Tylenol, Autism & the Clown Car of Public Health

In this engaging first episode of "The Present Illness," physician-hosts Arghavan Salles and Alyssa Burgart delve into the complexities of public health, politics, and culture. They discuss the controversial claims surrounding Tylenol and autism, emphasizing the importance of scientific evidence and the dangers of misinformation. The conversation also touches on the challenges faced by patients trying to access care, the medical community, the impact of deregulation, and the role of social media in spreading health-related myths. With humor and insight, Arghavan and Alyssa aim to make sense of a world that often feels febrile and underdiagnosed, inviting listeners to join them in exploring these critical issues.

00:00 Introduction to The Present Illness Podcast

The Swedish Study: Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability. Ahlqvist VH, et al. JAMA. 2024.

04:59 The Role of Science in Public Health 10:49 Eugenics and the Stigmatization of Autism

16:19 The Impact of Misinformation on Public Perception

Co-author of study linking Tylenol to autism says pain reliever still an option. Politico.

Harvard’s Public Health Dean Was Paid $150,000 to Testify Tylenol Causes Autism. The Harvard Crimson.

21:51 The Importance of Research Funding

Danish Study of Aluminum in Vaccines: Aluminum-Adsorbed Vaccines and Chronic Diseases in Childhood: A Nationwide Cohort Study. Andersson NW, et al. Ann Intern Med.

Explaining the Danish Study on Aluminum in Vaccines. VaccinateYourFamily.org.

27:38 The Future of Public Health and Vaccination

Book: The Poison Squad: One Chemist's Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century By Deborah Blum

33:36 The Role of NIH in Rare Disease Research

The Persian word Sheytân (شیطان) for "devil" or "evil spirit" is borrowed from the Arabic shayṭān (شَيْطَان).

39:11 The Dangers of Misinformation in Cancer Treatment

45:41 The Importance of Early Detection in Cancer

Cartoon: Autism Causes Vaccines. smbccomics on Instagram.

Thanks for listening to The Present Illness with Drs. Arghavan Salles and Alyssa Burgart!

Follow us on the socials!

Instagram @arghavansallesmd and @burgartbioethix

Tiktok @arghavansallesmdphd and @burgartbioethix

Read our hot takes at Arghavan’s Substack and Poppies & Propofol

Chapters

• 0:00 Welcome to The Present Illness Podcast
• 4:59 The Role of Science in Public Health
• 10:49 Eugenics and the Stigmatization of Autism
• 16:19 The Impact of Misinformation on Public Perception
• 21:51 The Importance of Research Funding
• 27:38 The Future of Public Health and Vaccination
• 33:36 The Role of NIH in Rare Disease Research
• 39:11 The Dangers of Misinformation in Cancer Treatment
• 45:41 The Importance of Early Detection in Cancer

Transcript

Alyssa Burgart (00:00.928)
Sure.

Arghavan (00:01.466)
So I bet I don't think we would want to clip this part anyway. So, right? Okay. So I'm just going to go and then you're going to go in that way. And then we're going to act and then we're going to get into it as it sets. Right? Okay. All right. All  Hey there, fellow culture nerds. Welcome to an episode of, well, I don't know about another feels weird for the first one.

Alyssa Burgart (00:04.954)
It's fine. People will be fine.

Alyssa Burgart (00:10.362)
And then we're gonna, we are.

Alyssa Burgart (00:20.762)
Welcome to our first.

Arghavan (00:22.572)
Okay, hey there, fellow culture nerds. Welcome to the first episode of The Present Illness, the podcast where two physicians try to make sense of a world that's a little febrile and definitely underdiagnosed. I'm Arghavan Salles, a surgeon scientist in your friendly neighborhood doom scroller in residence.

Alyssa Burgart (00:37.402)
And I'm Alyssa Burgart an anesthesiologist and bioethicist who tracks news and health law like their EKGs, full of spikes and surprises, some of which may very well take us out if we don't pay attention. The Present Illness is where Arghavan and I dig into public health, politics and culture, and ethics with a scalpel in one hand and a meme in the other.

Arghavan (00:58.177)
Big thanks to everyone listening, extra love to our subscribers, maybe you'll be the first one, and a warm welcome to anyone who just stumbled in from press conferences and UN talks and whatever else you've been paying attention to.

Alyssa Burgart (01:12.003)
We are glad you're here. Let's get into it.

Arghavan (01:15.598)
Okay, great, at least we have that. I think that was pretty good. So the reason I was like, we should record this because you were talking about hot, hot, and there was something I was gonna bring up right after that. But no, I lost it. But anyway, so.

Alyssa Burgart (01:17.523)
yes.

Alyssa Burgart (01:30.019)
Well, we can just start talking about how hot you are, Argavan, and how hot this country is. That's what I heard yesterday in Trump's news conference was that we're just the hottest country, which, you know, given that we're not going to let anybody have Tylenol anymore, I think that might be true.

Arghavan (01:45.268)
Right, right, because Tylenol, if folks don't know, obviously is used to treat fever and apparently now the government wants pregnant people not to treat their fever, which is associated with harm to a fetus, by the way, if you don't treat fever in a pregnant person.

Alyssa Burgart (01:56.876)
will end.

Alyssa Burgart (02:02.609)
and harm to the pregnant person and treating women's pain. Like that's been a huge problem and we're talking about taking away the one thing that we kind of let people have during pregnancy. It's pretty wild.

Arghavan (02:13.292)
Yeah, that's right. So I think maybe we should back up a little bit in case people haven't been following that story as closely as you and I have. And, you know, we're recording this on September 25th, which is a Thursday. On Monday of this week, there was a press conference held by RFK Jr., our so-called Secretary of Health and Human Services, alongside the head of the FDA, man named Marty McCarrey, and Dr. Oz, everyone's favorite doctor, and the president.

Alyssa Burgart (02:18.412)
Oof.

Arghavan (02:42.817)
the president felt that he needed to be there for this really important announcement because if people remember, back in the spring, RFK Junior had promised that by September, he would know what causes autism. And anyone who knows anything about science or medicine understands that that is not a question that you can answer in six months. And in fact, it's something that scientists have been studying for decades. But anyway, so here we are in September. And so they were...

publicizing that they were gonna have this press conference and they were gonna tell us finally what is causing autism and lo and behold Tylenol is the answer they came up with or acetaminophen is the active ingredient in the medication that the brand name is Tylenol. And so yeah, they have this whole press conference about how this is the real problem. And the president said, I didn't count, but at least six or seven times, don't take Tylenol.

Alyssa Burgart (03:35.766)
It's more than that.

Arghavan (03:37.397)
Don't take it. Do not take Tylenol. You shouldn't take Tylenol. Don't take Tylenol.

Yeah, so that was really special. Do you want to maybe explain why this is problematic?

Alyssa Burgart (03:49.686)
Well, good Lord. Well, first of all, I would like to say that I, all those people you talked about, you know, RFK, Marty Makary Dr. Oz, somebody that I just can't believe I have to say these people as like serious, serious members of our government. I think of them as the clown car of the apocalypse, you know, that's just the, the downfall of public health is being led by the clown car of these just fools.

So yeah, it turns out that fevers are bad for people. so Tylenol is a really important medication that we use to treat fevers and also to treat pain. It's not, is it the best pain medication? No, because it's literally the drug that when you're like injured in the ER, you're like, all they gave me is some fucking Tylenol because it's like a, it helps a little bit with pain, but by itself, it's not great.

Arghavan (04:39.517)
Hm.

Alyssa Burgart (04:44.885)
And that really shows how pregnant women don't have a lot of options for pain control. And so when they bring out this spurious argument, which is not supported by evidence, claiming that Tylenol during pregnancy causes autism, which we know it does not from a very robust sibling controlled study that was done in Sweden. What that says to me is one, these people who are

making choices for our public health do not understand science, which is not a surprise. We have known this for decades about RFK that he just kind of runs with an idea and makes a lot of claims about it that are not grounded in any scientific evidence. He has demonstrated throughout this administration that his goal is to, guess, just like only accept the science that he likes, that he's like really into, which again, not how science is supposed to work.

And you know, the other thing that I'm really worried about that that Trump said during this press conference is he said don't give Tylenol to your babies. And that's in addition to the harms that are going to happen to pregnant women. know, children with untreated fevers develop seizures. Children with untreated fevers, what if families are not going to bring their kids into the hospital?

Arghavan (05:47.211)
Mm-hmm.

Arghavan (05:56.001)
Mm-hmm.

Alyssa Burgart (06:01.355)
when their child has a fever that's not mitigated and they're not treating it with Tylenol. And then what if we have kids that are going to have even worse outcomes because their parents are now afraid when they go to the ED and the first thing they want to give the patient to decrease the fever is an effective antipyretic acetaminophen. One of my faves. Love the acetaminophen.

Arghavan (06:20.523)
Right. Well, and it is worth noting, as many have already, that Trump couldn't even pronounce acetaminophen. But I want to pick up on two threads in what you said. So one is this idea of how science is supposed to work, because I have a post about this whole situation that's gone kind of low-grade viral, if you will, on Instagram. so there are a lot of people in the comments who, I think, to give them benefit of the doubt, do not understand how science works. And so they're saying,

Aren't you the ones who are always saying we should trust the science and now all of a sudden you don't want to trust the science because you don't like the person who's sharing the science? And that's really not what the issue is. The issue is, as you said, that the folks who are talking about this issue don't understand the science. They're relying heavily on a study that isn't even a, well, it's not like a primary, it's not based on primary data.

that came out last month, which was not even a meta-analysis because the studies that have looked at any association between Tylenol and neurodevelopmental disorders are so different from each other that you can't really lump them together the way you do in a meta-analysis.

Alyssa Burgart (07:24.438)
And several of them were run by a person who is paid to be an expert witness to bring lawsuits against Tylenol.

Arghavan (07:32.427)
Well, yeah, exactly. The senior author on this, again, it's a review, but it's not a meta-analysis, is a man who was paid $150,000 to testify against Tylenol in a lawsuit, which is what we call a conflict of interest, which RFK Jr. has repeatedly said that he's very, very concerned about and used that as the excuse for firing every single member of the advisory committee on immunization practices, all 17 of them. But in the meantime, he's relying.

Alyssa Burgart (07:58.312)
It's just conflicts he doesn't like.

Arghavan (08:00.907)
Right, exactly, it's only a conflict if he says so. I get it. So anyway, so this study that they're relying on did look at 46 different studies that had come out. Only seven of them actually look at Tylenol and autism, I do. So I know there's a lot of people in my comments saying they looked at 46, well, seven that related specifically to autism and Tylenol and.

Most importantly, I think, is that even in that paper and even that author, the one who got the $150,000, they've been very careful to say that all of this data is correlational, which means that we see in some cases that a pregnant person has taken Tylenol and then they have a child who has autism. But there are many cases where a pregnant person takes Tylenol and their child doesn't have autism. And there are many cases when a pregnant person doesn't take any Tylenol and there is a child that has autism.

So it's just a correlation. what we are really looking for, again, when they're talking about root causes, is what causes autism. And there is no data that really tells us there's a causal relationship here. And that is why many of the major medical societies that have anything to do with treating pregnant people, so the American College of Emergency Physicians, the American College of Obstetrics and Gynecology, the Society of Maternal and Fetal Medicine, the American Academy of Pediatrics, and I could go on, including, by the way, international bodies like the World Health Organization,

have been putting out statements all week about how it is safe to use Tylenol in pregnancy and for young children, to your point.

Alyssa Burgart (09:28.421)
And I mean, not only is it safe to use during pregnancy, like it is important to use it during pregnancy for patients who are having things like fever and having pain. And as you mentioned earlier, know, untreated pain and untreated fever are things that are bad if you would like to continue a pregnancy. They are bad for fetuses to experience that kind of inflammation.

Arghavan (09:49.383)
Exactly. And so I have had a lot of people saying, but what's the big deal? Let's just not use Tylenol if there's a risk. there's a few, I mean, there's multiple problems with that line of thinking. One of which is if we thought that way, we wouldn't ever eat anything or go anywhere or do anything because you can, right? Because you can find a study that tells you like pretty much anything is bad for you, right? Being outside, you have risk of.

Alyssa Burgart (10:07.806)
We would all just die.

Arghavan (10:16.029)
you're getting exposed to UV rays, you have a risk of getting skin cancer, so I guess you better just not go outside. If you get in a car, there's a risk you have a car accident, so you better not get in a car. If you, like alcohol is a reasonable example, I think, of something that a lot of people ingest that is a known carcinogen. So, but if we're gonna not do anything that involves any risk, then really we can do nothing. Like everything we do in life.

Alyssa Burgart (10:35.325)
Mm-hmm.

Arghavan (10:41.703)
has some kind of risk, and I'm not, by the way, endorsing alcohol in any way, I'm just using it as an example of something people do, right?

Alyssa Burgart (10:47.624)
This podcast is not supported by the alcohol industry or the Tylenol industry or the acetaminophen industry, be honest. And nobody, we have no conflicts related to our opinions in this matter.

Arghavan (10:51.252)
That's right.

Yeah, we're not getting paid by anyone is the bottom line. Yeah, exactly.

because we're not getting paid. anyway, so, the idea that there's no harm in saying don't take it. I mean, Trump said this by the way, multiple times himself. He said, there's no downside to not taking it. And that is absolutely not true. As you already said about fever and untreated fever and pain in a pregnant person is bad for both the pregnant person and for the fetus. And, you know.

Alyssa Burgart (11:15.015)
false.

Arghavan (11:24.403)
there's an incredible burden on pregnant people to know everything and to do absolutely nothing that puts themselves or the fetus at any sort of risk. It's an immense pressure that weighs on them over the entirety of the pregnancy. And adding one more thing that may or may not have anything to do with anything that matters is just going to create additional stress for people that really isn't supported by the evidence. And for people who already have had children and

let's say they have a child who has autism, now you're trying to get them to, I'm not trying, but the result of this argument is that they will be thinking back to whether they took any Tylenol and whether it's something they did that caused this.

Alyssa Burgart (12:05.332)
I already have friends who are navigating this with their adult children, who are navigating this with their teen children, where their child who has autism or who has ADHD is saying, mom, did you take Tylenol when you were pregnant with me? Is that why I'm the way I am? But again, I think the other thing that's so horrible about the clown car of the apocalypse's approach to public health is that

This is also, it's implying that there's something bad about having autism. having autism is not something that is inherently bad. There, have a lot of friends who have autism and who have ADHD who are like awesome and really smart and wonderful. And they have great relationships with their families and they have great friends. And like the idea that like the existence of autism is this like horrible scourge on society is, is absolutely eugenics in action. And it's horrible.

Arghavan (12:40.603)
Mm-hmm.

Arghavan (12:55.269)
Mm-hmm.

Arghavan (13:00.784)
Yeah, no, exactly. Eugenics is exactly what I was going to say when you started down this road, because that's exactly what it is. It's this idea that people who aren't, quote unquote, perfect don't deserve to be here. And so we need to figure out how to not make any more of these people ever again, because it's so terrible to have people with autism around, which obviously is not a position that you or I endorse. But that's what's coming from our administration. And anyone who watched that press conference saw multiple people at the press conference describe in

really unfavorable terms what people like autism experience and what they look like and that's deeply offensive to really anyone who's a humanitarian but especially anyone who has autism or has someone with autism in their family to suggest that their life is not worth living which is again the eugenics argument about any disability is that we should get rid of all people with disabilities because those lives are not worth living.

Alyssa Burgart (13:56.401)
Well, and this is exactly where, you know, maybe it's a little early in the show to be talking about Nazis, but like the T4, the, the, the action T4 program out of Nazi Germany was like, I mean, that's how the Nazis really, you know, planned and then perf I'm going to use the term in quotes, perfected using, you know, the, the murdering people, was by starting with people with disabilities. And they started with people who had

Arghavan (14:04.337)
There's always a moment for it, you know?

Alyssa Burgart (14:25.459)
cognitive and physical disabilities, rounded them up, told their families that they were gonna go to these special care locations, and they were executed. Because it was all this money to feed and house people who were in these groups, and they said, well, we don't think those lives are worth living. These people cannot produce labor. These people cannot work, and therefore, they don't deserve to live. And so it is...

We are watching, we have been watching over the last 10 months. We've already heard about a desire that RFK Jr. has to make an autism and ADHD registry. And so you're already talking about creating lists and rounding people up. He has talked about sending people to work farms where he thinks that that, people don't need medication to treat their mental illness. They need to be sent off to a work farm. Go.

Arghavan (15:00.176)
Mm-hmm.

Arghavan (15:07.559)
Mm-hmm.

Alyssa Burgart (15:13.381)
go outside and do a bunch farm labor for free and that's going to be what we're going to do for you instead of providing evidence-based mental health support. It's outrageous.

Arghavan (15:22.331)
Yeah, absolutely. And I think it's worth pausing for a moment to just talk about why these ideas are attractive to people because there are a lot of people who support RFK Jr. And whenever he makes these various statements, they are supportive because they think that, well, one, they think that he's a different person than who he is. That's my belief because I think a lot of people think that he does actually care about.

Alyssa Burgart (15:34.631)
Mm-hmm.

Arghavan (15:50.341)
our health or our children's health. And that's not a position that's really supported by his actions over the last several decades. But I do think some people or a lot of people believe that. And so they believe him when he says he wants to get to the root causes of diseases and they believe him when he says that he wants to make our country healthier. But the problem is that, and so I can understand why that's a very desirable message, right? Like I would also like for everyone to be healthier.

You know, as physicians, we see patients who are struggling with all sorts of different problems. And I think that both of us would love to be able to just wish away all those problems so people can be healthier and go live their lives as they desire. But unfortunately, in reality, getting rid of red dye 40 or whatever one it was is, you know what I'm saying? Like that's not going to actually make any of us noticeably healthier, eliminating air pollution might.

but that's something this administration is not interested in doing. funding worthwhile research might, but again, for the most part, they're not interested in doing that. Addressing climate change might, but they're not interested in doing that. So for me, and I think a lot of us who are critics of RFK Jr., what we see is a rhetoric of one thing and actions that are completely opposite. But I think some people...

Alyssa Burgart (17:12.624)
Yeah, for sure.

Arghavan (17:15.664)
have a harder time recognizing that these things are disparate.

Alyssa Burgart (17:18.531)
Yeah, you know, I mean, to be honest, I don't think I don't think that RFK is nefarious. Like I think that he thinks what he's doing is the right thing to do. I think he's totally delusional because he has no connection to the reality of these actions. I mean, can you imagine that if over the last, I don't know, 30 years, maybe if just for the last like five years, he'd been like, I don't know, maybe I should get help understanding how to read statistics. Maybe I should understand conflicts of interest, you know, like

Arghavan (17:41.7)
Mm.

Alyssa Burgart (17:45.786)
We have a great responsible conductive research program where I work like we could have enrolled him. I would have been happy to help him with that.

Arghavan (17:52.325)
I'm sure many of us would be happy to help him with all sorts of things.

Alyssa Burgart (17:56.931)
Yeah. So, know, I, and I think also, you know, and John Stewart had a really good evaluation of RFK and his behaviors and stuff. like, you know, there's so many little, as with so much misinformation and disinformation, like there's so many nuggets in there where I'm like, I mean, yeah, of course, of course I want health, you know, just like you were saying I did, I will tell you the heroic work of reading his like, make children healthy again.

Arghavan (18:24.758)
wow. Wow. Thank you.

Alyssa Burgart (18:25.254)
Strategic report. Wow.

Arghavan (18:29.871)
don't know if I could stomach it.

Alyssa Burgart (18:30.053)
So it was painful, but I did it for us. I did it for us. And I love you too. One of the things that's really interesting, so one thing I want to point out for people, and I don't know if you've noticed this, this administration is really keyed into graphic design. They have done a ton of graphic design work. They're working with some sort of a graphic design group that is modern.

Arghavan (18:34.373)
Mmm. That's why I love you.

Alyssa Burgart (18:55.994)
and they've got all these icons and they're making all these beautiful images. And this shit is not made in Canva. These are professionally done. My brother's a graphic designer, so when I looked at it, I was like, ooh, yeah, this is high quality. Now, that is something that's important to, and part of why I noticed that is because it is easier to believe something that is packaged beautifully.

Arghavan (19:17.539)
Yes, that's right.

Alyssa Burgart (19:18.84)
Like when you look at a study, when you and I look at a study, you if there's a really compelling graph that very clearly demonstrates what it is that I want the reader to take away from the data. Now you and I do that in a way that is true. But you know, if you're trying to convince somebody of something, using beautiful graphic design is one very effective way to help mitigate behavior and to help drive people to believe certain things. So that was something I noticed right off the bat. And we've seen it in the administration, like all of the executive orders, for example,

Arghavan (19:27.311)
Mm-hmm.

Alyssa Burgart (19:48.056)
Like this whole thing of like having this big black screen with the fancy, you know, script lettering and the seal of the government. They didn't used to look like that. They used to look like government documents. They looked like meh, like yeah, the government. You don't expect the government to be too fancy. So that's something that I have noticed is, I think, very effective that they're doing to help people believe these things.

Now when you scroll through it, they have a lot of things that are in there that you're like, yeah, of course I can get behind that. Of course I can get behind that. But then so much of the things that when you read more about them, you're like, this is nonsense. Like, you know, and this is like, they, they have all these claims about vaccine safety that are just simply not supported by the evidence. I mean, there is, it's just infuriating. There's so many things. They're striking fear. They're using parental fear. Like you talked about, you know, I'm a mom. mean, I remember being in medical school and being pregnant.

and this was like in the rise of the mommy blog era. And you would go on the internet and you'd be like, is that real? And so like as a medical student, I had the ability to go and look some of those things up and like calm myself down, but that's not something that everybody else can do. And so, you know, the internet's been used to spread so much of this and you see it regurgitated in this strategy document. And one of the things that I found

Arghavan (20:49.676)
and

Alyssa Burgart (21:08.61)
very, very interesting and also not surprising is several pages down, they have an entire section that is dedicated to deregulation. So for example, you know, when you talk about, we need to address climate change, it's like, well, yeah, we know that there's effective ways to reduce the amount of damage that we're doing to the environment. And guess what? It's not, it's not in deregulating or, you know, companies and letting them do whatever they want. Those companies don't care about us. They are trying to make money. This is capitalism.

Arghavan (21:17.132)
Anyways.

Arghavan (21:37.229)
Right, no, exactly, exactly. Deregulation is not how we're going to have safer food, for example. And we all know this and we've seen it with the many outbreaks that have been happening in the last months to last year, at least I've seen quite a few. And I wanted to pick up on this vaccine idea because it also came up in the press conference and also...

relate that back to our conversation about how science works. Because one of the things I wanted to say about how science works is in general, we tend not to use any one publication as like the determiner of what truth is. Sometimes like when you have a new pathogen, like when we had in 2020 with SARS-CoV-2, maybe the first publication is the only publication you have. So for a minute there, that's all you have. But in general, when we're trying to see

for example, do vaccines cause autism? We're looking at the entire literature that has looked at that, which in that press conference, RFK Jr. said that that research had been suppressed. If you do a PubMed search of vaccines and autism, you get over 1,200 papers. So I don't think that's consistent with anything being suppressed. And in fact, I would say we've spent a lot more time and money on answering that question than would be merited really, because none of the valid studies that have been well conducted

Alyssa Burgart (22:52.418)
Mm-hmm.

Arghavan (22:56.778)
show any connection. But that's part of it. It comes back to this Tylenol question too, because you can pick a single study that looks like there is a correlation, but you can also find a single study that doesn't show a correlation. And I think this came up through the pandemic as there might be what some people saw as conflicting results from one study versus another, but it's because they're done in different ways. The data is collected, the data that is collected is different. And so our job as physicians is to put

Alyssa Burgart (23:17.187)
Yeah.

Arghavan (23:26.795)
all these pieces of data together and say, okay, looking at every study or at least the major studies that have been done, looking at this specific question, what can we say about like folate supplementation during pregnancy? What can we say about Tylenol usage during pregnancy? What can we say about vaccines and autism? And I'm mentioning this because a lot of people in my comments are saying, well, the Harvard study. Well, the Harvard study. Did you see the Harvard study? What about Harvard?

And it is, again, that's the same study that we were talking about earlier where the senior author was paid a lot of money to testify against Tylenol. But even if he weren't, it's one paper and it was a review that reviewed seven other papers that looked at this question. But again, we don't generally look at one thing in isolation like that. And there are different levels of evidence and they can actually be graded. not that I'm gonna go into that, but not every study

is given the same weight either because if you look at like if I do a study with five people and someone else is a study with five million people you can understand why the one with five million people is likely to give me a closer estimate to reality than a study with five people. And so we when we're assessing evidence we're looking at all of these things and it actually doesn't matter if it was someone from Harvard or if it was someone from Michigan State or whatever other institutions not the institution that matters it's the quality of the work. And so to this point the last thing I want to say about it is

Alyssa Burgart (24:39.543)
Totally.

Arghavan (24:54.22)
there was a study that came out, I think it was in July, that looked at patients in Denmark and aluminum exposure and whether these children went on to develop autism because in Denmark, the way they gave vaccines, the amount of aluminum changed at a specific point in time. I forget exactly what year. So they're looking at before that and after that. And basically the entire study, which had over million patients in it,

Alyssa Burgart (25:11.213)
Mm-hmm.

Arghavan (25:20.417)
The result was that aluminum in these vaccines did not seem to be associated with any neurodevelopmental disorders. Now, RFK Jr., when the study came out, because to your point, he's not looking for actual science, he just wants science, quote unquote, that agrees with him. So he was upset at this study because it showed that these vaccines did not, were not associated with autism. So he wrote a long diatribe on Twitter about why the study was terrible, and then also said that...

actually know it does show that there's an association between aluminum and autism. And people at first were very confused what he was talking about. He was talking about a figure in the supplement that was reporting, I didn't count, but like maybe 25 or 30 different outcomes. And one of them did look like there was an association, but that's also reflects his lack of understanding of statistics and like how we interpret that data. And also it had a confidence interval from 1.01.

and up. So it was by the narrowest of margins statistically significant. And then if you adjust it for the number of comparisons, it would no longer be statistically significant. Anyway, he actually asked the journal to retract the article. Like that's how disconnected he is with science, that he asked the journal to retract this article because he didn't like it.

Alyssa Burgart (26:38.39)
Did you see him during those congressional hearings where they were like, will you release the study protocol? And he just like lost it. And I'm like, and I was, you'll get it. You'll get it later. I was like, dude, this is, you don't even know how basic research works. So frustrating.

Arghavan (26:44.093)
yeah.

Arghavan (26:57.831)
Exactly. That whole hearing was actually like a fascinating display. Yeah.

Alyssa Burgart (27:02.75)
He was unhinged. I mean, you talk about somebody who is feeling threatened, right? So fascinating.

Arghavan (27:10.393)
clearly, clearly. mean, when the person, I don't remember if it's Congress person or Senator, actually, yeah, I can't remember. Tina Smith is her name, from Minnesota. When she questioned him about his assertion that gun violence, no, was that what it was? I think it was he was saying, you fact check me. I think she was saying, she was referring back to his comments from earlier in the week after the shooting in Minnesota, that he was saying that,

antidepressants were the cause of gun violence. And so wrong. And she brought this up and he said, I never said that. And it's like, but you literally did say that right after the shooting. when you're not grounded in reality, you can just say whatever you want, whenever you want. And what shocks me, even still at my big age, is that people believe them.

Alyssa Burgart (27:43.936)
That is so infuriating.

Alyssa Burgart (28:08.372)
Yeah, it's so frustrating. I feel like every day I try, like don't even want to look at the news because I'm just like, there's just one more terrible thing we have to worry about. like, you know, I've been really reflecting on the number of diseases I've never seen. And I'm sure you've never seen either. I've never seen a case of measles. I haven't.

Arghavan (28:31.268)
Yep. Me too.

Alyssa Burgart (28:31.403)
I have never seen, now I had chickenpox when I was a kid because I'm of the big age where we didn't have vaccines for that, A, which means that I'm going to have to worry about having shingles when I'm older. I love that I've been able to protect my children from that. But when they think about, for example, haemophilus influenza, I'm an airway expert. I have never seen somebody with

Arghavan (28:48.636)
Mm-hmm.

Alyssa Burgart (28:57.555)
like severe epiglottitis, where like the epiglottis is this, I call it the little toilet seat over your vocal cords. It protects you from like inhaling your own secretions. And when that gets really swollen, that's a really common complication of hemophilus influenza. I've never seen it. And that is an, it is a, like we learned about it in like anesthesia residency. We learned about it in medical school.

Arghavan (28:58.272)
Mm-hmm.

Alyssa Burgart (29:22.293)
but I've never had to actually treat somebody with it. And I worry about how much of that we are going to start seeing. I have never seen a case of congenital rubella. It still happens internationally. There are outbreaks of rubella. We have traditionally been protected from that, but because of how much we travel, know, all of these diseases have the ability to circulate so much easier than they had certainly in the...

Arghavan (29:46.153)
Mm-hmm.

Alyssa Burgart (29:47.196)
in the 1950s and 60s, air travel is just such a routine part of what we do now in a way that it wasn't when some of these vaccines came out. And so I have a lot of anticipatory anxiety about what it's gonna be like in this RFK generation of kids and what it's gonna be like to be practicing medicine at this time.

Arghavan (30:09.823)
I mean, I think that's what a lot of us are feeling right now because obviously we never want to see any patients suffering, but especially when patients are suffering from something that was preventable with a vaccine, I think it's hard on everyone, including that patient and their family, but also for us as healthcare workers, it's an added level of sadness because it was preventable.

Alyssa Burgart (30:19.924)
Mm-hmm.

Alyssa Burgart (30:27.934)
Yeah.

Alyssa Burgart (30:32.555)
Yep. Yep. That's that moral distress that I love to talk about. When you've got those barriers to doing the right thing and making things happen. It's a real bummer. You know, did you ever read Deborah Blum's The Poison Squad? It's a fabulous... Deborah Blum, she writes a lot about like historical poisons and things like that. And one of the books that she wrote, I read it during the pandemic, was all about the dawn of like food regulation and how...

Arghavan (30:46.973)
I did not.

Arghavan (31:01.127)
you

Alyssa Burgart (31:01.192)
Back in the day, in the late 1800s, people would just cut flour with dirt, and your coffee would be full of rocks, and all of these things, how a lot of people... Yep, yep, to make it look whiter, so they could add a bunch of water to it and water it down. People got really sick.

Arghavan (31:07.172)
Mm-hmm. Mm-hmm. Mm-hmm. Didn't they used to put chalk in milk? I've heard that one. Mm-hmm. Mm-hmm.

Alyssa Burgart (31:21.597)
canned meat was not preserved properly. So people from World War I in particular would like report back how disgusting the food was because they were and how sick they got from the food. And so anyway, this book talks about a chemist and the way that they were really figuring out the ways that, wow, the food supply is really dangerous and it's making a lot of people sick because it's full of these toxins or it's full of additives. It's full of things that are making us sick.

Arghavan (31:48.798)
you

Alyssa Burgart (31:50.311)
And this is really what led to the launch of the Food and Drug Administration to make sure that Americans had safe and healthy food to eat that was actually what it said it would be. And so, you know, reading about the deregulation, I mean, obviously this administration's really into deregulation.

Arghavan (32:01.233)
Mm-hmm.

Alyssa Burgart (32:09.065)
And it is not making us safer. Like it is a real problem when they lay off all these people at the FDA. It's a real problem when, you know, they're getting rid of all these folks from the NIH and not letting people do, do studies. To say that they care so much about nutrition and then fire so many nutritionists. I mean, it's just like, what are we doing? What, how are we, I don't understand.

Arghavan (32:28.367)
Okay.

Alyssa Burgart (32:35.495)
I mean, I guess I'm expecting a level of introspection that clearly is not present in the clown car. But I don't understand how people look at themselves in the mirror and think like, yeah, I did a great job today. I don't get it.

Arghavan (32:46.724)
Yeah, I mean, I'm with you on that. I also have a really hard time understanding how folks can resolve these things that seem to be at odds with each other. And clearly there is some mechanism by which they do it, right? For the folks that we're talking about, I don't think that they think every day about how they're saying one thing and doing another. I don't think they see it that way, right?

Alyssa Burgart (33:00.583)
Mm.

Arghavan (33:14.477)
have some view that makes sense to them internally about what it is that they're doing. But when we look at, from the outside, when we look at what is being said and what is being done, it really looks like a huge disconnect. And especially on things like research, when they're talking about wanting to cure diseases, but then at the same time, terminating thousands of grants and then wanting to cut the...

National Institutes of Health and National Science Foundation funding by significant amounts. It's like, I don't know, is there, I mean, I know that what they're saying is that all these researchers are fraudulent. I can't do any of laugh at that idea, but I know that's part of the logic there, but I still have a hard time understanding. Like when you look at these studies that, for example, the one that showed that from like, I think it was 2010 to 2019.

that 354 of the 356 medications that the FDA had approved had benefited from NIH funding, meaning they were developed at least in part by NIH funding. How can anyone look at data like that and say, the best thing we can do for the country's health is to cut NIH's budget and to fire people from the NIH?

Alyssa Burgart (34:16.135)
Mm-hmm.

Alyssa Burgart (34:26.343)
Well, I'll tell you, I'll tell you, I got in a fight, maybe a fight is an overstatement, but I made that argument on Substack not too long ago and some health economy guy was like, well, that's because of the private industry, they could do it even better for less money. And I'm like, there is no evidence to prove that actually. So give me the study, show me the money, show me.

Arghavan (34:48.634)
Well, also each dollar, that's very interesting because each dollar, the data suggests that each dollar invested by the NIH results in $2.56, $2.56 of economic activity for whichever space that dollar was spent. And to this question of, because I was just actually in DC lobbying for science funding last week, and this came up actually in our conversations with some staffers about

private companies and could they just fill the gap? And I'll share an example that I think this person would be okay with me sharing because she ended up talking about it at the press conference, but there's a young woman who came with us and her brother had a condition that, neuromuscular condition that was quite debilitating her little brother. And he was able to join a clinical trial that ended up giving him some additional time.

with his family before he sadly passed away. But without that clinical trial, he wouldn't have had that opportunity. And that clinical trial for people with such a rare condition would not exist if all we've had was private funding. Because private companies are not interested in a condition that affects 100 people, 200 people every year in the country, right? There's not enough.

Alyssa Burgart (35:48.422)
Mm-hmm.

Arghavan (36:08.182)
money in that market for them to care. But that's where like NIH really comes in because NIH has been the only funder of rare disease research in this country. And if we take that away, all these folks, and you might sit there and say, well, it's not that many people, but yeah, they are still people. Every single one of those people matters and their families matter. And we have an organization that has funded research to support them. And now we're for what, you know, unknown reasons, just

or I shouldn't say unknown reasons, but invalid reasons, cutting that funding. And that is going to hurt Americans. That's just the reality of it.

Alyssa Burgart (36:46.553)
Yeah, you know, we saw this, you know, one example, for example, is the drug new Sinterson, which is for spinal muscular atrophy, which is one of these neuromuscular diseases. And it's, quite rare. And it used to be that the, you know, the natural progression was that, you know, kids would die usually by age two and families got together and created opportunity. They created ways to fund researchers to really supplement NIH funding. And there were NIH.

funding sources that were generated specifically to address this issue of rare diseases and it was to help really boost this research to the point that there would actually be something that a company would want to invest in. I just feel like it's so short-sighted because that means that we're letting people in academia who are doing this NIH-funded research to really try to figure out the deep science involved.

Arghavan (37:16.187)
Thank

Mm-hmm. Mm-hmm.

Arghavan (37:39.471)
Mm-hmm.

Alyssa Burgart (37:40.654)
to really jumpstart a lot of these things that otherwise you're right. Like the industry just isn't, there isn't enough of a market to focus on those. And so it's also a demonstrated way of how frankly, NIH research helps make pharmaceutical companies a lot of money. And so it's actually really shocking to me that pharmaceutical companies haven't pushed back on this more because it's gonna hurt them. They are gonna have to do this work or they're just not going to. And we're gonna have fewer.

Arghavan (38:06.363)
Yeah.

Alyssa Burgart (38:08.238)
fewer new novel medications. The other thing that's super, super scary to me is Jim O'Neill, who's the guy who's temporarily running the CDC right now and already was the assistant director of the HHS. I forget what title he had or has. He is a raging libertarian of the, you and worked with billionaire Peter Thiel for many years, making him more and more money.

Arghavan (38:16.951)
Mm-hmm.

Arghavan (38:30.255)
Mm-hmm.

Arghavan (38:34.468)
Mm-hmm.

Alyssa Burgart (38:37.765)
And you know, this is a guy who thinks you should be able to sell your kidneys to like go on vacation. and he is all about deregulation. That is absolutely what he wants. And something that he has said again and again, in multiple interviews over the past several years is that he just doesn't think that the FDA should require drugs to prove that they work before they can be sold. He wants, he wants companies to be able to sell whatever the hell they want.

Arghavan (38:48.922)
You

Arghavan (39:02.457)
Huh.

Alyssa Burgart (39:07.235)
whether it works or not, market it however you want, and we'll just wait and see if it works after you've given it to a bunch of people. And like, you know, if people get hurt, then like whatever. You know, that is a profoundly dangerous thing. And especially in an environment in which people can't afford healthcare, you want people spending money on things that literally there's no evidence that they work. I mean, let people do that at the grocery store, I guess, let them buy all this herbal stuff that there's no evidence for.

Arghavan (39:35.588)
Mm-hmm.

Alyssa Burgart (39:35.651)
let them buy all sorts of other things that don't have any, any reason to work. But like, I'm sorry, when I go and I buy a drug from a pharmaceutical company, I expect that it is going to function. I expect that they have done studies to make sure it is safe and effective.

Arghavan (39:50.542)
Well, I mean, how wacky of you to want that. And I actually don't think that people should be able to sell whatever they want at the grocery store either and label it however they want. know, the supplement industry is much bigger than the pharmaceutical industry and it's pretty unregulated. Yeah, of course, of course. The problem is pharmaceutical industry and physicians, don't forget us. We're the big...

Alyssa Burgart (39:53.39)
Wackadoodle-doo!

Alyssa Burgart (40:02.01)
No, I mean, me neither. Samezies.

Alyssa Burgart (40:11.353)
but people love to hate on the farming industry.

Arghavan (40:20.223)
We have this phrase in, know, Farsi is shade to it. Anyway, we're like the big Satan. The physicians are the big Satan. No, please don't quote that. Archibald Salas said physicians are the big Satan. I said it in jest. I said it in jest. Let me be clear.

Alyssa Burgart (40:29.209)
Folks, you heard it here first. We are the big Satan.

Alyssa Burgart (40:42.885)
Listen, there are really important criticisms of medicine and you and I talk about that a lot, Like medicine has lots of problems, we have lots of cultural issues, we have things that we have perpetuated that are problematic and that is part of why people are looking to people like RFK for different answers. They're looking to be told something that is different from what we have to offer. Like I understand that. And at the same time, like we are genuinely trying to help people live and the things that we're able to do.

I mean, I do anesthesia. How freaking crazy is that? I literally am able to take, you know, a safe and effective medication. I sort of make this like cocktail and I can turn your brain off so that you will not move, feel pain, feel no discomfort. I can make it so that you wake up and your surgery is over. You will not feel it. You will not remember it. That is magic. And there is no like...

supplement that's gonna be, these are things that like medicine provides a unique service. Like we have really incredible things we're able to do. You look at cancer treatment. I was so sad to see the cutting of so much cancer research because I mean, even in the time since you and I have graduated from medical school, I mean, the outcomes from some of the most common cancers, like they keep getting better. People are living longer. People are able to survive, to raise their children, to meet their grandchildren. Like,

Arghavan (41:38.893)
Mm-hmm.

Arghavan (41:59.372)
Yeah.

Alyssa Burgart (42:05.74)
to make it to the things that really matter to them because they are able to survive devastating diagnoses. And it's, it's hard to feel, to be vilified for things like that. You know, when people are taught, you see all this stuff online about like, chemotherapy is all toxins. And so you'll see people who don't come in, they don't want to get treated. They don't want to see an oncologist. They don't want to start therapies that we know work because they're being fed this bullshit.

Arghavan (42:12.333)
Mm-hmm.

Arghavan (42:26.861)
Mm-hmm.

Alyssa Burgart (42:35.8)
out on the internet that like, but if you just go on a ketogenic diet, then you won't have cancer anymore. And that's how people die. And by the time they come back to the hospital, like it's too late. They're no longer in that treatable window. It's terrible. And it's so devastating.

Arghavan (42:35.921)
No.

Arghavan (42:53.913)
And it's in that same category, like we were talking about vaccines, it doesn't have to be that way. Sometimes we, for various reasons, sometimes the cancer is not identified until it's late in the game for any number of reasons. But for patients where the cancer is identified early, say from a preventative or a screening mammogram or from a screening colonoscopy, there are so many options for treatment and...

Alyssa Burgart (43:21.315)
Mm-hmm.

Arghavan (43:22.314)
and they've been studied at length and we have the NCCN guidelines, National Comprehensive Cancer Network that really breaks down for any kind of cancer, should the patient have surgery first, should the patient have chemotherapy, should they have radiation? And they synthesize all the data that's been done over all these decades so that for each patient, we can really provide as best information as we can based on all the literature that's available and that people are being convinced to ignore all of that.

in favor of like coffee enemas, which is a thing that people for real are recommending out there, is really disturbing to me. And then for those patients who are misled by these wellness influencers and go down that path and then don't, to your point, make it to a proper physician until now their cancer is really advanced and those options are no longer available to them, it is heartbreaking. And those folks, to your point about looking in the mirror, those are the folks.

Alyssa Burgart (44:14.327)
Yeah. Yeah.

Arghavan (44:19.904)
I really struggle to understand how they can go on the internet and say things like, no, you shouldn't get chemotherapy and cancer isn't actually a problem. And all you need to do is coffee enemas. I don't know how those people, because they have to know that that's wrong. So how can those people look themselves in the mirror knowing that they are causing so much unnecessary harm? Like they aren't making money off of causing unnecessary harm to fellow humans. I really have a hard time.

Alyssa Burgart (44:22.083)
Mm.

Arghavan (44:49.749)
wrapping my head around how they, like what's the internal rationalization that goes on for those ones? I don't understand it.

Alyssa Burgart (44:57.024)
Yeah, that reminds me of that show that I know you and I both watched where the woman was, what was it called again? So apple cider vinegar, that man, that was brutal. And watching that character and obviously like, you know, was based on a true story, but there's a lot of things that were not, you know, they were dramatized or whatever. But yeah, these people who like made a lot of money on nonsense and like wanting to believe something to be true. you know, it's

Arghavan (45:02.207)
apple cider vinegar.

Alyssa Burgart (45:26.142)
It's just as ridiculous. if, if I, and this is also part of what I don't understand. I understand that people want to be comforted and want to believe that they will be healthy and that if they just, just dream big enough, if they just have enough good energy, then somehow they're going to, they're going to prove all these experts wrong, you know? And, and obviously there's some, you know, the anti-intellectualism of America really feeds into this. think that there's,

Arghavan (45:45.8)
Mm-hmm. Right.

Alyssa Burgart (45:55.498)
a lot of fear, a lot of trauma. mean, going through chemotherapy, going through cancer surgery, like those things are really stressful and they're very traumatizing. But it's just as ridiculous if I started saying like, but it's okay. If you just eat jelly beans, you won't need to go through any of that. I have a proprietary blend of Jelly Belly Jelly Beans.

Arghavan (46:15.98)
Great.

Alyssa Burgart (46:21.89)
and they will be your answer. And I truly, it is as ridiculous as some of the things that I know you and I see on the internet. And you had on your TikTok, you did some responses to that. Who is that woman who was out there saying all sorts of banana stuff? Ashley.

Arghavan (46:37.302)
Ashley? Ashley? There's some woman named Ashley. She was the one who said cancer isn't bad, actually. And she said many things. Yes, to inflammation. Yeah. And what I took issue to as a surgeon, I took great issue with her saying that we shouldn't cut it out. you know, cancer surgery can be curative for a lot of people.

Alyssa Burgart (46:47.036)
right, she was like, your body's just responding to something something.

Arghavan (47:05.278)
So to tell people that they shouldn't cut their cancer out, which means you are basically suggesting to them that they should let it metastasize or spread to other parts of their body to the point that treatment may, there may no longer be any effective treatment. Like that is not just irresponsible. I think it's really quite evil. that was Ashley. But then when I had posted about Ashley, somebody sent me a DM about somebody whose name is Holistically Fit Mama. And I started looking at,

Alyssa Burgart (47:05.611)
Yeah.

Alyssa Burgart (47:14.325)
Yep. Yep.

Arghavan (47:34.612)
this person's videos. Huh?

Alyssa Burgart (47:34.973)
Red flag. Holistically fit mama is a red flag. That's a red flag.

Arghavan (47:40.511)
yeah, that's true, true. This is username itself. But this person calls herself a doctor in many of her videos. She starts out with, I'm a doctor and I would never get a mammogram. I'm a doctor and I canceled my health insurance. Yeah, exactly. She's certainly not an MD or a DO, I can tell you that much. From what I, my online sleuthing, which I'm not like the most talented online investigator, but I did find who I think this person is and she is not.

Alyssa Burgart (47:52.884)
A doctor of what?

Arghavan (48:09.32)
licensed to practice medicine in the state where she lives. So that much I know.

Alyssa Burgart (48:12.437)
I mean, is she like a preacher? Like there are preachers who go by doctor. Is she a preacher?

Arghavan (48:17.206)
No, somebody mentioned something like, I think they dug a little harder than I had or deeper than I had, and they said something about wellness, something, you know? Like basically she's a wellness influencer, but she calls herself a doctor and she says, I'm a doctor and I would never get a mammogram because, and then she goes on to say things that are not true, like that getting a mammogram would spread your cancer. I mean, it's just blatantly untrue, but these folks.

Alyssa Burgart (48:42.579)
So, and for context for folks who don't know, who have not yet had the booby squish, a mammogram is basically an x-ray of your boobs. And then get a special x-ray and they smush your boob and then they take a picture. And then a radiologist who is expert at looking for cancer in squished boobies tells you if you have anything of concern. And if you have breast tissue, for example, that is quite dense,

Arghavan (48:45.95)
Mm. Mm.

Arghavan (48:52.182)
and

Arghavan (48:56.915)
Ha ha ha!

Alyssa Burgart (49:12.021)
then you will be recommended to get an ultrasound in which we use specialized sound waves to look at your boobs and be like, is there cancer in there? And this is why we get screened. I don't want to die of cancer. Yeah, some MRIs. Yeah, yeah, sure, sure.

Arghavan (49:22.025)
Yeah, or MRI, sometimes some people are recommending to get MRI. But yeah, but that's whole point is to just screen because like, let me tell you, for example, pancreatic cancer is a cancer that is often found at more advanced stages. And part of that is because of where the pancreas is, the symptoms don't usually develop until the tumor is a little bit larger. And we have no screening mechanism whatsoever for it. until usually people don't find it until they have symptoms. And by then, often it is too far along.

Alyssa Burgart (49:32.711)
Ugh. Mm-hmm.

Alyssa Burgart (49:41.857)
Mm-hmm.

Arghavan (49:51.838)
for us to have a chance at really stopping it, which is why the long-term survival for folks with pancreatic cancer is not anywhere near as good as it is for something like breast cancer, where obviously our breasts are more easily accessible to assess than our pancreases. And we have developed this screening mammography, which really has helped improve our ability to diagnose breast cancer at early stages so people can have...

Alyssa Burgart (50:02.303)
Yeah.

Arghavan (50:19.782)
more often than before can have just a relatively simple surgery to remove that cancer and then plus or minus chemotherapy and radiation afterward, depending on how far along it was. And then they can be cured. To your point earlier, I think that's miraculous that we can do that for folks. And that's why it makes me so angry that there are people who would suggest that you not take advantage of that, that you not have a colonoscopy.

Alyssa Burgart (50:35.807)
Yeah.

Alyssa Burgart (50:45.482)
Well, yeah.

Arghavan (50:47.252)
when we could find an early cancer and then be able to even maybe sometimes just do a polybectomy or sometimes do a local colon resection of like a small segment of your colon rather than having to also take out pieces of your liver or whatever else, you know, later on.

Alyssa Burgart (50:55.422)
Yep. Yeah.

Alyssa Burgart (51:02.346)
Totally, totally. And it's also where, you know, I'm an ethicist. I want people to make informed choices, right? And so like to make an informed choice about what kind of treatment you choose to have or not have requires actually that you get accurate information from people who know what they're talking about. And so what's really sad for me and what I think is such a great injustice that is done when people get sucked in by these

Arghavan (51:24.126)
Mm-hmm.

Alyssa Burgart (51:31.377)
charlatans online is that people are either too scared to go and get expert information because they're worried they might agree with it. They and then what's going to happen if like they don't you know, then you have to give up this other belief in what this person has told you, which is a really nice sounding idea, like you don't need to have colonoscopy, you'll be fine. You don't have to worry about that. You know, and so it's just very, it's

Arghavan (51:40.122)
Mm-hmm.

Arghavan (51:50.639)
Mm-hmm.

Alyssa Burgart (51:58.011)
It's a, it's an injustice to patients to not be able. And obviously there's lots of issues with people getting into see physicians. Like that is a huge barrier. We need that to be easier. And there are patients who absolutely, they have insurance, they have, they have access to a doctor. They could get these things who are not doing it because some fool online is telling them some really nice story. That's total bullshit. And also

The fact that this person's calling themselves a doctor is deeply alarming.

Arghavan (52:30.198)
Yeah, I mean, I don't know how you're allowed to do that, but I guess you're, don't know, but it's obviously deceptive and intentionally so, right? They're using that to gain credibility and to say like, from my position of knowledge and power, even though they don't really have the knowledge or the power, but I'm gonna fake this position of knowledge and power and tell you something that's going to alter your behavior in ways that are likely detrimental to your health. And ultimately I'm not gonna...

take any responsibility for it because I'm just making TikToks on the internet. And that's what the Ashley lady, that was what was really funny to me about her was that like after she had gotten called out, she said, I'm just a girly. Like that's what she said in her explanation video. Like, I'm just a girly. Like you don't have to take my advice. I'm telling you what I would do, even though like that's definitely not how she framed her original video.

Alyssa Burgart (53:05.444)
god. Yeah.

Alyssa Burgart (53:12.497)
I hate that word.

Arghavan (53:25.072)
But what bothers me is not like Ashley or this whole sleep mama, you know, there's many people like this. It's not just these two people, but it's the idea that to your point that people, think, I think part of it is on us that like, it's been so hard for people to access healthcare. And so many people have been treated in ways that they didn't appreciate when they did go to a healthcare visit that they don't want to go back and see their doctor or any doctor.

Alyssa Burgart (53:45.105)
Mm-hmm.

Arghavan (53:51.384)
And so, but they still are worried about their health, right? Because we all are. And so they're turning to alternate sources of information. And when the information you hear sounds nice, like you said, like, you don't need to get mammograms. No, you don't need to get colonoscopies. All you have to do is take this supplement, look at the link in my bio, and buy this thing. I mean, I totally understand why it's appealing to people, but it is...

Alyssa Burgart (53:54.408)
Sure.

Alyssa Burgart (54:14.685)
Mm-hmm.

Alyssa Burgart (54:18.451)
Yeah.

Arghavan (54:20.313)
so disturbing to me as a physician that we have gotten to this place where people would rather trust a random person on the internet with no credentials than a physician. And again, I do think that our profession bears some blame for that. if we, and to be fair to us, part of the reason that our interactions with patients are the way they are is because of what our healthcare systems expect of us and because of what insurers are doing. So it's not like we're just terrible people. It's that.

Alyssa Burgart (54:48.412)
No.

Arghavan (54:48.497)
We're working in a system that's terribly flawed. And I'm sure there are a few less than fantastic physicians out there like in any profession, but the vast, vast majority of physicians are really every day showing up doing the best they can for their patients. But we're working in a system that makes it really difficult for us to provide the care that we want to provide. And I hope that patients know that. I don't know if they do, but I really, I mean, I would stand behind that. would, I'm not a religious person, but if were, would put my hand on the Bible. would swear to it like.

whatever, whatever you need. I swear my mother's grave. I don't know. I don't know what phrase would make someone believe me, but.

Alyssa Burgart (55:24.285)
Put your hand on your netter anatomy text.

Arghavan (55:28.178)
That's right, it's right back here. It's right back here actually. I know. But truly, I would put my life on the line for that statement. The vast majority of physicians are really just trying to help. And that doesn't mean we're always successful at it, but in a way, I really think that we're all coming, again, 99 point whatever percent of us are coming from a good place.

Alyssa Burgart (55:30.577)
Mine's up there. Yeah, I got it.

Alyssa Burgart (55:37.307)
Yeah, absolutely.

Alyssa Burgart (55:48.881)
Yeah. And, really just want to help patients. Hmm. It turns out that was why, that's why I got into the job. I was determined to help my fellow human beings have healthier lives. That was really my goal. despite.

Arghavan (55:54.14)
That's the whole point of the job.

Exactly.

Arghavan (56:03.918)
Exactly. And when we gave up our 20s, some of us are 30s, not for, I love it, today somebody said that my account was paid for by George Soros. I was like, where are the checks? I haven't been receiving any checks. Did I just get left off the payroll? What's happening?

Alyssa Burgart (56:18.589)
Give me the money.

Arghavan (56:23.954)
But my point is just that we give up so much and it's not to, I don't know, like put out some false claim from a pharmaceutical company. We sacrifice all of that to be able to help people. That's the whole point of the profession. And again, I recognize we don't always succeed and we don't always live up to our own ideals, but I do really think we're trying.

Alyssa Burgart (56:26.746)
Yeah

Alyssa Burgart (56:33.391)
Sure.

Alyssa Burgart (56:37.603)
Absolutely.

Alyssa Burgart (56:46.308)
Yeah, and I'll tell you, it's only gonna get harder with the clown car... the clown car of the apocalypse just taking public health and shoving it in the garbage every day. Every day.

Arghavan (56:50.946)
apocalypse.

Arghavan (57:00.041)
yeah, it's not just in the garbage, it's in the garbage disposal. It's like they're cranking that like incinerate that public health so there's no way of putting it back together.

Alyssa Burgart (57:10.328)
Arghavan, we're only 10 months into this administration.

Arghavan (57:14.159)
Yeah, I'm going tell you right now, we're not, literally this country will not survive if this term continues to its end.

I don't mean like, I'm not saying that like, oh, somebody needs to do something violent. What I'm saying is like, we need to stand up as a country because they genuinely do not think that this country, the country that my mother and I immigrated to when I was a child, this country, as flawed as it has been, but as great as it has also been, will not exist if we continue down this path for three more years. It will not.

Alyssa Burgart (57:30.17)
Yeah, absolutely.

Alyssa Burgart (57:46.82)
Yeah. Well, I'll tell you what my brother told me yesterday that I think is just fantastic. He said that he's heard. Now I'm going to be honest with you, there is no randomized controlled study just to show this, but I think it's worth studying is that if you take Tylenol while watching the news, it causes adult onset activism.

and I hope he's right.

Arghavan (58:07.281)
You know what else I saw today? I think this would be a good note to end on is that there was a cartoon, we'll have to find out who it is and put it in the show notes, but that said, among scientists, people with autism are overrepresented. So you could actually say that autism causes vaccines. Yeah, I loved it.

Alyssa Burgart (58:23.823)
That's hilarious. That's hilarious. All right. Well, I think that that that's it. What a great first episode. If you folks, if you didn't like what you've heard, this was, this has been the house of pod. Okay. And if you liked it, please subscribe to The Present Illness and leave us a review. Tell your friends or your primary care doctor. We would love to meet them.

Arghavan (58:49.264)
That's awesome.

I wasn't on the right thing. Is there anything I'm supposed to say again?

Alyssa Burgart (58:53.899)
No, it's fine. We were, sort of started making it up and then I stopped talking. on the one that says standard episode outro.

Arghavan (58:59.076)
But we can always, I know I'm trying to open the.

I know, I'm trying to open it but my computer is not really doing it for me. Hold on. Let's see if it'll wake up. Wake up little Simon!

Alyssa Burgart (59:11.033)
Wake up! Wake up!

Arghavan (59:14.621)
cause we can always just record that last last little bit, separate.

Alyssa Burgart (59:17.147)
Yeah, yeah, yeah, yeah. And we don't actually have a website yet, so we're not going to worry about that.

Arghavan (59:24.056)
Okay, it's really weird. I'm gonna open it in another browser because it's like not letting me... It's just stuck on the intro and won't let me open the outro. No idea why.

Alyssa Burgart (59:27.237)
Sure.

Arghavan (59:37.838)
my god, I have to sign in again. I don't remember what my sign in is for this.

Arghavan (59:50.407)
boy, verification code. Everything's, everything becomes so complicated and I appreciate it from a safety perspective, but at the same time, I'm like, I'm just trying to log into our notes.

Alyssa Burgart (59:53.263)
So confusing.

Alyssa Burgart (59:58.969)
Mm-hmm.

Arghavan (01:00:06.991)
We gotta do two factor. That's a smart thing to do, but anyway. Okay, I am now in here and now opening. Oh, okay, I see it. Do you wanna record what is in there or do you wanna leave what you had? What you had was pretty good.

Alyssa Burgart (01:00:22.041)
I mean, what I said was this part here on the top. Yeah.

Arghavan (01:00:24.195)
Yeah, I think that was pretty good. We didn't say we'll be back next week. We didn't say anything about cadence of episodes.

Alyssa Burgart (01:00:28.919)
Yeah, yeah, I mean, let's not worry about that, but I think we could say, you know, we'll be back with more headlines, hot takes and doom scrolling.

Arghavan (01:00:40.345)
Sure. You want me to say that?

Alyssa Burgart (01:00:42.597)
Yeah, sure.

Arghavan (01:00:46.233)
Do you wanna say, sorry, before that, do you wanna say anything about, I know what we have there about following the podcast, but it doesn't really say it. has the two, do you wanna say our stuff?

Alyssa Burgart (01:00:50.544)
Mm-hmm.

Alyssa Burgart (01:00:58.174)
our like, social media stuff? sure.

Arghavan (01:00:59.459)
Mm-hmm.

Okay, why don't you start and you do your accounts and then I'll do my accounts.

Alyssa Burgart (01:01:08.095)
sure, okay. I'm Alyssa and you can follow me at... Let me try that again. Woo! I'm Alyssa, you can find me on Blue Sky and TikTok as @burgartbioethix

Arghavan (01:01:27.266)
I'm Arghavan and you can find me on bluesky. I think it's @arghavansallesmd maybe and which is the same as on Instagram and then on TikTok it's @arghavansallesmdphd And I think we're both on Substack too.

Alyssa Burgart (01:01:42.754)
We are. We're both on Substack. Come find us.

Arghavan (01:01:45.623)
Yeah, and we will be back next week with more headlines, hot takes, and doom scrolling wrapped in hopefully some laughs.

Alyssa Burgart (01:01:52.952)
So until then, agitate, hydrate, take a nap. We'll see you next time on The Present Illness

Arghavan (01:01:59.501)
I think that's good.

Alyssa Burgart (01:02:00.932)
Great. my god, we did it.