mark zuckerberg returns to capitol hill tomorrow, testifying before the house energy and commerce committee to answer questions about the way facebook handled user data. live coverage begins at 10:00 a.m. eastern. next on c-span 3 teen of johns hopkins university school of medicine, ceo of childrens national health system and talk

about hospital capacity and obesity epidemic in america. this is a discussion is an hour. >> can i have your attention? can everybody kwif xif me your attention please? thank you. thank you everybody please continue eating and eat quietly. so we don't want any noise as this is going to be on c-span. two announcements one of our sponsors is united bank shares is here. rick, thank you very much. and a new member breakfast is

tuesday april 10th and please new members are are interested in attending and hi of you are welcome as well. okay. so. let me introduce our twitched panel to my left. paul walkman. wall is ceo of johns hopkins medicine and dean of the johns hopkins me cal school. he went to thr from aed witness at mit and captain of the crew. and then went to yale medical school. he coached the crew team at yale and when he got his crew work behind hum he was committed and subsequently did his work at columbia university's college of physicians and sujens. he was there many years.

and pam the dean perfect pking the head of johns hopkins in 2012. and his wife is a doctor as well. and she is a specialist in gas stroe enterology. right? impressive. okay. crays thompson i should disclose i'm on kettering's board i'm not that good of a member but i'm a member of the board. so he did to under rad witness work at dartmouth and competed for alichices in u.s. lichic in 1972 and to not make it. this did well as a result of that. and he did his under grad

witness work at dartmouth and university of pennsylvania and medical school and he holds 30 patents in immuno therapy. his wife is also in the family business, an md-phd and cancer researcher. okay. and kurt newman is a member of the club. okay? kurt is, was an athlete as well

as a payable player in high school. and he's going to duke university medical school and trained at childrens hospital in post on, and harvard medical school and came in 1984 to childrens hospital. he's opinion surgeon of chief at joseph roberts surgical center there for pediatric innovation.

and his wife is also in the family business, neo natal nurse practitioner. okay. wow. very impressive back grounds. so let me ask you the first question. do you, when you go to a cocktail party do people say i have a hurt here? this pain here? what do you think? do i need to see a doctor? do you think it's cancer? what do you think? do people ask you this all of the time? >> occasionally. >> it's, you know you want to help people. so it's something you try to do for folks that you meet. it's typical when you're acting in a role of being their physician so generally i tell them to go see your own physician. i'm in the going to diagnose you in a cocktail party. >> craig? do you get this? >> yes. this is a common thing any time

you're in hay cocktail party in new york or washington you get asked because health is the thu wealth in america. maintaining health and wellness is key. and people looked to the physician community because all three of us were on health care systems to get understanding. so at every level they ask me what should i take? to what should i do for my health? and it's a chance to join a beer or cocktail party and get some of the information out. >> do you get people asking about their children? if they ask me about themselves i can say i don't care of adults but i enjoyed getting calls

about children and have an opportunity to find the right hospital for them. >> you're. do you think someone who hasn't ever run a big health care system could do so and do a good job? >> i was a surgeon at childrens almost 30 years and became ceo it was a big jump if i'm a personal doctor i'm not sure. >> okay. >> better stop there. >> so i guess at one level, any physician is a small business owner and running a team of

people. i i imagine physicians deal you'd themselves into thinking they can do this stuff? to understanding what it takes to run a health care system. so took increasing jobs in our careers and like any other industry you need experience before running a health system. >> what do you regard as the most serious health care problem now in the united states? >> paul? >> it's a expanded with spending gdp on health care. you look at baby boomers aging

it's going to get worse. we improve the quality of the health care delivered so the cost is the largest issue. >> i worked in the white house in late 1970s, gdp was 17%. what do you think is the biggest problem? >> i think many people in the world are focusing on businesses and how you do maintain your business health care is the single rising cost for your key employees and so this is a burden on american industry. we're one of america's business of industries and we're leaders

that provide all of the new techniques and employ almost 20% of the americans in the industry but is it's providing quality care and reasonable costs with one level of the device. i have the privilege of rep sending the oldest cancer center in the country and world throughout the world and i go in to different hospitals and systems and every one wants to be introduced to me starting with where everyone from nurses trained in the u.s. to get their experience and where devices are going to be used and equipment was, and supplies based on companies in the u.s. and we're admired for that. and so one spectrum our biggest problem is maintaining america's edge as a letting industry and not drag down the american

economy. and we need to level wellness to our population. >> cost is a big part of it. i don't think we're doing enough to children. and we're not investing in children the way we ought to be so we're not going into prevention and access and so we have a tremendous health system but we're not in many ways taking care of the fundamentals. >> okay, would you say for hospitals obamacare, your hospital, has it been a plus or minus? >> so ends up because of the payment system it didn't have a huge affect one way or another.

and around the country it did increase access by 20 million people had access to health care. from that it had a huge effect. there are terms of down side and if you looked at what the main deposit is, on health care for 20 million out of 48 million people who didn't have access. >> i think that expansion of access, people felt they could go a doctor bealmçb.wá american cancer society, giving back to back talks and able to show for preft cancer and lung cancer and colon cancer, people

do go for screening more effectively when they have insurance. it's driven down the death rate because people got identified and diagnosed earlier because they thought they had insurance and they can go to their doctor as a right and do that. and there are many complicated things. it's not all positive and there is room for improvement in u.s. health care. >> for children and families it's a big plus we used to have controversies around preexisting conditions. we don't hear that anymore. kids can stay on parent insurance until they're 26. that is huge when you think about college age and things that go on. and so forth and then, the lifetime caps, child with a

serious medical illness can run through a $1 million cap in no time which was very prevalent perfect obamacare. so it made a big difference for children and families. >> and children can be on the health care system after 26 as well. in my experience. >> we're happy to take care of your kids. >> someone shows up at hopkins an they say i got sick and i need treatment. i don't have health care. and have nothing do you turn them away? >> there are no hospital that turns away anyone who needs care and i think it's essential because our role is to improve the health of the communities and i think physicians have that

responsibility to the community and i think people do that i think at every hospital. we the whole ximñi8e'$?t).j+óh" hospitals, it's about 100ss million a year. >> about? >> you don't have the same problem i assume? >> in the as great a problem but again we provide it as paul says, up to five times the poverty limb writ we'll for give co-pays but the biggest point is pediatric population. about 750 to 800 new kids, we take care of. that is devastating for families and cancer doesn't respect any social economic barrier. so we provided that care.

>> how much a year? >> for kids? probably $20 million or $30 million. >> there are people that don't have insurance? >> over half of the children we take care of, and this is in general, 55%. so we want to be where kids don't have coverage. >> what happens when people used to be you go an stay there a couple days and now they try to rush you out, it seems. what point do you lose money? is chill birth going to be out patient thing, sir?

>> our big point it's a push to get people out of the hospital. driver is not economic. it's actually because we think people, if they can, would do better at home than they do in the hospital. it's safe. and on the road to recovery. the decreasing the length is not economic. right now it's really because we can do a more more. and i asked surgical chairs i said what percentage of surgeries do you do in an out patient setting in 10 years? it's 80%. 80% is done in a hospital will be out patient within a decade. hip replacements, joint replacements. so there a lot here because of tech logic advances we're able to do it in a different setting.

if you don't have co-morbid diseases that increase your risk you're going to do better the less time you're in the hospital. >> how many beds do you have at johns hopkins? >> our health system as 2800 beds. main ship as 1100. we have 2800 beds. admit probably 160,000 people a year between those. but the pig wrest thing is 160,000, we take care of #.8 million as out patient. so compare that today, over 10 fold. >> you don't look at it trying to fill up rooms, hospital hast 1100 beds. >> we can get every one out faster than we can. we still won't fill hospitals. we're bursting at the seams.

it's the most you want to run and at times, 100% and so we're running as fast as we can. >> so how many? >> we're smaller and have 514 and run as paul said about 92%. cancer care moved into more effective therapies as you can see in the news the time takes longer. and we've made the decision to pill outpatient for cancer care. we do a full spectrum five blocks from the main hospital that you can not stay more than

23 hours at. and we thought maybe in a decade we'd be able to convince 7,000 people of a miss plan. we did 7,000 in the first year and we've learned patients recuffer more effectively in their own home and if you do education right you can xan access to complex care we have at the hospital but not have to burden down the hospital with care mission of taking people day in and day out. >> how many pedz do you have? >> 313 beds an that sounds small compared to these. >> are they filled every night? >> sorry? >> are they filled every night? >> yes. we have a different model, though. because we, kids and families

need to be in the hospital more than say being able to be an adult and at home. so we are full. we're thinking about expansion. with thinking about expansion, we got a big plan around expansion with our research and invasion center that will free up more beds to have at the hospital. >> what's the definition of a child? how old can you be and not get admitted there? are you 21 and not eligible? >> is this your -- >> no, no, they're over 21. what age you say you're not a child anymore? >> generally it's in the 18, 19, 20 range. we've had so much success with certain diseases that used to -- that children didn't survive with, if you think about sis sissic fibrosis, general heart

disease and cancers, and those children are being taken care of at the hospital. they love the environment. doctors, nurses, art, music, clowns, et cetera. they keep coming back. it's not uncommon to see sometimes a 40, 50, 60 yearly for that specific condition. >> wow. so you have a medical school, best run in the world. you accept roughly 3%. >> that's probably about right. 6300 applicants for 120 spots. >> so half female, half femamale average gpa is 3.91. >> what are those people doing in college? >> we can fill our class three hold over with the gpa. if you do really well in school that's not sufficient. we look for people who -- i mean institutions like ours, all

three of us i think, institutions have unique ability to change the world and make an impact. we're looking for people to not just do well in school but if demonstrated they can make an impact but want to maken impact on society and on if world. they're looking for people who are beyond having high gpas, we want someone who have don something that utilize to us -- >> when you get in these smart people, do they all graduate? >> yeah. less than 1%. it's actually interest me, hop kaines, not to brag but hopkins, you'll notice have the highest of any med school, 37% of all our graduates are on faculties of other schools. we're trying to clang the world. >> the medical schools are so hard to get into. why don't you have a bigger medical school? your class is 105 people i

think? >> 120. med schools have increased the size by about 30% over the last six or seven years. the limiting factor is not the medical school class but the residency slots. after you train in medical school you have to do a residency in whatever slot you want to do. they're paid for by the government, medicaid has not increased. if we're producing more students and there aren't places to train but doing a disservice for students and no place to train. we're at the hospital where every increasingingly american medical students cannot get into the the programs because the caps have been. >> what type of debt does a medical student have by the time he or she graduates? >> nationally the debt is

$190,000. that's nationally. at hop hopkins, our debt is $110,000, a little lower. >> if you want to pay back that quick ish you go into plastic surgery? i'll ask it differently, the question is does that lodge influence a specialization of students? >> it does. okay. >> it's interesting. they do surveys of that you are students and ask that exact question. the number is lower than i anticipate is the reality. so, if you ask them very few, less than 20% of the students say their specialty decision was influence by they're debt, but in reality i don't think that's -- i think a lot of them are influenced by debt. >> sometimes you get people with

perfect med scores with 4.0 but can't tie their shoe laces, do you admit these people before you meet them? >> i can fill my class with perfect caps and gpas that's mott the point, we're looking for people who can actually interact with peoplie. we do testing in our process to make sure they can interact with people. we're looking for more than just hiring cats, and tieing shoes is a big part. not the only part, because there's velcro and all this. a lot of ways to get around not tieing your shoes. we're looking for people who have empathy, who want to go out and serve mankind. the interview process is called the ho lisk process. we try to intersect that. >> growing up doctors -- it's not hard to attract people but they're attracting because they want to serve people it's not

because the income is that great relatively speaking, is that right? >> i think for people who worry about the general x or -- and worry about the income and all that. come to my class and interview those folks they are the most amazing dedicated people you'd want to meet. they're here for reasons you'd want someone to go into medicine and serve mankind. salaries is relatively flat it's not the driving force. >> what if you have a dig donor at the hob kins medical school calls up and say my child was good, he didn't do that good in med caps but he wants to be a good brain surgeon, in medical school admissions that makes no difference, right? >> so what i've learned i've been a dean for ten years, the

firewall between me and admissions is getting larger and taller so that i have no role in admissions at all. >> okay. >> i can't participant. >> is cancer in the united states increasing? >> unfortunately it is increasing but it's increasing for important reasons to recognize. 100 years ago the cancer instance was lower than it is now but we live it had 20 years less long. the major drive of the incident is our ability to live longer and healthy lives. unfortunately cancer is the disease of aging. now as americans are living into their 80s with great success we're seeing a higher incident of cancer on that basis. our ability to prevent cancer is getting better so the ability to deal with complicated cancer, the improvement in survival is 1% a year. it has been that 1%

approximately, every year since 1990. so mortality from cancer has gone down almost 30% in the last 25 years. >> now, if you get cancer in stage one, and i suppose it's breast cancer, it's 99% now recovery rate? is that something right? >> so certain of the common cancer's caught early, the survival rate is well over 98%. the problem is getting it diagnosed early enough. skin canner has been more and more arareness we're getting to those kinds of numbers. with colin cancer, we're getting to those numbers. women are doing a great job at mammograms, we're starting to get to better numbers. if i just talk about breast cancer, breast cancer we're learning isn't one disease. for the most common form of breast cancer, yes, caught early at stage one the survival is in

the 95%, plus. but there are rare forms of breast cancer we're just learning about where unfortunately we don't have effective therapies and for those women we need to develop new and innovative approaches. that's true of prostate cancer. many men will get prostate cancers and will not cause diseases in their life span. for a long time we thought smoking was the only issue with lung cancer, it's not any longer. people, still for lung cancer wait too long when they have symptoms to go to their doctors. >> and the cancers with the lower rates is that pancreatic cancers? >> yeah, there are a if you remember of cancers that we now diagnosis. by pathology the two that are relatively common that have almost no effective therapies are pancreatic cancer, it's if the back of our abdomen, and

patients don't present until their symptoms come after the tumor's wide by disseminated in most instances. it's an area you don't feel a lot, either directly or the physician can't --. in brain cancer, it's actually on an incidents right now. it tracks with social economic status in a positive way. the better your social status the better likely you are to get brain cancer. adult forms as oppose to the childhood forms we have no effect. >> will be the theory. why? >> no one has no idea. that's why you may have heard ten years ago it may have to do with cell phone use. if you had a cell phone you were more of social status. that's not the cause, it's an association.

we don't really understand why there's been an increase in brain cancer and particularly this particularly fatal form of cancer. we need more research in that cancer area. >> and today, using your symphocell phone is not going to cause brain cancer? >> there is really no -- anything reliable to suggest, other than the association that brain cancers of an increase rise with people of higher socio economic status. the idea that your cell phone is the cause is just not possible. we would have seen that go away because everybody in america has a cell phone. >> if you are the higher socio economic class and you gave away your money would your chance go down? >> correlations are not the same thing as causation. >> okay. all right. what is the most common thing that somebody comes in to children's hospital? >> probably the biggest thing kids come in with are different

types of injuries, whether it's concussions, fractures. it's situations like that. those aren't the most serious but the most common. >> okay. and how much of your time did you spend fund raising? with government reimbursement and people paying i assume you need more money. what amount of your time is spent looking for donors? >> i don't think of it that way. i advocate for john hopkins medicine all the time. it can be with donors. it can be with regularities. i advocate all the time so i'm always advocating for hopkins medicine, whether it's with potential donors are people who are going to -- remember most of us -- i think all of us, most of our money is from the federal government.

hopkins has $8 billion over $4 billion are from medicare with research. >> so grateful patients are thought to be people that might give money. i heard a story once, somebody was very happy at hopkins gave some money and said, in my will i will give a lot more money. if that person came in for an operation, you're sure doctors would do the best job, right? >> i will say one of the major donors for john hopkins who is a don forwe know very well, he lives in new york. he said, rothman you only get money while i'm alive. so, that is actually a -- i think a really good approach to filan throe pi from his per perfect. >> oh yeah. you got rid of his living will. okay do you have a lot of money

to raise i assume? >> we're a mission based organization. we been a cancer dedicated hospital since 1884. we're all about the mission that ties us to millennials in important ways because there's more millennials that want to see a purpose in what they're doing. a lot of my time is true fund raising and i'm out there talking about the hope of our mission. we benefit from that in a number of ways, i'll give you just two. we just completed -- identify talked to several people here, family members who were part of our efforts for cycle for survival. it's our spin event, in spin studios, cycle events where teams come together to raise money for rare cancers, the kind of cancers that don't normally get light shed on it. this year in the month of february in our partner equinox

we were in 16 different cities. we had 250,000 people donate money for us for the cause of rare cancer. we raised $39 million. but beyond that, because of what memorial has meant for the understanding of cancer, we're privileged to have 10 1/2 million living don fares. we haven't take care or nearly that number of people but they believe in the mission we're doing to decrease suffering in a human being no one deserves to have. >> present nixon says he was going to have a war on cancer in his fir time. will cancer be eliminated in our lifetime? >> there are three different ways to think about what causes cancer. cancer in the end has its root in the fact that we regenerate our body all the time. we make all our blood cells over every 100 days.

we make our skin over every two weeks, we make our hair over about every 100 days as well. the process when you break your arm and regenerate means cells has to proliferate to repair that tissue. when every cell divides it makes a mistake in remaking -- and cancer arises out of those errors. there's a natural way to -- probably does set there will be some incidents of cancer in all of our tissues as we grow older forever no matter what we do. we know 85% of cancer today is really preventable, it's because of things we have done to ourselves, environment toxins like tobacco, exposure to the sun. today the biggest prevent bl identify bl risk of cancer is

obesity, we don't really know why. it's passed tobacco as a leading cause of preventable cancer. that's something we can effect and make a difference within public health measures and others. finally, there is some genetic pre-disposition. 5% of cancer comes from people that have unfortunately inherited a gene that is involved in our regenerative process that isn't working properly. that's something called the mismatch repair gene that paul identified. >> when people have cancer treatment, i guess it's chemo, they lose their hair. why do they lose their hair? >> hair on our heads is growing every day of our lives -- >> speak for yourself. >> even for those guys who may be hair challenged you have fair

follicles and that hair is growing every day. when you get keep therapy, part of the side effects is to tell the hair follicle to stop that hair's growth and start over again. 100% of your hair falls out about a week's period and it all starts to grow back. it is a come case that is consistently reminding a patient of what they're going through and that's why -- and rude, it's so upsetting to everyone. >> how much time do you have to spend fund raising and why do you call it the children's national health system? why is it a system? >> when i became ceo i was frustrated people knew about our hospital but not all the other things we were doing whether it was in the community with our clinics, our mental and mobile health. whether it was our research that

we're doing and, you know, like these great hospitals all of our research. so, i wanted to find a way to signal that we were bigger than a hospital. so, came up with this idea the children's national health system, to be honest with you i'm not sure t perfect. we're taking another look at it because for 150 years, people, there's that identity we were the hospital for the children of this region. it's a health system, those word just don't resonate the way children's farnl -- so we're looking at that. on the question of philanthropy it's a big part of my job. i have to really be out there and telling our story, and there's many people in this room whether it's themselves or their companies, whether they were grateful parents or not, have supported us because they believe in our mission of taking care of all children, no matter

who they are. and also being at the top of our game, being one of the top ten children's hospital in the country. when you're taking care of so many kids, we have some promise here in washington, d.c. with the health disparity, infant mortality, asthma, these are not where they need to be. our hospital takes on that mission and it's a big rift. we're trying to do it as best we can. we couldn't do it without philanthropy. it's a great correlation with all the great things we can do. i've got to just say your honored guest here, jack has been a supporter for what we're trying to do in the city. >> you're a certain by background, right, why do surgeons want to do things at 7:00 in the morning when they might be groggy. why not in the afternoon when they may be awake, why they do

that so early? >> well, what you don't know david, they've probably been up for a couple of hours already. >> they're on top at 7:00 a.m. >> they're up early and you want to have the patients when they're on top of their game too. >> i got it, so, should i take an aspirin every day? >> the big question, should everyone take aspirin. >> okay. >> so, if there was -- if there's no side effects that -- i'd say yes, but in fact there are potential side effects of taking aspirin, including gi bleeding. the right person should take it, the right person could be a high risk of getting heart disease. if anyone wants to know this they can go online to look at some of these heart risk call clarts. it has to do with do you smoke, do you drink, your weight, blood

pressure, it can give crow the risk of having heart disease in ten years. if your risk is 10% or greater of having heart disease in ten years you should take an aspirin. now sometimes those tests, that's not a sophisticated way to measure your heart risks, there are test that you can do. coronary arty calcium scale. it cost somewhere between $150. if you're risk is greater at the attempts of having heart disease -- >> do you take an as sprint? >> i do. >> do you think people should take a stanton? i believe you're on the board of merck so leaving that aside. >> i would say statton is again in the cardio vas cure space,

something that clinical trials have been done today have suggested there is noloer limit to cholesterol. you decrease if you don't have side effects from the drugs. you don't get the aches and pain, in fact to lower your cholesterol the better off you'd be. we'd also hope that it had lower the incidents of alzheimer. other diseases that it may not have an impact. i don't know if everyone should take a statton. we should go to your individual risk profile. it's about cholesterol in this case, that's what statton's effect. i'll put in a plug for something much cheaper and that's aspirin again. there's now compelling evidence is if you can safely take aspirin about the side effects, i believe its ability to

decrease inflammation throughout our tract from esophagus, to stomach it does -- >> do you take? >> i do. >> should people get an annual physicals, some people say they're a waste of money. do you recommend that? >> i definitely recommend that, particularly with children because you want to catch things early and make sure the children if there is an issue, it can be something simple or something as complicated as a mental health issue. i think doctors are -- practitioners are in being age to see people over time is important. >> now mammograms, there was a discussion that mammograms shun be done as previously as they thought. how frequently should they be done? >> i think we're still seeing different recommendations for different age groups and different risk profiles. so, on average i think you really have to go to your

physician. a woman has to go through her physician, regular mammography is certainly beneficial. the frequency really match as paul said to your risk profile. you really need to go and have what your family history is what your personal history. your age. >> prostate? how frequent? >> that's become a very complicated problem. most prostate cancer in men is not going to lead to morbidity and shorten their lives. most will live without it impairing their live span. there is still a percentage that progress. the problem is, we can identify those prostate cancers that a pathology has to call prostate canner. what we can't discriminate is those you live with most of your

life. they never knew it and don't need to be treated for it and are unlikely to have any disease. the test right now are all focused on what discriminates someone where prostate cancer advances. the programs are being offered in all medical centers called watchful weighting. right now there isn't one universally accepted one we can do. >> now in prostate cancer, which i'm fortunate not to have had. i notice a famous researcher at hob kins and someone asked me if i would recommend him for a presidential freedom. and i wrote out a letter, my assistant came in and said do you rey think enabling men to maintain their ability to make love after prostate surgery is something that deserves a presidential medal freedom? this person said, my assistant, i can see why jim baker may get

a medal freedom, but someone whose made thing was that, they deem that the most important thing. i was like you're right, it's a noble peace prize. okay, so, right now the opioid crisis, how serious is this the opioid crisis? do you see it at hopkins all the time? >> the opioid crisis is one of the great tragedies in america. pause -- and you know the tragedy goes back to the fact that opioid deaths from overdoses and the epidemic, it's interesting it has been present in this country for a while and it isn't until it started to hit suburban america and middle class area that tz risen to what it has in public view. >> doctors overprescribing -- >> i hate to say it, one of the

issue is physician prescribing opioids but that was driven by the idea that pain is the vital sign. and the fact if you don't care for someone's pain you might get deemed by some regularities who are measuring pain scores. so, there is a drive of it through religiontory bodies to try to decrease everyone's pain level. that led to this idea that pain is a vital sign and led to people saying, if that's what i'm being measured at let's make sure i can fete rid of everyone's pain and led to of course the overdose prescribing. that's only one reason. very complex causes. i don't think any of us can tell you why there's an opioid epidemic. it end up the pairing prices way down and the pureeing coming into the country made higher. that's also the factor. >> you mentioned obesity

earlier, for a first time white males, their life expectancy is going down because of obesity. is the obesity because we're exercising less the food is not as good? what's the reason? for fat ng or more sugar in the food? why is obesity the problem now? >> it's a complex problem of why we lead the world in being obesity. america likes to be first in everything it's not a good one. you look at the simple thing from the size of an average meal that we eat. people seen what a mcdonald's hamburger look like from the late '50s to now. there's more calories in than out. there's a lot of important research being done. what sort of interesting and good for a lunch male. the average american eats a male, lunch or dinner in nine

minutes. you don't have to believe me, whatever your favorite lunch or dinner should be is, that's what we eat. we learned a lot about the physiology of eating and how it is our body knows we've got nutrition and now to move on in life. the hormones that signal between your stomach and determine whether you ate something, if it was a diet soft drink that doesn't have any coloric intake. if you're eaten a roll you're going to get color ik intake. the synthesis of that hormone takes 20 minutes. the stomach has to have food content in it for 20 minutes before we can make the hormone to signal back up to your brain, we ate, we're good, let's move on and flea danger whatever you're going to do. the average french family eats a meal in 38 minutes.

so, everybody talks about what's the french and mediterranean diet, it's a simple explanations, just the time it takes socially that they eat a meal to actually get to society not to overeat. this is over eating over a chronic time. you gain weight over five years, ten years, not what i mean over next month. we really is a society eating much too fast. we don't understand the rule of good nutrition. we learned a lot about cardiovascular health but not the rest of the overall health. you think fat was the problem, we now know it's simple carbohydrate calories that make much worse for the obesity epidemic. we take way too much simple sugars in our diets. and finally, exercise really does make a difference.

exercise allows our body to cleanse itself in a way that was just discovered in the noble prize was one last year, or a year 1/2 ago now for the discovery of process where we clear out outsides during exercise on a hard moanal basis and rejuvenate cells. we don't moe how much that factors in. so, when you are obesity you don't exercise as much. it's a compounded problem in that case. >> walking past the gym equipment isn't enough you have to use it. >> you actually have to use the gym equipment. if you think about how our lives have changed you don't walk the doirns you used to. you don't do physical fitness as a daily basis. you go to a gym but you're not doing physical thing in your life. >> for teenagers coming into your life, is alcohol the biggest problem or drugs? >> i'd say alcohol is the most

bigger problem. getting back to the opioid thing, one of saddest part of that crisis is to see babies born addicted. we have numbers of these where the mothers had become addicted and like dr. raffleman, there's all sorts of reasons for this, the answer may be in set regist research and trying to determine what pain is and how much we need to treat it and not just provide prescriptions or lots of drugs. >> so, if you had to do it all over depend would you go into private equity or medicine? you have to think about it. >> we actually say medicine -- it's the greatest job anyone can ever have. so sorry. i love private equity though. >> private equity, investment banking or medicine? >> i am incredibly lucky to find

medicine as a profession. i have to tell you now in my career it is just exciting to make up every morning and have the opportunity to help people. it's a great -- >> investment banking, private equity, hedge fund or medicine? >> i love being a surgeon, i love taking care of kids and family. being a ceo is a little different. there are times where maybe budget time being an investment banker might be a good idea but i just love what i'm doing and have an impact with kids and family here in washington, d.c. >> thank you all. thank you. so, i want to thank you all for a very interesting conversation. i know all of you and you've done a great job. thank you very much for giving us your time and thoughts. >> thank you for having us. >> thank you for having us.

facebook ceo mark zuckerberg return to capitol hill tomorrow, he'll testify before the commerce committee and housing energy to answer questions. begins here tuesday on c-span3. on thursday the senate confirmation hearing for secretary of state nominee mike pompeo. he currently serves as c irk a director. he'll testify before the senate foreign relation committee. live coverage begins on wednesday 8:00 p.m. eastern on c-span3. c-span washington journal

live with news that impact you. monday, a discussion on foreign rules in the u.s. with robert pittinger. california democratic congressman who representing silicon valley will join us to talk about facebook's ceo mark zuckerberg's testimony before congress. and a look at the health of the u.s. budge. the deficit will surpass $1 trillion by 2020, two years soon r than estimated. i'll discuss that with william hog land of the bipartisan center. be sure to washington live at 7:00 eastern wednesday morning. join the discussion. former cia and nsa director michael hayden spoke with author and floffer a.c. grayling about the influence on war in flocksy. they talked about new threats to