Katie Couric on Truth, Trust, and Women's Health

18:07Dr. Mary Claire Haver:Like when that alarm went off at three thirty every morning when you were, you know, doing the Today Show, did you ever feel like you were on that treadmill and you had to get up and perform every day?

18:16Katie Couric:I loved it. I also felt like, you know, I was helping people understand the world. You know, I mean, I think Like, I had this big audience and this big sort of community that I was a part of that I could say, hey, I really think we need to do a story on X, Y, or Z. I think, you know, so I had a lot of input editorially. Like, I controlled my own destiny. I would say, can I go do an interview on this? Can we do a fun series called Changing Places? I'll fill in for Jay Leno and he can fill in for me. And, you know, everybody can kind of pick something that they've always wanted to do and do it. So I had a lot of input.

19:03Katie Couric:But I think what's interesting for you as you were talking, I was thinking, you know, you as a physician can have such an impact on your patients. But it is a limited stage. And to be able to use your expertise and your knowledge. And for as much as people shit on social media, and I think it is really, there are a lot of negative aspects to it. Absolutely. The fact that it provides this entree of, and this, you know, really national, if not international stage where you can share important information that people are really hungry for. I think it's a really phenomenal thing. And that is why you have been able to build your company and serve people in a much more, you know, a much broader, more expansive way.

19:59Dr. Mary Claire Haver:I mean, I'm doing the same thing I was doing. Instead of sitting across from Katie in an exam room with a time limit, you know, it's exact same conversation I'm having with my phone. You know, because when you're reporting on social, you're talking to your phone. There's no one there. Right. Usually. Now, it goes out to millions of people, but I'm just repeating the exact same behavior I had in the exam.

20:20Katie Couric:Which is must be so incredibly gratifying to know that. And you think, you know, you mentioned time limits and you, you know, a lot of women don't have access to the best doctors or they live in rural communities or underserved communities or they don't have insurance. And, you know, so to be able to use someone like you as a resource is such a gift for so many people, you know, and so that must make you feel like a public servant, really. It does.

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24:41Dr. Mary Claire Haver:So how did you end up as a journalist? So you go and you were an English major?

24:47Katie Couric:Yeah, I majored in American Studies, so American Literature and History. And I learned how to write. I wrote for my school paper. During the summers, I was working at radio stations in Washington, D.C., because I grew up right outside of D.C. in Arlington. And, you know, it seemed to be tailor-made for my personality and for the things I like to do and for my sort of insatiable curiosity. And so I just applied for a job at ABC News when I graduated from UVA. And I really pursued it aggressively. I got my mom, I write about this in my book, to drive her cream-colored Buick station wagon down to the Washington Bureau of ABC News.

25:35Katie Couric:I said, Mom, just wait for me here. You know, she's parked on DeSalle Street, I think it was. And I go into the building and I said, Hi, may I talk to Davey Newman? Because I knew Davey Newman was the producer of World News Tonight. And Davey Newman's brothers, twin brother, Stephen Eddy Newman, had gone to high school with my sister, Kiki. And so they said, We can't just let you upstairs to the newsroom. So I saw a house phone and I called Davey. They said, you can use the phone if you want. I said, great. I said, hi, Davey. This is Katie Couric. You don't know me, but your brother, Steve and Eddie, went to high school with my sister, Kiki.

26:15Katie Couric:And I was wondering if I could just come up and say hi. And, you know, my dad always said I had Moxie, which is really what I wanted to name the book I wrote about my life and career, Moxie. But yes, and then ultimately, Davey Newman, I'm sure he wanted to get rid of me, introduced me to the deputy bureau chief, Kevin Delaney, who hired entry level people called desk assistants, where basically you were a gopher making coffee, Xeroxing. That's how you started. Fetching, you know, ham sandwiches for Frank Reynolds. Just like I imagine. Yeah, that's how I started. And I just worked really hard and tried to learn and then went to CNN when that started.

26:54Katie Couric:My friend Wendy Walker, who's still one of my closest friends in the world, was going over to CNN. And she brought me with her. And at CNN, it was like a startup. So you could do all sorts of different things. And it was a non-union shop. So I could even go out and do interviews and try my hand at on-air reporting. And it was so bad. the president of CNN called and said he never wanted to see me on the air again. Oh, my God.

27:19Dr. Mary Claire Haver:Yeah.

27:20Katie Couric:So I had to kind of fight and be scrappy every step of the way.

27:23Dr. Mary Claire Haver:But how did you overcome that?

27:25Katie Couric:Like I was I was like, wah, wah, because it was like my first big break. I was reporting from the White House and learning how to save Zipigniew Brzezinski and practicing all night and talking to my hair, my hairbrush like it was a microphone. You know, I just thought, okay, well, I sucked. And how do you get better? You know, I believe Malcolm Gladwell's right, you know, 10 ,000 hours. And, you know, I just looked around and I thought, these people are good. They're talented and smart or they can write and be in front of a camera. But are they that much better than I am? No, they just have more experience.

28:09Katie Couric:So I said, I'm just going to try harder, do more. And then I worked in local news in Miami after CNN and then worked in local news in Washington. And that's where Tim Russert, who was the Washington bureau chief of NBC, saw me because we were in the same building as the network, the local news people. And he saw me, you know, chasing Marion Barry, the mayor of Washington, D.C., who had a lot of problems around. And he asked me to come down to his office and said, we have an opening as a deputy Pentagon correspondent. Do you think you could do that job? And I said, you know, of course, I didn't think I could do that job.

28:54Katie Couric:Inside, I was like, holy shit, I know nothing about the military, that this is going to be a disaster. But I said, I said, you no, I don't have a military background, but I think I could do it. And he said, okay, well, let's give it a try. And that got me my foot in the door at NBC, got me a job on a national network.

29:21Dr. Mary Claire Haver:How old were you at that point?

29:22Katie Couric:I had just gotten married to Jay. It was right before we got married because I remember I couldn't start until after our honeymoon. And I took all these Pentagon manuals with me on my honeymoon. Our honeymoon was studying like the difference between an F-16 and an F-17 and an A-1A tank and, you know, all the different scrambled eggs that people wear on what they call the ribbons and stuff on their uniforms. So I got married in 1989 and I was born in 1957. So I had just turned like 32. But I had spent my 20s really focused on work and really wanting to get to a position where if I did have children and, you know, women have to kind of navigate all this, at least I'd be in a position where I wasn't just starting.

30:17Katie Couric:I thought, first of all, I hadn't met anyone. So I mean, I dated, but nobody who was really marriage material. and I really just wanted to have the flexibility to move. I didn't want to have to work with a partner and say, I don't know, is this going to be good for you professionally? I was just free as a bird to really pursue my own personal ambitions. And then, you know, by the time I had a baby and was pregnant with Ellie, I had gotten the job at the Today Show. So I had a very serendipitous journey professionally, but it was also backed up by the fact that I had worked really hard. And but I was also I think there was for me, I probably less so in medicine.

31:09Katie Couric:There was an element of luck because I think TV journalism, there's a subjective nature to it. And I was just kind of at the time, just what the doctor ordered at the Today Show. They had had a transition from Jane Pauley to Deborah Norville. The audience didn't really respond to Deborah Norville. And they kind of wanted to go back to someone who honestly was not as beautiful and perhaps threatening to a morning audience. So there I come along and I ended up being put in that position. And then it was kind of off to the races for me.

31:50Dr. Mary Claire Haver:So you did that for 15 years?

31:53Katie Couric:Well, I did the Today Show for 15 years. And then I became Les Moonves, who was head of CBS, brought me over to the CBS Evening News. And I did that for five years.

32:05Dr. Mary Claire Haver:Were you the first female nightclub? I was the first solo.

32:08Katie Couric:Barbara Walters and Harry Reisner, I'm really dating myself, had done it at ABC News. And then Connie Chung had did it, had did it. Connie Chung did it for a nanosecond with Dan Rather at CBS. But I was the first person woman to be the solo anchor. In other words, there was no man involved. And it was a big deal at the time. And that was really one of the things that motivated me. I thought I wanted little girls and little boys to see a female could handle that job with confidence and competence. And that's real. And plus, you know, 15 years, as much as I loved my job at the Today Show, like any job, 15 years is a long time.

32:57Katie Couric:And it started to feel a little repetitive. And I think I just wanted a new challenge. So that's why I went to CBS and ended up being a very challenging experience for me because CBS was quite old school, I think patriarchal. and I think between the internal kind of sexism and the external sexism of an audience not necessarily being ready for a female anchor in an evening news format, the most traditional audience. And then we, on top of that, tried to rejigger the format a bit, tried to make it a little more accessible and viewer-friendly. It just was it was a lot too much too soon for an audience.

33:48Katie Couric:And while I was very proud, Mary Claire, of the journalism I did on The Today Show, I did so many hard hitting, important interviews. I think because of the nature of the Today Show, people remembered me or identified me more with the fun, kind of softer, fluffier content. And so I think it felt a little bit incongruous for people to see me in a role that was 100 % serious, that really didn't allow me to show my personality at all, which only kind of can be conveyed when you're interacting with a co-anchor, you're doing something fun. And I think it just, it just, I think, felt to a lot of viewers, what happened to her?

34:35Katie Couric:Did she have a lobotomy? Like, she used to be fun and funny and friendly. And I think it was just kind of like a hard adjustment for people to make, me in this role. Looking back on it, I'm glad I did it. But I think for a lot of reasons, it was probably not the right decision.

34:58Dr. Mary Claire Haver:So here's what I remember about you. When I think about Katie Couric, like before I got to know you and, you know, I didn't watch the morning show. I was in med school. I was in residency. I was, you know, delivering a baby at eight in the morning. You know, I remember, of course, you know, who you were, that you were cute and fun and stuff. But I remember having a call as a doctor, you know, having a colonoscopy on national TV. I remember when you got breast cancer and talked about it. I remember when your husband died. and I remember you had two kids, two girls, because I had two girls. Yeah.

35:30Dr. Mary Claire Haver:And then Katie Couric Media.

35:32Katie Couric:Yeah.

35:32Dr. Mary Claire Haver:So what made you say, I'm going to do this. I'm going to start my own company. Well, you know, I had done really most of the big jobs

35:43Katie Couric:in network news. Still to my surprise, honestly, that I was able to kind of reach the pinnacle of the industry. After CBS and after that really didn't go that well, I stuck with it for five years. I knew that I wanted to keep working. And at one point, I think I was asked if I wanted to go back to the Today Show. But by then, I had sort of already committed to doing a syndicated talk show and an afternoon talk show, it turns out, I mean, they're great and there's so many people who are good at it. Obviously, Oprah was the queen. But for me, it didn't allow me to really dig into important issues.

36:38Katie Couric:I think afternoon talk shows are a little more infotainment. And, you know, No, it's funny. I'm such a dichotomy, actually, because I do have this very bubbly, outgoing personality. I mean, I think I've gotten less bubbly as I've gotten older. But Katie Couric Media is hard hitting. Yeah, I'm actually a serious person underneath kind of my effusive, bubbly personality. So a talk show wasn't kind of the best fit for me. So then I went to Yahoo because I saw the media landscape shifting from linear to digital. And then after Yahoo, never really realized fully or never really became the digital behemoth I was hoping it would be in journalism.

37:30Katie Couric:So here I was. I'd done a documentary series for Nat Geo. I had done a couple of other documentaries. And I remember taking a walk with a good friend of mine, Donna Rockwell Smilovitz, who tragically passed away after a hernia operation. She had a pulmonary embolism.

37:48Dr. Mary Claire Haver:And it was just crushing.

37:51Katie Couric:I just loved her so much. And she had worked at CNN with me and as a producer, and then she had become a therapist. And we took a walk around the reservoir here in New York City. And she said, you know, you should just do your own thing. You know, why do you need a big network infrastructure? And it's true. I mean, it was at that moment that disintermediation, the ability to go direct to consumer to an audience was within everyone's reach and only growing. And meanwhile, linear television news was really declining just because of the paradox of choice, if you will. So I thought, I'm going to do my own thing.

38:35Katie Couric:I can feel very liberated. I don't have corporate people breathing down my neck. I don't have pressure for ratings. I can really turn my lens on topics that I think are important, like cancer research and cancer screening. And, you know, that colonoscopy, you know, after my husband Jay's death really started me on a lifelong journey of advocacy, not only for cancer, but other things. You know, I did a documentary, my executive producer, a documentary about ALS. And I'm very interested in medical and news and science, you know. And I think it's because of my learned experience. You know, I had to understand what was going on with Jay when he was diagnosed with colon cancer.

39:28Dr. Mary Claire Haver:You wrote, I think in your book, I read you you were just like anybody else. You were like researching and trying to call, you know, people in New York. And, you know, you just felt helpless.

39:39Katie Couric:I called like pharmaceutical companies in Israel. If I read they had a anti-angiogenesis drug or a monoclonal antibody. And I learned everything about, at the time, about approaches to cancer therapies. And, you know, sadly, the same drug that had been used since the 50s, 5-FU and Leucovorin, was basically the first-line treatment. And there hadn't been many advances. And when Jay was diagnosed, it had metastasized so much. It was all over his liver. and a stage four colorectal diagnosis back then was the prognosis, as my doctor told me in one of those little corner rooms in New York hospital, he said, is bleak.

40:30Katie Couric:And it was, but I wanted to make sure that no stone was left unturned. And anyway, I have found my cancer work so rewarding and it's really been therapeutic for me, a way to honor my husband. You know, Ellie and Carrie, Mary Claire were six and two when Jay died. Yeah, they were babies. You know, and never got to know their dad. You know, when I took those aptitude tests in high school, they all said I should be a social worker, you know? I've always kind of had a lot of empathy, but I think to be able to really focus on this has given me so much purpose.

41:10Dr. Mary Claire Haver:I mean, you can tell. And I think you alone, whether you realize it or not, because I'm on the patient end, right? And I'm prescribing colonoscopy. Go get your colonoscopy. It's time. You took so much of that fear away just by being brave enough to just destigmatize it. And you really normalized, to me, the colonoscopy.

41:32Katie Couric:I don't think people even knew the word colonoscopy. I mean, Ronald Reagan back in the day had polyps. I don't know if you remember this. You're too young. But that put colon cancer and sort of colons, if you will, kind of front and center. I think Regis Philbin had one. I didn't share much about my husband's illness because that wasn't mine to share. And it was really important for me to preserve our privacy. It was so traumatic going through that. How long from diagnosis? Nine months.

42:05Dr. Mary Claire Haver:Okay.

42:06Katie Couric:And, you know, the tabloids were writing about it. And your brother?

42:09Dr. Mary Claire Haver:My brother was like two years esophageal, but widely metastatic at diagnosis. I remember you telling me that. Yeah. And he did all the treatments and, you know, it was never going to be good for him. And he held on for a couple of years. But yeah, you're just, and it was COVID. So, you know, trying to get over there to see him and because he lived out of state.

42:31Katie Couric:And esophageal is one of the fastest growing cancers. Yeah. And they think it might be because of Barrett's syndrome.

42:39Dr. Mary Claire Haver:He was a smoker. He quit, but he had been a longtime smoker and he had had reflux his whole life.

42:46Katie Couric:Don't they think, Mary Claire, that some of the reflux medications might mask some of the signs of esophageal cancer? or what are they called? They're called the proton pump inhibitors.

42:58Dr. Mary Claire Haver:Thank you. So I'm, I won't even take them anymore. Right. So, and I went for my yearly colonoscopy and I had arranged to have an upper GI at the same time because my brother had died of esophageal cancer and I'd had lifelong, like my whole family, we all have reflux. And, and I remember like getting there that day and I'd done the colon prep and everything. And they're like, Hey, you're we're covering your colonoscopy, but the upper GI is going to be like three or$4 ,000. And I just threw my credit card down, you know, because I needed peace of mind. And I thought, what did normal people do?

43:32Katie Couric:I thought that so much when I was being treated for breast cancer.

43:35Dr. Mary Claire Haver:The day of, I've gone through the emotions of the prep and, you know, his death and, okay, we're going to go do this. And what if they find something and I just thought, my God, and I thank God. And they ended up getting most of it covered on the back end. But it was a lot.

43:51Katie Couric:I have a question, though, since we brought up the subject, and I imagine some of your listeners and viewers might have acid reflux. So now, is it, do people, what do they do for acid reflux now if those things seem to be associated with esophageal cancer?

44:10Dr. Mary Claire Haver:More aggressive scopes. You have to look and We don't have a good screening test, like a blood test for esophageal.

44:18Katie Couric:But what do they do for the symptoms of acid reflux?

44:20Dr. Mary Claire Haver:So they are less aggressive with certain medications. They're trying to do lifestyle and diet and nutrition. And if they're obese, we get them on a GLP-1 because sometimes the pressure of being heavier. I mean, instead of just throwing everyone immediately on these medications, they're really... What are they called? I'm trying to remember.

44:38Katie Couric:What was the name of the drug, though? There's two, Nexium. Yeah. And there's another one.

44:44Dr. Mary Claire Haver:Yeah. Omeprazole and pantoprazole are the two main PPI.

44:49Katie Couric:And then there's H2 blockers, which block the acid production.

44:52Dr. Mary Claire Haver:And then there's one that turns off the pump that makes the acid. But instead of addressing, like for me, I had H. pylori. And so once we got that managed, I rarely, rarely have reflux anymore. My whole family had H. pylori. So I think we're getting better at the root cause.

45:09Katie Couric:Because of the rise in esophageal cancer, I think has, I mean, correct me if I'm wrong, prompted physicians to rethink how they treat acid reflux, right? Yeah. So I see. I love medicine. I'm so interested. I wish I'd gone to medical school.

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48:46Dr. Mary Claire Haver:So media, the media landscape. I saw some clips from Rich Roll. And so I'm trying to ask you about that. But you talked about, you know, in medicine, it's polarizing. Social media is polarizing. Was it that polarizing? Like you've watched the evolution of what the hell is happening? You know, why is I used to go and watch the news to learn things. And now I like watch the conservative media. And then I'll watch the I'll watch both because I want to know, are we somewhere in the middle? But like everyone loves Katie Couric.

49:18Katie Couric:But no, no, no. I think, you know, journalism is. It's a really tough industry right now, really tough business, but it's never been more important, honestly. And I think that we have parallel versions of truth. I think that, you know, we have media organizations that primarily serve as propaganda arms of the current administration. And then we have other media organizations who are who are labeled as liberal, who I think actually are doing more fact based journalism. Now, you could say, oh, they're not giving this administration credit for anything. They're attacking it all the time. But I think this is, we're living in such unprecedented times where institutions are being, you know, done away with.

50:28Katie Couric:journalism is being dismissed and disrespected and distrusted. And it's just a very crazy time because you have information coming to you from every direction. You know, when I got into journalism, there were very few outlets. And now everyone's a journalist. Everyone can give their version of the truth. Everyone can give their opinion. And it's just very confusing for the average news consumer.

51:01Dr. Mary Claire Haver:So my parents, my father passed away, but mama and mom has dementia. But you know, while she was still watching things and definitely my in-laws, my father-in-law just died this year, my mother-in-law still doing it, only watch certain news channels. They're only getting news from one source. Right. That's all they know. And they are convinced that this is true, It would never occur to them that maybe this is biased media because they watch the news to get the news. And they don't think of it as liberal or Democrat, you know, or as conservative or anything. They just think it's the news, but they only watch.

51:36Katie Couric:Fox. Yes. Yeah.

51:38Dr. Mary Claire Haver:All day. Right. Every day. I had to have a special TV put in our house. So my father-in-law, so it wouldn't be in the room with me because it just would go on all day. And these are good people. who went to college, who, you know, in their 70s and 80s are just nonstop, you know, while they're awake, this is on. And they're being fed these messages over and over again, and they don't see anything wrong with it.

52:02Katie Couric:Right. And I think that's such an important point, because I think sometimes each side demonizes the other. Yes. And I think a lot of it is the content that they are consuming. And that's shaping their worldview inevitably. And to your point, in many homes, it's kept on 24-7. And they're not necessarily getting a different perspective. I believe that the New York Times and the Washington Post and the Wall Street Journal, which has quite a conservative op-ed page that I am a big fan of legacy media, NPR, PBS NewsHour, network newscasts. You know, I know MSNBC has a particular bent. I know Fox News has the opposite bent.

52:54Katie Couric:You know, you really have to learn to be an educated news consumer and you have to consider the source of everything you read and get it from multiple outlets. I think it's one of the quintessential problems of our time. And how do we come together when we see things so differently? And the information we're getting, as my friend Nicole says, people are getting affirmation, not information. We're looking at sources that basically confirm our pre-existing biases.

53:33Dr. Mary Claire Haver:This is sounding a lot like the Women's Health Initiative. I mean, the exact same thing in a much smaller scale happened with that.

53:44Katie Couric:Right. Well, let's talk about that. You know, when that broke. So I was doing the Today Show and in fact, an article in the New York Times magazine written by Susan Dominus, who's a great reporter at the New York Times, talked about how not only the study, and I'd love, you know much more about this than I do, Mary Claire, but not only was the study flawed in terms of the subjects that were being evaluated for HRT, right? Right. But then the reason the study was stopped got misinterpreted and misreported. So I think it was kind of those two things coming together that stopped research into hormone replacement therapy.

54:31Dr. Mary Claire Haver:The downstream effects of this have affected an entire generation of women's health outside of reproduction and probably including reproduction. But like you were on the ground, you know, you're being fed reports, you know, like you got to read this or whatever. But like, do you remember, like it was the number one medical news story of 2002. Yeah. This estrogen causes breast cancer. Right. Mess. And I've had a few experts on the podcast. They're they're queued up, you know, for the next few weeks who were there like on the research and talking about like the fights behind and like this alternative view of the results.

55:08Dr. Mary Claire Haver:And, you know, and it just played out behind closed doors. And it just feels so much the polarization and, you know, the paternalism and the, you know, we know what's best and not allowing women to have a voice in their own care.

55:21Katie Couric:Right. Can you like give me a synopsis of what you've learned happened? It was a billion dollar study, which. But weren't the women mostly postmenopausal?

55:34Dr. Mary Claire Haver:The outcome of the study was heart disease. Is she going to have a heart attack or not? Right. You know, R is giving her hormone therapy at whatever age going to decrease her risk of a heart attack. And that was the observational data said that, but, you know, in medicine, we have to have control randomized. So they went with an older study group because it takes a while to have a heart attack. But the women were obese, had multiple risk factors, probably already had existing cardiovascular disease. They weren't getting caths or any evaluation of their coronary arteries before they were giving them HRT.

56:06Dr. Mary Claire Haver:And the average age was 63.

56:07Katie Couric:Right.

56:08Dr. Mary Claire Haver:Not 50-51, which is when we started hormone therapy, you know, back in the day, which is an usual time. So they reported, not only does it not help heart disease, but it will increase your risk of breast cancer. And that risk never reached statistical significance. And it was only in the arm that took estrogen plus progestogen. Plus, they excluded women with hot flashes because they know they were in placebo. There were so many little things that really skewed the results. We use this data all the time. Now that we can say, if you start young, there seems to be, there is a protective effect. If you don't have existing cardiovascular disease to protect you, you know, you will have a heart disease later in life, you know, if you, if you were on HRT, but that was like doing and looking at certain ages.

56:54Dr. Mary Claire Haver:If you start before 60 or within 10 years of your menopause, there is cardiovascular protection. But if you start older, there is not. So like all that new, there was zero nuance when they reported it, but it was a hell of a news story.

57:05Katie Couric:Right. But I think the big panic was this breast cancer risk. Right. And it was a very, very small percentage increase.

57:15Dr. Mary Claire Haver:So the nuance was relative risk, which is hard for me to understand. I do this work every day versus individual risk. So the absolute number of women who had breast cancer from taking the combined therapy of a very old medication we don't use anymore was like one case out of a thousand per year, but it was 25 % higher than the baseline rate. And so they reported 25 % increased risk of breast cancer, you know, and it scared the hell out of women. It scared the hell out of me as a young resident. And we were terrified and we were waiting. You know, we weren't even allowed to see the study when the headlines came out.

57:51Dr. Mary Claire Haver:And once that genie got out

57:52Katie Couric:of the bottle, it just stopped all the research in its tracks, didn't it? And I still get confused about the estrogen progesterone combo, because if you have your reproductive organs, you need

58:05Dr. Mary Claire Haver:something to protect the lining.

58:06Katie Couric:So you need progesterone.

58:08Dr. Mary Claire Haver:Yeah. So because the endometrium, the lining of the uterus, the inside, like where the babies grow, where your periods are made is highly sensitive to estrogen. It's it builds this tissue out.

58:19Katie Couric:Right.

58:20Dr. Mary Claire Haver:And progesterone makes you shut it at the end of the cycle. And if you just have estrogen going on and on and on, that tissue will just continue to grow and divide. And for some women, it becomes hyperplastic and then maybe malignant. So we can give you a progesterone and negate that risk.

58:34Katie Couric:You know, I was going through menopause kind of right around the time I became the anchor of the CBS Evening News. So I didn't want to be like Arthur Brooks in broadcast news, you know.

58:46Dr. Mary Claire Haver:Did you have hot flashes?

58:47Katie Couric:I didn't really have hot flashes. I had night sweats. But I also wanted to stay mentally sharp. You know, I didn't want to have a brain fart in the middle of the evening news. So I started, I went on the patch and then I took bioidentical progesterone at night. I sometimes forgot, honestly. And I loved it and I would have stayed on it forever. I don't know if I'm allowed to do that. I would have talked to my doctor, obviously. But then I was diagnosed out of the blue with breast cancer and it was hormone receptor positive breast cancer. Now, quick question while I have you, doctor. Was that caused by my HRT and progesterone?

59:32Katie Couric:No.

59:33Dr. Mary Claire Haver:When we look at the data, so there were other trials. There's like a KEEPS trial and a Kronos trial and other things in Europe because in Europe, they actually didn't use the Primpro that we used in the U.S. So the estrogen-only arm, which was Primrin, equine estrogen, you know, had decreased, 30 % decreased, you know, relative risk of breast cancer. So the estrogen-only arm, estrogen was very protective. We think because it's an anti-inflammatory and lowered their risk. And though the women who were on HRT at the time of their diagnosis had lower stage and better survival rates. So a certain amount of women are going to get breast cancer, and we're working on why that happens.

1:00:11Katie Couric:But women on HRT, especially

1:00:14Dr. Mary Claire Haver:modern HRT, and most women do not have a family history. Most breast cancer is a one-off.

1:00:20Katie Couric:Right. Right.

1:00:20Dr. Mary Claire Haver:It's like 82 percent or something.

1:00:23Katie Couric:Right.

1:00:23Dr. Mary Claire Haver:So you being on HRT at the time of your diagnosis probably led to an earlier stage diagnosis for multiple reasons. One, we think it plumps up the cells so that they're easier to find. Right. Did you feel a node or you just went in for a routine?

1:00:37Katie Couric:I just went in for a routine mammogram.

1:00:38Dr. Mary Claire Haver:And that you are usually getting regular screening because you're going to your doctor to get your refills and they're getting your mammograms.

1:00:45Katie Couric:Right. And also I'm kind of hyper about my health because I'm a single mom.

1:00:50Dr. Mary Claire Haver:So yeah, your HRT did not cause your breast cancer. It was probably feeding those cells that had had a malignant transformation from a healthy cell to a malignant cell. And so they, because you had estrogen receptor positive. So we all have estrogen receptors on the breast cells. and then if they when they go through the malignant transformation they might retain those receptors so we can use those receptors to attack the cancer cell and and put you on blockers and things so i don't know if you were on ais or any aromatase inhibitors or tomocophan i am now you are i'm on

1:01:20Katie Couric:uh i i an astrazole yeah what upsets me though of getting back to the women's health initiative is that for 30 years, this research really dominated. It was never really done. And I feel like if this study had not been stopped, and I remember interviewing Bernadine Healy, who was the female head of NIH, which was great. I thought, well, if that study had not been halted, they probably now would have some kind of therapy that would bypass any kind of estrogen in my breasts or... So they do.

1:01:58Dr. Mary Claire Haver:They do? Yeah, let me tell you about it.

1:02:00Katie Couric:But I know there's vaginal estrogen.

1:02:02Dr. Mary Claire Haver:You can use vaginal estrogen today. There is a medication called basodoxyphine, which is a CIRM, a Selective Estrogen Modulator. Basically, it binds preferentially to different estrogen receptors. We have alpha and beta. It's very high tech. So CIRMs are things like tamoxifen is a CIRM. Okay, it preferentially binds. So what basodoxyphine is.

1:02:22Katie Couric:When you say serum, I think people think of like the thing you put on your face. I mean in your blood. In your blood. So it's a pill though.

1:02:28Dr. Mary Claire Haver:So yeah. So basodoxyphine is a pill. They've combined it with primarin and it's called Duave or Duavi. And Duavi allows that estrogen to get to your brain, your bones, your joints. My skin? Your skin.

1:02:43Katie Couric:Thank God.

1:02:44Dr. Mary Claire Haver:But it binds and blocks the estrogen receptor and downregulates in the breast. Well, why hasn't my, I love my doctor. Hang on. So they're doing studies right now in high-risk patients who had stage zero cancers. And so far, the early data is showing that on this Duovie, they are not seeing, they're seeing decreased recurrence.

1:03:06Katie Couric:Wow.

1:03:07Dr. Mary Claire Haver:So we're getting there. But there is hope. So my patients who are high risk, we're talking to them or anyone who has like bleeding or severe breast tenderness, Just like, Doavi, like my best, best friend growing up, Carolyn, mom, horrific, died, you know, and she's so terrified. But her her symptoms were so bad. So I came to a compromise with her on this medication and it's changed her life. She sleeps at night knowing it's probably lowering her risk of breast cancer because the way the estrogen receptor reacts in her and in her breast and in her uterus. But she's getting the symptomatic treatment she needs.

1:03:43Katie Couric:Yeah, I would love to look into that because estrogen is like a wonder hormone.

1:03:49Dr. Mary Claire Haver:We tend to, as humans, function better when it's in our system. But, you know, it's a balance of recurrence risk versus, you know, everything else in your life. And what's missing in the post-cancer conversation for most women, they're great at giving you nausea medicine for your chemo. And they're great about, you know, warning you about all these side effects except for your sexual health, your bones, your joints, your, you know, the things that when we remove this estrogen, no one's like preparing you or like guiding you

1:04:18Katie Couric:through this. That's true. That's fascinating. And I'm so glad I know more about that now because I'm doing a documentary. I was going to ask, on hormonal. Do you have a name yet? Can I say it? Yeah. Yeah. I mean, we had our first meeting this morning actually with the directors and the producers and the researchers. And, you know, I've been interested in the disparities in medical research between men and women for some time. I think when I first learned that women were not required to be included in clinical trials until 1993, and the fact that the statistics are just staggering, that an average of four years longer to be diagnosed with the disease, women's pain has for so long, right, not been acknowledged, right, and so many things.

1:05:10Katie Couric:I couldn't believe, Mary Claire, that I just read that they finally have female crash test dummies that have breasts. And they did realize they had to make them smaller, but they didn't consider sort of the physiology of a woman's body. And now they have in crash test dummies. And who cares, right? Except we're way more likely to die in a car crash. Yes, exactly.

1:05:40Dr. Mary Claire Haver:Than a man, because the dummies that they do all the safety testing on and make the seatbelts for in the airbags were tested on male dummies, never on females.

1:05:49Katie Couric:And the statistics, there are so many that are so shocking. And so this issue has really, I think, bubbled to the surface, but I feel like it's kind of in bits and pieces. So we want to kind of try to give people, connect the dots and give them the big picture of why women have been so dismissed and ignored.

1:06:14Dr. Mary Claire Haver:The system was built, you know, by men, basically for men and actually Caucasian men. And throughout history and anything that that went what didn't fit that model was considered abnormal, atypical, you know, despite females are 41, 51 percent of the population, our chest pain and a heart attack is atypical. But I think the first step is recognizing it. And that's what we're so good at communicating. And then it's like, okay, we recognize it. And now we have to legislate it. We have to teach it. We have to make this mandatory part of the curriculum. I really see, I really, like my prayer is at the end of my life.

1:06:52Dr. Mary Claire Haver:So my daughter's in medical school. That she will understand the sex-based differences in health, you know. And at a level that was never taught to me. Isn't that crazy? that we have a women's health specialty. Right. That it doesn't include having babies. OBGYN is great, and I'm an obstetrician-gynecologist. That's the breast and pelvis, you know, and having babies. But, like, that should be one part and then everything else. Women's cardiovascular disease, women's autoimmune disease, women's musculoskeletal disease. Women's health should be a specialty outside of obstetrics. So there are a couple of fellowships.

1:07:28Dr. Mary Claire Haver:So my friends, Lisa Larkin, who is president of the Menopause Society, and Heather Hirsch, who's very active on social media right now, They both did women's health fellowships out of internal medicine.

1:07:37Katie Couric:So but we need more of that. You know what I thought was so interesting that and I don't know if it's changed, but I remember when I first started really digging into this topic that so many medical schools don't have a women's health rotation or curriculum. and that there was a group of, I guess, doctors at Stanford, I'm sure they were mostly women, who took it upon themselves to develop their own curriculum focusing on women's health. Today, do medical schools have this kind of specialty? That is insane to me. Or just fellowships?

1:08:12Dr. Mary Claire Haver:It's just really fellowships. And it is difficult. You know, the curriculums are so massive. And, you know, even in OBGYN, when I think about, we are expected to be social workers, psychiatrists, you know, surgeons, midwives, you know, all the things. And for me to like track all this stuff down and know the differences in male and female cardiovascular disease and male and female urology, it's a lot. And I think it needs its own specialty curriculum and we just have to demand it.

1:08:45Katie Couric:Well, getting back to estrogen, I thought it was so interesting that the reason that women weren't studied more closely in clinical trials was because of their hormones and hormonal fluctuations.

1:08:58Dr. Mary Claire Haver:That's considered hard. Right. Even the animal models, they take out the estrus. They don't have periods. It's a little bit different. You know, if you have a dog, you understand.

1:09:08Katie Couric:Well, didn't they use male mice for the longest times, right? Right. Yeah. So I think it's like we were too difficult to study.

1:09:17Dr. Mary Claire Haver:And is it really difficult? It's just us. But compared to men, you know, it's more expensive to factor in hormonal changes throughout the cycle or not having hormones as a postmenopausal person. You know, it's just more expensive. It's harder. And, you know, the cardiovascular drugs we use today were, you know, not really tested in women. Exactly.

1:09:38Katie Couric:And that's why we're calling this film that we're developing and getting ready to shoot hormonal because so much of women's health is predicated on hormones. And even as we get older, I think it's so fascinating. I don't know how much you know about this and I'm going to dig into it. You know, dementia and Alzheimer's and how our hormones are affecting our brain health, Right. And and also the microbiome. So interesting. But I think that I read that even though two out of three Alzheimer's patients are female, only 12 percent of the funding in Alzheimer's research is focused on women. Exactly.

1:10:18Katie Couric:And why women are getting this disease or the role hormones play. So I think it's going to be so revelatory. And I think there are a lot of things that are still I mean, there are many areas. Mary Claire, you know better than I do, of women suffering in silence. But I think about sort of the stigma around postpartum depression and even psychosis. And I covered stories about that at Andrea Yates in Texas. She was 20 miles.

1:10:46Dr. Mary Claire Haver:I was a resident when that happened.

1:10:47Katie Couric:Oh my God, that story stuck with me, has stuck with me for decades. And for your listeners who don't remember, Andrea Yates was from Texas, from Houston, right? Just outside of Houston. Houston. Between Houston

1:11:00Dr. Mary Claire Haver:in Galveston where I was practicing.

1:11:01Katie Couric:And she had five children, all very young, homeschooling them. Her husband, Rusty, worked at NASA. So she had postpartum psychosis.

1:11:10Dr. Mary Claire Haver:So the most extreme version of postpartum depression, she had a hypoestrogenic state that absolutely un... You know, she was hearing voices very clearly that told her she had to save her children by drowning them, by killing them.

1:11:26Katie Couric:Right. She killed them. She drowned her oldest son. In a very scary story, I went down with a producer from the Today Show, Sarah Claggett. We flew to Houston, and I met Rusty, her husband. And he invited me in the house. And he showed me where the little boys had kept their Legos, and they had a very young infant daughter. her. And then he said, would you like to see the bathroom? I think her oldest son's name was Noah, if I remember correctly. It was the worst story, Mary Claire. And she chased her oldest son and drowned him in the bathtub. And I said to Rusty Yates, I don't think I can, I don't think I can do that.

1:12:18Katie Couric:But I remember doing a lot of research and you might remember this too. She had both postpartum depression and psychosis, and they ended up like she she just got very shitty care. And part of it is they don't know how to treat this. Right. But but they took her off her postpartum psychosis meds, kept her on her postpartum depression meds, which made her feel well enough to act out her scary, intrusive thoughts, you know. and but anyway the reason I bring that up it was so heartbreaking but that's a topic that I think mothers new mothers are ashamed to talk about postpartum depression I think it affects so many and again that's because of your hormonal changes right Mary Claire that happen after you give birth

1:13:14Dr. Mary Claire Haver:yeah so you have this massive drop in estrogen postpartum especially if you're nursing because the prolactin will suppress the function of the ovary, which is meant to keep you from getting pregnant again so you can take care of your infant. And as you're nursing, the ability to reproduce goes down and that's an evolutionary advantage. But it will, in some women, will absolutely unlock, you know, intrusive thoughts. I had intrusive thoughts when Catherine was born. I remember being in the tub with her and giving her a little bath and I would have thoughts of her drowning. I had no impulse to act on it, but it was the scariest thing.

1:13:50Dr. Mary Claire Haver:No, it was like,

1:13:50Katie Couric:I had that too. I was always afraid that I would leave Ellie on the side of the road. Like, what if that happened? And I think it's like, it's both chemical and then this overwhelming sense of responsibility you have that you're responsible for this little hopeless thing, you know? So it is really scary. But what makes me mad is, I think it's another example of the medical establishment ignoring a very specific issue that happens to women and not really focusing on it, not providing the research dollars. Because I am sure everyone thinks about like Viagra, okay, men can't get it up. So they poured that, you know, millions of dollars.

1:14:37Katie Couric:And they create this drug in a nanosecond. And yet women who are suffering, they're being ignored and it really pisses me off.

1:14:47Dr. Mary Claire Haver:One good thing that came out of the Yates, by the time I finished early, you know, so within three or four years, we had mandatory screening for postpartum depression and psychosis. That had never happened before.

1:15:00Katie Couric:Yeah.

1:15:00Dr. Mary Claire Haver:And I don't know if that was just a Texas thing because I've only practiced in Texas, you know, until recently. But like every single postpartum patient, we were screening at every visit with a, you know, standardized screening test for depression. And that came directly out of what happened to

1:15:14Katie Couric:Well, thank goodness. And I hope that's done all across the country. But, you know, even Ellie said she struggled with postpartum depression and she didn't really even talk to me about it. And we're extremely close. And I just think anything we can do, I guess there are more support groups. People are talking about it more openly.

1:15:32Dr. Mary Claire Haver:Power of social media because they're sharing their stories.

1:15:35Katie Couric:I still don't think. The support. What do you do? There's enough focus on it and enough science that's really interrogating how we can mitigate the symptoms. So why do you keep working?

1:15:48Dr. Mary Claire Haver:I'm assuming if you quit tomorrow, you'd be fine. Like the house wouldn't fall down.

1:15:52Katie Couric:You would financially be okay. Oh, I would definitely be okay financially. I've been overpaid for years.

1:15:59Dr. Mary Claire Haver:But. What keeps you going? I mean, you are constantly working.

1:16:03Katie Couric:I know.

1:16:04Dr. Mary Claire Haver:And I love that about you.

1:16:05Katie Couric:I feel like I have this reservoir of trust that among some people now in the current political environment, you know, some people don't like what I'm doing. But I feel that I'm doing a public service. Honestly, I feel like if I can help give information to people that will either prevent them from getting colon cancer or help them understand an issue or clarify something and that people appreciate that my goal is to provide fact-based, scientifically backed at a time where science is being so, you know, sadly demeaned and, you know, just so upsetting to me because scientists are heroes in my book and so are doctors.

1:17:05Katie Couric:But I feel like I have an obligation to use whatever Reservoir of Trust I've built up and also the platform I have to try to give important information. And I love it because I am learning things all the time. You know, I was thinking the other day I went to some place and or I had a conversation. Oh, it was with Ellie Honig, the lawyer, all about like how the immigration courts are different than the regular courts and how due process is different for illegal immigrants and they, you know, or immigrants. Anyway, I just feel like there's so much I still don't know and still don't understand that in a way I'm being selfish because I'm learning these things in real time.

1:17:59Katie Couric:And through my experience of learning and understanding, I hopefully am illuminating things for other people. And so I just like it. I don't know what I would do. I mean, I think I would find like a cause I cared about or, you know, a charity or a nonprofit and really, but, you know, sometimes I think what's wrong with me? Am I worried of what will happen if I actually stand still for a moment? Maybe I'm afraid of that on some level, but that's between me and my therapist, I guess, which I don't have right now. Maybe I need to get one. But anyway, I just like being busy. I like being active. I like feeling like I'm having some kind of impact, even if it's for like five people and not 7 million or whatever the Today Show viewership was, that I'm being of service, as weird and cheesy as that sounds.

1:18:56Dr. Mary Claire Haver:So many of my followers get to this point. You know, I'm 57, you're 60.

1:19:01Katie Couric:68. And,

1:19:03Dr. Mary Claire Haver:you know, menopause happens, this midlife shift, this inflection point, and they feel invisible and that their words don't matter and that their actions can't change the world. But I just love that you're like, no.

1:19:16Katie Couric:Yeah, I've always been a bit of a nonconformist and not one to necessarily follow societal rules. And I just think it's so important. And, you know, getting back to sort of longevity and health span, you know, I think it's so sad that women live longer but don't live well. And I think obviously we're talking about our physical selves, but I think to live well, that means rich and important friendships and hobbies and things that you're passionate about, you know. And so I want to keep doing this in some capacity, maybe not at the ridiculous level I'm doing now, you know, working on documentaries and doing this.

1:20:09Katie Couric:And, you know, then I'm kind of like a cancer clearinghouse for so many people, too, because people reach out to me. But I want to stay engaged in the world, you know, and I'm sure you feel that way, too. And how do you do that? You do it by doing, right?

1:20:26Dr. Mary Claire Haver:You do it by doing. And just leaning into where you feel like you're doing the most good.

1:20:31Katie Couric:Yeah.

1:20:31Dr. Mary Claire Haver:So, well, thank you so much.

1:20:33Katie Couric:This was so fun. I really appreciate what you're doing. And you are performing such a public service for so many women and so many men who need to care about the health of their partners.

1:20:47Dr. Mary Claire Haver:You can hear more from Katie by listening to her podcast. Next question with Katie Couric. wherever you get your podcast or subscribe to her newsletter, wakeupcallatkatiekurik.com. You can find full episodes of Unpaused on YouTube at Dr. Mary Claire. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawselife.com. My upcoming book, The New Perimenopause, is available for pre-order on Amazon. If you're loving this podcast, I have an important request.

1:21:25Dr. Mary Claire Haver:Please take a moment to follow Unpaused on your favorite podcast app. Following and listening is what pushes this information to more women who need it. So if this podcast has helped you feel seen, understood, or supported, hit follow right now so you never miss an episode. Thank you for being here with me. Let's keep going. Unpaused. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

1:22:14Dr. Mary Claire Haver:Rinse knows that greatness takes time, but so does laundry. So Rince will take your laundry and hand deliver it to your door expertly cleaned. And you can take the time pursuing your passions. Time once spent sorting and waiting, folding and queuing,

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1:22:31Dr. Mary Claire Haver:So pick up the Irish flute or those calligraphy pens or that daunting Beef Wellington recipe card and leave the laundry to us. Rince. It's time to be great.