New Year, New You?

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Scientists have discovered a new antibody in the fight against drug-resistant superbugs. North Carolinians rushed to enroll in expanded Medicaid, prompting other conservative holdouts to consider expanding, too. The F.D.A. approves mass drug importation from Canada, and Covid test positivity hospitalizations and deaths are up as the JN1 subvariant surges. This is American dissected.

I'm your host, Dr. Abdul-el-Sayed, and welcome to 2024..

By the end of last year, folks, your host was running right between my day job, this one, and general goings-on. In this sometimes awful, sordid world, I was really feeling it. The usual spirit that I try to bring to my work faded, every email became an annoyance, every issue at work a drag.

Vacation couldn't come soon enough. Michigan around this time of year, let's just say it's not its most inspiring. The sun barely comes up, and then it's down again by 5 o'clock, leaving you in a dark, desolate freeze. So we booked a trip to L.A. And though Angelenos may complain about highs in the 60s, it does come with sun.

And look, this Michigander will take it. Our trip was proceeding as planned, jaunt to different eateries and attractions. Built around our 1-year-old sleep schedule and playdates for our 6-year-old, the best we can do as parents of two. Until day 4, when, after a day spent at Universal Studios, I came down with a rip-roaring fever, up to about 106..

Both our daughters had had low-grade fevers earlier, so we thought I was getting the grown-man version of whatever ubiquitous virus they'd had. I was Covid-negative, but took to wearing a mask in our hotel room anyway, and then the fever just wouldn't go away. I'd spike 3 to 4 a day, but only after I started to get a really bad sore throat on the third day. Did we two doctors step back and think that this might not be the same run-of-the-mill virus?

I checked into an urgent care to get a throat swab to learn that I'd had strep throat. To this day, I still have no idea how I got it, neither kid had had it or, thankfully, got it. Afterwards. Mask work. But even after 3 days of antibiotics and round-the-clock aspirin and tylenol, I was still spiking fevers.

9 days later, I'm feeling a bit better, but those 9 days, well, they really sucked. For those first few days, I felt really sorry for myself. I needed that vacation and I didn't want to spend it shivering under hotel covers. But I'm not sharing with you, so you feel sad for me.

Okay, maybe just a little, but because of what it reminded me, I'm really lucky, blessed, not to have to think too much about my or my family's health most of the time. Thankfully, none of us live with chronic illness or disability, so when I do get really sick, it registers as unusual.

And when I did get sick, my insurance covered most of my urgent care visit and antibiotics. And I could easily fork over the $60 copay for the visit and a buck something for the meds. That's not the case for too many people in our country and around this world. For millions of people, illness is an everyday occurrence, that pain, discomfort, forgoing of joy.

That's their normal. For so many others who may not be plagued by serious illness, getting treatment, if they do, wouldn't be as easy as handing over an insurance card and a credit card. It means they'd go without the care they need or risk financial catastrophe if they tried to get it. Shivering under a comforter in a courtyard suite in L..A. reminded me why we talk about these issues every single day.

If you're like me, and you're lucky and blessed enough not to have to worry about your health or how you'd protect it every day. Remember that millions of others don't have that privilege. And this work is about shining spotlights on those experiences, because they're all too normal for too many people. And if you're someone who struggles with your health or the financial consequences of trying to protect it. I hope you hear your experience in our work, and if you don't, I hope you'll share your experiences with us so that we can make sure you do. What does all this have to do with today's episode?

Well, New Year's happens to be a time where many of us think again about our health, but the things we'd like to improve about it. Lose a few pounds, start working out again, run a marathon, slow down on that, drinking. These are just four resolutions friends of mine have already told me about. Nationally. The three most common resolutions all center around health in some way or another.

But while those resolutions usually center our physical health, they sometimes miss what brings them together, and that's the fact that they start with our mental health. Our guest today has been thinking about the physical manifestations of our minds for a while now. He's a psychiatrist and author of three books, Unwinding Anxiety, The Craving Mind, and his forthcoming book, The Hunger Habit. I sat down with Dr.

Judd Brewer To learn more about the mind-body axis, the ways our diet culture is doing more harm than good, and how we harness our minds to heal our bodies, here's my conversation with Dr. Judd Brewer. Okay, can you introduce yourself at the tape?

It applies to the behaviors, it applies to all the things that are trying to get us hooked these days, from social media to food, to porn, to everything.

You know all the withdrawal and the nicotinic receptor, you know agonism and all those things, right? So we can say, okay, somebody goes into withdrawal from nicotine, you know, physiologic, they go into psychological withdrawal. Cigarettes aren't good for you, right? There's nothing like, Hey, you should smoke at least three cigarettes a day to live longer, right? It's the opposite.

So if we look at things that get a little more challenging, like food, where we need to eat to survive, it gets a little more complicated. Because here are people getting addicted to junk food, or this, or that, you know, all this food that's engineered to get us, really, you know, to eat more than you know. What's the Lay's potato chip saying? Bet you can't eat just one, you know, that came out back in 1963, by the way, you know? So it's like these things have been around for a long time. And people are getting diabetes. People are having clinical obesity issues where you know their weight is just not healthy, and this is where, you know, there's a. I think of this as the slow burn.

So it's not, you know, cigarettes. They're going to kill you in the long term, one way or the other, whether it's emphysema or cancer or whatever. And you can look at diabetes in the same way where it's not going to.

You know, it's hard to overdose on Oreos, although I'm sure people have felt like they have at times. But you can certainly overdose on opioids, you can overdose on alcohol, et cetera, so you can say, well, you know, alcohol, opioids. That's a problem. But it's really a part of the timescale.

But all of it comes back to this, you know, suffering. Question Is it causing problems for someone? I don't know. How does that ring with you?

It can do a certain thing for you, but you don't need one. Whereas with food and sex, those are profound human needs.

It complicates things because, you know the definition you shared was about a use, despite causing problems for you. And you know, one will always need to use food per se. I guess it's the nature and degree. And then you also spoke to the other point, which is to say that there is an overuse that is more dangerous in the chronic versus in the acute. Right? You know, you can overdose on opioids acutely.

Whereas you're not, like you said, going to overdose on Oreos, though. I've come pretty close to feeling like that.

And I think we take for granted that we live in an extremely addictive environment. I think people talk about having an addictive personality. That may or may not be true to some degree, and I'd love to hear your perspective on that. But we decidedly live in addictive times and addictive spaces, and, you know, being entertained, for example, is a human want and need.

You see it in the smallest children, you see it in the oldest adults. But the degree to which we have our most interesting and engaging entertainment literally on our pockets and can get to it at any given time. That is a new thing. And our brains, I don't think, have really developed around that. I'd love to hear your thoughts on the nature of sort of addictive personality versus addictive context.

But, you know, texting has now been shown to be more dangerous than drunk driving, and yet people can't stop doing it.

You can't really separate them, you can certainly pay attention to something and judge it, right? But that's not what I would think of as mindfulness. But if you're aware of something and you're curiously aware of something, that's kind of the crux of what I think of mindfulness as.

And bringing that curiosity to what's happening, and in fact, there, I don't know, did you know there are two different types of curiosity?

So, think of food as being hungry for the idea, exactly exactly. And it's even been shown in primate studies that they will forego food and drink for information, right?

So think of that as like food for our brain, right? We've got to know, and it helps us survive, right?

If you hear a rustling in the bushes, can't be like that. I'm sure it's my brother and not the lion.

You got to go figure out what that is, and so that deprivation that need to know is a nice survival strategy. The other type of curiosity is called interest curiosity, and this is the type of curiosity that I see as inherent to mindfulness practices. So that's, that's the the joy of discovery.

I think of these two. The easy way to remember this is deprivation is about the destination. When we get that piece of information, when we get there, we scratch that itch and it's no longer gone, we're no longer deprived of information. So that's truly about, like, getting some specific piece of information when we don't have it.

Interest, curiosity isn't about anything in particular, anything specific, it's about that journey, it's like that journey of discovery. As we go, we're not, you know, we're not trying to get somewhere in particular, although we could be going somewhere in particular. But we can be curious along the way, like, oh, no destination in mind.

But it's really that journey and that those the two types of curiosity feel very different, and there's a critical difference between the two. Both again, both helpful for survival, but just have a very different feeling tone to them. Well, let me ask you, when you're just truly curious about something, you know, how does that feel compared to the deprivation curiosity that you just described?

And yeah, it's in the highlighted. Emotions are, you know, almost an anxiety that I don't know, a thing that I feel like I need to know that could potentially hurt me. And then the joy at being able to know a thing and to learn a thing. And the entertainment of twisting and playing with an idea in my mind, which is, I think, such a human thing. I mean, I watch my my 11 month old now and and I watch her play with something she just found in it.

You can just see that this is, this is just a innate human joy. Nobody taught her to be wondrous about this little toy that she's playing with, but you just see the wonder in her eyes. And it is such a beautiful, pure kind of emotion, isn't it?

Itches, scratched. And then there's the joy of discovery, the joy of learning so different. both help, and it's the joy of learning, the joy of discovery.

That's that attitude and quality that I think is critical for mindfulness. Because we're not, we're not judging what's happening, we're we're really just being curious so that we can learn. You know, we can be with whatever is without actually judging it. You know, in Zen, they talk about beginner's mind, and so we're not prejudging this moment.

Right, that's where we can just be curious about. This moment feels totally different.

Be one of the first 100 people to sign up to join the MCF Book Club for this event. And get a free copy of the book. Tip of the Spear mailed directly to your door. While supplies last, then tune in on Wednesday, January 17th, to hear Marguerite Casey Foundation CEO and President Dr. Carmen Rojas moderate. A powerful and memorable discussion with author Dr. Burton and Imani Davis, founder and executive director of the Omoali Project and daughter of freedom Fighter Jomo Omoali, who was an organizer of the Long Attica revolt. Sign up to join the MCF Book Club today at caseygrants..org. Slash tip of the spear.

That's c-a-s-e-y-g-r-a-n-t-s dot org. Slash, Tip of the spear and save the date for the premiere of the Book Club Conversation on Wednesday, January 17th, at noon Pacific time 3 p...m. Eastern.

So, in your first book, Unwinding Anxiety, you frame anxiety as a sort of addiction.

How do you? how do you think about that? I have a sense of where you're going to go with this, given what we just discussed in these two definitions. But but how should we think about anxiety as an addiction, and what does that unlock for us?

So, you know, I didn't know this and I was really struggling to help my own patients with anxiety. And it turns out that if you prescribe medication, about one in five people is going to show a significant reduction in symptoms, like with the best medication. So I was playing the medication lottery like, OK, next patient. Are they going to benefit? And if you know, if they don't, what am I going to do? So, four out of five, you know, pretty frustrating.

So that's, that's not the best odds, even though it's better than other medications for other indications. So I started looking back at the literature and it turned out that back in the 1980s, about the same time that Prozac was introduced into the world. This guy, Thomas Borkovic, had suggested that anxiety could be negatively reinforced. And that opened my eyes really wide. Because as an addiction psychiatrist, I'm like, Oh, I know what negative reinforcement is. And we'd been doing studies with with smoking, for example. And we use mindfulness as a way to help people step out of these negatively reinforcing habit loops.

With smoking, for example, if somebody goes into withdrawal and they smoke a cigarette, they learn, Oh, this makes the withdrawal go away, so it's negatively reinforcing because it makes something unpleasant go away. So here's the here's the interesting thing about anxiety.

So the feeling of anxiety can trigger the mental behavior of worrying, and I hadn't really thought of mental behaviors as counting as behaviors, but oh, does this one count big time, right? So when we worry? Research has been shown that it makes people feel like they're in control, and feeling in control feels better than just wallowing in anxiety. Even if it's not actually putting them in control, giving them any more control over their situation.

I think of it this way, it's like worrying is doing something, and doing something feels better than doing nothing. Although if we look at it carefully, worrying actually just makes us more anxious. So so, if we look at this and form the habit of worrying through negative reinforcement. We're going to get stuck in these anxiety, worry cycles that's going to be really hard to get out of. And then we'll start associating this with, like, Oh, I need to be anxious to get things done.

This whole, you know, this whole Yerkes-Dodson law myth, it's really more a Yerkes-Dodson legend than myth around. You know, you need to have some level of anxiety to perform well and get things done. No research in the literature shown that I actually talk about this in the Unwinding Anxiety book. But the bottom line is, it was based on a 1908 study of Japanese dancing mice, and people extrapolated this to anxiety.

So they can read the details if they want to geek out about it. But the bottom line is that worrying doesn't actually help, it makes things worse. And so with that in mind, I started changing how I treated my patients in my clinic with anxiety. And then we developed a digital therapeutic, an app, to see if we could actually test that methodology and help people clinically.

The bottom line there is, we got a 67 reduction in anxiety in people with generalized anxiety disorder. Whereas when we added this to usual clinical care in a randomized controlled trial. And then when you just look at usual care, it's about 14, which is about on par with that number needed to treat a 1.5. So we're getting much better results by simply having people apply some of these mental technologies, let's call it that, to working with their anxiety habit loops.

And then the term for anxiety is hem, which comes from the same root word. And it's interesting because if you think about the overprioritization, trying to, like, completely reshuffle the cards over and over and over and over again to find what's important, you get hem. Which is like the anxiety that comes with trying to reprioritize everything. And I only, really, you know, when you were talking, I was like, that actually makes a lot of sense, because what is an anxiety loop? Except for being like, if I think about this enough, then I'm going to unlock some kind of insight which is going to help me solve it.

Which is the, as you talked about, almost the mirage of the way that worry makes you think you're in control, right? I'm going to figure it out if I think enough about this. But really, it just reinforces this notion that this is just something that makes you worried. And it was a sort of an interesting reflection that came to my mind as you shared that.

So I want to highlight that for anybody out there saying, but no, no, no, you know, worrying is really helps me. No, no, no. If you worry all the time randomly, you might come up with a solution. And I would also suggest the more you worry, the less likely you are to come up with a good solution.

Because, like, you're highlighting, we're getting stuck in these ruts. So we're less likely to be able to be creative or think outside the box, or actually have proper thinking. Because we're filling up our working memory with these, with these same grooves that we've been going over and over, and over and over.

You're like, you're like, too intensely focused on this one thing, where you know, that natural capacity of your brain to connect things in your subconscious kind of goes away because you're so focused on this thing.

I agree.

We're just grooving those, those habit patterns even deeper. So here we have the hypothesis that helping people not be as emotionally reactive. So there's a measure for emotional non reactivity. And there's also a measure for worrying. It's called the Penn State Worry questionnaire.

And we can look to see. We actually found basically that mindfulness increased people's ability to be emotionally non reactivity, non reactive. And that mediated a reduction in worry, and that reduction in worry mediated a reduction in anxiety. Because anxiety and worry are very tied together. So one psychological mechanism might be that people can notice that feeling of anxiety, they can notice the worry thoughts and not get caught up in them.

And that's anecdotally, what we hear people talk about.

But, like, Hangar is one of them. Like, if you haven't eaten, you get extremely hungry. I find it really difficult when I haven't eaten for, like, you know, 12 hours or so. Not to let my hunger just completely own me. And then part of me says, Okay, well, this is like a natural human response to not having eaten, because well, eating is critical to my life. But it feels like that ability to nuance the sources and strengths of your cravings is probably pretty critical here.

Can you talk a little bit about that?

And that is so prevalent and so well studied. Now that there are actually two different terms for hunger. One is homeostatic hunger, which is the one that helps us survive. You know, go get that food. And then there's hedonic hunger, which is driven purely out of emotion, not actual physiologic hunger. So I'll give an example of this. I was working with a group of people who had binge eating disorder in my clinic.

I was running a group medical visit and for the first month or so, we'd meet weekly, for the first month or so. I was like, What am I missing? what am I missing? Because I was trying to trying to help them by using mindfulness to help them work with these these habit loops of binge eating.

And it turned out that they had no idea how to tell the difference between homeostatic and hedonic hunger. And one of them put it beautifully. She just said, Well, I have an urge and I eat, and that I have an urge and I eat really said everything because their brains had just mushed together homeostatic and hedonic hunger.

And some of them, one patient that I'm thinking of in particular. It took years for him to start to dial back into his homeostatic hunger because he was so divorced from his body. And he was so used to just having that that itch of an urge and scratching it by eating, you know, itch, scratch, itch, scratch, itch, scratch. As compared to just sitting with that itch and asking, Am I hungry?

And even being able to tell the difference, you know, like you can. We can ask the question if we're hungry, but if we're divorced from our bodies, then we, then it's really hard to do. I highlight this quite a bit in a chapter in the Hunger Habit, where I start that chapter with this great quote from James Joyce. You know, this is. This is not a new problem. There is a there's a short story, he wrote, called a painful case.

And there is a person in that called Mr. Duffy, and he starts the story with this line I love it, Mr.

Duffy lived a short distance from his body. You know, it highlights it, right? How we're just these walking, walking heads with the body to propel ourselves around. Especially if we're not happy with our bodies. Whether how they look, or how they function, or how they feel, you know, we're going to try to get away from them, except that we're stuck in them.

But the bottom line is, when we take these calorie restriction diets, where we say, you know, it's it's the food rules type of thing, where I'm just going to eat this and not eat this. You know, it's like, calories in, calories out. A lot of people can get some momentum and lose some weight, and then their body goes into starvation mode. Because it says, Hey, hey, where's the food? What are you doing, you know? And so our bodies are built to hold on to calories when there's a lack of calories around, so our metabolism shift. And it actually makes it extremely hard to lose weight.

And so this is now has a term for it because it's so common. It's called yo-yo dieting. And you can imagine you lose some weight, you gain it back, you lose some weight, you gain it back. You know, yo yo, yo, yo yo. So the problem? There are many problems with this, but one of them is that, you know, we think, oh, it's, I just have to stick with the diet and there's something wrong with me.

If I can't do it, I don't have enough willpower. You ready for this? If you ask a neuroscientist, right? So if I put my neuroscience hat on and not my clinician hat?

So in medical school, I learned calories in, calories out. You probably did as well. But and they're like, Oh, duh, it's solved problem, but if it's a solved problem, why are clinical obesity rates going up in the country, right?

So this is not a solved problem. The formula is correct. But if somebody feels like it's their fault, they're going to judge themselves and blame themselves for not being able to stick with the diet. As compared to asking this critical question, which is, Hey, is this how my brain works? the answer is no, that's not how our brain works.

So from a neuroscience standpoint, we when you look at habit formation and habit change, there is no variable in the equation for willpower. It's a myth and so people, there's more of this correlation equals causation thing going on where people think, oh, I just don't have enough willpower. If something worked, they're like it was because of my willpower.

This is likely that we're just telling ourselves stories, you know? If you look at an Alzheimer's patient, you know they're perseverating all the time, or a lot if they have advanced disease. Well, it's likely that we tell stories about our lives after something happened and like, Yeah, I did that, or I didn't do that, or I couldn't do that. One reason I want to highlight this is that often people they judge themselves, they blame themselves, and then they get into these blame shame cycles, which often leads them to eat. You know, I had a patient who had binge eating disorder, who I won't go into the details, but she had some emotional trauma as a young person and had been.

She developed this coping mechanism of eating to, as she put it, numb herself from her emotions. By the time she came to see me, she was about 30. She was binging on entire large pizzas in one sitting, about 20 out of 30 days a month. And the only thing her brain knew how to do was to binge as a way to cope with her unpleasant emotions. So after a binge, sometimes she would feel bad about the binge, and then she would binge again. Because it would trigger that. Oh, feel bad, binge, feel bad, binge.

So she had tried willpower, you know, most of my patients have tried and failed willpower. And this is where I get really excited about science. Because we can step back and say, well, willpower is not working so well. So what does work well? If you look at the neuroscience and you look at the equations, it turns out that there is a variable, an error term. That will help us change behavior. And that is critically dependent upon one thing, which is awareness.

So this comes back to mindfulness. Let's use a pragmatic example, let's say that I have a new bakery that opens up in my neighborhood. And I've got a certain reward value of how good chocolate cake is in my brain, you know, I'm like, this is good chocolate cake. So I go in there and I eat. Go to the bakery and eat some of their chocolate cake, and it's like the best chocolate cake I've ever had.

My brain gets what's called a positive prediction error, this is that error term where it's better than expected. I get a dopamine spritz in my brain and I learn, Hey, good bakery. On the other hand, if I eat the cake and I'm like, Meh, I've had better, I get a negative prediction error dopamine spritz, learn.

So both of those help me change my behavior. If it's good, do it again, if it's not so good, don't do it. Notice how both of these are critically dependent on me paying attention. If I'm on the phone while I eat the cake, I go home and my wife's like, Hey, how was the cake?

I'm like, I don't know, I didn't taste it. So we actually did a study and I highlight this in the hunger habit. So folks, you know, they can read the details in there. But basically, we built this app called Eat Right Now, and built in this tool to help people pay attention as they overeat.

One of the questions we wanted to ask in that study was, how quickly does this reward value change and do people start changing their behavior? We found that as we helped people pay attention as they overate, it took only 10 to 15 times of somebody overeating for that reward value to drop below zero. They're getting these negative prediction errors that said, don't do this, this is not helpful.

Why are you doing this? And they would shift their behavior surprisingly quickly, even if they had the habit of overeating for 30 or 40 years. Which also fits pretty well with the evolutionary, you know, think of it as we don't have 20 times to get chased by the tiger to learn that it is dangerous, you know, our brains are tremendously plastic, so that neuroplasticity helps us adapt. And we can even adapt to something that we've been doing forever, as long as we pay attention.

We can adapt and change, I should say.

And what should folks be seeking out?

Let's just use the overeating if we are in the habit of overeating and we pause enough to pay attention and notice that we are overeating. Right? Because if we don't, then we're just going to keep doing it. That's the definition of a habit is automatic behavior, so we've got to pause, and often that pausing can come from the overeating, causing problems for us.

That's often where we're going to start waking up and saying, Hey, I got to make a change here. So if we get curious and we start just paying attention to what it feels like. When we overeat, we're going to get this negative prediction error. And that is a moment of mindfulness where we're learning, Oh, this isn't so helpful for me. And then we can start to bring that curiosity to the urge to overeat. It might be completion bias, where it's like, we've been part of the clean plate club forever.

And so we can go, Oh, this is what I always do. And so it's uncomfortable to change, right? because change is scary to our brains. Our brains are saying, Hey, this is dangerous, or is this dangerous when something's different? So we can start bringing that curiosity into those moments of cravings and go, Oh, is this dangerous? or is it just different?

And then we can start bringing curiosity to the craving itself and ask, Oh, what does this craving feel like? And we can start to notice. These are thoughts, these are emotions, these are body sensations, and if I just get curious about them, I don't have to do anything to make them go away. Why?

Because they will go away on their own. One of my favorite examples of this was a patient I saw when I was working at the VA hospital. And he comes in and he's like, Doc, if I don't smoke, my head's going to explode. I'm like, Oh crap. First case chief complaint of head exploding from craving.

So I fall back on my whiteboard because that's me. As the professor, my habit is to go to the whiteboard and start mapping stuff out and start diagramming it. So I start to ask him to describe what his craving feels like, and he's like, it's tightness, it's tension, it's burning, it's heat, it's restlessness, and I was asking him to describe the intensity.

And I was drawing an arrow because he said, it's going up, it's up, it's up. And then at some point, it hit this inflection point where it peaked and his eyes got really big. And he said, You know what? I always smoke a cigarette, but I didn't smoke a cigarette and I realized this craving goes away on its own.

Tremendous power in that, in helping him see that he didn't have to smoke. He could simply get curious about what that craving felt like. And it was going to come and go on its own. So, yet again, what's the simplest denominator here? It's curiosity, you know, being aware of these habits, being aware of what we're getting from them. I call this, you know, asking the simple question, What am I getting from this?

Being curious, and then bringing that curiosity in it as its own superpower. To help us be with whatever our thoughts are, whatever our emotions are, whatever our body sensations are. And that's really the crux of what mindfulness is, you know, it's like helping us be with our experience. I think of it as being as the new doing right.

What do I need to do? Well, be, learn to be with this. And it will change on its own, and you can change. You can be in relationship with it differently than you have in the past.

And that really captures a lot of our ability to sort of to activate that neuroplasticity to help us to make decisions that are ultimately the better for us.

That's the power of curiosity.

Judd Brewer is a New York Times bestselling author, and his two books include Unwinding Anxiety and The Hunger Habits. He is a neuroscientist and psychiatrist, and we really, really appreciate you joining us today.

And now it's in human trials, though it's pretty far from being approved for human use. Don't be alarmed if you've never heard of crab. It causes extremely drug-resistant hospital infections. Though infections with crab aren't aggressive, they're extremely tough to treat, which is what makes this new medication such an important breakthrough. Notably, Zosura Balpin is the first new antibiotic that targets gram-negative bacteria in a half a century.

In other good news, hundreds of thousands of North Carolinians got health care late last year. Because Obamacare a little late, right? Well, it only took 14 years for the North Carolina legislature to finally agree that taking billions of dollars in federal money to provide hundreds of thousands of people health care was a no-brainer. 280,000 people enrolled in Expanded Medicaid in Get This, the first week of the program. North Carolina is the 40th state, including D..C. to expand Medicaid.

That leaves another 11 holdouts. That said, given the success the program is having in North Carolina, it may just have been the final trickle before the dam breaks. Several other state holdouts have signaled that they, too, may finally embrace Medicaid expansion. The speaker of Georgia's House, John Burns, recently urged his colleagues to consider expanding quote health coverage, though he's being conspicuously careful not to call it Medicaid or Obamacare. Similarly, top legislators in brick-red Mississippi have also signaled extending Medicaid after Governor Tate Reeves nearly lost his re-election over the issue.

2024 could be full of political surprises and we'll be watching. If you listen to this show, you know that U.S drug prices are way too damn high, and that has nothing to do with the price of manufacturing them. It has everything to do with public policy that favors the interests of the drug manufacturers over the affordability of drugs here in the U.S.

Case in point, my office in downtown Detroit overlooks Windsor, Canada. There, the price of the same exact drugs I could buy at a pharmacy down the street are way, way cheaper. And that implies an obvious arbitrage problem. Arbitrage is what economists call it. When you can buy something for really cheap and sell it for expensive without that much work. So why can't we just buy drugs from Canada and bring them to the U.S, you ask?

In fact, that's something folks here in Michigan have been doing for a long time. But the F.D.A. just cleared the way for mass import of prescription drugs from Canada in a letter to the state of Florida. That plans to start buying directly from Canadian wholesalers. As you can well imagine, pharmaceutical companies are up in arms. They obviously want more Americans to keep buying at inflated American prices because, well, that means they make more money. Canada, for their part, don't like it much either, as the Canadian drug supply is far smaller than ours here in the U.S.

But being Canada, they're probably going to apologize for that. And all of this should force a really obvious question why go through all the trouble of buying prescription drugs at Canadian prices? When we could just change public policy here in the U.S to reduce American pricing? Well, because the prescription drug industry spends hundreds of millions of dollars a year making sure Congress won't do exactly that.

Finally, while Covid hasn't been making headlines, it sure has been making its way around our country. Covid test positivity, hospitalizations and deaths are up. As the JN1 subvariant has climbed to the top of the heap, JN1 is yet another omicron subvariant. It's actually been around since August and is a close relative to the previous king of the heap, Ba.2.86. These omicron subvariants, as you recall, are all mildly different from the last one, each exploiting tiny differences in our immunity. To get to have their moment.

Remember, whenever you hear about a new variant, ask three questions Is it more transmissible? is it more immune-evasive? and does it cause worse disease? The answer, thankfully, to all three of these questions, appears to be no.

That said, the increasing case positivity, hospitalizations and deaths we're seeing is probably a function of the weather. Remember, it's getting colder in much of the country, as I can attest, and folks are spending more time indoors. On top of all that, we've been congregating in medium to large groups for holiday gatherings. All in the context of an abysmally low vaccination uptake, and so JN1 has been loving it, even if we haven't. So look, if you haven't gotten your vaccine, please go do that.

And if your loved ones haven't, either, have a gentle, kind, earnest conversation with them about why you love them and why they should. 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, like right now, please go.

Just five stars, Abdul's great or good information? I really appreciate the show. Also, if you want to rep us, drop by the Crooked Store for some America dissected Merch, and don't forget to follow us at Crooked Media. And me at Abdulelsayed No Dash on the Gram, TikTok and at Twitter.

America dissected is a product of crooked media. Our producer is Austin Fisher. our associate producers are Tara Terpstra and Emma Lickfrank. Cheryl Atlantis mixes and masters the show. production support from Ari Schwartz.

Our theme song is by Takara Sazawa and Alex Uguiera. our executive producers are Leo Duran, Sarah Geismar and me. Dr. Abdulelsayed 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 present the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veterinary Services.