for everyone,
[11:18] but you end up not doing the most important things for the
[11:21] people who can benefit
[11:22] SPEAKER_00: the most.
[11:23] SPEAKER_00: And this concept of progressive universalism,
[11:26] that we're going to start with the highest impact services for
[11:29] the people most in
[11:30] SPEAKER_00: need,
[11:30] SPEAKER_00: will benefit most,
[11:31] SPEAKER_00: and then we're going to expand as resources,
[11:34] SPEAKER_00: financial and human allow,
[11:35] SPEAKER_00: you know,
[11:35] SPEAKER_00: keeping it simple, communicating well, overcoming barriers.
[11:39] But I think this issue of getting past the hype in personal
[11:45] health advice,
[11:46] SPEAKER_00: and one of the tools of technical rigor is understanding how
[11:51] SPEAKER_00: what I call burden times amenability.
[11:54] SPEAKER_00: How big is the problem and how much can we do about it?
[11:57] SPEAKER_00: So I would say shingles vaccine for dementia prevention,
[12:00] SPEAKER_00: I discuss it in the book,
[12:01] SPEAKER_00: there is some evidence.
[12:03] SPEAKER_00: It may still be residual confounding or methodological problems,
[12:07] but the most recent study is really good because it's an
[12:10] experiment of nature.
[12:11] SPEAKER_00: And we actually, this was the last reference.
[12:14] SPEAKER_00: There are more than 500 references in the book.
[12:16] SPEAKER_00: It was the last reference because it was just a preprint.
[12:19] And so on the last day of the galley proofs,
[12:22] they changed the title and a couple other things.
[12:25] SPEAKER_00: We got the reference right.
[12:26] SPEAKER_00: But yeah, I think you have to look at what's a hype free.
[12:31] SPEAKER_00: And sure,
[12:31] there are things that are unproven that maybe you want to try
[12:33] because you want to
[12:34] SPEAKER_00: do that.
[12:35] SPEAKER_00: But let's be clear.
[12:37] blood pressure is probably the single most important thing that
[12:40] any non-smoker can do.
[12:42] SPEAKER_00: If you smoke cigarettes, the most important thing you can do is to quit.
[12:45] SPEAKER_00: But for blood pressure,
[12:47] SPEAKER_00: the evidence is so strong that starting at 115 over 75,
[12:53] SPEAKER_00: your risk of a heart attack,
[12:54] SPEAKER_00: stroke,
[12:55] SPEAKER_00: or death doubles with every 20-point increase.
[12:58] And since the SPRINT trial,
[13:00] great RCT,
[13:01] we've seen that down to 120 knocks down your risk of...
[13:06] SPEAKER_00: Heart attack, stroke, or death by a quarter, 27%.
[13:08] SPEAKER_00: So I think if we – and they're all great generic medications.
[13:15] Globally,
[13:17] countries treat hypertension for $5 a year with the best
[13:21] medicines there are.
[13:22] SPEAKER_00: And statins, very, very effective.
[13:25] SPEAKER_00: Physical activity –
[13:27] SPEAKER_00: I know you're a big proponent.
[13:29] SPEAKER_00: The closest thing there is to a wonder drug.
[13:31] There's probably no pill or injection that can improve your
[13:35] health as much as
[13:37] SPEAKER_00: regular physical activity.
[13:39] SPEAKER_00: Right.
[13:39] Well,
[13:39] you know,
[13:40] one of the people questioned Stephen Thompson,
[13:43] I think his name.
[13:44] SPEAKER_01: And by the way, if you have questions for Tom or us, don't...
[13:48] SPEAKER_01: hesitate to put it in the message, but he said, future for whom?
[13:51] SPEAKER_01: And we are,
[13:54] SPEAKER_01: as I introduced,
[13:55] SPEAKER_01: talking about your book that gets at both levels,
[13:58] SPEAKER_01: the population and individual future.
[14:01] SPEAKER_01: And as you mentioned for the individual,
[14:03] SPEAKER_01: not only smoking,
[14:04] SPEAKER_01: blood pressure,
[14:04] SPEAKER_01: low sodium,
[14:06] SPEAKER_01: that blood pressure 120 over 80 still is not clinically
[14:09] SPEAKER_01: accepted.
[14:10] SPEAKER_01: You know,
[14:10] SPEAKER_01: that's still,
[14:11] SPEAKER_01: you know,
[14:12] SPEAKER_01: most primary care docs,
[14:14] SPEAKER_01: cardiologists even will accept much higher blood pressures.
[14:18] SPEAKER_00: And they don't even hit 140.
[14:20] You know,
[14:20] Eric,
[14:21] we spend four and a half trillion dollars on health care in the
[14:24] U.S.
[14:24] The single most important thing we could get right is to
[14:27] control blood pressure even to 140.
[14:30] SPEAKER_00: And we don't do that even half the time.
[14:33] SPEAKER_01: No, and then, of course, the exercise.
[14:35] But that brings up this other concept that I wanted you to
[14:38] develop with us today,
[14:40] SPEAKER_01: the prevention paradox.
[14:44] Tell us about how we are really the conflict between a personal
[14:49] benefit versus a
[14:50] SPEAKER_01: population-level benefit.
[14:53] SPEAKER_00: The prevention paradox is a really important concept.
[14:56] SPEAKER_00: Jeffrey Rose came up with it.
[14:58] SPEAKER_00: And the idea is that small changes across large populations make a bigger
[15:03] SPEAKER_00: difference than big changes across small populations.
[15:06] SPEAKER_00: And that can go in either direction, small benefits or small harms.
[15:11] SPEAKER_00: I'll mention two.
[15:12] SPEAKER_00: We talked about lead.
[15:13] SPEAKER_00: Just a little bit of lead less throughout all of society is
[15:18] SPEAKER_00: creates massive benefits, economic, educational, cardiovascular, kidney.
[15:25] SPEAKER_00: But no one person may know that they've been benefited.
[15:29] However,
[15:29] the industry that had to get the lead out may lobby and block
[15:34] those changes.
[15:36] SPEAKER_00: Similarly,
[15:38] SPEAKER_00: decreasing potassium or decreasing sodium.
[15:45] SPEAKER_00: If we just do that a little bit across all of society,
[15:47] SPEAKER_00: no one's going to notice,
[15:49] but it may prevent thousands or hundreds of thousands of heart
[15:53] attacks and strokes,
[15:53] SPEAKER_00: but the companies that have to change are going to oppose.
[15:56] SPEAKER_00: So this prevention paradox is really important for two reasons.
[15:59] SPEAKER_00: One,
[16:00] It's an example of why we don't see reality so effectively,
[16:04] so accurately.
[16:05] We don't see what's really driving health because we can't see
[16:08] the things that are
[16:09] making a big difference because they're making a little
[16:11] difference for a lot of
[16:12] SPEAKER_00: people.
[16:13] SPEAKER_00: But that has a political corollary, which means...
[16:16] SPEAKER_00: Basically,
[16:17] SPEAKER_00: you're going to have tobacco,
[16:19] SPEAKER_00: lead,
[16:20] SPEAKER_00: food,
[16:20] SPEAKER_00: alcohol,
[16:23] SPEAKER_00: the polluting industries,
[16:25] a very concentrated and powerful opposition to benefits that
[16:30] will be for everyone
[16:32] SPEAKER_00: diffusely.
[16:33] SPEAKER_00: So public health...
[16:35] SPEAKER_00: has the odds stacked against it.
[16:36] SPEAKER_00: We're always going to have to fight uphill.
[16:39] SPEAKER_00: We're always going to have to say,
[16:41] SPEAKER_00: listen,
[16:41] SPEAKER_00: this is good for everyone a little bit and bad for a few groups a lot.
[16:46] And we're going to have to mitigate those few groups and
[16:48] organize the people who
[16:50] SPEAKER_00: benefit from it.
[16:51] SPEAKER_00: Because the prevention paradox is a very important concept.
[16:54] SPEAKER_00: The things that will improve health most, we may never see.
[16:58] SPEAKER_01: Right.
[16:58] Well,
[16:58] you know,
[16:59] and it also applies at the physician side,
[17:01] because physicians will say,
[17:03] Well,
[17:04] I don't see this in my practice,
[17:06] but their practice may be a couple of thousand patients.
[17:09] SPEAKER_01: And it's been proven through other means.
[17:12] And so the same prevention treatment paradox is you just don't
[17:16] have a feel for the
[17:17] SPEAKER_01: bigger picture,
[17:17] SPEAKER_01: the bigger denominator.
[17:19] SPEAKER_01: Now,
[17:19] SPEAKER_01: one of the things I want to get to,
[17:21] SPEAKER_01: because this see,
[17:23] SPEAKER_01: believe,
[17:24] SPEAKER_01: create formula is what we have the antithesis of that right now.
[17:29] SPEAKER_01: We're not seeing anything.
[17:31] SPEAKER_01: We're denying everything.
[17:33] SPEAKER_01: And then we can't even get to the believe or create
[17:37] a plan or try to do something about it if you don't even get to
[17:41] the first part or the formula.
[17:43] SPEAKER_01: So what are you seeing about the mess that we're in right now?
[17:48] SPEAKER_01: What comments do you have about that?
[17:50] SPEAKER_00: Well,
[17:51] it's absolutely the case that one of the biggest risks here is
[17:55] that we are
[17:56] SPEAKER_00: undermining our ability to see the health threats,
[18:00] SPEAKER_00: threats to our lives,
[18:01] SPEAKER_00: our livelihoods,
[18:02] SPEAKER_00: our families.
[18:04] SPEAKER_00: Take one example from many.
[18:06] apparently because of budget cuts and staffing cuts and the
[18:09] devastation of the CDC.
[18:11] SPEAKER_00: Public health is under assault right now,
[18:14] literal assault as a gunman opened fire and fired close to 500
[18:19] rounds into the CDC
[18:20] SPEAKER_00: campus,
[18:21] SPEAKER_00: but also figuratively with massive budget cuts,
[18:25] SPEAKER_00: thousands of staff laid off,
[18:27] SPEAKER_00: half of the national centers closed.
[18:30] SPEAKER_00: And FoodNet,
[18:33] SPEAKER_00: PulseNet,
[18:34] one of the things that tracks foodborne illnesses is going to
[18:37] stop tracking
[18:39] SPEAKER_00: Listeria and Campylobacter.
[18:41] SPEAKER_00: These are two serious infections.
[18:44] SPEAKER_00: They're spread, by the way, by raw milk, among other things.
[18:48] SPEAKER_00: And,
[18:49] SPEAKER_00: you know,
[18:50] SPEAKER_00: if CDC isn't able,
[18:51] SPEAKER_00: now we have government shutdown,
[18:53] SPEAKER_00: if CDC isn't able to track things,
[18:56] SPEAKER_00: you go to the supermarket and pick up whatever it is,
[18:59] SPEAKER_00: a package of frozen peas or a TV dinner or something else,
[19:05] SPEAKER_00: it may have bacteria in it that make you sick.
[19:08] SPEAKER_00: So we are undermining our protections.
[19:11] SPEAKER_00: We are leaving ourselves blind to the microbial conditions.
[19:15] SPEAKER_00: and toxic threats.
[19:17] We're also turning back the clock on protections against PM2.5
[19:23] that already kills
[19:24] SPEAKER_00: 100,000 Americans every year,
[19:27] SPEAKER_00: against mercury and arsenic and PFAS and other forever chemicals,
[19:32] SPEAKER_00: which astonishingly,
[19:34] SPEAKER_00: to me,
[19:35] SPEAKER_00: contaminate half of the water in America.
[19:39] SPEAKER_00: And they've rolled back the protections there.
[19:41] SPEAKER_00: So what you have here is kind of those concentrated costs,
[19:48] SPEAKER_00: those companies that don't want to do things that will benefit everyone,
[19:52] SPEAKER_00: they're in control now.
[19:53] SPEAKER_00: And basically,
[19:55] it's open season on your lungs because they can pollute all
[19:59] they want into your
[20:00] SPEAKER_00: lungs.
[20:00] SPEAKER_00: And this is the opposite of the prevention paradox,
[20:03] SPEAKER_00: is kind of the harm paradox,
[20:05] SPEAKER_00: that basically you're allowing a few...
[20:08] SPEAKER_00: Self-interested industries to pollute,
[20:11] SPEAKER_00: to contaminate,
[20:12] SPEAKER_00: to sell toxic things,
[20:15] SPEAKER_00: and the harms will be very widespread.
[20:18] SPEAKER_00: But there is a way forward.
[20:19] SPEAKER_00: I hope so.
[20:20] SPEAKER_01: It's looking pretty bleak right now, Tom.
[20:24] SPEAKER_00: It is.
[20:24] SPEAKER_00: It is.
[20:25] And I don't think we should be anything other but eyes wide
[20:27] open about this.
[20:29] SPEAKER_00: But facts are stubborn things.
[20:32] And even if they're denied,
[20:34] suppressed,
[20:36] misused,
[20:37] misquoted,
[20:37] they're still facts.
[20:39] SPEAKER_00: And they're still the reality out there.
[20:42] SPEAKER_00: And people want to be healthy.
[20:44] SPEAKER_00: When you look at the Make America Healthy Maha movement,
[20:47] SPEAKER_00: it's tapping into something very important,
[20:50] SPEAKER_00: that people are so frustrated with our health care system,
[20:53] SPEAKER_00: where you can't get good care,
[20:55] SPEAKER_00: with inappropriate overemphasis on some pharmaceutical treatments.
[21:01] SPEAKER_00: I think that gets confused sometimes.
[21:03] SPEAKER_00: We over-treat some things and under-treat some things.
[21:06] SPEAKER_00: But there are stubborn facts and
[21:10] SPEAKER_00: And committed people,
[21:12] SPEAKER_00: and I think what we'll see increasingly is states,
[21:16] SPEAKER_00: organizations,
[21:18] SPEAKER_00: localities,
[21:19] SPEAKER_00: building forward,
[21:20] SPEAKER_00: not building back,
[21:21] SPEAKER_00: building forward to a health system,
[21:24] SPEAKER_00: including both healthcare and public health,
[21:27] SPEAKER_00: that's more connected,
[21:29] SPEAKER_00: that communicates well.
[21:31] SPEAKER_00: that prioritizes well,
[21:33] SPEAKER_00: that creates alliances and resilience,
[21:36] SPEAKER_00: that delivers results that matter to people,
[21:39] SPEAKER_00: longer,
[21:40] SPEAKER_00: healthier lives,
[21:42] that gets away from some of the really problematic conflicts of
[21:46] interest where
[21:47] we're paying way too much for medicines and vaccines and
[21:52] getting far too little of
[21:54] SPEAKER_00: the basic care that can save lots of lives.
[21:58] SPEAKER_01: Yeah.
[21:59] SPEAKER_01: Well, you touched on, again, the seeing part of our environmental toxins.
[22:04] SPEAKER_01: not just air pollution,
[22:06] SPEAKER_01: you mentioned the particulate matter 2.5,
[22:09] SPEAKER_01: but also microplastics,
[22:10] SPEAKER_01: nanoplastics.
[22:12] SPEAKER_01: We know they are causing harm.
[22:15] SPEAKER_01: You already have studies in blood vessels, the brain and whatnot.
[22:18] SPEAKER_01: Reproductive health as well, maybe accounting for part of that issue.
[22:24] SPEAKER_01: But instead of this movement to try to have a healthier America,
[22:30] SPEAKER_01: we're going in the wrong direction.
[22:32] SPEAKER_01: And of course,
[22:32] denying even climate change and its intersection with another
[22:36] pandemic is also part
[22:39] SPEAKER_01: of the story.
[22:40] SPEAKER_01: So in so many ways, we're going backwards.
[22:43] SPEAKER_01: And you have provided us a way forward, which is sensible.
[22:47] SPEAKER_01: It's pretty simple.
[22:49] SPEAKER_01: That's what's good about it is the knowledge to prevent.
[22:52] SPEAKER_01: It's all about that.
[22:53] SPEAKER_01: It's about ignoring or denying.
[22:57] SPEAKER_01: I mean, what we have with this Cassandra's curse is a lot of denialism.
[23:02] SPEAKER_01: And this is really unfortunate.
[23:04] SPEAKER_01: I like your optimism about where we can head, but I don't see any of it.
[23:09] Like,
[23:09] for example,
[23:10] yesterday was published an important paper about COVID in
[23:15] children and teens.
[23:17] SPEAKER_01: With the second infection,
[23:19] there was a doubling of long COVID with lots of other symptoms
[23:24] and outcomes that
[23:25] SPEAKER_01: were adverse.
[23:26] SPEAKER_01: And here we are, the COVID vaccines are only for people over 65.
[23:32] SPEAKER_00: Even that,
[23:32] SPEAKER_00: I mean,
[23:33] SPEAKER_00: Eric,
[23:33] SPEAKER_00: even that,
[23:34] the Advisory Committee on Immunization Practices at the CDC was
[23:38] basically taken
[23:39] SPEAKER_00: over by unscientific ideologues who don't have expertise in vaccine.
[23:47] SPEAKER_00: And I oversaw that committee for eight years.
[23:49] SPEAKER_00: It used rigorous, fact-based science, complete transparency, everything.
[23:56] SPEAKER_00: presentation on the web.
[23:58] SPEAKER_00: I think it could have communicated better.
[23:59] SPEAKER_00: But one of the things it did is to change vaccination against COVID,
[24:05] SPEAKER_00: even for people over the age of 65,
[24:07] SPEAKER_00: to what's called shared clinical decision-making.
[24:10] That's only used if we're at equipoise,
[24:13] and there is no evidence that it helps.
[24:16] SPEAKER_00: That's nonsense.
[24:17] There's a dramatic reduction in severe illness or death among
[24:22] people who get
[24:23] SPEAKER_00: vaccinated and are over 65.
[24:26] SPEAKER_00: So that's an abdication of the government responsibility.
[24:30] SPEAKER_00: Again, I think simplicity is important.
[24:32] SPEAKER_00: And what I hope people get from the book is not just a message of hope,
[24:36] SPEAKER_00: though I know we need that in this time.
[24:38] And it is that because we've made a lot of progress and we can
[24:41] make a lot more.
[24:42] SPEAKER_00: It's also a message of how.
[24:44] SPEAKER_00: How to make more progress.
[24:46] SPEAKER_00: Seeing the invisible and making it apparent.
[24:49] SPEAKER_00: Believing we can make progress, including making phased progress.
[24:55] SPEAKER_00: So step by step, you can build that confidence and cultivate optimism.
[25:00] And then creating a healthier future with prioritized,
[25:03] simple,
[25:04] well-communicated ideas.
[25:07] initiatives,
[25:08] solutions that overcome the barriers that are always going to
[25:11] be there.
[25:11] There are always going to be self-interested groups that block
[25:14] public health progress.
[25:15] SPEAKER_00: But for hundreds of years, we've been making progress.
[25:19] SPEAKER_00: And really, I mean, you know this so much better than I do, Eric.
[25:23] SPEAKER_00: We have amazing tools today.
[25:25] SPEAKER_00: We have the best diagnostics, the best medications, the
[25:31] SPEAKER_00: that humanity has ever had.
[25:34] I'm pretty impressed with some of the artificial intelligence
[25:39] tools of making our
[25:41] SPEAKER_00: work better,
[25:42] SPEAKER_00: faster.
[25:43] SPEAKER_00: And we have such potential to live long,
[25:46] SPEAKER_00: healthy lives,
[25:47] SPEAKER_00: to prevent most of the heart attacks and strokes that happen today,
[25:52] to avoid the toxic exposures that we're bathed in in our modern
[25:57] environment.
[25:58] Yeah,
[25:58] well,
[25:59] you know,
[25:59] that's where it gets us to the last topic I wanted to run by
[26:02] you.
[26:03] SPEAKER_01: When I talked to Susan Benares before she suddenly was no longer at CDC,
[26:10] SPEAKER_01: she and I were in alignment about the P,
[26:13] SPEAKER_01: CDC P for prevention,
[26:16] SPEAKER_01: which,
[26:16] SPEAKER_01: you know,
[26:16] SPEAKER_01: there hasn't been enough of that.
[26:18] SPEAKER_01: And we're at a time right now where if you can see your future,
[26:23] SPEAKER_01: you know,
[26:23] SPEAKER_01: as you know,
[26:24] SPEAKER_01: there was a recent Nature paper actually from Germany
[26:27] which predicts your future events in health for the next 20
[26:30] years remarkably accurately.
[26:33] SPEAKER_01: And not just the events, but when.
[26:35] SPEAKER_01: And then added to that,
[26:36] SPEAKER_01: as you just mentioned,
[26:37] SPEAKER_01: Tom,
[26:38] SPEAKER_01: there's all these diagnostics,
[26:40] SPEAKER_01: like for example,
[26:40] SPEAKER_01: it could be a polygenic risk score,
[26:43] SPEAKER_01: it could be your protein organ clocks,
[26:46] SPEAKER_01: all these other layers of data.
[26:47] SPEAKER_01: We can do this now.
[26:49] We can say who's at high risk,
[26:51] and we know the ways to prevent these diseases.
[26:54] SPEAKER_01: It seems to me that it's a really exciting time in medicine,
[26:58] SPEAKER_01: which is being missed because of this enhanced capability for prevention,
[27:02] SPEAKER_01: which I know you're into that,
[27:05] SPEAKER_01: because it starts with seeing,
[27:06] SPEAKER_01: seeing the future.
[27:08] SPEAKER_01: What are your thoughts about taking prevention, primary prevention,
[27:12] never getting the disease in the first place,
[27:14] to a new level in the years ahead?
[27:17] SPEAKER_00: Well,
[27:17] I think there are probably a handful of things that we could do
[27:21] as society and a
[27:23] handful of things that we can do as individuals that would
[27:27] really bring our leading
[27:29] SPEAKER_00: cause of death,
[27:29] SPEAKER_00: heart attacks and strokes,
[27:31] SPEAKER_00: down to much,
[27:32] SPEAKER_00: much lower levels.
[27:33] SPEAKER_00: Health taxes on tobacco, alcohol, sugary drinks, junk food.
[27:40] Tobacco regulation,
[27:41] including denicotinizing tobacco,
[27:43] which the FDA has the authority to do.
[27:47] SPEAKER_00: Alcohol prevention,
[27:48] SPEAKER_00: including strong warnings,
[27:50] SPEAKER_00: reductions of alcohol density,
[27:53] SPEAKER_00: and sales of alcohol hours and places of sale.
[27:57] SPEAKER_00: Front of pack warning labels.
[27:59] Chile,
[27:59] the country of Chile,
[28:00] did this,
[28:01] and it's a hugely successful way of improving nutrition.
[28:05] SPEAKER_00: reducing sodium and promoting potassium-enriched low-sodium salts,
[28:09] SPEAKER_00: regulating PM2.5,
[28:11] SPEAKER_00: soot,
[28:13] SPEAKER_00: having gun safety regulations.
[28:15] Gun violence is one of the major reasons Americans live shorter
[28:18] lives on average than Europeans.
[28:21] SPEAKER_00: in medical care, change the way we pay.
[28:24] So the healthcare system will make more money if they keep
[28:27] people healthy.
[28:28] SPEAKER_00: Right now, the healthcare system makes more money if people get sick.
[28:32] SPEAKER_00: And in public health,
[28:33] SPEAKER_00: we need better data systems,
[28:35] SPEAKER_00: faster action,
[28:36] SPEAKER_00: closer alignment with realities,
[28:38] SPEAKER_00: enough funding,
[28:39] SPEAKER_00: and getting back to scientific independence.
[28:42] I'm with you,
[28:43] but all the things you outlined were at the population level.
[28:46] SPEAKER_01: And what we saw when that is being done,
[28:49] SPEAKER_01: like for example,
[28:50] SPEAKER_01: vaccine mandates,
[28:52] SPEAKER_01: as an example,
[28:53] SPEAKER_01: there are many others,
[28:54] SPEAKER_01: they get people bristled that,
[28:56] SPEAKER_01: oh,
[28:56] SPEAKER_01: I don't want to do this.
[28:58] SPEAKER_01: I don't want to have my junk food tax.
[29:01] SPEAKER_01: I live on junk food.
[29:03] SPEAKER_01: Who knows what the comeback could be?
[29:05] SPEAKER_01: However, at the individual level,
[29:07] SPEAKER_01: Again, because your book gets into both levels.
[29:11] SPEAKER_01: And at the individual level,
[29:13] SPEAKER_01: there's so much,
[29:13] if people want to know the risk and they zoom in on how they
[29:17] can prevent that
[29:19] SPEAKER_01: condition,
[29:20] SPEAKER_01: That is something that we didn't have.
[29:22] SPEAKER_01: It used to be the Cassandra curse was,
[29:25] I don't want to know APOE4 status because I don't want to know
[29:30] if I'm a high risk
[29:31] SPEAKER_01: for Alzheimer's.
[29:32] Now we're at a time where we should be able to prevent
[29:35] Alzheimer's if we go after this.
[29:36] SPEAKER_01: In fact,
[29:37] SPEAKER_01: as you know,
[29:37] there's a couple of trials that are going to be out soon in the
[29:40] weeks ahead that
[29:41] SPEAKER_01: are testing a GLP-1 drug,
[29:43] SPEAKER_01: Ozempic.
[29:43] SPEAKER_00: Yeah.
[29:44] SPEAKER_01: Two big trials, Evoke and Evoke Plus, against Alzheimer's.
[29:47] SPEAKER_01: These are people with mild Alzheimer's.
[29:49] SPEAKER_01: They're not even preventing Alzheimer's in the first place.
[29:52] SPEAKER_01: If that hits, oh my gosh.
[29:53] SPEAKER_01: But I think we share the prevention's excitement.
[29:58] SPEAKER_01: And I want to nail you down at the personal level.
[30:02] SPEAKER_00: Yeah.
[30:03] SPEAKER_00: That's what I want to get to also.
[30:04] SPEAKER_00: Just one point about mandates.
[30:06] SPEAKER_00: It's one thing to mandate individuals.
[30:08] SPEAKER_00: It's another to regulate companies.
[30:11] SPEAKER_00: And, you know, I think mandates on individuals should be awfully rare.
[30:15] I don't think we should have been mandating vaccination,
[30:17] for example,
[30:18] during COVID.
[30:19] SPEAKER_00: but mandating or regulating companies so they don't hurt people.
[30:23] SPEAKER_00: That's not about taking away personal liberty.
[30:25] SPEAKER_00: That's about increasing personal liberty.
[30:27] SPEAKER_00: Okay.
[30:28] SPEAKER_00: Six.
[30:28] There's six things that I think really make a difference for
[30:32] personal health.
[30:33] SPEAKER_00: Get your blood pressure under 120.
[30:34] SPEAKER_00: Right.
[30:36] SPEAKER_00: Get your lipids healthy.
[30:37] SPEAKER_00: And that's probably your LDL under 70 and your APOB under 70.
[30:42] SPEAKER_00: Yeah.
[30:42] SPEAKER_00: Uh,
[30:45] SPEAKER_01: And soon it'll be 10-year LPA low, too.
[30:47] SPEAKER_00: Yeah, yeah, yeah.
[30:48] SPEAKER_00: Once we figure out what to do with that.
[30:50] SPEAKER_01: You got a drug coming for that one, yeah.
[30:52] SPEAKER_00: Physical activity,
[30:53] SPEAKER_00: the closest thing to a wonder drug,
[30:55] SPEAKER_00: at least four days a week,
[30:57] SPEAKER_00: at least 30 minutes per day of moderately brisk activity.
[31:02] SPEAKER_00: You know, it'll do more for your health than any pill.
[31:05] SPEAKER_00: And it's just great for everything.
[31:07] SPEAKER_00: It's great for mood.
[31:08] SPEAKER_00: It's great for depression.
[31:09] SPEAKER_00: It's great for diabetes.
[31:10] SPEAKER_00: It's great for obesity.
[31:11] SPEAKER_00: It's great for cancer.
[31:12] It's great for blood pressure,
[31:13] even if you don't lose one ounce of weight.
[31:16] SPEAKER_00: Sleep,
[31:17] SPEAKER_00: as you've emphasized in your sub-stack,
[31:19] SPEAKER_00: Eric,
[31:19] SPEAKER_00: at least seven hours,
[31:21] SPEAKER_00: seven to nine hours of sleep.
[31:22] SPEAKER_00: Easier said than done, but there are things that can be done.
[31:26] And thank you for pointing out the new class of sleep meds that
[31:29] some people may benefit from.
[31:31] SPEAKER_00: Nutrition.
[31:33] You know,
[31:33] nutrition is really complicated,
[31:34] but there's some things that are really clear.
[31:37] SPEAKER_00: More potassium, less sodium, more fiber, less processed meat, less sugar.
[31:44] SPEAKER_00: You know, it gets really complicated past that
[31:47] SPEAKER_00: But those things from an epidemiologic technical rigor standpoint,
[31:50] SPEAKER_00: I'm really certain will make a really big difference.
[31:52] SPEAKER_00: And then finally,
[31:53] SPEAKER_00: the sixth is avoid toxins,
[31:55] SPEAKER_00: tobacco,
[31:56] SPEAKER_00: alcohol,
[31:56] SPEAKER_00: PM 2.5,
[31:58] SPEAKER_00: and the new ones,
[31:59] SPEAKER_00: the big three,
[31:59] SPEAKER_00: nanoparticles,
[32:00] SPEAKER_00: microplastics,
[32:02] SPEAKER_00: and endocrine disruptors.
[32:03] SPEAKER_00: We don't fully understand what harms they're creating and how much,
[32:08] SPEAKER_00: but they are not good things to have in your environment.
[32:10] SPEAKER_01: Yeah, and they're tough to eradicate or
[32:13] SPEAKER_01: diminish because we need health policy changes.
[32:16] SPEAKER_01: You need there to go right back to the company's
[32:19] SPEAKER_01: and the need for governmental regulation and enforcement.
[32:23] SPEAKER_00: Anyway...
[32:23] I'll tell you two little things I changed in my personal health
[32:25] regime after
[32:26] SPEAKER_00: writing this book.
[32:27] I eat a lot more sweet potatoes because I had no idea they were
[32:29] so healthy and
[32:30] SPEAKER_00: they're delicious.
[32:31] And I bought a reverse osmosis machine for my water because
[32:36] that's a way of
[32:37] SPEAKER_00: avoiding plastics,
[32:38] SPEAKER_00: microplastics,
[32:39] SPEAKER_00: and,
[32:40] SPEAKER_00: you know,
[32:40] SPEAKER_00: 50% of our water has stuff in it.
[32:42] SPEAKER_01: Oh, it's a good idea.
[32:44] SPEAKER_01: Having filters or whatever technique to...
[32:47] SPEAKER_01: to reduce the microplastic exposure.
[32:51] SPEAKER_01: You know, it goes right into your formula.
[32:53] SPEAKER_01: See, you can't see it, but you know it's in there.
[32:57] SPEAKER_01: As you say, it's a big deal and we can't ignore it anymore.
[33:00] SPEAKER_01: Yeah.
[33:01] SPEAKER_00: Thank you, Eric, for what you do.
[33:03] SPEAKER_00: You know, you've been such a great voice of science.
[33:06] SPEAKER_00: You are always at the cutting edge.
[33:08] You're always telling us what's around the corner,
[33:11] what's now,
[33:11] what's important.
[33:12] SPEAKER_00: And I loved your book, Longevity.
[33:15] SPEAKER_00: And I was fascinated by that you,
[33:18] SPEAKER_00: from a very basic science,
[33:20] SPEAKER_00: science researcher standpoint,
[33:21] SPEAKER_00: and I,
[33:22] SPEAKER_00: from an epidemiologic analyst standpoint,
[33:25] SPEAKER_00: come up with pretty much the same formula for personal health.
[33:29] SPEAKER_01: Yeah.
[33:29] SPEAKER_01: One of the questions was, what reverse osmosis machine did you get?
[33:34] SPEAKER_00: I just,
[33:35] SPEAKER_00: I'm not going to,
[33:36] SPEAKER_00: I've never taken money from a company,
[33:38] SPEAKER_00: so I'm not going to say what brand I use.
[33:39] SPEAKER_00: But,
[33:39] SPEAKER_00: you know,
[33:40] get onto Consumer Reports and Wirecutter and independent
[33:44] assessments and see which
[33:45] SPEAKER_00: have a good assessment.
[33:46] SPEAKER_00: All right.
[33:47] SPEAKER_00: Well, the book is here, The Formula for Better Health.
[33:50] SPEAKER_00: I think you're here.
[33:51] And I do want to say that all proceeds from this book go to
[33:53] programs to support
[33:54] SPEAKER_00: health around the world.
[33:55] SPEAKER_00: They go to organizations and programs that resolve to save lives.
[33:59] The organization I lead work with,
[34:02] I don't get any of the profits of this.
[34:03] Well,
[34:04] you know,
[34:04] that's fantastic,
[34:05] especially when we've seen the USAID money.
[34:08] SPEAKER_01: taking a gutted and everything else, a foreign aid.
[34:11] SPEAKER_01: So you're phenomenal, Tom.
[34:13] Thanks so much for joining today and all the work you're doing
[34:16] with Resolve.
[34:17] SPEAKER_01: And keep up the great stuff.
[34:19] SPEAKER_01: We'll be following it.
[34:20] SPEAKER_01: That's for sure.
[34:21] SPEAKER_01: Same to you, Eric.
[34:22] SPEAKER_01: Thank you so much.
[34:23] SPEAKER_00: Great speaking with you.
[34:24] SPEAKER_01: And thanks, everybody, for joining today.
[34:26] SPEAKER_01: Really terrific conversation and questions and messages.
[34:30] SPEAKER_01: Thanks.
[34:30] SPEAKER_01: Bye-bye.

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