Preet Bharara:

Hey folks, I have some exciting news. Stay Tuned with Preet is on the docket again. We’re up for a Signal Award in the News and Politics category. The Signal Awards recognize the best in podcasting and we need you in the jury box. Please head to cafe.com/signal to cast your vote and help the CAFE team get a winning verdict. That’s cafe.com/S-I-G-N-A-L. You can also find the link in the episode show notes. Remember, polls close on October 5th. Thank you as always for your support.

From CAFE and the Vox Media Podcast Network, welcome to Stay Tuned. I’m Preet Bharara.

Dr. Vivek Murthy:

Yes, there are individual health crises that we are having, but I think it’s against the background of what I see as a deeper moral crisis in our country, and it’s a moral crisis and identity crisis where I think we have to double down on who we want to be. What is the character that we want to build back our country on? What is the character that we want to instill in our kids?

Preet Bharara:

That’s Dr. Vivek Murthy. He’s the Surgeon General of the United States. As America’s doctor, he focuses on a number of public health issues including mental health and wellbeing, social connection, health worker burnout and health misinformation. And he serves as an advisor on President Biden’s COVID-19 response team. He’s also the first Surgeon General to host a podcast, House Calls with Dr. Vivek Murthy, where he and his guests explore the importance of human connection and the meaning of life. Earlier this year, Dr. Murthy released “Our Epidemic of Loneliness and Isolation,” an advisory warning us of the mental and physical health effects of social isolation and loneliness. Dr. Murthy and I discussed his role as Surgeon General, the loneliness advisory, social media’s effects on youth mental health and how our country’s response to the pandemic has changed. That’s coming up. Stay Tuned.

Q&A

Now, let’s get to your questions. So it won’t surprise you to learn that I’ve gotten a lot of questions this week about the civil fraud trial of Donald Trump based on a case brought by Attorney General of New York, Letitia James. There’s an email from Carla who asks, “Can you share your thoughts on day one of Trump’s fraud trial?” There’s a thread from @Very_Angry_Skunk who asks, “Any predictions on the Trump fraud case?”

Well, I have a number of thoughts. First, my prediction, to borrow from one of the Rocky movies, pain. As you may already appreciate, there’s already been a ruling on the merits of count one of the complaint. The judge in the case has already decided in response to a partial summary judgment motion made by Leticia James’ office that Donald Trump is liable for engaging in a fraud. That fraud was to inflate the asset value of various properties and things that he owned, and that fraud was the massive inflation of asset values, misrepresentations he made to banks and to insurance companies.

And mostly the trial is going to focus on what the penalty should be. Now, bear in mind also that this trial that’s unfolding on television does not have a jury. It’s the judge, the same judge who ruled in the summary judgment motion, is going to make the final judgment about what the penalty should be. That is not to say the judge has already made up his mind, but we have some understanding of what the judge thinks about the defenses, what the judge thinks about Donald Trump’s credibility and what the judge thinks about the lawyers in the case because he makes that crystal clear in the summary judgment opinion. At various junctures, he calls some of the arguments made by Donald Trump and his lawyers risible or laughable. In other instances, he talks about some of the excuses made and explanations given for the massive overestimation of asset value by saying this is a fantasy world, not the real world.

So he doesn’t sound like he’s amenable to some of the explanations that are given. Now, another question people ask as far as predictions go, will Donald Trump testify? He likes to say that he wants to testify and set the record straight. He talks a big game when he’s not in a courtroom, but he’s done the same thing before in connection with impeachment, in connection with Bob Mueller’s investigation as a special counsel … He often says he wants to come talk, but he knows there are risks involved, and I would predict that if he testified in this case, he would be decimated on cross-examination. Now the problem for him is this is a civil case, not a criminal case. So when he does not testify, the judge, I would expect in a final opinion with respect to the penalty here, would use his failure to testify against him.

He can draw an adverse inference, as you’re allowed to do in civil cases, from the fact that a party chose not to testify. And that I think will be further justification for what I suspect will be a very significant penalty levied on Donald Trump at the end of this trial. Part of the problem for Trump is he didn’t exaggerate a little bit. He didn’t overestimate or over report his assets just a little bit. In the famous example that people keep using with respect to his personal residence in Trump Tower, he reported that it was 30,000 square feet when it was in fact only 11,000 square feet. The judge even, I think, generously allows for the fact that valuations are not exactly a science and that some discrepancies can happen. 10%, 20%, but not 200% as was the case with a number of examples that are given in the opinion with respect to Donald Trump. There’s one instance where Donald Trump valued a property of his, an apartment of his, as being worth more than any apartment had ever been sold for in the history of Manhattan.

That’s the problem for him. He exaggerated and overinflated way too much and it’s going to be impossible to explain. Now, what about one of the defenses that the Trump team is putting forward? And that is that the people who were defrauded or supposedly defrauded, among them, the banks, they didn’t lose any money. They profited from their business with Donald Trump, so there’s no victim, so there’s no harm, there’s no foul. First of all, that’s already been litigated in the summary judgment motion, and so it’s not clear why they’re making those arguments again when we’re mostly in the penalty phase. So I think it’ll fall on deaf ears. The other problem is they’re ignoring a legal principle. There are two different concepts at play here. One is the idea of restitution, right? So if you defraud someone and you’re a victim of the fraud, one theory of how a penalty should be applied is based on what the loss was to the victim. That’s restitution.

And here of course, they’re arguing that there’s no restitution. The banks didn’t lose money, so there should be no penalty. But that’s not the theory that’s operative here. As the judge points out repeatedly in his opinion before the trial began, what’s at play here is a disgorgement theory which focuses not on the loss to a victim, but on the ill-gotten gains by the miscreant, by the person engaged in the misconduct or the fraud. And on that theory, Donald Trump gained significantly. So it’s not about restitution and victims, it’s about disgorgement and ill-gotten gains. That’s why Donald Trump is not going to do well at this trial, in addition to all the other reasons I mentioned.

This email comes from Chris, “Hi Preet. First time, long time. My girlfriend is a 1L, meaning a first year, at NYU Law School and the one question she repeatedly asks me is along the lines of do I pursue public service or big law? Given the speed with which a path must be forged, do you have any advice for someone who is genuinely interested in both and which path is best to start with it? It is easier to switch from the public sector into big law or from big law to the public? Thanks so much for your help. Best, A useless as it pertains to the law but supportive boyfriend and massive fan and listener of Stay Tuned podcast.”

Well, Chris, you’re asking a lot of great questions. So, I’m pleased to answer the question, although I don’t have a definitive clear answer because everyone’s different, and everyone has different interests and needs and financial interests as well. But since I teach at NYU Law School, I’ll tell you what I tell some of my students every year at the end of the seminar I teach in the spring. I’m a big fan and promoter of public service, as you might appreciate. I absolutely encourage and advocate anyone who has some pension for public service to do that, whether you’re a lawyer or not, actually. I also think depending on what your interests are, you can start with public service or you can start at a law firm. It doesn’t really matter.

I’ll give you the example of my experience. I went to law school knowing I wanted to be a federal prosecutor in the Southern District of New York at some point, but SDNY for the most part does not take people out of law school. They want you to get some experience elsewhere first. So I went to a law firm, a big law firm, so to speak. Then I went to a smaller law firm, and I actually spent six years in private practice in what you call big law before going to the US Attorney’s Office, and then I spent 17 years in public service.

Then when I left that job after being fired by Donald Trump, I started this media company, the thing that allows you to listen to this podcast, with my brother Vinny. And then once again, I’m practicing law at a large law firm. So private sector, public sector, private sector once again. Some people do it the other way. There are lots of people that I know who joined public service right out of law school. They went to the public defender’s office or the DA’s office or the Legal Aid Society, did that for a number of years, then left for private practice. That happens all the time as well. Part of it depends on what your financial needs and interests are. If you come out of law school like a lot of people do loaded with debt, it sometimes makes sense to go practice law at a big firm for a while so you can pay off some of that debt and then enter public service later.

And by the way, you can do both at the same time. Lots of law firms, including my own, have very, very robust pro bono programs. So you represent private clients of course, but you also represent people in need who can’t afford legal services. Pro bono is a very, very viable way to fulfill your interest in giving back to your community and your country while you practice law at a firm. I’m a big fan of doing public service whenever you can, whether it’s at the start of your career, in the middle of your career, at the end of it, or throughout your whole period of time practicing law. Good luck to you and good luck to your girlfriend.

This question comes in a tweet from Twitter user @Unclouded. “#AskPreet. What is jury nullification and what do you and your colleagues think about it?” Well, that’s a good question. Jury nullification is basically a phenomenon in which a juror or jurors, based on their own sense of what’s right and wrong and what should or should not be prosecuted, ignore the law, ignore the facts, and essentially acquit a defendant even though the evidence pointed to guilt or may have pointed to guilt. So, I’ll give you an example, and this happens from time to time in courts around the country, state, and federal court. If someone manages to get on the jury and gets through the voir dire process by saying they can be fair but actually believe that the drug laws are an abomination and drugs should be legalized and no one should go to prison for distributing drugs, and they get seated in a drug trial, it would be jury nullification if that juror based on his or her own perspective about the drug laws votes to acquit, even if the evidence is overwhelming of the defendant’s guilt. That’s jury nullification.

As to the second part of your question, what do you and your colleagues think about it? Well, it depends on which colleagues you’re talking about. Prosecutors, by definition, if they bring a case and they think it’s righteous and in the interest of justice to convict someone of a crime as they’re enforcing a particular law, obviously want the conviction to happen, and they don’t want nullification because nullification by definition means no conviction. And I think prosecutors generally think that jury nullification, although it happens and you accept its existence from time to time, is an abdication of what the jury is required to do. It’s an abdication of the oath.

Now, if you’re a defense lawyer and that’s what you do for a living, in a particular case where the evidence is strong and the facts are bad and the law is bad for you, you might embrace jury nullification. In fact, defense lawyers all the time implicitly argue, if they can get away with it, for jury nullification because they don’t want their client to be convicted. So I guess the bottom line is jury nullification is a thing that happens. It’s a phenomenon that has been written about, studied to some degree. It is not something that is able to be advocated or permitted to be advocated in court. You can’t get up in court as a defense lawyer and say, “The drug laws are terrible. No one should be convicted under the drug laws, therefore you should engage in jury nullification and acquit my client.” That’s not permitted. Judges don’t allow that because as I said before, to not weigh the facts and the evidence is a violation of your oath as a juror.

Now, in a lot of cases, prosecutors will say when they get a bad result from their perspective that it was jury nullification, but often it’s not going to be possible to know. There’s nothing wrong with a juror finding that there was insufficient evidence or the instructions given by the judge required consistent with their own conscience to acquit the defendant. Some people might’ve thought there was a lot of evidence, maybe that particular juror thought there wasn’t. So it will often be the case when there’s an acquittal or a hung jury, was jury nullification at play or not? It’s hard to know. Sometimes you will know, however, if a juror or jurors speak to the public or speak to the defense team or the prosecution team and say, in my example from before, “I think the drug laws are terrible. No one should go to jail for it, therefore I voted to acquit.” But aside from that, sometimes it’s hard to know.

I’ll be right back with my conversation with Dr. Vivek Murthy.

THE INTERVIEW

Dr. Vivek Murthy served as the 19th Surgeon General under President Obama and is currently serving as the nation’s 21st Surgeon General under President Biden. We discuss the power of human connection and the ways in which loneliness affects our lives. Dr. Vivek Murthy, welcome to the show.

Dr. Vivek Murthy:

Thanks so much, Preet. I’m glad we’re having this conversation.

Preet Bharara:

We have so much to talk about that’s very important, that’s on your agenda and should be on the agenda of every American as it relates to health and wellbeing. But before we do that, so your name is Vivek, which is a not uncommon Indian name. There’s another Vivek who’s been getting a lot of attention lately running for president, Vivek Ramaswamy. Have you ever been confused for the other guy?

Dr. Vivek Murthy:

You know, I have been actually. Other people, in conversation have sometimes assumed that I might be Vivek Ramaswamy, and I’ve seen on news networks sometimes that they have confused us, as well. Sometimes used pictures of one of us interchangeably for the other. So, it has happened-

Preet Bharara:

Wait, they use a picture of you for Vivek Ramaswamy?

Dr. Vivek Murthy:

I have seen that happen, yes.

Preet Bharara:

And then, do you call the Justice Department and bring the weight of the law on those people?

Dr. Vivek Murthy:

No, no. I just have a good laugh, and I love the fact that more people can pronounce Vivek properly now.

Preet Bharara:

Yes, Vivek.

Dr. Vivek Murthy:

So, that’s a good thing.

Preet Bharara:

Good. So one more preliminary thing before we get into your role and your mission. When I was growing up, the Surgeon General was C. Everett Koop. Do we remember him?

Dr. Vivek Murthy:

Yes.

Preet Bharara:

And, he paid a lot of attention to the problem of smoking in America. You don’t hear much about that. Does that occupy any portion of your time as Surgeon General in the modern era?

Dr. Vivek Murthy:

It absolutely does, but you are right in that we hear less about tobacco than we did back in the 1980’s when C. Everett Koop was Surgeon General. There are many reasons for that, but what’s important … for example, one of the reasons for that is that we have certainly made a lot of progress on tobacco. People are more aware of the harmful effects of tobacco versus when Dr. Koop was Surgeon General, the awareness was much less. But there are also other issues that we find have taken center stage, like the opioid epidemic, the mental health crisis, COVID and other issues over the last few years that have dominated public health attention. The reason I’m glad you brought that up is because still today tobacco costs us nearly half a million lives a year. It is one of the leading killers in our country, and we have to keep that in mind because we have not solved the tobacco problem.

Many people think, “Oh, cigarettes, we took care of that, right?” No, it turns out that whether it’s cigarettes or whether it’s now the rise of e-cigarettes among young people, or the use of smokeless tobacco like chewing tobacco and other substances, we are seeing more illnesses including cancer, heart disease, diabetes, and others, which are linked to tobacco use. So, our office still does focus on that. We in fact have some work that will be coming out in the months ahead on tobacco. But yes, it continues to be a public health focus for the Office of the Surgeon General.

Preet Bharara:

That’s interesting. Let’s take a step back. Explain to people what the Surgeon General does, what the Surgeon General’s office’s authorities and powers are and how you’re different from the other health agencies that we talk about in this country, the CDC, the NIH, HHS, et cetera.

Dr. Vivek Murthy:

Well, great question. I think many people have heard of the Office of the Surgeon General, but they may not know what the Surgeon General does. The Surgeon General has two primary responsibilities. The first is to communicate directly with the public about issues of critical health importance. That could be about chronic illnesses like heart disease and diabetes. It could be about an acute threat that’s emerged. That was COVID over the last few years, but in my prior stint to Surgeon General, that was also Ebola and the Zika virus. But it can also be helping to make sure people understand not just what the problem is, but what they can do to address it. What steps can they take in their lives and their families to actually help protect themselves against those concerns? So that is one of the key roles of the Surgeon General, and there are a variety of ways through which that communication happens.

The Surgeon General reports speaking directly to the public using new channels. I’ve tried during my time, both the first time I served and this time around, to see how we can modernize the Office of the Surgeon General. We began, for example, a podcast called House Calls with Dr. Vivek Murthy to help create another channel to get the message out about health issues. So, that is one of the key jobs.

The other responsibility of the Surgeon General, which is less known but equally as important, is to oversee one of our eight uniformed services in the federal government, and that is the US Public Health Service Commission Corps. These are 6,000 uniformed officers. They include doctors and nurses, physical therapists, pharmacists, public health engineers, and many other health professionals who serve in public health roles in federal agencies across the country. But we deploy them during times of emergency to help with providing direct care after hurricanes and tornadoes, to help stand up and strengthen the public health infrastructure during major threats like Ebola or Zika or more recently COVID-19. And, we sent hundreds of them to Liberia, for example, during the Ebola outbreak in 2014 to help provide care and to help ensure that volunteers and residents in Liberia were cared for during that Ebola outbreak. So, I’m very proud of those officers. They do an extraordinarily important job helping protect the health of our nation.

Preet Bharara:

Do you think we need more doctors in Congress?

Dr. Vivek Murthy:

Yes. I also think we need more nurses in Congress.

Preet Bharara:

And fewer lawyers?

Dr. Vivek Murthy:

And pharmacists. Well, no. Look, I’ve got nothing against lawyers. In fact-

Preet Bharara:

No, but we have too … Look, I’m a lawyer and I got nothing against lawyers, but we could use some people from other professions. Although, I have not been enamored of every medical professional in Congress either.

Dr. Vivek Murthy:

Hey, look, no one’s perfect. Lawyers or medical professionals, none of them are. But the diversity of their voices matters when you’re making complex decisions on policy. And so that’s where, particularly when it comes to healthcare, you need people who have lived experience delivering care, working in the healthcare system, having experienced illness themselves. You need a variety of perspectives to ultimately shape what good policy ultimately becomes. And the absence of that, I think, really does a disservice to us because I think a lot of times people’s intentions are good and legislative bodies when they’re trying to solve a problem, but as I’ve seen up close, and I suspect you’ve seen this as well during your time in public service, Preet, you get to these points where sometimes there are five or six people sitting in a room and they’re having a discussion about how to respond to something or how to shape a policy or final comments before a proposal goes up to legislators.

And it’s the people in that room who have a major degree of influence about what is said, what’s proposed, what’s ultimately put into law. Who’s in that room matters, and this is where I think the more diversity we have in our legislative bodies, and that’s not just by profession, but also in terms of age and background, I think that helps us ultimately fashion solutions that do work for everyone.

Preet Bharara:

Are we training our doctors properly in this country? Our medical program, do we train them for the right number of years, have the proper policies in place for residencies? Or, does the medical profession, and we have these conversations about the legal profession all the time also, does medical education and training need any kind of reform in your view?

Dr. Vivek Murthy:

Yes, it does. It is good in many ways. We train some of the best doctors in the world, no question about that. But we can get better, and we need to get better because the needs of the patients we’re caring for are actually shifting and changing. And, I’ll tell you a few ways in which they are. One of the things that we have historically not done a great job of in medicine is focusing on prevention. Thinking about how can you engage in terms of your nutrition, your sleep, your physical activity in ways that will actually help and reduce the likelihood that you’ll get sick in the first place? We are very good at treating illness once it arises in medicine. We are less proficient at helping individuals and communities prevent illness. And so, that’s a place where I think our medical training could be stronger.

Another place where I think we could do better in our medical training is when it comes to behavioral health, so mental health conditions, substance use disorders. This is a place, again, historically there hasn’t been as much emphasis but we’re seeing time and time again in survey after survey, in tally after tally, that the toll in terms of illness and life lost to the addiction crisis in American, to mental health concerns, especially suicide, is unfortunately just continued to go in the wrong direction. So this is a place where we need our clinicians to be quite proficient at how to both recognize and assess behavioral health conditions, but then also either treat people directly or connect them to treatment.

So, I think these are ways that we can get better as a medical profession. But I also think as a country, Preet, we’ve got to make it a bit easier for people to go through medical training. We saddle our medical providers with massive amounts of debt, often in the hundreds of thousands of dollars, and then we wonder why it is that they don’t want to do primary care and go into very high paying subspecialty fields. And so I think that as a country, if we think that, as I believe we do, that we need more doctors and we need more nurses to serve patients, then I think we’ve got to think more critically about how we make medical training easier, less financially burdensome and how we also frankly make the practice of medicine what it should be, which is an opportunity for a doctor and a nurse to work closely and directly with a patient to provide care.

As opposed to what it unfortunately has been trending toward in the last decade or two, which is more and more time in front of screens, more and more time answering questions from insurance companies, dealing with prior authorizations and other barriers to care, which don’t serve patients and certainly don’t serve health workers.

Preet Bharara:

Do we have a deficit of primary care physicians in this country?

Dr. Vivek Murthy:

Absolutely, yes, we do.

Preet Bharara:

Because in your mind, based on what you said a minute ago, there’s an incentive to go into specialized areas because they’re more lucrative.

Dr. Vivek Murthy:

Yeah, because they’re more lucrative and also I think because the quality of work for many primary care doctors is not what it should be. I’ll tell you this, and I trained in a primary care program, Preet. My dad is a primary care doctor. My sister is a primary care doctor. The reason we went into primary care training, and that they’re doing primary care is similar to why many people do primary care. They want to be able to have a good relationship with the patient, to have a holistic involvement in their health, to be able to be a part of their lives. But what many primary care doctors are finding is that it’s becoming harder and harder for them to do that. They’re spending more time with the administrative and bureaucratic pieces of medicine, which only seem to increase with time. They’re finding that in addition to that happening, that what’s being asked of them is also increasing.

It’s not a coincidence that many times when guidelines come out or when recommendations are written, people will say, “Well, you should see your primary care doctor about that issue. You should see your primary care doctor about that issue.” And so we’re adding more to the plate of primary care doctors while saddling them with more administrative burden, and many of them are also carrying a fair amount of debt from their medical training. And I’m not talking about $5,000, $10,000, $20,000 in debt. It’s not uncommon for me to talk to primary care doctors who are dealing with $150, $200,000 in debt and paying it off for decades. So it essentially constitutes another mortgage for them.

So again, this is not to say again … physicians, again, in the grand scheme of things, they make decent money. They can take care of their families. That’s a good thing and that’s important, but I think if we want more people to go into primary care, we’ve got to make the work easier for them, reduce that administrative burden and reduce some of the debt burden that so many of them are carrying.

Preet Bharara:

You mentioned mental health a few minutes ago, and I think it’s an under-discussed and under-emphasized issue, although I think it’s being focused on more in recent years. Can you make the case, if there’s a case to be made, and there’s a lot of work to be done and we’ll get to the problems in a moment, but from an optimist’s point of view, can you make the case for how focus on and resources expended on and attention to mental health has improved over the last few decades, both in terms of stigma, cost, access, insurance, and the rest? Have we gotten better?

Dr. Vivek Murthy:

So, the short answer is yes, we have. And actually, I do think mental health, while it’s an area of great need, there’s actually a very encouraging story here that reminds me often that when we do put our minds and our heads and our hearts together to focus on an issue of great concern that we can make progress. And so, I’ll tell you some of the ways in which we made progress. For years and years, it was true that mental health was the stepchild of physical health. It didn’t get the same amount of attention, training, support in clinics and hospital settings and medical education. But what we’ve seen start to shift is a couple of things. In the last, I would say decade plus, we’ve seen a greater willingness to talk about mental health openly.

So the issue of stigma has been coming down. It’s still there, so people still feel ashamed to talk about mental illness, but that change, that cultural shift is happening, in part, driven by younger generations who, to their credit, have just realized that there’s no use, there’s no purpose served in us shying away from talking about something that so many of us are going through. And so, they’re really helping change that.

Preet Bharara:

Are you able to quantify whether there are studies that quantify or have a metric for the reduction in stigma in this area or not?

Dr. Vivek Murthy:

I think there may be some surveys out there, I’m not entirely familiar with them, that may try to do that. I think it’s hard to quantitate for a few reasons. One, because getting a sense of people’s shame is tricky because everybody thinks about this a bit differently. They’re not always willing to even speak openly or admit that they feel a sense of shame-

Preet Bharara:

By the very nature of the thing.

Dr. Vivek Murthy:

Yeah, exactly. So surveys are very tricky in this area. But, I think many of us, especially those of us who maybe in our 40’s, 50’s, 60’s can look back and very clearly feel like you’re reading more about people coming forward with their stories about mental health. You’re hearing about it more in workplaces. You’re certainly seeing schools, in universities and grade schools, you’re seeing much more conversation about mental health. So, all of that, and even if you look at legislators, you see more lawmakers, public figures, talking about mental health, about their own personal experiences, their family’s experiences. All of that is a sea change from what it was 20 years ago, but it’s not the only place where we made progress.

Even though we need to do more in terms of getting mental health training into medical education to a greater degree, we now have more curriculum dedicated to mental health, which is good, in medical schools. We have from a coverage perspective, we had a Parity Law that was passed in 2008, the Addiction Equity and Mental Health Parity Act, which was intended to require insurance companies to compensate and reimburse for mental health on par with physical healthcare and to no longer discriminate between the two. That was a step forward. It still had gaps because it wasn’t being adequately enforced and there were other barriers insurance companies were throwing up.

So, just about a month ago, President Biden announced that the Department of Health and Human Services in partnership with other parts of the administration were now putting forward rules to strengthen the Parity Law and close some of those loopholes. So, I do think on the reimbursement place, we’re making a difference.

And lastly, I’ll say when it comes to the provision of care itself, we have, I think, seen as this has happened particularly over the last three years during COVID, we’ve seen a surge in the use of telemedicine, which is actually now helping to extend our ability to bring mental health care to people and to parts of the country that were having a really hard time getting it. Think about rural areas which may only have one or two mental health care providers for a large number of people. If you can now also get your mental health care through a virtual screen, through telemedicine for somebody who might be in another state, another part of your state, that increases access. And that was something that was directly impacted by COVID which accelerated the use of telemedicine.

So, these are all good things that are happening. There’s even more that’s happening. We’ve seen the last couple of years, Preet, the largest investment in mental health that I believe that I’ve seen in my nearly 30 years in public health. That’s a testament to what we can do as a country when we put our minds to it. And, we’ve got a lot more to do so I hope that we don’t take our eye off the ball and say, “Hey, we solved the mental health problem.” We didn’t. It’s still a challenge and more has to be done.

Preet Bharara:

With respect to telemedicine, my understanding anecdotally from colleagues and friends is that there’s a problem in some states. So to become licensed as a mental health professional, that depends on the vagaries of your particular state. So it is not always true that if you live in state A and there’s an available and affordable mental health professional in state B, that legally you can do telemedicine. Am I right about that?

Dr. Vivek Murthy:

So you’re right that there have been barriers to providing that care across state lines, and one of the things that happened during the pandemic, there was actually in that emergency permission and authorities given to provide care across state lines. What many people said, including the president … I certainly strongly believe this, many in the mental health field do as well, is that those authorities should be made permanent, that there is no reason that somebody who is struggling with depression in Nebraska shouldn’t be able to get care from a mental health provider in Illinois virtually.

And so, there was an extension given to those authorities in the Omnibus that was passed in the end of 2022, but there needs to be a push, as many are pushing now, to make those authorities permanent because, especially when you’re dealing with a pool of providers that are too small, we need to increase people’s abilities to access their care in as many ways as possible.

Preet Bharara:

Can you explain the logic? This is maybe a dumb question. So I’m a lawyer by training, and you have to be admitted to the bar of each particular state that you practice in, but that makes sense in my mind because although there’s overlapping legal principles in every state, every state has different laws. Probate laws are different, divorce laws are different, business laws are different. As far as I’m aware, generally speaking, the human body is the same in all 50 states. Why do we require separate licensure processes in each state? And, maybe I’m missing something, but would there be value in having a national standard for both physical medical and mental medical professionals?

Dr. Vivek Murthy:

Yeah, it’s a good question, and I’ll tell you my personal view on this. This is certainly not reflective of a broader stance from the administration. But my personal view on this is that it would be much more efficient if we had more of a national model than a state-based model. That’s not to say that states may not have additional requirements that they may want to make. For example, if you’re living in a state which has a particular challenge with disease X, you might want your healthcare providers in that state to take a continuing medical education course and be proficient in how to recognize and treat that illness. So you could still have that, you could tailor some of the additional training for clinicians living in a state, but the notion that you have to go through an entire new vetting process and a re-credentialing process for every time you move from one state to another state, to me, that doesn’t entirely make sense because much of the practice of medicine is similar.

The criteria for depression doesn’t change depending on what state you’re in. And so, I do think it makes sense in an ideal world to have more of a national accreditation type model with the ability of states to layer on some additional requirements.

Preet Bharara:

Okay. Let’s get that done, Doctor. I’m on board. One more question about this, then I want to talk about your loneliness report. So I’ve been hearing some people talk very excitedly in many, many different areas, and we’ve talked about this on the podcast a million times, but artificial intelligence, AI, but the particular application of AI for use in therapy.

In other words, you have a sufficiently trained and artificially intelligent large language model chatbot who can be available to someone to interact with them and provide therapy at any hour of the day very cheaply and without judgment, because it’s not really a human being. Is that a pie in the sky thing? Do you have concerns about people going to therapy with artificial intelligence? What’s your thinking about that and what do you think the future is?

Dr. Vivek Murthy:

Such a good question, and part of this broader question of how AI is going to impact healthcare. Look, I do think that AI has a lot that it can add to healthcare more broadly, and in particular to mental healthcare. And AI-based tools could be very helpful in, for example, helping detect some of what may be initially very subtle signs that somebody may be heading the wrong way in terms of their mental health or moving toward a mental health crisis. And, I do think from a counseling perspective, there may very well may be AI-based tools that could help actually dialogue with a patient who may be struggling and help guide them in questions to ask or to reflect on some of their experiences.

Two things I think that are critical here though is one is before we wholesale say that AI can replace clinicians, I think number one, we have to pursue this in a very evidence-based way. We have to study this, look at what the evidence is in trials that shows us whether or not AI-based tools actually help patients or not, and use that to guide what we further develop and create access to.

What I secondly think though is also important is I still believe that there’s going to be an important role for a human being in this process, not just in the provision of mental health care, but in the provision of physical healthcare as well. I think that there’s a lot that AI can help do from gathering and assessing records, to helping go through the medical literature to look for potential diagnoses and treatments, and to check a potential approach that a doctor might be taking against established guidelines. There’s a lot of ways in which AI can be helpful, but at the end of the day, Preet, a machine can’t hold your hand and look into your eyes and understand in a deeply human way the loss that you’ve just gone through or the pain that you’re experiencing. And, I think that’s a very human experience.

One of the things I learned early on in my medical experience, Preet, and I learned this from wise mentors who guided me, was they helped me understand that the therapeutic effect we can have as doctors is not solely mediated by the medicines that we prescribe or the surgeries that we might do. It’s also mediated through the relationships that we build with our patients, which have their own therapeutic value. And that is something that I don’t think you immediately replace with AI. So, I see AI as augmenting our ability-

Preet Bharara:

But the operative word there, Doctor, is immediately. And people are predicting, and maybe it’s happened in some cases, it certainly has happened in the movies, we’re making an assumption that you can’t develop a relationship with an AI chatbot, and some people think that that will happen. Is that a bad thing?

Dr. Vivek Murthy:

Well, it depends. Look, I certainly think it’s possible that people will get to the point where they feel they have a relationship with an AI chatbot. Absolutely. In fact, I think that’s happening already in some circumstances. So the question isn’t so much is that a bad thing? In my mind, the question is that sufficient? And, I don’t think we know that. I think is to actually test this and to actually study it. But my gut feeling is that there will still be an important role that human beings play in this process. It’s not that AI-based tools can’t help you get started on a process or clarify what may be happening to you or alert you to when you may be heading in the wrong direction or spiraling. It’s not that they can’t help you along the therapeutic process, but I suspect, especially in more complex cases, that the role for a human being will always be there.

Preet Bharara:

I’ll be right back with Dr. Murthy after this.

A few months ago, you released what you call the Surgeon General’s Advisory on Our Epidemic of Loneliness and Isolation, which I think is very important related to mental health, overlapping with mental health. We’ve talked about this issue on the podcast before, as listeners may recall, specifically about the decreasing number of close friends that people have, especially among males compared to a few decades ago. Some of this is due to social media, screen time, et cetera. Can you tell folks what was your thinking in doing this advisory? What your conclusions where and where we go?

Dr. Vivek Murthy:

Yeah, you know, Preet, this was an issue I was not planning to work on. If you had asked me during my first stint as Surgeon General when I was starting that off what were my priorities, I would not have told you loneliness was one of them. But, this is one of the things that one of my mentors, August Fortin, taught me in medical school. He said, “Vivek, if you listen to a patient long enough, they’ll often tell you what’s wrong with them, what’s going on. But you’ve got to listen.” And so I was thinking about that when I began my first stint as Surgeon General, and I had this listening tour that I began with. And I would just go to different towns across America and just ask people, “How can I help?” And then try to just shut up and listen to what they had to say. And, some of the things that I heard were what you would expect, Preet. I heard that people were concerned about diabetes and heart disease going up. They were worried about cancer rates. They were concerned about violence in their communities.

But what I didn’t expect, Preet, was that I started to hear more and more stories that sounded like people were lonely. And, they wouldn’t use that word. They wouldn’t say, “Hi, my name’s Preet, or My name’s Vivek. I’m lonely.” They would say things like, “You know, I just feel like all these burdens in my life, I’m just carrying them by myself.” Or college students, I remember a college student on the campus of a large public university in the south told me, she said, “I’m surrounded by all these other students, but I just feel like nobody really knows me and I can’t be myself.” I’ve heard so many others tell me that they feel invisible as they walk through life and if they disappear tomorrow, nobody would even care. And, I was hearing this, Preet, interestingly from people who were younger and older.

I was hearing them from parents, from CEOs, from members of Congress who would tell me behind closed doors of how they were struggling with loneliness. It seemed like everyone that I talked to, there was some way, or shape or form in which loneliness was touching their lives or the lives of people around them. And so that led me down this path to investigate more deeply. And I discovered two things in that investigation, which ultimately led me to issue this report. One was that loneliness is extraordinarily common. So what I was hearing anecdotally was not a one-off. It turns out one in two adults are struggling with measurable levels of loneliness, and the numbers are actually much higher among kids.

But the second thing I learned was just how consequential loneliness can be, that there was more and more data telling us that when people struggled with a sense of disconnection, of being lonely or being isolated, that their risk of depression, anxiety and suicide went up, but their risk of physical illness went up as well, including heart disease, dementia, premature death, and on it went.

So that helped me understand something I didn’t know before, which was that loneliness was much more than a bad feeling. It was a public health issue and one that has both immediate and long-term effects on our wellbeing. I’d be remiss, Preet, if I didn’t also say that there’s a personal element to all of this as well for me, which is that even though I didn’t think of this as a priority or a public health issue in the beginning, it was an issue that was familiar to me. I had struggled a lot with loneliness as a child. There were many times I faked having a stomach ache because I didn’t want to go to school. And, this was in elementary school, and it was not because I was scared of teachers or tests. It was I didn’t want to walk into that cafeteria one more time and feel like I wouldn’t have anyone to sit next to. Or, I didn’t want to-

Preet Bharara:

We could have sat with each other.

Dr. Vivek Murthy:

We could have. I wish I had known you then, Preet.

Preet Bharara:

But we went to different schools and in different decades.

Dr. Vivek Murthy:

Yeah. But Preet, the interesting thing is I’ve talked to classmates since then, who I went to school with, and the funny thing is I thought I was the only one feeling that way during that time, and many of them said, “Hey, I was feeling that way, too. I didn’t know other people were.” It was a representation of just how loneliness has cascaded across our country is it’s made us feel badly. It’s had an impact on our health, but we felt like we’re probably the only ones going through this. Because you look around, whether you’re looking at someone’s social media feed or at how they hold themselves in the public sphere or in private conversation, and we’ve become professionals at putting masks on and making it seem like everything is great about our lives, yet so many people are in fact struggling.

Preet Bharara:

Well, the only people you see who are not your friends are in public, and people are going to be more social interacting in public. You got to a party, nobody looks lonely necessarily. But, you’re not seeing all the people who are sitting at home wishing they had a friend they could talk to.

Dr. Vivek Murthy:

Yeah, and even at parties, Preet … I don’t know, Preet, if you’ve ever had this experience-

Preet Bharara:

Never been to a party.

Dr. Vivek Murthy:

I know for sure that you have because you and I were at a big gathering some years ago. But no, the thing I’ve noticed is that in my experience is sometimes you can even be at a party and not feel like you’re connecting with everyone-

Preet Bharara:

That’s fair, yes.

Dr. Vivek Murthy:

And feel like, “Gosh-

Preet Bharara:

I’ve been at parties like that too, particularly when I was young.

Dr. Vivek Murthy:

Yeah. So, this is very common but it’s one of those things where many, many people are suffering in silence by themselves, not recognizing that this is a really collective struggle that we’re going through. And so, I issued the advisory on loneliness and isolation, Preet, because I one, wanted people to know that this is an extremely common issue. I wanted them to also know that it’s a really consequential issue for our health. Not just our individual health, but the health of society. We know that when communities are more connected, Preet, that they tend to be more economically prosperous, they tend to have lower rates of violence. They also tend to be more resilient in the face of adversity, like hurricanes or tornadoes.

So in the advisory, I lay out not just the extent of the problem but the framework for a national strategy for how we can, as a country, start to address a loneliness crisis, which I worry is stealing away our health, our vitality and our wellbeing.

Preet Bharara:

So, the pandemic obviously had an impact on this issue. Do you think the issue of the loneliness and the trend toward this probably predated the pandemic and was only exacerbated by it? Or, did the pandemic in some way provoke this crisis that you’ve written about?

Dr. Vivek Murthy:

So it definitely preceded the pandemic. The pandemic certainly poured gasoline on the fire, but this was an inferno long before COVID arrived on the scene. And, it was a quiet one and it was the result of a few things, Preet, that were happening pre-COVID. One, in the half century or so prior to COVID, there was a decline, a significant decline, in people’s participation in the organizations that used to bring us together, including-

Preet Bharara:

Including church.

Dr. Vivek Murthy:

Including church and other faith organizations, recreational leagues, service organizations. Participation in all of those went down. But the other thing that had happened is that we became the beneficiaries of this extraordinary time saving … in some cases time saving … technology, which has allowed us to get packages delivered to our door, never need to go to the grocery story anymore or a retail store. You can get everything to come to you. You don’t have to go to a movie theater. You can get everything in your home, and that is convenient but one of the actually consequences of that is we have less interaction with each other, including with strangers, with neighbors, community members.

But I do think, Preet, also that the advent of social media, I worry, even though the term social media would seem like the goal is to bring people together. And, I do think that was probably the goal but I think the effect for many people has been that they ended up substituting what used to be offline relationships for online relationships that were often of lower quality. And it also, I think, the use of social media for many people, especially young people, led them to experience a erosion of self-esteem as they constantly compare themselves to not just a few people a day, as I did when I was in school, but to some cases, thousands of people a day as they’re scrolling through images.

And that decrement in self-esteem has had a material impact on their confidence in interacting with other people, in building friendships. It’s contributed, I worry, to the loneliness that young people in particular are experiencing today.

Preet Bharara:

So what do we do about it? You have some ideas.

Dr. Vivek Murthy:

Yeah, so I think that there are actions we can take on three levels: as individuals, as communities, and as government. And to be clear, this is not one of those problems that government can solve on its own or should solve on its own because this is not just a policy problem, this is a technology issue. This is a cultural issue, as well. I think just to start in reverse order, the government perspective, I think government can certainly invest in research in this area to help us understand more about the drivers and the solutions to loneliness. It can also help build out a true national strategy that can help and bring partners together, stakeholders to actually help address and implement that.

But on a community level, there’s more we can do. We can actually help invest and build the organizations and forces that used to actually bring us together. We talked about faith organizations and about the power of recreational leagues and social organizations and community service efforts. These are all forces in our community which we need to rebuild. I think of them as the social infrastructure in our communities, which we have a chance to invest in.

But as individuals, lastly, I’ll say that there are steps we can take today. Like each of us, for example, can just take a few minutes each day to reach out to somebody that we care about just to check on them. We can make sure that when we’re with other people, catching up with family or friends, that we’re fully present, that we’re not distracted by our devices at the time. And even if that means we spend less time with them, five minutes of being fully present with someone can often feel like 30 minutes of being in distracted conversations. Extraordinarily powerful.

And finally as individuals, we can look for ways to serve each other. And serving of each other can be simply helping someone who’s dropped their papers to gather them. It can be checking in on somebody who’s having a hard time, a colleague who’s had a rough day at work, and stopping by at the end of the day to get them a cup of coffee or just to see how they’re doing. There are many ways we can serve, but these small acts of service, Preet, are extraordinarily powerful antidotes to loneliness because it is in the service of each other that we forge a strong connection but we also remind ourselves, Preet, that we have value to bring to the world, which is something that we forget when we struggle with chronic loneliness. Because with chronic loneliness, we often come to feel that we’re lonely because we’re not likable, and that can become a perpetuating downward cycle.

Preet Bharara:

In connection with all of this, do you have a view about whether people should be coming back to work or not? And by the way, the people who are not coming back to work physically and prefer to be remote, whether they’re lonely or not, they perceive certainly an advantage to being at home every day of the week or most days of the week where employers might have a different point of view. But is that exacerbating the problem, and is it your recommendation for these mental health and loneliness issues that people come back to the office?

Dr. Vivek Murthy:

Yeah, this is really important because I think with return to work, I worry sometimes that we’ve settled into this debate that everyone should just be able to be remote entirely or they should all be back in the office five days a week. And the reality is that we’re trying to balance two things. One is that for many people having flexibility to be able to work from home, either for part of their time or most of their time, can be profoundly helpful for family reasons. If they might be taking care of a sick relative at home, or if they have a long commute, it could save a couple hours a day-

Preet Bharara:

Or see your kids from time to time if you have a long commute.

Dr. Vivek Murthy:

Exactly. See your kids.

Preet Bharara:

Many people who work hard in an office, they don’t see their young kids.

Dr. Vivek Murthy:

That’s exactly right. And as a parent, I know first hand that being able to make it home for dinner for your kids before they head off to bed is a big deal. It’s really important to that relationship. So, I think there’s a lot of advantages to having that kind of flexibility. What you’re balancing that against is the downside, which I think we have to acknowledge, which is that relationships are much more powerfully built in person than virtually. And that is for 1000 reasons that I think are probably intuitive. Just the unscheduled conversation that happens when you’re in an office, the few minutes that you might arrive early to a meeting and chitchat with folks there, or the couple of minutes you might stay afterward to just say, “Hey, I noticed you seemed like maybe something that was bothering you in that meeting. You want to chat about it?”

Those kind of conversations just don’t happen as often when you’re virtual. Part of what I think workplaces have to do now is to one, more clearly and transparently assess the needs of their workers, but second, to create opportunities for people who may be doing hybrid work to gather in person on a regular basis from time to time. And lastly, what we have to do as workplaces, I think, is be more intentional about how we foster connection between people in the workplace. This is something I think we just took for granted, that if you throw a bunch of people together in an office building that over time they will meld and connect and find a way to have a healthy working relationship with one another. Well, I’ll tell you that that does not happen. In fact, loneliness in the workplace was an issue long before COVID came onto the scene.

And, Sigal Barsade, who was a professor at Wharton and was actually my old business school professor, she had done research showing in fact that not only is loneliness common in the workplace, but it was also consequential. The people, when they struggle with loneliness in the workplace, they were less engaged, their productivity was lower, their creativity was lower, and this all has implications for retention. So you can’t take it for granted that just because you’re bringing people back to some degree that they’re going to bond. What we do in our office is we once a week have something simple that we call our Humans of OSG exercise. OSG stands for Office of the Surgeon General. But, it’s 10 minutes once a week where we have one team member interview another, and it’ll be about any aspect of their life as long as it’s not about their current job. And, we learn so much in those 10 minutes, Preet.

We learn about what they were dreamed of when they were kids, what worried them, who their parents are, who they rely on during difficult times. We learn about them as a human being and often end up feeling so much closer to them as a result. That’s a result of 10 minutes once a week. So we’ve got to think about these kind of tools-

Preet Bharara:

Can I ask a question about that?

Dr. Vivek Murthy:

Yeah, of course.

Preet Bharara:

Does anybody feel like that’s getting too personal and there’s a blurring of the line between personal life and work life?

Dr. Vivek Murthy:

That’s a great question. Look, having lines between your work life and your personal life are absolutely healthy and they’re important. To me, that’s different from allowing people to see you as a human being to the extent that you’re comfortable. I may not feel comfortable sharing elements of personal illness that I had been through with the folks at work, but I might be comfortable sharing the fact that I had this great experience with my kids last weekend and it just made me so excited about being a dad. We each may have different thresholds of what we feel comfortable sharing, and the point of these kinds of conversations that I’m describing that we have in our office, and the point of activities that a workplace may craft, should be to allow people to share what they’re comfortable with in an environment that feels comfortable for them.

That is something that is, I think, achievable. Because one thing I am very clear on, Preet, which is that as human beings we have three basic desires, all of us, across cultures. We want to be seen and understood for who we are. We want know that we matter and we want to know that we’re loved. That’s a fundamental life need that we all have. And people want to be known in the workplace for more than just their skillset. To me, you and I have known each other for a little bit, to me you’re more than just Preet, the legal mind who does brilliant analysis. You’re also a human being, because I’ve come to understand and learn about pieces of your life over time. It makes a difference to people when we’re seen as human beings versus as skillsets. It makes a difference how we show up for work, in how we problem solve and how we build relationships with each other.

And any workplace that cares about not just their people, but about output, about retention, they should care about fostering those kinds of bonds because they really matter for the output of a business.

Preet Bharara:

I think that’s very well put. How concerned are you as the Surgeon General, but also just as an American, about the rise of the anti-vaccination movement? Not just with respect to COVID, but with respect to other things we’ve mostly vanquished in this country? And I keep hearing anecdotal reports of certain diseases coming back into the schools because people are not vaccinating. How big a problem is it and what can we do about that?

Dr. Vivek Murthy:

This is a big problem, Preet, and I’m very worried about it. The amount of misinformation that is circulating about health overall, but about vaccines in particular, has become quite profound. And, I do think it’s a crisis. It’s one of the reasons why the very first product I issued as Surgeon General was an advisory on health misinformation. And what we’re seeing is that that’s spreading from COVID vaccines to other childhood vaccines, which for years have helped to reduce our kids’ exposure and suffering from illnesses like measles and others.

So I worry that that progress is being rolled back, and more broadly, I think it points to a challenge that we have about misinformation and how to ensure people have access to accurate information. You referenced AI earlier in this conversation. This is a place where I worry that AI, while it can provide plenty of benefits to humanity, I think one of the challenges we’re going to face is that using more sophisticated technology means that you can also mask misinformation and make it look like it’s legitimate, like it’s an actual scientific paper, or it’s coming from somebody who’s a trusted authority, even though they never truly actually said that.

And so, I do think that this is one of the great health threats that we have got to address over the years ahead. It’s not going to be easy. And one interesting thing that happens here, Preet, is that I find that as people become less and less certain about what they can trust online, interestingly they revert more back to some of the channels that we relied on pre-internet, which is, “Okay, well what are my friends doing? What does my doctor tell me? Is there somebody in my family-

Preet Bharara:

The Cartoon Network?

Dr. Vivek Murthy:

Well, let’s hope not that. I hope that’s not a source of medical information.

Preet Bharara:

I go back to Tom and Jerry when I’m cross with the world.

Dr. Vivek Murthy:

Well, if Tom is doling out medical advice, then I think I just need to give up at this point.

Preet Bharara:

There’s a lot of workplace violence in Tom and Jerry.

Dr. Vivek Murthy:

There is, absolutely.

Preet Bharara:

That’s a whole separate issue.

Dr. Vivek Murthy:

Whole separate issue.

Preet Bharara:

You were the Surgeon General in the Obama administration and again the Surgeon General in the Biden administration. How are those times different for you? And, are they different because we’re in different times or because you’ve grown, or because we’ve had different presidents in charge of different administrations?

Dr. Vivek Murthy:

That’s a really good question. The experiences are quite different actually, and I think some of it is me. I think I have changed. I hope I’ve changed for the better as a human being. I certainly have learned from my mistakes the first time around, and I made mistakes on a personal front the first time I was Surgeon General. I think the most painful of those was making the … it wasn’t really even a conscious decision, but allowing my friendships and my relationships with family to really slide during that time, to be neglected. And I told myself this story, I think perhaps others might recognize, which is that, “Hey, I have this unique opportunity for a short period of time. Let me put everything I have into it and I’ll catch up with the rest of life later.” I just talked to a dear friend of mine, my best friend from middle school whose mother was in perfectly good health, and the other day in church had a terrible splitting headache and lost consciousness about an hour later and had a catastrophic bleed in her brain and ended up passing away.

And, that happened out of the blue. And it was a reminder to me when my friend called me on the phone that Sunday morning not too long ago, that we don’t know how long we have. We don’t know how long our loved ones are around, and decisions like the one I made back when I was first Surgeon General to just neglect those relationships in favor of work for a few years, those are not good decisions. And, I regret that. I had to learn from that this second time around.

So, I remember when President Biden asked me to come back and serve, I talked to my wife about it and she looked at me and she said, “Vivek, what’s going to be different this time?” And she didn’t mean in terms of the work. I knew what she meant. She meant in terms of how I handled my relationships and family responsibilities. And so, we’ve worked really hard together to make sure that I protect that time. I think that’s made a big difference, not just in my quality of life, but honestly in my perspective as well because I have, through the lens of my friends’ stories and my time with my children, come to see so many of the challenges that we’re grappling with around mental health, around COVID, and I think it’s made me a better Surgeon General to have those relationships.

But lastly, I’ll just say that the other thing that feels different to me, Preet, is it feels that our country is fundamentally in a different place, and not necessarily in a better place. But I worry that as bad as I thought the exhaustion and despair and polarization was back in 2015 and ’16 when I was serving, I worry that it has in some ways worsened now, and that it is taking a huge toll on people’s just overall mental health and wellbeing of people across age groups as well.

And as a father, this concerns me deeply because Preet, I, like I think everyone out there, wants the world to be better for my kids. I want them to be able to look at the world and feel like there’s a reason to be optimistic, but I also want the world, Preet, to be hospitable for our children. I want to know that if our kids stumble and fall, if they make a mistake, that they won’t be cast out or ridiculed or berated, but somebody will give them the benefit of the doubt and maybe help them up. I wanted to know that if they are in a really hard spot and are struggling, that somebody will not judge them, but actually help them get some assistance. And I want them to be able to do the same thing for other people, as well, but there are too many times, Preet, where I travel around the country and I hear people say, “You know, Vivek, it feels like it’s become more important to be right than to be kind, or more important to be powerful than to be compassionate-

Preet Bharara:

Than to be right. To be powerful than right.

Dr. Vivek Murthy:

Yeah, and that is concerning to me. So, I look at what’s happening in our country right now, Preet, and I think yes, there are individual health crises that we are having but I think it’s against the background of what I see is a deeper moral crisis in our country, and it’s a moral crisis and an identity crisis where I think we have to double down on who we want to be. What is the character that we want to build back our country on? What is the character that we want to instill in our kids? To me, it’s very clear that I want our country and I want my children to be grounded fundamentally in the core values of kindness and generosity, of service and friendship. And, I know many others want that, too.

If we want that, that has to be reflected in how we lead our lives, how we engage with each other, with how we advocate for issues that even if they don’t impact us impact other people. Those values have to inform how we choose our leaders, how we invest in our communities. If we don’t do that, then I worry that we will continue down a path where as so many people feel now we are becoming meaner and more isolated and more concerned about ourselves. I just don’t think that’s fundamentally who we are. I don’t think it’s who we have to be, but I think to avoid that, we need a moral reawakening in our country and we have to start engineering that today.

Preet Bharara:

Dr. Vivek Murthy, Surgeon General of the United States, thank you for your service and thank you for your time today. It was a great pleasure.

Dr. Vivek Murthy:

Thanks so much, Preet.

Preet Bharara:

My conversation with Dr. Vivek Murthy continues for members of the CAFE Insider Community. To try out the membership for just $1 for a month, head to cafe.com/insider. Again, that’s cafe.com/insider.

BUTTON

I want to end the show this week by honoring California Senator Dianne Feinstein, who died at age 90 last Thursday. Feinstein had served in the Senate for 30 years since 1993, and I had the privilege to get to watch her in action when I was working as an aide to Senator Chuck Schumer on the Senate Judiciary Committee. I wanted to revisit something that I said at the end of a show in February, shortly after Senator Feinstein announced that she would not seek reelection in 2024. It’s a personal look at why I so admired Senator Feinstein, and it feels appropriate today to revisit these memories and to acknowledge the massive legacy of this trailblazing public servant.

I want to end the show this week by talking about a true giant of the Senate. When I worked as an aide to Chuck Schumer on the Senate Judiciary Committee, I crossed paths with that person. I’m talking about Dianne Feinstein of California, who at age 89, last week announced that she would not seek reelection. So that means that 2024 will be Feinstein’s 32nd and final year in the Senate, making her the longest serving woman in the history of the Chamber. Now, anyone who follows this stuff closely knows that the last few years have not been easy for Feinstein. She’ll turn 90 this year and it’s plain to see she’s not the senator she once was. There have been reports, a number of them, of how her declining health has impacted her ability to do her job.

That saddens me. She’s received a good deal of criticism for it, for hanging on too long, and much of it is legitimate. Though I should note that I heard it less loudly about male senators like Robert Byrd and Strom Thurmond, both of whom died in office. But no matter how her career ends, Feinstein was a pioneer and a trailblazer and a true original, and she should be honored for that. Just look at how she first came into the spotlight. It was 1978, and Feinstein was president of San Francisco’s Board of Supervisors. She had developed a reputation as a moderate effective member of the board, but her political career seemed to be nearing its end. She had lost two elections for mayor and found herself the target of an assassination attempt when a domestic terrorist group called the New World Liberation Front planted a bomb at her home.

The bomb failed to go off, but she would go on to lose both her husband and father to cancer in the same year. By November of ’78, she was telling reporters that maybe it was time for her to step back from public life. And then a different kind of tragedy struck. One of her colleagues and friends, supervisor Dan White, shot and killed both Mayor George Moscone and Supervisor Harvey Milk, who was one of the first openly gay elected officials in the United States. And the murders happened at City Hall, just feet from Feinstein’s office. Amid all the chaos and confusion, Feinstein stepped up to a bank of microphones to announce to the world what had happened and to assume the role of mayor. That image of Feinstein, of competence and calm in the face of crisis, would become indelibly marked in the minds of San Franciscans.

She would go on to lead the city for 10 years. In 1992, she ran for the Senate and won in what would become known as the Year of the Woman. From her perch on the Senate Judiciary Committee, she became a relentless advocate for gun safety. She authored the 1994 Assault Weapons Ban and following its expiration in 2004, attempted again and again to renew it. Before many of the gun safety groups came into existence, there was Dianne Feinstein. She’s also served on the Intelligence Committee, where during the Bush administration, she helped initiate an investigation into the CIA’s so-called enhanced interrogation techniques that were used on detainees during the War on Terror. When President Obama took office, she became chair of the committee and she battled the CIA and White House officials to continue the investigation and make its findings public. Her staff would go on to produce a 6,700-page torture report.

And on December 9, 2014, the day the executive summary of the report was finally made public, Feinstein called the CIA’s Detention and Interrogation Program a stain on our values and on our history. There’s even a movie about it. Feinstein is played by Annette Bening. As I mentioned, I had an opportunity to watch Feinstein up close, and I can say that nobody worked harder than Dianne Feinstein, with the possible exception of my boss, Chuck Schumer. And she hired great people, like Schumer and Ted Kennedy, she was able to recruit and retain smart staffers, people who turned down high paying jobs in the private sector to do public service. She understood that to make a difference, you need a team, and that’s no small thing. Unlike most senior senators, Diane Feinstein gets to know other staffers, and they get to know her. At least that was true when I served in the Senate. I remember one time, Senator Schumer and I went over to her office to meet with her and her chief counsel with milk and cookies to talk about a press freedom bill.

I remember another time after going on the Atkins Diet, having eaten too many hot dogs and chips and fast food snacks in my time working around the clock for Senator Schumer, Senator Feinstein at a hearing looked at me and said, “Preet, have you lost weight?” I have to admit, that made my day. Most importantly, I remember the time that she refused to do something her democratic colleagues, or some of her democratic colleagues on the committee, wanted her to do when the Democrats were in the minority, and that was boycott a vote so as to deny the Republicans a quorum on some vote for a nominee or a piece of legislation the Democrats didn’t like. And, she refused. She said, “I’m not going to avoid coming to work. I came to the Senate to work, not to hide.” And, work she did.

Feinstein has displayed guts and courage, and like her or not, at a time when members of Congress increasingly favor soundbites over substance and focus on personality more than policy, Feinstein has dived into the work. It’s always about the work, and that is something to honor and celebrate. So Senator Feinstein, thank you for your service.

Well, that’s it for this episode of Stay Tuned. Thanks again to my guest, Dr. Vivek Murthy. If you like what we do, rate and review the show on Apple Podcasts or wherever you listen. Every positive review helps new listeners find the show. Send me your questions about news, politics, and justice. Tweet them to me @PreetBharara with the hashtag, #AskPreet. You can also now reach me on Threads, or you can call and leave me a message at 669-247-7338. That’s 669-24Preet. Or you can send an email to letters@cafe.com.

Stay Tuned is presented by CAFE and the Vox Media Podcast Network. The executive producer is Tamara Sepper. The technical director is David Tatasciore. The senior producer is Matthew Billy, and the CAFE team is Noa Azulai, David Kurlander, Nat Weiner, Jake Kaplan, Namita Shah and Claudia Hernández. Our music is by Andrew Dost. I’m your host, Preet Bharara. Stay Tuned.