The Present Illness

New War with Iran and Bad Energy with Casey Means

• Alyssa Burgart & Arghavan Salles • Season 1 • Episode 22

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0:00 | 1:56:06

Overnight war with Iran; Casey Means’ confirmation hearings; Newsom sucks

War in Iran

Casey Means

💊Take Two & Call Me in the Morning

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Credits

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

Alyssa Burgart (00:00)
I

mean, there is literally a chapter in this book called Trust Yourself, Not Your Doctor. And then she had the audacity. And I will get into this when we talk more closely about the confirmation hearings, where she says over and over and over again in this hearing, is the main like that's her main thing that she goes back to is, ⁓ every patient should have the opportunity to discuss with their doctor, which like there's a lot of people who don't have access to a doctor. So that's terrible. Also, your very, very popular book says

trust yourself, not your doctor. So, I mean, forgive me if I'm not super convinced, okay?

Arghavan (00:29)
Yeah

Arghavan (00:35)
hey there, fellow nerds. Welcome to another episode of The Present Illness, your absolute favorite podcast. This is the podcast where two physicians try to make sense of a very hard to understand world that is increasingly sick at all times, it seems. It's like a one-way road that we're on just getting worse and worse. Anyway, I'm Arga von Salas, a surgeon scientist and your friendly neighborhood dream scroller in residence.

Alyssa Burgart (00:59)
Well, I hope this doesn't become a palliative care situation. I'm Alyssa Burghardt, an 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 (01:16)
Yeah, I might need CPR any minute now. But anyway, big thanks to everyone listening. Extra love, as always, to anyone who is a subscriber or follower on any of the various platforms and a special warm welcome to anyone who just stumbled in from hearing about the firing of Kristi Noem, who is a big friend of dog's.

Alyssa Burgart (01:38)
famous dog killer, Kristi

Arghavan (01:40)
Correct.

Alyssa Burgart (01:41)
Noem.

This makes me think of something. I know she just got fired. We're recording this on ⁓ Thursday, March 5th. Kristi Noem was just fired, she'd be replaced by someone else we'll talk about later, Markwayne Mullin. I was talking to a friend of mine in town who's a veterinarian so I got an email from the vet's office saying,

we want you to get your animals vaccinated against rabies before they have any, ⁓ you know, elective procedures. Like it's a requirement. We're happy to do it during the procedure. And so I texted her, she's our family friend, and I was like, are people not vaccinating their dogs? And she was like, or their cat. She's like, we're seeing this like huge rise in anti-vaccine sentiment for people around their animals. And it just, when I think about Kristi Noem

Arghavan (02:13)
Mm-hmm.

Alyssa Burgart (02:31)
And I think about anti-vax dog families and cat families. just think like, I feel like everyone needs to watch Old Yeller, which I know has really traumatized multiple generations with the beloved dog who gets rabies and then has to be shot. But I feel like there's a real cultural connection there that, you know, maybe it's time to get back to that. I don't know.

Arghavan (02:54)
You know, I don't think you're too far off there. I have seen people talk about not wanting their dogs to get autism. That's been a thing, I guess, that's out there. I mean, we know that vaccines don't cause autisms in humans, but and they also don't cause autism in dogs, but I don't know.

Alyssa Burgart (03:11)
Can dogs have autism? I don't.

I'm not familiar with that diagnosis.

Arghavan (03:17)
But even if they did, not a reason to allow your dog to be vulnerable to something like rabies that would lead to their death.

Alyssa Burgart (03:26)
Yeah,

can make, you know, humans really, there's no treatment for rabies, you know, once you get it, you, it's bad, it's bad. ⁓ Anywho, listen folks, we're glad you're here. ⁓ We feel pretty confident that listeners of this show do not need to watch Old Yeller again. I personally was traumatized by it as a child. We do, however, just as a note to new listeners, we do tend to talk about.

Arghavan (03:33)
Yep.

Alyssa Burgart (03:52)
topics that can be intense, they can be a lot. So if you're listening to this with your little ones, you maybe want to pop in some headphones. And if you need to sit this one out, we totally get it.

So there's been so much that's happened in the news since you and I spoke last. I mean, we can't possibly cover it all, but I thought I would just touch on a couple of things. So like, one, we talk about the Epstein files on here a lot because we care about human beings not being abused, and we care about people in power not being able to do whatever they want.

Arghavan (04:06)
Mm-hmm.

Alyssa Burgart (04:24)
And so Hillary Clinton has been deposed on the Epstein files so I can put a link to that. People would like to watch it. Did you watch it?

Arghavan (04:33)
I watched the clips that came out afterwards. So she was deposed and Bill was deposed, I believe, the next day. What has been fascinating to me about seeing the clips is how many people online were like, where was this Hillary in 2016? She was right there. She was right there every single day doing as much as she could, flying all over the country, getting pneumonia, doing everything she could to prove that she was

the most qualified person for that job. And you all decided that her pantsuits were annoying and her email server was the biggest catastrophe ever. And I hope you all feel like fools in retrospect looking at what we got instead. But what really was remarkable to me about all these people, I mean, it was a lot of people like, ⁓ we made such a mistake. Yes. And I knew it on November 9th of 2016.

How are you only 10 years later coming to this conclusion? You are such a part of the problem, better late than never, I guess. But anyway, so what really struck me though was all these people who don't understand their own sexism enough to understand that they appreciate the exact same behavior that she's demonstrating now. They appreciate it now because she's not aspiring to power. And that same behavior was what they despised about her and made her unlikable or whatever.

back in 2015 and 2016. And that is exactly why we don't have Kamala Harris as president and we will not likely have a woman as president anytime soon. have like completely given up any hope that that's gonna happen because people can't even recognize these patterns in themselves.

Alyssa Burgart (06:20)
Well, this is like the comment when people are like, well, we're not Americans aren't ready for a woman president. No kidding. That's I mean, that is clear. That is clear. It's too it's too scary having those ladies. ⁓

Arghavan (06:26)
You

Yeah, ladies

with opinions who can speak clearly and coherently and not just try to violate every law possible at every turn. I will say though, for people, and again, I don't think you have to agree with everything Hillary says or believes to understand that she's a competent.

Alyssa Burgart (06:46)
I think you can hate the Clintons.

There's a lot of reasons why people in power for lots of reasons where you're going to be like, don't whatever.

Arghavan (06:55)
Yeah, but I don't think you can deny that she is competent and I don't think you can deny that she had a plan for everything that was possible. People talked about her being over prepared. Anyway, all that to say, I hope

Alyssa Burgart (07:08)
Can you imagine what

it would be like to be an overprepared president right now? That'd be awesome. I would love that.

Arghavan (07:15)
I would certainly love that rather than one who's like, I don't know, why do we go to war? Well, I don't know. Today's the reason is let me spin the wheel and see what I tell you today. Tomorrow will be different. Maybe this afternoon will be different. But at this very moment, what's coming to my mind is spin a wheel and what are pin the tail on the donkey, whatever it is. ⁓ Anyway, so what I'm hoping though is that Hillary saw some of that. I hope that she saw the reaction. I hope she saw that people really do appreciate her. I hope it didn't make her upset.

Alyssa Burgart (07:17)
Wow.

Arghavan (07:43)
about why they didn't appreciate her the way they should have in 2015 and 2016. I know it made me upset. It made me for a second think what we might look like, what the United States might look like today in 2026 if all these people had had this realization in 2015. For a second to dream. I mean, think about that. Think about a world without Trump 1.

Alyssa Burgart (08:11)
fan fiction writes itself.

Arghavan (08:13)
It's just incredible. It's just incredible. And then I got immediately angry. I started thinking about that for moment and I got immediately angry at what we could have had and didn't because of misogyny in this country. Anyway, yes, so I did watch some clips.

Alyssa Burgart (08:28)
Well, mean, speaking of misogyny, I thought we could also talk about another presidential hopeful who's been in the news lately, which is Gavin Newsom ⁓ from our state of California. Newsom did an interview at the end of February, which is like since picked up, ⁓ people have picked up on some terrible things that he said and the shit eating grin on this man's face as he talks about how it's totally fine. And in fact, demand of the Democratic Party to be more quote,

Arghavan (08:35)
you got it.

Alyssa Burgart (08:55)
culturally normal by not making sure to prioritize the needs and values of people who are trans in this country. So, you know, apparently felt really good about just stomping on their rights, really minimized the things that trans people are going through in this country by saying like, well, you know, Democrats really need to not focus on things like pronouns. Actually, I could play a clip. Do you want to hear it?

Arghavan (09:20)
Yes, please.

Alyssa Burgart (09:24)
So this is Gavin Newsom responding to, he has just made a comment on how he was way out ahead on gay marriage and how he really got hammered because of that and Obama didn't want to talk to him or be on camera with him or something. you know, rather than thinking he should push for justice, this is his response.

for another athlete to succeed and I said that and I believe that and it's not out of an indictment to the trans community quite the contrary and a record that can back that up a record that is you know that I'm attacked for my advocacy for the community but I do think it's a very different issue it's a different issue and what lesson do you take from that as somebody who's trying to

make sure that Democrats, maybe even you, win. Yeah, I mean, I think there's, from a tactical perspective, from the prism of purely politics, ⁓ there's no doubt that the Democratic Party needs to be, dare I say, more culturally normal. I believe that. Less prone to spending disproportionate amount of time on pronouns, identity, politics, more focused on

tabletop issues, that really matter, the stacking of stress in terms of electricity bills and childcare costs and healthcare and obviously housing costs and how easily we get trapped in that. How I've fallen prey to that. I mean, here I was, way out front on the marriage quad. So I understand this from both on the receiving end of this and on the front end of this leading the pack. So I think there has to be some consideration of

The shit eating grin on his face when he's like, well, I know how hard it is because, you know, if you come out too early to care about people's human rights, you can't win elections. I mean, fuck you, Gavin Newsom. So so so yeah, and like as though the main issues that are concerning for trans people are pronouns, which, yes, it's important, I think, Gavin, that, you know, people use the language that people want to be referred to. But like

Arghavan (11:16)
That okay, it's so funny because.

Alyssa Burgart (11:34)
That is not the main problems being faced by trans people. They're being murdered. They're being dismissed. They're being told that they're not who they are. I mean, it's just infuriating.

Arghavan (11:42)
What?

One, their access

to healthcare is being revoked. And also we have that whole thing, was it Kansas? I didn't prep for this topic, but I think it was Kansas where they announced that in a couple of days, their driver's license was going to be invalidated. So if you were a trans person living there, there was no grace period. There was no like implementation of this that was thoughtful. It was just one day you were gonna wake up and your driver's license was no longer valid and you weren't gonna be able to get to work.

Alyssa Burgart (11:50)
Ahem.

Yes.

Well, it's not just, it's that people woke up, received a letter in the mail that said, your license is already invalid. It was.

Arghavan (12:22)
⁓ I thought it was like

as of like whatever Thursday of whatever week it was.

Alyssa Burgart (12:25)
They, by the time people received these letters, their licenses were already revoked. So, and obviously it's not about trying to improve access or trying to rectify some documentation thing that is no longer in alignment with the state of Kansas. I mean, because they absolutely could have just sent people new driver's licenses, but they didn't do that. So how is it that somebody is supposed to drive? And Kansas is a big place. ⁓ I grew up getting to drive to Kansas, because that's where my great grandparents lived.

There's like a lot of fields there. It is a lot of parts of Kansas are incredibly rural. so like, where are you supposed to get a ride to go get your license renewed? Because now you have an invalid license. And so if you're caught driving with an invalid license in Kansas, I don't see that going well either.

Arghavan (13:15)
Well, and I agree. And the whole premise of it, right, is that if you are a trans person, the reason they're invalidating your license is they want you to go back and get a new license that has the sex assigned to you at birth. So then you're going to have people who are femme presenting who will have a driver's license that says they're male. And there will be people who are masculine presenting who will have a driver's license that says they're female, which is going to create

not only discordance for people to have to carry these identity cards that don't match who they are, but also like imagine you get pulled over and someone's like looking at the license and looking at you and looking at the license and looking at you. Like they're gonna have to go through that experience every time they have to show their license for something. And of course, your driver's license isn't just for driving. We use the license, you you go to pick up medication at the pharmacy. I mean, there's all sorts of times, go to the bank to pull out money, whatever.

Alyssa Burgart (14:11)
Well, and

what will happen is those individuals will be accused of either stealing their license or they will be seen for being trans people and there will absolutely be people who have power and authority, whether that is through appointment through the state or it is just simply vigilanteism, who will commit violence on people because of that disconnect, which...

Arghavan (14:32)
Yes.

Absolutely. It's endangering trans people's lives. And he sits there and acts as though sports is the only thing that matters. I mean, we have literally hospitals all over the country that have cut back on gender affirming care because that is what the federal government has demanded of them. And yeah, and he's sitting there talking about sports, which not to say that sports isn't important also, but compared to these more

Alyssa Burgart (14:51)
and they're coming for adult care next.

Arghavan (15:02)
These issues that are affecting many more people, there's a very small number of trans athletes and just to be clear, I think you and I both agree they should be allowed to play sports and that is appropriate for their gender, not their sex assigned at birth. And these other issues affect many more people than just the sports issue.

Alyssa Burgart (15:19)
Well, and this, the whole sports.

Well,

and the trans athletes and sports issue is an issue that was manufactured by the right in order to make it so that people have these conversations. You know where he got this? ⁓ One of the things that he talked about right before this in that interview was how he had Charlie Kirk on his podcast. ⁓ Newsome had Charlie Kirk on his podcast and asked, know, how is it that you motivated so many young men to vote? And I mean, this is the kind of stuff that he was talking about. So it's like, yeah, go ahead and scapegoat an entire community.

an already deeply marginalized and traumatized community and go ahead and actually just say that they don't matter. Go fuck yourself, Gavin Newsom. That's my opinion.

Arghavan (16:01)
Well, and I think that's one of the first things he did with his podcast, if I recall correctly, that he launched a year ago, either his first or his second episode was this same nonsense. it was like, obviously people who live in California, we already know that he's got a lot of flaws, like throwing people off of homeless encampments, for example, is just ⁓ horrific from a humanitarian perspective. But then to have that be like one of the first things that you talk about, when you're chasing,

votes based on what you think people want you to say, it's never gonna work. People see that that's not authentic. And I don't see him honestly having a successful run. Yes, he has a nice smile and as you've said before, nice hair, whatever, and that will take him far. But I think this is disingenuous, it seems to me, what he's doing now. He's just trying to do what voters want.

Alyssa Burgart (16:49)
It's also really,

it's also stupid because there's so many people who don't vote and there's so many Democrats who didn't vote in the last election because they didn't feel that they were being represented or whatever. And so the idea that the way to get the vote is to court the people that the other side was able to mobilize in the past is like, you've been a politician for a long time, Gavin. I feel like you should know better. You should know better.

Arghavan (17:15)
Yeah, I

agree. I also don't think it's a successful strategy. I just think that's what he's trying to do. And I think it's going to fail on multiple fronts.

Alyssa Burgart (17:21)
Well,

and the idea that we should be, quote, culturally normal and that cultural normalcy is to dismiss the needs of citizens in this country, to throw them under the bus. Fuck that. I don't want to be normal if that's what normal means. No, thanks.

Arghavan (17:39)
Yeah. And also

that's not, I mean, you can say a lot of things about democratic party and we have, and we will again, but that's not what that party is about. I mean, if we want to be in a party that ignores large swaths of the country, then we can go be a Republicans. Like that's who's served by that. I mean, that's not, he's got it. I think he's got a very fundamental misunderstanding of what a lot of voters in the democratic party are looking for.

Alyssa Burgart (18:03)
Yeah, well, here we are. none of that, Argavan, is what we had planned on talking about, but we have so many thoughts. We have so many thoughts.

So we are really excited to get in today's episode. And I will tell you, we were wildly unprepared for how much news would be released and how many like wild things would happen since Arghavan and I talked last week because we talk a lot, you guys, like we talk a lot. And so so this week, we're actually going to have such a long episode. The first part is going to focus on Iran and the war that has broken out since since Arghavan and I spoke last week.

And then the second part of this is going to focus entirely on Casey Means and her Senate confirmation hearing.

⁓ So I know and you know, and I'm sure that many of our listeners know, that shortly after, just a few days after we recorded our last episode, ⁓ Trump was like, I'm just going to go ahead and bomb Iran. ⁓ So I was hoping that you might give us ⁓ an Iran update, because it is

Arghavan (18:58)
Yeah.

Alyssa Burgart (19:05)
You're you are our Iran expert on this show. It's not me. You are you are the Iran correspondent of The Present Illness.

Arghavan (19:08)
the Iran correspondent. ⁓

Yeah, so for folks who don't know, I was born in Iran and left when I was quite young. I've been back multiple times, still have family in Iran. And I say that just to position myself. I didn't grow up there and I don't pretend to be an Iranian who lives in Iran, right? Like I live in California, I have for a long, time.

And I pay close attention to what Iranians are saying on social media and of course what we're hearing from family, what we hear from Iranian news sources, not meaning Iranian state media, but other news sources that are run by Iranians that cover what's happening in Iran. And so what's really challenging, I think in this moment, well, there's multiple things that are really challenging. One is the internet again has been shut down.

in Iran as it was in January, and that's been since Saturday ⁓ midday. And so that's, we're already almost a week into almost complete internet shutdown, which is really problematic for many reasons, one of which is, you know, these kind of evacuation notices that Israel is putting out there. It's very hard for people to get those notices. ⁓ There's not a national emergency response type system where they're getting

anything pushed to their phones to tell them about those kinds of alerts. So that's extremely problematic. People can't coordinate with each other for, say, leaving specific areas. I mean, we've seen Tehran, for example, the capital is a site, a major bombing site from, you know, US, Israel, whatever, it's a combined effort. And so some people have left.

I think a lot of people, from what I'm hearing from folks there, a lot of people have left Tehran, at least temporarily. I don't know how long they'll be able to stay away, but also they're bombing all over the country. Many will have heard about the school in Minhab that was bombed on Saturday. That was one of the first places that was bombed by the US and Israel. There has been some controversy. I'll just point out around that with some folks, particularly Iranian folks thinking that Iran did that, that the Islamic Republic Guard Corps

was responsible for that bombing. Obviously we don't totally know, but I don't think that's what the majority of the evidence suggests. The majority of the evidence suggests it was the US and the reason is likely that it was in proximity to a previous IRGC military base and most likely it was just imprecise is my guess. But the US has not owned that. Israel has said they didn't do it, but the US has not quite owned that yet. Karen Lelevin has been asked about it and you know.

as she always does, yeah. But there had been video of like a failed Iranian missile that you see kind of falling to the ground, but that wasn't actually there. That was in a town far away from there. So that's, think, what caused the initial confusion. And of course, we know that the Iranian government has no qualms about harming its own people and has previously poisoned schoolgirls. So it's not out of the realm of possibility that they would have done that or even that they would have done that to

create some sympathy for Iranians to blame the US and Israel. None of that is out of the realm of possibility, but it doesn't seem at where we sit today, Thursday, March 5th, from based on what I've seen, my personal assessment is that probably was the US missiles that did that. But there continues to be some cloudiness around that specific location. We've seen, or many of us at least have seen photos, overhead photos of the graves that they dug for these. ⁓

Alyssa Burgart (22:45)
Sure.

Arghavan (22:54)
victims of that casualty, whoever launched those missiles. The New York Times is saying 175 people dead, which is pretty similar to other figures I've seen, 183 maybe, somewhere in there, most of them being children. And so there's these overhead images of just serial graves being dug row after row. Obviously that's heartbreaking, whoever did it, and there's no excuse for targeting a school and killing children. And...

One thing that a lot of Iranians have pointed out online is that a lot of the people, mostly Americans, US citizens, I should say, who are really upset about these children having been bombed, had nothing to say about the tens of thousands who were murdered in Iran by the Iranian government in January. And I think that's hard for us to see, not because we don't care about those children. Obviously we care about those children.

And over 200 children were killed in the streets of Iran in January by our own government, along with 40,000, 50,000. We don't know the exact numbers, but tens of thousands of mostly young Iranians. And people were largely silent. And I think that's just hard for us to see that those huge numbers of people were murdered and mostly people looked away. And now because the US has some involvement, people

are acting like they care about these 200-ish children and maybe they do really care, but what about everyone else? Or what about if we go back to 2022 and the hundreds of people the IRGC killed and the Basij killed as part of the Women Life Freedom protest, what about the executions? Iran executes more people than I believe any other country and therefore one of the common charges for these protesters is like we've talked about before,

crimes against God just because you protested the Islamic Republic and the head of the Islamic Republic is a representative of God, then by protesting you have committed a crime. mean, the IRGC, one of the IRGC leaders was on TV in Iran, I just saw this video this morning, threatening parents about their children's behavior that if they say anything, anyone who says anything against...

the IRGC or is in alignment with the so-called enemy, which is either US or Israel, will be executed. I this is the kind of regime that we're working with. And so I say all that to say there's a lot of anti-war sentiment that I see in the US and online, and that makes perfect sense. this one, let's just be clear, this war is illegal. The US government, Hegseth, Rubio, the president, the vice president, they've given many shifting explanations for why.

Alyssa Burgart (25:22)
Ahem.

Arghavan (25:44)
They decided to bomb Iran. They've said, well, because they were going to get a nuclear weapon within two weeks, which by the way Netanyahu has been saying about Iran since the 1990s. You can go watch the clips. It didn't happen, obviously. That was like 30 years, not two weeks. So that's one explanation that's been given. Another has been, but because we want to have regime change in Iran. Another has been, we want to help the people of Iran achieve democracy. Another has been, we.

That Rubio said actually was that well Israel was going to strike Iran and Then Iran would have retaliated against the US so we needed to preemptively strike before Israel's strike so that Iran wouldn't do you know what I mean like ridiculous It to speak to that point just real quick a member of the military Went to protest this yesterday saying we don't want to die for Israel. We are US military, you know, we gave up our

We're willing to die for the US, but we're not here to die for Israel. And he was at a senator's office and the senator and the security forces there in the senator's office broke this man's arm, a US service member. Anyway, so there's been lots of different reasons. The most interesting perhaps to you and me and our audience, I don't know if you saw this, I'm just gonna read you a ⁓ quote that came from military folks is that,

their commander, so this is one person says that their commander opened up the combat readiness status briefing by urging us to not be afraid as to what is happening with our combat operations in Iran right now. He urged us to tell our troops that this was all part of God's divine plan, referencing numerous citations from the Bible referring to Armageddon and the imminent return of Jesus Christ. He said that quote, President Trump has been anointed by Jesus to light the signal fire in Iran to cause Armageddon and mark his return to earth.

Alyssa Burgart (27:25)
you

Arghavan (27:36)
He had a big grin on his face when he said all of this. No, no, a military commander. there's a group called the Military Religious Freedom Foundation, and they've received over 200 complaints from military members that their commanders are saying things like this. This was text from one specific complaint that I just read to you. But apparently this is a widespread thing throughout our military right now that commanders are telling

Alyssa Burgart (27:40)
Wait, wait, wait, wait, who was this? Was this Pete Hegseth?

⁓ an unnamed.

Arghavan (28:05)
U.S. service members that the reason we are in this war is to cause Armageddon so that Christ can return so that we can get to the end times. ⁓ The head of the Military and Religious Freedom Foundation said these calls have one thing in common. ⁓ service members who are coming to us report the unrestricted euphoria of their commanders and command chains as to how this now, sorry, this new

Biblically sanctioned war is clearly the undeniable sign of the expeditious approach of the fundamentalist Christian end times as vividly described in the New Testament of Revelation. So yeah, exactly. That's probably the most bonkers and disturbing of the many reasons that have been given.

Alyssa Burgart (28:51)
I also,

I mean, to be fair, we have been told the end times is coming many, many, many times. And it just still hasn't come yet, to be fair. It hasn't come yet in any of those times, actually.

Arghavan (29:02)
It hasn't come yet. You the funniest thing I saw, yes, one

person said that we should collect pajamas and put them on Pete Hexett's lawn so that he will think the rapture has come and he didn't get to.

I don't remember where I saw that. Apologies to whoever said that, that I'm not giving them credit, but I did think it was funny. Okay, so we have, these are some of the basics of what we're working with. I forgot to mention probably the most important thing to many Iranians anyway, is that on Saturday when these strikes started, the US or Israel, some combination thereof, took out Khamenei, who was the supreme leader.

of Iran since 1989. So he was the man who was responsible for these tens of thousands of Iranians being killed, massacred in the streets in January. many, I we could go back much longer. We go back to 2009. We could go to November of 2019. We could go to the late 1980s when they massacred a bunch of political prisoners in Iran. Anyway, he was the head oppressor of Iranian people from 1989 to 2026.

And yes, many people, many Iranians both inside and outside of Iran cheered for that man's death. There are some handful of people, right, we've talked about before, there are some people who do actually support this regime. Mostly they are members of the regime, family members of the people of the regime, people who are getting paid by the people who are part of the regime. But the vast majority of Iranians, again, both inside and outside of Iran celebrated.

his death, there are videos in Iran of people cheering in the streets, there's people shouting from their windows across apartment buildings out of joy that he is finally gone. And he was one man. ⁓ The Islamic Republic of Iran has been around a long time. It's been there since 1979 and there's a reason they've survived this long. They are smart. They may be evil, but they're also smart in contrast with our government.

they have really been very thoughtful. I'm not saying that as a positive, but they've been very thoughtful about how their infrastructure has been designed. The Islamic Revolutionary Guard Corps, is either between somewhere I've seen 150,000 to 200,000 people who are not just in service of the regime, but they are the regime.

and they also are not just military or security forces, they also run a significant portion of Iran's economy. They are integral to the function of the country as it is, and they are fully integrated into the Islamic Republic of Iran. So the success of these IRGC members depends on the success of the government. So they can't, not that they can't, but it's unlikely that they're going to turn on the government, which is ultimately what we need. We would need them to defect and join the people.

Alyssa Burgart (31:47)
Come.

Arghavan (31:58)
but their incentives are not aligned to do that.

Alyssa Burgart (32:01)
So I obviously have not followed this as closely as you have, but I've been trying to keep up and I did hear somebody interviewing President Trump about, know, what's the worst that could happen now that you've taken out this man and he was, and like, who do you think is going to be next? And he was like, well, you know, there's, some other people that we thought maybe we'd put in, but they, might be dead too. And there's some other people, but they might also be dead. So I guess the worst thing that could happen is

Arghavan (32:16)
Well, yeah.

Alyssa Burgart (32:29)
We just end up with somebody who's worse than that guy. like the casual, less the state building that we're getting out of this administration.

Arghavan (32:37)
No, mean, clearly, clearly he does not care about what happens with the people of Iran. I have a whole video about is the US actually trying to free the people of Iran? I think it's pretty obvious the answer to that is no. I mean, we can have a whole different conversation about if they were, would they even be successful? But are they even trying? And the answer, I think, is pretty clearly no. Like, if they were trying, just to give you a snippet, they would have thought about these internet black.

blackouts, right? Like we already know it's very well established. That's what the Iranian government does. When there's any sort of unrest, they shut off the internet. So they could have made plans to make sure that people in Iran could get around these blockages and blackouts. And some people think that there have been some ⁓ starlings that have been smuggled in. I don't really know if that's happened or not, but certainly not on a big scale, right? Like the people who monitor internet activity in Iran have been telling us since Saturday that there's almost no activity.

So whatever efforts, even if they were minimal, have been made have not been successful. So that's a thing that would have been helpful. If you think, at different points, Trump has obviously said different things because that's what he does. There's no consistency, but he has said like, it's up to the people. The people need to take over. They need to take control of their government. Well, how do they do that if they can't communicate with each other, right? And how do they do that when they have no weapons and you know that the government is armed with military grade weapons and not only are there those like 200,000 IRGC, but we also have the Basij and we don't actually know how many of those there are.

estimates are up to 10 million. I mean, they're wide ranging estimates of how many besieged this paramilitary force there are. So sorry, go ahead.

Alyssa Burgart (34:09)
Well, I mean, I was just gonna say like, I feel like we've seen this movie before, you know, when we were like, we've been in Afghanistan for all of these years and we're just gonna all of a sudden be like, peace out guys, we're gone. And shocker, it didn't go well. ⁓ And I'm not saying that.

Arghavan (34:25)
We should lay the blame for that where it was, which is on Trump because he released a bunch of Taliban ⁓ operative before he led that withdrawal. So I think the complexities that I hope to try to communicate to folks, because you can read about specific news events anywhere, but I think what has been really challenging to think about, to talk about, to communicate about in these last days and almost week is,

Alyssa Burgart (34:33)
Yeah.

Arghavan (34:55)
The mixed feelings among diaspora Iranians, but more importantly, Iranians in Iran. I think what a lot of people don't understand, especially in the US, is that people in Iran were desperate. You and I have talked about this. They have come out in the streets time and time again, and every time there's been massive loss of life.

and detentions on top of that. When we lose, like we talk about these 40,000, 50,000, however many were killed in January, but then another set of tens of thousands were detained and these people are not treated in any remotely humane way in prison. There have been, we've talked about before, reports on the widespread sexual violence, for example, in Iran's prisons and the executions come very quickly and there's not.

There's not a formal legal, I mean, there is a prescribed formal legal process, but it's not really, people aren't held to those standards. Confessions are forced out of people for things they never did in order to protect their families. There's all sorts of like terrible things that you see often in fiction, to be honest. But anyway, those are the things that are the reality for people in Iran. And so people there are, many people there are desperate to see a change. They have been begging the international community for help for a long time.

Time now does that have to be military force? No, and i've said this many times that there are specific diplomatic activities that I wish other countries had taken they could have for example expelled the family members of the regime who live in europe and the us and canada or they could have frozen their assets They could freeze the assets of the regime members where they hold their assets in other countries. There's lots of things they could expel iranian diplomats. They could close down their

I mean, there's many diplomatic actions that could have been taken and were not. Would they have led to a regime change? I don't know. Obviously, I don't predict the future. But there are things that could have been tried without military force that were not, the point I'm trying to make. And this is what's happening. mean, whatever we think about it, this is what's happening now. And there are plenty of people in Iran who welcome it. I'm not even saying it's the majority because we don't know. We don't have good data.

You know when there's no internet and no journalists from outside are allowed there any news you get from inside Iran by So-called journalists is controlled by the regime even if it's like a CNN journalist or a BBC journalist Everything they put out is approved by the regime before it goes out if they are actually inside Iran So people should know that so all that to say some people

Alyssa Burgart (37:33)
Well, and

the other thing I would say is that you were just telling us how families have been told, like, if your child, if anyone in your family says anything in opposition to the regime, then we are going to execute them. And so even if we did have good data, I mean, what I'm hearing is there are going to be a lot of people who are simply not going to share their honest opinion.

one way or the other because the only opinion that keeps your family safe is to say that you support the regime.

Arghavan (38:03)
That's right. That's right. And we have no freedom of the press just as a reminder for folks, obviously in Iran. So some number of people, and it's a decent number. Do I know what proportion? No, I don't. But I know what I see from folks posting online about their experiences. For example, there's tons of videos now of bombs exploding like in Tehran or Isfahan or whatever. And often, if you're paying attention, there's joy in the voices of the people. They're like, there it goes. There's another one. What building was that?

And I'm not saying that's good and I'm not saying that's how I would feel, but what I'm saying is that is how some people in Iran are feeling. And I think that's very hard for people in the US to understand, but it tells you how desperate they are for help. Now, do they think the US is actually trying to help them? No, they're also not stupid. Like they understand that Trump is not their friend. They understand that Netanyahu is not their friend. What many of them are thinking is that for a brief moment in time,

the interests of the US and Israel may line up with the interests of the Iranian people to the extent that the interests of the US and Israel were to, for example, get rid of Khamenei, to the extent that they're trying to get rid of the IRGC. For example, it's not clear that that's what they're doing, but to the extent that they're trying to do that, the Iranian people or a lot of them are in favor of those efforts because they see that as a chance.

They don't see that like, oh yeah, they're gonna come rescue us. Oh, the US is gonna liberate us. No, most people do not see it that way in Iran. But what they see is a chance at disruption, a chance that they did not have themselves without weapons. Is that everybody? No, no group is a monolith. Are they scared? Yes. I mean, again, to the extent that I see, do I know every Iranian in Iran? Obviously not. But what I'm seeing from reactions from the videos and comments that are being posted is that there's a lot of fear.

But there's also some hope, which is something that they have not had at all, especially after that uprising in January that was just completely shut down by the brutality of this government. And so when I say things like, I don't think that the US bombing Iran is going to make Iranians support their brutal government, and people laugh at me and call me names, I'm not saying that because that's what I...

out of nowhere think sitting here in California. It's because that's what I know of people in Iran. The people who would rather go march in the streets and risk dying than to be stuck with this regime, to think that they are going to be mad that someone's taking out IRGC military bases is really inconsistent. And then people will say, well, you think they're cheering the murder of school girls? No, absolutely not. Absolutely not. What a ridiculous thing to say. And

They've already lost tens of thousands of people and they are desperate to have a regime that's not going to continue killing them.

Alyssa Burgart (41:02)
think what you see from the US, which is not super surprising, is a combination of both moral disengagement. So you talked earlier about, like, yeah, people are really worked up now because suddenly the US is in a war and ascribing it to the harm of these kids and whatever, ⁓ but having nothing to say in the past. And then you also have this moral superiority that we just love in

we love to be morally superior to everyone, regardless of the degree to which it is earned. And so that's when you share the kinds of horrid interactions you have online with people who are like ascribing a lot of meaning to the things that you say. There are things that you never said. I really hear this combination of like, it's like the outrage. People love to be outraged right now, especially ⁓

Arghavan (41:50)
Mm-hmm.

Alyssa Burgart (41:59)
the moral disengagement of not wanting to see what's been happening and only deciding to pop in and be engaged in very particular times, and this constant set of moral superiority, the desperate need to be right and to be over someone else, whoever it is, even if it's some random person on the internet that they don't know.

Arghavan (42:17)
Mm-hmm.

Mm-hmm. Yeah, and obviously, people in the US have a right to be upset. As we said, this is an illegal war. He did not go to Congress. Trump did not go to Congress to get approval for this war. He didn't even, you know, we can talk about George Bush all we want, but at least that man tried to convince people that he was doing the right thing, even though obviously it wasn't the right thing. But he campaigned for a long time and

acted like and actually seemed to some extent care what people actually thought, which is obviously not the case here. And so people in the US have every right to be outraged that their taxpayer dollars are being spent on a war that they did not want to engage in. And at the same time, as we've talked about many times, people are losing healthcare, people don't have housing, people don't have access to healthy food. And then they see, I saw an estimate that was a billion dollars a day being spent on this war in Iran.

Obviously we have right to be outraged about that. Obviously we have a right to be outraged that our taxpayer dollars are killing people in other countries. So just to touch on that briefly, the New York Times estimates something like 900 people have been killed across the different countries, including Iran strikes, right, on other countries, ⁓ including the United Arab Emirates, Kuwait, Bahrain, Lebanon, and Israel. And we've lost at least six US soldiers who were based in Kuwait.

I should note that an Iranian human rights agency that's based in the US estimates over a thousand civilian deaths in Iran, 183 of them being children with another 6,000 injured. It's very hard to know exactly what the numbers are. So obviously I'm also a US citizen. Like I'm also upset that we are doing that to people. And I have to hold in my head also that there are some Iranians who see this as the only chance at this point of getting rid of the regime that's been oppressing them for 47 years.

Do they think Trump is going to make that happen? No, they don't. They absolutely don't. But they're seeing a moment of disruption, as I said, and they think maybe there's a way. Maybe there's a way, not because Trump is going to make it happen, not because Netanyahu is going to make it happen, but maybe there's

Alyssa Burgart (44:26)
But maybe this opens

up a space for people in Iran to be able to do something.

Arghavan (44:32)
Basically, that's the idea. Now is that again, not everyone others are very much against it and the same is true in the diaspora, you know, there are Honestly, it's disturbing to me. There are some people in the diaspora who are very supportive of this war they're wearing like Lindsey Graham shirts and thanking President Trump and I can't wrap my head around that because Watching I mean just I was born in Tehran. That was the first home I ever knew and watching these bombs. I've been there multiple times

watching these bombs explode all over this metropolis that's a beautiful city with also so much culture and history is heartbreaking. I can't, I don't genuinely, I don't understand those who are like so excited and those same people, the second you say anything like, hey, maybe the US doesn't actually care about Iranians, they will call you a traitor as an Iranian. And they'll say that you're betraying our people by expressing that maybe that's, you the US

motives here aren't genuine. So it's just a really like challenging space to try to communicate in on any platform, both with Iranians and with US citizens, because emotions are very high, understandably. And especially for Iranians, you know, we're dealing with decades of state induced trauma. And so people have a lot of reactions like do I love that I grew up away from my family? No.

And do I have a lot of anger toward this regime that they did this to us, that they spread Iranians all over the country? Yeah, I have a lot of anger over that. But not as much as the people who are living there still every day on the street, not knowing if they're going to see their son or daughter back home after work or whatever. Anyway, I could ramble on, but my point is just that there is a lot of complexity here, both in the diaspora and in Iran. There are people who have lots of different

opinions, but here we are. And the question I think that haunts us all the most is, is there a way that this actually leads to this regime being overturned? And if so, how do we make that happen? What can we do from here? What can Iranians inside Iran do from there, knowing that the U.S. and Israel are not going to help them on that part? But what can we do to increase the chances that that happens as opposed to what we saw in Iraq?

what we saw in Afghanistan, what's happened in many different countries where the US has intervened that has led to just destruction and dissolution of any sort of functioning government. Those are the things I think a lot about. And I'm scared, like a lot of people. I'm scared they are going to absolutely destroy Tehran.

Alyssa Burgart (47:12)
Hmm.

Arghavan (47:22)
and they've already damaged the Golestan Palace, which is a palace that's been there since at least the 1800s. It's a UNESCO heritage site. There's been damage to lot of hospitals. Patients have had to be evacuated from multiple hospitals because of the damage. Although they weren't, I guess to be fair, whatever, they weren't the target. They were near some other target. And so the blast damaged the hospitals.

Alyssa Burgart (47:45)
⁓ you know, and this is just because you're talking about hospitals and we had touched on this briefly previously. ⁓ I sent you, ⁓ I think it was Sunday morning, there was a big spread in the New York Times of ⁓ doctors, nurses, healthcare workers throughout Iran, really talking about the horrors that you have been telling our audience about. ⁓

And I mean, I believed you and I, you know, had I had read some of those. But seeing. We'll put a link in the show notes, but seeing so much of that and then finding out about the war being launched, you know, in the middle of the night, right before that being ⁓ posted. mean, I myself have a lot of complex feelings. I think this is the first time in my life that I've actually not had a family member in active military service. So all the wars that you just mentioned, my family went to.

All of those and.

I just my I'm deeply deeply alarmed by the situation that has been allowed to unfold in Iran. And I'm very concerned about the way that this intervention is being conducted, and especially having, you know, I really try not to listen to Pete Hegseth ever if possible, because like he really makes me really angry. But listening to the way that he has characterized

the response to this and like, we're not going to have any more politically correct wars. I'm like, shut the fuck up.

Arghavan (49:21)
Yeah, and no

rules of engagement. We're not following any rules of engagement.

Alyssa Burgart (49:25)
We're

not doing any of woke shit. I just...

Arghavan (49:27)
Well, did you see,

I wanna just give an example of that. So there was an Iranian ship that was part of ⁓ an exercise organized by India ⁓ and the US was supposed to be part of this exercise and pulled out at the last minute. These ships did not have any weapons. That was part of whatever this exercise was that they were doing. There were no weapons on these ships. US pulled out of the exercise and then basically

destroyed that ship, that Iranian ship that was there as part of this exercise with India. And that ship had nothing to do with, you know, they, yeah, exactly. They had no weapons. had nothing. And that's a war crime. That's a violation of international law. I have no love lost as you know well for anyone who's involved with the IRGC or the Iranian government, but it's important to know that military service is mandatory in Iran. So...

men of, I forget the exact ages, but they are required to serve. So some of the people on that ship also could not give two hoots about that government, but are forced to serve there. And not only did the US bomb that ship, but then they didn't make any effort to rescue any of the people who had been on that ship. I believe, I can't remember if was India or another country, somebody else made efforts to rescue them and were successful apparently at rescuing some of the crew from that ship.

And they made a video, right? The White House made a video glamorizing this. Everything is a video game to these people. I saw some poor person who didn't even have a large account. was like, that's, or they were like, that's my song. How did they even find the song? It has like a thousand listens on whatever platform. What do I do? Like it was a very small artist. What do I, what do I, I don't want this. How do I, what do I do about this? Why are they using my song in this way? know, Kesha also, they use one of her songs for also were

propaganda and she made multiple posts about how this is not okay with her. Anyway, it's all a video game to them, but there are real people. There are real people, there are real US people, there are real people in Lebanon, there are real people in the UAE, there are real people everywhere being affected by this, including obviously Iran. Anyway, so I guess what I'm just trying to convey to folks is that it's maybe not as clear cut.

as some folks would like it to be. Yes, war is bad. Yes, this was illegal. Yes, Trump is incompetent and a terrible person. And there are some people in Iran who are happy to see someone taking out IRGC military bases. So it's not accurate to say that this is entrenching Iranians against the US, some Iranians, certainly not all Iranians.

And it's also not accurate to say that Iranians are stupid and think that Trump is going to help them. No, they don't think that either. ⁓ And there's just a lot of gray here and people are people have a hard time with that. I understand it is challenging. It is challenging. You want to think, well, if the IRGC is bad, the US is good. Or if the US is bad, IRGC is good. No, they're both bad. They're both bad. The only good here is the people. That's who's good.

And that's who we're trying to protect. And that's who we need to center. And we can understand that the US government here, not just for this specific case we've talked about, we've talked about many other things, that the US government is doing a lot of bad things for people in the US and people outside the US. And also the Iranian government also does a lot of bad things for the people in Iran and people outside of Iran. These are both bad actors. And then people always go, what about Israel? Yeah.

Same. mean, like none of these actors are good actors and we don't have to pretend like they are. There's not a good guy and a bad guy here, again, except for the people.

Alyssa Burgart (53:20)
Arghavan, I really appreciate all the work that you have done to update our listeners, including me, on

all of those details that you brought to this and especially your perspective as someone in the diaspora. I think that's something that's often missing for people who don't have the privilege like me of knowing someone like you.

Alyssa Burgart (53:38)
And now we're going to move on to the second topic. Are you ready, Arghavan

Arghavan (53:43)
Can we?

I sure am.

Alyssa Burgart (53:48)
We're going to talk about Casey Means. We have to talk about her. She is the current nominee for Surgeon General of the United States. She was nominated back in May 2025 by President Trump. She just recently had her confirmation hearings, which I watched them. I watched the whole thing.

Arghavan (54:13)
the whole thing, wow.

Alyssa Burgart (54:14)
I did,

I'll be honest with you, I did it on 2X though, because I was like, this is gonna take so long. So I listened to it on 2X and it was very painful, but I did it. I did it for us, Argovon.

Arghavan (54:29)
thank you for doing that. That's quite the service.

Alyssa Burgart (54:32)
Well, you did all that work to keep me updated on Iran, so I wanted to be able to update you on this. ⁓ So Casey Means is a ⁓ former physician and longevity wellness influencer, and she was nominated for Surgeon General after somebody else was nominated for Surgeon General. So there was a woman who was initially Trump's pick, who was named Dr. Jeanette Nishwat. I'm not actually certain how to pronounce her name.

She was a former Fox News medical contributor. And it turns out she had not been entirely honest about having gotten her medical degree. And so she had very much allowed people to believe that she had gotten her medical degree from the University of Arkansas, where she completed her residency. But in fact, her medical degree was actually from the American University of the Caribbean School of Medicine in St. Martin.

Arghavan (55:02)
Mm-hmm.

Mm-hmm.

Alyssa Burgart (55:28)
I don't know, guess earlier in the administration they were little more committed to this like radical transparency thing that they claim they're going to do. I mean, I do feel like they're over that now, but.

Arghavan (55:40)
I'm not really sure there was much of an effort at that in the first place. My guess is there's something else about her that they didn't like. I mean, I think she actually had promoted, just to be honest, I'm pretty sure it's been a while since I looked into it, but I think that she had promoted vaccines at some point. So maybe that's what we'll...

Alyssa Burgart (55:43)
know about like surface level.

Well, that's a real

downer in this administration.

Arghavan (55:58)
I do wonder if that's like the real issue there. Who knows?

Alyssa Burgart (56:01)
Well, RFK freaking loves Casey Means and loves her brother, Callie Means. Casey Means actually attended RFK Jr.' ⁓ confirmation hearings back before this hellscape was unleashed in our public health. ⁓ And there's a disclaimer, I think, that you and I both really should do because ⁓ it's all over the news.

Arghavan (56:06)
I have a book.

Alyssa Burgart (56:30)
Casey Means went to Stanford Medical School, it's where you went to medical school, it's where we both work. ⁓ Nothing that we say.

Arghavan (56:32)
You do.

It's also where Peter

at Pia went to medical school. Giving us a great name.

Alyssa Burgart (56:40)
Yes. Yes,

yes, Stanford has graduated some real winners. You're a real winner, but I was saying that sarcastically about some of the other people. ⁓ But you and I both work at Stanford University. This show is not. We do not speak for Stanford University. We do not get. This is our free time. This is our hobby outside of our full time jobs. So we don't receive any money or anything from Stanford to do this project. ⁓

Arghavan (56:46)
Yeah.

Alyssa Burgart (57:09)
I will say I was neither of us actually was at Stanford while she was there. ⁓ She finished medical school before before I started my fellowship there and my and later my faculty position, ⁓ which I'll say I felt immense relief because somebody asked me like, do know, Casey means she went to she went to Stanford. And this was this was a few years ago before she got really famous.

And I started, I was like, God, I haven't heard of her. But then I was like, I have seen this book. You could not get away from it. It was in like every airport in America, this good energy book, which we'll talk about. And I looked up when she graduated and I was like, it was very clear that she had become this wellness influencer and had a lot of.

influence, health influence for things that I am not a huge fan of, especially in terms of like selling supplements and whatever. And so I was like, thank goodness, because I teach ethics to every single medical student, every single PA student that graduates from Stanford. And, you know, we only get a few hours to teach them during their entire medical school career. But I was like, thank God she was not in my class. ⁓

Arghavan (58:22)
That must be

a Louise.

Alyssa Burgart (58:23)
That

would have been, I mean, I'm sure that sometime in the future there will be some other jemoke that will have taken my class and will still turn out to be a grifter, but, you know, at least it wasn't this one. I dodged this one. So anyway, so she graduates from Stanford Medical School. One of her perpetual lies is that she was top of her class at Stanford, but as you know, there are not class rankings at Stanford.

Arghavan (58:33)
You dodged this bullet, yes.

Alyssa Burgart (58:51)
students are not pitted against each other in terms of, you know, their top of their class. And I'll link

Arghavan (58:57)
There's

no grades even. There's only after I graduated, they started this pass with distinction thing. So many medical schools ⁓ listeners may know have various grading ⁓ schemas for their clinical time, even if they don't have grades for their preclinical time. But Stanford has, I mean, I was lucky when I was in medical school, we didn't have that at all. The entire four years were pass fail.

But then they added due to pressure from the AMC and residency programs having difficulty distinguishing students from each other. They added this pass with distinction. So at Stanford Medical School, you get a fail, a pass, or a pass with distinction. ⁓ So it's not A, B, C, D, F, or anywhere close to that. Anyway, carry on.

Alyssa Burgart (59:43)
Sure. Well, and I'll put a link in the show notes for people who want to see our friend Eric Strong, who's also a faculty member at Stanford, did a really great video picking apart her book. And I will share some fun facts from that. But it was interesting because he did teach there ⁓ while she was a student. And he was like, yeah, me and my friends, like, none of us remember her. So she can't have been that great because nobody remember.

but you know, whatever. So she must, however, have done well enough in medical school and on her exams, she got a really very competitive residency spot. She got into the ENT program, otolaryngology, ear, nose, and throat surgery program at Oregon Health Sciences University, which is in Portland, Oregon. It's a very prestigious program, very difficult to get into that specialty ⁓ as folks inside the House of Medicine know. She did not complete it.

Quite late in her training took a leave of absence Attempted to come back and then decided to leave that program So she never finished residency She does not have an active license to practice medicine and has never worked as an attending physician Sure

Arghavan (1:00:55)
Yeah, but let's talk about that for just one second.

know, Auntie is five years of surgical residency. As I recall from when I looked into her more in detail when her nomination was first announced, as I recall, she made it all the way to the last year. correct, correct. And also moved several years into his surgical residency before leaving. And look, we don't know.

Alyssa Burgart (1:01:11)
Yeah, similar to Atiya, who did not finish his surgical residency.

Arghavan (1:01:21)
what exactly happened. She has said she became disillusioned with medicine. But what I can say is, it's very unusual to leave a surgical residency in your last year. Because even if you've decided you're not going to practice, you've made it all the way through the four years of med school, and now you're in your fifth year of residency. know, once you finish that fifth year, you can get a board certification, which she will never be able to get because she never finished the residency. So it's not

Alyssa Burgart (1:01:47)
Mm-hmm.

Arghavan (1:01:51)
Typical to leave at that stage and it has a lot of people wondering if she was either asked to leave or If she was asked to repeat a year and did not want to do that Obviously, we don't know this is speculation, but it is just very unusual to leave at that

Alyssa Burgart (1:02:09)
Well, the LA Times actually did interview the chair of her of that program. Yep. And so actually, I'll read you a quote. His name is Dr. Paul Flint, and he claims that she left because she found the job too stressful. ⁓ And so in that quote, at least she had the strength to recognize that in her fourth year. ⁓ It took a lot of guts. I did not push her out the door. He adds, however, you lose some credibility when you just drop out. He says he believes that since then, she has mischaracterized U.S. medicine as a conspiracy to keep people sick.

Arghavan (1:02:12)
That's right. That's right.

Alyssa Burgart (1:02:39)
She's wrong, he said, adding, it's a certain attitude that denies all the successes that occur in medicine. So there's actually two, there's two articles. There's the LA Times article, and then there was a Vanity Fair article that also came out, I think, the next day. So I'll put links to both of those in the show notes. There's also ⁓ several of her co-residents who have anonymously provided comments as well. ⁓ Again, I still truly cannot imagine, I mean,

You and I both did very competitive residencies, very difficult residencies. I think almost all residencies are very difficult. like, gosh, when you're that close to the finish line, you are really giving up a lot. ⁓ And it is very stressful. And I think a lot of us think periodically about quitting.

Arghavan (1:03:25)
Yeah, absolutely.

I mean, I think, thank you for bringing up that article. I had read that article, again, back when she was first announced as the nominee. ⁓ And what I wondered at the time was, you know, did they have any sort of separation agreement when she left? Like, was this, you know, the agreed upon story? It's always hard to know. And I'm not saying that to fuel, like, whatever, but just that it is possible that she...

Alyssa Burgart (1:03:40)
Yeah, I don't know.

Arghavan (1:03:52)
was asked to leave or asked to repeat a year and didn't want to do that. And then this was the agreed upon narrative for why she left ⁓ a legal agreement that this was the story that was going to be told. I have no reason necessarily to suspect that aside from, as you said, why would you leave at that stage? Of course, it's stressful. We all found it very stressful. Like, I definitely thought about quitting. I don't know anybody who didn't think about quitting. But especially that late in the game, I mean, you're almost

there. ⁓ So anyway, carry on.

Alyssa Burgart (1:04:24)
Yeah. So she then, after leaving, built this reputation as, I've completely transformed, and that's why I left medicine. So she's rebranded herself as somebody who just saw the failures of medicine and just had to leave and find a better way ⁓ and decided to do that by founding a company that would sell rich people a lot of stuff to make a lot of money. And.

Arghavan (1:04:43)
Mm-hmm.

Yeah. Well,

are you going to talk about her mom's cancer?

Alyssa Burgart (1:04:54)
I wasn't going to talk about it in detail, but I was going to mention it. I, my heart goes out to her. Her mother died of pancreatic cancer. It's terrible. ⁓ Any sort of a loss is so sad. ⁓ I was not able to finish her book. was, I found it so irritating and disingenuous. However, she does use her mother as this sort of ⁓ narrative tool, frankly.

to drive this whole story of like how absurd it is that her mother, you know, had several chronic illnesses. I mean, it sounds like hypertension, pre-diabetes, whatever, obesity, very run-of-the-mill stuff in America. They're obviously very wealthy families, so she saw lots and lots of specialists, which again, not super clear why. Her mom flew back and forth from here in

Arghavan (1:05:37)
Mm-hmm.

Alyssa Burgart (1:05:53)
Palo Alto, know, you're in California to ⁓ Mayo Clinic to get additional workup or whatever, and ended up dying very shortly, I think a week and a half after her diagnosis with pancreatic cancer, which is not unusual, especially when a lot of times people's ⁓ initial diagnosis is when they're actually having quite late stage symptoms, yeah. ⁓

Arghavan (1:06:14)
Yeah, the reason

I asked about it was just that what I recall is that she has said that she thought her mom wouldn't have gotten pancreatic cancer if she'd had different dietary habits and there's really no evidence for that. And she has made this part of her story of why she didn't stay in traditional medicine that

You know, she saw what happened to her mom and felt like her death was preventable if only she'd had different habits earlier. And I understand why that's actually somewhat of a comforting narrative to believe because as we talked about before, it's nice to think that you could control something like pancreatic cancer and that if she had more, I don't know, leafy greens that she wouldn't have died, but that's just not reality. Pancreatic cancer is a devastating diagnosis.

likelihood of living past five years is somewhere around 10%. It's just a terrible, terrible disease. And she's unlucky and it's tragic that her mom got it. But then to turn that into this whole empire, basically deceiving people, it's hard for me to support. go on.

Alyssa Burgart (1:07:28)
and her and

her mom's not alive to stand up for herself defend herself, you know, she just gets to be this. I'm not I'm not saying that, you know, means doesn't love her mother. And I can only imagine how trauma traumatizing this experience was. But ⁓ yeah, spinning a comforting narrative that uses your mom to make a lot of money. It's I don't love it. I don't love it. And

You know, I have people in my life that have died of pancreatic cancer. It's a horrible disease. It is tragic. ⁓ You and I have both been in the operating room when someone's having an exploratory surgery to determine whether or not their pancreatic cancer is operable to find out that there's nothing to do and you just close them back up and have to wake them up and tell them this devastating news. So I have immense, ⁓ immense compassion for people who are going through this.

I also think that she has woven this entire narrative of like, doctors don't learn anything about nutrition. And I was thinking about it. And do I think that we could learn more about nutrition? Absolutely. Would I love to see even better nutrition education? Sure. But I have never in my entire life gone to a doctor, like a primary care doctor or a pediatrician, and not had a conversation about a healthy diet. And I was thinking about it. I was thinking about when I was in medical school,

Arghavan (1:08:53)
Mm-hmm.

Alyssa Burgart (1:08:56)
My first year of medical school is when we first started doing OSCEs, which are like for people who are not familiar, there are you know, exams where you have to like work with a standardized patient ⁓ and do a history and physical, and you need to do some counseling, and other people watch you do that and then give you feedback on how you can do that more effectively. And I remember my very first ⁓ like practice OSCE, I had to coach another medical student.

I actually had to do my coaching on ⁓ smoking cessation and then my partner had to do dietary counseling with me. And so it was like literally one of the very first skills we learned was how to do dietary counseling for people. it's, you know, there's nothing in this book that she has either that's like a revolution. You should eat more vegetables. Like no fucking shit, lady. Like every

Arghavan (1:09:52)
When RFK Jr. and all his cronies say things like doctors don't talk about diet and exercise, that's, I mean, most people are frustrated that they go to see their doctor to talk about headaches. And then all they get is, well, what are you eating and how much are you exercising? I mean, that's just like a standard part of the conversation. And they think it's revolutionary to suggest that doctors should be talking about diet and exercise. Anyway.

Alyssa Burgart (1:10:02)
And that's all they get. Why can't you give me a pill?

Well, I mean,

this this whole grift of vilifying medicine for the overall failures of society and like what foods are we allowed to be sold and who gets who gets to make enough money to go to a farmer's market versus who gets to make enough money, who lives in a food desert and who doesn't like literally. I mean, she's this longevity grifter like a Tia. And, you know, it turns out that.

The zip code that you're born in is far more predictive of your life expectancy than whether or not you have access, you know, well, obviously there's a lot of connection between your zip code and what you have access to. But again, this whole book is really written from the grounding of rich people and like what do rich people get to have? And to be fair, rich people buy books. They buy books. And so that's a great market if you are going to sell books is to sell them, to market it to people.

Arghavan (1:11:08)
Mm-hmm.

Alyssa Burgart (1:11:10)
who have the money to buy them.

Arghavan (1:11:12)
Rich people can have their own spa in their house the way that RFK Jr. and ⁓ Kid Frock can have their own cold fun.

Alyssa Burgart (1:11:18)
Don't, why do you have to make me think about that terrible, ⁓

Arghavan (1:11:24)
Anyway, they can have an entire home gym. then, yes, I know it's a terrible ad I just made. I

Alyssa Burgart (1:11:24)
I literally started seeing that video. You did that to me.

Arghavan (1:11:30)
apologize. But like that's also part of that problem. Like that whole campaign is like, yeah, if you had a fancy gym, you could ride a stationary bike every day or whatever. You you can get in a sauna and what most people don't have access to any of that.

Alyssa Burgart (1:11:34)
Yeah.

I

mean, there is literally a chapter in this book called Trust Yourself, Not Your Doctor. And then she had the audacity. And I will get into this when we talk more closely about the confirmation hearings, where she says over and over and over again in this hearing, is the main like that's her main thing that she goes back to is, ⁓ every patient should have the opportunity to discuss with their doctor, which like there's a lot of people who don't have access to a doctor. So that's terrible. Also, your very, very popular book says

trust yourself, not your doctor. So, I mean, forgive me if I'm not super convinced, okay?

Arghavan (1:12:15)
Yeah

Alyssa Burgart (1:12:21)
I just, I mean, she bangs away on it in the hearing. Like, I was so fucking tired of hearing her say that when I was like, but you don't even trust or believe doctors. You left the profession because you were so burned out or whatever, and you've decided to spin this narrative that it's like, doctors are the problem. Like, you're not, you're not a, anyway.

Arghavan (1:12:22)
very internally.

Alyssa Burgart (1:12:43)
It makes me very annoyed. ⁓ So anyway, I'm going to put in we're not going to spend a ton of time talking about this book, but I am going to put in a link to Eric Strong did a video. I kid you not. He spent he did this heroic labor. Thank you, Eric. He went through all he read the whole book. But what he did is he was like, it would take me too long to go through this entire book. So I'm just going to go through the 11 page introduction. And he literally went through every there's no citations in this book, by the

Arghavan (1:12:44)
Thank

You

Alyssa Burgart (1:13:14)
It's apparently a science book. And ⁓ I just put that in air quotes for people who are doing the audio. anyway, if you're going to write a science book and you have no citations, I am concerned. And ⁓ Eric points out she did, however, have 50 pages of recipes, ⁓ but no citations for the dubious claims. So that's cute. That's really cute. ⁓ So anyway, Eric did this work. You can listen to him for an hour. He goes through and he actually takes every single one of her claims.

Arghavan (1:13:36)
Mm-hmm.

Alyssa Burgart (1:13:44)
and says whether it's true or not, he tries to reverse engineer where some of these numbers might have come from and ⁓ figuring out, on the best available evidence, what would that number be? And was she close? Was she far? Was she in the same stratosphere? I don't know. ⁓ And so I think that that's really helpful, and especially because

Arghavan (1:13:50)
Mm-mm.

you

Alyssa Burgart (1:14:10)
It's only 11 pages and it was an hour long video. mean, there was a lot to unpack. And ⁓ he goes through and actually finds real sources and then provides that backup. I think that for folks who are, I mean, listen, I think that if you're somebody who wants to believe Casey Means, if you're into her brand of healthism, which really blames individuals for.

everything that happens in their health, which is the maha. That's a core element of the maha belief system is health ism. Then yeah, you're probably going to love her book and you're going to love if you can afford her, you know, program that cost, you know, fifteen hundred dollars a year. ⁓ mean, I guess go ahead. But if you're somebody where you're a little bit skeptical and you want to see what you should really believe.

Eric Strong has done the research for you. You don't have to do it all yourself. He has gone through the data as an expert physician, as an expert medical educator, and he has made that available. So thank you, Eric Strong. Yeah. OK, so let's move on to the Senate confirmation hearings. Is it? ⁓

Arghavan (1:15:11)
Yeah.

Great.

Ha!

I only watched the clips and I found it infuriating, so I can only imagine how you feel.

Alyssa Burgart (1:15:25)
Yeah,

I really was committed to doing this for you. I wanted this to be my gift. OK, so first of all, her hearing was supposed to initially happen in October 2025. And the reason that that didn't happen is because she actually went into labor with her first child, like five hours before the hearing started. So very appropriately, the hearings were appropriately delayed. Now, to show how little I expect of the Senate,

Arghavan (1:15:31)
Aww.

Alyssa Burgart (1:15:55)
In the past, there have been other times where people have tried to woman-friendly, parent-friendly things for the Senate that have had a really hard time getting through. So the fact that they didn't just disqualify her from office because she had a baby, I mean, guess that's one positive. They did open the hearing ⁓ with congratulating her on having her baby. There was a 15-minute break in the middle of the hearings. ⁓

Arghavan (1:16:14)
Yeah.

Alyssa Burgart (1:16:25)
It said presumably for her to go breastfeed her child. ⁓ Now again, I would say first of all, a 15 minute break in the middle of a two hour confirmation hearing seems very reasonable. I will say I was breastfeeding my baby when I was a chief resident ⁓ in anesthesia. And for those who don't know the culture of anesthesia, we get a 15 minute break. And now the 15 minute break begins the moment that you leave the operating room and it ends with the moment you return to the operating room. So you got to include travel time.

So I saw Casey Means get up and go off to presumably go breastfeed her baby, which means she maybe had like, if it was really close wherever she was going, like maybe she had 12 minutes to like breastfeed her baby. I'm assuming that her baby was there and she didn't have to pump. I will tell you the difficult, that is basically what I had to do. I had to run from an operating room. I had to go to a, ⁓ I would use our call room, which by the way,

had like a keypad on the outside. So anybody who knew the keypad could get into the room. There was no like internal lock. So I had to like create a little badge that I would put that was like, I'm breastfeeding in here or I'm pumping. And there was always this one guy who constantly walked in on me. I was just like, bro, did you do this in college when people put a sock on the door? Like, do you not read the signs? Don't just read the sign. Anyway, and you're like super stressed out because now you basically have like a little more than 10 minutes.

Arghavan (1:17:29)
Yeah.

That's great.

Okay.

Alyssa Burgart (1:17:53)
breastfeed and then all these fucking mommy blongs are like it's so hard to breastfeed, try to relax, watch a picture of your baby and I'm just going like get out of my body. I'm milking myself with this thing and then you would have to like run back to the OR and of course like half the time my attendings would completely blow me off and so I'd be like practically leaking milk before I even got out there. So anyway, cheers to this Casey Means that you got to have a break.

to go breastfeed. And I know it wasn't long enough. So I am going to acknowledge that is an area where I think the Senate could improve in the future if they're looking for pro tips for helping women who are mothers and breastfeeding to participate in civic society. ⁓ So it opens up and God, I can't think of his name. The guy from the guy who had the deciding vote for RFK to be able to be confirmed.

Arghavan (1:18:49)
Bill Cassidy.

Alyssa Burgart (1:18:50)
Say it again.

Arghavan (1:18:51)
Bill Cassidy.

Alyssa Burgart (1:18:52)
Bill Cassidy. Thank you. So Bill Cassidy opens it up and you know, he's a pediatrician and so he's like, you know, welcome back. We're, you know, we know why you needed to delay because you had a baby. Congrats on your baby. Great.

Shortly later, ⁓ it's Bernie Sanders time and he very cursorily congratulates her on having a baby. And it was like kind of hilarious because he doesn't care. He's like, moving on to my questions. So but what I thought was really funny was Bernie Sanders ⁓ clearly was hoping that he could get her to he was saying, hey, I think there's some things that we could agree on. I think we can agree on the fact that Americans need better access to health care.

Arghavan (1:19:16)
No.

Alyssa Burgart (1:19:35)
She kind of answers that. he's clearly trying to get her to then eventually as one of his last things to acknowledge that a single payer healthcare system would be the best thing for Americans. And, you know, she doesn't take the bait, shocker. And ⁓ so she didn't come out for single payer healthcare. I don't think any of us are surprised, but I thought it was a valiant effort by Bernie to try. He was like, every that's the one thing I think we need. And nope.

Arghavan (1:20:00)
Mm-hmm.

Alyssa Burgart (1:20:05)
We're not going there. OK, great. So, know, and these and each of the senators only has like a few minutes to ask however many important questions they have. So I'm going to shoot a mirrored from that. And then it switches over to Mark Wayne Mullin, who we mentioned in part one of this episode. He is the ⁓ senator from Oklahoma. He is ⁓ from the Cherokee Nation. The two of these guys like Bernie Sanders and Mark Wayne Mullin, like they hate each other.

They hate each other. Did you see the clips?

Arghavan (1:20:36)
I saw only I think I saw Bernice. don't think I saw Mark Wayne's clip that I.

Alyssa Burgart (1:20:41)
So

when Bernie is done talking, Mark Wayne Mullen, it's his turn to start talking. And he spends the whole time, he spends like at least a minute and half of his time, like berating Bernie Sanders for, I don't know, whatever, being a socialist. ⁓ then like Bernie Sanders is like, well, if you're going to attack me, I'm going to speak. And he's like, it's my turn to talk. And the two of them are just like, And I'm just going like, OK, this is like.

I mean, step aside WWE because the Senate confirmation hearings are juicy. They're juicy. Okay. So then it goes back to Casey Means who's like, I'm just going to take a breath after that. Like she needed to like settle herself after observing these two grown ass men being dicks to each other in her confirmation hearing about stuff that had nothing to do with her. It had nothing to do with her.

Arghavan (1:21:13)
you

Mm-hmm. Yeah,

it's their own beef. ⁓

Alyssa Burgart (1:21:40)
But they hate each other anyway.

I will say she overplays her experience. And I this was one of those times where I was just.

really wanting to yell. I wanted to yell a lot. So she said, Having practiced, seen thousands of patients, worked in a system for nearly a decade in clinical medicine. It's not the focus. And she was talking about well-being and nutrition and whatever. ⁓ But I really felt that that was an overstatement.

of her qualifications because so now she as we talked about she did do around four years of this residency.

I don't know if that includes her intern year or not. ⁓ To call it practicing for nearly 10 years, I think, is not fair. ⁓

Arghavan (1:22:36)
Yeah,

counting all four years of med school as practice.

Alyssa Burgart (1:22:39)
So, and for example, you know,

I have been an attending physician for 10 years this year.

Arghavan (1:22:49)
Mm-hmm.

Alyssa Burgart (1:22:52)
I could argue that I have been part of clinical medicine for 20 years, 23 if I count, because my first job was working at a hospital as a clinical ethics assistant back in 2003. ⁓ But I would never say I've been in practice for 23 years. That's not true. I've been in practice for 10 years. And she finished medical school when I was finishing my residency.

Arghavan (1:23:03)
Mm-hmm.

Alyssa Burgart (1:23:21)
That's not fair or true. ⁓ Saying that she's seen thousands of patients, I'm not sure if that's possible during those limited four years of a surgical residency. ⁓ I ⁓ find that a little sus. Now, I think that she is counting the 10 years that she, and still, again, less than 10 years that she has spent running this company levels.

Arghavan (1:23:36)
Yeah.

Alyssa Burgart (1:23:49)
where she's been promoting people using continuous glucose monitors and metabolic health. ⁓ So I found that to be infuriating as an actual physician with actually 10 years of experience. thought that was wrong. I did not agree with her.

Arghavan (1:23:53)
Thank you.

Alyssa Burgart (1:24:09)
It did not find that to be a trustworthy statement.

Arghavan (1:24:08)
Mm-hmm.

Alyssa Burgart (1:24:13)
⁓ She has said a bunch of disparaging things about birth control over the years and Senator Murray tried to call her out on that and she claimed that she's a supporter of people having access to birth control. But again, kept going into this people need to have a detailed informed consent conversation with their doctor. And that's the other thing as an ethicist that I have been hyper-keyed into is the the MAHA movement, the anti-vax movement. ⁓ They really love to use

the term informed consent ⁓ as a unique device. ⁓ I think we do need more informed consent and deeper informed consent. I'm incredibly, I'll put a link to the, Harriet Washington has a fabulous book called Carte Blanche that talks about ⁓ how consent has sort of evolved and devolved in many ways and who is it that are the winners and losers. So I'm a huge fan of informed consent.

but I'm noticing it increasingly being used not just in the anti-vaccine movement, but across many other domains of healthcare to imply that physicians are explicitly hiding complications of medications, are hiding information from patients. And I don't think that that's true, generally speaking. yeah, Senator Murray tried to bring up

Arghavan (1:25:30)
Yeah, generally speaking.

Alyssa Burgart (1:25:36)
some things that Tracy Beth Hogue has said, which is our very anti-vaccine points against RSV. will tell you, ⁓ anybody who is a fan of Casey Means will say, she's not anti-vax. She's not. And this is the same as people who are big fans of RFK. They'll be like, he's not anti-vax. He told people they could take the MMR vaccine. They could. So he's not anti-vax. And I'm like, such a very narrow view.

Arghavan (1:26:02)
Mm-hmm.

Alyssa Burgart (1:26:02)
of what

that means. But I will say that her book is full of so many talking points that are perfectly, perfectly aligned with anti-vaccine sentiment. And so again, the thing that she kept saying every time she was asked anything about vaccines is she would go, I think that every person has the right to have a conversation with her doctor, which again, nobody's saying that they don't. Nobody's saying that.

Arghavan (1:26:24)
Yeah, so

I want to talk about that for a second because I saw two clips that I saw a lot or the section with Bill Cassidy where he's asking her whether she would recommend the measles vaccine. And then the section with Tim Kaine where he spends his entire three minutes asking her over and over and over again about the flu vaccine. So he starts out with.

Alyssa Burgart (1:26:33)
Mm.

And she doesn't.

Arghavan (1:26:52)
asking her about something RFK Jr. had said in January that there's no evidence to suggest the flu vaccine prevents serious illness or hospitalization among children. And he asks her, is that true? And she goes, I haven't seen that statement. I haven't read that article. He says, OK, fine. Put the article aside. Put the statement aside. Does the flu vaccine prevent serious illness and hospitalization among children? And she refuses to answer the question. She says all sorts of things. And he just

keeps asking her over and over and over. And finally she says, at a population level it does. And it's like, that's the whole point of vaccines is to operate at a population level. Number one, number two, correct. Number two, this idea that the reason she's saying it that way is because she's an anti-vaxxer because

Alyssa Burgart (1:27:36)
It's literally public health.

Arghavan (1:27:47)
That allows her to plant the doubt that it may not be right for you or your child. That maybe on the whole it's okay, but not necessarily for you. And then she repeats that same point that you mentioned about people should talk to their doctors. She also says, well, I'm not any one person's doctor. And they say, this job is to be the nation's doctor.

Alyssa Burgart (1:28:08)
Isn't that the truth?

Arghavan (1:28:11)
I think that was Bill Cassidy, if I recall, talking about the MMR and saying, like, would you recommend this vaccine? We've got the largest outbreak of measles that we've had in over 20 years. Would you recommend the vaccine? And she just refused to do it. Anyway, so back to.

Alyssa Burgart (1:28:25)
Because

she doesn't have a license to practice, she can't recommend shit to anybody.

Arghavan (1:28:29)
Well, and she did have to admit, think somewhere in that testimony that she can't prescribe medications. the thing, so the things that I thought were clearly anti-vax were her saying, you have to talk to your doctor because that's another way of throwing doubt on the whole thing. It was the population level. ⁓ And then there was one more that I talked about in one of my videos and see if I can remember what it was. But like, it was very clear to me just in watching those clips that she's definitely opposed to vaccines. and.

Alyssa Burgart (1:28:35)
It was, yeah.

Arghavan (1:28:58)
This wasn't the third thing, but another thing is that she has in the past said that hepatitis B, newborn hepatitis B vaccination is a crime. How is that not anti-vaccine? mean, I don't know how much more you can do.

Alyssa Burgart (1:29:06)
Yep, she has. Well, this is what I mean. This is what

I mean, right? Is that folks who are so eager to defend these people and themselves, right? Like they know that it's bad to be seen as anti-vax. And so instead they'll say, but I'm not anti-vax. I just want people to talk to their doctor. Also, the other thing about this whole like talk to your doctor thing about vaccines that I find really offensive is that part of a major strategy during COVID and for flu

is to have people be able to just make an appointment at the pharmacy. And the pharmacist can provide you with that information. And if you have additional questions, they are actually really, really well situated to answer many of those questions. So I also found it to be very, I was offended on behalf of pharmacists. ⁓

Arghavan (1:29:51)
Mm-hmm. No, think the whole

thing was disingenuous and she just kept denying, know, well, I haven't seen this, I don't know that. I mean, it's not as Tim Kaine said, it's a very simple question. Does the flu vaccine prevent serious illness and hospitalization? Which obviously you and I both know the answer is yes, but she couldn't just say that. And it was very clear to me that it was because she didn't want to be seen as being in contradiction of RFK Jr. who

is her future boss for this job if she were to get the job. And anyone who's going to put his views or the relationship with him in front of, ahead of the health of the nation is not suitable for that job. Even if all those other things were not true, even if she had a medical license, even if she were board certified, even still, a person who is going to prioritize RFK Jr. over the health of the nation should not hold this position.

Alyssa Burgart (1:30:47)
Well, you know, the thing that when I was listening to that whole section on the flu, the thing that I kept thinking back to is how many entities I worked with, both from the ethics service as well as from my anesthesia work, ⁓ you know, doing things like tracheostomies, which is something that people who are going to survive severe covid and severe flu, many people have needed because they need a prolonged intubation because their their lungs are so damaged. They have such severe pneumonia. They have sepsis.

And so I truly kept thinking like, wow, if you had been able to finish your residency and had gone into practice, I wonder, Certainly there are physicians who became more anti-vax during COVID. That is an unfortunate reality. There's definitely a minority of people that did that. But it does make me wonder, you know, if she had genuinely had the experience of being an attending physician, somebody who has, it is such immense responsibility.

⁓ And I know even as a resident, like I knew it was gonna be a big deal when I became an attending. I knew that it was gonna be a big leap in responsibility. But there was nothing that could have prepared me for how much actual responsibility it is to be that person.

Arghavan (1:31:59)
Yeah.

Yeah, I don't think anyone understands until they're in that moment and they're the final decision maker. There's no one else's name above them on the chart.

Alyssa Burgart (1:32:04)
Yeah, to like

Yeah, yeah, it's a really big responsibility that I know that many of us take exceptionally seriously. So I thought that was a bummer. that was the other thing, too, that came up about vaccines was that, you know, Bernie Sanders, when he was before the fight, he was asking her a bunch of questions about, ⁓ you know, there's all of this data to demonstrate that there's no connection between autism and the MMR vaccine. ⁓ And he had a line of questioning related to that. And she refused to basically say,

that has been determined. so then when Mark Wayne Mullin had his chance to talk, he was like, ⁓ people are always saying do the science and science is perfect. So like, why is it that you're not okay with people doing more research? And I was just like, bro, because we already have spent like bazillions of dollars doing the research to demonstrate that it's not a fucking problem.

Arghavan (1:32:41)
Mm-hmm.

Yeah, there are other things that that continue to be like actual problems that are affecting people's health that we should be studying, that we should be spending money on.

Alyssa Burgart (1:33:09)
Absolutely.

So anyway, there was a lot of the vaccine sentiment was prevalent. Now, the other thing that was a huge section of the hearings was her conflicts of interest, which, ⁓ yes, yes, conflicts of interest. So yes, well, and even before that, there were questions. Senator Baldwin had an entire line of questioning that was related to money that Casey Means had taken from Genova Diagnostics.

Arghavan (1:33:21)
yes, yes.

It's Murphy asked her about that,

Alyssa Burgart (1:33:39)
a company that had had to pay out $43 million for medically unnecessary claims that violated the False Claims Act. The False Claims Act is not only about medicine, it was actually started in the Civil War related to people spending false records for spending money on the war, on the Civil War. And it's also used now to deal with medical fraud. And her response was, I'm not familiar with that settlement, which I was just like,

feel like you would have prepped for that. ⁓ So I'm going to read you this quote from Senator Baldwin. She said, it's troubling because the surgeon general must ⁓ be a person that the public can trust, someone who does their homework before accepting money or lending credibility to a company. For me, this raises questions about your judgment and does not inspire confidence that you will make America healthy to promote a company who has to pay a settlement for violating the False Claims Act. ⁓

Senator Baldwin also pointed out that membership into Casey Means's company for whatever the premier membership is, $1,500 a year, which is, she pointed out, the cost of renting an apartment for a month in her state. And so she talked a lot about supplements and how many of the people, and you and I talked about how clearly she's

Profiting off of off of wealthy people spending money who are afraid of death who are who want longevity whatever ⁓ But she put the senator pointed out a third of low-income adults have at least two chronic conditions and they need an affordable solution So where's the affordable solution that you're gonna bring as the nation's doctor? ⁓ And this quote this quote from senator Baldwin ⁓ Delicious, it seems you've built a career on making money from flaws in the system

Which is true, and I think that this is what leads a number of physicians to become these like wellness hustlers, right? To like sell, you you and I often say like, listen, if a doctor is selling you a supplement, they're probably not a good doctor. They're not somebody who you should be paying attention to. ⁓ Senator Husted did an entire ⁓ piece all about ⁓ farmers and what are we supposed to do if you say all this stuff about how pesticides are really bad, but how is it that we're supposed to

make enough food to feed this nation. And obviously that's a very complicated topic. ⁓ Senator Murphy, ⁓ know, really on the heels of Senator Baldwin talked about ⁓ how she's violated FTC rules a bazillion times. There's a really great, ⁓ if people haven't seen it yet, I'll put a link in the show notes. ⁓ Public Citizen, which is a nonprofit group that does deep dives into, you know, major issues that are impacting

Americans did an entire report on Casey Means, her maha connections and money, ⁓ really showing the wide variety of ⁓ connections that are there that should be deeply alarming to people. So some of the key findings of their report, which showed up throughout the testimony ⁓ in the hearings,

said while Maha wellness influencers lambast conventional medicine, they've amassed their own wellness empires built on selling products and ideas based on distorted views of public health. And they go on to talk specifically about not only Casey Means and her FTC violations, all the times that she's promoted products without disclosing that she had received money from those companies. ⁓ And her brother, Kali Means, who is also the tech

He's listed as the co-author of her book, although it's not clear to what degree he participated in writing her book. He's a senior HHS advisor, and he also uses his own platforms to promote false health information. He has a company called TrueMed that has a really dubious business model. ⁓ Anyway, ⁓ all these people, it is this ecosystem of people profiteering off of the worried well in America.

Arghavan (1:37:45)
Yeah, that's

right. And I think the I made a video about Chris Murphy's portion of the hearing as well, because, you know, he did a great job, as you saw, of going through, how about your posts for this company and this company and this company? And they had added up, you know, how many posts she had done for each specific thing and how many of them she had actually disclosed was getting paid by these companies. And it was

Alyssa Burgart (1:37:53)
huh.

Mm-hmm. Yeah.

Arghavan (1:38:11)
I think it was like five different companies that they brought up 21 % of the time is how often she disclosed that she was getting paid It should be a hundred percent obviously she so one out of five times is all the times that she's disclosing four out of five times She's not disclosing she's making an ad for somebody, but she's not telling you that it's an ad and that is Totally inappropriate and I believe she's under investigation by the FTC

Alyssa Burgart (1:38:35)
Yeah, which is hilarious. Also, one of the companies ⁓ that she had endorsed, I forget what it's called, something harvest, good harvest something. Do you remember? Anyway, it's a company that makes pre-made meal plans and that company owes a ton of money because they made so many people sick with their contaminated food. I'm sorry, it's not funny that people got sick, but it is funny.

Arghavan (1:38:44)
Something I haven't written down somewhere.

Alyssa Burgart (1:39:03)
that this woman who's claiming that she's going to make America great, make America healthy again is, know, public health, you know, it's going well when it's invisible, when people are healthy, outbreaks are controlled early. I am just deeply, deeply alarmed at not only her approach, this personal, that everything's a personal decision and that if you were a smart person,

and you were a good person and you were a morally correct person, you would eat well. Because when you look at her book, I'm like, it just feels like if her mom were alive right now, she would probably make her mom feel like shit. Because she'd be like, well, you should have eaten better when you were younger, mom. And I don't want to believe that that is how she would behave towards her own mother. ⁓ But there's a whole book about it. I don't know.

Arghavan (1:39:58)
Yeah, there's not really evidence

that she wouldn't behave that way.

Alyssa Burgart (1:40:02)
I mean, and it's just, we are so obsessed with personal responsibility in this country. It's the great mythology of America that it's like, just one person pulls up there, pulls themselves up by their bootstraps. But it's like, there's a whole ecosystem around this. There are many systemic factors that impact who is plagued by chronic illness. And sometimes you're just unlucky. And so it makes me really upset to see somebody going into this role who clearly, I mean, one,

Arghavan (1:40:24)
Mm-hmm.

Alyssa Burgart (1:40:32)
is totally unqualified to do so. They are not a practicing physician. They are not bringing any sort of clinical expertise. They are bringing a profiteering mindset to the most powerful physicians role in the nation.

Arghavan (1:40:45)
Yeah. And we have the previous Surgeon General ⁓ who had served under Trump in his first term has been pretty vocal to about her not being qualified yet ⁓ editorial in stat. I believe it was about it. You know, she, I don't think we've ever had a Surgeon General who's not got an active medical license.

Alyssa Burgart (1:41:06)
I don't think so. Are you talking about Jerome Adams? Did he write it? Yeah. Jerome Adams is an anesthesiologist, by the way. He comes and talks at all the anesthesia conferences.

Arghavan (1:41:09)
Mm-hmm. Yeah.

Nice. ⁓

I'm sure he does.

Anyway, yeah, no, I agree. She's clearly unqualified. But what really stood out to me just from the clips that I saw is this is just another loyalist who they're trying to.

Alyssa Burgart (1:41:30)
yeah.

Well, I also think that ⁓ she may have been somebody who, you know, if the administration had been different, would have played it differently. You know? ⁓

Arghavan (1:41:41)
Hmm. Yeah, I think so too. I

mean, it was very clear she had a script, right? Like this whole, cause she said multiple times, yeah, that was the other thing that she said over and over and over again, vaccines save lives. They're like, would you recommend the MMR? Vaccines save lives. I'm not asking if vaccines save lives. I'm asking about this specific vaccine. And there wasn't a time, maybe it happened, you saw the whole thing, but in the clips that I saw, I did not see a single time where she said,

Alyssa Burgart (1:41:58)
Yeah. Yeah.

Arghavan (1:42:08)
They asked her about a vaccine and she said, yes, that particular vaccine is effective. So she was trying to play both sides, right? Because she knew that she shouldn't sit there and say, vaccines are terrible. So she kept repeating this line of vaccine save lives, vaccine save lives. But no, I can't say that one. And no, I can't say that one.

Alyssa Burgart (1:42:14)
Sure.

Well, and you know, the other thing that I'm deeply curious about, which we will never know, is did she vaccinate her own child against hepatitis B? And I mean, based on the things that she said publicly, I'm guessing she did not. But, you know, we also had when, you know, when Trump was in power during COVID, you know, he secretly got vaccinated, knowing that it would upset his base. And so I am curious if her child is receiving these vaccines. And of course, if she's

actually reading any of the data, which again, I'm a little doubtful based on the things that she said in the book, but you know, I'm open to it. ⁓ The rational choice is to vaccinate your children. ⁓ It is a way to protect your children. And as a new mom, I have thought a lot about her, not only in this like maha, whatever businesswoman setting, but like she is a postpartum woman.

Arghavan (1:43:02)
you

Alyssa Burgart (1:43:24)
Being in confirmation hearings in the Senate, I mean, she's still got the post-baby phase. She is in a very unique time of her life as a new parent. And so many of the questions that she was asked, not necessarily the financial questions, but the questions about public health, are things that would deeply impact her own child. But we did not see her come out and say whether or not she did that.

Arghavan (1:43:38)
Mm-hmm.

Mm-hmm.

Alyssa Burgart (1:43:53)
I don't know if her kid got vitamin K. I'm very curious. Again, I have taken care of children who have ⁓ unfortunately had severe strokes because their parents did not believe in vitamin K because of people like RFK and people in anti-vaccine community who have equated vitamin K with vaccines along with their anti-vaccine rhetoric. And the survival rate from those strokes is very low. ⁓

Arghavan (1:43:56)
Mm-hmm.

Alyssa Burgart (1:44:21)
And even for kids who do survive, the morbidity is quite high. And I will tell you, if I never have to do an emergency anesthetic on an infant ever again in my entire life, I would be happy. And so for the sake of her child, I hope that her child got vitamin K, because I would not wish an infant stroke on any person ever. It just wouldn't.

Arghavan (1:44:33)
Mm-hmm.

Mm-hmm. Yeah, no, I do too. hope actually that her child is getting all the recommendations, not the new ACIP recommendations, but the AAP, Association of American Pediatricians, ⁓ recommendations for vaccines. Because that's what's evidence-based.

Alyssa Burgart (1:44:57)
Yeah.

It sure is, it sure is. ⁓ What a time to be alive, Argonvon.

Arghavan (1:45:08)
It sure is a unique point in time. Well, I'm hopeful, you know, Casey Means, terrible candidate, very mismatched for this job. I understood that as of last week, right after the hearing, they didn't have enough votes. ⁓ I'm hopeful it remains that way.

Alyssa Burgart (1:45:28)
We will keep a lookout and let all of our listeners know if she gets confirmed.

Arghavan (1:45:33)
Yeah, I mean, don't have a lot of hope, just to be clear, but I have a little bit of hope.

Alyssa Burgart (1:45:36)
No, I don't either. I don't either.

Well, I mean, to be honest, it also was not lost on me watching, watching Cassidy talk to her about vaccination when I'm like, you got us in this fucking situation. You traitor. You traitor.

Arghavan (1:45:51)
Right. Well, so

that's part of why I do have a tiny bit of hope because I, you know, he voted to confirm RFK Jr. He had made this deal. Yes. And he had gotten RFK Jr. to make various commitments, all of which he's broken, like not changing ASIP, not changing the childhood vaccination schedule, for example. And so I do just wonder if he has learned

Alyssa Burgart (1:46:02)
He was the deciding vote.

Arghavan (1:46:21)
Cassidy has learned any kind of lesson from that and whether he, even though he would never say it publicly, whether he regrets having made that decision. I mean, every time RFK Jr. had said some bonkers thing about vaccines, Cassidy has posted on Twitter about like why that's wrong. So I do think he cares to some extent, you know, about children and he understands how important vaccines are. So is that enough? ⁓

Alyssa Burgart (1:46:45)
talk about blowing

his opportunity to protect America blew it.

Arghavan (1:46:50)
Yes. So

I have wondered, know, does he regret what he did enough to take a stand now and make sure that she doesn't get confirmed? I don't know.

Alyssa Burgart (1:47:00)
I am very curious. ⁓

I really am. And I also just don't really trust him to do the right thing for kids. I don't trust him to do the right thing for America.

Arghavan (1:47:12)
Yeah.

Alyssa Burgart (1:47:19)
I also worry that compared to RFK who goes out there and is talking about having brain worms and whatever, she looks like this moderate whatever. She's somebody who can use her white womanhood to say, oh, I'm going to do such a great job. I just, I don't know. I don't believe it. I don't believe it. Anyway, well, I'll tell you what I need after all of that talk. We spent the first part of the.

Arghavan (1:47:32)
Mm-hmm.

You neither.

Alyssa Burgart (1:47:47)
Part one of this episode talking about violence in Iran. We spent the whole second half talking about the downfall of American public health. You know, just one more person coming out of the clown car of RFK Jr.'s clown car of public health. So what do you prescribe? So I need a little pick me up now, Argavan. Can you amuse me with Take Two and Call Me in the Morning?

Arghavan (1:48:08)
Yeah. Yes.

Absolutely. So, ⁓ you know, and people who have listened ⁓ since the beginning will know that I love Tiny Chef. Tiny Chef is, for those who don't know, a small chef. He's a felted green creature. People are always asking me, like, is he a frog? I don't know. He's a chef. I don't know what he is. Don't try to put him in a box. He's a frog. ⁓ So, Tiny Chef.

Alyssa Burgart (1:48:21)
Yes.

Arghavan (1:48:38)
⁓ was nominated for a few Emmys and they won, I believe, three of the four that they were nominated for. ⁓ They won the Outstanding Directing for Preschool Animated Series Award for their Spooky Stump Spectacular. They won the Outstanding Editing for a Preschool Animated Program for the Spooky Stump Spectacular.

And then I believe they also won ⁓ outstanding preschool animated series. And so that's awesome. Folks may recall that the show was canceled, unfortunately. this is, yeah, that's how I became aware of Tiny Chef in the first place was when the show was canceled and the brilliant people who create Tiny Chef and the whole Tiny Chef universe had posted a video of him receiving the news.

Alyssa Burgart (1:49:18)
No, I did not know that.

Arghavan (1:49:34)
of the cancellation and it was very upsetting to And it was just such a beautifully made video. And I think they gained tons of fans, myself being one of them. Anyway, so they won a few Emmys, which is great, although bittersweet because the show's been canceled. And I saw a video they posted, which is probably an older video, but of Chef dancing. So Chef loves to dance. And this one is, he's dancing to this aerobics video.

Alyssa Burgart (1:49:37)
⁓

Arghavan (1:50:03)
like if you think back to like the 80s and 90s aerobics videos there's uh you know women in these leotards yeah and he's like kind of and he's like doing the moves um it's really really cute i love it when chef dances so i'm gonna put a link to that video for folks to watch um and uh what was the other thing oh and then also chef had like a little acceptance speech

Alyssa Burgart (1:50:11)
Like, Jazzercise?

Arghavan (1:50:29)
And he, of course, being how he is, he forgot to take his notes up to the microphone to accept his Emmy ⁓ in the imaginary world of Chef, because obviously it's real people who won the actual awards. But anyway, it's very cute. ⁓ So if you want something a little lighthearted and whimsical, I definitely recommend watching some of these little snippets. So I'll put a couple of clips in the show notes. How about you? What do you recommend for folks?

Alyssa Burgart (1:50:54)
Excellent.

So as folks on the pod know, I am an anesthesiologist. I give drugs to children for my job. It's wonderful. ⁓ And I came across a video of a physician. think he's an ER physician ⁓ having a video taken of himself being anesthetized with propofol. And it was, it's, I mean, I know how quickly I can have somebody go to sleep. ⁓

But it was fascinating because he, it was just way faster than he thought it was going to be, which was interesting. And I always think it's funny when patients are like, I'm going to fight it. I'm going to fight it. And I'm like, go ahead. You do whatever you want to do. I'm just going to keep doing my job. ⁓ And I always win. That's what I do. I'm a winner and I always win. ⁓ Maybe propofol is the winner. But anyway, I will pop. I have the tools.

Arghavan (1:51:46)
Yeah.

the tools.

Alyssa Burgart (1:51:54)
I will, and I always do it, of course in a safe way, with airway equipment available, monitoring to make sure my patients are safe. So I will put a link to that in the show notes.

And then the other videos that have been, I just find them very amusing is for anybody who has ever had an MRI done, the machine, it's a giant magnet, it's in that donut thing, there's like a tube that you go in and out of, and the magnet, there's a noise that happens that's very rhythmic when the MRI is running. It makes different noises, and like at a different...

rate, I guess, a different percussive sound, depending on what kind of ⁓ MRI is being done, what organ are they looking at, ⁓ how many slices does it need, so it'll change what the speed is of that beeping noise. And so I have seen a number of videos on TikTok that I find very funny where it says, waiting for the beat to drop in MRI. And there is somebody who works in an MRI who is

recording themself with the MRI machine in the background and you can hear the noise. And the one that I'll put a link to in the show notes, it's Shania Twain's I Feel Like a Woman. have you seen that one?

Arghavan (1:53:10)
I saw that one and I was like,

I almost wanted to ask the guy like, what sequence is that? Cause it's usually people who've had an MRI, like it's not usually consistent sound. It'll be like staccato and then there'll be a long and then a short, know, like it's not any sort of regularity. And the sound that he found in that sequence was like, just over and over again. I was like, what is that?

Alyssa Burgart (1:53:17)
Yeah

Yep, yep.

And it's possible that he edited it to make that sound. I don't think so based on the audio quality, but I'm open to that being a possibility. But I will say, people who don't know this, as a pediatric anesthesiologist, I spend many hours almost every week in MRI because it's one of the main out of OR places where we provide anesthesia to kids because...

It's hard for adults to get MRIs. It's really hard to keep a kid still for a long scan. ⁓ And so I have heard many different beats dropped in MRI. And I don't recall ever hearing that specific one. But I am tempted the next time I'm in MRI to play it for my colleagues, my rad tech colleagues who have so much knowledge. And I am very curious what they think. if I can find out some details, I'll report back.

Arghavan (1:54:29)
Thank you. I would love to hear. Yeah, those are hilarious. I only saw that one. So I'm glad to hear there's more.

Alyssa Burgart (1:54:37)
I'll try to see if I can pull some other ones, because I've seen several songs and I'm amused.

Arghavan (1:54:41)
Maybe they will show up on my FYP. Who knows? ⁓

Alyssa Burgart (1:54:43)
Hahaha!

Arghavan (1:54:45)
Anyway, okay, well, I think that's it. Is that it for this week's episode? All right, well, if you didn't like what you heard, this has been the America First with Nicholas J. Fuentes podcast. If you liked it, don't forget to subscribe to The Present Illness. Please leave us a review or rating and tell folks to check us out.

Alyssa Burgart (1:54:49)
That's it.

We know that people who listen to this pod are not into Nick Fuentes, so I feel confident. Since you hung out with us this long, you like us. So you should go ahead and subscribe to The Present Illness, leave us a review. We are on TikTok, Instagram, we are on YouTube, and you can stay on top of all of our TPI-related news.

Arghavan (1:55:14)
you

And we will of course be back next week with more headlines, hot takes and doom scrolling wrapped in some laughs.

Alyssa Burgart (1:55:31)
Until then, agitate, hydrate, and take a nap. See you next time on The Present Illness. Production by Arga von Salas and Alyssa Burghardt. Editing by Alyssa Burghardt. Social media by Arga von Salas. Original music by Joseph Epof. Don't take 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. Please take your medical questions to a qualified professional. And I know that we brought this up earlier in the show. Just an additional disclaimer, none of our opinions are.

representative of Stanford University.


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Alyssa Burgart, MD, MA

Host
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Arghavan Salles, MD, PhD

Host