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Brian Lehrer: It's the Brian Lehrer show on WNYC. Good morning, everyone. We're going to begin the show and end the show on the topic of alcohol. Today, we are privileged to have the US Surgeon General, Vivek Murthy, with us to expand on his recent recommendation that alcohol containers be marked with warning labels about their cancer risks. You no doubt heard that headline. At the end of the show today, we'll have a call in for people whose New Year's resolution was to have a dry January. Dry January, no drinking this month seems to only be getting more widespread each year. We'll invite you to say why you're doing it and how it's going.

First, to Surgeon General Murthy on his cancer warning label recommendation. We'll talk about other things, too, in an exit interview, as General Murthy is about to end his tenure as the Biden administration comes to an end. He was also President Obama's surgeon general. Arguably, his main interest has been fighting what he sees as a crisis of loneliness in the United States. He even published a closing article to cap off his tenure emphasizing the importance of community. Of course, we'll talk about that, and we'll see what he thinks the public health community and all Americans concerned about our health should be watching for if an RFK Jr./Dr. Oz agenda brings a lot of change in the coming years.

By way of background, Dr. Murthy's official bio page notes that he was raised in Miami, went to Harvard undergrad med school, and then for an MBA in management at Yale. He is author of the bestselling book Together: The Healing Power of Human Connection in a Sometimes Lonely World. On top of all that, his bio notes that he is a mango aficionado. Dr. Murthy, we really appreciate that you've come on with us several times during your tenure as Surgeon General. Welcome back to WNYC.

Dr. Vivek Murthy: Thank you so much, Brian. It's always been good to be on with you and good to have this be one of my very last interviews as Surgeon General. Thank you.

Brian Lehrer: We're honored that you're making it that. Listeners, we welcome your questions for the US Surgeon General, Dr. Murthy, on any relevant topic at 212-433-WNYC, call or text, 212-433-9692. Dr. Murthy, let's start with your recent recommendations about alcohol warning labels. Why did you recommend this now? Has there been recent evidence about a link between alcohol and cancer that we didn't have until recently?

Dr. Vivek Murthy: Thanks, Brian. The reason I issued advisory, a surgeon general's advisory on alcohol and cancer risk is, number one, there has been growing evidence that's been building for years about the link between alcohol and cancer, the causal link. The other thing, though, that came to my attention is that very few people in the country actually know about this link. Putting that growing evidence together with the lack of awareness became clear to me that we needed to make sure that people understood what science is telling us, which is that there is, in fact, a causal link between alcohol consumption and seven types of cancer.

Brian Lehrer: Go ahead.

Dr. Vivek Murthy: Those seven cancers, by the way, include breast cancer and colorectal cancer. Now, many of us may know people who have breast and colon cancer. As a doctor, I've certainly taken care of many patients over the years who have struggled with those cancers. They also include mouth cancer, throat cancer, voice box or laryngeal cancer, as well as esophageal and liver cancer. Just to give you a sense of the magnitude of this risk, alcohol is the third leading preventable cause of cancer in the country, behind tobacco and obesity. It's responsible for 100,000 cases of cancer each year in America and 20,000 cancer deaths.

I've always believed that people have the right to make their own decisions about what they do in their life. I also believe they have the right to have the information we know that science tells us about so that they can make the best decisions for themselves and their families. In my view, this is an important piece of information to people, for people to keep in mind as they're making decisions about how much they drink.

Brian Lehrer: People want to know specifics of their risk assessments. When we talk about topics like these, I'm sure you know. Would you say one drink a day, one drink a week? How much, if any, amount would you recommend is safe without raising your alcohol cancer risk much above zero?

Dr. Vivek Murthy: That is an important question, and it's a question that I spent years talking to patients about one-on-one in the hospital. Here's how I would think about it. Number one, an individual's risk is going to differ from person to person. If I have a family history of cancer, if I have a personal history of cancer, if I have a genetic risk for cancer, like I have the BRCA gene, for example. These are all factors that may increase my risk relative to somebody else, and that might make me think differently about my alcohol consumption compared to the next person.

On a general level, what we see in the data at a population level is that even drinking within the current guideline limits, which are one drink a day for women and two drinks a day for men, seem to increase your cancer risk, and particularly for breast cancer, for mouth and oral cancer. There was another recent report that just came out from the Department of Health and Human Services which looked at the overall health impact of alcohol on the body, which not only confirmed this but showed that there was an increased risk of esophageal cancer even at drinking within these limits.

What I would say to that is for the average person that drinking a drink a day or two drinks a day, if you're a man, that this does seem to significantly increase cancer risk. I would recommend personally considering drinking below those levels. Now, the key with the data that we're seeing is that more drinking equals more risk. If you hence reduce your consumption, you reduce your risk. It's hard. In public health, we talk about degrees of risk. There's rarely something that confers zero risk. It's about lower risk versus higher risk. If you're drinking once or twice a week, for example, that will likely put you at much lower risk than if you're drinking once or twice a day when it comes to cancer.

Brian Lehrer: I saw some pushback from the industry in an article on winespectator.com headlined Surgeon General Opts for Simple Slogans Over Solid Science. I'll read a few lines from the article and invite your response. It says here, "Murthy undercut his own medical colleagues at Health and Human Services. Two weeks before his advisory, the National Academies of Science, Engineering, and Medicine issued a report by a panel of 14 academics, including experts in public health, family medicine, epidemiology, and biostatistics.

As part of their review for the dietary guidelines, the panel and its staff conducted an extensive deep dive into the current relevant science on alcohol's impact on health and found with 'moderate certainty' that people who drink alcohol in moderation have lower all-cause mortality than those who don't drink." Lower all-cause mortality than those who don't drink. They conclude this section saying, "Murthy chose to ignore that in favor of a simplistic message. He focuses on alcohol as a cancer risk and ignores any health benefits."

The writer says, "I guess I shouldn't be surprised. If there is one trademark of the growing neo-prohibitionist campaign, it is that simplistic slogans sell, nuanced science doesn't. Would you respond to the science cited or claimed there about this recent literature review by your colleagues that found moderate drinking associated with less overall mortality risk?

Dr. Vivek Murthy: I'm really glad you brought this up. Let's look at this science around this. First of all, just to clarify things, the National Academy of Medicine is not part of the government. It's a non-governmental organization. Let's be clear on that. Number two, let's also be clear that the recent report from the Department of Health and Human Services, from scientific colleagues from the CDC, NIH, Substance Abuse and Mental Health Services organization and others, as well as outside experts who have studied alcohol for years, confirmed not only the cancer risk that we noted but also found what other researchers have found, which is that there is not clearly a mortality benefit to drinking.

In fact, even five years ago, the Dietary Guidelines for Americans stated that no one should start drinking for health benefit, that it's not justified by the science. The growing data around the world, not just in the United States but around the world, increasingly points to not only the cancer risk but the lack of mortality benefit. If you want to talk about the National Academy's report, it's important to be clear. That was one report by one group of researchers that took a narrow look at the data.

They only looked at data after a certain time period. They excluded a number of studies that showed that there was in fact risk. They came. In fact, even in that study, though, they demonstrated that there was in fact some cancer risk. The bottom line is when science, you have to look at the preponderance of evidence. That means where is the majority of evidence taking you? From different populations in your country, around the world. You put all of that together.

Most experts feel fairly consistent about this, which is that the narrative is that alcohol does not seem to confer overall mortality benefit, means it doesn't make you necessarily live longer. It is associated clearly with cancer risk. There is some debate, and let's be clear on this about the impact on the heart, because many of us, myself included, when I was in medical training about 25 years ago, were taught that, "Hey, drinking may be good for your health as long as you drink around one or two drinks a day or less."

It turns out that is a lot more complicated than we had thought. Some of the early studies that showed that that might be the case, that alcohol might be good for your heart were flawed studies that included in their control group people who had an alcohol use disorder and then quit drinking. That changed the results. When those studies have been redone, a couple of things have popped up. Number one, the Benefit, that alcohol or the purported benefit, what was believed that alcohol might help prevent heart attacks. It turns out that if that benefit exists, it's likely a lot smaller than we thought.

Instead, there are other effects on the heart which are troubling, namely that alcohol use increases the risk of abnormal heart rhythms like atrial fibrillation. It increases the risk of high blood pressure and of heart failure. The overall impact on the heart, I would not say is necessarily positive of alcohol. Again, what we do know with clarity, replicated now over multiple studies around the world, is that alcohol is causally linked to cancer. That's one of the reasons why I think it's important for people to know that because science evolves, we've got to make sure that we communicate that evolution in science to the general public.

Brian Lehrer: Does the beginning of your answer there, though, indicate that there is some scientific uncertainty and disagreement on the preponderance of the evidence between your office and the academy?

Dr. Vivek Murthy: Here's what our report and the academy agree on is that there's cancer risk. That's one of the reasons that I've been out there underscoring the risk regarding cancer and alcohol. Because not only does the academy report suggest that, not only does our report suggest that, not only does the recent report from the Department of Health and Human Services suggests that, but multiple international research councils, the American Medical Association, the American Society for Clinical Oncology, the American Cancer Society have all agreed that there is a causal link between alcohol and cancer.

We should be clear on what there is broad agreement on. Where there is sometimes a difference of opinion is on the degree of impact on the heart. Some people, in some studies, it may indicate that there is a mild, modest benefit in terms of slight reduction in heart attacks. Other studies don't show that. Some studies indicate that there is an increased, or rather decreased risk of what's called ischemic stroke. Others show that there's an increased risk of another kind of stroke called hemorrhagic stroke.

There is still some questions in terms of degree to be adjudicated in the science, but there is broad agreement in the scientific community that alcohol causes cancer. That is the reason that I put out this advisory because most people don't know that. In my mind, having cared for people who have cancer, having lost my own family members to cancer over the years, if you had told me that there are certain steps that we could have taken in our loved ones' lives to help reduce their risk of cancer, I would have wanted to know about that.

Again, it's up to each person to make their decision about whether they take those steps to reduce their drinking if they want to reduce risk. I would at least have wanted to know that information if it could have reduced the risk of a loved one getting cancer.

Brian Lehrer: We're getting a few listener comments and questions about other parts of the world where people seem to drink a lot of wine and don't incur the same risk. One listener texts, what about the "blue zones," such as Sardinia, where people live to 100 and drink wine daily? William in Norwalk has a related question. William, you're on WWNYC with the US Surgeon General, Dr. Vivek Murthy. Hi, William.

William: Hi.

Dr. Vivek Murthy: Thank you for taking my call, Brian.

William: Doctor, I was reading about something where red wine has a good effect on a certain, I guess, your beneficial cholesterol. There's something I mistakenly called the Mediterranean, but it was referred to as a French paradox where people that drank wine seem to live long. What you're just commenting on. I would love to hear what you got to say about it.

Brian Lehrer: Thank you, William. Dr. Murthy.

Dr. Vivek Murthy: Thank you, William. No, I appreciate that question. William, I'm glad you asked it because I've heard that question from a number of people. It's good for us to talk about that. In science, when we're trying to peel apart cause and effect, we have to think about confounders, which is the following. I might have a certain trait, and I might in this case, let's say, drinking alcohol. It might seem that I live longer. The question is, are those two related or is there something else I'm doing that actually might be making me live longer?

This is a paradox that also came up decades ago with smoking. 1964, when my predecessor, Surgeon General, Dr. Luther Terry, issued the first surgeon general's report on tobacco, people wondered then as well, is it really true that tobacco is bad for your health? Because in Europe, people seem to smoke a lot and they seem to be doing okay. Similarly, what we found there is that, sure, at that time and perhaps now smoking rates may be higher in some populations in Europe, and they might look like they live longer, but they may be doing a lot of other things differently in their life.

What we know, for example, if you compare many European countries and the United States, is that diet is different, that work style and stress levels are very different. Access to healthcare is very different. They often have universal access to healthcare. We do not here in the United States. All of those factors actually have a profound impact on how long you live. That's where we have to be careful because if we use that similar way of thinking, we could have assumed that smoking was, in fact, good for your health because some populations in Europe and other parts of the world that smoked a lot didn't necessarily seem to live shorter lives than we did. Now we understand that, in that case, smoking does, in fact, cause cancer. In this case, the data is telling us pretty convincingly that alcohol does as well.

Brian Lehrer: There was a Washington Post article this week, maybe you saw it, called Americans Drank Less Alcohol even before the Surgeon General weighed in. It says Surgeon General Vivek Murthy recently called for rethinking recommended limits on drinking alcohol. Much of the country is already ahead of him on that. Yet I think we see, and you're concerned about increasing addiction, especially to opioids, as a major problem, and even causing a decline in average US life expectancy even before the pandemic. Do you think alcohol use is declining? If so, where does it fit into the overall addiction picture in this country generally, if addiction is becoming more of a serious problem?

Dr. Vivek Murthy: Brian, I'm glad you asked, because in 2016, when I was serving my first term as surgeon general, I issued a report on addiction, and it's focused on alcohol, drugs, and our overall health. The reason we included alcohol in there is because many people had assumed, because we've talked about alcohol a lot over the years and because we've talked about things like cigarettes a lot over the years, that those two issues were in the rearview mirror. We didn't have to worry so much about them, that it was opioids and newer substances of addiction that were the primary concerns.

What that belies is the fact that tobacco, for example, remains actually the leading cause of preventable death in the United States, responsible for nearly half a million lives lost. It also turns out that not only many lives but billions of dollars in health care expenses we see related to alcohol use disorders as well and other consequences of alcohol use. These, both tobacco and alcohol, remain profound challenges for our country. When I travel around the country and talk to communities about how they're doing with their health and what they're worried about, it is so striking to me how many families are still struggling with loved ones who have an alcohol use disorder.

Maybe they've been diagnosed. In some cases, they haven't been. The family is worried that their loved one is having difficulty reducing their drinking, that it's affecting their behavior and their health and leading to more accidents or to violence in the home. This remains a common challenge for Americans. We have to address new challenges or newer challenges. The opioid epidemic is one of them. It's one that I focused on a tremendous amount during my first term as surgeon general. We can't forget that some of the old challenges, like alcohol and tobacco are still with us.

Brian Lehrer: Before we move on from the topic of substances to other things, certainly your parting prescription for America, as you call it, having to do with community connection and some things our callers are calling in about climate change, red dye number three, and your take on the future, if there's an RFK Health and Human Services department in our near future. Before we move on from substances, I'm curious if you have any thoughts on legal cannabis in this context. Increasingly legal, as we know in many states, health risk versus risks from over-policing cannabis or any other lens on that?

Dr. Vivek Murthy: Yes, look, cannabis is really important for us to talk about, and I don't think we actually talk enough about its impact on our health and well-being. What we've seen, in fact, Brian, over the recent years is that public policy has really raced ahead of science when it comes to ensuring that we have appropriate safeguards and guidance for people on how to manage potential downside risks of cannabis. Now, let's be clear about two things. One is that I do not think it makes sense to criminalize people for marijuana use, to put people in jail because they're using marijuana. I don't think that made sense years ago. I don't think it makes sense today, and I don't think it benefits society.

The second thing that we should also keep in mind that I want to be clear on, is that cannabis, certainly in my view, is less of a public health threat than tobacco. Tobacco remains the primary challenge that we're facing when it comes to preventable deaths in the United States. What that does not mean is that cannabis is harmless. My worry is that the message that has been sent, I think, to millions of people, including millions of young people and our children as the legalization movement has moved forward, is that somehow cannabis is harmless and there's nothing to be worried about.

We know that about 9% of people who use cannabis develop an addiction to it. When you start early in life, when you start during adolescence, for example, that number goes up to about 20%. We have to recognize that cannabis can have downside consequences. Addiction is a real concern for many people, and it does have impacts on behavior, on our ability to engage and pay attention at times. It's not to say there's not a room for it to be used and it should be studied and our research should guide us on the appropriate circumstances in which we use it for medical purposes.

I don't think we have enough discussion about the downside risks of cannabis. Finally, if I was advising my own kids, they're small now and not yet at an age where their peers are talking about cannabis. I would not want them to smoke. I would not want them to certainly drink while they were underage, and I would not want them to use marijuana as well because of the risk of addiction and because of some of the downstream and downside consequences that I've seen.

Brian Lehrer: You compared it there in that answer to tobacco, would you compare it to alcohol in any way, relative risk?

Dr. Vivek Murthy: I think as far as we know, and I think cannabis is actually, relatively speaking, been studied less than tobacco and alcohol in terms of its overall health impacts, although there's a lot of data on the health impacts of marijuana. I certainly, I think I always hesitate a little bit to compare which one is better because I don't want to-- or worse because I don't want people to think that the other one is risk free. I would not want my child to use any of the three tobacco, alcohol or marijuana.

I do think the risks we see with alcohol are profound and have been longstanding. I think tobacco and alcohol together are generating some of the significant portion of cost to us in terms of dollars and human suffering and lives lost. I think those should be priorities. I don't think that we're having enough conversation about marijuana. I'm saying this not just from the data I've seen, but the conversations I've had with families all across the country. There is a very clear perception among young people that marijuana is completely safe and does not convey any harms because it is legal. That is just simply not true.

Brian Lehrer: We'll continue in a minute with this exit interview with the US Surgeon General, Dr. Vivek Murthy. We have a lot of other topics to get to, including some of your questions on the phones and in texts. Stay with us. Brian Lehrer on WNYC as we continue our exit interview with the US Surgeon General, Dr. Vivek Murthy. Let's go on to your closing paper for Americans as you leave the Surgeon General's office. It's called My Parting Prescription for America. It's on the topic of your book, The Healing Power of Human Connection in a Sometimes Lonely World. Most specifically, your parting prescription is about community. Where would you like to start?

Dr. Vivek Murthy: I've been thinking for the last two terms about a specific question that has been bothering me, and it's been about why and what is causing the deeper unhappiness and pain that so many people are experiencing across the country. This is a pain I encounter commonly. I spend a lot of time in town halls and community meetings all around the country, in big cities and small towns. On the surface, we could say that the explanations we read about in the paper, that economic difficulties and uncertainty is hard, that uncertainty about what the future is going to hold is difficult. Lack of access to health care certainly can add stress to our lives.

All of these are real and they matter and they impact our happiness. I came to realize that there was something else that was going on, something even deeper that was happening under the surface that was impacting people's happiness and well-being. After many years of conversation and research and talking to experts across fields, what I came to circle around was that there were three critical components for our fulfillment and well-being which have been eroding in our lives. Those are relationships, purpose, and service.

It turns out we struggle with high levels of loneliness. Many people, including majority of young people, say that they don't feel like they have meaning or sense of purpose in their life. When it comes to service, only about a quarter of the country engages in formal service, only about half in informal acts of service like helping friends or neighbors. It turns out these three elements, relationships, purpose, and service, are what I call the triad of fulfillment. The three critical components that drive and increase our chances of being fulfilled.

They're also the core pillars of community. If we really want to rebuild community in America, if we want to increase our chances of living lives that are truly meaningful and fulfilled, then we have to figure out how we rebuild those three critical components of relationships, service and purpose in our lives. Finally, Brian, there's something else that is happening alongside the erosion of the triad of fulfillment. That has been the rise of a different triad, which is a triad of success, which is grounded in wealth, power, and fame.

I came to realize this talking to young people, in particular college students and high school students. I would ask them often, "What do you define as success?" What I was really asking them is how is society defining success for you? What they often said was they felt that these three elements of fame, wealth and power were what they had to achieve in order to be successful. If they weren't successful, then they didn't have worth in the world and life wasn't meaningful and that they wouldn't be happy.

Now, there's nothing wrong with pursuing wealth, fame, or power. The challenge is when we assume that those are the path to fulfillment. Too many people, too many people I've encountered as well have followed that pathway, that triad of success, and realize it doesn't actually lead them to longer-term happiness. We need to increase our emphasis and our grounding in relationships, purpose, and service, because that is the triad of fulfillment.

Brian Lehrer: We have a caller on this topic. Christine in Brooklyn, you're on WNYC with US Surgeon General Dr. Vivek Murthy. Hi, Christine.

Christine: Hi, Brian. Hi, Dr. Murthy. Thank you so much for having me. I'm wondering if you have any thoughts on what is known as creatives aging vis a vis your work on loneliness and community. It's something that's gotten a lot of buzz in the arts, various arts fields lately. I know there have been studies shown that seniors who participate in hands-on arts learning, which is what creative aging is, have various benefits, like less prescriptions, fewer falls. There's a doctor named Dr. Jean Cohen who's studied this a while back and yes, it's a compelling idea on many levels. I'm wondering if you have any thoughts on this.

Dr. Vivek Murthy: Christine, thank you so much for asking that. You're hitting on a real passion of mine which is the power of the arts to improve our health and well-being. I do, and this is true at all ages, by the way. I think as we get older, one of the things I worry about is that people who are older tend to lose access to so many of the critical things we need for our health and our fulfillment. That includes connection with meaning and with purpose. The arts can be a powerful source of meaning in our lives and purpose and joy.

The arts also, often when we engage in them, they bring us in contact with other people, whether it's in the creation of art or the enjoyment of art. That social experience is also a very powerful part of what makes the arts good for your health and well-being. It's one of the reasons in social prescribing models which are models where clinicians like doctors and nurses are able to refer a patient to programs that can help them build community in their lives. The arts are often a key part of those social prescribing programs.

I am certainly a big advocate for the arts in our lives at all ages. I think for elderly people in particular, I think we have to do more as a society to support the elderly, to connect them to the resources, the social and creative resources that ultimately support their health and give them a sense of joy and fulfillment. Too often I worry that older people in America get left behind, that they fall by the wayside, that we have such a focus on youth in our culture that we have lost, I think, value for the wisdom that comes with age and with just the respect I think that elderly people deserve for all they have contributed to society. I think investing in the arts and creative pursuits is one of many things that we need to do to support the elderly in America.

Brian Lehrer: Since you frame this closing paper as My Parting Prescription for America, that's the title. Is this just for Americans to consider behavior changes as individuals, or is it also a prescription for public policy on some level?

Dr. Vivek Murthy: Brian, it's a prescription for individual action, for programmatic change in our communities, and for public policy. It's a prescription for America, but it's also a prescription for the world. Because the truth is, many countries are struggling with what we are struggling with today, with more loneliness and isolation, with reduced or diminished engagement in service, and with many people who are struggling, young people in particular, with the lack of purpose. The fabric of community has really weakened and in many cases frayed in countries around the world. This has been a product of not so much east versus west or north versus south, but modern culture.

I do think that this is a global concern. From a policy perspective, there are things we can do to create more opportunities for people to engage in service that brings people of different backgrounds together to connect more deeply with each other. There's more public policy can do to invest in social infrastructure, which are the physical structures and the programs that bring people together in communities, whether that's bringing parent groups together or students together or people across backgrounds and differences.

While there's an important role for policy, in the prescription, I also lay out the steps that individuals can take seemingly and deceptively small steps that we think, "How could that really make a difference in my life?" They have a powerful impact. Things like, for example, making sure you're spending at least 15 minutes a day reaching out to someone you care about, just to check in on them, making sure you're doing one small thing each day to help somebody else in your life, whether it's a stranger, a work colleague or a friend.

Also having conversations with our kids, as well as with our colleagues and our friends, honest conversations about what really gives us purpose in our life. We need to be able to talk about these things. We need to be able to invest in our relationships and actions where we help each other. Because a society where people care about each other, where they know each other, where they're invested in each other, that's a society where all of us can thrive and be fulfilled.

Brian Lehrer: You were a top COVID advisor to President Biden at the height of the pandemic. A lot of the pushback, largely from the political right, was about enforced isolation that they objected to government imposing. I'm curious if that overlaps with your concern about isolation in general and whether you look back on COVID policy in 2020, 2021, as having made any mistakes in this regard.

Dr. Vivek Murthy: It's an important question because I do think the pandemic worsened the isolation and loneliness that many people experience. We've thankfully seen a bounce back since then. In the throes of the pandemic, about one in two adults were saying that they were struggling with loneliness, and more recent data thankfully shows that that number has improved to about one in three. Still a very high number, honestly, but certainly better than the 50%.

With that said, with young people in particular, I think that not being in school and with their peers was an important factor, and they contributed to their loneliness, and many of them are still struggling to get out of that. That's what I hear about very often when I'm in schools. Now, it's important for us to look back on pandemic policies and ask which ones were right, which ones were wrong, which ones were well-informed, which were not. Sometimes in emergencies, whether it's a public health emergency or otherwise, you have to make the best decision with the information you have at the time. Sometimes you want to err on the side of being cautious.

Decisions about, for example, whether to close schools were important and hotly debated issues. Those decisions, of course, are made by local government, by school boards and local city government. Many of the local government entities decided to close schools early in the pandemic. I don't necessarily blame them for that, even though we know that there are consequences in terms of health, because there was a pandemic that was rapidly emerging. We didn't fully understand the impact of it on our health.

We didn't know necessarily that young people would do better than older people at the very beginning of the pandemic, we didn't know. Out of abundance of caution, many school districts decided to close schools. I certainly don't blame them for that. I do think that the decision that was made in end of 2020, early 2021, when President Biden came in to say, "Okay, 42% of schools are still closed. Our goal should be to get them all open." That was the right decision.

How you do it matters, and doing it with care, and making sure that schools had the funds and the resources to support educators to get testing and masks and other safety apparatus inside the school so that people could reduce their risk, especially kids who had chronic illnesses and were at high risk. That was the right, cautious way, I think, to go about doing it. As a result, several months into his term, by the beginning of the fall of 2021, 99% or so of schools were in fact open, but they had the resources, in many cases provided, to reopen more safely than they otherwise would have had.

Look, we have to go back and ask what we could have done better. One of the things I'll tell you we could have done better overall as a country and as a scientific and public health establishment specifically, is in how we communicated to the public about the pandemic. I think I saw a very clear tension between, on the one hand, some people who felt we got to boil this down to the simplest message possible, because people only really can take in the simple message, and the papers are only going to carry the simple sound bite. We just got to boil it down as simple as possible.

On the other hand, there are people who are saying this is not so simple. There's real nuance here that not everyone's at risk. Some people are more at risk, and in some circumstances testing is useful, others it may not be. How do we talk to people about that? That remains a real tension today. The approach I always take, this is drawing from my experience taking care of patients, is that if you can sit down and be open with people about risks and benefits, what you know but also what you don't know based on the data, that is the best way to help them to make good decisions.

How to do that when you're communicating in a three-minute interview to the whole country or to your state or to your city, that can become more challenging. I saw many local public health leaders really struggle with that, as did national public health leaders. We still have a lot of learning, I think, to do, especially when it comes to how do we build trust and in some cases rebuild trust after the pandemic. I think it's urgent that we learn these lessons, talk about this and incorporate these into our new approach. Because the truth is there is going to be another pandemic at some point. We don't know exactly when, but we have to be prepared for it when it comes to public communication and science.

Brian Lehrer: One more call. Mimi in Brooklyn, you're on WNYC with the outgoing US Surgeon General, Dr. Vivek Murthy. Hi, Mimi.

Mimi: Hi. Good morning. Thank you so much. I'd like to ask the surgeon general about the role of climate change in our health. I think that there are serious mental health effects, whether conscious or unconscious, on all people, I think, especially young people who really fear for their future. I think justifiably so, as well as the health effects. I mean, the very serious and potentially lethal effects of overheating. I wonder if you could talk about your thoughts about climate change and health.

Dr. Vivek Murthy: Thanks for that question. This has actually been there, I've been concerned about for a long time. 2016, in fact, the department here of Health and Human Services had put out a report on the impact of climate and health showing that not only can it impact everything from the nutritional content of our crops to our exposure to natural disasters and extreme weather events like hurricanes and tornadoes and wildfires, but it can also have an impact on our mental health and well-being. I've actually seen that firsthand as I've traveled around the country visiting communities that have been hit hard by extreme weather events.

I grew up actually in Miami, Florida, and I remember very clearly the effect of Hurricane Andrew, which came through and damaged our home and tore apart the homes of so many people that I went to school with and lived with for years. It took us months and months and months to recover. Our mental health took even longer for many of us to recover. Those effects are real. When I talk to young people, I think they're worry about the future, their anxiety about what the planet is going to look like when they are out of school. That anxiety is real. It's present.

Now, what I don't think we can do or should do is resign ourselves to the fact that this is just the way it is. There's nothing we can do to change the reality of climate change. I think we have to look at this as not only an opportunity, but a challenge, like some of the other challenges our country has had to take on in the past. It's not easy. It requires us coming together and mobilizing around individual actions, and equally, if not more importantly, public policy actions to ultimately reduce emissions, increase resilience in terms of our ability to withstand the impacts of climate change, increase and improve carbon capture.

I think a lot of the improvements and investments that have been made in the last few years through the funds provided by the Inflation Reduction Act, those are good, really important. Those are the biggest investments we've made in climate change in our country's history. I think that we have to keep that momentum up. We can't allow climate change to be an issue that is politicized or divides us.

I do think young people are going to be potentially one of our most important solutions here because they understand this issue is important. I don't think it's as partisan or as polarized among young people as it is perhaps among older generations. As it has been in the past, it will likely be young people who help build the broader cultural movement that shapes the public policy conversation that ultimately leads us forward to a better path.

Brian Lehrer: Listeners, if you're interested in this topic, later in the show, we're going to be doing a segment on President-elect Trump's nominee for energy secretary and his confirmation hearing yesterday, partly around the questions over whether he is a climate denier and whether that would affect population public policy under him. That's coming up a little later. Dr. Murthy, last question for you. I appreciate you giving us so much time one more time during your administration.

As we look to the next administration, we know that RFK Jr. and Dr. Oz have confirmed and other nominees who are not as well known are highly controversial. I'm curious what you'll be watching for to see if they lead a science-based public health era or something that's more ideological or just out of touch with reality. Get as specific as you can on this. What keeps you up at night worrying what the administration will bring?

Dr. Vivek Murthy: I think times of transition are always hard. I think when you come in in the middle of major challenges, in this case, whether it's climate change or whether it's the mental health crisis that we're dealing with in America or whether it's the prospect of another pandemic, there's a lot to get done when you're starting. In this regard, I just want to say that for anybody who is starting the new administration, I do sincerely wish them well and I want them to succeed because their success is tied to whether or not America can succeed or not.

That's why I and many of my colleagues from this and past administrations, Republican and Democrat, have often raised their hand to say we're here to support and to be a source of advice if that's ever helpful to people from the past and for people who, rather who are coming into office. That's what I would offer to people in the current administration. I do think that what is going to be essential is that, number one, that we communicate as openly and transparently as we can with the public about why decisions are being made.

I think, number two, it'll be important to engage the broader scientific community in decision-making, whether it's around pandemic preparedness, whether it's around mental health, whether it's around food and nutrition or other challenges. Look, I do think that there are some issues that have been in the news more recently as some of these confirmations or nominations are being covered that I do really think we have to work on.

Take food, for example. I do think that one of the great contributors to chronic disease in America is the fact that we have a food supply that is, number one, very expensive to take part in if you're looking for healthy, fresh food, but that in fact instead has a preponderance of highly processed food which has been made cheap and quite affordable. Now, that has real consequences for our health and well-being. When nearly two-thirds of our children's diets in America are ultra-processed foods and half of adults diets are ultra-processed foods. We see growing evidence that those are linked with health concerns, including weight gain. We have to do something about making our food supply healthier.

Frankly, we haven't done a whole lot to make that happen in the last several decades in America. If there is something that the next administration can do to move the needle forward on that, that would be a huge contribution to the country. I am hopeful that there are issues that the administration can move forward building on the scientific collaboration and progress that we've seen over and enjoyed over decades. At a time of great polarization and coming out of the pandemic where I think trust did drop in public health and science, I think we have to be very careful about making decisions without transparency that seem like they're driven by ideology, by personal belief.

We have to lay out the science for why that matters and bring the scientific community with us. Frankly, that's something that I've always felt in our office was very important. Every advisory we put out, every issue we spoke on, we engaged the scientific community with that. We had groups weigh in and often speak out at the same time as we did to share their point of view. That is going to be important going forward.

As I close here, I just want to, one, Brian say thank you to you for being such an important voice for New Yorkers over the years, but giving me the chance to also join you on multiple occasions. I leave my time as Surgeon General feeling a mix of nostalgia but also immense gratitude. I have over the last two terms had the extraordinary privilege to do something I never ever dreamed I would be able to do, which is to serve my country and to contribute hopefully in a meaningful way to the public health of millions of Americans who I care deeply about.

My parents came here from India decades ago. They were hoping to find a home that would give their kids an opportunity to live a better life, to get an education, maybe to be able to raise a family. I still remember in 2015 being sworn in as Surgeon General and reflecting with my parents and my grandmother and my sister right in front of me that there are few countries in the world where the grandson of a poor farmer from India could be asked by the President to look out for the health of an entire nation.

That is the power and the promise of America. I will always be grateful for it and I will always do everything I can, as I hope we all will, to make sure that opportunities to serve in government, to succeed in business, to get a good education, to have good health care are available to every single American because they deserve it.

Brian Lehrer: I appreciate all that, and I appreciate your accessibility coming on here and taking questions from me and listeners multiple times. Very quick, like one-sentence follow-up on your previous answer. Is there any one thing you would say in addition to the general thought about let's keep everything science-based going forward, where you might say, "Geez, I really hope they don't do this?"

Dr. Vivek Murthy: I think it's very important we don't roll back the progress we've made on vaccine-preventable illness. We have saved millions of lives around the world, preventing polio, measles and other illnesses, particularly that have taken the lives of children over the years. We've been able to save those lives, and we should make sure that we don't roll back that science certainly and understanding. We should make sure we continue to make life-saving, preventable tools like vaccines available so that we should keep the benefits of science while continuing to push forward and exploring new frontiers, developing new treatments, developing new prevention strategies. That's what I hope the new administration can do.

Brian Lehrer: Dr. Murthy, thanks again. I hope we'll continue to talk when you're in your next capacity, whatever that is. Thanks again.

Dr. Vivek Murthy: Thanks so much. Take care, Brian.

Brian Lehrer: Brian Lehrer on WNYC. Much more to come.

 

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