MTT #110: Peptides, politics & the perils of medicine without evidence

0:11Dr. Robert Pearl: Hello and welcome to Medicine the Truth, one of the four weekly podcasts in our Fixing Healthcare podcast series. I'm Jeremy Corr, host of the Popular Books of Medicine podcast and CEO of Executive Podcast Solutions. With me is Dr. Robert Pearl. For 18 years, Robert led the Permanente Medical Group, the nation's largest physician. He's a healthcare contributor at Forbes, bestselling author and professor at both the Stanford University School of Medicine and Business. His most recent book, Chachi PTMD, How AI-Empowered Patients and Doctors Can Take Back Control of American Medicine on the Impact Generative AI Will Have in Healthcare, remains a bestseller.

0:41Dr. Robert Pearl: Information on a range of medical topics can be found on his website, robertperlmd.com. Robbie, peptides have become one of the hottest topics on social media. Many listeners aren't sure how effective or safe these eight drugs are. With FDA now debating whether to make access possible to the United States, can you provide some scientific perspective on the substances?

1:00Jeremy Corr: Jeremy, we could do an entire Medicine the Truth on this topic, but I'll try today to provide a first level of understanding and provide some details about these substances. Listeners should know that we are recording this program on Thursday, August the 20th, and circumstances could change between now and when we'll post five days from now. However, at this point, an advisory committee, with many of the members appointed by Robert F. Kennedy Jr., has weighed in and narrowly recommended allowing compounding pharmacies. These are pharmacies that make and sell specialized medications, ones that doctors prescribe, allowing them to provide six experimental peptides to patients.

1:41This recommendation is different from traditional FDA approval of new drugs in that the agency doesn't actually evaluate the medications themselves, but instead simply allows suppliers to provide the peptide

1:57Jeremy Corr: ingredients necessary for the compounding pharmacies to fill the prescriptions. But in practice, if the recommendations are approved by the FDA leadership, many patients will assume that similar approval has been granted to peptides as to other drugs. And most likely, if implemented, then the type of rigorous scientific studies needed to assess efficiency and safety, they won't be done. The reason is that for the businesses that currently promote these experimental peptides and the doctors who prescribe them, there would be little to be gained if unbiased research were done and there would be much to lose.

2:33Jeremy Corr: Although the FDA commissioner can follow the recommendations or choose not to do so, once the advisory group recommends moving forward, almost always that's the path that's taken. And with RFK Jr., the current head of HHS, being such a strong advocate for peptides? It's likely that he will say yes. Critics of the decision point out that more than half of the advisory group that RFK Jr. recently appointed came from the peptide industry, and they potentially will benefit financially if final approval is granted. Analysts estimate that in total, the peptide industry would benefit by an estimated$2 to$3 billion if approval were given.

3:16Jeremy Corr: And they point out that the advisory group's recommendations contrasted sharply with the opinions of the FDA scientists and the staff, who felt that these peptides should not be approved due to unresolved concerns about safety and clinical efficacy. The argument of support is that people are already obtaining peptides from China, over the internet, and through the gray market, where there are minimal or no regulations and poor quality control. Critics counter that the FDA approval will drive user volume up dramatically, and that could put millions of Americans at added risk compared to today.

3:55Dr. Robert Pearl: Robby, can you provide more details on peptides and how these substances are being used today?

4:00Jeremy Corr: Jeremy, the best place to start is by noting that peptides are very similar to proteins. Both are made up of a series of amino acids, and they support biological functions of the human body. The biggest difference is the number of these building blocks that are required. Peptides, these are short chains, usually between 2 and 50 amino acids. In contrast, proteins, they're massive in size, with hundreds or even more than a thousand amino acids included. As a result of their size, proteins fold into complex 3D structures, which are central to their function. Peptides, particularly the very small ones, they tend to be much simpler in structure.

4:43Jeremy Corr: Hundreds exist naturally in the human body, including oxytocin. It only has nine amino acids, and it's vital in labor and breastfeeding. And the currently recommended GLP-1 weight loss drugs are also peptides, but these are FDA approved. Because amino acids are broken down during the digestive process, most peptides must be injected. Although, as we've noted in this podcast, there are now GLP-1 pills that can circumvent that restriction. The six peptides that currently are being recommended are often promoted by influencers, trainers, and some clinicians to promote longevity, boost overall health, reduce inflammation, improve muscle recovery after exercise, and assist with sleep.

5:31Jeremy Corr: However, so far, there's a paucity of scientific studies to justify these claims, with almost all the evidence coming from animal studies, particularly ones in mice, or small human trials, but without comparable control groups.

5:47Dr. Robert Pearl: Since many listeners may be considering using one or more of these six peptides, can you describe why they are promoted in the scientific evidence to data?

5:54Jeremy Corr: The first one that the committee voted to include for compounding was BPC-157. It's often recommended for the treatment of ulcerative colitis and other GI inflammatory diseases. Three studies have indicated a potential positive impact, but in two of them, there was no control group, and in the third, no peer review of the data. And there are FDA reports of allergic reaction, with several of the patients who received the peptide, having to obtain ER treatment to treat the allergic episode. The next is KPV. It's a hormone that's derived from the pituitary gland, and it's usually applied as a creamer gel to the skin to promote healing and treat inflammatory skin conditions.

6:40Jeremy Corr: Proponents recommend it as a means to strengthen the immune system. Most of the evidence is based on studies in mice and demonstrate potential anti-inflammatory properties. However, one recent study showed this peptide wasn't effective at penetrating the skin, which would imply that it would be completely ineffective if people applied it to their bodies. The third is TB500. This is a peptide that's used by people with the hope of improving healing. Supporting this direction is one mouse study, with another study showing no improvement. There's no safety or efficacy research on this peptide, relative to humans.

7:18Jeremy Corr: The fourth is MOTS-C. This is a peptide derived from mitochondrial DNA, and it's different from the more commonly studied nuclear DNA that's responsible for genetic inheritance. This peptide is promoted for obesity and for treatment of osteoporosis. But as for the TB500, there's no published research studies on humans relative either to efficacy or safety. The fifth peptide that the advisory committee recommended was epitalon, a substance extracted from the pineal glands of cattle that supposedly helps people with insomnia. Its mode of action is hypothesized to be regulating circadian rhythms.

8:01Jeremy Corr: However, the most common use of this experimental peptide is as a means to allow patients to increase longevity. And the basis for this indication is that the peptide is thought to lengthen telomeres. This is a part of the DNA chromosome that shortens with age. Although there's some data from animal studies as this telomere lengthening may happen, there are clinical concerns about this approach, since the process of telomere lengthening has been associated with higher cancer risks. As such, the peptide could be carcinogenic with prolonged use. We just don't know. The sixth peptide that the committee recommended be available to compounding pharmacies was CMAX for impaired brain flow, migraine headaches, and facial pain.

8:53Nearly all the information on this experimental peptide comes from studies in the Russian literature with

8:58Jeremy Corr: incomplete data. The one U.S. study that showed a potential improvement for migraine sufferers had a total of 12 subjects and no control group. Robbie, which peptide failed to be approved? Jeremy, emideltide was the one peptide not approved. The reason for this rejection was unclear, although this peptide is rarely used by people today. Proponents believe that it could be helpful relative to sleep. It's been promoted for chronic insomnia and for narcolepsy. The peptide can be found in the brain, and its mode of action is thought to relate to our circadian rhythms. In studies involving small numbers of participants, ones done in the 1980s, IV infusions of the peptide seem to help people fall asleep quicker and stay asleep longer.

9:47Jeremy Corr: However, none of the studies was in a placebo group and there's not been any published data on complications. Jeremy, when you put all the research together, I can't find any studies that would meet the academic requirements of publication in a well-respected peer-reviewed journal. As such, I don't want to tell listeners that these peptides are dangerous, but I also want to stress that we just don't know if they actually make a positive difference or how safe they may be. And none of these experimental peptides has completed the three-step clinical trial requirements needed for formal FDA review.

10:28Jeremy Corr: The idea of allowing compounding pharmacies to obtain these peptides from suppliers and to sell the drugs to patients is that the physician would be in the middle of the process and responsible for deciding that the drug was appropriate and safe. And the clinician could stipulate the exact dose to be given. But of course, without any scientific studies, it's unclear how clinicians could make these determinations with confidence for individual patients. Hopefully listeners understand how these advisory committee recommendations differ from formal FDA approval. On one level, this approach is less of a green light to prescribe the experimental peptides than when the FDA gives a formal approval for medication.

11:14Jeremy Corr: However, on another level, this means these peptides can be prescribed by doctors for a huge range of indications and applications, and that no subsequent studies of efficacy and safety would be required. As I mentioned earlier, I worry that clinicians and patients will never know if these experimental peptides are beneficial and safe. If they work, more Americans should be on them. But if they don't and the risks are too great, doctors need that information to advise patients who request a prescription. As such, if the FDA wants to give its blessing to expanded access, our nation will remain in the Wild West relative to peptides for years, if not decades, to come.

11:58Dr. Robert Pearl: Jeremy, what do you think the FDA should do?

12:00Jeremy Corr: Jeremy, I haven't seen all of the evidence available on either the safety and efficacy of these six peptides. That's what the FDA staff does full-time and the advisory committee does at its meetings. But I do have strong feelings that simply saying either yes or no would be a mistake. I believe that if the FDA leadership greenlights the advisory committee recommendations, it should pair access with participation in research efforts. That's the only way we're going to understand whether they work or whether they're safe. For example, if compounding pharmacies are going to fill the prescriptions for patients who are currently using one or more of these experimental peptides, the recipients should be expected to report complications to the FDA.

12:49Jeremy Corr: And for people who want to use one of the six for the first time, I'd enroll them in a research study, maybe one done by the NIH, to assess efficacy and safety. After one year, the FDA wouldn't have all the information that we need to be fully certain about these experimental peptides, but we'd have exponentially more data than today. Both of these types of requirements to report complications and be given the drug in their research program, they've been used by the FDA for the benefit of our nation's health for other drugs, and I believe that it could be applied to these six peptides.

13:29Dr. Robert Pearl: Listeners appreciated your update in the last Medicine the Truth episode on the parasite cyclospora that has infected people. Would they like an update on the topic?

13:38Jeremy Corr: First, the good news is that the number of new cases is slowly falling. The bad news is that the total is very high, and we still don't know for certain the exact origin of the outbreak. Michigan, which has been the epicenter, has experienced approximately 13 ,000 documented or presumed infections, with almost 300 hospitalizations and two deaths. The two people who died had compromised health, and they likely succumbed from dehydration and other consequences of the infections. These Michigan cases account for approximately half of the nation's 25 ,000 to 30 ,000 documented or medically assumed cases this year.

14:16Jeremy Corr: But I want listeners to know that in total, some people have estimated the actual number of cases, they could be as high as one million since so many infections are less severe where patients never come for medical care and recover on their own. As new cases have fallen, regulators in Michigan no longer are cautioning residents against buying bagged lettuce. The main reason for the declining cases appears to be that Taylor Farms, remember this is the company associated with this outbreak, that the Taylor Farms have already recalled all the lettuce grown in central Mexico, which is believed to be responsible for the current epidemic.

14:55Jeremy Corr: At the same time, new cases are popping up in six more states. There's now a total of 15 states with documented infections. Testing indicates that these newly infected individuals have the same strain of cyclospora as we discussed in the last Medicine of the Truth episode, and therefore most likely share a common source as the origin of its cases.

15:19Dr. Robert Pearl: A couple of episodes ago, you mentioned that President Trump has nominated Dr. Erica Schwartz as the new CDC director. What has happened to her nomination since then?

15:28Jeremy Corr: Earlier this month, the Senate voted to confirm Dr. Schwartz. Given the political nature of these confirmational hearings, the vote is a testimony to the excellence of her credentials and the breadth of her experience. And as shocking as it may sound, this is the first time in a year and this violent agency has had a full-time director. The vote was along party lines with one Democrat supporting her nomination. Listen, they remember that she was the deputy surgeon general in Trump's first term. She's a retired rear admiral in the U.S. Public Health Service. In this new role, we can expect that she'll face huge problems leading an agency that has had a full-time director for a total of one month out of nearly two years and has seen approximately one-third of its staff resign.

16:18Jeremy Corr: And she begins in a complex global medical environment, increasing number of life-threatening infections, outbreaks around the world, including Ebola in Africa, and both cyclospora and measles in multiple states in the United States this year. Although Dr. Schwartz is a supporter of our nation's vaccine programs, she'll be forced to confront ongoing efforts by RFK Jr. to weaken vaccine requirements and to find a link between vaccines and the rise in the number of cases of autism. And that's despite sound scientific research that concludes that there is none. I don't envy the challenges she will face in her new role or the massive amount of political pressure that she will experience.

17:02Jeremy Corr: And she starts with a depleted team, given the massive number of highly qualified individuals who have stepped down from their roles and exited the CDC, the FDA, and the NIH for less politicized and contentious jobs. Rami, what about a third follow-up story? Jeremy, last month we talked about the growing risk to kids from e-bikes. We now have data. An article published in the journal Injury, researchers from Johns Hopkins Children's Center tallied the cases reported to the National Electronic Injury Surveillance System of ERs, found that from 2020 to 2024, this is a period in which EI banks were used far less than today.

17:45Jeremy Corr: There were 2 ,117 pediatric e-scooter injuries, including multiple deaths, and use has risen significantly over the past two years, although the exact data isn't yet available. Although some states like California now prohibit use of Class 1 and Class 2 e-bikes that can travel at speeds up to 20 miles per hour, and they prohibit the use by kids under the age of 12. There's no data on how well these laws are being followed. Moreover, many states don't yet have any age restrictions. As the number of injuries sore and deaths mount, we can expect that the number of places that restrict use of e-bikes in very young kids, that too will rise.

18:26Jeremy Corr: The big question is how many kids under the age of 12 need to die before states and federal agencies act.

18:34Dr. Robert Pearl: Rebi, how about a new study that you think has major medical implications?

18:38Jeremy Corr: Jeremy, there's a new study from Stanford that will have massive healthcare implications, although as of yet, it's uncertain whether that will be positive or problematic. Scientists have used AI for years in research on viruses. What makes this new work important is that rather than applying information that AI provides to understand and to replicate and create viruses that already exist, the Stanford researchers discovered and created new viruses. These are ones that have never been found in nature. And that ability simultaneously opens the door to new infectious disease treatments. But it also risks bad actors using similar gen AI tools to invent dangerous pathogens, ones that don't currently exist, and then to spread them.

19:25Jeremy Corr: In this study published in the medical journal Science, the researchers reported that an AI tool was first trained to recognize the DNA patterns in existing viruses, and then prompted to use that information to design new ones. But it's one thing to come up with a theoretical design. The question the researchers want to answer is whether the resulting organisms would be able to survive and replicate. And the answer is yes, they could.

19:55Dr. Robert Pearl: I know many listeners will want to know more details. Can you provide a basic understanding of the process that scientists use and what made it unique?

20:03Jeremy Corr: I'll give it a try. The AM model, called EVO, functions similar to a large language model like Chats, GPT, Clutter, Gemini. Like an LLM, it's trained on a massive corpus of information, and it's taught to recognize patterns and then make predictions using that information. To understand the process that the scientists used, remember from a previous episode that our DNA is structured like words, although there are only four letters, A, C, G, and T, in the language of DNA, not the 26, as in the English language. The scientists knew that there had to be a foundational language for life that had to be built into every living creature or organism.

20:48Jeremy Corr: So they hoped to have a generative AI application to discern it. Rather than providing specific rules, they provided a massive number of examples of DNA from living organisms. You might think of it as similar to how babies learn. Parents don't provide the child with lists of specific words. They don't give them definitions and grammar rules to apply. Instead, children learn by listening to thousands of conversations, and they figure it out on their own. To accomplish this goal, the researchers provided EVO with the genetic sequences from millions of viruses, bacteria, animals, and plants. In total, the application reviewed approximately 9 trillion nucleotides.

21:31Jeremy Corr: This is a task way beyond an entire lab of researchers could accomplish in a lifetime. What happened next? The AI application was able to recognize the patterns that bridged all of these genetic maps. And the next step was having to use them to create new organisms. The researchers decided the best place to start would be with the least genetically complex organisms. These are viruses. For comparison, human DNA has over 3 billion nucleotides, while the DNA virus, a few thousand. But this information is the foundation. The researchers then did a second round of generative AI training, this time in 15 ,000 viruses, ones that were genetically related and had been used and studied in research labs for decades.

22:22Jeremy Corr: Each of these specific viruses have only 11 genes, and none of them are capable of infecting people. Based on that training, Evo created 700 ,000 potential blueprints for new viruses, ones that don't currently exist. The researchers then selected 285 that looked most promising. They then created each of these 285 in the laboratory and injected them into bacteria that were growing in petri dishes to see what would happen. In most cases, injected virus did nothing, and the bacteria just continued to multiply with little evidence that anything was different than usual. But they noted that in one of the petri dishes, they could see dots surrounding the bacteria, indicative of viral replication and survival.

23:12Jeremy Corr: As they tested more of the genetic options that Ivo had suggested, they found 15 more viruses that produced similar petri dish findings and confirmed biological life. And contrary to the hypothesis that these AI-generated viruses wouldn't be as viable as the ones that nature had produced through the process of survival of the fittest, many appeared to replicate faster than those that already existed. How might clinicians use this information? This is where the scientific research becomes promising. Already there's growing resistance to antibiotics for bacterial infections in humans. Across the world, millions of people die each year from bacterial infections, for which there are no effective antibiotics at this time.

24:00Jeremy Corr: Imagine creating a viral genotype that could not only replicate in bacteria, but kill the organism. But of course, someone with intent to harm could ask Evo, or a future more powerful application, to build a virus that could infect not bacteria, but humans with lethal consequences. That's why scientists didn't use any virus that was capable of infecting plants, animals, or humans. But that doesn't mean that another lab somewhere in the world couldn't do it. But before listeners become overly fearful, researchers believe that humanity has time. The reality is that there already exists a variety of toxic substances and biological organisms that could inflict similar lethal harm in people and would be far easier and cheaper to obtain or make than these AI -designed viruses.

24:53Jeremy Corr: However, in a commentary published alongside the one on this scientific breakthrough, two health security experts from Johns Hopkins wrote, quote, the ability to compose viral genomes using generative AI now exists. The governance to safely steer it does not.

25:12Dr. Robert Pearl: Robbie, that viral research is pretty exciting, amazing, and scary. What else do you have in the infectious disease category?

25:18Jeremy Corr: Jeremy, the biggest viral news is the outbreak and growing epidemic of Ebola. We're talking about it in the Democratic Republic of Congo. And it's not good news. This is the second worst Ebola outbreak in history. And it continues to spread faster than any of the ones in the past. Already the country has experienced 1 ,500 deaths. That means around 500 people have died on average each month since the beginning. And that rate of increase, it's five times faster than previous Ebola strains. Some public health officials predict that by the time the current outbreak is fully controlled, it will exceed the mortality from the worst previous one, an epidemic that killed 11 ,000 people in the years from 2014 to 2016.

26:10Public health officials in Congo report almost 3 ,500 total cases to date.

26:16Jeremy Corr: And when you do the math, 1 ,500 deaths would constitute a 40 to 50 percent mortality rate. The best way to control the disease currently is through case identification and contact tracing. In adjacent Uganda, this allowed the Ebola spread across the border to be identified almost immediately. And there was a total of only 20 deaths. And now there's been complete eradication. and it happened in a matter of weeks. For a variety of reasons, including ongoing civil war in parts of Congo, identification has been delayed, and the virus was able to spread wildly. And that's why officials are so worried.

26:56Among recent cases in Congo, 80 % of these could

27:01Jeremy Corr: not be traced back to a known contact. Based on previous outbreaks, people living in an urban area exposed around 40 people on average. This gap in case identification means that rather than being around 18 ,000 people who public health officials believe currently are at high risk of developing disease, there may be close to 140 ,000. You can see why public health leaders are so fearful of what will happen next. A major problem with Ebola is that doctors don't have any current vaccines to prevent infection or drugs to treat patients who become infected. However, scientists at Oxford University are working to develop a vaccine, and clinical trials of it are set to begin this month, with 50 individuals now being vaccinated to confirm the safety of the vaccine.

27:53Jeremy Corr: And a Singapore research group is developing a second vaccine, one based on a related species to the one that's currently infecting people in Congo. What's happening in this large African nation is eerily reminiscent of the early days of COVID-19 in the United States, when officials were continually behind what the virus was doing.

28:14Dr. Robert Pearl: Robbie, how about a third virus story, hopefully one that's more positive than the one from Africa?

28:19Jeremy Corr: Jeremy, there is one for the United States. The FDA recently approved the first mRNA vaccine for flu. Developed and manufactured by Moderna, this is one of the companies that created the COVID-19 vaccine. It will be recommended for adults 15 and older. Most Americans don't pay much attention to the influenza virus since it's been around for so many years. But what they may not realize is that 30 to 40 ,000 people die annually from the flu. And we're talking also about hundreds of children. Every virus has its own story. And when it comes to the influenza virus, the challenge is the unpredictability of its genetic makeup year after year.

28:58Jeremy Corr: All the best scientists can do is observe what happens in the southern hemisphere We're talking about in their fall and winter, which is our spring and summer. And then assume that the virus, when it reaches us eight months later, will be the same. But the influenza virus mutates frequently, and often the variant that arrives ends up being very different than what vaccine manufacturers had predicted. And as such, the vaccine, the one that had been prepared, isn't very effective. That's why using mRNA technology is so promising. Since the vaccine can be developed and manufactured much faster, the decision on its composition can be delayed until the virus is much closer to our shores.

29:38Jeremy Corr: As an example, in 2024 to 2025, the experimental mRNA vaccine for influenza was 27 % more effective than the standard flu shot, and the vaccine proved equally safe.

29:55Dr. Robert Pearl: How does an mRNA vaccine differ from a traditional one?

29:58Jeremy Corr: Jeremy, remember that our proteins in our body are manufactured not in the nucleus of the cell, but in the cytoplasm. And messenger RNA is what brings the information from the nucleus to the ribosome in the cytoplasm. So rather than, as in traditional vaccines, first having to grow the virus, that's usually done in eggs, and then weaken or kill it, as well as test it before it can be injected into people, scientists simply identify the structure of the virus. They find parts that are distinct from humans. They identify the proteins that make up that viral fragment and reverse engineer them to the underlying DNA and subsequent mRNA.

30:45Jeremy Corr: Now they have the blueprint and they can build the mRNA to instruct the ribosome on the protein that they desire be created. As such, rather than injecting the actual viral protein, the mRNA vaccine contains the instructions to build pieces of those proteins. These are the blueprints that we just said for the small fragments of the virus. And once injected, the ribosome then makes the protein, the recipient's immune system creates an immunological response to what it now perceives as a foreign invader, and we have biological protection as the immune system, when the immune system encounters it for a second time following infection.

31:30Jeremy Corr: And since the protein that is responding to isn't found in humans, the vaccines are safe and they're effective. But what we've seen in Trump's second term is that politics have intervened several times. This is, and may remember from a previous Medicine the Truth episode, that when Moderna first submitted a request for the FDA to review and approve its mRNA vaccine for the flu, the FDA refused to even consider it. The decision was broadly criticized as political, and subsequently, under pressure from public health officials. It was reversed. And in June of this year, an independent vaccine advisory panel, where the majority of both physicians and vaccine scientists unanimously voted that the benefits of this mRNA vaccine against the flu outweighed the potential risks in adults 50 to 64, and potentially for adults 65 and older.

32:29Jeremy Corr: Following that unanimous advisory group recommendation, RFK Jr. replaced all of the committee members with new ones, including many vaccine skeptics. A federal judge then ruled that RFK Jr. hadn't followed federal legal procedures, and since then, no committee has met. Now with final approval given, the mRNA vaccine should be available this fall. Other companies with mRNA expertise, like Pfizer, are expected to request FDA approval for their vaccines in the near future, and an mRNA vaccine against both the flu and COVID was recently approved in Europe. Unfortunately, the political challenges extend beyond the FDA.

33:13Jeremy Corr: Listeners may also remember that last fall, the government decided to cancel funding for mRNA vaccine research, including studies that could be used to prevent cancer and fight AIDS. Claiming the artifact of RFK Jr. in the Health and Human Services Department canceled 22 projects and half a billion dollars of grants. The result of each of these non-scientific interventions is cumulative. If they continue, the United States is likely to seed pharmaceutical leadership to China and potentially other nations that are welcoming our best scientists and funding their research. To show the short-sightedness of this politics over science, let me note that yesterday, Moderna announced that it developed an mRNA vaccine that could prevent melanoma, the deadliest of the skin cancers, from coming back after the surgery.

34:05Jeremy Corr: At this point, Jeremy, we don't have the actual scientific data, so I plan to wait for that before discussing the details on medicine, the truth. But a vaccine against cancer has been a focus on Moderna for over a decade, long before COVID-19 arrived. Think back three years. In 2023, two Americans were awarded the Nobel Prize in Medicine for their work developing the mRNA vaccine for COVID-19. I worry if the current government and social media-driven, unscientific approach continues, we can expect fewer and fewer Americans to receive these awards in the future. As research funding dries up, the best scientists from the world, they'll decide they don't want to come to our shores, and they'll simply go elsewhere.

34:55Jeremy Corr: Robbie, any final thoughts for our audience? Jeremy, I was shocked last month when Trump issued an executive order, one that changed the vaccines that would be recommended for kids and the schedule in which they would be administered. It's hard to believe that millions of people would have more confidence in his recommendations than ones coming from clinical experts located in scientific agencies and national medical societies. But that's today's reality for millions of Americans. Preventing scientific progress is a prescription for harm. And linking his presidential order around vaccines to autism was both foolish and highly unscientific.

35:40Jeremy Corr: There are dozens of excellent studies disproving the myth. We discussed in the past some of the president's efforts to lower the total number of vaccines and spread their administration apart. But the most absurd part of the executive order was requiring that the MMR vaccine, this is the measles, mumps, and rubella, that would be given as three separate vaccines. In an Oval Office signing event, the president said that MMR vaccine, quote, together, there could be a possibility they're quite lethal. When he was pressed about this comment, he acknowledged that he had no evidence, but he said, some people say it is that way.

36:25Jeremy Corr: There's no scientific evidence that I've ever seen confirming this view, and numerous studies showing the complete opposite. The vaccine is effective, safe, and it saves many lives every year. When it comes to most decisions that presidents are required to make on national financial risks and global threats, there are no objective ways to answer the thorniest questions. But medicine is different. Of course, some decisions are subjective. And in that case, just about anyone can have an opinion. But when the data is overwhelming, you better have evidence to support deviating from the conclusions.

37:04Jeremy Corr: Even if you don't have data, you need to know the facts. And when it comes to splitting the MMR vaccine into three individual injections, the hurdles of doing so, the hurdles of requiring that it be done, will seem and be impossible for doctors to get over, at least in the short term. These single shots, they don't even exist in the U.S. market today. Creating them would require new FDA approval. Moreover, the recommendation to give only one shot per visit would mean that even though fewer vaccines would be given in total, doctors would need to administer more injections to children and force parents to come to their office more often.

37:43Jeremy Corr: This approach will make it harder for families wanting expertise for acute problems to be seen and increasing the demands on parents who are already overwhelmed by the combination of work and family. In Japan, we're splitting the MMR vaccine into this component parts which tried. it was a disaster, with vaccination rates plummeting and infectious disease rising across the nation. The good news, Jeremy, is that legally the president will find it nearly impossible to implement this executive order, since Congress has designated the advisory committee of the CDC as the deciding body, and the decisions around requirements for entering school are clearly the domain of states.

38:23Jeremy Corr: As we discussed throughout today's episodes, making medical decisions based on politics, not science. They invariably result in harm and unnecessary deaths. But that's where our nation seems headed. And as a doctor, a father, and an American, it saddens me.

38:42Dr. Robert Pearl: As a reminder to listeners, this episode is available on our website, FixingHealthCarePodcast.com, and on all podcast apps, including Apple Podcasts and Spotify. If you like the show, please rate it five stars and leave a review and share it with your friends and family. To submit a question or comment to the host, please visit the contact page on our website or send us a message via LinkedIn, Twitter, or Facebook. Thank you very much and have a great day.