270. Dr. Stephanie Haridopolos: On Screen Harms in Kids, the 2010 Drop & the Surgeon General's New Advisory

0:00If you are exposed to screen time at a very young age, before 18 months, it could affect the full development of the brain. And so it's not just about how much screen time quantity, it's also the quality of it.

0:14Gary Brecka:Hardly a parent in America today would say, I have no concerns at all about what my child is consuming on social media or the amount of time that they're spending on their phones. In the office of the Surgeon General, you have such a huge megaphone to discuss very pertinent health emerging threats to the public. And how then do we amplify that message to increase health and wellness? In a perfect world, pulling all of your experience, what would be the utopia of success for you if what was accomplished? Believe it or not, this is probably the most surprising.

1:02Gary Brecka:Hey guys, welcome back to the Ultimate Human Podcast. I'm your host, human biologist Gary Brekka, where we go down the road of everything, anti-aging, biohacking, longevity, and everything in between. And as you know, lately I have been very involved in the Maha action, which is essentially this public-private partnership between health and human services and the general sector, talking about and influencing and having interaction with health and human services on the direction of healthcare in America. And most of all, looking at initiatives to keep people out of the system. Not everything that you're doing in HHS and the US FDA is designed to fix the healthcare system.

1:43Gary Brecka:A lot of it is designed to keep people out of chronic care. And today's guest is one of those thought leaders. She is a practicing physician. She's a mother, ballroom dancer. She is an absolutely wonderful human being. Dr. Stephanie Herodopoulos is now the acting chief of staff and senior advisor to the U.S. Surgeon General's Office. Her role is updated, so I'll allow her to update us on that tune. But thank you so much for coming on the Ultimate Human Podcast. This is truly an honor. I appreciate the invite. Thank you. I'm so happy to have you here. You know, one of the things I've noticed about this administration, at least as it relates to health care and health care policy, is they're asking hard questions.

2:27Gary Brecka:They're challenging some of the status quo. They're shaking things up, all to have a positive impact on Americans' health care. They are not accepting the fact that we are spending nearly$5 trillion a year on health care, and the outcome has been some of the sickest, fattest, most disease-ridden human beings on the planet. And I think I would love, first of all, for you to correct your title because I know I left some of those out. Recently, I was promoted to Principal Deputy Assistant Secretary of Health at HHS. and I've been there for 15 months. I had a calling to make a bigger impact than I could just seeing the direct patient care.

3:14I miss it. I'm missing my patients. And for over two decades, being able to see generations of families of all life, the whole lifespan from womb to tomb. But with that - Womb to tomb. I love that.

3:29Gary Brecka:I've never heard that saying. I like that. Cradle the grave. But, you know, we can we're in a big shift in health care right now. And I wanted to be a part of that movement. You know, with Kuhn's Law, we talk about a, you know, sometimes you have crises and then a drift. But then now we're in a paradigm shift. And with that paradigm shift, we can, with a broad brush, change the trajectory of so many lives in America. And so I said, I want to serve. And it was just such a true honor for President Trump to entrust this huge responsibility in me as one of his political appointees during this time.

4:16Gary Brecka:You know, I wonder if we might just for, you know, most people that are watching this podcast, everybody has heard of the Office of the Surgeon General, the Surgeon General for sure. But and states have Surgeon Generals as well. But can we just kind of demystify the office for a minute? And like, what is the role of this in the government? And what are some of the initiatives that are going on in the Surgeon General? Why should my audience draw their attention or care about what's going on at the Office of the Surgeon General? My goodness, such long history of the Office of the Surgeon General.

4:47You've heard from previous surgeon generals in the 60s that brought attention to the harms of combustible tobacco to Everett Coop in the 80s with HIV and AIDS. In the office of the Surgeon General, you have such a huge megaphone and you have a platform to discuss very pertinent health emerging threats and harms to the public. And how then do we amplify that message to increase health and wellness? So there are many different ways in which the office of the Surgeon General can communicate. It could be a call to action. It could be an advisory, and it could be a commissioned Surgeon General report, which takes years and longer period of time.

5:40In the Office of Surgeon General, we also oversee Public Health Reports, which is a peer-reviewed journal that's been in existence for 148 years. Wow. It's the longest peer-reviewed journal in the nation's history. And we also oversee the operations of the Public Health Service Commission Corps that has been in existence for over 200 years. So right now we have 5 ,500 Commission Corps officers. They're military uniformed, unarmed health care warriors that are all over the United States and some international posts that are there to help with natural disasters, outbreaks. headaches, if there is, you know, a problem with illnesses coming into our country, ports of entry.

6:36They work in every department of the U.S. government. And so it's a true honor to serve alongside them in the office.

6:42Gary Brecka:Wow. That's, I mean, because I think, you know, very often we don't humanize these departments. And one of the things I loved about getting to know you is you had 25 year history as a physician, raised a family, you're a wife, you're a mother, you're a practicing physician in family medicine, you've had hands-on patients for decades, and you're just bringing that day-to-day decades of knowledge of having been a practitioner into the office of Surgeon General. So I feel like you have a really good handle on real-world problems, right? I mean, what is everyday mom and dad in America? What are they suffering from?

7:23Gary Brecka:What ailments do they have? Where are the issues? Where the government can possibly intervene and give support, guidance, help, great awareness. And so I'm very fond of a lot of the folks in the administration because they do seem to be very, at least related to Maha, because they seem to be very purpose-driven and passionate. And we talked earlier about your drive to become a physician. And I wonder if you might just share that story with my audience because I find it really compelling. Thank you. I was born with a congenital heart defect called the atrial septal defect. And I was lucky to have access to care and lucky to have astute physicians that heard the murmur and got a plan of action and care and eventually having open heart surgery.

8:13At what age? At age four. Oh. I know at Columbia Presbyterian Hospital, and it closed the hole, and I have been able to live a healthy, normal life since then, where I won't eventually have a right heart failure, which could happen if the shunt was not closed. I had a four-to-one shunt, which was a big hole. and so um you know i'm very passionate about making sure that people have access to care and to health but also preventative medicine in the sense that uh when what drove me at that age i set my north star that i wanted to be a doctor at four years old that's just so awesome i think

8:55Gary Brecka:at four years old i wanted to be a police officer a cowboy and i also also wanted to be an indian I think I wanted to be a fireman and an astronaut. And I'm none of those. So for you to set your North Star floor and be sitting here now in the office of the Surgeon General, that's pretty, I mean, that's commitment. Well, thank you. By the way, you're making such a big impact with your work, so I commend you for that. You really have a huge reach. Thank you. I am just so blessed to be here and I am grateful every day. And I feel compelled to live a purpose-driven life with God-given talents. Yeah.

9:38Gary Brecka:When we were having lunch earlier today, you know, we talked about just some of the basics, right, that go missed in modern medicine. And, you know, one of the things I really enjoyed about our conversation was we started to talk about community connection, how children are becoming isolated. You know, they're missing that real human connection because, you know, we've developed a dependency in the sense that we're connected through our screens and our phones and our laptops and our iPads. And that's actually not true. And I think a big concern of parents today is, you know, my children are have spending so much time on screens, but what is coming through those screens?

10:24Gary Brecka:Um, and what, you know, what are they learning? What are the threats? Um, you know, how is this helping or hurting the developmental cycle of their brains? And I know this is a big passion project of yours. And I wonder if you might just talk about what is the office of the Surgeon General doing, you know, with respect to screen times. Um, well, I'm going to back up a little bit. And last August, the White House released the Baja Strategic Plan, and it had many different action items and deliverables. And one of them was delineated for the Office of the Surgeon General to bring awareness to the harms of screen use in youth.

11:07And the actual conversation had started with the previous Surgeon General talking about social media and mental health. But I decided to pull it a little broader than that. Let's talk about harms of screen use and also what it could do to not only mental health, but neurocognitive development, your physical and metabolic health and social interaction and health and well-being and mental health. So this is so exciting that this was one of the prerogatives of the Maha Strategic Plan, and we developed a wonderful advisory from the Surgeon General. So I'm so excited to talk about that with you today.

11:59Gary Brecka:Yeah, I'm really excited to talk about it because I think that, you know, hardly a parent in America today would say, I have no concerns at all about what my child is consuming on social media or the amount of time that they're spending on their phones or, you know, what they're communicating, what's being communicated to them. And, you know, there's so many stories about the scary issues around predators. But even without the direct dangerous risks of social media, you're talking about the amount of time they're spending on screens and neurodevelopmental issues. Yep. So we decided to release an advisory on the use of screen harms in both adolescents and children.

12:46And so with that, advisories will not only give you the best scientific evidence that's available, all in a wonderful nugget, 25 pages, well-cited, with up-to-date research that were obtained from NIH, CDC, ASPE, all within these divisions within HHS. So we came together and we gave the best available information, but not only that, toolkits. What could be done about it? What can advice can be given to parents, educators, policymakers, and the youth themselves as well as what could tech companies do to make it better at this point? So I highly—

13:38Gary Brecka:You seem to be a big willing participant in that company. Well, you know, we just put what's out there and what's scientifically available for everyone to read. So what I could tell you is from our findings that this has affected brain development. So it can actually affect your executive functioning skills. If you are exposed to screen time at a very young age, before 18 months, it could affect the full development of the brain. And so it's not just about how much screen time, quantity, it's also the quality of it. So we need to think about what actually they are watching. You'll see states around the country, and I think there's like 37 of them, that have some bell-to-bell policy.

14:35What that means is during schools, they're actually eliminating some districts and some statewide that you cannot use cell phones in school. I love that.

14:47Gary Brecka:Isn't that smart? Look, you and I grew up in an era with no cell phones, and we did just fine. And when there are emergencies, parents can get a hold of the school. School can get a hold of the parents. you don't need to constantly be in communication I mean maybe there's some rare exceptions someone has a Holter monitor or something where they actually need to be connected to a phone but I can't imagine what my high school collegiate years would have been like if I had this screen constantly pulling my attention away because when you're learning and you're trying to take in information you're constantly being distracted by whatever you're doom scrolling about But what surprised you in your findings?

15:28Gary Brecka:Was there anything that surprised you in the evidence or your findings? Well, I can go into some of that. Well, I'm glad you asked. I'm glad you asked. All right. Well, let's talk about the physical findings. That's different from the last general report. So we're finding we know the risk. We know obesity rates in children are so high. We understand so many children are not qualified to serve in the military if they wanted to. We're talking like almost 70 percent because of some health. Poor metabolic health. Poor metabolic health. So the more sedentary we are, the more we are going down a rabbit hole of doom scrolling and we are looking at a screen, the less active we are.

16:14What we want to be is get moving. So just if we're looking at doom scrolling late at night, we're not sleeping. That's affecting our overall health. We're less active. We're less socially engaged. So that's not surprising, but it's worth saying that there, can we say causation versus correlation? We think that the more screen time that you're on, the less active you are. Therefore, it is a multifactorial cause.

16:45Gary Brecka:Certainly a correlation there, right? I mean, if you're sitting and you're on a screen, you're not moving. That's right. And not to mention, if you're on a screen inside, you're not outside. So the more you're on a screen, what could that do to something called nearsightedness? Myopia is also a name that means that you can't see far. And it is estimated by 2050 that 40 % of kids will have myopia. so we really need to bring that up that is it that's a harm that's a hazard from being on screens too much and not going outside the distance that you can focus and sort of observe your outside environment because you're bringing your your outside environment 15 inches from your nose that's right right and i don't think evolutionarily we were designed uh to to live within 15 inches of her face.

17:40I don't think so. I think that, you know, we're the Gen Xers, right? I am a mother of three Gen Zers.

17:49Gary Brecka:What do we do after Gen Z? Do you go back to A? Oh, we're back to the beginning. It's like naming hurricanes. We kind of go through the whole alphabet and start over again. It's like a demographic cohort, right, when you talk about from baby boomers to Gen X millennials, Gen Z, and then alpha. And so you're following a population from when they were born, and that's what they have. That's a common denominator. So believe it or not, this is probably the most surprising. NAEP, National Academic Evaluation Progress, is something that's been used since the 1970s that evaluates math and reading. Since 2010, so over a decade, we have seen precipitous decreases in both of those metrics.

18:43Gary Brecka:Math and reading scores. Yep. So competency level. Yep. So in 13-year-olds, you'll see a 7 % decrease or 7-point decrease in the reading and a 14 % decrease in math. what started in 2010 ubiquitously screens yeah yeah yeah it's the screen revolution factor so this generation doesn't know life without it so really we were blessed to be able to grow up without it and be able to be young enough to navigate with it yeah but this is an experiment with this generation, both the Zers and Alphas, that what is going to, what harms are they going to have because of it? And I think that history will judge us not only about the actions we take and the steps we take, but the inactions that we let happen.

19:50So I feel like we have a moral and ethical duty right now to bring this to the surface. Yes, there's more research that needs to be done, but our children don't have time for us to tease all of that out.

20:05Gary Brecka:Is there any data coming from some of these states where they're actually doing this bell-to-bell policy? Are you seeing positive data emerging from? Yep. And what does that look like? Well, first of all, can you imagine being a teacher in a school where you're trying to teach and someone is just looking at their screen on their cell phone and ignoring you? So my hat's off to teachers in the United States that work so hard to do the right thing. And none of this is a diss on parents. We want to elevate parents' ability to have the tools they need. But the thing specifically, you'll see kids actually talking at lunch to each other.

20:44You see academic scores improving. You see less disciplinary actions in the schools. You see that kids are more involved in sports and other activities. So overwhelmingly, and in other countries that have adopted some sort of bell-to-bell policy, you're seeing the positive trends going in the right direction. I love that. Yeah. I think that there's something to that. And I commend the states and individual districts that have adopted those type of policies. But kids are not being exposed outside of that. I think that we have the responsibility as physicians, when we see a metaphysical with the parents, ask about it in anticipatory guidance.

21:31How much screen time? Know your number. How many hours a day are you on a screen? And bring it to the attention. So there are evidence that kids are now on their cell phones more often than they sleep or in school.

21:47Gary Brecka:Wow. Yeah. So then where are they getting their education from? If they're absorbing data from their cell phone more than they're absorbing data while they're in school, then where are they really getting their education? Right. Where are they getting what's shaping them? Right. And what are they being exposed to when they are on? And there are definitely some major harms that we probably should discuss at some point. Yeah, let's discuss it. Yeah. I mean, we know that there has been some mental health issues, increased depression, increased anxiety. Since 2010 with this, have been the screens.

22:24Body dysmorphia, you know, wanting to be perfect, wanting, you know, almost like a fear of missing out. We, you know, I think that that has driven a lot of mental health issues, especially in girls. but what are they being exposed to as far as exploitation, right? So I think that children and youth should have also some, I'll call it digital citizenship, being aware of what they should put out there. You know, because it follows you. It could follow you in a positive way, but it also can follow you in a negative way. But there's also sometimes even a sports picture of an athlete out there on the Internet could be a deep fake that's put into a dude and then people are being exploited financially.

23:19And unfortunately, there's been suicides coming from that cyber bullying or exploitation. So that is a real harm that we need to talk more about. and what maybe a chatbot could do in saying massaging a conversation that unfortunately has led to suicide instead of the other direction. These are real things we need to be talking about.

23:47Gary Brecka:So in a broad sense, what does this initiative on screens coming out of the Surgeon General's office in a perfect world, what would it accomplish? Would more states adopt these bell to bell policies? I think so. I think policymakers could be empowered with some making, you know, data, some data, but also more money in research possibly going forward. They could ask tech companies possibly to make sure that they protect the well-being of youth. I can see parents coming up with a wonderful plan, a digital plan for the kids, maybe delaying technology, modeling behavior with a do, do like show them how they should be like.

24:36So that's a delay, a do divert. If a kid is looking like that's all they want to do, divert them to a positive activity. um you know a maybe a a digital disconnect it doesn't we call it a detox but having an environment where you um have like at meals we are not going to have that cell phone have digital free zones in the house and five discuss discuss the plan so the kids understand and buy in like i don't want adolescents to feel we're talking down to them. I want to empower them. I want them to be the CEO of their life.

25:20Gary Brecka:Yeah, it should sound empowering. So is this some of the guidance that is coming out? And so you'll have guidance for parents, guidance for educators. Are you going to publicize some of what your research has shown linked to some of the harms? Absolutely. So within the advisory encompasses the harms that we've delineated, but then the toolkits are for the different stakeholders, parents, educators, policymakers, and the youth and tech companies. So it's all nicely packaged for it to be hopefully cited in the future when people are trying to pass laws or change their behaviors, but use it for health care providers also to educate and in a way where it's public facing and it's easily digestible.

26:19Gary Brecka:Why don't you think more states have adopted these policies? Well, 37 have in some capacity, and I think about 20 have full state-to-state. It's a shift. It's a paradigm shift that is moving in that direction. You're going to see more and more. There's always a delay in what we know and action that follows. So I think that it could be in progress. You have to wait for state legislatures to convene, and then you pass it, and then the governor signs it, and then it's an implementation phase. And is there a fiscal attached? attached and are, you know, is there the ability to do it in a way that is streamlined?