Meidas Health, Episode 13: Trump's First Surgeon General Speaks Out

0:00Hi, Mighty Smitey. Welcome to episode 13 of Midas Health. This is a great episode that we have in store for you. I have my first co-host, Anjalee Khelmani of Yahoo News. She's a senior health reporter for Yahoo News, a dear friend. We also have one of our country's most distinguished healthcare leaders, Dr. Jerome Adams, the 20th Surgeon General, here to talk about all matters, health and health policy. Without further ado, I'm going to bring in Dr. Adams and Anjalee. Thank you both for being here. Hey, glad to be with you today. Same. Awesome. So for our listeners here, Anjali is joining me as a co-host for this episode.

0:35I think we're going to try this out. Just given that one person often isn't enough to really make sure that we're answering and are asking all the right questions. So Anjali, I really appreciate you being here. I don't know what that's about me, guys, that you needed two people to ask me questions, but we'll see how this goes. I know, I know. You're going to feel all the pressure. I can't wait for this. I'm so glad. Thank you so much, man. Yeah, I'm delighted. You know, first of all, Jerome, I know it's been a pretty sobering week. You've been quite outspoken. I just wanted to give you the floor to speak to our listeners about how you're doing.

1:14Well, I'm feeling okay. I'm hanging in there. To give context, because you never know who's going to be listening to this or when, last Friday on August 9th, a gunman opened fire at the Centers for Disease Control and Prevention headquarters in Atlanta. And at least as far as preliminary reports, they suggest that the shooter may have been motivated by anti-vaccine sentiment. So I'm very concerned that this tragedy isn't an isolated event. I see it as a reflection of ever escalating threats public health workers face in a climate that's being shaped by misinformation, politicization and inflammatory rhetoric.

1:56And unfortunately, much of that is coming from our current health leadership. So I'm in a moment where I'm fearful as a public health worker and someone who every day is going into the hospital or going into the clinic or going into to work at Purdue University trying to improve public health. I'm concerned for my friends and colleagues at the CDC, at the NIH, at the FDA. And I'm concerned for our country and our citizens because we're in a moment where instead of tamping down the rhetoric and really trying to bring people together, it seems that our current health leaders are intent on throwing gasoline on the fire.

2:42An example of that is this event happened on Friday. It took 18 hours for our health secretary to issue a statement on Twitter condemning the violence. But as I said very publicly, it was a tepid statement that literally excused people if they felt like the CDC and the federal government was not serving them. It gave them an out in terms of the violence. And in the meantime, the secretary posted pictures of him fishing, but didn't say no violence, didn't say I support the people I'm supposed to be leading at the CDC. didn't say this is unequivocally unacceptable. And then you had the NIH director, the current NIH director, Dr.

3:33Bhattacharya, on earlier this week, Monday or Tuesday of this week, put out an op-ed doubling down on, quite frankly, falsehoods regarding mRNA vaccines. And so I don't want to take up all of our time talking about this, but literally people are being shot at And at least one person, the officer who responded to that attack, David Rose, was killed because of this current environment that we're in. Jerome, I wonder, I mean, considering that you have been part of a prior administration with, you know, Trump in the hot seat, you yourself have been part of the health leadership before. How does this term differ from what you experienced?

4:24Because there was a lot during COVID. There was a lot of anger and there was a lot of frustration from the public. But I don't think it manifested in the way that we're seeing now. Well, there's a saying in politics and in life, never waste a good crisis. And I don't want to oversimplify things, but I think a lot of people politically have tried to leverage our once in a century pandemic, which would have been difficult by any measure to deal with into a political advantage. And to be frank, both Democrats and Republicans have done this. Alternatively, I was just doing an interview where I pointed out that in 2020, the two highest profile people to say they wouldn't trust the vaccines were Kamala Harris at the vice presidential debate.

5:19and Governor Cuomo of New York City, who literally said, I'm going to not trust the FDA on this. I'm going to stand up my own review committee before I say COVID vaccines are safe for the people of New York. Now that said, what you're seeing right now is a climate where politics is about pulling together coalitions to get to 51%. And the current administration has pulled together a coalition of folks who were in the MAGA camp who are traditional conservative Republicans. And there's a big difference between those groups. But then also a coalition that includes what are now self-described as Maha, the Kennedy followers.

6:04And they're a very interesting constituency because Kennedy started off running as a Democrat. And then he shifted to be a third-party candidate. And he found that the best way to advance his agenda was essentially to assimilate into and co-opt the Republican Party. And in many ways, that's what's happened from a health standpoint. So you ask what was different. What was different is in the first administration, there were debates about health and health policy. But there were never debates about whether or not we trusted vaccines. uh donald trump uh trusts vaccines he's vaccinated his kids are vaccinated i've had conversations with him about it hhs secretary azar um during the first administration when we had a measles outbreak said unequivocally um vaccines work they are safe and people should get vaccinated these were things that we actually saw our leaders um do and say and emulate um in the first administration.

7:05And now you're seeing RFK being given permission to do whatever he wants. Trump said, I'm going to let RFK run wild on health. And he's holding true to his word right now. You saw the Advisory Committee on Immunization Practices get disbanded and replaced by people who have a history of profiting off of misinformation, Robert Malone, who was named to that committee after the CDC attacks, said very provocative things about public health workers and really doubling down on the dangerous rhetoric. And that's someone who'd been named to replace the people on the ACIP committee. He unilaterally removed recommendations for pregnant women to get the COVID-19 vaccine.

7:58He pulled$500 million in funding for mRNA vaccines, which doesn't just affect vaccines. mRNA technology is being used to develop chures for cancer and rare diseases like cystic fibrosis. And so, again, you're really seeing RFK coming forward with a lot of what he's been doing and saying for well over a decade as the head of an anti-vax group. But it's being put into the mainstream because he's now the most powerful person on the planet in terms of health. And when you look at the influence and the financing that HHS has. Right. And I know we've talked about that broadly. You know, in the past, there have been discussions.

8:43We've been talking, you know, as a society and as a country about the decrease of interest in vaccinations. So I'm curious about, you know, the rest of the leaders you called out, Dr. Bhattacharya. I know that there's also Mari Makari over at FDA. There are others who are surrounding him right now in reference to RFK. And I just wonder, having been in the position yourself where you may not fully agree with the leadership and those who are, you know, on the ladder above you, you've been more vocal now than in the past. What can you tell us about putting yourself back in that position about maybe what is the priority in terms of keeping your position and trying to do as much as you can in that seat versus disagreeing and going out on a limb and kind of defending your position?

9:35Well, it's a great question. And it's a question I get from audiences and people who are interested in leadership roles all the time. And what I say is every job has guardrails. Every job, you have a boss. Every job is going to have pros and cons. And when you think about these major health positions, you go in and they're political appointments. So, number one, if you want to get the job and keep the job, that doesn't happen by you going out there and literally just setting fire to the platform of the party and the person who brought you in. That is just a fact. I deal with that, you know, dealt with that when I was in general.

10:21And I deal with that every day when I'm working as a anesthesiologist in the hospital. I can't go out and say my boss sucks and this institution is doing terrible things. Now, that said, I tell you personally that I have said to to to to people above me in the past, I will never lie to you and I will never lie for you. And I'm proud to say that I I I held up to that standard throughout my time serving the Trump administration. and I've worked for three Indiana governors and I've said that, meaning I'm going to tell you the truth behind the scenes so that you understand where I'm coming from because my job is to be your health advisor.

11:07I also understand that the final decision may not come down to what I say is best from a health perspective because everything has multiple variables. So COVID is a great example of this and a lot of the frustration around COVID. People die if you don't take COVID precautions. That's a fact. People also die if you go overboard with COVID precautions and you shut down their opportunities to earn an income and they can't put food on the table. They can't pay their rent. Those are very real trade-offs. And so I say that because you're not always going to get your way, But for me, it was always about do I have the opportunity to give input?

11:48And if you decide something different than what I tell you, then don't expect me to go out there and defend it, you know, as your health representative. What concerns me about the folks who are part of this current administration, I know some of them, but it seems like in many cases, they are, whether they believe it or not, are willing to go out there and actually continue to spread myth information that RFK Jr. has also been spreading. And so that's what's terribly concerning to me. The mRNA situation is a great one. If you don't agree with them on that, fine. But don't go out there and put out an op ed saying things that just are blatantly untrue if you're the NIH director.

12:36And so that's what concerns me is that you have folks who either who are in these high profile positions who either just don't understand the science or who are willing to to to go along with the spread of misinformation for the sake of maintaining their position in the administration. One of the best pieces of advice I got was a long time ago when I was asked to be Indiana State Health Commissioner, and a former health commissioner told me, make sure you have your resignation letter filled out on day one. And what he meant by that is you have to understand where your guardrails are, and you've got to be prepared to walk away if you disagree.

13:16During my time as Surgeon General, I always felt that I was doing more harm than good. And as I mentioned, I also never went out there and lied or misled on behalf of the administration. And I can't speak for them personally, but I have to feel like some of the folks in some of these positions in HHS are getting perilously close to crossing that line.

13:45Jerome, your candor is, as always, I think it's just so welcome and it's really appreciated. I know we've talked about this. You were in an impossible situation. I think it's easy for everybody. I remember saying this to you directly when I saw it for the first time in person a few years ago at an NBA event. It was easy for me and others in the peanut gallery to quarterback and opine, but you were in the hot seat. All eyes were on you. I am curious, a few years now removed from your role as Surgeon General, do you think knowing what you know now, would you have taken that position of knowing what you know now?

14:28Absolutely. Absolutely. I mean, I would have. And so here's the thing um number one i was the second african-american male um to to serve as surgeon general in history um in over 200 years uh and so when you get asked to do something um historic like that where where you get to go and represent not just yourself but but but an entire group of people who who had been underrepresented throughout the history of this nation um it's going to take a lot to say no to that. And I can't tell you how many times since then, since my time as Surgeon General, people have come up to me and told me how much it meant to them to see me on TV, to see me at the White House, to see me commanding the attention of the most powerful person on the planet and sharing my perspective.

15:25I got to talk about my asthma. I got to lift up substance misuse disorder and the story of my brother who suffers from addiction. I got to promote a naloxone advisory that has saved countless lives. We know naloxone dispensing went up 400 % after that advisory. During the pandemic, I was involved with Operation Warp Speed, helping increase diversity in those clinical trials. They ultimately ended up being the largest and most diverse clinical trials in history. So as I mentioned earlier, there's always trade-offs, but I feel like I was able to do a lot of good and a lot of unique good. And alternatively, interestingly enough, you see right now in this moment, the cost of me not having been there.

16:12And that's a very interesting phenomenon that's occurring right now. When I was Surgeon General, as you mentioned, it was easy for people to say, well, you should just leave. You shouldn't be there. You're you're propping him up. They didn't see the harm that would have been done had I not been there. And that's the problem with public health. Interestingly enough, if no one sees the harm that was a burden, no one sees the measles case that was prevented. They only see the harm that's going on in the moment. But now you literally see the harm that's being done when good people, when when people with the background and experience to actually give good and sound advice to our leaders aren't there.

16:53I want to give you your flowers here for a second. And just for all our listeners who may not know this about you, of course, they know you as the former surgeon general. But the reason you were picked for that role is you did incredible work, Jerome, in 2015 in addressing a massive HIV outbreak in Scott County, Indiana. I'm just looking at some of my notes here, which was linked to injection drug use. And you helped implement a needle exchange program to curb the spread of HIV. and that work, I have to say, I remember reading about it in real time, deeply admiring it. I admire that about you.

17:29There's real substance here. You're a practicing anesthesiologist. You're the type of person that should be in that role. And I do think a lot of people sort of piled on because it was easy to pile on. I am curious when you see what happened last week, I see this as a pulmonologist, the way that Kennedy is talking about and Babicharya are talking about the mRNA vaccines and just talking about it in a way that is fundamentally wrong. In the secretary's post on Twitter, he talked about how these vaccines are not good at preventing upper respiratory tract infections. And I remember convening with fellow clinicians of mine and saying, either he's talking about it in those terms to deflect and confuse, or he doesn't know the difference between the upper and the lower respiratory tract.

18:17I don't know what you're worth. Either you're being ignorant or you're either you're ignorant or you're being nefarious. I mean, quite frankly. Exactly. And I'm wondering how you if you were still in the role as say you were the current surgeon general, how you would approach that specific issue either behind the scenes or at a podium? Well, number one, and I've talked about this in a stat news op-ed that I did after the shooting. I've talked about it on Face the Nation. Number one, as a leader, you've got to have those clear guardrails. And one of those clear guardrails is no violence. Violence is wrong.

18:52I don't care how angry you are. Period. Point blank. End of story. that that's a that's got to be a non-starter and anyone who is not willing to come forward and say that in a high position at HHS doesn't deserve to be there I'm sorry I just I feel very strongly about that especially with my colleagues being under attack and being shot at that's number one number two I would get asked questions all the time and the media does this they will try to pitch you against your boss, against your leaders. But as I mentioned, I laid the ground rule with my leaders early on. I'm not going to lie to you.

19:31I'm not going to lie for you. If there's something that you want to do that's not consistent with what I've told you I think you should be doing, then don't expect me to go out and be the flag bearer for you on this issue. Again, I don't know what conversations were had behind the scenes between some of these individuals and RFK. But that said, that's something that I think is important, that behind-the-scenes conversation. And then whenever I got asked a difficult question that was putting me at odds, I would always go back to, here's what the science says. And so if Donald Trump wants to say or believe something, if someone else wants to believe or say something, that's their prerogative to believe and to say it.

20:12But me, I can only control what I say as Jerome Adams, the Surgeon General or former Surgeon General. And so you can look at countless media interviews where I've done where I would be asked, do you agree with Donald Trump on this issue? And do you agree with the current policy on this issue? And I would always bring it back to, hey, here's what the science says. Here's what we know on this issue based on the science right now. because I'm speaking not as a representative of the administration. It wasn't my job to defend Donald Trump or defend anyone else. It was my job to speak on the science as I knew it.

20:48So that's how I personally handle those situations. And I think that because I was honest behind the scenes, people, even when they disagreed with me internally, still respected me for it. There were plenty of times that I said things that Donald Trump didn't agree with, but he still respected me in terms of someone who was going to give him honest feedback and someone who wasn't going to take the bait to be pitted against him publicly, but would still speak my truth when asked. Well, and I wonder about that, because to your point, Jerome, you know, there there has been more of a I want to call like a unified front, at least publicly between the health leaders in a way that I don't remember seeing in the past.

21:34And maybe that's just me. I would love your take on that, too. And I think the framing of this is also that, you know, you and your predecessors and, you know, even Vivek Murthy, those who have been in this position have had their say, have had their platform. and it seems like a very specific role within the administration. And largely individuals who have been qualified in some way or fit sort of a quote-unquote traditional background in terms of being in this type of position. And so not to continue belaboring this whole idea, but I think it's interesting to get your perspective on what we're looking at right now.

22:19So do you think that those kinds of background conversations are not happening or that the conversations are more, hey, we have to have this unified front. Everyone's on the same page. And if you're not in, you're out. Well, one of the things I would say is that I would say that we had a unified front when we were during the first Trump administration. But that unified front was around the science. Alex Azar, Brett Chiroir, myself, the FDA commissioners who we worked with, Scott Gottlieb initially, Seema Verma, we would all powwow and get together and we would hash it out. And sometimes, you know, even even when you're talking about science and data, there are different interpretations of it.

23:02And we would hash it out behind the scenes and we would say, OK, it's important for us to present a unified front to the American people. What is a message that we can agree on and who's the best person to carry forth that message? So I say that because the unified front isn't what's different. It's what that unification is around. And during Trump 1.0, that unification was around science. I mean, Operation Warp Speed. No one wants to give President Trump his laurels on this. But it is the greatest scientific achievement of the last 75 years in this country, easily estimated to have saved at least 2 million by the most conservative estimates, but by many estimates, over 20 million lives saved.

23:47Clearly, we supported science and innovation in the first administration. And what's different now is that that unity isn't around science and public health and building up the infrastructure. It seems to be a unity around demonizing public health, tearing down the infrastructure and loyalty to RFK and the Maha movement. And so you didn't hear me out there saying Alex Azar is always right, you know, in consistency with anything that Alex Azar said. But but but that's that's where I see the difference between 1.0 and 1.2.0 is is is around what they're unifying around that litmus test that it seems everyone has had to take and is being judged by.

24:37Well, and I know that some have called out the irony of Trump being in power and having, you know, 1.0 support mRNA and then 2.0 essentially tear it down and all the work that was set up by Operation Warp Speed. Using that as sort of a backdrop for this, for continuing this conversation. What are your thoughts about that, about having, you know, I actually just as a side note here, when I talk about, you know, the mRNA thing to folks who may not understand as much, I say that maybe the missed communication in this whole story was everyone got excited about the effectiveness of mRNA and then forgot to explain, you know, yes, it wears off just like every other vaccine.

25:21And oh, yes, it wears off much faster. It has, you know, a different time frame than other vaccines. And here is why. And I think the scientific community got behind it so aggressively that the communication, which continues to be the problem, is the reason why we're facing this backlash right now. And is that maybe the reason why we're seeing this kind of movement where those who have felt unheard and those who are in position of power right now feel like they're serving the public by giving a voice to those folks who were against it or who felt like, you know, trust was lost? No, I think you hit on a key point there.

25:58Two key points that I quickly want to cover. Number one is the sentiment of the public. Our health care system is the most expensive in the world, yet we're ranked 67th in life expectancy. People can't afford health care. You saw Brian Thompson, the United CEO, who literally was assassinated on camera in broad daylight and many people defended. That shows you the level of discontent that the public has. And shame on us if we won't, if we refuse to acknowledge that the system is broken. However, you can't attack individuals or parts of the system and expect that that's going to solve the broader issue.

26:44And that's what I see is going on right now. We're attacking and demonizing individuals and literally trying to tear down the entire system. Now, to give the benefit of the doubt to someone like RFK, I think he does recognize the system is broken. However, being in a leadership role means recognizing you can't just tear everything completely down to the ground. You can't burn it all to the ground without hurting someone, number one. Number two, it means understanding that the language you use, the rhetoric you use, actually matters because it can stoke violence on the part of the public. So I think that is a place where they've gone wrong.

27:27Number three, there are a lot of people involved in the current administration who criticize pharma and traditional medicine, but have no problems promoting ivermectin and hydroxychloroquine and glucose monitors for everybody and supplements. And so it's a little bit disingenuous to say those people are grifters. You shouldn't trust them. But then to say you should trust us, even though we profited off of disinformation and unvalidated remedies that we're promoting on our websites right now. And so to me, that's a lot of what the difference is. You acknowledge the systemic issues, you acknowledge the pain and the frustration that Americans are feeling, and then you have to offer them a real way forward, which gets to your point about communication.

28:15I have a whole chapter in my book right here where I talk about the importance of better communications training for public health officials and medical officials. When I was Surgeon General of the United States, I was running a 6 ,000-person agency, Public Health Service Commission for a 6 ,000-person company, a billion-dollar budget. And guess what? I was doing my own social media. I was doing my own tweets. There was no CEO of any company in America that size that is doing their own media. Fortunately, I'd had some media training, TV, radio, written during my time as Indiana State Health Commissioner, which Dr.

28:59Goopda mentioned earlier. But that said, we need more support, more training, and the media communications routes changed drastically during my tenure. I often say I was the first real Twitter surgeon general. So people forget in early 2020, the debates we were having pre-pandemic even over nurses on TikTok dancing, you know, and talking about patients. We've shifted from a time when who would go on the news if he wanted to say smoking was bad and he had to hit four channels, ABC, CBS, you know, the big four channels at the time. And he would hit 70, 80 percent of America back then. And people would believe it.