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today." tell your smart speaker, "play c-span radio." c-span, powered by cable. >> c-span is your unfiltered view of government. we are funded by these television companies and more, including comcast. >> you think this is just a community center? no, it's way more than that. >> comcast is partnering with community centers to create wi-fi-enabled listings so studentsan get the tools they need to be ready for anything. >> comcast supports c-span as a public service along with these other television providers, giving you a front row seat to democracy. joined by the chief medical advisor to the bipartisan policy center formerly deputy assistant hhs secretary for health under george w. bush and obama administrations. welcome to the program. >> great to be here. tell us about the mission of the partisan policy center and what

you do as chief medical advisor. >> the policy center is a nonprofit organization founded in two thousand seven by former senate majority leader's really trying to take the best points from both sides on health security and opportunity. so we engage individuals on both sides of the aisle, we tackle pressing issues, ones that congress is about to face and we come up with expert analysis and recommendations for congress. i provide both the clinical and public health piece for the organization so really on the health care side as chief medical advisor. host: you wrote a book called prevention first, policymaking for a healthier america. the second edition is out now. it sounds kind of obvious but why has prevention not been a priority. eyes american health care not focused on the cures and the

medication instead of preventing illness in the first place. >> we live in a pretty reactive town here where there's a crisis it seems like all most every single day or week. prevention demands you be proactive so it's a whole different mindset there. my experience i've seen policymakers not always understand the evidence behind prevention and if you don't you can certainly have misconceptions you can think of it as the nanny state. secondly we had a stickier system still in our country we are trying to change that. the incentives, harder to make money on preventing illness than treating illness. and that i've also noticed don't really have a grassroots movement in the country pushing prevention but at the end of the day my book is that prevention ought to be the top health priority. it's what the majority what afflicts us.

and the majority of health care costs. >> president elect trump is picked rfk junior to head hhs. you worked there. under several administrations. tell us about the extent of the agencies in the programs that would fall under his purview. >> vast number of programs, hundreds of programs, a lot of the three letter acronyms but the public is familiar with. the food and drug administration, the nih, national institutes of health. center disease control and prevention. medicare and medicaid, those are a couple of examples. 80,000 employees, the majority of which are civil servants as you would expect so a massive organization there that rfk is currently nominated to lead. host: a couple issues rfk junior has brought up and one of them i want to ask you about is fluoride in the drinking water.

this is an ap report with this headline. u.s. government reports fluoride at twice the recommended limit is linked to lower iq in kids. break this down for us. how do we know what is considered too high, what do we know about the levels of fluoride in the drinking water now and what effect they might be having. >> this is one of public health's greatest achievements in the 20th century, insuring our water has fluoride. it has tremendous impact in preventing oral cavities and promoting floral health. the question now is do we still see that coronation in our water given that we can get that from other sources and there are an array of studies out there. some are suggesting higher doses than what we currently get water. there could potentially be neurodevelopmental impacts

particularly in front and that's really the scientific issue here where i think we want our scientific agencies like nih and cdc and epa to take a look at this. but right now our water is currently safe. a dose of fluoride in the water is absolutely fine and it is as intended reducing cavities and improving oral health. host: if that were to be taken out, what can we expect to see either with dental health, or also with iq and the allegations these are lowering iqs in children. host: so again the majority of these studies are using doses much higher than are currently what we drink in the water. in terms of other jurisdictions around the country or in other countries. saying we are not going to florida eight anymore. many have seen increases in oral

cavity infections increase hospitalizations, health care costs as well. it's a complex issue that deserves i would say more study, probably not a day one recommendation that we ought to stop flora dating. >> but those decisions are done at the local or state level. they are not done at the federal level. if the federal government were to say stop putting fluoride in the water, would anything happen or would it just be a matter of people just saying maybe this is dangerous maybe we should ask our local officials to make a change. guest: exactly you would not see that uniformity we see and we don't see complete uniformity of the united states. you see jurisdictions then approaching it in many different ways. i think what we rather want is get the best minds together and let's see where we are at and let's study this.

>> we are talking about health policy with the doctor at the bipartisan policy center. you can do so, our lines are by party so democrats, 202-748-8000 . republicans, 202-748-8001. independents, 202-748-8002. you can start calling in now. if you want to ask about vaccines because this to kennedy has been a skeptic on vaccines paired what's your take on that. >> i think this will come up in the confirmation hearings and you will hear from both sides and i suspect there will be some threshold questions, do vaccines cause autism. no. childhood vaccine save millions of lives yes. mr. kennedy is going to have to be unequivocal on those statements and if not i think he is going to get pushback again on both sides. first he has to say the correct

things, but then senators have to believe him because he's got a track record and history of making these types of statements. so i think it will be interesting, let's see how the confirmation hearing goes. i think it is perfectly fine for him to say you know what we spend a lot in terms of vaccine procurement and development. we need to spend more, there are some research questions, do we need to better coordinate the system. i think all of those are fine points but he starts questioning the basics in terms of what we know from a science perspective i think you will have a hard time on both sides. >> the kaiser family foundation reports childhood vaccination rates continue to decline as trump heads for a second term. why do you think childhood vaccination rates are falling? guest: it's unfortunately some spillover effect from the covid pandemic and we know that was a pandemic that was very much

polarized. we are seeing for vaccines like measles, mumps and rubella in 14 states across the country less than 90% of childhood kids take these vaccines. why that matters is we are seeing more and more outbreaks across the country and they need about 95% of the vaccination rate to ensure there is herd immunity in a community so there are many people who can be vaccinated so to protect them it's important to keep that. >> i want to ask you about the covid vaccine. that has been on a lot of people's minds. dr. deborah birx served as the white house coronavirus response coordinator in the first trump administration. she was asked about rfk junior's comments about that vaccine and here she is and i will have you respond to that. [video clip] >> so it's not good enough to say vaccines don't cause autism,

it's us finding what is the cause of autism. >> i would absolutely agree but it is ridiculous that there isn't a lot of research and established causation on autism but what he has said in the past is autism is caused by vaccines and there is no scientific basis for that conclusion. >> that's correct. so when he talks about transparency i'm excited that in a senate hearing he would bring forward his data and the questions from the senators would bring forth their data. what i know for sure is he is a very smart man who can bring his data and evidence base forward and we can have a discussion that many americans believe already is a problem. until we can have that transparency and open discussion from both sides. i know the members have incredible staffers who will bring great questions from their constituents and that hearing would be a way for americans to really see the data you are talking about that we can see

that causation right now but what is causing it. so you are absolutely right. what the cause is will be critical and i think why this confuses people's we weren't clear about what covid vaccines do and do not. so now people are questioning what did my childhood vaccines do or don't and they don't understand that some of the vaccines their children are getting attacked them from both disease and create herd immunity and some of them that they get are just for their child. to prevent their child from getting very serious illness. host: what do you think? >> i agree with that dialogue. during the pandemic we were learning as we were going and as the science changed i don't think we always communicated well with the public to keep them up to speed. they heard mixed messages and that affected public trust. i think all of the topics that were raised really need to come out in this confirmation

hearing. hhs is a massive department. you cannot really pick and choose what you work on. you have to work on multiple things. host: one more question than we will go to calls. one more test drinking raw milk, something mr. kennedy has brought up. can you explain why we pasteurize milk, what are the risks and benefits. >> the main benefit is to reduce the risk of infection via transmission. pasteurization heats the milk to such a degree that you are really reducing the potential of a microbe or infectious disease to be transmitted. right now that's important given the avian influenza outbreak particularly in dairy cattle. therefore the public health recommendation is that you do not drink unpasteurized, raw milk. host: are there any health benefits to raw milk that we

might be missing out on? guest: it's a great question. it's not an area i am an expert in but particularly on the infectious disease side it is important. host: here is mary, you're up first in wisconsin on the line for republicans. caller: good morning. that prefrontal cortex, the part of the brain that's the last mature in the late 20's for boys and girls and prior to that development, the only thing important for them is relationships and societal acceptance. and the part that seems to mature in the late 20's is responsible for decision-making. they are trying to get puberty blockers to kids in their teens and early teens. and those kids get to their late 20's and say why did you do this to me. so we are taking sort of an abused society taking advantage of kids to change their sex when

they can even make that decision on their own. but we should as parents all be informed about that so we can help our children grow and be beautiful human beings. host: what do you know about puberty blockers? guest: i think this broader issue of gender identity is also going to come up during the confirmation hearings of rfk and it was an issue in the presidential election as well. and there are issues related to science, of their issues related to families and culture here so there are an array of complicated issues here where i think we will have discussions and certainly help desk health and human services you will have different policies than the biden administration as well in terms of flexibility and what is allowed and what's not allowed. >> here is richard in oceanside,

california. >> thank you for taking my call. we are talking about fluoride in the water, talking about pasteurization and vaccinations. and it amazes me, i know a fellow up the street from me 30 years marine corps veteran and the fact they chew left and right and then make it to 1000 push-ups. will he believes against vaccinations now. and i asked him i said how did you survive 30 years in foreign countries with his malaria and typhoid and everything else imaginable. how can you not believe in vaccinations for people to change. fluoride in the water. i don't know what year they started doing fluoride but i was born in 1947.

i'd a lot of cavities and i was a kid. my teeth are amassed. my entire family lost their teeth. their older people born back in the 20's and stuff. i'm the only one of the whole crowd that has any teeth left at all and there's a lot of them. so a lot of those people around here and they used to teach in the schools about such matters. i'm wondering now do they teach this stuff anymore in schools to little kids about louis pasteur and his miracle about fluoride in the water and so on. >> what do you think doctor? >> i hope so and i wish that's the case because i think we forgotten a lot. we take public health for granted. it's saving our lives and has saved our lives in the last century. public health is credited for raising our life expectancy 25 out of the 30 years. all of these things whether it's vaccine, is we don't see anymore fluoride in the water preventing

or enhancing oral health, these are all very important things and i think education is critical. with times changing as well we have to keep up with the times so always important to do research and remember why we do all of this stuff. host: axios is reporting one quarter of americans suffer from chronic pain. what's causing that? >> an array of conditions cause chronic pain. some primary, others secondary. let's say you're in a motor vehicle accident. let's say you have a particular neuropathy like you have in diabetes. there are many different reasons why people suffer chronic pain. about 100 million americans actually suffer. there's been a lot of focus on how do you best treat this chronic pain and try to ensure efficient -- people don't just get prescribed opioids

willy-nilly. a really important public health challenge for millions of americans. host: jennifer in evans. you are next. caller: yes i have a question, i think his book is really timely at this point. you talked about how preventive health will help our health care industry and you are tying it. if robert kennedy is the health and human services head, what would be the three things you would like to see him do when it comes to the american diet. because my belief is it's the american diet causing a lot of these economic issue and the health issue and we could save a lot of money if all americans tomorrow decided to go on a healthy diet we would save a lot of money. we talk about inflation and we look at the cost of inflation in

terms of food, most of the inflation is higher in things like fats and processed meats, inflation for fresh produce and unprocessed meats is much lower. we eat so much more than we need to and all of these statistics say 30% of americans are overweight, 42% are obese. tilden born today have a 50% chance of being diabetic. so your book i think is important in talking about that how it could help us from a health care cost perspective, and overall economic perspective what would be the three things you would suggest to robert kennedy to get implemented right away policy wise. host: it is important to note to the public that poor diet now is the leading risk factor for mortality in the united states. it surpassed cigarette smoking and 2019.

probably the most important arguably health policy issue that we are facing. so to your question what are a couple of specific policy issues. i think we need more healthy food finance initiatives. we need to ensure the healthy food is not the most expensive food. we need to make sure for example in underserved areas we get grocery stores in those areas. we need to also continue working with the industry to significantly reduce what i call the hyper palatable ingredients in the food supply. the added sugars and sodium's, the saturated fats really driving the epidemic in this country paid we need to look at agricultural subsidies as well particularly with congress looking at farm bill reauthorization next year. and then we ought to look at that policy also. why is it the marketing of unhealthy food to children leads to tax breaks. should we be perhaps taxing

certain types of foods. as an array of policy issues there that the next hhs secretary will take a look at. those are really important health policy issues. >>ol sent us a text on the physicians which is a thing you talk about in your book. many don't have phd' can we better intensify -- incentivize doctors to become a primary care physician. should medical school take the initiative to reduce tuition for those committing to the practice for at least 10 years after graduation. guest: there are a lot of important solutions we should think about, loan repayments, scholarships, other ways to reduce debt, ways to reduce tuition. 50 years ago in the country, half of physicians were primary care physicians like myself. now today it is less than a quarter.

the reason why that matters is primary care is the one health care that is been associated with better health and greater life expectancies. we are certainly in a crisis today where we have a primary care shortage. not supporting the team-based care that primary care would provide. you can imagine the reimagined primary care system showing americans get their services and medications for opioid use disorder. but they are providing care for individuals who have physical and mental health issues. that is what primary care can do and that's why i think other than obesity i would put primary care there. those two issues are really fundamental to build a high functioning health care system as well as saving lives. >> we talked to john in memphis

guest: that being said, i think

this is an area that ought to be looked at. we ought to get the scientists together, assess the research, efforts here, and really chart a path forward to better understand what is the best recommendation to make to states and localities. host: you mentioned getting the doctors and scientists together to study this, but the pew research center has talked about public trust in scientists and views on the role in policymaking going down, especially if you break that up among party, republicans have a much lower trust in scientists and democrats having a higher degree of trust in scientists. talk about that and what impact you are seeing. guest: yeah. it is really concerning. the silver lining in pew's latest poll for the first time

since the pandemic those numbers have come up in particular for republicans which i think is really important. so we don't have that divergence by party. but look, i think it is really , really important that there be trust in science and public health and also it goes sort of both ways, so how can science and public health officials and professionals better connect to the public, how do i make sure they are communicating in the right way that they are demonstrating empathy, that they are able to communicate that. so it's really important lessons over the last few years. host: oklahoma, independent line. caller: i'm just wondering if we are going to be able to get robert kennedy past big pharma . they are the ones who don't like his opinions. the thing about elon musk. i watch the cost per pound for lunch go from 60,000 pounds to

25,000 pounds so a person who doesn't like elon musk but he has a way of defending costs and making a profit. i'm all for rfk getting involved and stirring things up with big pharma. host: what do you think? guest: i suspect that is also going to be a topic in the confirmation hearing. there are a lot of issues to talk about their from the cost of pharmaceutical drugs to how much we rely on pharmaceutical drugs for conditions that could be prevented. so certainly i think that's going to come up. it's probably not the only sector that will be watching the confirmation hearings closely. i think the agriculture sector and pharmaceutical sector there are many sectors there that have special interests that will be watching to see what he has to say. host: wally in naples, florida, wants to go back to the fluoride

issue and asks, toothpaste and mouth wash, florida is in the process of eliminating it now. guest: many would argue it certainly because we can get fluoride from different parts of society now that maybe we don't need it in our water and i think this is one of those things that we look at very closely, other countries in the world do it differently. communities in the united states do it differently as well but we haven't really had a concerted analysis and science here. before we make knee-jerk recommendations, let's look at the research. this is a comprehensive issue and then we can go from there. host: robert in new york, democrat. caller: hello. i have a question. where does fluoride come from? what is the source? is it labeled in a container as a hazardous material? guest: it is a natural element

, and it is critical particularly again for oral health and has been shown to improve oral health, reduce cavities, and providing fluoride to the population through the water supply for decades now has been shown to be a really effective way to improve oral health. i think that's really been the bottom line and also at what dose should there still be fluoride if any in the water given what we just talked about , that you can potentially get fluoride now from different sources. host: john in massachusetts, independent line. good morning. caller: this is what happens when you have doctors and corporations on the payroll. they do not tell you real history. the real history is fluoride was created from a derivative of oil processing.

ok, the goulash during the days of the bolsheviks used to use this to calm down the prisoners, dumb them down. this is government corporate fascism. basically what it is. host: let's get a response to that. guest: i don't really know what to say to that. i don't know that background that the caller is discussing. i can tell you that what we know from the science is community fluoridation, providing fluoride in the water for decades has improved oral health in the united states. i think it is perfectly valid to assess whether that is now the required given some of the studies we've seen related to infants and neurodevelopmental health. again those doses were higher , than what are currently provided. i don't want anyone thinking right now that the water is unsafe but let's look at this and provide recommendations to

states and localities. host: this is on x from someone who says after the covid-19 periods we won't trust the "science" for a long time. don't need a mask, wear cloth, wear two n95's, kids need to get the shot, it may give them myocarditis. give them a shot even if they had covid-19 already. host: so the thing about covid . -- guest: so the thing about covid in the pandemic is we were learning as we were responding and i think as the science changed i do not think officials did as well as they could in explaining to the public here is what we knew and here's what we know now and this is what we think the best recommendation is. at times we were too definitive and the recommendations did change. people were rightfully so

discussing. there were a lot of lessons related to the covid-19 pandemic, leadership matters. real-time data is important not only for situational awareness but in convincing the public to take the right action of the right time. a lot of things we learned. i will say and i write about this in my book. the overarching lessons are still that of the 1.1 million deaths in the united states, the majority were preventable and had we done nothing, millions more would have died. it's important also to keep in mind those bigger themes of it. no question about it. could be communication and building trust with the public could that have gone better? absolutely. host: john in virginia, a for -- on the line for democrats. caller: hello. thanks for taking my call. doctor, if i'm an engineer and i tell the people this building will collapse by tomorrow if you do not move out, people would move out. you are dealing with people who do not believe science. you have to un