that's expanding the bench. i'm not optimistic that happening under our current president. yeah, i don't know know. i got nothing back. becca is going to also be books here in just a second, so you should get your book. and if you have individual questions. her. yeah, come see me. you can come talk to her at the book signing tent as well. but i just to thank you all for coming and thank back offer for being here to. thank you for coming out to this panel about a very important subject health inequality and health, justice. we have here to fantastic authors with books that i every american needs to read.

first off, we have beth macy. she's a virginia based journalist. her previous book was, dopesick dealers drug doctors and the drug company that addicted america. she was an executive producer and co-writer on hulu's peabody winning dopesick series. before that, she spent many years reporting for the roanoke times in virginia. she occasionally contributes essays to the new york times. she's here with her book lazarus hope, justice and the future of america's overdose crisis. and next to her, we have thrasher. he holds inaugural daniel rensburg chair at northwestern's middle school. the first journalism professorship in the world to focus on lgbt q research. he's also on faculty of northwestern's institute of sexual and gender, minority health and well-being. written about the aids, hiv, covid 19, a monkeypox epidemics for the new times, the guardian atlantic, buzzfeed news, as well

as numerous scholarly. and he's here with his the viral underclass, the human toll when inequality and collide. so i think we're going to have a a great discussion. i want to start this off sort of framing this quote that appears in raising lazarus from martin luther king jr. of all the forms of inequality, injustice in health is the most shocking and the inhuman because it often results physical death and think that's so important to keep in mind as we continue with this discussion, i want to start with you, beth, with raising lazarus and. you know, this is in many ways a follow up to dopesick, which i can only imagine was very difficult book to report on. i can't imagine sort of the the sorrow and the and the pain that you would have to share with people in that. so if you could just explain why i returned to reporting on the

opioid crisis again and i'd love you to share the story that title because it's such a it's a important, vital part. the book. yeah. thank you. thanks, everybody, for coming on. i already can't stop talking, stephen so this was a great pick. whoever this. why write a second book about the opioid crisis? i was so bereft by the time i dopesick. my main person i had been following a young woman who had struggled with addiction for five plus years, had been murdered after being by every system that was meant to help her and. the last image of that book for those of you who've read it is her mother saying goodbye to her battered body at a funeral home and bereft of the loss of tess, but also bereft of the poor response of our nation to the opioid crisis and i really like

i wasn't ever going to write about it again. my husband said, you should write a cookbook and and then i started going out and talking to people and learning about really things that surprised me, particularly when you have people doing cutting edge harm reduction and low barrier care in rural states in rural communities that haven't even passed medicaid expansion. i'm like holy cow if they can do it why aren't they the model for our nation going forward. you know, we still have an 87% treatment gap in america for opioid use. and that means that only 13% of folks were able to access treatment. and that's because of stigma and inaction. and so i thought with this opioid money about to be coming down, the litigation settlement,

why don't i write this book, which is more hopeful certainly the bits of hope aren't to the scale that we all wish it were. but this help teach communities how to how to best spend that money, which is in the ways that the evidence supports and also just in the ways that humanity supports. which leads to the title. a lot of people think the title raising lazarus a is a reference to narcan the overdose reversal drug, and narcan is part of it. but really i started reporting these two women who are married and they started what at the time they called the nation's only queer, bi racial faith based harm reduction group. and they started passing out needles on the sly before it was legal in north carolina out of the back of their pickup truck and then they were poised when needle exchange was legalized in north carolina to become a full

fledged organization and. they now they do amazing work. they do cutting work. but people call upon michel, the minister, when she's trying to get christian groups to check their blind spots about, harm reduction, which is this idea of going to people where they are even in chaotic use, treating them with non-judgmental care, love and being if they're still using, you're still a person. if you're still using. we know that people who go to needle exchanges are five times more likely to enter treatment. so i'm about to lay in this sorry, this is a long answer, but so the first time i meet michelle, she's in this community, meaning where that gets hijacked by, somebody who says, well, i think when they overdose, we should let them die, take their organs. really? so she stands up and she tells the story of lazarus, you know,

jesus was four days late getting to lazarus cause he was dead when he got there. and and jesus performs the miracle of bringing lazarus back from the dead. but it's up to the disciples to roll the stone like to remove the barrier. so i have a chapter called stone rollers and and it's the disciples to do the dirty, messy work of unbinding lazarus but only by getting close to folks on the ground can you experience the miracle of raising lazarus. so that's that's where the title came from. yeah, i love that phrase. the stinky, messy work involved in that is stephen. let's talk about the viral underclass, which is is not a phrase that you coined yourself, but which you use to to great effect within the book. i, i love the sort of framing that put on the book when we follow the any virus, really, we follow fault lines of our

culture is really sort of the through line of what exploring there in the book that interrelationship between the spread of diseases and marginalized. so what was the genesis of this book. well, thank you so much for having me. and i'm really honored be here with beth. and my mind is brimming with things that you just talked about. the virus class. the phrase it was originally used by an activist named shines through and 2011 and it was using it to describe how and why people are criminalized for transmitting hiv or exposing other people to hiv. i think there are many points in our books connect. one of them is understanding the ways that stigma is the system that keeps people from getting the help that they need and for people who don't know and the audience it is illegal to expose someone else to hiv or transmit it into somebody else under many circumstances and about half of u.s. states and, about 70 countries around the world. and it's a really, really bad law because when people are positive and hiv or covid or monkeypox or any communicable disease, what we want for them

to be able to come forward and get the care that they need and to know that they're not going be judged and that they're certainly not going be thrown in prison. so i started about a case of a young man named michael johnson in saint louis in 2013 who was arrested for criminal exposure to hiv and transmitting hiv to two people. he was facing life in prison. he eventually got sentenced to 30 years in prison. and because our reporting at buzzfeed and a lot of activists, we got him out about 25 years early, but he still spent most of his twenties in prison and was a real wakeup call to me to understand that even if people think that they're doing things that might lead to exposure to someone else. nobody's to give anyone else covid. nobody's trying to give anyone else hiv or aids. but when you tell people that, you find out you're positive and for the rest of your life, you can be prosecuted. and they see somebody go to prison for 30 years. that becomes the stone that keeps people from getting tested in the first place. the work of the hiv people that i work with got much harder after the beginning of that

case. so a viral underclass i started seeing as the way sean used it, to talk about how people living with hiv are living under an explicitly different set of laws. i heard activists it in slightly different way and i was trying to this became series they wrote for a long time. that became the basis my my ph.d. dissertation. i really understood it as a way understand systemic racism because over whelming the people who are prosecuted black. anywhere in the world that this happens. and i started use this as a way to think of it as viral underclass as an analytic to understand and why similar groups of people exposed to different social conditions and different kinds of viruses, hiv when you look at where people get hiv, where it progresses to aids, you also finding who are dying of addiction. you're finding criminalized overpoliced and you're finding police killings under the same. you just see it on maps. when the covid 19 that started happening in 2020, i saw the same maps filling in and my move in the book, the viral underclass.

i still build off of the work around race, but i one of the ways that our books really intersect because have a chapter set in west virginia is that this not only a matter of race, race is a big of it, but this is affecting poor white people. this is affecting people who are lgbtq. it's people who are disabled and in another way, our books really intersect. people who've been incarcerated. and i want to add quickly, one point of hope is that activists, the time i started working on this have done really good work raising awareness about the criminalization of hiv. only two states have gotten rid of the laws entirely. and when people are cynical about, the two party system, i tell them the two states that have gotten rid of hiv laws are illinois, where i live, blue top to bottom and, texas. so thank you for all of you. this happened under your government with lots of bipartisan support. it's great. great. i think the first area i'd like to drill into a little bit more, you both alluded to in your discussions of your your books just then is and it's it's stigma because.

it's it's such a big part of what you both are reporting about on in this book. and it's to me stigma about, you know, creating the sense of where the, you know, these problems issues are for other people and, other groups that we can sort of shunt. and i think in this country, most of us have a pretty good awareness of how we treat people as others when it comes things like racial division or sexual orientation or gender identity. but what you all both explore is this treatment of when it comes to drug use, homelessness or incarceration and or sex work, or even just people having some of these diseases that come with stigma, hepatitis, hiv. so you know i think it's put so well by somebody in raising lazarus. i can't remember who, but treating human beings as objects you know, instead these marginalized peoples. so i love both of you to drill in a little bit more about how

stigma prevents us reaching solutions in these public health crises. hmm. that's such a great question. and so so much of the. do you want me to go first? yeah, go ahead. so so much of the stigma association comes from this place where people fall through the gaps and die. and that is this tension between treating people like a criminal and a moral and treating them like the human beings that they are with a treatable medical condition. i mean, they really are people with a treatable medical condition, just like you would take insulin if had diabetes, which i have. so and if you look at that, it goes back to the harrison narcotics. of 1940. it goes back to the nixon's war on drugs. i take brief digression to talk about nixon his early years when he actually

treatment funded as well as as he had incarcerate for drug use funded and he appointed the first the nation's first drug czar this super crusty psychiatrist named jerome, who reported directly to him and designed a program on demand methadone clinics. but then, you know you see it start to become a way police people in order to get votes and you know the southern strategy that he employed is which is well documented that is harsher against poor people particularly people of color. when i think of stigma i think of the story in my book that got me the most i was following a ryan white hiv who whose job to tell who to test and treat people for hiv in charleston, west virginia. the state that has the most concerning hiv outbreak in the

nation and state. the just criminalized needs based syringe exchange. the one thing that we know works to prevent the spread of these infectious diseases. and so i'm following around this ryan white worker named parker. and she's looking for three people. but but they're mostly unhoused and she can't find them. and then the needs are just screaming out of there, like like coming out a right and left and at one point, we're looking a person we're at a homeless encampment. we run into this man in a wheelchair he's dopesick. he's crying he's picked maggots out of the abscesses his feet earlier in the day and he won't go to the hospital even though he's going to die of this bacterial infection because. he went there last week. you was treated like --. 18 hours. he's not going to go. not going to go. she's begging him to go. so she sits at his feet and it was like watching jesus. she sits on the dirty ground. she opens her first aid kit, she

puts gloves on, and she packet after packet of antibiotic ointment on him. and he's wincing, he's crying and he's dopesick. he needs to get drugs to get well and at that moment, a police officer comes up and puts an eviction notice on the homeless encampment. and i thought all of the stories just came together in that moment. and a sex worker who also lives in the homeless encampment comes up and says so too, brooke. honey, that antibiotic ointment ain't going to cut it. i was a nurse for 17 years, an lpn. and then i got married and then it was like, but i'm up. and she went like this. like a vaudeville. it was incredible. and she walked away. and brooke said. she should be the person treating him if something hadn't gone wrong for her. and this is what we have to remember.

this is at the base of stigma. if we have to remember that this guy in the wheelchair had a family, he had kids. he could be just like us. and so i think stigma is really at the base of all those many things, all the layers of discrimination in one moment and just how poorly people in our own health care system which by the way participated in starting the opioid and they need to participate in putting an to it. steven so the statistic that i think about most that i write about in the book and have for years is that one in every two black gay men are projected to become hiv positive in our lifetime. and there's no reason for that happen, and certainly there's no reason for anyone to die of aids. hiv is an extremely slow acting virus. it can take five, seven, ten years for people to start having bad health effects.

10 to 15 years until they die. that 10,000 people still die of it in the united states every year. the better part of a million die of it around the globe. and part and a big part of it is economics. but a lot of it is stigma. people are made to feel so bad. this disease made to feel so shameful through. hiv criminalization laws through jokes, through the ways that people are treated in health care settings, that they don't get the help they need. and i was thinking while you were talking about to as well if people don't have a safe place to sleep it doesn't matter whether or not you get them these drugs. hiv is relatively easy to deal when you catch it and its early stages people take one pill a day, they go on with their pretty much normally thereafter. but stigma is a huge barrier and then being able to get the care that they need. and what i was saying something nice about your state earlier with hiv criminalization laws but what abbott is doing with trans children with the ways that trans children and lgbtq people are being criminalized in this state, and florida and arkansas is creating these pathways the state to let viruses, antibodies, you know,

if trans people or if trans people cannot get the medically care that they need for hormones and safe setting of people who are dealing with addiction as a health matter cannot get sterile syringes. then the state is opening up their veins in their to hiv and to hepatitis and other pathogens because they're going to get they're going to get the care they need somewhere, whether or not sterile. and stigma not only does that is that sort of a physical matter but? stigma becomes this barrier that makes people feel ashamed to get the help that they need. so one of the stories that touched me the most, the first person in my outer social to die of covid, was a really amazing activist named, lorena burrus, who was known as the trans latin x mother of that she was known as the mother. the transplant next community in jackson, in new york, in queens, and herself had been living with hiv for decades. she had been a sex worker. and she did really amazing volunteer work. she would go out on the street and give people sterile

syringes. she would give them food and condoms and, kind of anything they needed, and really met people where they were. and then she was the first person i knew who who contracted covid and died. and when she had covid and those very, very early days and march 2020, she did not want to go to the hospital because of all the bad experiences that she had had the hospital herself. and i wrote, i won't go into any depth here. you know, i wrote about an experience that i had had when i needed a sonogram, when i doing my my ph.d. work. i was a little bit older for a student, but not that old. and i was made to feel very unwelcome because my age, the receptionist made a joke about, not thinking i could be a referral from a from a student health center. and that really made me understand the ways that if a trans person is going for health care, particularly around something sensitive like sexual reproductive health or cancer or something like that, and if they're met, that kind of response, you don't look like what i was expecting. that's a big reason why they might not want to go in and get

care. and that's one of the reasons why they are so much more likely to get sick unnecessarily. i want to i want to ask about intention here. so we have this health system in our country that's capitalistic and profit driven. so what what interests me to explore a little bit is to what extent do you think that the people making, the decisions in our public health system and in our health care companies, in our hospitals and have some sense of, you know, malignant intention, intentionally marginalize these groups. and to what extent, is this just a byproduct of structure of our system? because it is profit driven. go ahead, bill. before dopesick came out, i was asked to talk to the nonprofit hospital system in my region called carillion, the largest employer in the whole half of the state, five hospitals, medical school, blah, blah,

blah, and tested just died. and i watched her struggle not to be cared for at their own hospitals. and i said, i know not all of you took a free trip courtesy of purdue pharma to arizona and florida to become paid speakers from the country. but you all participate in the system. you should participate in the correcting it. and so i think a lot of it at that. so that was 2017. two years later, they totally changed the they do medicine. they started doing buprenorphine or medication assisted treatment, offering it in the ed, whereas before they thought that was just treating a drug addiction with another drug it wasn't their job. so they they can change the world. and then when they changed one guy with a lot of power decided he could change rules. and, you know he had incredible

and. that's what i see over and over in this book is like one person sometimes it's a mother or sister of somebody who's out of overdose somebody. it's sometimes it's just somebody like dr. burton who who i asked him what happened. he said, well, we read your book. and then we looked into the research and we said, how can we not be doing this? and now he becomes kind of an evangelist for four other hospitals wanting to do this evidence based practice. but it's like 5% of hospitals do it. it's not that heavy a lift. and i don't know that it's is because of the capitalistic system as much as you know, the creation of the overdose crisis to begin with which which begins purdue pharma introducing a very addictive drug in 1996 and basically, you know buying off of the politicians and lobbyists and you know the fda the guy who stamps approval on oxy cotton goes to work for purdue,

tripling his government salary three years later. i mean, nobody is regulating these systems. and so we've got to get rid of the revolving door is one thing you that happen again later when the dea basically gets kneecapped from going after suspicious pill mill doctors suspicious orders because of a law that the lobbyist basically that used to work for the drug. i mean you almost couldn't make this up but i think it's both. i think the health care providers want to get back to to doing harm. i quote a guy this medicine doctor met i'm doing this because he wears this big cross and he's very religious and he runs a homeless out of the basement of his office. but he says the answer comes back to quote from 1926, francis peabody at harvard said, for the seeker of caring for the patient is to care for the patient.

and i think, when we let capitalism, we get away. we have to get back to caring for the patient. stephen yes, i will directly blame capitalism. the point capitalism is to extract profit and extract value. so the health care system under capitalism is not about health care like the point of these companies is to drive profit. that's their, their primary motivation. and many of sicknesses are opportunities to do so. there's a phrase that i've heard a lot of active activists use. act up is the was one of the main the main aids organization that fought aids very successfully or or fought government reaction business reaction aids very successfully in the 1980s and 1990s, perhaps their most important contribution is that they forced the fda and the government to change how trials were done. and that's why billions of us have now been able to get vaccines for, covid, in a process that used to take ten years, could take as little one year now. and they had a phrase that they

used that by 1996, when aids medications came. science one science won the debate about to do about aids they figured out how to do it they figured out how to save lives. science won the battle. but capitalism, the war. capitalism is the reason why more people have died of aids after the invention than the medication that died before capitalism. the reason racial capitalism is the reason why there is a higher rate aids among african-americans. 2015 than there ever was among americans before. there was medication 20 years earlier. and so is these are the kinds of results that the capitalist health system creates. the people that you're about, and raising lazarus who are doing the work out of the back of, their truck, they're interested in care. i think that's a point between. our books that i notice is we're writing about people who have a ethics of care, a new effort a new ethics of care. and i that the covid 19 pandemic would inform and has, you know,

many more to have different senses of ethics care. i certainly know so many people who worked in offices prior to the 19 pandemic that once they were home, truly enjoyed doing things like getting groceries for their neighbors and a mutual aid networks and things of that and those the models that i think we need to look at for more care for people the person doing the work housing people in their basement they're that work the people that i have interviewed about monkeypox this summer sex clubs and gay saunas who work their -- off all summer to inform people about monkeypox, fight the government to try to get vaccines, actually distributing the vaccines, stopping their sex parties and their activities and them into places to get people. they're the ones really doing a new kind of work that's interested in people's whole health. and as a last start, i'll say something else. i thought about while reading your book, beth, was how covid 19?

put into effect a very, very different response. the world from the world's governments and companies than hiv did. and monkeypox did. and that work around anything that involves sex or drugs and genders from the society. and we could have an ethics of care that did so with much less judgment about those activities that not only benefit people on the individual level would create a much better public health outcome overall for the society. great. i'd like to invite anyone, the audience that would like to ask a question of our panelists to come up and step up to the mic what we're doing while we're doing that, let me i want to talk a little bit about hope, a little bit towards solutions, because one thing that comes across in both your books, this idea that the people that need that need the most care are the ones with the least access to care and seems very distorted. and you both point to individuals who are of i don't want to say fighting against the

system, but finding ways to help in the ways that they can. are those solutions scalable? is there a way to take those models that you find and make them work on a large scale? but i think have to be we can't lose hope. i also write about a bureaucrat comes along and in the same community where they said let them die and take their figures out a way to offer post overdose response teams and peer recovery specialists that every person now overdoses gets. a peer, a person in recovery to come out and help them make those first hard steps into care. and but but he had battle so many i mean it's a problem more than it is anything else. he has to battle judges that don't want to allow a drug court, even though he has money for and and so when these kind

of i call the peers my rowdy angels, people who run needle exchanges and do this peer recovery where they actually reach out in this one community, find one good cop. i mean one of my advice at the end the book and something that gives me hope if you can turn one good cop into doing things differently to diverting people care into from and into care you then show how that worked. and so i think that's something that scalable. but i'll just say very briefly what i think is has been scalable in the past years are things that people who do work, who've been doing the work around, drug use and around queer health for decades is now understood by millions and billions of people much more. and i think that we're going see ripples in that for decades. the the huge unionization effort that's happened at starbucks, amazon and places like that is attractive results from the covid 19 pandemic and people feeling unsafe, their workplaces

and coming together to with things. and i think that young people, teenagers, people in their twenties, are going to take the lessons that they've learned from these years and understanding the need for much collective response to dealing with social problems. then everyone feeling like they're an individual failure and they must figure out problems individually. great. let's go to the audience. the microphone, is it on. that go. do you want to come up here and

repeat it you can just say it will repeat to the just say and say i'll repeat it in my sing out, louis is i will repeat it i suppose you mentioned. you can and i. first of all, let me back up. we do hear thank you. but i think i, i want to pay for it that i sort of consider another another. yeah, it's not working. it's okay. we can hear. we'll repeat it. i sure i'll use that. there are certain times where we feel and i often refer to you guys talk about i didn't like

the. so i just wondered if you had a medical here. yeah, you're right. it's not always so. so the question. the question about older adults and how they also are are stigmatized, treated as other. and and stephen's book actually addresses this when it comes to covid how these congregate living situations created these traps for older adults during covid. yeah. so i can jump in to that. so elderly are a huge part of my book. i have an entire chapter about the closest person to me who of covid, which was my former village ed ward, harkening. and it was completely stupid reason he he had a tooth infection ended up in icu in new york state where i lived at the time they were putting people with covid into nursing homes. and when he was recovering from his tooth infection, he got covid and died. one in every ten people in nursing homes died of covid one in every 12 in congregant care settings, which also include

younger people who are disabled one in every 12 of them died as well. and i've gotten many letters from, people who are elderly about about their experiences with and one of the things i hoped with my book was to give people a chance not only to mourn people they lost, but older people who think that or people who've had covid, who feel like they've been forgotten. and this was very much an assault. the elderly and this figures into my critique on capitalism. capitalism mostly cares about your health and well-being when you're quote unquote, working age. they care much less about children they don't care at all about the elderly and very crude terms. economists talk the elderly as a drain because are costing money from the economy, contributing to it. and i read a little bit and other research that i've done that the elderly are also affected by hiv, aids and stis. they're actually one of the few demographics that increases in studies, because we assume elderly people don't have sex. and so there's no sort of consideration given to health care, pleasure, things like that

in connection. so yeah, very much the elderly are a part of how i write about the viral underclass and enormously as borne the brunt of this disease. i think it was your attorney general here in texas who talked about, you know, can't you know, grandparents give up their lives few years for the good of the economy. and it's been really really disheartening and that's why i think that my disability justice framework is helpful because the elderly in a way are disabled. capitalism disability is usually thought of as how are you to the economy. and so growing old at a certain point means your body is not able to do certain things. and it's really, really disheartening to see across the political spectrum and certainly in a lot of mainstream media are reversion at this point of talking about covid, you know, it's only harming the people who are who have other problems. and we don't to be so concerned because they're not hale and hearty enough to survive when we still have more than 10,000 people a month dying over, while

mainly elderly people. matthew, when add to that. yeah, yeah you're talking also. yeah, that i also think a lot about i live locally and how all the hospitals seem to be owned by religious organizations and that affects people's care and the limits their care and also i think that means our tax exempt as well. did you cover that in your books any about i mean along with the capitalism and, the religious aspect of what a hospital or ownership ownership? i didn't really get into that as much from a structural level. but i you i explained the title raising lazarus in the use of how is it mostly individuals

this point. individual people with personal ethics of many of them based on their their religious beliefs are really the ones leading us out of this and are the mutual aid and. you know i tell the story at the end where this catholic nun activist who's in her eighties and, she's having to reach out to me to start a go fund me because. she can't pay her light bill for her addiction education center. and i say that, you know, the sackler light bill is paid for 200 years and here's this 88 year old counselor, 12 hours a day and asking money. you know, most of these nonprofit, you know, they're not paying taxes. and they did participate in the system that ultimately led to 7

million americans being addicted. and i think they should step up. i deal with it very briefly. in my book, religion both ways that there are ways that religion really contributes to homophobia and transphobia at an individual level, particularly with catholics, there are people involved in mutual aid work that i've seen doing really phenomenal things. i've written a bit more about it this summer because i turned in the book, i turned in right before the dobbs decision. it came out my book out right after the dobbs decision that there's a real link in the ways that we conceive religion and tax status and speech. and so it's very dangerous ways that corporations have been so far able to say we want to pay for abortions because that violates our religion. and similar things are happening with queer stuff already. there's lawsuits have already been filed and that's a really dangerous thing. and i think it was the times that might have made propublica, but there was a massive

investigative story a month, two months ago about how these hospitals are nonprofits, but they're using aggressive bill collecting techniques for people who are supposed to be getting care for free. and they're not even aware that supposed to be getting care for free because they're the same kind of bill collectors. they would get from a for profit hospital system to get to. and you got it. thank you. thank you. one of the thing on the reproductive rights front, i thinking this through on a panel the other night that the hyde amendment which basically only made abortion illegal for poor people and only there was really only full access to abortion for a few before the hyde amendment came in. very similar legal thing is happening now with trans care that in florida they've made it so that if you have medicaid, you can't get trans care and other states are going to do things like that. and that's putting us on a very similar path to how the hyde amendment to over time, abortion

not being legal in many places. thank you both for your books. i forward to reading them. ms. macey you talked about one bureaucrat that you with who is doing work that's really, you know, trying to address these issues. did either of you talk with other working in the government who are really trying to make change and do things differently to solve some of these issues? yeah, i was just at the white a few weeks ago for a recovery summit and i met with the drug czar and i know he knows what all the research because he's authored some of the. and again we come back to politics and i am hopeful that that in knows ways to make sure we get evidence based care but we still you know i kept asking everybody at the of my book what's the magic wand what's the fix and there is no federal

because health care is run by states and communities. so you might have one community that doesn't allow needle at all and another might have 17. still, lot of states have made illegal. we still have 13 states that haven't passed the medicaid. so it is like where you live in the country determine your your ability. if you're a poor to get health care or not. and that's really concerning. i think the administration is aware of it, but they're just struggling about how bring it into view. i don't write much i don't interview many government officials. i'm interviewing people in the viral underclass and i'm more critiquing how things play out in the government across party lines. the biggest one being that 400 people, 400,000 people died of covid trump, 650,000 and

counting have died under biden. trump didn't have the vaccine. he was a cartoon of dealing with the pandemic. the biden administration. they're going to listen to the science. lots of good people. i now have gone into the administration. but when people don't have homes, there's only so much we can do. and when u.s. has more incarcerate, hated people than anywhere else in the world, that like the major driving engine of disease, particularly respiratory illnesses. so i'm writing more about kind of critiques around that. but it's dismaying to me that i've known really, really good people who go who go like go into the administration. and then i feel like i don't hear from them again. that's a good point. we have another one more. so the question is why we hear from, you know, good people. they'll be very loud in public

and. they'll do scholarship and activism work that's cutting edge and is critiquing, you know, the administration or sort of government response and then they brought in to ostensibly keep doing that work and then like i just don't hear from they stop tweeting, they stop publishing everything they write has to be vetted through the administration. you i mean, i'm sure they're scared of getting fired. yeah. and so i mean, i say, like, there are a handful of exceptions, dimitri, who is a very, very out gay leather or, you know, sex positive person, worked did hiv work in new york city, did at the cdc, got brought in to do monkey pox work. he's actually maintained a quite a presence in the world but a lot of people i'm oh their ideas are so great i hope that's going to be what drives the administration and it feels like that's where their ideas go to die. we'll just that's one last question here this morning. got my mail in in my mail was,

you know, a political ad the republican party, you know some pac that said all these, you know, pieces of missing information about puberty blockers, about trans youth, you know, and what the treatment is for trans youth and in our country and. so i'm just curious what what can i do? what can people do to try combat or you know reverse that misinformation that's coming out coming into all the homes in austin might have gotten that pamphlet you know so what am i to do to make sure that my neighbors and my friends aren't believing that. i. go ahead. i think as a cisgender person, it's on us to always explain what's wrong about it to anyone. listen to explain that, you know there's people take, you know, quote unquote few blockers or all of medications that that affirm gender for all kinds of reasons and across their lives

of all gender spectrums. and many of them been used by cis people for a long time. i think it's important to share that as a gay person, i find that really important to explain to other gay people. transphobia comes up in our community that the ways that we were talking talked about as gay people in the 7080s and nineties and told you know, like it's something you should have to get over that. you should go through conversion therapy. we would never accept anymore as gay people conversion therapy when that's basically what's being for for trans people. and so i think it's to talk about that within my community and i think we have a real epidemic of and a lot of that you can trace back to particularly rural areas. you can trace a lot of it back to the fact that the jobs went away, the government did for the people that left behind capitalism ruled that one to then things like the opioid crisis come into being and were ill equipped to deal with that.

i. i thinking a lot about now the media's role in specifically the declining media's role in covering a fact based. i worked at a newspaper for 25 years. we numerous national awards it had 125 employees in newsroom when i got there. now it has eight reporters and so i think it's really important that we talk about revolutionizing nonprofit journalism and supporting journalism that's left out there because when when i mean this kind of stuff you're getting in your mailbox, we've to counter that with information. thank you. one very quick fact that people will say, you know, we don't know what's to happen with trans people. we don't want to comment. this is not true. there's 40 years of research. the decades, decades of research of it. and john, better than any national level, you know, journalists like got the general of arkansas.

it's say no no no -- -- --. this is how it works. there's you know, there's decades of research. so educate yourself on the research that's available and tell neighbors yeah i just want to echo what beth said support local journalism please subscribe to texas monthly where i work thank you thanks so to beth and to steve and for coming. thank you all for coming they'll be in the book signing tent if you'd to to purchase a book and get signatures. than