Tom Mueller: The Most Dangerous Part of America’s Healthcare System Isn’t What You Think

29:14Oh yeah. To solicit, you know, to hang out and be on private jets, expensive dinners, expensive gifts, with a company that will print driver's licenses. They have the exclusive contract essentially. Forever. It's massive amounts of money, but it's exactly what you're saying. And when you, you know, when we talk about complicit, I love that you use that word because when we talk about somebody like Warren Buffett, I go, I will not call Warren Buffett good or bad or whatever, but it is interesting. It is interesting that we would never accept that excuse, let's say from another person, if they, if it turned out they funded the Sinaloa cartel if they owned 40 % of it.

29:53Like imagine if you said to somebody, I own 40 % of the Sinaloa cartel. They'd go, you're a criminal. And you're like, no, no, no, no, no. I just invest in the Mexican drug cartels. I don't engage in it. They're a good investment. They're a great investment. They're rapidly growing, good market share. All of the return on assets is awesome. It's a great, but look, do I condone everything? Of course I don't. But I'm not there for the murder. I'm just there for the investment. There is a level of asking yourself, if everyone gets to say that they are not responsible, then who is responsible? Yeah.

30:28I think it's also how things are phrased. An inquiry, an inquisition, a white collar crime, corruption, bribery. It's theft. All of it is just theft. And I was asking you before we started that, what is it that makes people steal? I know what would motivate someone to tell the truth and blow the whistle I can kind of figure it out You get tired of how things are You go, I have to make a change I have to be the change that I want to see But in your research, what makes someone go Here's a million dollars that's supposed to go to public good And I'm just going to buy a nice car and a nice house Well, first of all, steal from necessity I'm hungry, I gotta eat, my family has to eat I get that I'm not condoning it, but I get it And a lot of that is caused by the white collar crime we were talking about earlier, right?

31:19But second of all, if you ultimately, if you and your peers are an aggressive corporate culture and you talk about how you really got to push things, you really got to go for the throat, you know, all these sort of sports slash killing analogies of war. I mean, corporations as war fighting machines. Yeah. That's kind of, you know, penetrate and take, you know, enemy territory, this sort of thing. Then you're going to naturally push hard and you're going to do things which are potentially illegal, but maybe, you know, there's this sort of nudge, nudge, wink, wink. The compliance department says we're doing everything just right.

31:59We have a gold-plated compliance department. Plausible denailability. Go on, go on. Off camera, you can do, you know. But then there's this worship of money and the way in which people keep score in their lives. I mean, it's hard to figure out when you're doing the right thing. If you're saying, am I doing the right thing today? By, I don't know, by writing a book, by doing a comedy show, by talking. It's hard at the end of the day or the end of a year to say, I've done something really important. It's easy to count money. And if you're in that culture where you say, look at that. I got five million bucks.

32:34that's very tangible and now it's 5.2 and on this and the stock market is growing growing the wealthy people that i know the ones that have 100 million they only talk about the people who have 200 and 300 million the ones who have 300 million they talk about the billionaires the ones who have a billion they talk about the two but it's never enough it's like the shark that can never get full and that's where i think that's the ultimate problem it becomes especially when the society worships these people and condones all of their actions, it becomes this sort of endless hunt for more money at the end of the day.

33:11And it's a status thing. But how can you possibly live? How can you possibly use even a million dollars, let alone a billion dollars? I mean, how can you? It's a counter for the quality of your life because the quality of your life, I don't know. I mean, again, working in banking for a brief time, I saw some amazing people, incredibly smart people, doing incredibly dumb things with their life, throwing away their time in order to have a metric ton of money. They didn't have cars. They didn't travel. They didn't live. But they felt successful. And for me, after two years, I was like, you're losers, you guys.

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36:04We had an episode of the podcast with Rutger Bregman. And some people might not know his name, but he was the guy who rose to a little bit of infamy by, he went to Davos. and at Davos, he basically said to everyone in the room, he's like, hey, hey, why is everyone here trying to solve the problems of the world as if you are not causing the problems of the world? And he said to everyone in that room, just pay your taxes. Everyone here is avoiding, you flew in on private jets and you're like, what should we do? He's like, pay your taxes. And then they were like, who invited this guy? Don't invite him back again.

36:37But one of the things he talks about and that's what he's working on now is he said, we've created a society where the smartest, brightest minds go into fields where they're just trying to extract from society there was a time when the most brilliant scientist tried to work on the science that would change the world in the most positive way invent a light bulb create an airplane find a new type of health solution you know what i mean and then now that person goes like go to a company that can make as much money as possible as quickly as possible mathematicians were trying to solve going to space or you know trying to figure out the circumference of the globe whatever and then they were just like go to this company make as much money as possible get the trading but but what you said i think is key it's the reverence you turn on the news and they go larry ellison now the richest man but why like if society like and and i mean that on like a media level not not the people on the ground because i think the people are oftentimes sort of not victim to it but you you you're experiencing it.

37:40If the news tells you that this is good and important and the media tells you it's good and important, then you think it's good and important. And not by accident, half the media is owned by those very people. If you look at the oligarchs that are owning the big news outlets, they're legion. And trying to tell Jeff Bezos that he really shouldn't be a monopsony and all good sold in the united states you will not last very long right there's a lot of self-editing so i think that's no that's absolutely right um this reverence the sense that they are gods and it builds into this sense too that there is an ubermensch society and then there are underlings and those underlings if they're you know homeless well they're not human really it's not my problem i mean that's the sense that i get it's horrible to say but um there are people who the haves and have nots have always existed since ancient greece since rome since whenever but this is a sort of a institutionalized um form of of superior being um judged by your you know net worth and then everybody else is really expendable to talk about expendable you you you can look at one of the examples you give in the book and you go through multiple um multiple hospitals and healthcare systems i i was reading about the dialysis and and and how each system doles it out and to what you're saying in some of these stories man it it it sounded less like health care and more like a fast food drive-through chain it felt like they're trying to get people on and off a machine as quickly as possible use as few nurses as possible make as much time work as possible look after the patient for the least possible and i went i mean i guess this is great if you're trying to get fries out quickly but these are human beings you know what i mean it feels like the business model isn't it's not about health care it's about health profits 100 it's fast food medicine and it's a model that wasn't invented by dialysis was embedded in the 60s by um by people who actually um ran kentucky fried chicken franchises and and wendy's literally Literally, who then started buying up, you know, started privatizing hospital systems and putting together.

40:03So they literally were the people with this branding experience and this mass, you know. And in theory, I mean, you know, Atul Gawande wrote the Cheesecake Factory article in The New Yorker, which got a lot of attention. I don't like it, but he's a smart guy. He's a doctor. And the idea of focusing in on a specific medical procedure, making it as efficient as possible, and delivering it in as low cost a way as possible, that's potentially a useful idea. The important thing here is that it not become turning patients into widgets on an assembly line, which is precisely what the fast food model or the Cheesecake Factory does.

40:45you're not tailoring your care to the individual needs of your patient you are looking and once again this is a finance version of you the person person who brought this into dialysis or popularized camp theory he's a former ceo and the founder of devita one of the two big companies he made his at bain capital that's a private equity firm he was a he was a finance guy the kind of guys that I worked with. And he basically, and he said, speaking to a business school audience, he said, you know, if I were running Taco Bell with, I forget the exact numbers, 23 ,000 outlets, and I would be doing all the same things as I'm doing.

41:22It's not about the patients, is what he said. And some doctors hate it when I say this. These are quotes, right, from his speech. This is an actual quote. Actual quote. Yeah. Yeah, I can show you the video. It's quite striking. But again, it fits in a business situation in which you are Wall Street facing and you're talking about return on assets. If you have 2 ,000 dialysis clinics around the country and your main focus is shareholder value, and I'm getting paid in stock as a CEO, so my shareholder value is pretty important to me too, right? It's a conflict of interest on a massive scale. Anyway, if that's your aim, you want to run as many patients through every single one of those facilities as you can because your asset base your buildings your machines and so on the more units you shoot through them yeah and it is just like taco bell so people are not burritos right every single person who goes into that facility needs should have a treatment that is tailored to their individual problems their individual biology their individual size and everything and if you're running it as a fast food you know assembly line model you're not going to do that one size fits all one size fits all and you're going to penalize the people who slow things down who say oh actually you know tom here he should be getting five hours no way no way and they're violently pushed back and the doctors some of the doctors i've talked with who work in these facilities are not best pleased and some of them some of the workers are also suffering from serious moral harm because they realize it's like soldiers forced to commit you know yeah yeah yeah That's the perfect analogy, actually.

42:58It is, yeah. I actually think they're a perfect analogy. They're literally, they know what's wrong and they are not able to fulfill their Hippocratic oath to their patients and take care of their patients because the structure they're working in doesn't permit it. Yeah, I think that's the perfect analogy because we take for granted how much an overlord and a system can then oppress even the people within it. And then what happens is in a society, we start fighting amongst ourselves as if there's not one central thing that we should be looking at. So you have leaders and governments who send soldiers to do things that are despicable.

43:30Those soldiers return home to their countries. They get spat on in the streets. The defense company doesn't get spat on. The people who lied about weapons of mass destruction, they don't get spat on. Do you know what I mean? And the same thing happens here. People go, my doctor is trash. My this is. But it's when you delve into it that you go like, oh man, my doctor's victimized by the same system. A doctor is called a provider now or even a vendor. I mean, you know. Yeah, yeah. He or she is a cog in a wheel. And again, certain things, maybe burritos should be made that way. I'm game for that.

44:02But healthcare, there are other things. I mean, are we good with private prison systems? Are we good with private war fighting? Are we good with... There are certain things that should not be primarily profit-facing. Yeah. And healthcare is one of them. But there are a lot of others. And we just, in America, we've lost that discourse. when you look at other countries what did you find because i i think there's a perspective that you bring in this book and in your work that i think is really important because oftentimes people will go well i mean show me a better way to do it and you're like oh yeah i can and you actually go to other countries yeah and you show a better but but talk us through some of that because like australia japan like a wealth of other wealthy countries show that this is not the normal way that it needs to be no precisely i mean we've gotten so caught up in american exceptionalism that we lose sight of the fact that there are a lot of places where things in general and healthcare in particular are done a lot better.

44:58And the example, and the most brutal example, is how long do patients on dialysis survive in the U.S. versus other countries? What are the stats? They die two to three times faster than any other developed world, and many lesser developed countries as well. I mean, we're talking 20 % to 22 % per year death rate. Whereas mortality in Europe is anywhere 12 to 15 percent and more on the 12 side. Japan, 6 percent. I mean, we're talking the most and that's just how soon do you die? Quality of life is another big issue. But I mean, the central premise that everything has to be for profit is preposterous because every other country in the world does it better, does it cheaper.

45:49I promise of the Reaganomics era and ever since is we will do it better because government's the problem and we will do it cheaper because we are so efficient now in in America we do it worse and we do it vastly more expensively at the same time so something's rotten in the state of Denmark not Denmark you know what I'm talking about yeah and you have so in most countries you have you have the fisk you have the treasury that collects taxpayer dollars and you have I don't know patients in hospitals where patients go. And the money goes from the treasury, boop, boop, boop, boop, to the hospitals, pays the doctors, pays the staff, and pays for the treatments.

46:29In America, you have the treasury and you have the hospitals, or the dialysis facilities in this case. In the middle, you have these twin towers of massive corporate absorption. You talk about middlemen and the cost to healthcare. this is a classic example you have these two twin towers that are that are soaking up a lot of the billions and billions we're talking roughly i wouldn't do twin towers in the hands like that it might be the it looks like the wrong thing yeah i'm using thousand i was like and it's just whoa whoa tom tom wrong hands let's find different analogy different analogy let's go with something two large yeah two large you know what sinkholes sinkholes that's better two sinkholes and all And they're sucking everything in.

47:16That's way better. It looks nothing like the 9-11. You went to towers and then your hands did this. And yo, man, we from another country, Tom. Don't be doing that to us. Yeah. Look at the calendar, man. Look at the calendar. What was yesterday? Yeah. No, no. You're absolutely right. These are the twin sinkholes of money absorption. And the money goes into the sinkhole and not so much comes out. And this is, again, this is not unique to dialysis. It's particularly, in my view, obscene in dialysis. But it happens, you know, what is UnitedHealthcare's model? It's to take as much money as they can and give as little as they can away.

47:51That's it. And the rest goes into the sinkhole. I feel like it's the Rosetta Stone of healthcare. That's what you've shown us with the dialysis model is you've gone, let me show you this example, show it to you so clearly that you can then understand every different language of what's going wrong in American healthcare and how to actually look at it. You know what I mean? And when you look at these other countries, what would you say is the biggest thing, like just on one level that they're doing differently? I mean, I can understand the government is paying and it's a different, but what would you say is like something that they're practically doing differently than in the US?

48:26Well, they're following universally accepted medical guidelines, which have to do with how long, how gently you treat, at what values you treat. Do you do it at home or not? I mean, if you look at Australia, the majority of, they push patients to home dialysis. Wow. And ever since the 1960s, ever since this miracle cure was invented, the people who are not trying to make money off of it said home dialysis is the way to go. You get to control your destiny. You get a feeling of, I mean, any chronic disease, a sense of agency is critical to getting well or to feeling better, right? And being a passive recipient of care.

49:02Lie down, put your arm out. I'm going to take your blood. I've heard patients tell me this in diocese facilities. You need to have control of your destiny, and doing that at home is the way to do it. Also, again, you can tailor your care, and it's doable. So Australia pushes people home. But that is another of the fundamental, widely, universally accepted laws of diocese. It's being broken in the United States. It's being broken because there are companies that make a lot more money doing it elsewhere, but it's also being broken because cms well the health um health and human services doesn't enforce best practices on their you know i i beat up in my book i beat up a lot on corporations i think they deserve it but i didn't give sufficient time to the silent partner in the crime and that is the cms that is the national health administration in america that is simply in bed with or complicit with or toothless to do anything about major corporate wrongdoing in what is cms uh it's the center for medicare and medicaid services okay it's the ones that administer medicare and medicaid funds and they know what good dialysis is yeah they know what the metrics are okay they're just not counting them okay so they don't count treatment time yeah they don't penalize people who don't treat longer.

50:27They don't count UFR, ultra filtration rate, which is the speed with which you remove liquid from someone's blood and their body, which are critical to survival. They don't count those things. Like, what are you counting exactly? They don't count septicemia, which is one of the major causes of death. If you're not counting that shit, what are you counting? I mean, it's putting the ladder up against the wrong wall. Yeah, but the question is, who's telling them what to count and how to count i guarantee you the answer is the revolving door in my book i i i cite several examples of people from the white house who have gone to the board of of the big pharma company yeah man same thing big analysis companies and vice versa yeah people from you know from the from from um the boardrooms of the big healthcare companies who go straight into government and are making these policies.

51:22And I cite examples of ways in which the policies got softer when these people arrived. I wonder why that is. And again, it's the notion that a corporation is going to do it better because we've been penetrated and taken over by this mentality to this point where we don't even recognize that there is common good anymore. It's just, let's grab as much as you can before, while it's your turn to eat. You know why? They've done a great job of tricking us. It's one of the greatest scams that has ever been pulled on people collectively. What they did was governments were providing a good. It doesn't mean that they were perfect, but the good was being provided by the governments.

51:59In this case, it's the 1970s when Medicare says they're going to cover dialysis. This is revolutionary. You have this problem with your kidneys. They're going to come in. The machine will be there. The government is going to help you out. And because you can amortize the cost across a population, it will work. It will work. And then very quickly, companies who see a gap go wait wait wait if the government's paying for it we can get that money and then they go if we can get that money how do we get more of that money and then they become part of the cycle it's so crazy how you see this in every country whether it's the uk whether it's south africa whether it's the united states wherever you're having these issues the people who work in government work with the companies to make the government look inept yeah the people on the ground then go the government is terrible we should give this to the private companies the private companies then take the work yep and then they provide a professional ineptness that not only doesn't do the job as well but it extracts more wealth so it's like before the government was going to be maybe not great yeah but they weren't going to be as expensive and now you're getting a shit thing for an expensive price yeah but you then hate the government you or the government doesn't do anything.

53:13It's like, yeah. And the companies that made that happen are the reason you keep coming. It's such a pernicious cycle. It's such a con job. And exactly. And the government does become, people in America, oh, big government, it's really bad. I mean, you look at the Pentagon, trillion dollar, and that is a bunch of sock puppets. I mean, they have Lockheed Martin up their butt with their hands going like this. Right. You know, I mean, and you see the revolving door between the generals who go onto Lockheed's board and I'm just speaking Lockheed, even Raytheon, you name it, they got it. the whole outsourcing government contracting thing is such a scam because it corporatizes and at the same time is able as you say to to push the blame onto onto government big government which never gets it right and talk about socialism i mean you look at war fighting in america a trillion dollars a year to the to the pentagon trillion dollars yeah that's socialism right oh no no it can't be because it's america sorry my my bad yeah and because it's war No, it's war.

54:09And it's because it's war. It's amazing how war - Yeah, war is always the thing where people are like, the government shouldn't be smaller there. You're like, why shouldn't the government be smaller there? We cut everything else, but 10 % raise for the Pentagon. You know, they're like, oh, we have smaller government. And he's like, except for war. Oh, war, I mean, no. And how successful have our wars been recently at producing security and national defense? Not so much, actually, if you think about it. More importantly - Oh, but I don't want to think about it. Sorry. More importantly, this is the question I often ask people as I go.

54:39You are so comfortable accepting the premise that America's job is to go out and fight wars. Why? To protect Americans. Far from America. That's what you say, right? We are willing to spend trillions of dollars to go out into the world to protect America. Why wouldn't you spend trillions inside the country to protect America? if americans are dying from kidneys dialysis machines that are too expensive health care that's not being provided you know food on a basic level that's a war that you could be fighting in your country without bombing anybody and that's exactly the reason in the 1970s a number of people this is during the you know the the cold war the coldest part of the cold war and the fight against russia and everything else and yet at the same time um bipartisan congressional figures republicans and Democrats are saying, we're spending billions, back when a billion was a big number, billions to build these rockets and we can't even take care of our own citizens.

55:38And they were pushing for dialysis in that way. And the other thing about war is of course, and the trillion dollar Pentagon is that, as one former general told me, when you get to be a big hammer, everything starts looking like a nail. I mean, we got to go out there and I built all this cool stuff. You've got to find a reason to use it. Highly trained in doing this stuff. We've got to find a way to use it. And we have to get rid of it because we have to make more. you're not wrong that's right you're not wrong that's right there's new stuff coming on and some of it gets lost in these smaller third world countries oh my goodness don't even get me started on that it's almost like what you guys are explaining to me it's almost like a shepherd that is not tending to the flock but is out there hunting for wolves that's a perfect analogy actually that's very good that's the perfect analogy the wolves are taking over in the shepherd's room like wolves are cooking dinner having lunch okay now you can sit this one out we'll take care you want to you want to do something about that wolf whoa whoa whoa wolves have their rights too you know these poor you do you know how the wolf feels about the sheep you're the shepherd though oh yeah yeah yeah but i mean have another beer come on you know that's that's you know what you're good when you when you think of it like yikes man it's scary because you see this moving into everything yeah people wonder why things are getting shittier and shittier in everything yeah and when i looked at this dialysis story i couldn't help but think of the analogy of it's almost like what what these health care companies did And would be the equivalent of car companies realizing the value of a seatbelt.

57:18Yeah. And then going, we're going to charge you every time you need to put it on. Yeah. And now you have to gamble with your life and go, do I - Can't afford that today. Can I afford it? Can I not afford it? But you shouldn't, this shouldn't be a choice. We know that you need the seatbelt, put it on. And now it's like, ah, but can I, can I? And they're like, oh, do you want to play with your life? And they know because to your point, it's a duopoly. It's what, two companies? Is it still two companies? The two major companies own and control 80 % of the market. Yeah, but I mean, that's a duopoly.

57:45You control everything. No one can push you around. And because it's your life, that's the craziest thing. I think corporations realize one thing. The minute a society we said, there are no holy cows or sacred cows, they thought to themselves, we will leave no sacred spaces. They've moved into organized sport. Yeah, you're not wrong. Yeah, you're buying the soccer jersey. You're coming to the matches. They're paying your hero. They're controlling their life Religion They've made them miserable So they've made us all complicit And I worry a lot Whenever I watch big organized sports I'm like The fact that people who love that sport Assume that 90 % of it is natural talent Always amazes me It's like when people have that debate Thinking before steroids were illegal in sport How great was sport And I'm like no no Before corporations were involved in sport How fair was sport Right Right, exactly.

58:38And the money aspect, again, you see sports betting now. And to me, that is another thing where it's like the stock market versus the real economy. I mean, when you're putting a bet on something, you debase it inherently. And your focus, again, turns from the activity on the field to outcome. And you can have derivatives that are bets on bets. And this is all stock market stuff. This is the way in which you think if you're not really engaging with the real world. And not only is it not helpful to what's going on in the field or what you're eating or what your health care, it's diametrically opposed.

59:10If you focus all your energies on making it into a money-making operation and betting on it, you're actually taking the energy away and the resources and the intelligent people and all the things who should be saying, how do we make a better dialysis machine? There hasn't been a better dialysis freaking machine in 40 years. No way, Tom. Oh, no. Absolutely. There have been tiny little adjustments there, but there's been no phase shift, major breakthrough. Why is that? Because there's no freaking money in it. These two corporations, big corporations, before them there were others, have locked in the market.

59:43They have their cash cow and they are milking it relentlessly. They're not interested in a new milking machine. They're not interested in the cow. You know what I've realized as well I don't know how it is in this country But in South Africa When you get life cover now You're not obligated to take an HIV test Whereas before You were obligated to take an HIV test If they're going to insure you For a certain amount of money So you'd have to test Or they have to know What your lifespan is What your CD4 cell count is But right now they're like No just bring it And then we'll see when we get there So I'm like Was HIV always that dangerous To the body and your longevity Or they found a way To not profit from You having HIV anymore do you know what i'm saying i wonder which one it'll be though because remember that before there was no home testing yeah they would have to send you to a facility yeah then you'd i'm saying i wonder which one it is because my brain goes which one is it have they found a way to de-risk it or have they found a loophole on the other side i'm saying i don't know which one it is it's just interesting when i hear that i go like huh i wonder what changed do you know what i'm saying yeah yeah like like what switches in a system that changes something how do we look at it differently i even think of man that can i tell you that there are parts of your book where i was just like i have to just meet this person because no there's there's books and there's thinkers that you encounter in life where you go who is this person and how are they so magical in the way they approach things or crazy because no but crazy in a good way or takes naps yeah at noon he's a noon napper but like there's there's a part of the book where man i was i was so impressed and like just like taken by how you stitched together even civil rights in in american health care and the way we think about how it's doled out to not doled out because you see again i i didn't know and i would have never known how you can trace dialysis and medicare and who gets treatment and who doesn't get treatment back to segregation and desegregation in the United States.

1:01:42No, literally, I mean, talk a little bit about that because that blew my mind. I was just like, oh man, we really have to think holistically and sometimes I don't think our brains are big enough. No, yeah. One of the most shocking things in my research for this book was the way in which dialysis impacts disproportionately black and brown communities. um if you're black in america you're 13 of the population but you're 35 of the um end-stage renal disease or kidney failure population you're four times more likely to get dialysis than if you're white and and it's this death by zip code redlining you know that that i've gradually begun to see i mean dialysis is a perfect map for but there are many other uh diseases that you know the incidence of hypertension, diabetes, and obesity, the way in which these communities, historically, the wrong side of the tracks, and I mean that literally, I'm working in South Chicago where there's a disparity in life, in longevity between North and South Chicago of 30.1 years.

1:02:51In the same years. 30 years in the same city, 30 years. You're in North Chicago, the wealthy areas. you live 30 years longer, 30.1 years longer than in South Chicago. That's insane. It is insane. It is utterly, utterly unacceptable, and it has been going on. I mean, as one, Magellan Hanford, one of my great dialysis nurses who was formerly an LAPD officer, as he said, it's got Jim Crow written all over it. This is absolutely, if you look at the maps of the impact of dialysis on communities, and that's kind of what I'm doing now. this book i couldn't walk away from the book as usually with with with books um you know i write it i care about it but six months before it comes out i'm thinking what's next i don't have any next this is next um so i've gotten together with um folks at the um at the new school the institute for race power and political economy and we're doing some research on on these areas in chicago south Chicago and east LA, Boyle Heights, where the impact of dialysis is disproportionate.

1:04:01Try to understand not just on individuals what bad dialysis does, but what does it do to a community? How do they start to see dialysis as sort of the part of their life's arc where you'll end up in the chair? Grand did, my uncle did, my kids are coming with me now to my treatments, they'll probably end up, I mean, it's just nightmarish. And especially when there are solutions that are in hand that are in you know again every other country does it better but there are very straightforward solutions to prevent this from happening in the first place so come back to your question i mean the it is absolutely dialysis in america is absolutely perfect um radiograph ct scan of what's wrong with racialized structural racism in america it is it is the poster child of what go wrong um and it is for me it's been quite a i mean a kind of a rediscovery of what america is i'm going to places i haven't spent a lot of time in i can imagine and um and i understand what the wrong side of the tracks means now i mean in chicago you literally walk underneath the tracks and you're in a different world everyone's a different color yeah i mean literally in the space of it's the most segregated city in the in the country but many many many areas are like that And it's, yeah, I'm rediscovering my homeland in a way that is deeply, deeply disturbing.

1:05:22We had an episode where we spoke to one of the most interesting people we've spoken to in South Africa, Dan. And we spoke about the remnants of apartheid and what people who say, it's been 30 years, it's time to move on now. And I said, what the genius of that system was, was to ensure that the longevity or the quality of life of a black person for generations will not be the same as the life quality of a white person. And I said, here's a typical example. Malnutrition within the black community is such a, you might have groceries in your cupboard, but are they keeping you healthy? That is the question.

1:06:01And what I did one day with a friend of mine is we drove to two schools. We drove to a very private school, wealthy, black and white children. Then we went to a township school with only black children. And we took a photo, right? That we just said, you take this photo, take this photo. And then we compared the photos at the end of the day. And we saw the sizes of the kids. That's heartbreaking. And they were not even 40 minutes apart from each other. Right. What they ate, what they did. You even see it when they do, they've even stopped doing it now in South Africa, where they do inter-schools.

1:06:33They never mix now schools that are doing well with schools that are not doing so well and doing sport because it becomes so glaringly obvious that there's size differences, that there's nutrition differences, and also there's concentration differences. I mean, the cues that will come up. I was, when I was growing up, they took us into this rugby clinic at one of the biggest stadiums. It was a program by the rugby club. the one thing that happened when all the township buses landed at the stadium or arrived at the stadium is all the township kids went to go queue for food that's the first thing they did first thing we we did not they i was part of the the kids that were in the bus from the township school that was one of the first things that we did it was we left where we were and the first thing we were like we're gonna eat something because clearly it's not gonna be where we come from And I'm thinking to myself.

1:07:22Hunger and malnutrition as a government agenda, as a weapon. Of oppression. And no one ever talks about that. And I always think whenever big companies expand and whenever corruption is going to take place, you can always see by how much hope they give to people about how many of them they'll employ. Yeah, that's right. They love that. Bringing this many jobs. Oh, they love that. Love the mining companies. Yeah, they love that. They're great. Oh, no, they love that. Yes. Yes, in South Africa now, they're trying to clamp down on illegal mining, but they've discovered that the billions of rands in illegal gold lands in the mainstream.

1:07:59Yeah, because the gold needs to be sold into a market that is formalized. So at the end of the day, it all comes back. Back to the enablers. Yeah, it all comes back in a loop. And that's why, and I'm glad you really give them the credit they deserve. That's why whistleblowers are so important. like you i mean i know you've got a whole book on it but without these people you just don't know no exactly you literally just don't know without a whistleblower in fifa without a whistleblower in the banking system without a whistleblower in the healthcare industry without a whistleblower in the defense contractors without a whistleblower you just wouldn't know and it's fascinating to see the um the organizational reaction to a whistleblower it's like this immune response and the T-cells go out there.

1:08:44Yeah, bacteria. I mean, people lose their minds. They're so angry and so frightened. Because at the end of the day, what you said is exactly right, that those whistleblowers really do have the kryptonite. Yeah. The question is whether they'll be able to give the kryptonite to someone who can use it before they are rubbed out, literally or figuratively. Yeah, yeah. But it is a really interesting thing to see this sort of organizational people just perfectly sane, professional people go completely off the rocker when a whistleblower stands up in their midst. You are making me realize there's so much power in words and phrasing.

1:09:19You started with white collar crime and now you're even speaking about whistleblowers. When it's corporate, it's whistleblowing. Yeah. When it's violent crimes, it's a witness. No, besides it's not a witness. It's an informant. The person is bringing information. That's interesting. That could absolutely lead to something. But when I'm telling the truth about how many people are losing lives and how much money, what are you doing? Why are you blowing? Who still blows a whistle? But information is timeless. But whistleblowing also makes it feel like you shouldn't be doing it. It has an annoying connotation to it.

1:09:50Where do you find a whistle? You have to have it first. You're a whistleblower. You're a snitch. You're a rat. It's got a snitchy vibe. You whistleblower. And why are you blowing it? Why is everyone keeping their whistles quiet? And there's always, in whistleblowing, there's never plurality. No, no, no. That's right. The individual. Assange will stand on his own. It's always this shunned person who will generate as much noise as possible. Edward Snowden. Snowden, yes. But if you get rid of them, you almost feel like you've gotten rid of the problem. Right? Exactly. That's exactly it. If you can't deal with a message, kill a messenger.

1:10:22I mean, that is literally the way in which you, the reason why there's a scorched earth approach to whistleblowing is literally they can't deal with a message quite often yeah you know a corporate informer will say there's a trillion dollars in fraud here or they've been dumping arsenic into the water or the bhopal or whatever and so you can't actually say well actually not so much or not too many people were died they you go after the messenger you totally destroy their credibility you destroy them financially you destroy their home their home life you destabilize them psychologically and all of a sudden there's kind of a quirk or a disgruntled person you can dismiss them so that's the way uh you can't when you can't actually face the facts and say actually no he's wrong on this and this and this point and we can prove it because you can't because the person is right the whistleblower is right you just destroy their credibility and it goes away and say you know a disgruntled employee you know someone who's deeply or just psychologically not stable yeah but what they don't realize is they can only kill the messengers for so long and then at some point as we saw with luigi mangioni society turns around and goes all right i guess i'm also going to make my own rules i'm not saying luigi did or didn't do it disclaimer i'm just saying like we saw in that trial in that case yeah someone said you know what i i don't agree with this and i realize that i cannot beat you in the game because you have created the rules precisely so i will then play my game by a different sets of rules precisely and you know one of the reasons I think it's so important we have these conversations where I try and talk to as many great authors as possible particularly people who have done like all the real research I always say this to Eugene one of the things that I hate the most is how people will say something they'll go like I'm going to do my own research and I'm like no you're not you're not going to do your own research you are going to go read an article that either affirms what you think or read someone's research yeah you're going to go read someone's you're not going to go do the research and yes you can argue on a semantic level.

1:12:20Yeah, on a semantic level, you can be like, but that is research. No, no, no, no, no. Cumulative effort. Yeah, I like to read the work of people who have done the work. Do you get what I'm saying? And that is how we should acquire knowledge in life. I don't think every one of us should go and test the principles of Newton to actually apply them in our lives. No. We can apply - We're not going to run those experiments. Exactly. It's a cumulative process. Exactly. You know what I mean? But when I look at that situation where the UnitedHealthcare CEO is shot, and then even that story that was like a weird one you know the gunman in Manhattan went into that tower oh yeah and then shot and then they said like they said they were there to shoot the NFL person but then they shot a person who was in I think they were a CEO or they headed up a division that was specifically tasked with housing but I really think and everyone was like oh wait wait wait this is weird you're saying they went there to shoot someone in the NFL yes but they shot somebody who a lot of people don't like yes did they shoot anyone else not really and you're sure they're going for that coincidence yeah and you're like wait and and what i found most interesting is just after the luigi mangi only story what i found most interesting and i'm not naive about this is how the news and how these healthcare ceos and all ceos and joe came out on tv and they're like why would people be celebrating this why why then i was like wait wait i'm not condoning any of this yeah but you're shocked you you really don't know why people are cheering for this you're really going to act like you don't know why people are cheering for this exactly but the reason i think we need to keep having these conversations i'll talk to an author who's written a book 10 years ago 20 years ago like robert putnam we had i was like because the thing about the book is it expands it dives deep it gives you concrete understandings of what the situation is it's not glamorous it's not glossy it's not quick it's not snappy it doesn't catch you really quickly but what what when you're done reading it you really really really understand and i i wonder if like it's a little frustrating for you you go into this process you write this whole book you do this whole thing you see a moment like luigi mangioni everyone was in on like everyone's like health care let me tell you what's wrong with them and let me tell and then she and was selling t-shirts of luigi mangi on his face and then there's like a movie emma stone's gonna be doing a movie about luigi man and then it just trickles out and then and then you just see new headlines health case united health care buying this united health care announcing that cutting these jobs expanding on this merging with that and you go huh it's like people enjoy the flash of the moment but not what the moment actually meant like how do you keep yourself going despite i'm assuming you might be but but maybe i'm wrong no no it's deeply frustrating and and to see something with a sort of a lot of pr um potential um an opportunity a crisis gone wasted um because you haven't changed the structure you haven't basically asked the fundamental question number one are you really serious that you don't understand the outrage and the anger and the sense of of of powerlessness and number two, are we really going to make sure that something called United Healthcare is primarily focused on health and not primarily focused on their share price?

1:15:42We haven't done anything about that. We haven't gone upstream and said, is capitalism indeed the best way to organize our society or better? Is profit motive the only way we should be focusing on our healthcare industry? Is it really an industry? These are bigger questions that never get raised. and i i had my own sort of luigi manjani moment i was corresponding with i since my book came out i have i had countless um contacts from people in the industry and one of them was a young nephrologist uh dr andrea bua who um was very is and was very very frustrated about the um about the misuse of dialysis by certain nephrologists that he named.

1:16:28And he sent me a lot of data. He showed me, he has a website, as a matter of fact, kidneykiller.com, which alleges the use of certain drugs to knock out people's kidneys so they will be on dialysis sooner, all sorts of stuff like that. And he wrote, we corresponded for three months until January of this year, and then three days after his last email which were data filled really thoughtful he gets in a car he drives from miami to terra hood indiana he attempts to allegedly attempts to murder one of the nephrologists wow that he had mentioned in his emails um and were and was mentioned in other lawsuits now i of course when i heard this i was horrified um and i went through those emails a million times saying what could i have seen this coming of it they were the absolute picture of data driven thoughtful measured right yeah but at the very end of one of the last ones he said i just can't see a way to make this stop i can't find a way to make change and you know it's a horrifying thing to uh to to to be in the middle of it but i think that sense as you said trevor a pointlessness of sense of hopelessness and of powerlessness to stop um and just the just the obscenity of a situation of the luigi manjoni situation where you have one person who apparently allegedly murdered another luigi murdered brian thompson but you have brian thompson who has been making a very successful career on in part denying care um to people who claim their whose doctors claim they need it Now, I don't know about you, but until we can talk about that second group of people making an enormous – making a killing, as they say, on denying care as a form of taking people's lives, if we can't say it out loud, we're not going to get anywhere.

1:18:31We're not going to ever get anywhere. And if we can't say it out loud that making money doing that makes it worse, we're really not going to get anywhere. And money may not be the root of all evil or the love of money, but it's a pretty good proxy until you find it. And we really need to get off the money drug. Somehow find a way to reorganize our view of how life should be led so that money isn't the number one thing. And those folks can't come on and say, oh, I'm shocked, shocked. I can never condone violent acts against. But, yes, you have two people. And how many, again, how many people has the major healthcare CEO accounted for in his long career?

1:19:12Yeah, but it's that old line, right? If you owe the bank$1 ,000, it's your problem. If you owe the bank$1 billion, it's the bank's problem. If you do something on a big enough scale. I was thinking Voltaire, the murder to the sound of trumpets by the thousands is good. One murder is unacceptable. Yeah, there's a weird thing that happens in society where if you get the scale great enough, it's somehow not seen as the same issue multiplied when in fact it is. What is it? Stalin's one murder is a tragedy, a million is a statistic. Yes, exactly. But that's exactly what it is. And to your point, accountability is also doled out differently.

1:19:53Yeah. Right? Because if Luigi Mangione. Blue color, white color. Yeah. There it is. If Luigi Mangione is found guilty, he's gone, gone for gone for gone. Like life, death, like gone, gone. right not if when healthcare ceos and their companies are found guilty there's no life sentence there's no death sentence there's barely even a financial sentence right the last i checked the sackler family who are responsible for more deaths in the u.s than most criminal organizations at all criminal organizations they're still out there think about how many families have lost a father, a mother, a brother, a sister, a child because of opioids that they were told were there to help them.

1:20:37Those people became addicted, died from pain, whatever, you name it. Sackler family, they didn't even lose all their wealth. Just think of this for a moment. Even if you said to me, okay, they're at zero. We took away everything. I know they're not in jail, but they're at zero. I'd go, it's still not fair, but they didn't even take all their wealth. the people could still fly away in a helicopter like my brain do you know what i mean it's like wait wait then are we living in a just society and that's the thing that i think people at these levels either don't understand or either act like they don't understand if a justice system is not just then people stop believing in the system yeah yeah and we're seeing that more and more i mean the violent acts are because the the safety valve is clogged yeah and we're blowing you're like why Why would you not see this?

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1:23:43I think what's going on in the world, you're absolutely making so much sense. What's going on in the world is what usually happens in the classic mafia movies. You know, first part for me is no one ever talks about the marketers. People talk about the great CEO that came from this company that did this to this thing. But if you think about it before, when people trusted the government more, they would buy government bonds. And the government would be accountable to the people that bought the bonds because the government would have to pay the bonds back. The same people that make the legislation, which is the guardrails that are supposed to keep people safe, Now going to private business, they get rid of the guardrails, but they still keep the government bonds system by saying you're selling people shares.

1:24:20But the marketers have realized, just like in that scene in The Godfather, where he walks around the square and he bites an apple, and then later on, the nonna would come and complain, and Don Corleone will take care of it. Everyone is wetting their beak. If you are betting online, if you are buying shares, if you are watching the stock price go up, if once in a while, the thing that astonishes me more in this country is when you watch television, these ads about, you know, you owe this much money if you call this and then this was up. And then they always give the stat of how many people haven't versus how many people should.

1:24:52And all of a sudden, I look at the drug companies different and go, but if they care so much, they're here buying ads, but they're advertising the product. Are they, do they really want you? Which lawyers must you call to do this thing? Yeah, it's all, it all becomes, yes, everyone's beak is wet. Everyone is eating a little bit here and there with online betting, with buying shares, with working there, knowing someone who is in it. And no one's looking after the little guy, us, right? And no one is looking at the Consumer Financial Protection Bureau is constantly the target of attacks, has been dismantled.

1:25:25No one is out there saying, yeah, but what about, you know, Sally out there? What about Bob? I mean, what about, you know, there's no one after them. And that's the thing that, I mean, that's kind of what I saw in dialysis, but I see it everywhere is a sense of the most vulnerable people are taking it in the neck. And everyone's sort of, oh, well, you know, they're sort of vulnerable. Maybe it's their fault. Who knows? And blame the victim, yeah. Yeah, medical aid companies do that all the time in our country. They'll co-opt you into going and using their app that monitors how many times you go to the gym, how much healthier you are.

1:25:57But I'm like, since when are we being lectured about living our lives when your job is to improve our quality of life? So now you've foisted me with the responsibility of not getting sick while I pay you to keep me from getting sick. And I give you my data, too, yeah. But that's why I was even saying that I think as society, especially if you have a platform and a megaphone, we must be very careful not to use our privilege as a way to lecture people who are hopeless. Right. Yeah. Right? That's right. Yeah. Yeah, the lecturing part is very tricky too when you helicopter into these situations. I'm working in Boyle Heights in Los Angeles, and it's in an area that's 95 % Hispanic.

1:26:34And I can just sort of helicopter in and say, hey guys, how's dialysis working for you? And by the way, there's a way to fix this. So I hook up with local organizations. Homeboys Industries is the most, if you haven't been, you gotta go. The coolest place I have maybe ever been, but it's certainly the most impressive. It's a gang rehabilitation organization that was started in the 80s by Father Gregory Boyle, no relation to the neighborhood. But now they have this view of, Boyle Heights that is all inclusive and it's in you know Boyle Heights centric every business has to be in Boyle Heights they have urban gardening they have all kinds of other things they have art but they are actually taking the people who are most at risk so when I arrived I mean the people that everyone else fails to do and won't even take a chance at because their statistics might be skewed when I arrived I couldn't get anyone on the phone but I wanted to talk with father Gregory Boyle and I wanted to talk with um you know the head of of research and so on so I just arrived and sat down and they have a wonderful homegirl cafe sat down and and I said I'd love to talk with father Boyle and and Michael Aron and and these other people they oh well he's very busy today and I said that's okay I'll stay as long as it's necessary and they said well you know he may be busy all day oh that's okay I'll stay today and I'm coming back tomorrow and i come back the next day and i went and sat down and i really meant to go my computer i was perfectly happy and i wasn't you know and i really needed to meet these people and about five minutes later someone went back i remember this is gang rehabilitation these are some the people with like tattoos or their faces and stuff they read you in a heartbeat yep they can see they know their territory they know who you are and and 20 minutes later a couple guys came and sat down and had lunch and and one of them looked at her oh that's the kidney guy yeah and so by by the by the third hour i had already met with the people i needed to meet with and we are we are off and running but that feeling of of entering this space where hope is in the air they have been in a terrible place and they're still facing incredible difficulties but there is a sense of let's not let the state or the government of the federal government or let's do this in a community is that's i think part of the system that we need to employ to get back on our feet as a country but uh but that place is amazing and that's and that's a sort of street level uh person to person um information that you really need to make a difference and to understand what dialysis or anything else is doing in a community is find the people who know that community who grew up there who were really plugged in yeah you know what i realized reading your book and then meeting you is you you're that person from the movies no you know those movies we used to watch they don't really make them anymore but remember you'd watch maybe my problem you'd watch these movies where they'd be like some random person they'd be in like a suit that doesn't really fit too well and they've got their briefcase yes and then they go to like an office and they'll be like excuse me i would like to meet thee and they're like i'm sorry he has no appointments so it's like okay i'll just sit here and then it's like and then like two hours later They're like, hey, he's not coming back.

1:29:52It's like, it's fine. I'll just sit here. And I remember watching those movies and I'd go, there's no one like this. Yep. Now I've met one. You have like a, it's a dogged and insatiable attitude towards like finding the truth, the people, the story. It's like, is it conscience that's pushing you? Is it like, what's motivating you beyond? Don't get me wrong. I mean, it is a noble cause, But beyond that, what is making you sit down for that long? What's making you go talk where people don't want to talk? What's making you investigate unbeatable, quote unquote, corporations? Yeah, that's a really good question.

1:30:32And part of it is a sense of unfairness. I do have this sort of sense that bullies are one of the worst species. And hypocrites are also one of the worst. So you have a bully hypocrite who's beating you a line. That's the worst of the worst. And I run into that a lot in corporate America. so um also just a sense that you know we can do better we have to do better we must do better and that it can start with it needs to start with information good information so what is really going on in the dialysis industry but it can it can i think in in a in a pretty short space of time you can turn something around by taking the small community view and building outwards rather than trying to fix it with a blanket everything needs to change and besides which there is no blanket anymore so you know might as well do it in your own backyard because no one's going to be looking out for it yeah but you've also done something that's pretty amazing because people would write books people do you you you know it's it's it's so many stages first of all you hope someone will help you make the book you hope somebody will publish it and put it out there you then hope that people will read it you hope that it'll connect yeah but the hardest step after all of those hard steps is you hope it'll make a difference yeah that's and and there's something that happened with your book that is again it's like a hollywood movie that you you hope would be written there's a moment where the fda the head of the fda goes i i want to use your book to go after these two sinkhole companies that are you know scamming americans for their health care for scamming the government essentially for all of the money that it's trying to provide to help people and i think your book if i remember correctly got cited 21 times and there was a lawsuit what's the latest on that is like is is this still moving forward are these companies still being held accountable because your book actually made a change on a level that people didn't think a change could be made?

1:32:30Well, it is work in progress. Nothing has been fixed yet. But I will say that Marty McCary, who before he became FDA head, had read my book. When he became FDA head, he asked me for a memo. How do you fix dialysis? Give it to me. And he said he's spread it around to Dr. Oz and to RFK and others at the highest levels. Who knows what's going to come of that, but at least they asked. There has been a recent lawsuit, came out in May, alleging antitrust violations of all kinds. They did cite my book 21 times and cited people. I cited another 15. And they'd simply lay out, in my view, they're all allegations until proven, but in my view, a pretty good case for why you have two huge corporations that control 80 % of the market.

1:33:20That's harming patients, that's harming workers, and that's harming taxpayers. I think they made a pretty good point. So, yeah, I mean, Robert Wood Johnson Foundation is funding some of the work that I'm doing. There is forward motion on this. And there is a sense, I think, I've received thousands of emails from people inside the industry, whether they're patients or families or whatever. And I would say it's bipartisan. There is a sense of enough is enough. Some of them are Trumpists. Some of them are voted for Kamala Harris. Some of them, who knows? They didn't vote. It doesn't matter. It's health.

1:33:53It is a fundamental thing that goes beyond politics. Your kidneys don't vote, bro. They don't. They do not. And those babies all. I've never had such a warm and fuzzy feeling for my kidneys. You don't think about your kidneys, right? Yeah, man. Your kidneys don't vote. They are the conductor of the whole orchestra of your body without those kidneys. People don't talk about renal fortitude. They talk about guts and brains and heart. They don't talk about kidney power. They should. They should. It's one part of you. You know the analogy I used? There was someone I was having this discussion with, like, after reading your book, and they said, I don't know.

1:34:29I think, you know, the market, this, and I don't think you should get, the government shouldn't get involved in what's happening here. And I think private companies, and I was trying to figure this out because I was like, wait, okay, how would I explain this? And then it struck me. I went, I would never deny that there are many private companies that have done an amazing job providing us with products that we love and use. we're using a bunch of them now right but there are certain aspects of life where you have to ask yourself who should be in charge of this and the reason you need to ask yourself is because of the ramifications on the other side yeah right if a private company is in charge of making these microphones and then they don't make them i guess we'll talk without microphones you know what i mean it's inconvenient but we'll have to find another way if a private company is in charge of your health which is your life what are the ramifications on the other side if they screw you over and then someone will go oh but who says government you know then i'm again i come back to this remember what a government is supposed to be there's a collective force of the people yeah common good yeah we've made it seem like it's this foreign entity no no it's our collective force that's acting it's your friend it's almost like having one friend where you go they go to the bar hey what do you guys want for drinks yeah that's government yeah you go get us drinks and then you hold them accountable be like yo where's my drink that's what it's supposed to be but now we've made it seem like your friend at the bar goes to the bar and then all of a sudden you're like that bar guy man let me tell you about berries like took my money yeah it's like no no this is took my money yeah it's like took my money yeah but we're supposed to take your money to buy you the drink that you wanted them to buy yeah and when you think about like health care and these types of industries i keep i keep thinking and this was the analogy i use with this person i said so you think it's fine they're like yeah well they made money they found a way to make money on these things i said okay what if i found a way to make a technology that could suck the oxygen out of the air what if i found a way to do that and you lived next door to me if i sucked the oxygen out of the air you know there's no law that like stops this right now right and now i say to you oh no no no no no please i'm not saying you shouldn't breathe i'm just saying you should pay me to breathe would you accept that and would you live in that society right now even someone would be like that's a crazy that's a that's a ridiculous analogy is it though ai what's happening with ai right now it's sucking the oxygen if somebody if somebody has a machine that decides whether you live or die and you have to pay them in order like a crazy amount of money to stay alive and then your government doesn't really cover you the way they should because that same company has convinced them to not and how is it any different?

1:37:20I think you said the key word they're convinced. I think we've had we have a lot of whistleblowers. We have a lot of researchers. But I think the fight back from these corporations and these companies and these institutions is how much they invest in marketing. Yeah, they do. And the language that they put out there. You're not wrong. For example, I think even body organs are not given priority based on what the language, the common colloquial language is for that organ. For example, a kidney. As essential as it is, marketing and language has made it seem like you can do without it. And also, marketing has also made it feel like it's something that someone will give begrudgingly if you need to, but they'll be fine with it.

1:38:00Get a kidney transplant. Get a kidney transplant. Oh, man. The doctor's not called the kidneyologist. They're a nephrologist. That's interesting. There's also this shroud of mystery that's put around things. And sometimes if it's not mysterious, it's trivialized. So you don't take it as seriously as it should be. You know, the biggest example for me is Department of Defense versus Department of War. And I say to people, whenever they talk to me about self-defense, I'm like, why don't you maybe go to a self-offense class? Yes. Because that will help you more. Because self-defense means we're blocking, right?

1:38:34Or we're getting away from the thing. So it's the language that people use. But I think the fight back right now after people like you have done the job that they've done is for marketers to reinvent how people see a subject or how people even speak about a body organ for it to become as prolific as it should be in people's lives. And people go, when you talk about kidneys, I know what you're talking about. I need all of them to function. It's basically on us in these forums. Essentially, that's what I feel like. Absolutely. Because there's no money in that marketing. If we're honest, there's no money in that marketing.

1:39:04You're not going to make money from that part of it. but the man the one thing i really love and i appreciate about your work and that's why i really appreciate your time not you oh not you i do love your work but not right now one thing i appreciate about your work at tom is like is it it reminds us that we are the ones who are supposed to make it matter you know we are the ones who are supposed to give it a voice we are the ones who are supposed to speak out about it and we don't know who will read the books that's the ironic thing you didn't know when you wrote that book that the head of that the person would become the head of the fda right wow do you get what i'm saying yes that's like such a crazy they they were not in that position they read your book they go into that position put a message in a bottle no and to your point eugene it's like we take for granted what those messages you know where those messages land up like where those bottles wash up on shore where they you know yeah it's just that there's an urgency to this that gets me, keeps me awake at night because every time, you know, I took a lot of people's, patients' stories and convinced them to tell me their stories, despite the fact that they were putting themselves at risk.

1:40:14I mean, there's a real risk of retaliation. Yeah. And a couple of them used the same kind of language. They said, okay, I'll tell you my story, but when I'm gone, you have to promise that this won't happen to somebody else. wow and i you know you don't it's not the kind of promise you'd make lightly and it's not one i take lightly every day since we've been talking here people are in harm's way this needs to stop like yesterday so that's kind of what uh at the at the same time there are positive movements and positive positive symptoms and a very clear game plan for what needs to happen right it's hard but very clear 10 point plan um there's an urgency here that just i can't let go of does it make you interact with the healthcare industry on a personal level differently it does yeah it does and and uh yeah with um with my brother who's who's uh undergoing some real real health challenges right now i uh i see i see a lot of what i reported on in a way that hits home um hits home very hard so yeah i mean it's we're all in this and it's all up to all of us that's the other thing that i think you brought up but i think is really important for people to remember it's on you it's on us there is no you know yeah the knight in shining armor is going to arrive the cavalry is not coming you are you are it yeah yeah and and but we can i mean we definitely can and i've seen you know these small groups and and larger groups people's lobby in in chicago and homeboys in la and a bunch of others who are just saying okay let's just do this you know let's just do this right here among us and then we see how it goes and and i think that's kind of that's kind of my model until i see a better one hey man i'll tell you now you you've put forward one of the best models i hope as many people as possible read your book because one of them might become the next head of the fda one of them might become the next something of something and uh yeah wherever we can help let us know man it's it's really worth worthwhile thank you for taking the time thank you very very much trevor and eugene it's been a pleasure this was really great man thank you so much tom for real man thanks we've got to stay in touch about your brother yeah yeah it's tough yeah it's tough it happens but you don't think it's gonna happen yeah no but can i but can i tell you it's um you know my mom is more prophetic in the family but she would say something to the effect of we don't know what wars life is preparing us to fight right we just experience the battles you know and i i almost feel like you know in a in a in a weird way it's it's almost come around where you go like damn you're the you it's it's it's put you in the front seat to fight the thing that you're already fighting in an even more energizing way yeah that's true You already had perspective, you needed urgency.

1:43:15Yeah, that's right. That's exactly right. That's a more eloquent way to say it. Thank you.

1:43:22This episode is presented by Whole Foods Market. Whole Foods Market is the place to get everything you need for Thanksgiving. With great prices on turkey, quality organic produce, grab-and-go sides, and everyday low prices from 365 brand, you can prep for the holiday with big savings. Shop everything you need for Thanksgiving now at Whole Foods Market.

1:43:45What Now with Trevor Noah is produced by DayZero Productions in partnership with SiriusXM. The show is executive produced by Trevor Noah, Sanaz Yamin, and Jess Hackle. Rebecca Chain is our producer. Our development researcher is Marcia Robiu. Music, mixing, and mastering by Hannes Brown. Random Other Stuff by Ryan Parduth. Thank you so much for listening. Join me next week for another episode of What Now. Thank you.

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