Hypertension, Potassium, and Anti-Cancer Vaccines with Dr. Tom Frieden

Welcome to That Can't Be True, a show that sorts fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton, and today I'm talking with Dr. Tom Frieden, who is a physician with deep public health and epidemiology training. He led the CDC for almost a decade and also ran New York City's health department. He now heads up Resolve to Save Lives, an organization that focuses on epidemic preparedness, cardiovascular health, and actionable public health policy. His new book is called The Formula for Better Health, How to Save Millions of Lives, Including Your Own. And I had the pleasure of talking with him about it recently at the New York Public Library. We're going to talk about all of that, especially about hypertension and his six tips to live a longer and healthier life, plus some of the top public health stories leading the news right now, and of course, our factor fiction questions, which will cover measles, tobacco use, potassium, and dancing. Hi. Hi. It's so nice to see you. Thank you. Great to see you. And it was great to do the event at the library. I loved that event at the library. In fact, maybe we'll start off talking about your book and that You've been on a tour for your book, The Formula for Better Health, and just so curious what questions you're getting. Have any of the questions or where people's attention has gravitated toward? Has any of that surprised you? I think there were probably two main questions that I heard over and over. The first was, where can I go for reliable health information? And that's not so easy. And what do you say? What do you say, Tom, in these days? Well, depends what you're interested in. If you're thinking about vaccines, a group like the American Academy of Pediatrics. If you're concerned about health during pregnancy, the American College of Obstetricians and Gynecologists. But this is a landscape that's changing really fast. And there is massive amounts of misinformation. I would start with saying don't believe anything from anyone who's trying to sell you anything. Seems like a good adage for life in general. And I also think we need to go a little more deeply into the levels of certainty. And I talk about this in the book, that there are things that we're virtually certain about. You know, we're never going to find out that tobacco is good for you. And there are things that are highly likely, but they might change. There are things that we have some evidence about. it's a reasonable, there's at least one good study, but it could definitely be wrong. And then there's things for which there is no evidence whatsoever, which doesn't mean they're not right, just means we don't know. And so I think it's really important to kind of understand those four areas. And they apply to so many things. They apply to personal health, they apply to public health advice. And when we think about something no one wants to talk about anymore, but COVID, The fact is the virus is changing. The vaccines are changing. Our immunity is changing. The environment is changing. Our knowledge is changing. And so we need to adapt what we recommend, what we do. And that's kind of a level of nuance that's important for people to understand. And yet has always been fundamental to science, right? To the fundamental tenets of what the scientific method is. You know, good science doesn't give you certainty. It gives you humility because you understand how much you don't know. So that was the first main question. Where can I go for more information? And I'll just say before wrapping up that question that I do think artificial intelligence is changing this in a big way. Talk more about that. What do you mean? So in a negative way, you're seeing kind of the industrial scale production and dissemination of misinformation through artificial intelligence. And you're seeing even in leading models, continuing hallucinations and inaccuracies where you really wouldn't want to use this for making medical decisions. On the other hand, there are some products that are medical AIs that are optimized for medical information. They don't have any stock in it or financial interest in it, but I use open evidence every single day, multiple times. Well, and I remember at our event at the New York Public Library, you said arguably doctors who weren't doing that were now engaged in malpractice because they weren't availing themselves of the best possible tools today to help them do their jobs. I don't practice full-time. I was on a flight a few weeks ago, international, and overhead is there a doctor on board. There was a patient having a medical problem, or a passenger, I should say, became my patient having a medical problem. And it was not a life-threatening medical problem, but the situation was a little complicated. And I suddenly felt, hey, you know, I just don't feel comfortable taking care of this person without double checking with AI. And paid for the Wi-Fi for the flight, got onto the AI that I use for medical stuff, put in my careful history taking and the situation. and it came back with a potential diagnosis that not only had I not thought of, it was a very rare side effect of a medication that she started about six months before, which she's now had three episodes of this symptom. Oh, wow. And it is so rare that I happened to be with one of the world's experts in this condition just a week or two later. And I said, did you know about this? He said, I had no idea. So medical science is so complicated that it's virtually impossible for anyone to have a complete and comprehensive understanding. That doesn't mean we're going to defer things to AI, but it means it's a tool. And like any tool, it can be used well or it can be used poorly. How many questions did you get about you personally? Like were people asking you, like, what do you eat or do you exercise or do you really sing happy birthday two times while you wash your hands? Did you get questions like that too? In the book, I outline the formula for better health, see, believe, create. See the invisible, believe that things that may seem inevitable can be changed and create a healthier future. And after outlining all of those in great detail, I then go to how does that imply things for how we do our health care and public health system? And then finally, how is that relevant for your personal health? And I did get a lot of questions about personal health, food, exercise, sleep. And what's really striking is that when you look with the eyes of an epidemiologist on personal health issues, it's not all that complicated. There are six things that everyone should do if they want to live a long, healthy life. Control your blood pressure, ideally to 120 over 80. Control your cholesterol, ideally with an LDL under 70. Get enough sleep, seven to nine hours per night. The wonder drug, get physical activity, at least 30 minutes of a brisk walk, enough so you can't sing happy birthday. You're a little out of breath for at least 30 minutes, at least four days a week. avoid toxins tobacco alcohol and then some more complicated toxins that are more recent in our environment we can talk more about that and then six eat healthy and although there's a lot of debate about healthy food the essence is really pretty simple eat more healthy food particularly fruit, vegetables, nuts, eat less unhealthy food, especially sugar, processed red meat, red meat generally, and fatty foods. And, you know, for me, I really like red bell peppers. And so roasted as a snack in salads, you know, it's a food I like, I enjoy, and it's really healthy. So sweet potatoes. I have a substack. I wrote an ode to sweet potatoes. Was it also a poem? Was there a poem in there? No, it was not. Just an ode, but in prose, not poetry. Yes, definitely not. This is one thing I've changed since doing the research on the book. Like who knew that something that tastes like a dessert could be so healthy? It's high in potassium. It's high in all sorts of vitamins. I mean, Tom, I feel like my grandmother has always knew that sweet potatoes were rather magical foods. I think both of them always were trying to maybe even sneak more sweet potatoes into parts of the kind of lunch or dinner. Well, and you know, if you look at the things I just went through, it's what your mother told you, go out and play, get enough sleep, eat your vegetables. These aren't really complicated, and they're right. I mean, and in the book, I go through what's the rigorous evidence for how many more months of healthy lifespan, healthspan, will doing that give you? And it's pretty meaningful. I want to talk about all of this more, particularly your focus on blood pressure, because it's what I found so striking when we kind of did our event together recently. Before we, though, move deeper into your book and to your work, I do want to talk about some of the news of the day. You referenced some controversy around kind of whether or not we all should be eating more fat or not. And we've talked already on this show a lot about our food pyramid, although it's not really a food pyramid. It's an upside down triangle. But one thing that we haven't talked about at all is sort of the Trump Rx program that has been percolating for quite a while. But late last week, Trump unveiled the new Trump Rx website and gave some indication of kind of what he hopes it will facilitate and enable, but also is pretty clear about what it's not going to tackle in terms of kind of some of the challenges in our healthcare system, including as it relates to pharmaceutical pricing. So I just want to play a tape of what he said as it was covered by ABC News and then get your take. The Trump administration last night launching its new website known as TrumpRx designed to make prescription drugs cheaper. Dozens of the most commonly used prescription drugs will be available at dramatic discounts for all consumers. The website does not sell medications directly. Instead, it offers pharmacy coupons like this or discounts through the manufacturer. The president saying consumers can expect big savings on medications used to treat diabetes, heart disease and obesity. Trump Rx discounts are available only to cash paying patients and do not apply to those using insurance. So, Tom, basically, what do you make of all of this and where do you hope we go from here? Well, let's start with the end of that clip, that it only relates to people who don't have insurance. Currently, that's less than 10% of Americans. However with the legislation that the administration signed into law last year something like 20 million Americans are going to lose health coverage Many have already lost it Drug prices are scandalously high in the U And a lot of that is from you know it's not popular to say, but basically from extortionate prices by the pharmaceutical industry. And, you know, one of the approaches of the Trump administration to the difference in price between in the U.S. and Europe is to try to get companies to increase their prices in Europe so that there's less of a difference. That's a very strange approach. But look, if someone gets affordable medications through TrumpRx, that's a good thing. I think there's another aspect of medical care costs, and it's related to, you mentioned hypertension. We've looked at the issue of, hey, what about a $5 a month copay? Isn't that okay for patients to pay? And it turns out, No, not for medications that are really important for prevention and for which there are no symptoms. We'll talk more about high blood pressure as an example. It's the world's leading killer. And we find that in many countries, patients are charged to co-pay for medications. Hypertension is called the silent killer because the first symptom is often a heart attack or stroke. If my shoulder hurts, I'm going to pay the five bucks. If you tell me, hey, you might have a heart attack or stroke or have dementia in 5, 10, 15, 20, 30 years, maybe I want to spend something else, spend that $5 somewhere else. So the evidence is quite clear. And a really good health care system would identify medications that are preventive and make sure those are really free and easy to get to patients where you can get three months, maybe six months at a time if you're stable. get them in the mail, don't have to pay a penny for them. So I think access is really important. We pay, as you know, twice as much as the next highest paying country in the world for our healthcare. And we have a lower life expectancy than any other high income country and lower than several middle income countries as well. So we're not doing a good job with our health system. And part of that should be that core medications, and they don't have to be expensive, are available free of charge to patients. So, you know, TrumpRx, hopefully a step in the right direction, but not the end of the road. Since we've now talked about hypertension, I do want to talk about high blood pressure here because, you know, I think in this moment, you know, I see and I'm asked questions all the time about, you know, should people be like taking this new peptide or should they be taking this new supplement or should they be taking this vitamin? Should they really be monitoring their vitamin D levels? Like, should everyone have a continuous glucose monitor? But I was quite struck when we were at our event together at the public library where you said, I'm paraphrasing, but effectively, if you paid attention to one thing and you really, really spent a lot of time trying to control one thing that could have the highest ROI, if you will, like for your health, it's blood pressure. Absolutely. Absolutely. Why do you think that's not more in the conversation? I think it just comes back to the formula for better health. See, believe, create. First off, see. We need to see that most American adults have unhealthy blood pressure. We need to believe that it's not a normal part of the aging process. And it is not. And do you think that that's a real challenge here? that kind of a lot of people think like, oh, I just get older and my blood pressure goes up. Do you think that's also a challenge with how like doctors and nurses may be talking about this with their patients? Absolutely. You know, we were taught in medical school that it's normal for blood pressure to increase with age. And although it is the norm, it is far from normal. And not inevitable. Not inevitable, I think is what you're saying. Not inevitable. That's exactly right. And there's some fascinating studies that looked at some pre-industrial populations where people were consuming 10 times as much potassium as we consume and about one-tenth as much sodium. So their sodium-potassium ratio was totally different. And they had no, zero, age-related increase in blood pressure. 90 over 60 at age 16, 90 over 60 at age 60. Now, we're not going to replicate that dietary pattern in all likelihood, but there are things we can do switching to low-sodium potassium-enriched salt with at least 25% potassium. If you've got a kidney problem, check with your doctor first. That's one of the few ways that we can systematically reduce the risk of high blood pressure. But most of us will need medications. And just since we met, the American Heart Association has reduced the target from 140 to 130 for most people, saying 120 is ideal. And that's really the case. There are these brilliant studies from a group in Oxford that looked at people over many years and showed that for every 20-point increase in blood pressure starting at 115 systolic, Like your risk of a heart attack or stroke doubles, doubles. Oh, wow. And that's heart attack or stroke before age 70, between age 29 and 70. So think of high blood pressure, that the blood in your arteries is like a battering ram slamming into your heart, your brain, your kidneys, with every single heartbeat of every single day doing damage. and there are simple ways you can take your medicine every day. You know, I put mine in the way that I can't actually get to my breakfast unless I go through my medications. So I'm going to take them every morning before I have breakfast because I like to have breakfast every morning. Whatever works for you to take them every day makes a big difference. So, Tom, you just spoke about so many of the different factors around high blood pressure, limiting sodium intake. Earlier, you spoke about kind of limiting processed red meat consumption and focus on cholesterol. I know because we spoke about it at our event and you talk about it in your book, also a real focus on eliminating industrial produced trans fats. And yet in this moment, a heavily carnivore diet with a lot of natural fat has become a core part of how this current administration, certainly Secretary Kennedy, talks about what they believe to be a healthy diet. How do you reconcile, or is it possible to reconcile, like all of the evidence that you use in your book or kind of that, you know, continues to inform your future work, this conversation, you know, that we're having today, kind of with what the administration is saying it believes to be a healthy diet? I think there is nuance here. There is some evidence that if you consume more saturated fat, you feel full satiety, as it's called. so that you may eat somewhat less. And that's pretty consistent evidence. And so examples of saturated fat are for people who may not know. A hamburger, okay. A fatty piece of beef. Frying things in beef tallow is not a health food. But having more saturated fat may allow you to consume fewer calories over the course of a day. And so I think it's important that, again, from virtually certain to highly likely to possible to we don't know, it's possible that for some people, having more saturated fat may help them with weight and health. But there's a real disconnect between what Mr. Kennedy says and what the guidelines say because the amount of saturated fat that the guidelines outline, you would go way through that limit with anything like the kind of diet that he's demonstrating. So saturated fat is one of the more complicated issues. But what we know for sure, fruit and vegetables are good for you. Nuts are good for you. Sugar is bad for you. Processed meats are bad for you. And I think there are unknowns. But what we often miss is there's a lot that we do know. And we should focus on implementing what we do know while we try to find out more about the things that we don't fully understand yet. There's also a kind of strain in the kind of Make America Healthy movement that is antagonistic to any medicines. I mean, you've now referenced, you know, some people should take, you know, a statin or, you know, maybe something else. I know there's also a really live debate right now around taking a statin versus taking a PSK9 inhibitor. Would love to hear your thoughts on that. And also, you know, what you would say to people who think, you know, if we really focus on our diet and we also, you know, do all the other things that you recommend, like get enough sleep, which is still my main area of need for improvement, you know, get exercise, that you definitely don't need, you know, any medications. What do you say when kind of people, I'm sure people have said, you know, similar things to you. How do you respond? I actually agree with Mr. Kennedy on some of the over-medication issues. I think especially for conditions that have symptoms, ADHD, we are seeing over-medic pain. We're seeing over-medication rather than a more systematic approach with physical activity, physical therapy, counseling, other issues. And so I do think there is over-medication of kids and others. But it's really dangerous to suggest that you don't need any medicines if you just live healthy, eat healthy. You know, personally, I basically do just about everything right. And I still have hypertension, which is really annoying. And I've got to take a couple of medicines every day and try to get it under 130, under 120, ideally. That's just the cost of living our modern lives. And thoughts on the PSK9 inhibitor versus statins? Okay, first off, really great article just came out reviewing massive amounts of data on statins. Statins are really safe. There's a really interesting analysis that in the placebo-controlled studies, there's no increase in muscle pain with statins. But in the unblinded follow-up, people who know they're on a statin say, oh yeah, my muscles hurt. And interestingly, there was a study that compared three groups. One group was on a statin. One group was on a placebo. They didn't know if it was a pill or a statin. And one group was not on either pill. Both the placebo group and the statin group said yeah my muscles hurt The group not on any pill said no no my muscles don hurt So you know that a real issue There are a couple of other great medications We don have long-term safety information on them to the degree that we do for statins. And so, you know, I think a lot of people should be on statin. You know, too much information, but a couple of months ago, I started with statin, not because I'm at high risk, but because I have hypertension and given the age group I'm in, even though my cholesterol lipid panel is pretty good, it's not perfect. And the evidence suggests that the lower the LDL and the lower your apolipoprotein B, the lower your risk of a heart attack, disability, and the higher your likelihood of living a long, healthy life, which I certainly want to do. I think most people do. Absolutely. I want to talk about infectious diseases too, but before we do, thoughts on how frequently you would recommend someone who generally is healthy, you have all those levels checked. It's like, you know, get your levels checked every month, be really on top of things, right? Or once a year probably isn't enough, like maybe twice a year or once a quarter or actually like once a year should be fine as just a continued baseline. Really depends who you are. Really depends who you are. So if you're young and healthy, you get a baseline, it's fine. Annual or even less is just fine. If you're on medications and you're adjusting the medications, you may need to check them every month or even more. So it really is about you and the situation that you are in. One thing that is important to understand is that for some of these numbers, there's a normal and an abnormal level, but what's more important is your personal trend. So it may be that you're in the normal level, but over time, you're heading in the wrong direction. And we may need to intervene earlier. That doesn't mean medications. That may mean looking at your diet, physical activity, other things that could be changed. And I think that's really quite valuable. Take something like hemoglobin A1c, glycosylated hemoglobin. That can be normal, but creeping up to the abnormal level, and that's really important to catch early. Same with your blood pressure. You know, 125 is not normal. 130 is not normal. Doesn't mean you should necessarily be on medications, but you should be thinking of what you could do to get it down to below 120. So we've talked a lot about hypertension, blood pressure, cardiovascular health, how diet, exercise, medications, maybe shifting the balance on potassium and sodium affect all of that. I do, though, want to get your thoughts on some of the kind of infectious disease news that we've seen painfully, particularly thinking about not only the explosion of measles cases in South Carolina alone, but additionally, the clusters that we've really seen in many states now across the country in the last year, as well as the Trump administration disclosing that there have been a couple of measles cases at a large ICE detention facility in Texas that we know recently. There were reports of exposures in airports and public transportation systems in different cities. How worried are you about this? Do you think this is just our new normal? Do you have a glimmer of hope that we'll be able to increase vaccination rates again, and hopefully this will be kind of a blip and not predictive? What do you think? I'm worried. I'm worried. And I've been worried since 2020, actually, because we've seen a weaponization of science. We've seen the basically retreat from a concept that there is a shared reality that we can understand and learn about. Senator Moynihan used to say you're entitled to your own opinion, but not to your own facts. Now I think many people feel they're entitled to their own facts. I started my public health career working on measles outbreaks in New York City. And we had thousands of cases, hundreds of hospitalizations, dozens of deaths. And this wasn't that long ago. No, no. And that's what led to the Vaccines for Children program. And what we see Mr. Kennedy doing is systematically dismantling our vaccine infrastructure, systematically. We've seen the ideological takeover of a key committee, the Advisory Committee for Immunization Practices. We've seen the muddying of the conversation about what should be recommended. You know, what the CDC should say is simply, this vaccine is proven to reduce or not proven to reduce these outcomes and to do so safely or with this rate of side effects. We've gotten away from that to, eh, up to you if you want to get a vaccine or not. That approach, for example, applied to hepatitis B, that will condemn dozens, hundreds, or even thousands of American children to getting a lifelong and often fatal infection in their infancy or childhood. So there are real implications of this. Measles, you know, when I see Mr. Kennedy saying, oh, you know, it's a mild childhood illness. Well, that's not completely wrong, right? There used to be three or four million measles cases a year in the U.S. in bad measles years. But when you have that many cases, that meant you had hundreds of deaths and thousands of kids who were disabled for life from it. So, yeah, it's not serious unless it is. Same was true of COVID. Sure, most people have relatively mild illness and get over it. But some are going to have problems for life and some will die from it. You know, Tom, I wonder too, if you can reflect on what we've learned about the long-term effects of COVID, certainly, but also what we've learned about the long-term effects of measles and wiping out immune memory and what we know about how other viruses, even once maybe the symptoms have left us, actually can continue to haunt us for years or perhaps a lifetime. Let me give you three. Please. It's really interesting. Let's start with measles. We know a lot about it. Measles used to kill millions of kids per year around the world. Still kills over 100,000 kids a year in lower-income countries. The measles vaccine is highly effective. Dr. Bill Fage just passed away two weeks ago. And Dr. Fage led the global eradication of smallpox. And one of the things that he used to say is that measles was like the tugboat. that because families could get the measles vaccine, they were also going to get other vaccines as well because they saw the devastation that measles virus causes. And it doesn't kill people from measles. It kills kids because it knocks their immune system down and you get bacterial and other infections afterwards. And, you know, it was just shameful that Mr. Kennedy went to Texas, met with families and said, oh, they didn't really die from measles. They died from infection. No, that's how measles kills. So yes, measles sets kids back on their growth curve. Quite literally, right? It has a stunting effect. Yes, yes. And a really big increase in illnesses. Now for COVID, we're still learning more. Long COVID is changing over time. It does appear that vaccination reduces the risk of long COVID. There are people still suffering with long COVID. The rate of long COVID after infection seems to have been coming down quite a bit. And we're still learning a lot about long COVID. But the third one to mention is chickenpox. Chickenpox also, routine childhood infection. It's one of the ones that it looked like the advisory committee might stop recommending because there are a couple of countries in Europe that don't recommend the chickenpox vaccine. Big mistake, right? I mean, a lot of kids really miserable with it. No harms of the vaccine. Some kids quite seriously ill from it. Rare, but quite seriously ill. But interestingly, Chelsea, and I would put this in the some evidence, there is growing evidence that getting a shingles vaccine over the age of 50 doesn't only protect you from shingles. That we're sure it does. Because if you've had chickenpox, you've got a real risk of having really terrible, painful shingles late in life. We know the shingles vaccine works to prevent that very effectively. But there's increasing evidence that it also works for reasons we do not understand to reduce the risk of dementia. So you're seeing a big reduction in dementia risk in people who got the shingles vaccine. And the studies have been very elegant on this, where you might have a group that the shingles vaccine was just recommended for a certain age during a certain month, and they compared the group before to the group after, and they see a 20-30% reduction in dementia risk. So there are real benefits to vaccines. Well, and the HPV vaccine. It's quite extraordinary that Australia believes that it will completely eradicate cervical cancer within the next decade because of effective universal HPV vaccine coverage. Both HPV and HPV, hepatitis and HPV vaccinations, these are anti-cancer vaccines and they're very effective. And I wish that we use that language more because I think to your kind of earlier framing of sort of seeing, I don't think kind of we in the public health community have always done a good job of being, as you also mentioned earlier, humble around what we don't know or continuing to have our knowledge kind of evolve around. and also bold in making the linkages between how preventing a virus today may help prevent a cancer tomorrow in the proverbial sense. Absolutely. I think communication is changing in a big way. We're seeing more video, more YouTube, Instagram for people getting their news. And in public health, we're kind of behind. We're fighting the last war. And we need to have our messaging that works better. There are some influencers out there who are responsible. It doesn't always mean it has to be 30 seconds or less. People are interested in information. The challenge is how can we identify for people what is reliable and what is not, what is hype and what is fact. And that's hard. I don't think we have a good answer to that so far. Before we go to our last section, which we call kind of fact or fiction, where I'll ask you a variety of questions or maybe more accurately kind of throw out different claims that we've been seeing circulate. I do want to just spend a little bit more time talking about technology. You mentioned earlier in the conversation about open evidence and kind of the extraordinary ways in which responsible AI really built by experts really now is an imperative that experts themselves kind of use And you shared that kind of harrowing story about kind of being the doctor on the plane. And I'm so thankful, having been on a few airplanes where kind of similarly the bell has rung. Grateful that there's always been a doctor on the plane to answer it. just want to know what other kind of tech innovations you might be especially excited about or arguably wary about, you know, thinking about all of the different stories I've seen recently on robotics, including, you know, Dr. Oz praising the use of robots to help deliver ultrasounds to pregnant women in Alabama. What, if any, kind of thoughts, hopes, concerns do you have about those examples and also others in the aegis of technology? So there's a lot that's inefficient, and telemedicine is really important. It doesn't replace hands-on medical care. If you look at our healthcare system, the biggest gap we have in the U.S. and the biggest gap we have globally is primary health care, being able to see a doctor, a team of health providers who understand us and will help us interpret and make a choice that's right for us. And to the extent that new technologies can help with that, great. But, you know, having a robot do something because you don't have enough doctors, because you're not paying enough for primary care, you didn't expand Medicaid in your state, I don't think that's a great solution. At least it may help some people, and that's a good thing. So if it helps extend care, to paraphrase, you think that's a good thing? And also in a moment where we've had such a precipitous decline in kind of trust between kind of patients and providers, we should be doing more to help train and compensate providers so that they actually have the time to build those human-to-human relationships with their patients. Another shocking fact I learned while doing the research for the book, The Formula for Better Health, is a primary care doctor, after 20 years of work, dedicated works, caring for people, will make less than half as much money as a surgeon who graduated yesterday. Wow. Sobering and important, I think, for those of us who care about improving healthcare access and, importantly, health outcomes in our country to know. So just for our last segment, which, again, called Fact or Fiction, I'll throw out some claims and you'll tell us whether they're fact or fiction or if there's nuance. All right, so we already talked about painfully the growing presence of measles in the United States, and I do think it's really important that every parent know the signs of measles. So, Tom, fact or fiction? Measles only spreads after the rash shows up. Fiction. Measles is really infectious. It is probably the most infectious of all infectious diseases. I investigated measles outbreaks where one person who didn't have a rash was in an emergency department, left, and many kids who came in in the following hours got measles from that one person. Wow. You talked about starting your career here in New York City. You also returned to New York City to kind of lead public health efforts in our beloved city. And one of those was trying to lower tobacco use. Americans are smoking less today than ever before. Fact or fiction? Fact. Well, not than ever before, but then at any time since the 1950s. Yes, since we've been alive, I should say. Despite this, tobacco remains the top cause a preventable death in the U.S., fact or fiction? Fact. Fact. I don't think enough people know that. Yeah, it still kills about a half a million Americans a year. That's a lot of people. That's a lot of people. It still causes about a third of all of our cancers, about a third of all of our heart attacks and strokes. So there's still groups in the U.S. that smoke at a high rate, but we are seeing encouraging decreases, but not low enough. Other countries have gotten their smoking rates even lower. One thing that is really encouraging is how low smoking rates are among kids. They're really low. They're in the low single digits. And that is the lowest that's ever been measured. That's super encouraging. And clearly still have more work to do because no kid should be smoking. Hypertension is a risk factor for dementia. Factor fiction. Fact. Big increase in dementia risk and a reduction in that risk with control to 130 or less. dancing can help lower your risk of dimension. Fact or fiction? That is true. That is a fact. You know, for physical activity, do whatever you love to do and do it at least four times a week for at least 30 minutes so you get out of breath. And if that's dancing, more power to you. Studies have shown that people are getting sicker more often today than since before the COVID pandemic. Fact or fiction? I would say fiction. Although that one is a toss-up. In general, health is getting better. We don't see that because the headlines, if it bleeds, it leads. But in general, health is getting better. We've seen a recovery post-COVID. Globally, what we're seeing is for diseases like tuberculosis and HIV, we've seen a little bump in cases and infections because of the interruption in services before or during COVID. And frankly, in the past year, we're seeing a bump because of the abrupt pullout of U.S. assistance in global health with a big increase in malaria for the first time in decades, a decrease in child survival globally. But if you're talking about the U.S. environment, I would say it's quite cyclical what people get sick from with different viruses circulating. We're learning more about allergy and asthma, but that's a more complicated one. I would say that's a maybe. Everyone should be taking some form of supplement for something. Absolutely false. Most supplements are not necessary. I do outline why you might want to take vitamin B12 in my book and in my substack. Most supplements really don't have any value. Another exception is creatine. If you're doing strength training, building muscles, Creatine does support gains in strength and muscle mass, especially in older adults. And it's safe. It's well-studied. And it's a rare supplement that works. But it only works if you work out. We talked about this a bit earlier, but I just want to be clear. We don't eat enough potassium as Americans. Fact or fiction? Absolute fact. We probably have half or even way less than half as much as we should be taking to have a long, healthy life. And interestingly, if you consume potassium, you often will feel more energetic. That's been studied. And I didn't even realize this until very recently. When you increase potassium, it isn't just that potassium is healthy and sodium is unhealthy. But when you increase your potassium consumption, you also increase the amount of sodium you excrete. So it has a double benefit. I feel like that was like chemistry in high school. Absolutely. If people don't like bananas, what would you recommend that they eat? Find high potassium foods that you enjoy. Pistachios, sweet potatoes, yogurt, avocado, tomatoes, mushrooms. There are lots of high potassium foods. It's not so simple because there's bioavailable potassium versus total potassium. It matters how you cook the foods, but basically fruit and vegetables. There's no strong evidence that cold plunges boost immunity long-term. Fact. Absolute fact. I mean, cold plunges may be exciting, but there's no evidence for a long-term health benefit. Zero. That doesn't mean there isn't any. Just to be very clear, there's an old saying, the absence of evidence is not the evidence of absence. One of my favorite sayings. But no, it's fiction. But when I ice my feet after the marathon, that's not harmful to me. No evidence that that hurts and hope it makes you feel better. And congratulations for running a marathon. Tom, thank you so much. Is there anything that we should have talked about that we didn't? Well, going back to your first question, you asked me what were the most common questions I got in traveling to a dozen plus states and giving dozens of talks. I talked about where to get more information, but the other main question I got is, how can we maintain hope? How is it possible, given all of the challenge that we have, to continue to be hopeful? And I think, frankly, there's plenty of reasons to be hopeful. We do have better technology than ever before in human history. We've been in hard times before, although we are seeing unprecedented attacks on public health. But facts are stubborn things. Facts are on our side. And facts are powerful. And even if they're ignored, twisted, or suppressed, they're still facts. And one of the facts is that people want to live a long, healthier life. And by seeing the invisible, believing that we can make what seems inevitable actually much better, and working together to create a healthier future, we can have a more connected society, longer lives, lower healthcare costs, and feel better for longer. Tom, Dr. Frieden, thank you for leaving us on an optimistic note. Thank you so much for coming on. And I hope that we get to continue this conversation over the hopefully long road ahead. Thank you just so very much. Thanks so much. It's been a real pleasure to speak with you. Thanks for doing this. And thanks to those of you who are listening for listening. Thank you. You can follow Tom Frieden at DrTomFrieden on Instagram, and his organization is called Resolve to Save Lives. Thanks for listening. Talk to you next week. That Can't Be True is a production of Lemonada Media and the Clinton Foundation. The show is produced by Catherine Barnes. Mixed in sound design by Ivan Kuraev. Kristen Lepore is Senior Director of New Content, and Jackie Danziger is VP of Narrative and Production. Maggie Crowl-Shore is our Managing Director of Partnerships. Executive Producers are Jessica Cordova-Kramer, Stephanie Whittles-Wax, and me, Chelsea Clinton. Special thanks to Erica Goodmanson, Sarah Horowitz, Francesca Ernst-Kahn, Caroline Lewis, Sage Spalter, Barry Leary-Westerberg, Emily Young, and the entire team at the Clinton Foundation. you can help others find our show by leaving us a rating and writing a review and if you can think of someone who might benefit from today's episode please go ahead and share it with them there's more of that can't be true with lemonada premium subscribers get exclusive access to bonus content when you subscribe on apple podcasts you can also listen ad-free on amazon music with your prime membership