Long time listener, first time caller?  We got one of those, the other day.  David’s brother, Dr. Seth Powsner, requested a live session with the team from Failure—the Podcast/Innovation Blab to take us to task.  We convened on a Saturday to accommodate. 

The good doctor, a professor at Yale and a practicing ER physician, would seem to have the credentials to take us on.  He wouldn’t admit to being a long-time listener of this podcast, but he let on that he’d mistakenly heard our last episode, “Drugged Out.”  (He claims he stumbled over it on a NY Times Wirecutter list of top sleep podcasts).   Turns out that our view of the public health system is all wrong:  only a limited number of diseases can be cured.  We’d thought we’d learned otherwise from a prior guest, who said that the cures were there — including, perhaps, for diabetes — but that financial incentives were keeping them from the market.

The good doctor felt otherwise.  Yes, the health care payment system isn’t optimal, but that isn’t necessarily the issue.  It’s really a question of will.  The collective will of a nation to solve a problem.  Sure, the recently announced diabetes cure may bear fruit.  But, it’s a long way from the lab to marketplace, pointed out Doc.  More likely, the answer will come by solving the root cause:  obesity.  That, says he, will require initiative and the resolve of a nation.  Don’t count on that from a country that can’t even agree on restrictions to another public health crisis:  the AK-47.

We’ve done it before, he points out.  As a nation, we’ve proven we can solve big problems in public health.  Take water fluoridation, an effort that began in the 1950’s to eradicate tooth decay.  By 2020, well over half the U.S. population was getting fluoridation through community water supplies.  Eradication of polio, diphtheria, tetanus, pertussis, measles, mumps, and rubella make the point even better:  in the U.S., well over 80% of school-age children are vaccinated from the ravages of these and other ailments.

The team from Failure—the Podcast/Innovation Blab reminds that parents added fluoride to their toddlers’ morning OJ, before treated water became available.  Perhaps, it’s time to start adding a touch of Ozempic — at least until public works commissions figure out how to get it into community water supplies.   A fat vaccine (aka “faxcine”) offered with the standard series to school children might be even better, though that surely won’t come until there’s a collective will to solve the obesity crisis.  And, by the time the populace bellies up to that bar, we might as well simply start eating better.  That may prove a better cure than even Big Pharma can provide, with or without an adequate reimbursement mechanism. 

In the meanwhile, hold the Ozempic, and pass the iodinated salt.  We may not agree on much, but until a fringe Supreme Court decides that the 1st, 5th and/or 14th Amendments to the Constitution trump … er, Trump? … the power of states to regulate public health, we can agree to protect our thyroid glands.

Enjoy our little detours into the fun of the ER night shift and popular TV shows as we grill Dr. Seth Powsner on the trials and tribulations of improving public health.