The Present Illness

Protect Trans Kids, Not Peter Attia

• Alyssa Burgart & Arghavan Salles • Season 1 • Episode 18

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“Longevity” Doctor Peter Attia in Epstein Files 2,000 times; How to Leave Open Comments on Fed Regs Banning Gender Affirming Care; Bad Bunny’s Big Week; Trump wants women to smile more.

Dr. Peter Attia and the Epstein Files

Gender Affirming Care for Minors

Submit to BOTH dockets:

🥊 Hospital Ban (CMS-3481-P)

🥊 Medicaid/CHIP Funding Ban (CMS-2451-P)

💊Take Two and Call Me in the Morning

  • Bad Bunny’s album, Debí Tirar Más Fotos, is the first Spanish-language album to be awarded Album of the Year
  • Josh Johnson talking about the Super Bowl halftime show
  • Alyssa recommends Cadbury Mini Eggs and Cream Eggs.

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Credits

  • Production by Arghavan Salles and Alyssa Burgart
  • Editing by Alyssa Burgart
  • Theme Music by Joseph Uphoff
  • Social Media by Arghavan Salles

Alyssa Burgart (00:00)
Why are

people so eager to forgive monsters? They do not deserve your attention. They do not deserve your money. They do not deserve your praise. None of these are things that people are entitled to.

Arghavan (00:03)
Yeah.

Hey there, fellow nerds. Welcome back to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that is, I don't even know what to call it anymore. Usually we say febrile, but I feel like we're also having febrile seizures now. I don't know what's going on. I'm Arghavan Salles, a surgeon scientist in your friendly neighborhood, doom scroller and resident.

Alyssa Burgart (00:34)
And I'm Alyssa Burgart a pediatric anesthesiologist and bioethicist who tracks news and health law like they're EKGs full of spikes and surprises. The Present Illness is where we dig into public health, politics, culture and ethics with a scalpel in one hand and a meme in the other.

Arghavan (00:49)
Big thanks to everyone out there listening or watching if you're seeing us on the interwebs. ⁓ Extra love to our subscribers and those who follow us. And a warm welcome to anyone who just stumbled in from watching our president berate yet another woman journalist.

Alyssa Burgart (01:02)
I saw that video was terrible.

Arghavan (01:05)
Yeah, it was Kaitlan Collins for those who haven't seen it and she's a reporter for cnn and she was asking him about A very serious topic which is the Epstein files and he was she was asking about Howard Lutnick and Elon Musk two members of his administration and that The fact that they are in the Epstein files and dared to ask him if he had read Any of what related to them and ⁓ he

said, no, of course not, I'm too busy. That's what a silly thing to say. And obviously if it were a big deal, it would be headlines. It would have been headlines. So it must be nothing. And also now that we've found out that I'm not in the files, let's just move on. I think it's time for us to move on. And then she asks about the redaction. And she says, what about the survivors? Some of the survivors have been very upset about entire witness testimonies being redacted out.

And he goes, well, you know, you tell me they think too much is taken out. Other people tell me they don't think enough has been taken out because they released nude photos of these girls and women and their names and their addresses. So he's making it sound like it's an equivocating, nobody really knows what the right answer is here thing when clearly they've just gone wrong in both directions. then he just like goes off on her and says that he never sees her smiling. And you know,

She's a young woman and he never sees her smile. He's known her for 10 years. He never sees her smile. He goes off. mean, it's really, he throws a tantrum about it. And she says, well, Mr. President, I'm asking you about survivors of sexual assault. But of course it doesn't matter that it's obviously a very serious topic. He doesn't.

Alyssa Burgart (02:47)
Well, and his response

is essentially, you're ugly and I don't like that you don't smile at me. I mean, it's so stupid. it's, a thousand percent.

Arghavan (02:55)
Well, and it's abusive behavior, right? You know,

it's not hard to imagine that someone who behaves that way to a reporter doing her job may also have abused other people in other contexts.

Alyssa Burgart (03:08)
Well, and it's, you know, you and I have talked a lot about how ⁓ people with predatory behavior do so in an environment that makes them feel safe. And like, he just feels so safe. He's so safe.

Arghavan (03:21)
Yeah,

well he knows nothing's gonna happen because he's done this so many times. Quiet, piggy, and like, I mean there's a real that somebody put together of like back to back to back to back to back numbers of inappropriate statements, many of them that he's made to Yamiche Alcindor who's a black journalist. Anyway, so.

Alyssa Burgart (03:24)
Nothing has.

So.

Arghavan (03:42)
The

thing is, he said, now that we know I'm not in the files, let's move on. I believe his name is in the files like almost 40,000 times.

Alyssa Burgart (03:51)
Yeah,

he is in the files, guys. He's there.

Just a little Ctrl F, you too can see how many times he's in the files.

Arghavan (04:01)
You don't even have to control

F, you just put it in the search box and the DOJ pulls up every document. And that's after they've redacted. That's after they've redacted. ⁓ Anyway, okay, I know that's not our main topic, but it is infuriating.

Alyssa Burgart (04:10)
I know. ⁓

Well,

listen, we are glad you're here. As a note to new listeners, as you can tell, we often talk about topics that are intense. They can kind of be a lot. We did not intend to talk about SA and CSAM in the intro, but you've heard it now. So if you're going to listen to this in the car, may want to, you know, put it in your headphones or don't listen with your little ones. So if it and if this is an episode you need to step away from, we totally get it. ⁓

But on to, I don't want, again, we talk about these tough topics. I also don't want to miss an opportunity. This week was Women in Medicine Day, Argavan. So happy Women in Medicine Day. You're an incredible woman and I'm lucky to know you and to get to hang out with you.

Arghavan (05:02)
Happy National Women Physicians Day and this Sunday, February 8th is National Black Women Physicians Day. So happy National Black Women Physicians Day to anyone out there listening.

Alyssa Burgart (05:08)
Yay!

please reach out to all of your favorite black physicians and thank them for their service. All right. We have a lovely listener shout out that I'd like to do from ⁓ Dr. Leanna Gefter. And she wrote, I really enjoy the insights I gained from listening and you somehow make these heavy topics manageable to digest. Kudos. Thank you.

Arghavan (05:17)
Absolutely.

Amazing.

Thank you for the kind comment, Dr. Gefter.

Alyssa Burgart (05:41)
Yes. ⁓ Okay, so, Arghavan we have two main topics that we're planning to discuss today, and one is the relation between healthcare workers and the Epstein files, and then the second topic we're planning to talk about is ⁓ gender-affirming care. But I thought we would start with the Epstein files.

Arghavan (06:02)
Yeah, what a sentence, healthcare workers in the Epstein files. I mean.

Alyssa Burgart (06:07)
Well,

because you know, I'm going to be honest with you. I think that for people who still trust doctors and nurses to any degree would want to believe that there are no doctors or nurses in the Epstein files. But tell us why that's wrong, Arghavan.

Arghavan (06:24)
Yeah, so obviously the DOJ released millions of documents last Friday and ⁓ There's a lot there's a lot so people are learning a lot there There are a lot of things in there that are from tip lines that are not necessarily Substantiated but there's also sworn witness testimony and there's the direct emails as we've seen before to and from Jeffrey Epstein and multiple people so

Alyssa Burgart (06:29)
Mm-hmm.

Arghavan (06:48)
Very quickly, folks in the medical community picked up on the fact that Peter Attia is in the files almost 2,000 times in this batch that was released. You have to look on a little closer, yeah. Almost 2,000 times. ⁓ And this is from the batch that was released on Friday. And the first thing I'll say that people picked up on ⁓ is you might call it crass, you might call it insensitive. don't know. So trigger warning, as we've said. ⁓

Alyssa Burgart (06:59)
That was my vomit face for folks who were listening.

Arghavan (07:18)
But Attia is in conversation with Epstein and ⁓ the email itself has a subject line, got a fresh shipment, and he has sent some kind of image. We don't see the images, they're not there. So he has sent some kind of image to Epstein. Epstein writes back apparently with an image of a woman. We don't see that picture, but that's what we're told is there. And then,

Attia writes back that pussy is low carb, unclear about the gluten content. That's not word for word if folks want it, I can pull it up. that's what he writes back. And so you're already thinking, well, that's not good, but it's also not a crime to speak about women's bodies in that way. But that's not, it turns out, the totality of it. I just pulled it up in case people want to know.

The first email from Peter Attia that got a lot of people's attention was an email between him and Epstein where Attia says, so trigger warning again, this is crude, crass, inappropriate, dehumanizing language. He says, "pussy is indeed low carb, still awaiting results on gluten content though." So that's the first one that I think people

you know, we're understandably upset about. But you might think, okay, well, it's, you know, locker room talk as people like to say, but it's not nice. It's not professional.

Alyssa Burgart (08:51)
I mean,

Arghavan (08:52)
worth noting that all of the communications between Peter Attia and Jeffrey Epstein are well after 2008, which is when Jeffrey Epstein pleaded guilty to soliciting prostitution of a minor. Okay, so it's not, it wasn't like a hidden fact that he was a child abuser, yeah.

Alyssa Burgart (09:08)
Who knew? Who

knew? Oh, it turns out people knew.

Arghavan (09:13)
Yeah, people knew.

Alyssa Burgart (09:15)
Why are

people so eager to forgive monsters? They do not deserve your attention. They do not deserve your money. They do not deserve your praise. None of these are things that people are entitled to.

Arghavan (09:18)
Yeah.

Alyssa Burgart (09:31)
we've also all been now habituated to the idea that, you know, grab them by the pussy is something that apparently your president can say.

Arghavan (09:39)
Right, right. So you might be like, okay, like it's bad form, but is it really a big deal? Well, then we have this email with a subject line, got a fresh shipment. And Peter Attia says, you the biggest problem with becoming friends with you. So we think he meant to say, you know the biggest problem with becoming friends with you. The life you lead is so outrageous and yet I can't tell a soul. Now that kind of implies, I think that he knows.

Right? What Epstein does, that he abuses children, that he traffics women. Because what do you mean? You can't tell a soul. And there's other emails indicating that he wanted to visit the island. He has a back and forth with Jeffrey Epstein about other islands in the Caribbean. And Jeffrey's like, no, I don't go to those because there's other people there. And then he says, I need to visit sometime. Attia says, I need to visit sometime.

But perhaps the most concerning thing, at least for me when I became aware of this, is that in 2017, Jeffrey, sorry, Peter Attia writes about this in his book, in 2017, July of 2017, he was in New York and his wife and infant son were, I believe, in California. The son, one month old, stops breathing. Attia's wife, who is a nurse, does CPR.

they have to admit this child, this newborn, practically newborn, one month old, to the ICU. She's asking Peter to come home. He says in his book that she was begging him to come home, and he did not. Now somebody put together that, based on these emails, what he was doing at that time was arranging a meeting with Jeffrey Epstein in New York, because he's got this in his book. He says it's July 11th, that his baby,

has this emergency, and there's emails on July 12th and 13th between him and Epstein about what time they're meeting in New York. And he says in his book that he, well, he doesn't talk, he doesn't say, just to be clear, he doesn't say in his book that he was meeting Epstein. He just says that he was in New York for quote, important work. And then he says in his book that he regrets that decision, that it was terrible judgment, he should have gone home. But.

again, enterprising folks out on the interwebs figured out the timeline. And it's not just bad decision-making or bad judgment. It's abandoning your own family to meet with a child predator.

which I find hard to move past for someone who is a physician.

Now for folks out there who don't, who are like, who is this guy anyway? Cause he is very well known, but certainly not everybody knows him. So. ⁓

Alyssa Burgart (12:30)
⁓ But you've

seen his book. Whether you've read it or not, you have seen the cover.

Arghavan (12:35)
Probably it's called Outlive ⁓ and he was on 60 minutes ⁓ I don't remember exactly when sometime in the last couple of months. So folks may have seen clips from that He is a guy who went to Stanford Medical School, which is also where I went to and so Bummer bummer all around on that one and then he went to Johns Hopkins for a surgical residency that he did not complete and

Alyssa Burgart (12:59)
Yeah, I heard

that. didn't realize that he hadn't completed a residency. You know, sort of assume and I'm, you know, and again, this just shows how you really have to look up what people's credibility is. You know, I genuinely had just assumed that he had completed a residency. And if you think about, ⁓ you know, Casey Means, who's been nominated to be the Surgeon General of the United States, another person who just didn't manage to finish their residency. They're not licensed to practice medicine.

Arghavan (13:29)
I think he has a license. I didn't fact check it, but his website says he's licensed, but he's not board certified.

Alyssa Burgart (13:35)
Sure. What is, I mean, he, I mean, the reality is that if you've done an intern year in most states, you can get a medical license to basically do general practice. ⁓ but you're not board certified in anything, which, you know, I don't know if you, do you remember when that happened to you? Like when you were able to get your first permanent license? I just remember being like, are you guys crazy?

Arghavan (13:55)
Yeah.

Alyssa Burgart (13:59)
Like I'm not ready for this responsibility. have years of training left to do before it will be safe for me to truly be out on my own, taking care of people. just remember it being like such a profound responsibility and it's, is really, you know, irrespective of all the terrible things we're specifically talking about, about this person. I just, I'm struck by the absolute arrogance to, to behave in this way.

Arghavan (14:04)
You

No.

Yeah, well, it's, when you're about arrogance, it's worse than what you've just heard because, so he didn't finish residency and then he went on, did some other things, you know, if you look at his LinkedIn, like he did some consulting work and, wait, he took a route to that. Like he went for several years and did like business consulting stuff, whatever. And then he kind of, correct. And then he,

Alyssa Burgart (14:40)
Well, he's this like longevity influencer, like whatever.

not practicing medicine.

Arghavan (14:53)
in recent years has branded himself as a so-called longevity expert. It's important for folks to know there's no medical specialty in longevity. There is no residency or fellowship or certification. It's not really real. It's more akin to the wellness space that we've talked about many times where is wellness influencer selling people supplements essentially. And anyway, that's kind of how he started to get famous was doing all this longevity stuff.

Alyssa Burgart (15:11)
Mm-hmm.

Arghavan (15:22)
And according to a CBS article, he was charging at least 100,000 per person for his services, whatever his services are, as someone who's not an expert in anything and not board certified. So that's the background of who this guy is. I he has a popular podcast. He's got his YouTube, his Instagram, his Twitter. He's got this book that came out and has done seemingly pretty well.

He was just a couple of weeks ago named as a contributor to CBS News.

Alyssa Burgart (15:58)
Suck it, CBS.

Arghavan (16:00)
Yeah, the thing is, CBS News is not what it used to be, may or may not be aware, and it's under, as they say, new management, new management that doesn't really care so much about news or integrity. And interestingly, so once all this stuff came out over the weekend, he's been, I think he was the chief scientific officer for something called David's Protein. I only know they exist because I see their ads everywhere. Anyway, they removed him as their chief scientific officer. And apparently what I read was that there are some

Alyssa Burgart (16:18)
Yes, yes.

Arghavan (16:28)
Discussion at CBS where Barry Weiss who's the head now of their news? I did not want to let him go and parent folks at Paramount apparently did want to let him go but apparently as I read today Thursday February 5th that they were keeping him on as a CBS News contributor

Alyssa Burgart (16:46)
But Arghavan,

why would you want to ruin a good man's career?

Arghavan (16:49)
Yeah, I know these ⁓ accusations of terrible behavior really get men down, don't they? They really have serious consequences. I wanna add a couple more things. He even was close enough to Epstein that he stayed in one of Epstein's apartments in New York when he needed a place to stay. In one of his emails, I think about that actually, about the apartment, he says something like, I hope to see him soon. I go into JE withdrawal when I don't see him for a couple of weeks.

He also, this is important because it comes up in his statement in response to all this, he at one point had bought tickets to go to Epstein's ranch. People may not be aware, Epstein has a large ranch called Zorro in New Mexico where as many terrible things as you can imagine happened, allegedly. And so he went to, as far as having bought plane tickets to go to the ranch and that trip was canceled by Epstein. So.

Let's fast forward to then, Attia puts out a statement a few days ago about everything that we've now seen and put together from the files. And ⁓ I will say, one, he's clearly a smart guy. Two, he clearly hired someone who's also very good at their job. So I think for many people, the statement has the appearance of the things you want to see. There's some semblance of contrition, but...

not really real, you know, when you look at it in detail. To me, doesn't hold up at all, but I've had people in my comments telling me that they read his statement and he seems sincere, so they're ready to forgive him. I mean, he says things

Alyssa Burgart (18:29)
the parasocial relationships that people think they have with these huckster, these hucksters. And I just do not understand the eagerness

Arghavan (18:39)
Mm-hmm.

Alyssa Burgart (18:44)
to just, well, you know, he said he was sorry, so we're good to go. It's okay if he raped a bunch of girls, but you know, it's fine. I mean, he said sorry.

Arghavan (18:47)
Yeah!

Well, he didn't even say sorry is the thing. ⁓ That's why I said it was a statement. ⁓ It wasn't an apology. I'll just briefly highlight some of the things that he said in his statement. I love your mom face.

Alyssa Burgart (18:57)
⁓ come on!

because you want to see my vomit face again? Is that why you're doing this to me? OK, fine. I'm ready. I'm going to need to

get a facial after this to smoothen myself out. OK.

Arghavan (19:16)
He says shortly after we met I asked him directly about his 2008 conviction because he's gone on about how he didn't know He didn't know Epstein was abusing children. So shortly after we met I asked him directly about his 2008 conviction. He characterized it as prostitution related charges in 2018 I came to learn this was grossly minimized Now here's the thing about that he knew there was something

Because he asked, right? He asked. And then the answer he got was apparently sufficient. Like, I'm just gonna be honest, Alyssa, if you were like, hey, I had a conviction for prostitution, I would probably go home and Google it, to be honest. I'd be like, I wanna learn a little bit more about what was going on there. I'm gonna be associating with this person repeatedly as they did for years. So either he wants us to believe

that, or he wants us to believe that either he didn't look into it at all, he just literally took Epstein's word for it, was like, fine, know, men, men's little subversities, no big deal, or he wants us to believe that he knew and now he's lying to us. Like those are the options. And as someone who's presenting himself as a medical expert who like takes the insights from the medical literature and delivers them,

to people, synthesizes information, gathers together medical research. Look, if you couldn't look into who this guy was, you are not trustworthy to be giving people medical advice.

Alyssa Burgart (20:56)
Can he even Google? Can he even pub? mean, this is like.

Arghavan (20:58)
This is what I'm saying.

So it's either that, it's either he wants us to believe he was so ⁓ incompetent that he didn't, he couldn't figure out, even though he knew there was a problem, that he couldn't figure out what the actual problem was, or that he knew and now he's lying to us and he thinks we're just gonna go along with it. Can't be both.

Alyssa Burgart (21:17)
Can't be both.

I was just gonna say, ⁓ on the longevity front, I did an interview sometime before the pandemic. And it was all about like the ethics of longevity and these billionaires that are like investing all this money and spending all of this money on people like Aatiyah. ⁓ Because they're like obsessed with living for a long time.

Arghavan (21:35)
Mm-hmm. Mm-hmm.

Alyssa Burgart (21:42)
And like there's a reason that there are no actual medical experts in this because it's bullshit. Like you want to live a long time, like be rich, live in a nice neighborhood because like your zip code is something that's going to predict your lifespan more than so many other things. You want people to live longer, like get rid of pollution and make it easier for people to, to afford food and make it so that everyone has a place to live. Like there are very fundamental ways to make it so that people live a long time.

Arghavan (22:11)
Yeah, and it's not biohacking. It's as you said. Yeah.

Alyssa Burgart (22:13)
You know, it's not vitamins and like

meditation. I mean, I'm not saying that meditation is bad, but it's not like vitamins and I don't know, whatever this crazy shit is that these people are doing. And there's a whole litany of insane things that people are doing to be like.

Arghavan (22:26)
Yeah, it's really a lot of

vitamins and supplements, but in reality, like you said, sleep, high quality, regular sleep, healthy food, time for exercise, lowering stress levels, like these are the things, and your genetics, and as you said, your neighborhood. I mean, all these things together, there's not, you can't biohack your way to longevity, which is what they want you to believe, but they want you to believe that so they can take your money.

Alyssa Burgart (22:41)
course.

They want rich, they want people with money to believe that they could biohack their way. Yeah.

Arghavan (22:53)
That's right. So, okay,

I just want to point out a couple other things. So he says multiple, actually twice in the statement that he was never on his plane, never on his island, never present at any sex parties, ⁓ actually in another places he was never at the ranch. But again, that may very well be true, but it's not for lack of trying. Like we have the email for him saying that he would like to visit the island. We have the plane tickets that he bought to go to the ranch and then Jeffrey's assistant canceling the trip. So.

Yeah, good for you, buddy, that you didn't go to these horrific places, but it wasn't because you didn't want to go.

Alyssa Burgart (23:24)
I I guess the claim to fame is Jeffrey Epstein didn't want to bring him? I mean, is that what he's trying to use as an argument? Like, well, Jeffrey didn't want to hang out with me.

Arghavan (23:31)
No, doesn't know he

thinks we didn't know that much. That's what he thinks because he doesn't say oh You know Bobble he doesn't address that Epstein actually blocked that um, and he he does address the god of fresh shipment I think you'll find this amusing. He says that that email was about you'll never guess met Foreman That's what he says

Alyssa Burgart (23:52)
I'm sorry, nobody

is shipping metformin. It's like a $4 drug. mean, come on, shut up.

Arghavan (23:57)
But also

who's sending an email to their billionaire friend about a shipment of metformin?

Alyssa Burgart (24:04)
Nobody. This is stupid. What a what that's not even a good lie

Arghavan (24:06)
literally nobody.

No, it's not a good lie. And he says in his statement, he says that he had sent this email with a photograph of bottles of metformin and that Epstein replied with the words, me too, and attached a photograph of an adult woman. Now let's just imagine it was metformin. How does that make any sense? It makes me wonder if in fact you were sending a picture of metformin. I have to be honest because what kind of person responds to it?

picture of medications with a picture of woman. know, and we know Epstein is not like a normal person, but still it doesn't make sense.

Alyssa Burgart (24:46)
Also, like, I'm sorry, just don't insult my intelligence. just, that is-

Arghavan (24:49)
Well, that's what he does

repeatedly in this statement. I think people will just, I think genuinely, think a lot of people won't pick up on it. okay, the last thing I'll say about it, it's a very long statement, but the last thing I'll say about it is that his main explanation seems to be, I just didn't know what was going on. I was so naive and there were fancy people and fancy places and he was important. And so I just didn't know. ⁓

You might ask, how old was he? How old was Attia when all this was happening? Well, he was 42.

I know, because he says, oh, I've grown so much in the last 10 years. I would never fall for this now. OK, he's 52 now, so he would have been 42 at that time.

Alyssa Burgart (25:32)
I mean...

What an insult to men in their 40s.

Arghavan (25:42)
I mean, just an insult to humanity that we're supposed to believe that in your early 40s you didn't know better than to hang out with a child abuser.

Alyssa Burgart (25:51)
and that that's your excuse. Anyway, forget it. I'm just... Well...

Arghavan (25:53)
Yeah, okay, sorry, okay, I know I said the last thing and I know I do this

all time. have one really last thing.

Alyssa Burgart (26:00)
Okay, I'm gonna hold you to it. We got a schedule.

Arghavan (26:00)
Look on your face. Okay. Yes, for real for real. The last thing

the nail in the coffin is in 2018 November 2018 Julie K Brown who I'm sure I've mentioned here before she's a reporter for the Miami Herald She put out the first of a series of investigative reports really exposing a lot of behavior and what happened with that sweetheart part deal that he got in 2008 so there's an email in these files from

Alyssa Burgart (26:16)
right.

Mm-hmm.

Arghavan (26:28)
Attia reaching out to Epstein after this saying, hey, any fallout from that article? Not like, hey bro, we can't be friends anymore or just like not communicating with him. No, he's like, hey, any fallout? To which Epstein says zero. And by Attia's own admission in his statement, he continued to meet with Epstein in person through spring of 2019. So months after this, and he had clearly as evidenced by his emails,

knew what was in that article and continued to meet with this person. And he says in his statement, he says in his statement that I told him directly he needed to accept responsibility for what he did. And of course people are like, where, show us, where did you do that? Because it just sounded like you were interested in whether it was gonna reach you. That's how I interpreted that email anyway. Any fallout from that article is like, how is it gonna affect me as someone who's affiliated with you?

But I'll just keep hanging out with you for a while until until you're practically in prison, right? Like he was arrested I believe in the summer of 2019 and he says Attia says they were hanging out through spring of 2019. Anyway, all that to say I don't buy it. Nothing in that statement is credible to me and it is unlikely he will face any real consequences for any of it.

Alyssa Burgart (27:50)
Terrible. Terrible. Screw that guy.

Arghavan (27:58)
I mean there really should be accountability for everyone who was interacting with Jeffrey Epstein after that conviction in 2008.

Alyssa Burgart (28:07)
What I am going to be looking for and will be 0 % surprised if something comes out is if Ahtia has been, if he gets accused of essay.

Arghavan (28:21)
Yeah.

Alyssa Burgart (28:22)
I will be 0 % surprised if that is what happens. So TBD.

Arghavan (28:26)
Same, same.

Yeah, we'll have to keep an eye out. I mean, he says that he, in his statement, he says he never saw young girls with Epstein, but it's been documented many times that he had photos of these young girls all over his houses, and Attiya stayed in the apartment, also went to the mansion in New York multiple times. So I think he just thinks we're too, we're not intelligent enough to realize there's a difference between, you didn't see a girl in person, but you saw all those photos, and we're supposed to believe you didn't know. Anyway, okay.

Let's talk about gender affirming care.

Alyssa Burgart (29:01)
That sounds great. ⁓ You know, there are ⁓ two bills right now that are open for public comment, so I wanted to bring that to our listeners' attention. So as you all have probably noticed for the last several years, gender affirming care for minors has become one of the favorite dog whistles of the right-wing movement, ⁓ especially ⁓

know, it's a very small population of people who are incredibly marginalized and getting care of any care is really difficult and being treated with dignity and respect is, is unfortunately remains a huge problem for people who are trans and non binary. And so it's terrible that this population has been attacked. Simultaneously, folks may have noticed I'm sure you have, ⁓ you know, the attacks, for example, on, ⁓ you know, ⁓

I'm really having some weird finding difficulty here. ⁓ People have likely very much noticed the attacks as well on drag performances and ⁓ people who really are using, are demonstrating in a very visceral way how gender is a performance. There's so many things about gender. about the costume you put on. about the way we do our hair. It's about what you make your face look like. ⁓

Arghavan (30:02)
happened.

Alyssa Burgart (30:29)
Gender affirming care for minors has become this dog whistle. early on, there were many people who were supportive of trans and non-binary kids being like, hey, we need to protect these kids. We need to protect trans kids. And folks in the right wing really turned that around to say, ⁓ we need to protect trans kids from you people who are butchering these kids and doing things to them. It's all very ridiculous.

So there's two main ways that the federal government is trying to make it so that it is absolutely impossible for any trans or non-binary kid to receive pretty much anything except psychotherapy. And so the two things are there's one that's a hospital ban. And what this would do is any children's hospital or any hospital that provides ⁓ gender affirming care to minors. And this is not just surgeries. This is surgery. This is hormones, any sort of treatment.

that is considered gender affirming care would be banned and these hospitals would lose access to CMS funding. And we've talked a lot about CMS funding and how important it is. Children's hospitals, many children's hospitals cannot stay open without CMS funding. Many children's hospitals rely on CMS funding for 40 to sometimes 50 % of their just operating costs because there's so many children, because we've made a political choice in this country that we are

Arghavan (31:43)
Mm-hmm.

Alyssa Burgart (31:57)
we have not made it easy for families to be able to afford healthcare for their children. And so many, many families rely on CMS funding through CHIP ⁓ in order to get services for their kids. And so the one bill bans hospitals. So if you are a hospital that provides any of these services, you will be barred from receiving any CMS funding for anyone.

Arghavan (31:59)
Mm-hmm.

Alyssa Burgart (32:25)
And so that's basically putting children's hospitals in a bind where it's like, well, you can either do the thing to protect this incredibly vulnerable, tiny, marginalized community, or you can not be able to take care of the vast majority of your patients. And so this is one of these ways that trans kids are being used as this terrible, terrible bargaining chip to force hospitals to not take care of their patients.

Arghavan (32:51)
Mm-hmm.

Alyssa Burgart (32:55)
to not provide evidence-based care ⁓ to these kids. The other ban that is coming through is actually specifically on Medicaid and CHIP funding. And so it would make it so that it is impossible for any of these services to be reimbursed by Medicaid or CHIP funding. And so this is ⁓ you know, really a two-pronged attack to make it so that basically

Arghavan (33:06)
Mm-hmm.

Alyssa Burgart (33:22)
Poor kids won't be able to get any services at all because CMS will not pay for them and they will stop any other children whose parents have the resources to be able to overcome ⁓ the limitations on funding. Those kids won't be able to get services either. And so, you know, it's a very coordinated plan to make it so that it is banned. The other thing that the hospital ban does, it actually makes it a federal offense for a clinician to provide any gender affirming care.

Arghavan (33:30)
Okay.

Alyssa Burgart (33:52)
because you know they want to put us all in jail. There's a list that the FBI is keeping where you can report doctors who provide gender affirming care to minors. ⁓ And so one of the things that has been used to fuel both of these bills to ban gender affirming care for minors is an HHS commissioned report that was on gender dysphoria and shockingly

Arghavan (34:01)
Thank you.

Alyssa Burgart (34:20)
It was, you the deck was stacked against gender affirming care by ensuring that all the people who helped put together that report had, were basically anti-trans activists. And that includes the ethicists who were ⁓ put into that ⁓ group in order to make those ⁓ recommendations. And so the takedowns of this report ⁓ on scientific grounds and on clinical care grounds have been vicious because it is a terribly

Arghavan (34:30)
Yeah. Yeah.

Alyssa Burgart (34:49)
poorly researched document that just does not stand up to even the smallest amount of scrutiny. But there's an entire section there on ethics and it was written by two people who are ethicists and they are both anti trans activists. So one of them is a ⁓ adult palliative care ⁓ physician on the East Coast. And one of them is a philosopher who is opposed to transgender care as well as their

that person's sibling is also an anti-trans activist academic. And so, you know, these people, from what I can tell, were selected because of their previously very prominent, I mean, this is what has made these two people frankly famous. One of them is known for ⁓ promoting ⁓ the relationship between spirituality or religion and medicine, which, you know, I don't have a problem with doctors being religious.

perfectly fine. I do have a problem with doctors imposing their religious beliefs on other people. I don't think that's appropriate. ⁓ So anyway, the ethics section in this is like such a joke to me as a pediatric bioethicist. so ⁓ several very prominent pediatric bioethicists that I am very fortunate to know, ⁓ six of them and me, we got together and wrote an op-ed really going through the ethics section of this document and being like,

Arghavan (35:50)
Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm.

Alyssa Burgart (36:17)
here's how you apply basic pediatric bioethics principles, because also neither of the people who wrote the ethics section on care for minors actually takes care of children. Like one of them doesn't take care of patients, and one of them is an adult doctor. And so neither of these people actually have the expertise in the area where they had this big responsibility. And they frankly did a pretty crap job. I mean, it doesn't stand, the things that they argued are just, they really,

have made this argument that, well, we don't have enough information and so we shouldn't let anybody have access to this treatment because we need to have the utmost caution and we shouldn't let anybody have any of these services because it might be harmful. Despite the fact that there's growing evidence year over year that if you provide a supportive environment, if we have kids get the support that they need in order to explore their gender identity, to allow them to

delay puberty for a period of time while they go through this exploration, that these are actually things that are really important and they reduce the risk of suicide. So the idea that we should take away these things that absolutely benefit some patients because there is this idea that they have that it's harmful because they've already decided that it's harmful.

Arghavan (37:38)
Right, that's the thing, that's not a scientific position, it's not a scientifically backed position, I should say. And as we've seen with what they've put out regarding vaccines, for example, like they're not really, this HHS is not really concerned about what data suggests, the literature shows, they're really much more concerned about pushing a specific agenda. And so it makes sense that they wouldn't have people who know what they're talking about write that section or write, in fact, the entire report or maybe it's written by...

It's some chat GBT. don't know. But you know, ⁓ it's that part is not surprising to me, although it is extraordinarily harmful to have done this because you know, one of the things you kind of briefly touched on is what I think there's a lot of propaganda out there about what gender affirming care looks like for minors because it's mostly supportive care, right? And hormones and things that are all reversible. ⁓ and they

Alyssa Burgart (38:15)
Mm-hmm.

Mm-hmm.

Mm-hmm.

Mm-hmm.

Arghavan (38:34)
as you rightfully pointed out, are associated with a lower risk of those children dying, which I think is what we want. We don't want children dying, right? I know that might be a radical position, but I don't want to see children dying. So.

Alyssa Burgart (38:44)
Yeah. As a

person who spends my clinical time trying to help children not die, there is no higher calling than if you have a way to help a child not die, you should help them do that thing.

Arghavan (39:01)
Yeah, exactly. And then they are instead of reading these data and understanding the benefit of just supporting people who are not feeling well, right? They're feeling quite unwell. That's why they're seeking care. Instead of doing that, they are trying to demonize this very small group of people. And you know who is not in the Epstein files? Trans people, drag queens. Do you know what I'm saying? Like that's...

Alyssa Burgart (39:27)
No drag queens found.

Arghavan (39:31)
After all this hullabaloo about, you know, bathroom safety, whatever nonsense they're putting out there, it's not, and we've always known this, but if you just take this as a piece of data of like who's in the Epstein files, it's a bunch of, as far as we can tell, CIS-het dudes, mostly white. Although Deepak Chopra's in there, I don't know if you saw that. Anyway, there's a...

Alyssa Burgart (39:51)
I did. I've always

thought he was skeevy, but like, you know, just more confirmation. Well, so, you know, and one of the things to your point about, ⁓ you know, how is it that evidence is being applied? And like, they basically they have a statement in this ⁓ in this report that basically says, like, common sense is enough for us to know that this is harmful. We common sense. That's that's all we need to show that this is harmful is common sense. But we're going to hold evidence of benefit to a high technical bar.

Arghavan (39:57)
away from the...

Alyssa Burgart (40:20)
I mean, that is an unreasonable way to think about benefits and burdens. Well, also, common sense to who? Because I don't share your sense of common sense.

Arghavan (40:23)
You can't compare common sense on one side with research on the other. That's... Yeah.

Yeah. Well, and speaking of common sense, okay, just because we've talked about this before, I know if people saw Ballerina Farms, Hannah Neeleman they were one of these raw milk people, know, selling raw milk to people, which are HHS secretary and things like that. Exactly, because guess what? It was contaminated. People were getting sick. Anyway, so...

Alyssa Burgart (40:44)
I heard they got shut down.

Arghavan (40:52)
If you think, because I mentioned that because a lot of people think it's common sense. cows are natural. Raw milk is natural. No, there's a reason we came up with pasteurization, which is that people were dying.

Alyssa Burgart (40:58)
No, no, freaking... They roll around in their own

shit on the ground. Has no one had been to a farm? This is... Come on, guys!

Arghavan (41:06)
Yeah!

I know. Well, who was it? Now I'm gonna forget who it was, but somebody had said, it's fine. I go to the farm. I look at the cows. I meet the cows. Then I feel good about the milk. And somebody else I saw recently was like.

Alyssa Burgart (41:10)
Go to a farm!

And you feel good about it until you get Shigella or Shiga toxin.

Arghavan (41:24)
Well, like, have you seen the cows? ⁓ their point

was like what you were saying. Like, the cows are disgusting. If you've seen the cows, you should want your milk to be pasteurized.

Alyssa Burgart (41:30)
I listen,

I love a cow. think it's lovely to be near them. I think they're beautiful creatures. I do not personally eat them. ⁓ But also, I love my dog, but she licks her own ass.

Arghavan (41:38)
No!

You

Yeah, they're not really exactly living up to our sanitary standards, ⁓ which is why we have faster. Anyway carry on.

Alyssa Burgart (41:54)
So, listen, I wanna get, so there's a couple things I wanna talk about

in terms of gender affirming care, because I it's really important. And so there's actually several things that MAHA we've had a lot of problems, and you talked last week actually about how ⁓ RFK Jr. was berating somebody in Germany about their healthcare and like, why are you getting in between a doctor and why is the government getting in between a doctor and their patient? And it's like, well,

Arghavan (42:21)
huh.

Alyssa Burgart (42:22)
That's exactly what these two bills are doing is by literally inserting the government in between patients, families who care about their children, and physicians and nurses who want to take care of these kids and social workers. I'm so fortunate that I was able to practice during a time when our gender affirming care program was really strong and was able to function in its full capacity. And it was.

fascinating because we actually had them come and give a presentation to our ethics committee because this was like kind of before it was really in the news and all this stuff. I was like, it's like we'd like to hear about your practice and understand how you're approaching, you know, this as you as you build this program. And like they just had such a fabulous way of really wrapping these families in support so that they could go through this period of exploration together to decide what was right.

Arghavan (43:14)
Mm-hmm.

Alyssa Burgart (43:14)
And

it wasn't the government coming in and deciding what was right for them. It was patients, their parents, and their clinical team all working together to support that family, to make sure that they had the resources that they needed so that they would have access to the best, most up-to-date evidence ⁓ in that particular population. And that's really what's being taken away here. The other thing is it's also this complete dismissal of the role of

emerging adolescents and their emerging autonomy. know, adolescents should have a voice in their identity and in their care and to basically take away those opportunities from trans kids. It's wrong and it is deeply, deeply harmful to these kids. And so my, ⁓ will put a link to the op-ed that we wrote. ⁓ I hope that you all, you know, will take a look at it. I think that we've done a really, ⁓

Arghavan (43:52)
Mm-hmm.

Alyssa Burgart (44:11)
straightforward job of explaining. mean, frankly, this is the deal. I do not think that it is, it is, let me rephrase that. It is completely inappropriate at this point to say, well, should trans people exist? That is an inappropriate and undignified comment that diminishes the value of trans people in our communities who have always existed. It is inappropriate. And yet,

Arghavan (44:36)
Mm-hmm.

Alyssa Burgart (44:39)
That is what this document, this ⁓ HHS report is trying to say. They're trying to say, well, these people shouldn't exist and we want to use psychotherapy to make it go away. I mean, it's just back to like sending kids off to camp to like pray the gay away. It's ridiculous and it's very harmful. ⁓ What we should be doing is encouraging genuine shared decision-making by making sure

Arghavan (44:51)
I

Alyssa Burgart (45:02)
that families and clinicians are able to access each other and able to have open and honest conversations without worrying about the government coming into the exam room. It's just, it's crazy. So there's two things I really hope for those of you who have any sort of feeling, whether it is that you, that it's specifically about gender-affirming care, but if you want to be able to have the government not interfere in the decisions that you want to make with your healthcare provider, I really urge you to think about how these bills would also impact

the to do that in the future. Because I don't think these bills are the, I think these bills are the beginning. I don't think these are the end. So their public comment is open. The deadline to submit public comment for both of these bills is February 17th at 5 p.m. Eastern time. If you wait until the 17th, the websites can get kind of bogged down. So I really encourage folks to do that a little bit earlier if you have the capacity to. And then my friend,

Matthew Cortland, who is a lawyer ⁓ and does just incredible advocacy work online, has put together an exquisite, truly an exquisite commenting guide. I had reached out to them and I had said, hey, I'm putting together these comments and I feel like my colleagues in academia, like, we're not exactly sure the best way to approach this. Like, how should we be referring to ourselves? Should we submit comments together? Should we submit them separately? Like, what's the best way to do it?

Arghavan (46:23)
Mm-hmm.

Alyssa Burgart (46:30)
And in their they put together this commenting guide that has something for everyone. So you can kind of go through it. They have an explanation of ⁓ what it is that, like kind of a summary of the issues. And then they also have a guide kind of for, know, if you're a trans person, here's something that you can do. If you're a family member of somebody, this is something that you can write about. And they have specific sections for clinicians and for academics.

Arghavan (46:35)
Hmm.

Mm-hmm.

Alyssa Burgart (46:55)
And so I personally, I learned so much about how to use, how to do these comments more effectively. And so I'm so appreciative. ⁓ If any of you, the commenting guide is open, I will put a link to it in the show notes, super helpful. And I really hope you all will take the opportunity to do that.

Arghavan (47:12)
Thank you so much for sharing about that and thank you for writing the comment or the op-ed that you did and do you want to talk about the backlash?

Alyssa Burgart (47:21)
okay, guys. ⁓ I've reached, wait, what is it called? I'm not a gamer, but like, what is it called when you level up? You know, ⁓ it turns out that sound ethical reasoning is terrifying to far right influencers. And so I have the badge of honor now of having been featured, having my face featured ⁓ in Libs of TikTok. So thanks a lot, Libs of TikTok, which by the way is run by this like

Arghavan (47:32)
Yeah.

Alyssa Burgart (47:51)
Bananas lady. How do you say her name again? Kaya rechick. Yeah

Arghavan (47:53)
think it's Kaya, Kaya Reich. So

for folks who don't know, Libs of TikTok, it doesn't stand for liberals, just so you know. Yeah, they're terrible. They have called schools asking to do harm to the folks at the schools. They've incited people to actually threaten schools because of bathrooms, having all gender bathrooms, for example. They're just a horrific.

Alyssa Burgart (48:02)
Well, it's like own the libs. We're gonna own the libs.

Arghavan (48:22)
organization if you can even call them that. But they love to target people who care about human rights ⁓ as Alyssa does. So I'm so sorry that they featured you. I agree it's kind of like a badge of honor like you you've made it. ⁓ You you're doing the right thing so much that they noticed and now they're mad. And I'm hopeful that it doesn't bring a lot of distress to you that whatever attention they're trying to send your way.

Alyssa Burgart (48:45)
Thank you.

Well, you and I have both faced at different times in our lives and careers online backlash for trying to do and say the thing that elevates the human dignity of people around us. So ⁓ I've decided I'm going to buy a piece of jewelry to commemorate it. I'm thinking maybe like a vintage charm or something. So, you know, if folks have ideas,

Arghavan (49:08)
I love it.

Alyssa Burgart (49:11)
Let me know. Send me a link. Send me an Etsy link. I don't know.

Arghavan (49:15)
I love that. Yeah, I look forward to seeing what you buy. deserve all the things. Thank you for your advocacy.

Alyssa Burgart (49:21)
Well,

that's the perfect transition, I think, to take to and call me in the morning. What do you think?

Arghavan (49:28)
Perfect, I love it. ⁓ I'll go first. So one of the things that I really appreciated in last week is the Grammys. ⁓ I'm not like a big, know, I'm not like obsessed with the Grammys or anything, but I liked that this particular Grammys had multiple people getting up on stage and saying with their whole chest that we don't want ice, that we want to abolish ice, we want to get rid of ice, ice out.

Alyssa Burgart (49:31)
Great.

Yes.

Mm-hmm.

Arghavan (49:57)
We want to protect our communities and I loved that they were so vocal about it. Folks like Bad Bunny and Billie Eilish and just multiple people, Kehlani, ⁓ they just did not hesitate. And there were a lot of people wearing ice out pins, including Lady Gaga. ⁓ And we have been dealing with so much awfulness ⁓ that it was just refreshing to see.

Alyssa Burgart (50:11)
Mm-hmm.

Arghavan (50:23)
so many people reiterating those messages and being very well received by the way, by the audience. You know, the applause was thunderous. And of course, Bad Bunny winning so many awards and then giving an acceptance speech in Spanish. Take that, take that right wingers. ⁓ I loved it so much. I believe he's the, ⁓ I'll fact check myself in the show notes, I believe he's the first Latin artist.

Alyssa Burgart (50:37)
Mm-hmm.

Arghavan (50:53)
to win the album of the year, which is an incredible accomplishment, ⁓ especially in this environment where people are literally being pulled off of the streets because they look like they might be Latina of any kind. So that fidget felt especially nice.

Alyssa Burgart (51:07)
Yeah. Also, you

and you know, you and I are in the Bay Area. ⁓ Bad Bunny is going to be in town. He's going to be playing the Super Bowl. It's going to be here in San Jose. So I am just delighted that he will be gracing our fair city and he will be just, you know, singing to the people in Espanol.

Arghavan (51:16)
That's right.

Yes.

Yeah, I'm hopeful there will be not a word of English in the whole Halftime Show. You know, Josh Johnson, know you, I wanna hear your thing, but I just say real quick, Josh Johnson had a great, he's a comedian, he had a great piece where he was talking about, you know, the Super Bowl and the Halftime Shows and how people, some people, some segments of our population have been upset at how black the Super Bowl Halftime Show has been.

Alyssa Burgart (51:42)
I love him.

Arghavan (51:55)
He was talking about the Kendrick Lamar halftime show, which of course was amazing. And then he goes, I bet they thought that was as black as it could get. And now they got someone who won't speak English.

Alyssa Burgart (52:04)
I've seen this.

I saw that skit and I laughed so hard and I have watched it more than once so we will definitely put that in the show notes as well. Love Josh Johnson.

Arghavan (52:17)
Perfect.

Yes, he's amazing. Well, I think that's a good note to, no, yours, I'm so sorry,

Alyssa Burgart (52:22)
Arghavan You were like, you're getting a vintage charm. We're done.

Arghavan (52:25)
I am losing ⁓

it.

Alyssa Burgart (52:31)
Well, OK, at the risk of a little bit of ASMR, which I hope it's not too aggressive on the microphone, ⁓ my favorite seasonal candy is in stock. And I will tell you, I look forward to this all year. This is my favorite. These are Cadbury mini eggs. ⁓ I actually buy a lot of them so that I can ration them out as long as possible.

Only downside is that last year my kids also discovered how good they are. And so ⁓ I'm going to have to, think, maybe up the candy, the candy hiding for for the future. But that's one of my favorites. And as a close second, I have always loved these like Cadbury cream eggs because they look like an egg inside. And I think that's very clever. ⁓ I will say the American ones don't taste quite as good as the ones from UK. And when I was ⁓

Arghavan (53:15)
Mm-hmm.

Alyssa Burgart (53:25)
When I was growing up in LA, I used to babysit for a family that was from the UK. And so if they needed to go back to the UK, they would bring me back like a little sampler of Cadbury chocolates, which is delish. Love it.

Arghavan (53:36)
Mm-hmm.

Mm-hmm,

mm-hmm, fantastic. I love those. ⁓ I do, I think I've had those, I've definitely had Cadbury Eggs, but I think I've had the little mini ones as well. ⁓ Yeah, they have that like candy shell coating, right? Yeah. There's a little crunch. Yeah.

Alyssa Burgart (53:42)
Alright.

They're just like a delightful treat.

Mm-hmm. Yeah, it's like a nice little crunch.

Arghavan (53:57)
All right, well on that note, that's it for this week's episode. If you didn't like what you heard, this has been the Peter Attia Drive podcast.

If you liked it, don't forget to subscribe to The Present Illness. Please leave us a review or rating and tell people you know to listen in as well.

Alyssa Burgart (54:05)
⁓

Yeah, share it with your friends. We're gossipy and fun. You can follow us on TikTok, Instagram, and YouTube. We're at @ThePresentIllness and you can stay on top of all of our TPI related news.

Arghavan (54:24)
We will be back next week with more headlines, hot takes, and doom scrolling, hopefully wrapped in some love.

Alyssa Burgart (54:29)
So until then, agitate, hydrate, take a nap. ⁓ a nap is so good. We'll see you next time on The Present Illness. Production by Arghavan Salles and Alyssa Burgart. Editing by Alyssa Burgart. Social media by Arghavan Salles. Original music by Joseph Uphoff. Don't take your medical advice from random people on a podcast. This shows for informational purposes. It's meant to be fun and it's certainly not medical advice. So please take your medical questions to a qualified professional.


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Alyssa Burgart, MD, MA

Host
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Arghavan Salles, MD, PhD

Host