The $hittiest Episode with Rose George

The Tennessee state legislature expels two members for protesting school shootings. Idaho makes it illegal to help people travel out of state for an abortion. A Texas federal judge overturns the FDA's approval of a critical abortion bill. Nationwide. Deaths among young people are skyrocketing in the U.S. This is America dissected.

I'm your host, Dr. Abdul El-Sayed.

Look, you hear a lot of crap on podcasts, but you know what, you don't hear a lot about crap. Which is why today we're going to address that injustice. We're talking about all things crap.

Because, you know what crap matters, and particularly in public health, avoiding crap matters. The reason why should be obvious our minds are uniquely attuned to the smell of it.

Think about it. There are a lot of bad smells in the world a lot, but none of them are as odious as the smell of doo-doo. We know immediately when we smell it and do everything to distance ourselves from it.

Why? Because not only is it nasty, but it's also potentially deadly. And through tens of thousands of years of evolution, we've developed a life or death need to distance ourselves from it. So today, I wanted to spend a bit of time explaining exactly what crap is beyond what you already know, why crap is harmful and how it sits at the very foundation of public health. This part should be obvious.

But crap is what gets left over when your body processes food. But it's actually pretty complex, and here's the crazy thing a huge proportion of it is made up of other beings. What?

Yeah, that's right. 25 to 55 of the solid, dry biomass of SCAT is made of bacteria from your large intestine. In fact, if you blew up all the bacteria so that they were the size of a grain of sand, you'd have enough to coat the earth several times over. Those bacteria are really important, too. Think about the idea of a quote probiotic.

It's literally trying to get the right mix of the right bugs in your large intestine. Your crap also contains undigested protein, carbs and fat, but it also has a lot of byproducts from critical biological processes. For example, when red blood cells break down, your liver converts the byproduct into bilirubin, an emulsifier that helps digest the fat you eat. And then those bacteria in your gut. They break down bilirubin further into a compound called stercobilin, which gives poop its characteristic brown color.

That smell. It's scat hole, a compound that's produced from the digestion of tryptophan, the amino acid that everybody blames for making you feel tired when you eat turkey. And this part's wild scat hole. In low concentrations smells like flowers, in fact, it's a critical component of orange blossom.

So yeah, orange blossoms literally smell like shit. I remember learning a lot about poo in medical school.

It turns black because the blood has been digested. I know that sounds disgusting. Hard stools usually mean you're not consuming enough fiber or are severely dehydrated soft stools. That can mean one of two things.

You've consumed something that is pulling water out of your body into your stool. On that note, do yourself a favor and look up the Amazon reviews for sugar-free gummy bears someday. There's a simple explanation the sugar alcohols they use to sweeten the gummies instead of sugar aren't digestible. Which is, of course, the whole point. But when they get to the gut, they pull water in to dilute them to the same level of dilution of the rest of the body. Because water always tries to even things up.

Well, that causes extremely watery stools, like the poor folks with harsh things to say on, Amazon can attest. The other reason your stools may be so soft, though, is because you get the wrong kind of bacteria in your gut. And that that can be a deadly problem. In human history, bacterial diarrhea, such as cholera or typhoid fever are among the worst killers. Cholera is a particularly terrible disease characterized by extreme diarrhea, literally described like rice water that cannot be controlled.

It sucks a person dry. Though we think of it as a problem of history, it's a reflection of our privilege. Upwards of 4 million people a year get cholera today. In Yemen, where the brutal civil war, subsidized in part by U.S weapons given to Saudi Arabia raged, the most common form of death wasn't war itself or even malnutrition.

It was cholera, and that's because cholera thrives where basic infrastructure fails. These diarrheal diseases are spread when, and I know this is disgusting. We literally consume the bacteria that causes them from the feces of an infected person. We call it quote fecal-oral spread to avoid having to imagine it. That usually doesn't happen directly.

It usually happens when water that someone else has taken a deuce in mixes with water we drink before. We've had the chance to treat and purify it. In fact, the apocryphal story at the heart of the founding of my Science epidemiology centers around exactly this an outbreak of cholera in 1854. This was back before the germ theory of disease, which postulates that small particles, which we know to be bacteria, viruses and sometimes fungi, can cause disease. An enterprising anesthesiologist named Dr. John Snow, thought that the prevailing logic of the day, which held that these diseases were the consequences of a poisonous gas, a miasma, was bunk.

And he set out to prove his theory. In the midst of the outbreak, he counted and mapped cases of cholera to demonstrate that the folks who were getting cholera all happened to be drinking. From a particular pump, the Broad Street Pump, which was spewing contaminated water. He petitioned the Board of Guardians, the local government, to remove the pump and stop the outbreak in its tracks. Look, I love me some John Snow, don't get me wrong, King of the North and all.

But the real magic? the real magic only happened ten years later. When the City of London built a sewer system to manage the flow of waste, vastly reducing the cholera burden in the city. In fact, that sewer system made a cameo in one of TV's most popular shows set in London.

Shit's deadly. But that doesn't mean that we fully manage the problem, those awful norovirus outbreaks that happened this year, fecal-oral transmission. Oh, and there's the weird way folks manage cleaning after we go to the bathroom.

Or the fact that every time we flush the toilet without closing the lid, we're pushing plumes of gut bacteria into the air in our bathrooms. You know where our toothbrushes are? We do some weird shit, we're going to get into it, and there's literally nobody better to talk us through it than our guest today, Rose George.

A while back, she wrote a book about Caca, thinking about it from the top to bottom, big to small. I wanted to have her on to digest this through with us.

Ha, I'm a dad, had to do it. Here's my conversation with Rose George. Can you introduce yourself to the tape?

But at the time, I couldn't. But anyway, why did I want to write a book about shit? Well, you know, someone has to. I don't know it was....

Did all those famous, scandalous Benetton adverts in the sort of 80s and 90s?

And then alongside it, we had these little captions, sort of maximum 200 words, just about things that we came up with. And I then left. Colors. Years later, was sitting in a publisher's office at Granter, trying to get him to publish another book that I had an idea about, and he didn't want it. And then he said, Well, what else have you got? And so I said, Well, toilets are pretty interesting actually, and then I set off with, I think I did my at the time. 2.6 billion people don't have a toilet, which still blows my mind.

And I think I threw a few statistics at him and he was. He started off with his a look of kind of disgust on his face. And by the end of it, he'd actually got out of his chair and was walking around the room, going, Yes, let's do a book about shit, I love it, so there you go.

That's how I, that's how I got to do a book about shit.

Like, I just think that a fart is the funniest thing there is. It's like it makes a funny sound, it has a funny smell. It comes out of a funny part of your body. And it's like, it's like a natural gift to our humor.

Like, it's just if you ever need a light in the mode, just, you know, it's hilarious. And so like, I actually think there's both a lot of a lot of joy in having this conversation, but also, probably most importantly, a lot of healing. And one of the things I really appreciate about the book is that you lean into what is the central problem in public health for most of human existence? Which is, how do you make sure that we are not drinking and or eating? Where someone else has shat like, that is the central problem. Figuring that problem out in its own right saved probably more lives than any other thing we did, including the discovery of vaccines or antibiotics. But it has fundamentally reoriented human society.

The challenge right with that is is that that story doesn't often get told because you don't want to talk about it. You know, as you were doing your research, how did the centrality of the Don't Eat Where You shit problem come up in your reporting and your writing and become a central pillar of the book?

Other people have written poop humor books. I didn't. I thought, you know, there was a lot of serious stuff going on in the world about sanitation. But I also didn't want to make it dry and academic, because who wants to read a book about feces that's dry and academic? So I had to find a way of talking about these huge issues, which are, you know, pretty terrible. That children are still dying of diarrhea, which is eminently preventable, easily preventable, and yet they're still dying of it. And the reason that the book was actually really easy to write was two reasons one if you look at the world of sanitation. The people who work in it are just the most fabulous characters because you have to be to work in that world.

So from everyone, from the flushers who work in the London Sewers to the guys who run the World Toilet Organization, to anyone who's in this world. Even the people working in NGOs in what you would think quite dry jobs. They're just fabulous and they just open their mouths and talk, and it's just a gift to a writer. And the other thing that made it really easy is that people as soon as I approached this topic with them, let's say just general, anyone. Anyone? Suddenly thought, Oh my god, it is okay to talk about this, and they would pour out these stories.

So that's how I did it, I did it through characters, I think, and that's how I conveyed the seriousness of the situation.

Without wanting it to be off-putting or.

I wanted it to be galvanizing rather than depressing, and I wanted people to finish the book and go, Hmm, shit, I didn't know any of that. What can I do about it? And then maybe go and give some money to a good toilet-building charity or something like that?

In lesser-developed, lower-income parts of the world.

I think that's actually growing rather than decreasing. You had a situation in San Francisco, beginning in 2014, where kids were stepping over human shit to get to school.

So I'm just making that point that even though there is massive inequity, even though it is about capitalism, even though it is about access, it's more complex than that. And actually, I don't think it is that easy to fix, it's easy to fix diarrhea. You remove them from a potentially dangerous substance, which is human waste, which can carry a lot of disease, bacteria and cysts and worms and all sorts. But you then cure it by giving them salt and sugar and water, but then that water has to be clean.

And that's also difficult because providing clean water is harder than you think. But the other issue is that the reason that this isn't, and seems sometimes like an intractable solution. And the reason that we're in 2023 with still nearly 2 billion people without any sanitation whatsoever, not even a box or a bucket, is that people are sometimes not resistant, but more complex than you think. So, for example, if you look at India, which is kind of the poster child of sanitation has been. Since Narendra Modi took power, I can't remember when he took power. But in 2014, he declared this huge program called the Swachh Bharat, which means clean India, and the government put $30 billion into it, allegedly built 100 million toilets all over India.

This wasn't the first sanitation campaign in India. Plenty had been done before, right from Gandhi, saying that a toilet was more important than independence. India has known that it has a big problem and it's poured money into it. But yet, even after Swachh Bharat, even after money has been allegedly thrown at resolving these inequities of infrastructure and access to sanitation. You still have millions, probably of unused toilets, standing all over India. Because people think that it's cleaner to go and do open defecation, particularly if they're living in a rural situation, and that's a cultural belief.

And also you have a systemic problem as well that the government gave people money like $160 or something. To build a toilet, great, but then there was hardly any monitoring of whether the toilets actually got built. And when I traveled around India, what 2006 or something for the book, I was shown these toilets that had been turned into storage sheds. There were bags of grain stuck in them.

And people were ignoring these pretty shabby latrines and toilets and going off into the bush and defecating, which is what causes the huge public health problem. Because, as you say, one of the best things that happened in human history was the realization that we have to be separated from human shit.

And one of the greatest public health measures was the installation of sewers and toilets and hand washing with soap in London in the late 19th century. And one of the greatest heroes was probably Joseph Bazalgette, who built the London sewer system.

So it's a very, very, very complex situation. You think it's as easy as giving someone a toilet, but then you give someone a toilet, say, in a developing country. You then have to install the rest of the waste stream, so you need the sewers and you need the wastewater treatment plant. Do you have money for that to operate?

Do you have the staff for that to operate? Then? Where do you discharge the treated waste? Does it just go into a river? does it go into the sea?

Is that the best method these days to use? Teddy Roosevelt, in 1910 said Surely civilized people had a better way of dealing with shit than putting it in their drinking water? And we're still doing that, and it costs money, and it costs energy, and it's just not particularly sensible to do that.

But because that is now considered the system, then that's still being installed all over the world, this kind of Western intensive infrastructure, heavy energy intensive wastewater treatment system. Whereas, in fact, depending on the situation where you are. If you're a farmer in Malawi, maybe your best solution is a composting toilet. Maybe it's a latrine that you fill in and plant a banana tree in. Maybe you don't need a fancy Western toilet with all this expensive tail behind it, a very efficient tail that has saved millions of lives and probably put 20 years on our lifespan.

But it's really been fascinating the last 15 years since my book came out, to watch how things have changed in one way. And there's a lot more talk about different solutions and how one size does not fit all. And the paradigm of the clean ceramic toilet and the sewer and the wastewater treatment plant is not necessarily a solution, and even when it is a solution. So in the U.S. or in the UK where we have these systems, they're not working, they're overloaded.

In the UK, we've got massive problems of water companies just pouring sewage into the rivers untreated and unpunished. I'm pretty sure you'd have the same situation in the US.

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And we're back with more of my conversation with Rose George. You're bringing up a couple of different points here, which are that whether it is investing in a.

Early 20th century-style water-based collective sewer infrastructure. Or it's investing in research and development to free us of that high-infrastructure, high-lift kind of approach.

Either of those solutions require a lot of collective action and they require a lot of investment. And it kind of comes back to this notion that this is a problem that has a fundamental fixed solution. And it takes a lot of people deciding that they're going to put their shoulder to the work. And the hard thing about collective action is that there are more nodes of disinvestment and failure. And you talk about this investment in India. My spouse is Indian, spent a bit of time traveling in different parts of India.

And there is, as you talk about it, there is a sort of a norm and a culture of this is how we go to the bathroom and look a little bit askance at that toilet. And at the same time, there is such, I mean, India is a mass of people. And there is such a disconnect between decisions that are made at the very top and decisions that are made in the nooks and crannies of villages in the country. And it takes everybody kind of saying, all right, we're going to do it this way and make this investment. And then also recognizing that any investment in a research-limited context is implicitly competing with a bunch of other needs that people might identify as more important than this one. Similarly, right in this country. The point that you made about our failure to invest in functional or continue to invest in functional sewer systems is a really important one.

And even then, when we talk about inequities. It's not the high-income communities in states all over this country that suffer for lack of infrastructure, it is lower-income communities. In Michigan, for example, where I live. We had massive flooding a couple years back in the summers and you had wastewater flowing back into people's basements. But it wasn't high-income people's basements, it tended to be poorer people's basements.

You go to some of the communities in Alabama. We've had a hero, an activist named Catherine Flowers, on this podcast in the past. And her work is fundamentally about the environmental injustice of our failure to build and update functional sewer systems. But again, you're talking about the poorest region of the country, and you're talking about predominantly Black folks who are suffering it. But it's that ability to sort of invest in collective action and all decide that we are going to put our minds to this work, to stay ahead of it that matters. And the problem is that where that usually falters, it's when we're talking about systems that would service the lowest-income, most marginalized people.

I want to ask you, right? Because another example of this is ongoing cholera outbreaks. Cholera is the worst of all diarrheal diseases. When you look at just the number of people who have died of it and where you end up getting cholera. Almost always you end up talking about places where the ability to upkeep infrastructure has failed. So where we've had the worst cholera over the past several years has been in Yemen, where a brutal, U.S..-funded civil war has fundamentally decimated basic infrastructure and led to both famine and cholera epidemics. Sweeping and killing mainly kids.

I want to sort of just pivot off this conversation that we've been having about the centrality just of infrastructure. Around this question, you tend to see these two things go hand in hand. Where you can invest in infrastructure, you can prevent these kinds of diseases where you can't, you don't. We don't talk about this, though, this is not a conversation.

When you talk about the civil war in Yemen, it's rare that people talk about, oh man, it's bombed out sewers that are leading to cholera outbreaks. What does it take for us as someone who's made an intervention on the public conversation and what we're trying to do? Here on this podcast, talk a bit more about this to make sure that this is the thing that people connect. This is the killer, this is how people die over the long term, when people make war on each other. What does it take for us to make sure that that is what people think of, that is what people talk about in these contexts?

It's a failure of imagination, and it's a failure of empathy, isn't it? If we can't we, those of us who have a relatively functioning toilet and sewer system, and we can flush it and forget it. And we don't need to worry about it. Unless we're in a lower income neighbourhood where, you know, flood and waste water backs up into our basement, so those of us in that flushed and plumbed world.

It's very difficult to move people into a place where they can imagine being a seven-year-old kid. Having, you know, having to poop outside. And whose entire family is dying of cholera? I mean, I went to Haiti several years ago, which, along with Yemen, has had one of the worst chronic cholera outbreaks. It's been going on for years. It was actually brought into the country by U.N. peacekeepers. But then, of course, because of the situation in Haiti, which has deteriorated even more now. But even at the time was extreme poverty, extreme lack of clean water and toilets.

And of course, it's just Cholera's absolute playground. Loves it. And also high population density people living very much cheek by jowl in very poor neighbourhoods. How do we fix that? is what you're asking me.

And I just think it's just we just have to imagine and imagine that things can break down very easily and nobody really wants to think about that. Do they? We don't want to think about being a Ukrainian where one day is normal and the next day everything is absolutely, devastatingly terrible. And you're getting bombed until you experience being someone in Michigan whose basement is suddenly filled with liquid shit, you possibly haven't ever thought about that before. And I think, as humans, I think we're not very good at imagining risk or calculating risk properly because you don't want to think about it.

You don't want to imagine yourself in a disastrous situation, so I think it is that failure of imagination.

In people who are equipped and served properly by infrastructure and sanitation. And I honestly, I wish I had an answer for you, Abdul, but I don't know what the solution is beyond just keeping plugging.

Emphasising the communality between us. We all have to defecate and urinate every day. We all could possibly be one day in a very normal situation. And the next day everything's gone. The sewers don't work, everything backs up. And who wants to think about that?

Who wants to? When everything is so bleak already? And I'm not defending people, I'm trying to explain to myself why these situations are allowed to continue.

Is one of the most powerful things that we can do. No one word is ultimately powerful, but continuous flows of words that occupy brain space, they can be. That's what changes the course of history. So I appreciate you being someone who's tried to force us to pay attention and the kindness with which you've done it. Because I think humour sometimes is the best way to talk about very difficult things that other people don't want to talk about because we all like to laugh.

But sometimes we don't appreciate that, the things that we get to laugh about, other people cry about. I want to move to some of the lighter parts of the book, about things that people do when it comes to this issue that are sometimes less than hygienic. You talk about how men urinate, and I'll be honest with you, it has always astounded me. I do not use urinals as a matter, of course, because of the obvious physics of urinating into a ceramic wall.

And then what happens to that urine? Seemed pretty clear to me. When I was like a little boy watching at the ground level, being like, Oh, that's just piss, going right back on that person's pants.

Why do you think we use urinals, and why did we build them this way, and what is the consequence of that? In reality, I know you've done some inside research about it.

And it's what's cool, I think it's a cognitive dissonance, isn't it? You cannot allow yourself to think that you are getting sprayed with urine every time you use a urinal, so you don't think it. It's like, every time. It's not just urinals, every time someone flushes a toilet and leaves the lid up or seat.

Your entire bathroom is being sprayed with fine particles of whatever's in your toilet. And I do like a bit of cultural relativity, so I like it when people from other cultures are absolutely bewildered that we do not question. Something like leaving a toothbrush in a glass next to a wash basin in a small room that also has a toilet in it. And then leaving the lid up when you flush it. I mean, it's just, you know, once you think about it, you're like, Hmm.

Right?

There was an exhibition in New York and it was secret Lotter Stories. And the lotter is a cup that in it's an Indian word, so it's the cup that you know. You use a cup of water, you cleanse yourself, and obviously you wash your hands.

And so these these young people from water cultures, so either Muslims or Hindus, or Sikhs, or, but, you know, from from the water, water, anal, anal, water washing part of the world.

So anyone who doesn't?

So I'm trying to get over myself and just like, you know, be proud. But I understand those young people in that, you know, trying to disguise their Lotus stories because the societal pressure or the societal expectation. That toilet paper is it. And actually we're all walking around with, well, not all of us, but those of us who only use toilet paper are walking around with very dirty anuses.

And that's what you were always called, right? That's the euphemism. And it doesn't help that you have very pungently smelling food and then you walk out of your house smelling like onions. And people are like, Yo, you smell like food. And I'm like, Well, another question is, why don't you? But anyway? And so you were always told that this was like a dirty thing to do, and it was always like being gaslit by the whole culture.

You're like, No, no, it is not. It's actually really clean comparatively, and if I had to choose right, I don't understand, I don't understand how it's done.

Anyway, I digress. One of the best things to come out of the pandemic is. It seems as though a large swath of internet culture discovered bidets for the first time.

And then, yeah, I'm gonna get some weird looks. But like, I'm also Muslim and have found myself washing my feet in the sink. So like, I know what it's like to get weird.

Cause, like, that's what we do, so like, you know, you get used to just being like, this is how we do it. And and usually making light or joking about it. And you know, I've I've gotten either dirty looks or comments in the past.

And, uh, fortunately, I've. I've always had a quick and sharp tongue. And so most of the time, you know, I, I leave those interactions feeling, Meh, I, I, I fought my good fight. And also I'm going to walk out of this bathroom clean and you're not, so there's that.

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So there is this phenomenon that happens when people will become Muslim who don't come from predominantly Muslim cultures. And about how we clean and why you clean a certain way. And I remember sitting with a friend of mine. So my mother, my stepmother, converted to Islam, you know, back when I was a little kid, and so we'd often, you know. She took it upon herself to just sort of be an ambassador. To help folks who are new to this, you know, faith and sort of system, learn about how we do it.

And part of the problem is, I think a lot of folks just don't understand the physics of it. So when you're a kid in an aww culture, you're taught this is how you go to the bathroom, right? And, like, you know, in a lot of aww cultures. Also, there is a very, very clear differentiation between what you do with certain hands. Which is to say, obviously, you wash your hands very, very vigorously. But, you know, you eat with your right hand and you wipe with your left hand.

And like, that's just a known thing, right?

And so the physics of how you do this thing and what. And literally, like, play by play, what you're doing to make sure that, however you're cleaning yourself, you're not, you know, inadvertently moving fecal matter elsewhere. Like, I think a lot of people stumble on the physics, right? Because they're just like, I don't know how to do this and do it cleanly. Like, I think it's just you're making a really great point. But at least when I'm using paper, there's a clear barrier between that and my hand.

And I think for a lot of folks, they're like, Okay, so what do I do there? And you're like, well, there's a lot of ways to just make sure that you're not making anything else dirty, but you're also in the process of cleaning yourself. And that I think that moment, that physics is a big stumbling block for folks, and they're like, Meh, I just can't, I can't get past that. So I actually think that, like, one of the things here is, you know, as Bidet culture continues to take hold. There's also just a space for, like, the kind of education that you give to a, you know, three four-year-old who's just learning to use the bathroom.

It's like, this is how you do this in a clean way.

And sort of move people past the barrier there, which I think is like a really, like, a very real thing. Just in having had conversations about this, but like, it's also just an uncomfortable thing. I mean, this whole episode is premised on the idea of how do I protect myself from something that comes out of my own body? Which is kind of a weird thing. Like most of the time, there is this notion of like, Oh, this is part of me. But like, you know, shit and piss are two things that are just like, Yes, this is once.

This leaves my body, I want nothing to do with it ever again. And so you have this odd moment which is like, Well, I got to deal with the fact that, like, you know, this is not a a surgical removal of this stuff. And I have to figure out like that, that interim moment, when this is part of me to not part of me, how do I make sure that less of it is part of me? When I walk away? Yeah, which is is an uncomfortable thing to have to think about.

And, like, I would argue, is like, central to the human experience, it's like, central to the human experience. That we. We are not immaculate beings like we are, we are are deeply non-sterile. And this is that moment of being like, well, I have to, like. I have to figure out this transition from carrying this stuff to not carrying this stuff. And do it cleanly. And it's going to be uncomfortable, no matter how I do it.

It doesn't, it shouldn't smell, but you know, it's a different, it's a very different situation. And this kid had grown up and then the first day that she went to kindergarten and they had a regular flush toilet. And I think she must have done a poop. And she was absolutely horrified. She was like, Oh, it's floating in the water. That's disgusting, and I just thought that was so funny because it's like, you can. It's so children are so malleable at that age, and honestly, if we gave them all aww training, we would have an aww world very quickly.

He takes his team down to the London Sewer as a metaphor for trying to separate negative emotions from positive ones, and he actually name-checks the founding of the London Sewer system. Ivor, my friend, why don't you help these fine fellows with some fun facts about this here? Faeces Factory.

It's difficult when it goes into an industrial sewer system because you get all sorts down the sewers. But if it's in a relatively pure situation, it can be a very useful fertilizer. Compost it can be, you know, you can burn it to make electricity, you can. There's all sorts of things that can be done with it. But yet it's often still too easily discarded. Because that's the public health paradigm that arose in the 19th century. Is you just get rid of it? So I wish people understood that human waste is not waste and we do not need to waste it. I wish they understood that well. We've just talked about this at great length. I really wish they understood that they should clean their butts better.

But I wish that people understood that sanitation is.

Maybe unfashionable, still underfunded, definitely. But an absolutely crucial public health issue around the world, not just in the developing world, but even, you know, even in the U.S. As we've talked about.

Yeah, and then I wish they'd go and read up on Joseph Bazalgette and John Snow and Ignace Semmelweis, and then go and, you know, hug their toilet.

You know, passing red flag laws, expanding background checks, or even banning assault-style rifles. If you really want to go there, No. Instead, they expelled two of their fellow lawmakers for having the audacity of leading a protest to call out that hypocrisy. There are a couple of aspects to the story I want to speak to here. The first is the lengths some folks will go to protect the gun lobby. Make no mistake, the full-throated defense of guns by politicians has nothing to do with principle. And it's everything to do with protecting a grift that helps them cement their grip on power.

The gun lobby spends millions to help elect politicians who support their aims. After every mass shooting, every single one, gun purchases skyrocket. As people turn to the very thing that caused this mess as a last resort to protect themselves, when they know their government's going to do nothing about it, gun manufacturers make money. They then turn around and plow some of that into conservative politicians re-election campaigns to make sure that after the next mass shooting, there's no regulation that might affect their profits. Those politicians all sing from the same hymnal, deflecting the obvious blame away from the guns themselves.

This is that on steroids. Not only will they deflect, but now they're moving to silence any voice that might call them out. There's something more here. This is a frank assault on democracy itself in the name of guns.

To expel democratically elected legislators for views that oppose the majority is to dismiss the votes of the people that elected them. Now, consider the fact that there were three legislators up for expulsion two young Black men and a middle-aged white woman. Guess which two got expelled? Both Black men from predominantly Black constituencies in formerly confederate Tennessee.

Need I say more? Meanwhile, this week, another state legislature decided to wild out Republicans in Idaho are set to ban interstate travel for abortion.

States aren't allowed to interfere with the free movement of citizens across state borders. Except that's exactly what Idaho just did, all to exert control over other people's bodies. Because you know how many of the legislators would have their ability to travel restricted by this zero?

None zilch nada. Not to be outdone by Republican state legislatures, conservative court appointees raced to put limits on Americans lives this week, too.

Developing now.

Remember, the majority of abortions in this country are medication abortions, and this ruling targets one of the two key medications used to perform them. And this ruling calls out the hypocrisy of the Supreme Court when they overturned Roe last summer, arguing that abortion rights should be a quote. State's issue. I guess not. But it also goes further. It puts the ideological bent of a single judge ahead of the science-based processes we use in this country to make decisions about medication safety and efficacy.

He called the FDA's reasoning quote unsound. Oh, I didn't know. They taught clinical study design in law school. It's a gigantic encroachment of ideology on science. But on the same exact day, literally the same day. Another federal court judge, Hero, in Washington State, filed an injunction directly opposing the ruling, blocking the F.D.A. from doing anything to limit Mifepristone access.

The Biden administration is also filing an appeal in the case. These dueling rulings, though, suggest that it'll be headed to the Supreme Court. You know, the same Supreme Court that kicked all of this off when they repealed Roe. For now, though, Mifepristone remains available. And if it wasn't the second drug in the medication abortion regimen, Misoprostol can also be used on its own, though there's another case targeting that drug, too.

We'll be watching. This new data out shows just how dire America's precipitous decline in life expectancy has become, and exactly who's dying. U.s life expectancy has been in free fall over the past three years, for which we have data 2020 through 2022.

A simple explanation is, of course, Covid, but that doesn't explain all of it on its own. See. Life expectancy also dropped back in 2015, the first time it did so in decades in this country, It dropped again in 2016. And while the next few years saw a reprieve, everything went to shit with the pandemic before Covid. This drop in life expectancy was attributable to what epidemiologists have taken to calling quote deaths of despair, deaths by suicide or overdose. Most among low-income, middle-aged, rural white men.

But since Covid, there's been a change in those numbers. Whereas life expectancy has begun to bounce back in nearly every other high-income country in the world, it hasn't in the U.S. Why deaths among young people? The probability of a five-year-old dying before they turn 25 in this country is 4%.

That compares to, right around 1. In similar high-income countries. Kids and young adults are four times as likely to die here. And there's one reason that jumps out above all of the others death by gun, whether homicide or suicide, guns are killing young people.

Now I wish after three of them died in Tennessee, the legislature there would have done something about it, but no. Instead, they kicked out two young Black members. That's it for today. On your way out, don't forget to rate and review.

It does go a long way, really. Please rate, review also if you love the show and want to rep us, I hope you'll drop by the Crooked store. For some American dissected merch, we've got our logo, mugs and t-shirts, and our signs Always win, sweatshirts and dad caps.

American Dissected is a product of crooked media. Our producer is Austin Fisher. our associate producers are Tara Terpstra and Emma Lickfrank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz.

Our theme song is by Taka Sazawa and Alex Uguiera. our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-Sayed, your host. thanks for listening.

This show is for general information and entertainment purposes only. It's not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.