Bernie Sanders on a 32-hour workweek, the Long COVID moonshot, and Ozempic

That's C-A-S-E-Y-G-R-A-N-T-S dot org slash book club.

A third case of H5N1 bird flu is diagnosed, this time with more traditional flu-like symptoms. New research shows that bird flu virus can be found in the muscle tissue of infected cows. A study of human and canine testicles finds plastic particles in all of them. And a WHO report found that the pandemic took us back a decade in global life expectancy gains. This is America Dissected, I'm your host, Dr.

Abdul El-Sayed.

To say that American politics is broken is almost quaint. at this point. Our government seems at risk of shutting down every budget cycle. And instead of getting down to the work of legislating, our legislators are usually more interested in using whatever news of the day has grist to drive a cultural war. The gridlock that causes is usually what people mean when they say that government is quote broken.

But there's a broader issue at the heart of our broken politics that I think gets missed, because it's hard to pinpoint. And it's less about what is said than what is not said. See, our politicians have, by and large, ceased to be big thinkers. Most of them spend their careers tinkering on the margins, trying to find marginal wins at the edge of outdated ideas. to address yesterday's problems.

Take the challenge of social media. Even as big tech makes quantum leaps in AI technology, Congress seems forever stuck on the cusp of social media regulation, barely catching up with major technological challenges of the 2010s. It's hard not to conclude that by the time Congress wraps its head around AI, the technology and the incentives driving its creation will have already done their worst. That intellectual ossification is particularly bad in healthcare. It's not just that legislators are failing to solve our problems, but rather they're aiding and abetting them.

The most important class of drugs to be developed this century, GLP-1 agonists like Ozempic and Mugovi, have the risk of bankrupting Medicare. Why? Because prescription drug companies have so wrapped their tentacles around our politics that they can continue to gouge the very government that funds their research and development. Healthcare systems are gobbling each other up at a record pace, simply shutting down low-margin hospitals that just happen to be the only healthcare providers for miles in rural communities across America. Health insurance companies, meanwhile, are raising premiums and deductibles.

So much so that more than 50% of those who incurred bad medical debt in 2023 were insured. And these problems, well, they're not new. They're just the logical endpoints of a set of trends that have been ongoing for decades now. Prices accelerating, insurers passing on those costs to families, hospitals falling into bankruptcy. Rather than address these crippling trends at their heart, politicians and policymakers seem content to debate small-time solutions that don't fundamentally change any of the incentives at play.

And that's probably because it's in their political interests, not to. Healthcare represents three of the top ten largest lobbyists by industry. Coming in at number one is pharma, which spent nearly $4.3 billion, yes, with a B, on lobbying over the past 20 years. At number two comes the insurance industry, spending about $2.8 billion, and hospitals come in at number eight. With so much money spent to shape politicians' opinions, it's no wonder that they have the opinions they do.

And that's not to mention all the money they spend through their PACs and SuperPACs and 527s to help get their folks elected. But our guest today, well, he's bucked that trend. No stranger to being a maverick, he's leveraged his leadership to force conversations that cut to the very heart of what's broken in healthcare. Bernie Sanders is single-handedly responsible for the movement for Medicare for All, holding the first ever hearings about it in the Senate in 2022, where yours truly had the opportunity to testify. But that's not where his leadership ends.

He's just about the only politician still talking about the lagging epidemic of long COVID, and one of very few proposing bold ideas to tackle the possible impact of AI on the future of work. Given his leadership, I wanted to have him on to talk about some of these ideas and more. We discussed the 32-hour workweek, his push for a long COVID moonshot, and the price of Ozempic. Here's my conversation with Chair of the Senate Health Committee, Bernie Sanders.

And you've come out recently with a proposal of legislation that would take us to 32 hours. I'd love to hear. how would that work, and what is the thinking behind trying to reduce those work hours, and what does it mean for people across the country?

But we have not changed the official 40-hour, not moved away from the 40-hour workweek. So the thinking behind what we have proposed is not terribly radical. It says that if workers today are far, far more productive than they were 80 years ago, I want the increased productivity and the wealth that is created from that increased productivity to go to the workers and not just to the CEOs and the corporations. And on top of that, we are a nation where our people work some of the longest hours of any people on earth, any industrialized nation on earth. People in many ways are exhausted.

They don't have enough time for family. They don't have enough time for their friends. Impacts mental health, impacts our way of being as a people. So I think, for a lot of reasons, we should be moving in that direction.

And one of the things I love about this legislation is that you recognize that it's important for us now to recognize that, rather than eliminate whole swaths of jobs and expect the folks who are left over to be working 50, 60 hours a week, instead, the recognition that, rather than eliminate whole aspects of your labor force, what they should be doing is making sure that everybody can work less for that same pay and forcing CEOs to share what they think is going to be money that comes to their bottom lines with workers. And I think that's context that sometimes people miss. I'd love you to reflect on 32 hours in the context of AI.

And then, as you suggest, right now, we're looking at another revolution in technology, AI and robotics. Who's going to benefit from that? Left alone, the large corporations will do exactly as you said. Hey, it's a great opportunity. I got robots.

I got AI. I don't need writers. I don't need factory workers. Throw them all out on the street. We can make more money.

And that is why we have got to fight back right now. It's part of what the trade union movement is organizing around and say, yep, if technology is going to increase productivity, workers are going to benefit from that, not just the 1%.

is you see movement in those directions, both because civil society picks it up or labor unions pick it up. You think about the fight for 15, exactly the story where you see a $15 wage has become the de facto floor in most contexts, even if federal policy hasn't moved. Do you see that happening when it comes to a 32-hour workweek?

People are desperate to spend more time with family and friends. They are overwhelmed in many respects, and COVID obviously exacerbated that problem. So when we talk about our health, you know, you're a physician. You know this better than I do. The role that stress and anxiety plays in 100 different illnesses, all right?

People are stressed out. They're worried economically. They're worried about the future of their kids. They're worried about how they survive. They're sick and tired of going to jobs that often they really don't enjoy.

And all of that contributes to the fact that our life expectancy is much, much lower than it should be. So creating a healthy society means that people should not be exhausted, should not be stressed out, should have the income that they need so that they can spend time with family, friends, enjoy leisure, enjoy culture. It's a hugely important issue.

And it's exactly that. And the thing that I think folks don't appreciate is that people are more productive when they've got their lives in order and they're not rushing to try and live all of their lives two days a week.

They are more focused. They produce more than when they are tired and unhappy. Yeah.

And we're seeing that in the acute sense when it comes to long COVID today. But we don't really know what COVID is going to mean over the long term, 20, 30 years from now. You think about shingles. And what shingles is, is just recurring chicken pox, like 20, 30 years later, because it's coming out of its hiding place as your immune system starts to struggle. And so we don't know what comes later.

And what you're doing is, I think, bucking a political trend where nobody wants to talk about COVID. One of the things I'm frustrated about is Republicans want to pretend like it never happened. And Democrats want to pretend like it's over. And I think you're coming out here and saying, actually, for a lot of people who are struggling with symptoms of long COVID, it's not. And so you've declared a COVID, a long COVID moonshot.

a young woman from California, used to run. Right now, she's on 12 different medications dealing with her symptoms, managed now to have a job. Another woman, maybe 40, 45, loves to work at a community college, has a hard time getting out of bed. Mother of a teenage girl, kid, was social, active, healthy, and now in really, really difficult shape. Point is, over 20 million people suffer from long.

COVID. Government has spent, I think, $1.2 billion up to now. It is not enough. We have talked to the NIH about improving what they're doing. And about more money in order to address the causes, try to come up with treatments that are effective.

We have proposed a 10-year, $10 billion moonshot proposal, which will go a long way to coming up with cures to this very, very serious illness. And that's something we're going to focus on.

It's like the CEOs all stepped up and said, no, no, no, we got to go back to the old way, less people think that they actually deserve healthcare. I want to ask you, what's been the industry response to the long COVID moonshot? And how do you see that playing out over time?

And I think one of the things we want to do with our legislation is to educate physicians about the reality of the disease and how they can best treat at least the symptoms that their patients are experiencing. The point that you made about what we try to do during ARPA and other legislation during COVID is it made obvious sense to us and the American people that, at a time when, you know, hundreds of thousands of people were dying, that we have to make sure that everybody was able to get vaccines, everybody was able to get the healthcare that they need. You know, and I see your book on the, in your bookcase right behind you. You know, and I know that the insurance companies and the drug companies will do everything that they can with their unlimited amounts of money. They're lobbyists all over Capitol Hill, do everything they can to tell the American people, you think healthcare is a human right?

No, it's not. You got to pay for it. It's expensive. You got to pay, you know, top dollar for it. And what you and I know is that as a nation, we're spending twice as much per capita on healthcare as the people of any other nation, and our outcomes in most cases are worse.

I don't know if you talk about it much on the podcast, Abdul, but this issue of life expectancy never gets the attention that it deserves. So here we are spending over $13,000 every man, woman, and child. We live far shorter lives than people in Europe and Asia. And, second of all, in this country, what is beyond belief and never discussed, if you are wealthy and I'm poor, on average, you're going to live 12 or 15 years more than I do in the United States of America. How insane, how cruel is that?

So you and I know that all over the world, healthcare is considered as a human right. The insurance companies do not want the American people to perceive that. They got a lot of money preventing us from moving toward Medicare for all, but you have been a leader on that. I have introduced the legislation here in the Senate. We're going to continue to advance.

It's what the American people want and certainly need.

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And in this long COVID moonshot, you're one of few who's willing to say that COVID is still around. And I worry that, in the haste to move past COVID, we have failed to learn the lessons from COVID that make us safer for the next one. And there is going to be a next one. Could be 100 years from now, could be five years from now, could be tomorrow. I want to ask you, what will it take to actually get us to be thinking about pandemic preparedness and investing in the public health infrastructure we need and deserve in this country?

Tens of millions are uninsured, underinsured. And there is not even the capability of dealing with prevention. I had the heads of the CDC and the other important agencies who are working on the issue of future pandemics. Because you're quite right. The entire scientific community agrees, whether it's next year or 10 years, there will be another pandemic.

Could be even worse than COVID. And I asked a lot of them. I said, are we prepared? No. Are we prepared?

No. Are we prepared? No, we're not prepared. We're not investing in research. And, by the way, what complicates this issue, this is an international issue.

It ain't going to be an American pandemic or a Chinese pandemic. The entire world is going to be impacted. So you need international cooperation. A lot of people around, oh, we can't work with the Chinese. We can't work with this group.

We can't work with that group. So, I mean, I think, our lack of preparedness, and they will, the experts in this country will tell you we are not anywhere near as prepared as we should. Some work is being done, not enough. But it again speaks to a broken and dysfunctional healthcare system, which is more interested in making money for drug companies and insurance companies than investing in prevention and keeping us healthy and keeping us prepared for future pandemics. Now, I will say some good news is the Biden administration has appointed some good people dealing with the high cost of prescription drugs in poor countries around the world.

Generally speaking, in the past, the drug companies were very clear. Their goal was only to make money. So what if a poor country, nobody could afford a drug to keep them alive or to prevent them from becoming sick? In that area, we are beginning to make some product, some progress.

That's just lobbying. And one of the issues that's come up, that's become a real touch point, has been the emergence of these GLP-1 agonists, these near miracle drugs that benefit certainly when it comes to weight loss, but also have cardiovascular and diabetes benefits. But the companies that, by the way, took NIH-funded research to turn these into pharmaceuticals that they sell, are pricing them far higher in this country than in almost any other country in the world.

And both, what does this particular drug or class of drugs teach us about our current system? And what can we be done to solve it?

Right now, as you know, we are paying by far the highest prices in the world for prescription drugs. In some cases, 10 times more. I remember during my campaign, I went from Michigan across the Canadian border, and we bought insulin for one-tenth of the price being paid in the Detroit area. And that's true of many, many drugs. Here is the good news.

The good news is that, for the first time in American history, Congress passed the provision in the Inflation Reduction Act, which will give Medicare the ability to start negotiating prices with the pharmaceutical industry. Up until now, drug companies could charge you any price they wanted. Oh, today is a sunny day. Let's double prices. Let's triple prices.

Hey, I think we could get quadruple. What do you think? Let's do? that. Doesn't matter.

There was no restrictions on what they could do. We're making a little bit of progress. We have put a cap on insulin for seniors at $35 a month. at the start. I have worked very hard, with some success, in dealing with asthma inhalers.

You've got millions of people dealing with asthma in this country. Inhalers can cost $200 or $300.. We've got to put pressure on the major manufacturers. As of June 1st, at least two out of the three major manufacturers, two out of the four, will reduce their price to $35 at the counter. That's a step forward.

Biden has a proposal that nobody in America would have to pay more than $2,000 out-of-pocket. Of course, talked about that in the State of the Union. We're working on legislation to do that. So that's the good news. The bad news is, as you mentioned, these weight loss drugs produced by Novo Nordisk and Eli Lilly, Ozempic, Wegovia, two of the major ones, are having a significant impact in dealing with obesity.

They are very important and, I think, positive drugs. The bad news is that Wegovia costs us, list price, $1,300 in this country. I think it's $59 or so in the United Kingdom, $150 in Canada. So we are paying, in some cases, 10 times more than other countries. We did a study on this.

And if tomorrow, Medicare would say that anybody with obesity could take these drugs, anybody with diabetes could take these drugs, we would end up spending more money just for those tiny sector of drugs, tiny than all other drugs in America. And we'll bankrupt Medicare and our health care system. So we are right now in the process of talking with Novo Nordisk and essentially telling them, hey, stop ripping us off. We are not going to allow you to charge us 10, 20 times more than you're charging people in other countries. So that's kind of where we are in that.

Humans can, in fact, get a respiratory form of H5N1 influenza from cows. That has important implications for how we think about containment. Not only do we need to steer clear of raw milk, but also, given the spread of this virus among cattle, unnecessary and unprotected interaction with cattle right now, particularly in communities where there've been infected cattle, should be avoided. This case and the other one from Michigan also remind us of how critical proper adherence to biosafety protocols and the proper use of PPE among dairy workers is right now. Neither of these last two cases was using the appropriate PPE when they were infected.

In other H5N1 news, up until now, the main focus for potential cow-to-human crossover has been through infected milk. And that's because, as our conversation with our veterinary virologist guest a few weeks back demonstrated, the virus seems to have a predilection for cow udders. But this week, scientists studying H5N1 bird flu infection in dairy cattle found that the virus does, in fact, infect muscle tissue. So why does that matter? Well, it may seem obvious, but when we eat beef, we're mainly consuming the muscle tissue of cattle, which implies that there may be real risk of H5N1 infecting our beef supply.

Though there has been no evidence of H5N1 infection in beef cattle just yet, the findings do suggest that this is at least theoretically possible. I want to step back for a minute here, because, as anyone tracing our knowledge about H5N1 in cattle can surmise, our understanding of this is, at best, non-linear. But it does offer us a great lesson in how science makes progress. Science draws outlines and then fills in the blanks, and over time, we get a more complete picture. That happens because we ask and then answer questions.

As answers emerge and more data clarify our picture, we adjust our knowledge and ask new questions. So far, there has been no evidence of infection in beef cattle, but could it infect them? Up until last week, we didn't really know. And now, we think it could. But then, why doesn't it?

Well, we need more science. Rinse and repeat. For now, given the fact that we have yet to find infection in beef cattle, the risk for transmission through meat is between zero and extremely low. But we'll keep you posted as science progresses. A new study in the journal Toxicological Sciences analyzed 47 canine testicles from neutered dogs and 23 human testicles of deceased men.

You gotta wonder what happened to that other one. you'd expect an even number here. The researchers looked for evidence of any of 12 types of microplastics, and they found that literally every single testicle had microplastics in it. Every single one. For context, testicles have two jobs.

They make testosterone and generate sperm. And for the past few decades, testosterone levels have fallen precipitously, dropping by a third between 2000 and 2016.. Sperm production has dropped by 50% since 1978.. Scientists have chalked it up to lower physical activity and higher adiposity, or fat levels, in men. But this may clarify our understanding.

While it's not a smoking gun, the fact that microplastics seem to concentrate at three times the rate in testicles as other tissues may help us to understand more about what's leading to dropping testosterone, sperm, and fertility rates. Plastic, of course, is unnatural. We make it from petroleum, and because it's cheap and easy to manipulate, we've found all sorts of uses for it. And because it's not natural, it doesn't really break down. It just gets ground down into smaller and smaller particles that wind up, well, in people's balls.

This and other recent findings of both the concentration of microplastics and the health consequences of them should be pushing us to be regulating single-use plastics in packaging and other uses. This is absolutely urgent work. Finally, a WHO report looking at data from 2020 and 2021 laid out the broad consequences of COVID for global life expectancy trends. Life expectancy fell by up to three years in regions like North America and Asia, levels not seen since 2012.. Contrary to a shifting proportion of deaths attributable to chronic illnesses like cardiovascular disease and cancer, COVID also drove a surge in deaths to communicable diseases.

Of course, to COVID itself, but also to other communicable illnesses for which people in lower-income countries were unable to get care. Though we're likely to see a rebound, I worry that some of these trends, well, they're going to persist. For example, vaccination rates for other diseases, like measles, remain far lower in lower-income countries than they had been prior to the pandemic. as pandemic-era myths and disinformation continue to shape uptake. Rates of death to mental illness, particularly through suicide, continue to climb, as the pandemic's long lag continues to shape our mental health.

All of this should remind us, as Senator Sanders did today, that turning our attention away doesn't make the pandemic go away. And we're going to need leadership and political will to continue to deal with the pandemic's long tail. That's it for today. Thank you so much to Bernie Sanders for joining us. And if you have guest recommendations for the show, share them with us at info at incisionmedia.co.

On your way out, please don't forget to rate and review the show. It really does go a long way, particularly now that we are independent. America Dissected is also on YouTube. Follow us on YouTube at Abdul El-Sayed. It's also where you can follow me on Instagram, TikTok, and that place formerly known as Twitter.

Finally, to check out more of my content and subscribe to our newsletter, head on over to incisionmedia.

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Thanks for listening.

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 necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.