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down the long story of how lead found

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bloodstream of many Americans, maybe even yours. Look

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for the episode titled, How Lead Poisoning Rewired America,

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in the What a Day feed, out now. American

0:49

Dissected is brought to you by the De Beaumont

0:52

Foundation. For 25 years, the De Beaumont Foundation has

0:54

worked to create practical solutions that improve the health

0:56

of communities across the country. The foundation

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advances policy, creates partnerships, strengthens systems,

1:00

and improves communication to give everyone

1:02

the opportunity to achieve their best

1:04

possible health. To learn more, visit

1:07

debeaumont.org. A

1:20

judge in Alabama rules that frozen embryos are

1:22

children. Florida's Surgeon General plays down

1:25

the risk of measles amidst an outbreak. Epidemiologists

1:27

estimate that Israel's destruction of Gaza could take

1:29

another 85,000 lives in

1:32

the next six months alone. This is America

1:34

Dissected. I'm your host, Dr. Abdul Alsayyad. Think

1:37

about the best conversation

1:39

you could have in

1:49

10 minutes. What would it entail? What

1:51

would you discuss? How much information do you think

1:53

you could actually communicate? Now, step

1:55

back. Consider the fact that the 10 minute office

1:57

visit has become the standard for the way most

1:59

health... care is delivered in this country. That

2:01

means that people, many times with multiple ailments,

2:04

what doctors call problem lists, several

2:06

diagnoses long, are trying to fit

2:08

conversations about life and death into 10 measly

2:11

minutes. That's become America's new normal

2:13

when it comes to health care. It's become

2:15

what we all just expect. Now

2:18

imagine that you're experiencing excruciating pain that comes and

2:20

goes. You don't know what's causing it. You can't

2:22

predict it. It's not life-threatening, but it makes you

2:24

feel like you want to die. You've

2:26

been having it for months and you want answers. Is

2:28

10 minutes really enough? Put yourself

2:30

on the other side of that 10-minute conversation. You're a

2:33

physician with a packed day. You're five patients

2:35

into your day and you're already running behind. Over

2:37

lunch, you'll try to pare down that ever-growing list

2:40

of messages in your patient portal. And

2:42

you've got this patient that's got a set of

2:44

symptoms with a differential diagnosis. Doctors speak for the

2:46

list of things that could be causing this a

2:48

mile long and they want relief. And you

2:50

know that in these 10 minutes, you can't give it to them.

2:53

Frustrated by this interaction, you walk into the next one and

2:55

the next one after that. This system,

2:57

designed mainly about generating RVUs or relative

2:59

value units, a measure of physician output

3:02

designed to equalize across various kinds of

3:04

health care, it doesn't dignify

3:06

either patients or doctors. But

3:08

it's particularly bad for people whose ailments don't fit

3:11

inside a usual box, people whose ailments

3:13

sit at the outer edge of what we understand about

3:15

what makes a body sick. And

3:17

why don't we know it? Well, a lot of

3:19

that goes back to the way that science is done.

3:21

Remember, science is a process designed to take bias out

3:23

of the pursuit of knowledge. But there are

3:25

two places where bias tends to sneak in, at the

3:28

beginning of the process and at the end. At

3:30

the beginning, bias shapes the questions we even ask.

3:32

And at the end, it shapes the way we

3:34

interpret our study results. But while

3:37

there are some awesome scientists out there doing great

3:39

research driven mainly by the pursuit of knowledge itself,

3:42

a lot of the scientific pipeline is girded to

3:44

the medical system we have. The one

3:46

built around creating neat and tidy check boxes that

3:48

can be easily billed and monetized by the behemoth

3:50

corporations that make up our health care system. The

3:53

more monetizable, the better. It's why

3:55

so much attention is given to diseases that

3:57

require regular treatments throughout folks' lives. Audioimmune

4:00

disorders don't fit neatly into a single

4:02

10-minute office visit, nor are they diseases

4:04

that we understand much about. And

4:07

yet, 1 in 10 people are affected, and that

4:09

number is rising every single year. For

4:11

millions of people who struggle with them, they

4:13

can be deeply debilitating. But for many, particularly

4:15

those whose illnesses aren't easily diagnosed, or for

4:17

which there isn't much treatment, part of the

4:20

agony isn't just the pain or dysfunction, it's

4:22

also the anxiety and lack of knowledge. It's

4:24

the fact that you know it hurts but don't

4:26

know why, or how long, or where. And

4:30

that, all that, is exacerbated by the fact

4:32

that you don't get enough time with your

4:34

clinicians, nor do your clinicians have the space or

4:36

ability to really work through this with you. That

4:40

was today's guest experience, too. For nearly

4:42

a decade, Megan O'Rourke suffered a series of

4:44

undiagnosed illnesses, and with them, the indignity of

4:46

a healthcare system not designed to care for

4:49

people like her. Her New

4:51

York Times bestselling book, Invisible Kingdom, is both

4:53

a reflection on her experience and a form

4:55

of outreach to a quiet, invisible kingdom of

4:57

people suffering in silence just like her. I

5:00

wanted to have her on the show to share

5:02

her experience, reflect on what it's like being caught

5:04

in the gray area of science and medicine, and

5:06

what she wishes people suffering with undiagnosed chronic illnesses

5:09

and their providers understood. Here's my

5:11

conversation with Megan O'Rourke. Okay,

5:13

are you ready to go? Are you recording? Yes,

5:15

I am. Yes, I'm recording and I'm ready to

5:17

go. Okay, can you introduce yourself for the tape?

5:21

Hi, I'm Megan O'Rourke, the author

5:23

of The Invisible Kingdom Reimagining Chronic

5:25

Illness. Tell me what

5:27

it meant to you to write this

5:29

book. Before you answer the

5:31

question, I just want to say that I've written a couple,

5:34

two very different kinds of books, and the

5:36

process is you're putting something out there, and

5:39

you do it because there's something agitating inside that you

5:41

really want to put in words and in some respects,

5:43

you write for other people, but in

5:45

other respects, you write for yourself. So what

5:47

did it mean to you to write this

5:49

book and to get it out there in the world? That's

5:53

a great question. I'm

5:55

a professional writer. I've been a writer for

5:58

all my adult life. And

6:00

I do think that on some really

6:03

personal level, I

6:05

do this profession because I find

6:08

it meaningful to

6:10

step back from the kind

6:12

of hurly-burly of life and reflect

6:14

and shape experience into nuanced stories

6:16

of the kind I often don't

6:18

see in the media. And so

6:21

as a writer, I'm really drawn

6:23

to these subjects where I feel

6:25

that we're telling ourselves a story

6:27

culturally that feels to me to

6:29

be too simple and to be missing some

6:31

complexity. So there was that immediately. But

6:34

on an even more personal level, I had this

6:36

very strange experience of getting sick and

6:38

having that illness go unrecognized by the

6:40

medical system for more than a

6:43

decade. And at some

6:45

point, that autobiographical experience just

6:47

began to feel so incredibly

6:50

lonely. And I had

6:52

a moment of thinking if I'm going

6:54

through this and I'm highly

6:56

educated in an urban area, upper

6:59

middle class white women, think about the

7:01

millions of people in America, in the

7:03

world, who are having similar experiences

7:05

of becoming mysteriously ill and

7:08

being met with a kind of curious

7:11

in curiosity. And

7:13

I really wanted to get that

7:15

experience down because I think that

7:18

people who believed I was sick thought

7:20

that the suffering of the sickness was

7:22

the hardest part. But in

7:24

fact, the hardest part was having the

7:26

sickness be rendered meaningless by

7:29

virtue of the fact that no one believed me. I

7:31

didn't have a language, a container, a story to talk

7:33

about this kind of amorphous illness

7:36

and the symptoms that came with it. So I

7:38

think those were really the reasons I wrote the

7:40

book. So it's enough of

7:42

what I presumed was an invisible kingdom

7:44

of people out there who

7:46

were like me, that as lonely as I felt,

7:48

we were actually all out there somehow. And if

7:50

we could just kind of name the problem, we

7:52

could come together and start to solve it. I

7:55

really appreciate that. You know,

7:58

it's interesting because I... In

8:00

some respects, you write to give clarity

8:02

to your own thinking, but you also

8:04

write because you hope and

8:07

aspire to give clarity to others. But there's also this

8:10

harmony in being able to find

8:12

folks who are thinking and feeling the way you do.

8:15

I think Nirvana as a writer or as a speaker

8:18

is when you're able to help somebody find

8:20

the words to explain what they're feeling. For

8:22

a moment, you all are sitting in the

8:24

same wavelength of experience. It's

8:29

a really cathartic feeling. And

8:32

I can imagine all the more so because

8:35

of the way that you describe your

8:37

illness is almost taking away a sense

8:39

of your mattering

8:41

and your experience mattering. I

8:43

want to step back because the

8:45

experience of illness is kind of a weird thing. I

8:48

try to identify the time at which

8:50

I realized that or

8:52

when I first became disembodied. What I mean

8:54

by that is that when you realize that

8:56

you are kind of a conscious that's independent

8:58

of your body, I think when you're a

9:00

kid, you know, it's going to sound

9:02

obvious, but it's I am me. I am

9:05

this thing and that thing is me. And

9:08

for me, it really wasn't until

9:10

I sustained a sports

9:12

injury when I

9:14

felt the pain of the injury and

9:18

then realized that I

9:21

was having an emotional reaction to my

9:24

reaction. And at that point,

9:26

I was like, wait a second. Like, this is

9:28

weird. Like, this body is not actually

9:30

what I am. It's the container

9:32

in which I live. But it's

9:35

sort of separate for me. And

9:39

I that became a lot more clear, even as like, I

9:41

started to play more sports and you know, you do things

9:43

like I'm going to stretch and I'm going to like, be

9:46

able to be more limber or I'm going to lift

9:48

weights and I'm going to gain muscle and strength or

9:50

I'm going to train and I'm going to get faster.

9:53

And you realize this is like, okay, well, part of

9:55

that is that your body itself and it does certain

9:57

things and it doesn't do other things. Part

10:00

of that is this mental aspect of trying

10:02

to work on your body. I

10:04

would imagine that an illness like this, where

10:08

you don't really have... What I'm

10:10

describing is almost a certain recognition

10:12

of non-mastery and then a process

10:15

of attempted mastery. But

10:18

when you

10:20

can't really explain what your body is doing,

10:22

nor can people who ostensibly are experts in

10:24

bodies explain what your body is doing.

10:28

For you, I give this

10:30

really big wind up to ask, when

10:33

did you start to realize that something was

10:35

really, really wrong? That

10:37

there was something beyond

10:39

the usual, I'm sick and

10:42

my sickness is going to fit into some pattern and

10:44

somebody who's an expert at bodies is going to tell

10:46

me what it is and there's going to

10:48

be a neat answer here. When did

10:50

that really dawn on you and what were the

10:52

set of experiences and emotions that really drove your

10:55

thinking at the time? That's such a great question.

10:57

I love the wind up. I think it sets up

10:59

the question in the ways it needs to be answered.

11:02

I have two answers, two parts to the

11:04

answer rather. One is

11:06

that, as I described in the invisible kingdom, I

11:09

was sick for a long time without quite

11:11

realizing that I was sick. I had

11:13

gone to so many doctors to say,

11:15

I just don't quite feel like myself

11:19

to pick up your sense. I only

11:21

have doctors say, well, all your labs look

11:23

normal, maybe you're anxious, maybe you're stressed. I

11:26

really internalized this idea over time that

11:28

this changing experience I had

11:30

of the world was maybe either

11:32

slightly imagined or I was putting too much

11:34

stress on it. There

11:37

was a quite shocking moment where I was driving

11:39

home. I taught at the time. I taught at

11:41

Creative Writing class at Princeton and I drove home

11:43

with a friend. I was driving and

11:46

I looked over at him and he was a long-term

11:48

colleague. I had known him for more than a decade

11:51

and I had no idea who he was. It

11:53

wasn't just that I didn't know his name. I knew

11:55

I knew him but I really couldn't understand who he

11:58

was in relationship with me. category

12:00

of experience that was no longer pleasant. And

12:03

I came home that night and I said to my husband, I

12:06

know we've been wondering if all these strange aches

12:08

and pains and odd symptoms really are anything, but

12:11

maybe it's just part of getting older, but

12:13

isn't this weird? Like, isn't this something unusual

12:15

for someone who's 35 to experience?

12:18

And he kind of got a shocked look on

12:20

his face and was like, yes, that's something that's

12:22

really unusual. So there was that first moment and

12:25

that helped set me on the path of really

12:27

seeking more answers and going to more experts. And

12:30

then there was another moment where I

12:32

was in the office of a really wonderful

12:34

doctor of women's health. And for

12:36

the first time, and she was someone I saw

12:38

shortly after the moment of

12:40

not understanding who my colleague was, for

12:43

the first time I had a physician say

12:45

to me, I believe something really is wrong.

12:47

And that was she immediately said it. And

12:49

she said, and I highly suspect you have

12:51

some kind of autoimmune disease, including, but maybe

12:54

not limited to autoimmune fibroiditis. And that's driving

12:56

some of your symptoms. You have to see

12:58

what your labs look like, but let's look

13:00

at this. And

13:02

sure enough, I had that disease.

13:06

I had some other markers. She was like, I'm going

13:09

to give you medication. We're going

13:11

to treat you, and you should be feeling a lot better in

13:13

six weeks. Six weeks later,

13:15

as in her office, I felt moderately

13:17

better, but not noticeably better.

13:19

And that was when we started

13:21

to have a conversation about, well, an autoimmune disease

13:23

is something that might really permanently change your life.

13:25

It might leave you feeling 80% at best. It

13:29

might mean reshaping your identity.

13:31

And by the way, it can come and

13:33

go, and different things can trigger it, and maybe you

13:35

need to start beating wheat. And really

13:37

in that office, and as I walked out, I

13:39

thought, oh, OK, this is not the

13:41

kind of quick fix that I've been led

13:44

to believe we so

13:46

often can offer people. This

13:49

is something else. This is a different kind of

13:51

category of disease. And in fact, it turned out

13:53

there were other things going on that we she and

13:55

I didn't even realize at the time. But

13:58

that moment was the moment of walking. through

14:00

the portal into a different kind of experience

14:02

of health and illness and that

14:04

which I sort of simplistically had grown

14:07

up with. I

14:09

really appreciate there's a profound contrast

14:11

in that moment. One

14:14

of the things that you're taught in med school is

14:16

that naming a thing is a narrative.

14:19

So if I say you have cancer,

14:22

you can imagine a world where

14:24

the story plays out of the

14:27

cancer experience, right? You can imagine

14:29

the loss of hair, which is

14:31

what people stereotype is going through,

14:33

chemotherapy and multiple rounds

14:35

of treatment and then being

14:37

cancer free for some time and then all of a

14:40

sudden the cancer coming back. These are all permeations

14:42

of an adventure and I don't

14:44

mean that term lightly but a

14:46

journey that people

14:48

can ascribe to cancer. If I say you have

14:50

a cold, that's a different narrative. It's

14:53

okay, you're going to be kind of stuffy and feel kind of crummy

14:55

for a couple days and then a couple days later you feel

14:57

a little bit better and then after that you're going to feel

14:59

fine. COVID is

15:02

a narrative but what's interesting is that

15:04

those stories tend to end in a

15:06

certain kind of way

15:09

and the clarity of that narrative is

15:11

actually an end point. It's like a sort

15:13

of sense of control over

15:15

the outcome that you give to people

15:17

in a diagnosis. The

15:19

challenge with what you shared is

15:21

that this doctor who by

15:24

all accounts was a caring, thoughtful,

15:27

engaged, curious physician gave

15:29

you a diagnosis

15:32

and then in some respects the narrative

15:34

you came to expect was dashed

15:37

by that diagnosis. How did

15:39

that contrast play out in your mind? After

15:41

those six weeks when you started to realize,

15:43

okay, I'm in for something that's very different

15:45

and even though I had thought that, this

15:47

naming of this disease gave me some sort

15:49

of mastery over it. What I'm starting to

15:51

realize is actually I'm not going to have

15:53

that. Walk us through

15:55

that moment and what goes through your mind in

15:58

a moment of lack of clarity. clarity like that.

16:00

You've been experiencing all these symptoms. You think it's

16:03

going to go away. This is the moment of

16:05

catharsis and then not

16:07

quite. How does that play in your

16:10

mind? Yeah. Well,

16:13

to really answer this question, I wrote the

16:15

book. So I'll try to take

16:17

a very short, which is to

16:19

say I could give you a very long answer and it's a

16:21

complicated answer. I

16:27

will say that what I realized

16:29

coming home from the doctor's office pretty much

16:31

that day was that

16:34

there was going to be some kind

16:36

of identity shift. Right. I

16:39

did intuitively understand

16:41

that the diagnosis

16:43

was no longer the end point.

16:46

It was now a kind of beginning or

16:49

even actually not a beginning, a point along

16:51

the way, a kind of marker. And

16:54

that I was going to have to start to build a

16:56

new kind of story and a story

16:58

that went beyond the diagnosis. And I think in

17:00

a sense that that's the moment I really began

17:02

thinking about this book, The Invisible Kingdom. I didn't know it

17:04

at the time. I couldn't have said, oh, now I'm thinking

17:06

about a book. But I immediately

17:08

became really interested. It's like you

17:10

describing having a reaction to your reaction.

17:13

I began having a reaction to my own

17:15

reaction and thinking this is different. This is

17:17

not what an easily

17:19

measurable, easily treatable disease like those I've

17:21

had or injuries I've had in the past

17:23

was like I'd had surgeries, you know, go

17:26

in, fix the problem, you go home,

17:28

you recuperate, then you're better. This

17:30

was different. And I began to

17:32

start to think about what it meant to have

17:34

both an autoimmune disease and what the symbolism

17:37

of an immune system turning on itself

17:39

did or didn't mean. And

17:41

I began to think about chronic illness

17:43

and this idea of what

17:45

kind of story is out there or

17:48

is there a sufficient story out there about

17:50

chronic illness, right? In a

17:52

kind of quick fix culture. And

17:54

then this goes, this aspect of

17:56

our culture goes far beyond medicine,

17:58

right? Our whole culture. in America

18:00

at least is about get in

18:02

there or just do it, whatever it is until you make

18:04

you stronger, like you suffer through it, you fix it, you

18:06

make it work. And in this period

18:09

of time, by the way, I was really, really sick, but I

18:11

would like, I had been a runner for a long time and

18:13

I would drag myself out of bed and try to go running

18:15

pretty much every day. And it would

18:17

make me, it made me sicker and sicker, it didn't work.

18:21

But very, which is to say that the

18:23

process of coming to understand that I was

18:25

going to have to start to tell myself

18:27

a new story was

18:30

a slow one. I understood I

18:32

had to tell myself that new story,

18:34

but what the new story was going to

18:36

be, my actual acceptance of it, the new

18:38

identity that I was going to build in

18:40

response to having a diagnosis,

18:43

all that took a lot of time. And there were many,

18:45

many steps along the way, including by

18:47

the way, I'm not just a

18:49

sick person, right? And

18:52

how do I live with the kind of uncertainty

18:54

in my life? How

18:56

I make a life, how do I plan, how do I

18:58

build a family, how do I continue to work, none of

19:00

which I could really do at that time because I was

19:03

so sick still. But

19:05

that, it was a

19:07

kind of entering like a murkier world rather

19:09

than a world of clarity. And

19:12

yet there was a clarity in acknowledging

19:14

for the first time that murkiness that

19:16

in despite this technological

19:18

age we live in where we know more than ever

19:20

about the body, I was somebody

19:22

whose body was at the edge of medical knowledge at

19:24

that point. And that's what I

19:26

began to feel. You know, it's interesting. So

19:28

I've got a six year old and I talked

19:31

to a little bit about recognizing my reaction

19:33

to my reaction. And

19:37

I had cut

19:39

myself and it was bleeding and she looked

19:41

at me and she said, Bubba, you're not

19:43

crying. I was

19:46

like, I know. She's like, why are you not crying? Doesn't it hurt?

19:48

I said, yeah, it hurts. She's like,

19:50

okay, but when I get hurt or

19:53

I get cut, I cry. And

19:56

I said, Emily, do you cry because it hurts or

19:58

do you cry because you think it's going hurting.

20:03

And it was a

20:05

moment of recognizing that, you know, I

20:07

think about getting injured now. And

20:09

it unfortunately doesn't happen all too uncommonly. But

20:12

there is, there is this anxiety

20:16

that comes out of, okay,

20:18

how long is this going to take? And

20:20

am I fully going to regain function? And

20:23

so so much of what we characterize

20:25

as pain is

20:28

the fear of loss of function, and

20:30

then the loss of control, or at

20:32

least knowledge about the future. And

20:35

so much of what I really appreciated

20:37

about your book is that you dissect

20:40

that set of feelings in a really

20:42

important way. And it's almost like

20:44

you you not I don't want to say you made peace

20:46

with it. And it's that, you know, peace is not the

20:48

right term. But it's almost like you

20:50

set you want you realize this is not a

20:52

battle. This is going to be

20:54

a long protracted war. And

20:56

war may not even be the right

20:59

analogy, because it doesn't. War

21:02

implies that there's a winner at the end, or at least,

21:04

you know, one would think that there'd be a winner at

21:06

the end, although one could get very philosophical about whether anybody

21:08

wins wars. But but but

21:10

this notion of a this is a new

21:12

normal. And I have to

21:15

get comfortable with the lack of

21:17

knowledge of where this is going.

21:19

I wonder, you know,

21:21

as you think about the relationships

21:23

you were hoping to build with other

21:25

readers, how much

21:27

of your experience that you shared was

21:30

about trying to get at that question of

21:32

what do you do with the implicit anxiety

21:34

of not knowing? It's

21:36

interesting, I've been thinking about this a

21:38

lot, because I'm writing something about hypochondria

21:41

right now, which is a term that's

21:43

been replaced in the DSM, illness, anxiety,

21:45

and other terms. But I

21:50

think that I, how

21:56

can I put this? I

21:58

think it became very clear. me

22:00

that to really

22:03

be present for what was happening in

22:06

my body was going to mean

22:08

a kind of radical rearranging of

22:10

the furniture in my mind of

22:12

all these received ideas that I

22:14

had about having control over

22:17

my life, you know, working hard

22:19

and getting the outcomes I wanted. You know,

22:21

I was pretty young when I got sick. I mean, I

22:23

was sick in my 20s, then I really got the diagnosis

22:25

in my early 30s.

22:28

But I had lost my mother who died at the

22:31

age of 55 from colorectal

22:33

cancer pretty certainly and

22:35

surprisingly. I mean, not

22:37

some way she went for a long time. And

22:40

I think I already knew that life doesn't

22:42

quite go the way we plan it to,

22:45

to say the least. And so

22:47

I do think that part of what I really

22:49

wanted to do in this book is carve

22:52

out a space where those

22:54

of us who have lived in this invisible

22:56

kingdom can actually reflect on

22:58

some of the really important philosophical and

23:01

existential questions that come with being ill

23:03

in a way that I found very

23:05

hard to do before I had the

23:07

diagnosis or when I was with my

23:11

physicians, partly because those encounters were

23:14

so charged with my own desire

23:16

to be believed, my own desire

23:18

to be recognized and validated. It took

23:20

so long to get that recognition and

23:23

validation that once I started to understand,

23:25

okay, I have these

23:27

diagnoses, I am sick, but

23:29

I'm also alive. I

23:32

felt kind of ferociously that

23:34

I wanted to lean into that space and

23:36

reflect on it, because the ability to reflect

23:38

on it had been almost taken away

23:40

from me by science's inability

23:43

to recognize what was wrong with me. And

23:46

so I think first and foremost,

23:48

I wanted to try to write

23:50

about the ways that although

23:53

we absolutely need medical sciences objectivity,

23:55

its desire to measure, its desire

23:57

to name, there's a feature of

23:59

that. of experience that

24:01

is subjective, that changes

24:05

day to day, hour by hour, minute by minute. You

24:07

know, you catch me on a day where I'm having

24:10

a lot of symptoms and I feel that

24:12

sense of, I don't

24:14

control anything. Like I would just want to play in the

24:16

snow with my kids and why did that trigger this

24:18

reaction? And maybe I'm really sick and this

24:21

is so scary. Right. And then

24:23

I have to kind of talk myself down

24:25

from it. So this is a whole part

24:27

of experience that's barely talked about in the

24:29

medical encounter. There's

24:32

not time, there's not space, there's not. And so

24:34

I wanted the book to contain

24:36

that for those of us who live in

24:38

that world. How

24:47

are indigenous leaders confronting the mounting climate crisis?

24:49

What are meaningful rules allies can play in

24:51

redressing the ongoing harms of settler colonialism? Why

24:54

is it so vital to learn the history

24:56

of the land you're living on and the

24:58

inequities and injustices carried out on those lands?

25:00

Dive into these important questions and so many

25:02

more with the Margaret Casey Foundation book club

25:04

reading for a liberated future. This month, the

25:07

book club featured essays of the book Invisible

25:09

No More Voices from Native America. You can

25:11

catch the conversation by signing up to join

25:13

the MCF book club for free today at

25:15

caseygrants.org book club. That's C A S

25:17

E Y G R A N T

25:19

s.org/book club. The US healthcare

25:22

system, as we talk about all the time here, is confusing

25:24

at the best of times and opaque at the worst. Tradeoffs

25:27

is a podcast that digs into healthcare's toughest

25:29

policy challenges, untangles the pros and cons of

25:31

possible solutions, and advances the conversation in a

25:33

way we can all understand. Host Dan Gorinstein

25:35

has been a healthcare reporter for years and

25:37

does a stellar job examining the data with

25:39

people who best understand it and putting a

25:41

human face on that data by telling the

25:43

stories of those who are affected by health

25:45

policies. Subscribe to tradeoffs wherever you get your

25:47

podcasts. Part of what

25:49

I think drives most people in

25:51

medicine is

25:59

this idea of the that you can solve a

26:01

problem for someone. And that's

26:04

a really loaded set of aims

26:06

and intentions. And

26:12

doctors, healthcare providers get frustrated when patients

26:14

don't fit into that box. And

26:16

there's a lot of different parts of it. And because doctors

26:18

are motivated, or providers generally

26:21

are motivated by see a

26:23

problem, solve a problem, move on. We've

26:26

allowed a healthcare system to be built

26:28

around that model and monetized around that

26:30

model. And there are a

26:32

lot of places in the book where you

26:35

demonstrate just how broken that model is. I

26:38

wanna ask you, big picture, what

26:40

was your best experience with the healthcare system?

26:42

The things that went really right and then

26:44

what was your worst? Well,

26:47

interesting that you framed it this way. Cause

26:50

I would say that one of the most

26:52

important encounters I had took place years before

26:54

I got a diagnosis. And it was with

26:56

a neurologist. Young

26:59

neurologist, I'd never seen her before.

27:01

I was having very strange neurological

27:05

symptoms that felt like little pinpricks all over my

27:07

body. And I had no idea what this was.

27:09

No one had, finally I end up in her

27:11

office. And she

27:13

basically said to me, I don't know what's

27:16

wrong with you. I'm not

27:18

sure I can help you. In fact, I'm

27:20

pretty sure I can't help you. But

27:23

I believe you. I suspect

27:25

you have some kind of small fiber neuropathy

27:28

that we can put you into some, we can do

27:30

some tests and it will help our research. But it

27:32

won't let me help you. But no matter what, it

27:34

might not be that. Cause there's these aspects of

27:36

it are not quite similar. Most

27:38

of all, I believe you and I've seen other young women

27:40

like you. I can't tell

27:42

you, I always bring up this example because

27:45

she did not, nothing ever transpired. I

27:47

didn't end up doing the test at that point. She

27:49

stayed my neurologist for years. She's amazing. But

27:52

the work of

27:54

naming, validating, recognizing,

27:56

and kind of containing, creating space for

27:58

us both to be. held in that

28:00

container of not knowing. It's like

28:03

I felt giddy on the way home.

28:05

I felt totally changed by this encounter

28:07

because I felt human, right? I

28:09

felt that I had two humans to talk to each other.

28:12

And I do think that that's just, it's

28:15

really not understood how profoundly important

28:17

that is, maybe especially in the

28:19

experience of chronically ill people, right?

28:22

Where we're living with this day in and out. And

28:24

so to have that recognition matters. So

28:27

that went well. I

28:29

think there

28:32

were other moments that went really well and

28:35

they all have in common this theme

28:37

of listening and caring and

28:39

believing a little bit. And believing

28:41

that there might be things about my

28:44

experience or my body or what was happening in it that

28:46

couldn't be picked up or hadn't been picked up on

28:48

tests. Did you also ask what was the worst

28:50

experience? Well,

28:53

there's a couple, but I

28:55

think one of the worst, one

29:00

of the worst was when I was

29:02

really quite ill and my insurance changed.

29:04

Okay, this is part of spoken healthcare

29:06

system. I changed jobs, my insurance changed.

29:08

I left my GP of many years,

29:10

wonderful, empathetic, always kind

29:12

of believed, even if we never found anything wrong with

29:15

me. Now

29:17

this new GP and I was

29:19

really not feeling well. And I said as much

29:22

and he said, well, let's do some tests. Maybe

29:24

something's going on. And basically everything

29:26

came back looking totally great. I

29:28

was a little low on iron, but was in normal.

29:30

And he basically was like, I think you're just anemic

29:32

from having your period. So I don't think we should

29:35

really worry about this. And I was

29:37

on the phone and I said to him, but I've

29:40

always had my period. And I've never felt like it

29:42

was like, I've really gone off a cliff, something has

29:44

gone wrong. And we just couldn't talk to each other.

29:46

There was no time, there was no ability to

29:48

pursue. There was no desire to pursue it. And we

29:50

didn't know each other, we didn't have a relationship. And

29:53

that's kind of what stranded me there being really

29:55

sick for about a year before I kind of

29:57

mustered the courage to then go and see another

29:59

doctor. because of course as a patient, many of

30:01

us really see the doctors as experts. So when

30:03

the doctor says this to me, I'm

30:06

30 years old, whatever I am, I really took it

30:08

seriously and I thought, I'm imagining that something's wrong

30:10

with me. I'm complaining, I shouldn't pursue

30:12

this. So,

30:16

but can be dangerous about

30:18

these encounters or complex

30:20

for the patient is how

30:23

much the words, even brief sets of

30:25

words really matter to us and

30:27

kind of shape our story. Yeah,

30:30

there were a couple of things in

30:33

your response here that I really

30:35

just wanted to pick out because I think they're just so

30:37

profound. I mean, the notion that one

30:39

of your worst experiences came as a

30:42

function not of a choice to

30:45

change a provider-patient

30:47

relationship, but instead as a structural

30:50

feature of a healthcare system that

30:53

cares you out of that relationship as a function

30:55

of who's paying for healthcare because you got a

30:57

different job. And we

30:59

don't think about the role

31:01

that those structural features bake

31:04

into our experience with physicians, but

31:07

they matter quite a bit. The

31:09

other is this

31:11

idea of being believed, but also having an

31:14

honest arbiter of the science. Here's the thing

31:16

about it is like, science is

31:18

the best tool we have for knowledge

31:21

in humankind. It

31:25

is like really one of the greatest systems

31:28

of thinking inventions that

31:30

we have. The

31:32

thing about it though is that we mistake the

31:34

power of the tool for the outcomes of the

31:36

tool. And we assume that because

31:39

science is so powerful that science has answered

31:41

everything, even though for

31:43

the most part, science offers us

31:45

frameworks that we interpret within.

31:48

And in medicine, one of the

31:50

things that hits you pretty quickly from

31:53

day one of medical school, there's

31:55

just a ton we don't know. I mean,

31:57

I remember sitting in my embryology class being

31:59

like, It is a miracle that humans have been

32:01

born in the first place. It's truly a miracle.

32:06

We're understanding all of the odd

32:08

cell signaling that gets cells

32:10

to turn and curl just so

32:13

to give us a

32:16

functional body. We understand what happens when

32:18

that fails. The reality of it is most

32:20

of the time when it fails, you just

32:22

don't have a pregnancy to begin with. It

32:25

happens when it fails. It fails in a way

32:27

that can continue to sustain human life. All

32:31

this is to say that I think when

32:34

we get it wrong, whether it's in a

32:36

patient interaction or it's in public health generally,

32:38

it's when we over interpret what

32:40

we think we know and we offer a

32:42

set of answers that are actually what we

32:45

call off data inference, meaning we have a

32:47

framework. We're going to fit someone tightly into

32:49

that framework even though they may be at

32:51

the very edge of what we think we

32:53

understand rather than having humility about what science

32:55

can actually answer. But the other part of

32:57

that is also you are a woman. In

33:04

the way that our archetypes

33:07

about how we think about pain and

33:09

how we think about disease

33:12

play, I want

33:14

to ask you, how

33:16

much more likely do you think

33:18

you would have been to be believed

33:21

if you didn't present as a

33:23

young white lady? Yeah.

33:28

There's part of me as a writer that's a journalist, so

33:31

it's a little bit similar to science. I like data. I

33:34

like evidence. I like facts. There's part

33:36

of me that I can't fully answer that question. I

33:38

don't have the data for it. But it certainly was

33:40

my intuition

33:43

that my being young and

33:47

looking fit, quote

33:50

unquote, to

33:53

my physicians led to my being

33:55

dismissed, that the words I was

33:57

saying did not translate into ... and what do

33:59

I mean by that? that often what

34:01

physicians, especially once I was meeting for

34:03

the first time, focused on was that

34:05

I was slim, my cholesterol looked great,

34:08

I didn't meet obvious categories of problems,

34:10

and I had a really high pressure

34:12

job initially when I first started having

34:14

mild symptoms. And so that

34:16

probably therefore I was anxious, right, that

34:18

I fit into this archetype of one

34:22

of the so-called worried well, which is a term

34:24

that will be here, you know, in sociology to

34:26

describe people who are actually

34:28

well, but are worried. Maybe something's wrong and

34:31

they're anticipating and, you know, and it's an

34:33

interesting conundrum

34:35

and a kind of culture where we can

34:37

prevent and test more than ever, right? We

34:39

can look inside our bodies, so maybe we

34:41

should look inside our bodies and sometimes people

34:46

but also this legacy of hysteria,

34:48

right, this idea that the body

34:50

is speaking the stress

34:52

of the mind or the trauma of the

34:54

mind felt very pleasant in every doctor's office

34:56

with me. And so when I was writing

34:58

the book, I began to really research this

35:00

and try to think that it to describe I

35:04

could know about my experiences, what we knew about

35:06

others, and, you know, as you see

35:08

in the book there's quite a lot of data showing us

35:10

that, you know, although medical science,

35:12

and I agree with you infinitely

35:15

that science is one of the best tools we

35:17

have for knowledge, although it

35:19

aims to be, you know, objective

35:21

and fair, the practice

35:23

of it is not always right. And

35:26

we bring biases, we all bring

35:28

our biases into all spaces and

35:31

medical science brings biases into the

35:33

room. And that led to

35:35

the fact that it was hard, it is,

35:37

we know we have data that women are

35:39

just less likely to be believed about their

35:41

pain levels, about

35:45

their medical history, about subjects,

35:47

so-called subjective symptoms like fatigue,

35:49

which often can signal a

35:51

real problem. So,

35:53

you know, that was in there in the mix

35:55

with me and it became pretty clear to me

35:57

pretty early on and I think it really conscious

36:00

of trying to present myself as being

36:02

very rational and reasonable and remember very

36:05

vividly a rheumatologist describing me as a

36:07

patient with a pleasing affect. He dictated

36:09

his notes in the ads

36:11

that I was sitting there and I was

36:13

like, yes, I've persuaded him that I'm reasonable.

36:17

Right? But that's a really complicated set

36:19

of kind of reactions to reactions and

36:22

trying to... We

36:24

often, I think, as patients walking into a

36:26

room or people with illness walking into a room,

36:28

have to think about how others are going to respond

36:30

to us in that medical encounter. You

36:33

know, it's a really important point and

36:36

two things. One is that

36:39

as much as a woman, you

36:43

fit into a stereotype about what

36:45

you were likely presenting with. You

36:48

can also imagine a circumstance

36:51

where you code as

36:53

upper middle income, you

36:55

have a high paying job,

36:57

you had insurance, and so your

37:00

visit was being reimbursed at a

37:02

respectable rate. I ask,

37:05

how do you think your experience

37:07

might have differed if you

37:09

hadn't had those privileges, right? Even as

37:11

privilege took away or you had circumstances

37:14

that took away privilege in that encounter,

37:16

how much do you think

37:18

your experience might have differed had you had

37:21

to worry about some of the other ways

37:23

in which you could be discriminated against by

37:25

the system? Yeah, I'm so

37:27

glad you asked that question. And because we

37:29

do know that the system discriminates against people

37:31

of color, people, you know, if

37:35

there's language barriers, also there's a very

37:37

basic access to care issue in rural

37:39

areas. So the reason I wrote this

37:41

book was because I thought if this

37:44

was my experience, and I

37:46

actually had quite a lot of privileges and

37:48

tools, right? I was a journalist. I really

37:50

knew how to talk to people and get

37:52

information and get referral. I really knew how to

37:54

work the system at a certain point. I didn't

37:56

go in knowing that, but I had the tools to learn

37:58

how to do it. And

38:01

it's very clear to me that,

38:03

you know, I got mostly better,

38:06

right? Better is a complicated

38:08

word. I still live with chronic conditions, but

38:10

I went from being someone who's, in

38:13

essence, felt that the promise of

38:15

my life had disappeared and was no

38:17

longer accessible to me, to now

38:19

feeling I have an incredibly rich life

38:21

full of, you know, my kids, my

38:23

work, and, you know, I'm living a

38:25

rich life with limitations. I'm

38:28

only living that rich life because

38:31

I persevered so hard. Right?

38:33

That's not quite English, but I worked

38:35

so hard to keep getting answers. And

38:38

one of the people that I interviewed in the

38:40

book, who

38:43

was the former head of the Permanente Federation,

38:45

I think that's what it's called, said

38:48

to me, I asked him this question. I

38:50

said, what if you're not me? You don't have,

38:52

you know, really good insurance. You don't, you can't

38:54

take many days off from work to go sit

38:56

in a doctor's office and wait to be seen.

38:59

What happened to those people? And I will never

39:01

forget what he said. He said, those

39:03

people suffer alone. They fall into

39:05

the cracks and they suffer

39:08

alone and we don't know how to help

39:10

them. And I wrote

39:12

the book because of that. You know, I wrote

39:14

the book because I thought I

39:17

can write the book. And there are

39:20

people who didn't get to the end

39:22

of their story or the

39:24

place in their story where they could reflect in the

39:26

way that I can. So

39:28

we really do need to kind of

39:31

name that and come together to think

39:33

deeply about how to change that fact.

39:35

I really appreciate that perspective. A

39:38

couple weeks ago, we had

39:40

a pediatric hematologist who

39:42

lives with sickle cell disease on

39:45

the show. And we talked a lot

39:47

about the other way that science can be biased, which

39:49

is in the questions we ask in the first place.

39:51

And we talked about how we interpret what we find.

39:54

And there's also this question of whose diseases

39:56

we pay attention to. And

39:59

as we think about... the set

40:01

of diagnoses that you

40:03

were ultimately given, these are

40:05

largely autoimmune disorders. Autoimmune

40:09

disorders affect four in

40:11

five patients are women. I

40:14

want to ask you, as you think

40:16

about where we pay attention, the spotlight

40:18

that we actually do shine on

40:20

the set of illnesses, it's rather clear that we

40:22

just don't know as much about these illnesses, about

40:25

what causes them, about how to treat them, then

40:29

you think we should. And I want to ask you,

40:31

how much of that do you feel like is

40:34

a function of whose diseases we pay attention to

40:36

in the first place? I

40:39

think there's two answers to this question. And

40:41

I think the first is about the function

40:43

of whose diseases we pay attention to. It's very

40:45

clear, and I mean, it seems quite clear, I

40:47

lay out in the book that, you

40:49

know, we don't pay as much attention to

40:51

diseases that are experienced by women. We

40:54

both know less, and we

40:57

trust women less to report

40:59

on their experience. We just

41:02

understand less about women's

41:04

biology. We have done a lot

41:06

of testing on male lab animals,

41:08

right? But I think there's

41:11

a second piece. And this is about this idea

41:13

that you brought up, which is larger, which is

41:15

almost a kind of like ontological idea, which is

41:20

what questions are we asking and what questions

41:22

are we not even thinking to ask, because

41:24

there is a paradigm of thought in place

41:27

that we arrived at that looks

41:29

like scientific progress, that looks like

41:31

knowledge and was, but perhaps

41:34

turned out to be limiting our ability

41:36

to see certain aspects of human biology

41:38

and experience. So what I mean by

41:40

that is that one

41:42

of the great moments in scientific history

41:45

is the advent of germ theory, right?

41:47

The moment when we start to understand

41:49

that many diseases are caused by distinctive

41:52

pathogens that produce very similar responses in

41:54

people and can be described by similar

41:56

sets of symptoms. We

41:59

also around you know, not long after

42:01

we really develop an understanding of

42:03

germ theory, start to be able to measure more than

42:05

ever. These two things come

42:07

together to really form a kind of

42:09

concept of disease that was quite dominant

42:12

in the 20th century where they were

42:14

what were called specific disease entities and

42:16

they looked really replicable body after body,

42:19

right? That's one of the definitions, that's

42:21

one of Koch's postulates is the replicability

42:23

of how a pathogen behaves

42:25

in the body. But as

42:27

I think COVID has really

42:29

dramatized to us quite

42:31

vividly, it's turning out to look

42:35

pathogens, the way people respond

42:37

to pathogens can be more variable than

42:39

was at first thought. And in

42:41

some subset of people, the encounter

42:43

with infection can trigger a kind of

42:45

long standing immune response that

42:47

we still don't fully understand, right? Is

42:50

it autoimmune? Are they rampant

42:52

inflammation? We're looking at long COVID, people are

42:55

trying to study it, there's still no clear

42:57

answers. But a lot

42:59

of clues. So there was this kind of

43:01

paradigm about infection associated illness that was in

43:03

place for a long time that led people

43:06

not to ask the question of, well, why are

43:08

some people saying after they have a virus, hey,

43:10

I really don't feel good for a long time.

43:12

And in recent years, we're seeing suddenly

43:15

a lot of science show that, oh,

43:17

actually people with MS do

43:20

seem, I mean, people who have Epstein-Barr virus,

43:22

there does seem to be a connection to some

43:24

subset of those people developing multiple sclerosis.

43:28

But these questions either weren't asked

43:31

for a long time, or were sort of dismissed for

43:33

a long time. And so I do think that's

43:35

part of why this category of disease, including autoimmune

43:37

disease that I talk about, is,

43:40

as one researcher put it to me, about

43:42

a decade or two behind diseases like cancer,

43:44

which we can really measure and look at

43:46

more clearly. I really appreciate that. So it's

43:49

almost like a lack of curiosity about

43:51

the less common variations of an event.

43:55

For a long time in medicine, you're sort

43:57

of taught the test case or the usual

43:59

case. And so much

44:01

of what is important when you

44:03

think about something like an

44:05

autoimmune disease or told

44:08

a different way, the experience of

44:10

your non-70 kilogram man, which is

44:12

the functional

44:16

media patient, these

44:18

are where most of the scientific

44:20

breakthroughs and so much of the pain and pathology

44:22

sit. And if you're

44:24

uncurious about them, you

44:27

miss out on the opportunity. And that

44:29

lack of curiosity can manifest itself as

44:31

just a lack of scientific curiosity or

44:33

it can manifest itself as a

44:35

lack of interest in the experiences of people who

44:38

don't look like the 70 kilogram man and

44:40

those two things become self-reinforcing. You

44:43

mentioned feeling a lot better and I'm really grateful

44:45

to hear that. I want to ask you, as

44:47

a last question, what would

44:49

post-Invisible Kingdom Megan O'Rourke

44:53

go back and say to that

44:56

young woman sitting in that room

44:58

with that neurologist about

45:00

what her experience would be? I

45:03

always get a little teary when I guess I've been

45:05

asked a version of this question once or twice before.

45:08

I find it a really profound question

45:10

that I can't adequately answer, but I

45:12

think the number

45:15

one thing I would say and the reason I

45:17

wrote the book is that she

45:20

should trust her

45:22

experience and she has

45:24

the right, the

45:27

human right really, to ask

45:29

for help from the medical

45:32

system in trying to

45:34

diagnose, treat, manage

45:36

that experience. I

45:39

think so many of

45:41

us feel a bit broken

45:43

by the illness itself, a bit

45:45

thrown off by that and then further

45:48

broken by that encounter of being either

45:50

disbelieved or told everything's fine,

45:53

which we want to believe, but then

45:55

realizing over time, no, no, no, we know something's wrong. I

45:58

think I would say, you know, in

46:00

yourself and also as alone

46:03

as you feel, you're really not alone

46:05

for better and for worse. But there

46:08

is something quite

46:10

powerful about recognizing

46:12

that illness is not

46:14

something that isolates us. It can be

46:16

something that brings us together in conversation.

46:19

And I've really felt that since the book

46:21

was published, just talking to people, hearing from

46:23

people and seeing, especially being

46:26

able to have conversations with people in the medical

46:28

system such as yourself. So I think

46:30

just the hope of knowing

46:34

that you're not alone is a really important piece. I

46:37

really, really appreciate that. And thank you for taking the time

46:39

to share your experience both through the book and then also

46:42

on our show. Our guest today was

46:44

Megan O'Rourke. She is a journalist, a

46:46

bestselling author, and the book is The

46:48

Invisible Kingdom. Megan, thank you so much

46:50

for your candor and your courage and

46:52

your time. Thanks so

46:54

much for having me. As

47:03

usual, here's what I'm watching right now. In

47:05

all the crazy opinions that come out of conservative

47:07

courts, this one I never thought I'd hear. In

47:10

Friday's unprecedented decision, the all

47:12

Republican court ruled that frozen

47:14

embryos are the legal equivalent

47:16

of children. Now, Alabama's

47:19

largest hospital is pausing all

47:21

in-vitro fertilization treatments. So let

47:23

me break this down for a minute. The Alabama

47:25

Supreme Court ruled that embryos deriving

47:28

from IVF, which stands for in-vitro

47:30

fertilization, meaning fertilization literally happening

47:32

outside of bodies, that

47:34

these IVF embryos have the legal standing

47:36

of children and therefore cannot be destroyed

47:38

without killing a kid. Already,

47:40

the largest IVF providers in Alabama have

47:43

paused all IVF services because of it.

47:46

There are so many facets of this story, so I want to

47:48

break down a few of them here. But first,

47:50

a quick primer on IVF. When

47:52

folks can't conceive naturally, they turn to fertility

47:54

treatment. Contrary to what most folks think, fertility

47:57

treatment is a lot bigger than just IVF. specialists

48:00

will try other modalities to identify the

48:02

barriers to fertility. Should those fail

48:04

to trigger conception, specialists then turn to

48:06

IVF. IVF involves harvesting eggs

48:08

and sperm, and then combining them outside the

48:11

body. That sounds simple enough, but

48:13

involves months of sometimes painful treatments from

48:15

both partners. Women, in

48:17

particular. And also it involves

48:19

tens of thousands of dollars paid for the

48:21

treatment. IVF is a near miracle.

48:23

It is done wonders for people who could

48:25

not conceive and have children because of that

48:27

process. But given the expense on

48:30

both the body and the pocketbook, doctors don't

48:32

just harvest one egg, they often harvest several,

48:34

with the goal of creating several embryos and

48:36

implanting the healthiest one. The

48:38

other embryos? Well, they're cryogenically stored, should a

48:40

couple want to conceive again in the future.

48:43

Needless to say, there are thousands of these

48:45

embryos being stored in medical grade freezers around

48:47

the country. And according to the Alabama Supreme

48:49

Court, those embryos are kids. You can't

48:51

make this shit up. Now let's dissect. Why

48:54

is this happening? Well, because a small proportion

48:56

of this country believe that life begins at

48:58

literal conception, the moment sperm hits egg. And

49:01

whether you agree or you don't, they want to

49:03

read their religious beliefs into our laws governing you.

49:05

Never mind the separation of church and state. Remember,

49:08

this is the same reason why dozens of states

49:10

have outlawed abortion. It follows logically that

49:12

if you think life begins at conception, then the

49:14

moment sperm and egg meet, in a uterus or

49:17

in a tube, that's a human

49:19

life. So, in some respects, the Alabama

49:21

Supreme Court here is following this to

49:23

its logical conclusion. However insane it might

49:25

be. But just think about how

49:27

absurd the logic here is. If embryos

49:29

created by scientists in a test tube

49:31

are life, then folks who are

49:34

trying to read their theological interpretation into

49:36

our secular laws are also admitting that

49:38

scientists can create life. Seems

49:40

to be a contradiction of the broader goal

49:42

here, no? And then there's

49:44

the fact that in their crusade to force their

49:46

quote, pro-life stances on the rest of us, they've

49:48

robbed thousands of couples who want to have kids

49:51

from the ability to do so. It's

49:53

nearly impossible to do IVF without

49:55

creating extra embryos. Which

49:57

by definition at the end of the process have to be the

50:00

destroyed. But what this does

50:02

more than anything else is demonstrate the complete

50:04

absurdity of the anti-abortion position in the first

50:06

place. Embrios just aren't children. They

50:08

don't have feelings or memories or hopes or

50:10

dreams or ideas. They don't love. Trying to

50:13

give them personhood rights is itself an abrogation

50:15

of what it means to be human, and

50:17

in the process it robs the rights of

50:19

actual humans. Meanwhile, just

50:22

south of Alabama, in Florida... Florida

50:24

Surgeon General is defying more than 50 years

50:26

of CDC guidelines in response to a measles

50:28

outbreak at a local school. A

50:30

few weeks ago, we talked about the massive measles

50:33

outbreak in Europe. Considering our globalized world and just

50:35

how transmissible measles is, it was only a matter

50:37

of time until it hit our shores. Last

50:40

week, six kids at a school district outside

50:42

Fort Lauderdale were confirmed with measles. To

50:44

be clear, that means one kid probably got it, and

50:46

then it started to spread. And given

50:48

the fact that measles will infect 90% of susceptible people

50:51

exposed to it, the most obvious guidance

50:53

is to recommend that any and all

50:56

unvaccinated people vaccinate, and that anyone who

50:58

doesn't stays home. Except that's not

51:00

the guidance that Florida's quote, Surgeon General gave. Instead,

51:03

in a letter to parents, dudes specifically reiterated

51:05

the normal recommendations and then said, and I

51:07

quote, However, due to the high immunity rate

51:09

in the community, as well as the burden

51:11

on families and educational costs of healthy children

51:14

missing school, the Department of Health is deferring

51:16

to parents or guardians to make decisions about

51:18

school attendance. So basically,

51:20

here's the recommendation, but honestly, whatever.

51:23

What the F? A letter like

51:25

this does nothing but to muddy the waters.

51:27

It is an explicitly ideological act meant to

51:29

placate his boss Ron DeSantis' politics, rather than

51:32

to protect children from harm. It's

51:34

public health malpractice, and it's a reminder of what

51:36

the forces trying to put ideology over science, just

51:38

like we talked about last week with the leaders

51:40

in Ottawa County, can do. Finally,

51:42

since our episode about Gaza last month, an additional

51:45

5,000 people have been murdered

51:47

at the hands of Israeli bombardment, with no

51:49

signs of stopping, that Yahoo has all

51:51

but ignored growing international pressure to bring this to

51:53

a close. For our part, our

51:55

government shamefully vetoed yet a third

51:58

UN ceasefire resolution and continue to

52:00

send weaponry to fuel the onslaught. As

52:02

we discussed though, the full consequences of the assault

52:04

don't end with the shelling and bombing. They

52:07

extend to the destruction of Gaza's water infrastructure

52:09

and the overcrowding that allows respiratory illness to

52:11

rip through the population. Epidemiologists

52:13

at the London School of Hygiene and Tropical

52:16

Medicine, as well as the Johns Hopkins Bloomberg

52:18

School of Public Health, modeled the expected death

52:20

toll overall under three scenarios. In

52:22

a media ceasefire, an extension of the current

52:24

status quo or an escalation. All of them

52:26

are grim. They found that an

52:28

extension of the status quo would lead to 65,000 deaths over the

52:30

next six months. Or

52:33

an immediate ceasefire could lead to 44,000 fewer deaths, 11,000 in

52:35

total. 44,000 lives that

52:39

a ceasefire could save. Think about that. But

52:42

as Netanyahu's incursion in Torofah demonstrated, the

52:44

bombardment could still escalate. And under that

52:47

scenario, the researchers found that it

52:49

would take up to 85,000 lives in

52:52

the next six months. And all of that

52:54

is a reminder of why we need an

52:56

immediate ceasefire now. 44,000 lives in

52:58

addition to the tens of thousands already lost are

53:00

on the line. We're not

53:02

above correcting the record here in America dissected. In

53:04

our last episode with the public health leaders at

53:07

Ottawa County, I misstated the qualifications of the individual

53:09

whom the Ottawa County board tried to appoint. I

53:12

called him an HVAC repairman in an avid

53:14

Facebook anti-vaxxer. The individual is not an HVAC

53:16

repairman, but works as a health and safety

53:18

manager at an HVAC repair company. He

53:20

said he's not an anti-vaxxer. However, we

53:23

made those statements because he's mocked Governor

53:25

Whitmer's press conferences supporting COVID regulations and

53:27

has supported things like ivermectin and opposed

53:29

masking. That's it for today. On your

53:31

way out, don't forget to rate and review the show.

53:33

It does go a long way. Also, if you love

53:36

the show and want to rep us, drop by the

53:38

Crooked store for some American dissected merch. Don't forget to

53:40

follow us at Crooked Media and me, Abdul Alsayed, No

53:42

Dash on Instagram, TikTok and Twitter. directors,

54:00

publisher producers, arbitrator,start data

54:23

and