Mexico Tried to Regulate Tony the Tiger. Here’s what Happened Next.

Perfect for the family holiday party where you know your MAGA cousin is going to corner you and talk about the plight of millionaires. Head to Cricut.com Slash store to shop. America Dissected is brought to you by the Debeaumont Foundation. From clean water to food safety standards to pandemic preparedness, public health saved your life. Today. At the Debeaumont Foundation. They create practical solutions that improve the health of communities across the country, enabling everyone to achieve their best possible health.

To learn more about how advancing policy, creating partnerships, strengthening public health and improving communication can make a difference, visit Debeaumont.

Org.

Infant mortality in the United States increased in 2022, the first time in two decades. The American Medical Association considers supporting single-payer health care. Health care activist Audie Barkin dies of complications of ALS at 39. This is America dissected. I'm your host, Dr.

Abdul-el-Sayed.

Saturday morning cartoons Remember those? Among the many reasons I'm grateful to have grown up in the 90s was that hallowed Saturday morning ritual, observed by millions of children. Like me, I'd be up at like 8 before anyone else in the house. I'd turn on that tube television with 47 channels, and I'd fix myself a bowl of cereal. Mom wouldn't let me eat the sweet stuff on weekdays, but weekends. Ah, my time.

It was cocoa puffs or cinnamon toast crunch for me, as I devoured those little sugar bombs. Their commercials would intersperse my cartoons, featuring either Sonny, who was, of course, cuckoo for cocoa puffs, or the cinnamon toast crunch. Chefs virtually guaranteeing that they'd be a regular part of my breakfast every Saturday. All was right in the world, only it really wasn't. I didn't realize it. But the millions of us were unsuspecting victims of an elaborate scheme. To convince us and our parents that the mainline sugar we were eating was, quote, part of a balanced breakfast.

That scheme hinged on the industry's ability to do a couple of basic things feed us cheap ingredients at marked-up prices and guarantee that we'd keep buying it. It starts with the first ingredient in cocoa puffs. Corn Corn is artificially cheap in America, a byproduct of a decades-old public policy in this country that has u.s. subsidizing its production by factory farms. Those subsidies have helped drive the consolidation of agribusiness, displacing family farms nationwide. And those corporate farms sell directly to multinational food corporations that rely on our artificially cheap corn supplies to manufacture the very cereals I and millions of other kids were eating.

But if all I was eating was subsidized Iowa corn, I probably wouldn't be so excited to eat it. It's that second ingredient that got me, and millions of other kids hooked the sugar. I have to admit that I'm still at almost 40 years old. Cuckoo for cocoa puffs It's not just the fact that they're little sugar balls. There are lots of ways to get a sugar fix, after all.

It's the fact that they embody the nostalgia of childhood. That's because, for decades, the company that sells them, General Mills, made sure that they literally became the taste of my childhood. That has nothing to do with the puffs themselves, it's a product of the marketing that the company put into them. Cocoa Puffs have been around since 1956..

Their avatar, Sonny, he's been around since 1962.

He's gotten a couple of redesigns and some new voices, but he's still the same old Sonny, and he's still well. Cuckoo for cocoa puffs, and because of Sonny, whenever I hear cuckoo for I think cocoa puffs, chances are, love them or hate them, you do, too.

And that brand, that's powerful. And the companies that have been feeding American kids like me cereal for decades have put a lot of time and effort into making sure those brand associations stick. Let's try something name the avatar for each of these children's cereals frosted flakes.

Fruit loops cap'n crunch Okay, that one's literally in the name if you named Tony the Tiger, Toucan Sam, and well, cap'n crunch, a.k...a Horatio magellan crunch. Their marketing worked on you, too.

Now, look, I'm not one of those finger-waggy public health people that believes there's no room to live a little. I still enjoy a bowl of sugary cereal every once in a while, though my tastes have evolved a bit. Along with cocoa puffs, I also enjoy a bowl of Reese's puffs nowadays. And if you haven't had one, I'm not recommending it. But I'm just saying. But when I enjoy it, I enjoy a bowl for dessert once in a while.

The fact that millions of children around the country and around the world, because of our country, eat this stuff every morning as breakfast, that's wild. The recommended serving of cinnamon toast crunch has the equivalent of three added teaspoons of sugar. And let's be clear, most folks don't eat the recommended serving. They eat a lot more than that. What's the upshot?

Rates of pediatric diabetes are higher than they've ever been. And for that reason, in 2019, the Mexican government decided to fight back against the cereal industry. They forced manufacturers to put warning labels on products with excess sugar or fats. Worse still for the manufacturers, if their products contained a warning label, they were banned from promoting their products with their ubiquitous mascots. So that meant that Kellogg's manufacturers of frosted flakes and froot loops could no longer include Sam El Tucan and El Tigre Toño on their boxes.

And let's just say they went cuckoo. I learned about Mexico's efforts to protect the kids from marketing designed to normalize diabetes-causing foods in a recent article from Nick Florco at Stat News. And I knew I had to have him on the show. To share more about what Mexico did, how the manufacturers responded, and what it means for similar regulations that may be coming around the pike here in the U.S. Here's my conversation with Nick Florco. Can you introduce yourself for the tape?

I have mixed feelings about Tony, the tiger, or El Tigre Toño, as he's called in Mexico.

You know, in preparation for this, I was looking back at some history. And the former head of the federal Health Department in 1990 gave this quote, which I have to read. The grocery store has become a tower of babble, and consumers need to be linguists, scientists and mind readers to understand the many labels they see. So that's where we were, just, you know, three decades ago. And to your question of Do food labels work? the research that I've seen says Yes, they do.

I mean, there's this new experiment going on which I'm sure we're going to talk about, which is adding a warning label to the front of a food package. The idea being the consumer is making a split-second decision, trying to decide, should I buy this cereal or this cereal? They see a warning on the front of one of them that says, Hey, there's excess sugar. They might not buy it, they might go to another one.

We're still gathering data on sort of the actual impacts of that, but that's sort of the new frontier in food labeling. And what a bunch of countries around the world are doing, and what the U.S is actually doing as well.

Micronutrient-poor foods that are highly processed in or super processed in. The language of one of our previous guests here. And you're talking about stuff that one should not be thinking about, eating all too often as a part of a regular diet. And there are a lot of countries that have gone far further, far faster than we have to give us context, though. In order to, you know, to think about labeling as a public health intervention, you have to understand how the corporations that manufacture these foods try to market themselves.

Can you give us some context about that? What is the way they market, how do they try and push themselves into the eyes and ultimately into the guts of consumers, particularly our youngest consumers?

As a kid, you're more likely to sort of have a biased view of how healthy that food is as an adult. And what we really know is that when you try to take away those sorts of marketing tactics from food companies, they will fight pretty darn hard to keep them. I'm happy to go into it. But the experience in Mexico with them trying to ban mascots on their products is really one clear example of sort of what happens when you try to take away Tony the Tiger.

Can you explain? You know, you talked a little bit about the connection between childhood and adulthood, can you explain, you know? Particularly why breakfast became this way to like, really jam kids full of sugar at the beginning of a day. And like, why breakfast cereals tend to be so marketed in this particular way.

Excess any macronutrient is the problem. Why are we focusing on added sugar when we're not focusing on total sugar, like sugar you'd find in fruit? What we've seen is like, decades of this debate over whether sugar is good or bad. And we've ended up in this country with looser restrictions around sugar than other potentially unhealthy substances. Like, if you look, for example, at sodium, at least in the U.S. there's a voluntary goal for manufacturers to lower their sodium in food.

It's voluntary, but it exists. That doesn't even exist for sugar. So we are just like, when we think about what we should be limiting in our diet, sugar has sort of been like the last issue to be addressed.

I want to now turn to the Mexico example, right? And we can talk about Antigua and Antonio here. So the Mexican government decides to take a stand against what is largely American corporations selling straight sugar to kids, in effect, and they take the stand in 2019..

So Tony the Tiger was curating Spotify playlists, he was on commercials alongside soccer announcers. And then, I mean, my favorite, and I think the one that really has just stuck with me the most is that. Essentially, Kellogg paid to have a drone show above Mexico City, where they use drones to sort of draw all the characters in the sky. So the goal, of course, of all of this is to sort of not erase the mascots from consumer memory. And to keep using them even if they can't actually use them on certain food packages.

At least public information suggests that at this point, they're not considering a ban on mascot. And it sort of raises the question of, like, was Mexico sort of onto something here? Is this something that actually could have a potential public health impact if the food companies are just so aggressively trying to fight it and so openly trying to fight it?

Was doing something similar and it was really eye-opening, how quickly talking to advocates in the country, sort of how aggressively. The food companies bought this and how big of a deal it was for them. Because it doesn't. It sounds pretty basic and not super controversial. To add a little bit of information about, you know, food's health effects on the front of a label. And maybe restricts the marketing. But it really, really has prompted a response.

Kariuma has been our go-to sneaker for a while now because they're really comfortable, go with everything, and they're made with consciously sourced materials. Look, I love and wear Kariuma sneakers all the time. I literally just took them off because they're comfortable, they look great, they last a long time and they're good for the planet.

Last year, we collaborated with Kariuma to create No Steps Back sneakers. We can't believe they now have designed a second limited edition collaboration with us. The Love It or Leave It sneaker. These shoes have a colorful design with lots of Easter eggs, I mean, not Taylor Swift level Easter eggs. We're not insane.

Just fun stuff, like Pundit on a surfboard. Plus, a portion of the proceeds from every pair sold is donated to VSA's every last vote fund. Our first Kariuma collab sold out super fast. So if you want a pair for yourself or the Love It fan in your life, make sure to snag one now.

They make the perfect gift for the holiday season with free returns, just head to Kariuma.com store. Embrace the power of freedom with a message from the incredible 2023 Marguerite Casey Foundation. Freedom Scholar Professor Charmaine Chua Charmaine's wisdom is crystal clear Freedom is a democratic enterprise, and it's up to us to shape it.

We can't sit back and wait for others to shift the balance of power, we've got to do it ourselves. MCF Freedom Scholars are at the forefront of academia, offering critical insights for social justice and sparking groundbreaking ideas to transform our democracy, economy, and society. Join MCF in the Journey of Change and discover more about Charmaine and the entire 2023 Freedom Scholars. Visit them at caseygrants..org or connect with them on social media at Casey Grants.

American Dissected is brought to you by article. If you want beautiful, well-crafted furniture that stands the test of time and looks great in your home. Without having to pay a middleman or the hassle of having to worry about shipping, article is your choice. Article believes in delightful design for every home, and thanks to their online-only model, they have some really delightful prices too. Their curated assortment of mid-century, modern, coastal, industrial hey yes, Scandian boho designs make furniture-stopping simple.

Article's team of designers are all about finding the perfect balance between style, quality and price. They're dedicated to thoughtful craftsmanship that stands the test of time and looks great doing it. Article offers fast, affordable shipping across the U..S and Canada.

Plus, they won't leave you waiting around, you pick the delivery date and they'll send you updates every step of the way. Article's knowledgeable customer care team is there when you need them to make sure your experience is smooth and stress-free. Article's offering our listeners $50 off your first purchase of $100 or more. To claim, visit article..com.ad and the discount will be automatically applied at checkout.

That's a-r-t-i-c-l-e.

Com.

AD for $50 off your first purchase of $100 or more.

And the first time I saw this, I sort of went home and I mulled it. And I was just sort of like, how could a froot loop have that little sugar without just tasting completely different?

So I was totally confused, and eventually I went back to that Walmart and looked even closer, and what I found was that. The product listed allulose or allulose as an ingredient, and allulose is a sugar-free sweetener. But it's one of the few that's technically not considered by Mexico as an artificial sweetener. And there's reporting to suggest that the food industry did sort of lobby the Mexican government to not have allulose classified as an artificial sweetener.

And so Kellogg's basically found a way to sell its product without an added sugar warning by reformulating it. But then they were also able to avoid the warning that was meant to warn consumers about the reformulation. And I think the other interesting thing here, since we already talked about mascots, is that by doing this, they're also able to keep their mascots in the stores. Because that new product doesn't have any warnings on it, which means Toucan Sam can be on the package. So essentially, when you walk around the grocery store aisle, you see the warning label version, which is a plain box, and then you see the one with Toucan Sam, the reformulated. And that means that the mascots are getting into the grocery stores and into the cereal shelves just as much, and kids are seeing it.

So it benefits them in multiple ways.

But your tongue recognizes it, so you taste the sweetness, albeit with more what we call avidity, meaning it binds a lot stronger to your tongue. That's why a lot of these sweeteners taste saccharine like they're artificially sweet like, not like sugar, which is just the right taste for our taste buds. But your gut doesn't recognize them, so they flow on into your large intestine. But here's the thing about it.

In your large intestine, because they are undigested molecules, they pull water into your colon and they cause diarrhea. And so you can imagine, right? Like? I remember when I was a kid and I used to eat these sugar sweetened cereals. I wouldn't just have a bowl, I'd have like three or four bowls. So you can imagine a bunch of kids. Unfortunate children who saw Tony the Tiger or Toucan Sam decided to buy the sugar, or, like, push their parents to buy the sugar. Ate three bowls and then just had diarrhea for the rest of the day.

And it's like an awful thing that these manufacturers know is going to happen, like they know that doesn't happen. And there's like, no indication that this is any different than the usual cereal, except for it looks like the cereal used to look.

S doesn't have a requirement to warn about artificial sweeteners on their packages, but, interestingly enough, the group that's pushing for more disclosures of artificial sweeteners is the sugar industry. And they're petitioning the F.DA to require companies to sort of more clearly state when a product has an artificial sweetener. And to block companies from claiming that their products are lower in sugar without also noting they have artificial sweeteners. But the reason I bring this up is because on the allulose front, they've actually specifically petitioned the F.D.A. to require companies that use allulose to have a warning that says it may cause a laxative effect.

I want to ask you, you know, obviously this battle is still ongoing. Where do you think this ends up? Where are the legal teams for Kellogg and the Mexican government going next? What do you think this evolves into? Do you feel like they'll be able to repeal some of these laws?

Do you feel like they'll just put up with it? Where does this go next?

And a bunch of those have already made it up to sort of their appeals level courts. And those courts actually do put out sort of draft opinions before they decide on what they're going to do. And those seem to suggest that they are going to uphold the law. And the Mexican regulators that have been behind this have been really steadfast throughout the regulatory process. The food companies have tried to make tweaks along the edges to this, and they've been very skeptical of those and really pushed forward with what they were intending to do.

Honestly, the bigger legal fight might be here in the U.

S.

Because the U.

S is considering a similar food labeling policy, one that's a little bit weaker, to be honest. But here in the U.S, I mean, even when I talk to the most enthusiastic supporters of this. They acknowledge that our rules around, sort of when the government can regulate a corporation's speech, they're going to be a problem. And the food companies are already sort of making very thinly veiled threats around, like potentially suing over any sort of mandatory front-of-package labeling here in the U.S. I mean, that's really where the fight's going to be.

In Mexico, it's actually looking pretty good. I mean, it's survived thus far. I mean, there's no indication at this point that it's going to be thrown out.

S.

So not like the stop sign that says excess sugar or excess fat, but something relatively similar. So, like some of the designs they're testing, kind of look like stoplights. Where it would be like, you know, green food, you know, low in sugar, red food, high in sugar. And so they're deciding above, I think it's six labels right now, sort of which one they're thinking about.

But the policy won't include sort of things, at least thus far, it hasn't included things like artificial sweetener warnings. It's also they're not thinking about this as sort of a warning. You know, folks have said like, you need to be putting warning labels on products, and essentially they're saying, no. We're going to say the products are high in sugar or high in fat, we're not going to warn around it.

And then it's not going to include things like mascot bans, for example, at least not yet. I mean, like I said, it's really early stages. Anything could change, but all indications suggest that they're going to go with something a bit simpler. That essentially just says, Hey, this food is high in sugar.

And so he feels really passionate about this, like, it's pretty clear. And this is also part of a larger strategy that the Biden White House is pushing. Because they had this large summit on nutrition and health a few months ago. And so, I mean, this overall is clearly a priority. I don't think this is the sort of thing that's going to get slow walked at the agency.

It's going to be a slow process, I mean, the way this works is. They're going to do these studies, they're going to review the studies, they're going to put out a proposed rule, they're going to take comment from the food industry.

They're going to get so many comments you won't believe. They're going to have to go through them all really carefully and address them all. Because they're going to get brought up in litigation eventually, then they're going to finalize it and then there's going to be probably an implementation period, which could be months, it could be years.

So, I mean, it's going to be a while, is the short answer.

You know, in so many ways, as you talked about, our public policy tends to be a lot more sympathetic to large corporations and a lot more sympathetic on speech grounds. What I'm hearing you say is that they would have to put a warning label on their product, which, of course, has a lot of precedent in the setting of tobacco.

So in both cases, these sorts of things, anytime you get into compelled speech, you almost always in the U.

S get a lawsuit and it gets fought out. The other interesting thing, I'll just say, is that the policy argument here is kind of interesting. Because the food companies are essentially arguing. We're already doing this, and there's a less burdensome way that we can do this ourselves. Which I think will eventually sort of feed into their legal argument. But essentially, if you've been to the grocery store, you've probably seen that. Some foods do have some sort of information on the front of them that says, this has this much sugar, this has this many calories. That's what the food industry calls facts up front.

It was their voluntary effort to sort of address this issue. There's a lot of differences, though, between those labels and what we actually see in terms of what the F.D.A. is studying. Because those labels, for example, will say like five grams of added sugar or five grams of total sugar, and it won't say high in sugar, for example. So the average consumer looking at that isn't getting anything to sort of interpret is this good or is this bad?

They're just getting the same information that they saw on the back, on the front. And basically, the food companies argue that, like, Hey, we can do this, you can't mandate us to do this thing. Where you say, you know, you set a guardrail or a guideline on what is high amounts of sugar? And then we have to put it on our food, because you think our food is high in sugar.

It's high fructose corn syrup, and that corn syrup comes out of corn that is highly subsidized in the American marketplace. And you know, you think about the ways that that drives the economics of being able to put sugar everywhere and make a lot of money off of it. I wonder how valuable it is relative to other things. And at the same time I think about is. This is an example of the industry just being willing to push back as hard as it possibly can on any regulation.

Or is it the industry really believing that this is going to take a hit relative to some other policies? Or is it the fact that in the United States, we've just been so piss poor at regulating the food industry at all? In a positive way, you cover the commercial determinants of health, and I'd love to hear your thoughts on the kind of public policy we should be seeing. If we truly really wanted to reduce the burden of diabetes, for example, in our society, what would we be doing to regulate the food space? Is it this?

Is it something else, is it some combination of some of these policies? So, I mean, I'll say as any good reporter.

One of the other really interesting policies that we're seeing, tried, but I don't think we really have great results on yet, is simply just banning the sale of sugary products to kids. The state of Oaxaca in Mexico has actually tried that, and it's actually pretty funny to contrast that to sort of what we see here in the U.S. Because covering the commercial determinants of health, I often end up covering these sort of food fights for lack of a better term. And one of the things that the U.S.DA is considering right now is simply limiting the amount of chocolate milk that can be served in schools. So they're considering either banning chocolate milk in elementary school or allowing schools to sell chocolate milk so long as they sell a low sugar version.

And if you're concerned about, like, added sugar, a policy like that makes sense, because there's a good amount of added sugar and chocolate milk. But you wouldn't believe the level of vitriol that sort of has come out of that regulation. I mean, I would never have thought about that when talking about chocolate milk. So like, you can't get something like a chocolate milk restriction here in the U.S for elementary school kids.

You know, it's hard to imagine sort of a policy like banning the sale of all sweet products to kids. But it's definitely like an experiment that I'm really watching right now, because it is, you know, relatively innovative. You know, it frustrates me as someone who is very.

In this country, we believe that everyone has the freedom to choose and that we can educate, but we cannot ban. And then when it comes to something like food labeling, which is entirely about saying we are not going to take any option off the table, we are just going to educate consumers about what options are less and more healthy. Then it becomes an entire fight about freedom of speech, right? So it's like the freedom of choice versus the freedom of speech.

And what tends to really be the case is that these companies do not want to have to bear any of the costs of the externalities that they put on the world. And I know that's a fancy economics term, but it basically means when you sell a product, the consequences of which bear out on society. In some pretty important, but not direct ways, that you should have to bear the cost of those outcomes. And that means some sort of regulation to force you to engage in. And what's worse of all is that our taxpayer dollars not only are we not regulating, but we're actually subsidizing the production of a lot of these goods. As you think about where the American mind is on these things, which of these arguments do you think makes the most sense?

Do you think that there's sort of an easier time to make an argument about freedom of choice with clear education and compelled speech? Or is the average American more willing to support something where there's a ban? I have my opinions on this, but I'd love to hear yours as someone who.

You know, I'm sort of making an educated guess here. But my thought from covering these issues would be that, you know, a policy that just gives consumers more information is a lot less likely to be controversial. Like anytime I've ever covered anything that resembles a ban or limits choice in the U.S. It generates some backlash, but I mean, I haven't seen besides the food companies, right? I haven't seen the same level of backlash to something like. Including more information on the front of a food package that says, Hey, this is unhealthy. The question, right, and probably the question, more for you than for me, is which one of those is actually more effective from a public health perspective?

Like, I can tell you which one is probably more helpful just from a political messaging perspective, but the question of which one actually works the best? I don't know if I have a good answer to that. That's a harder.

I mean, it really just comes down to the question of giving you something.

They tend to promote these monocrops, and, um, they tend not to promote the kind of diversity of farming that we really, um, I think need to have and would really like to have. And most importantly, could benefit, uh, our health in a pretty profound way. And then I think, you know, once you do that, then there's the question of trying to guide somebody, uh, around choice-making. I also think that, you know, even in science curricula, we don't do a really good job mapping the basic science that we teach folks to choices that they can make every day, right? So, like, you know, similarly with math, you want to explain why math is important, explain compounding and investment.

Right? But like, we don't really do that. So we tell you about how compounding works in like, complete abstraction, but we don't explain why. Compounding is probably the single most important thing that should dictate how you store your money, right? Um, similarly, we'll we'll tell you a lot about the Krebs cycle, um, but we don't really explain how.

That then maps to, um, you know what you're eating and help you make good decisions. So I really think that it's not just, you know, red for bad or green for good. It's also like, let's give folks a little bit more ownership of the choices that they make. Um, and do so by really trying to orient baseline curricula early on to some of these really big, important choices that people are making every day. I really appreciate you joining us. Um to, to share a bit more about your reporting. Uh, and uh, and the effort to defang, uh, uh, anti-gay Antonio in Um in. In Mexico, our guest today was Nicholas Florco. He is a health reporter for Stat, where he covers commercial determinants of health.

Nick We really appreciate.

As usual, here's what I'm watching right now. Infant mortality, literally a measure of the number of babies who died before their first birthdays, increased in 2022. That's the first increase in decades. We've done a couple of episodes on infant mortality here. And that's because in America, more babies die per capita than in 53 other countries in the world. Our infant mortality rates are higher than they are in Latvia and Bosnia and Herzegovina.

Infant mortality is a complex outcome, a measure of a number of factors that affect the womb before a fetus is ever conceived. The health of the person carrying the fetus, the circumstances affecting the birth, and the environment that shapes the infant's life for the first year, all of this is shaped by circumstances that are a lot bigger than simply healthcare. Remember, these numbers are for 2022, meaning these infants were most likely conceived in 2021. And if you remember, 2021 was the single most deadly year of the COVID-19 pandemic, but COvid deaths are the tip of the iceberg.

Also, all the ways Covid shaped the mental and physical health of folks leading up to pregnancy. That includes everything from isolation, diet and physical activity, access to in-person healthcare. It also includes the readiness to get pregnant in the first place. Remember, Covid created a quote baby bump, which means that a lot of folks who would have been able to avoid pregnancy ended up getting pregnant. And getting pregnant when you don't want to be pregnant implies that, by definition, you aren't in your best place. To carry a pregnancy to term or care for the infant after they're born.

Which brings me to the question of choice of when, where and with whom to carry a pregnancy. Quote. Pro-life folks think they really are quote saving lives by denying abortion access. What they don't really realize is that when people can't control their own fertility, it creates circumstances where they're forced to carry a pregnancy and care for an infant. When they don't feel prepared to do so, those circumstances are terrible for the health of the parent and for the health of the infant.

And sadly, I worry that because of the fall of Roe v. Wade, we're going to see these numbers simply continue to climb. For a long time, the American Medical Association has claimed to speak for physicians, despite falling completely out of step with where physicians are today. In the past, physicians mainly worked for physician-owned practices, they owned their own businesses and usually contracted with hospitals. That used to be actual non-profits, focused mainly on providing health care to the local communities, rather than maximizing their bottom lines.

Look, I wish we lived in a world where all physicians cared simply for the best for their patients, and not money or autonomy. But that's simply not the world we live in. So it made sense, at least economically, that physicians in the past might not support single-payer health care in that world. But let me remind you how much health care has changed over the past two decades. Rather than truly non-profit hospitals of yore, today's hospitals might as well be for-profits if they aren't already.

And they've been buying up physician practices left and right. As of 2019, the median physician no longer worked for a physician-owned practice. Instead, they worked for a large health care system. And guess what else changed? The median physician also supported single-payer health care, or Medicare for all.

Which makes it all the more confusing that the AMA still opposes single-payer health care, but that all might change. See, some heroes have been organizing within the AMA to shift its positions, and they might just move the organization. But the last time the AMA's House of Delegates debated the question was in 2019. And that effort to shift the tide and force the AMA to support single-payer health care was led only by the medical student section.

They failed by just 6. But this time, they'll be joined by a coalition of practicing doctors from New England. We'll keep you posted.

Finally, the world lost a giant this past week. Ady Barkan was an activist, organizer and leading voice for the health care system we deserve. He was also my friend and my brother in that work. Ady campaigned for me in Michigan when I ran for office.

He wrote the foreword to my first book, Healing Politics. He died of complications from ALS at 39 years old. He leaves behind two children, Carl and Willow, and his incredible wife Rachel, who will continue his legacy. You can donate to support his young family.

We'll leave the link in. The show notes Ady's was a vivacity born out of a righteous fight for the rest of us. When he was diagnosed with ALS, he could have resigned to spend the rest of his days with his family. Nobody would have blamed him. Instead, he used the final moments of life to remind us how much life was actually worth and what it meant to protect it.

I loved Ady for his passion, his grit, his joy, his wit, but most of all because he loved all of us. I want to leave you today with inspiration from Ady's interview way back in 2019, when I asked him what the solution to our health?

No more getting on the phone trying to convince your insurance company to cover something, it's all covered. This is personal for me. One of the things I've come to deeply understand over the course of this diagnosis is that our time here is the most precious resource we have. Should we really be spending the limited amount of time we have on Earth on the phone with Aetna?

Why does it have to be that way? I've been asking.

That's it for today. On your way out, don't forget to rate and review the show. It really does go a long way. Also, if you love the show and want to rep us, I hope you'll drop by the Crooked store. For some America, dissected Merch.

America dissected is a product of crooked media. Our producer is Austin Fisher, our associate producers are Tara Terpstra and Emilic. Frank Vasilis Fotopoulos mixes and masters the show.

Production support from Ari Schwartz. Our theme song is by Takao Sazawa and Alex Uguiera. Our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul, your host. Also a very special thanks to Michael Martinez, for whom this will be his last show with Crooked Media.

Thanks Mike. good luck with your next endeavor.

This show is for general information and entertainment purposes only. It's not intended to provide specific healthcare or medical advice and should not be construed as providing healthcare 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 represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.