Transcript of EWG podcast ‘Ken Cook Is Having Another Episode' – Episode 32

In this podcast episode, EWG President and co-Founder Ken Cook and his guests spotlight the growing measles outbreak in the U.S. At the time of recording, there were more than 800 confirmed cases and at least three deaths, including two young, unvaccinated children.

Measles is one of the most contagious diseases on earth, and it spreads quickly in communities with low vaccination rates. It was once nearly eliminated in the U.S. But a rise in vaccine hesitancy has opened the door for its return, fueled by misinformation, especially since the Covid-19 pandemic.

Ken talks with two leading experts about why it’s critical that parents and caregivers stay informed and make sure children are fully vaccinated – not just for their safety but for the health of communities. 

The first segment is with Dr. Mike Koster, pediatric infectious disease professor at Brown University. The second segment features Jessica Malaty Rivera, M.S., an infectious disease epidemiologist and award-winning science communicator.

Disclaimer: This transcript was compiled using software and may include typographical errors

Ken: There's a lot of conversation right now about vaccines, of course, fueled by the recent measles outbreak and the public comments from figures like RFK Jr. And for some people it raises a bigger question. Why do groups like EWG sound the alarm about chemicals in our food, our water, personal care products, but we don't sound the alarm about vaccines, which are also chemicals.

Well, the reason is not all evidence evaluation, not all judgments, not all authority is equal, and we look at each source of authority with a critical eye. Vaccines are subject to years of rigorous testing, strict government review, ongoing safety monitoring. They're among the most. Studied and effective tools in public health, and we know that they have saved millions of lives.

Food, chemicals, pesticides in food, plasticizers in food. All those kinds of contaminant situations often bypass meaningful review. I mean, thanks to a loophole in federal law companies, not the FDA, for example, can decide if a chemical added to your food as a dye or a colorant is generally recognized as safe, A big loophole that allows the companies to basically self-regulate.

Now, EWG'S standard is science, not blind trust. And with that, I, I wanna put to bed any questions about EWG'S stance on vaccines and vaccination. EWG has consistently supported vaccines and vaccination full stop. Any claim to the contrary is completely false and a grave mischaracterization of our history.

Those who like to criticize our work point to a 2004 report that raised questions about thy Marisol, a mercury based preservative once used in some children's vaccines and under scrutiny at that time by public health agencies and scientists will go back and look at that part of our history, that time period, the late 1990s and early two thousands in greater detail on other podcasts.

But if people read the report, EWG made its support for childhood immunizations. Unmistakably clear. Here's what we said in that report. The environmental working group strongly supports the standard battery of childhood immunizations recommended by the American Academy of Pediatrics and the CDC. Now, our position hasn't changed.

Vaccines are essential to protecting public health and we urge all parents to make sure their children are fully vaccinated. The US is currently facing a growing measles outbreak. At the time of this recording, there are 800 confirmed cases confirmed by the CDC and at least three deaths, including two young children who were unvaccinated and those children did die of complications of the measles, which is often pneumonia as we'll hear later in the podcast.

These tragic losses were almost certainly preventable with the MMR vaccine, which is safe, highly effective, widely available, and has never had thy Marisol in it. Measles is one of the most contagious diseases on earth. It spreads very quickly in communities with low vaccination rates while it was once nearly eliminated in the US a rise in vaccine hesitancy vaccine rejection fueled by misinformation, especially since the COVID-19 pandemic.

Has opened the door for the return of measles. The danger isn't just measles falling vaccination rates 0 threatened to bring back other serious preventable diseases that were once under control. In today's episode, we'll hear from two leading experts on why it's critical that parents and caregivers stay informed and make sure children are fully vaccinated, not just for their own safety, but for the health of our communities.

My first guest is Dr. Michael Koster. He's also a professor of pediatrics and a clinician educator at the Warren Albert Medical School at Brown University. He's practiced medicine internationally, and his interests range from viral respiratory illnesses, osteoarticular infections, which are infections of the bones and joints and pneumonia in children.

Right on our topic today. After that, I'm joined by Jessica Malti Rivera. But I'd be remiss to keep you waiting any longer. So let's get to my conversation with Dr. Koster, which I opened up by asking him if he saw any measles cases during 0 his training. 

Dr. Koster: First. Ken, if you just allow me a second to give my, you know, heartfelt condolences to the families, uh, through all of these outbreaks, because I think, especially as your point about a vaccine preventable illness, you know?

Yes. I just wanna help parents and families and guide them through with, you know, good decision making. Uh, yeah, we, we had a case here in Rhode Island this year, and in the past I've done a lot of global health. So I saw a case once, uh, in a international setting where we still see developing, kind of setting.

Exactly. Mm-hmm. Uh, but this year was the first year that I've seen measles here in Rhode Island, and it was the first time we've had it here in decades. It is not something that most people see. And I think as an infectious disease doctor, I'm privy. I'm gonna see any case that's happening here in Rhode Island because I'm gonna be involved in it, but it's not something we see at all, you know, routinely.

So it's, it's difficult diagnosis to make. And I think as we think about helping parents navigate this landscape of,  you know, fear mongering and the amount of overwhelming information and disinformation that they're getting, I mean, I just feel compassion for them as they're trying to make the right decisions for their kids.

I. Luckily I have that opportunity often to sit with families and build that connection of trust. 'cause it starts with listening, it starts with empathy, and it starts with caring about the child and their wellbeing. And I think when you can connect with parents at that level and help them understand that you're making recommendations for their child to keep their child protected, and in this case, Ken, to save their life.

Because beyond all of the symptoms that you were just asking me about in your question, back to the question. CNS infections or central nervous system infection, brain swelling, sclerosing encephalitis years later, and the fact that a measles will wipe out your immune system against all the other viruses and infections and bacteria that you're protected against from both getting  those illnesses and developing immunity or having vaccines to protect you against them.

So it comes with, unfortunately, massive ramifications of death, disability, neurocognitive impairments, and immune system deficits because of, uh, how it affects your body. It is a very severe infection. 

Ken: You know, I've noticed that in some of the commentary, particularly amongst, uh, vaccine skeptics or anti-vaccine influencers, they sort of suggest that there aren't very many deaths that come from measles.

Obviously, downplaying a. The damage that can occur with measles that you just described, that's short of death. That is, I mean, the whole notion that just because a child doesn't die of measles, that this is not something to worry about too much. And we have a health secretary who in effect made that point early on in the, uh, outbreak in Texas, uh, and that's then spread  to New Mexico that, you know, not many deaths.

We freak out whenever our kid goes to the hospital, even when he has a, when he has a broken bone. Right. So. Hard to diagnose once you diagnose. And it's an in, uh, you know, a, a very young child, typically, I think under age of three is very common, right? Mm-hmm. What do doctors see? What are the symptoms? Yeah.

How do they figure out its measles and then if a child has to be hospitalized has happened in Texas, I think, um, both children were hospitalized Yeah. Before they died. But many more children were hospitalized that have survived, but quite possibly with some of these other biological damages that will, you know, be chronic, lifelong in some cases.

So what happens? A kid comes in, what are you looking for? And then if they have the measles and it's progressed, how do you know it's progressed? What are some of the symptoms? Can you talk 

Dr. Koster: us through that? Yeah, absolutely. Ken, like, really great question because, you know,  first and foremost there's a few triage questions that I'm always asking, right?

Because I. If I'm practicing medicine in the middle of the Texas outbreak right now, I'm gonna have a much higher suspicion for measles, because there's three things I want to know. Are you immunized? Because if you're immunized, your risk is much lower, especially if you've had both immunizations, 97% protection, right?

The second thing is, do you have an exposure to someone with known measles? Are you in the daycare where someone's been diagnosed with measles? Then of course, we gotta think about it. And then the third thing is international travel. The fact is, these are just a handful of outbreaks that have resulted in over 600 cases of measles in the United States, right?

These are imported cases that find the small pockets of unvaccinated or large pockets of unvaccinated people. Those small amount numbers of people within the state itself, but a large pocket of unvaccinated people. And it spreads like wildfire. So the first things that you see is often the  prodrome, which is like any other virus, some fever, malaise, just not feeling well, like the child's getting sick, right?

And then there's some classic things we call cough za and conjunctivitis cough. Everyone knows what that is. Conjunctivitis is redness in your eyes. So there's a number of other viruses. Adenovirus, sometimes even flu, can cause some conjunctivitis. There are other viruses, a lot of viruses that can cause conjunctivitis, but measles causes a very severe conjunctivitis.

And then it also causes a lot of nasal discharge. So much so that there's a lot of, if you can imagine like crusty boogery stuff on the nose and runny nose. Yeah. And so that's what cough horizon in conjunctivitis often called the three Cs of measles. And at that moment in time, if you're examining a patient, there is something, and we use this fancy word called pathognomonic, sort of that in which nothing else it can be, or very specific to measles, which is a, uh, white patches inside of the mouth  on the, uh, inside of the cheek.

And those are called colic spots. And if you see those Okay. That's almost as slam dunk diagnosis. It's just of measles. Yeah. Yeah. Now that's all before the rash, right? Because measles, unfortunately yeah. Is contagious four days before the rash. The rash is day zero and four days after the rash. So a very long period of time of contagiousness right?

And then the incubation period can be out to 14 days, up to 21 days. So it's a very long meaning once you're exposed to developing symptoms. So that's why these things can last very long and someone's not gonna necessarily develop symptoms the next day after exposure. And super contagious, very, very contagious.

Now, typically, uh, when the rash starts and as it starts to fade away, so two days into the rash, so about six days into illness, the fever goes away. So if the fever, for instance, is still there at the time the rash has  disappeared, that tells you that there could be a bacterial super infection, pneumonia.

Bacteremia or sepsis, right? So you're losing all of this inflammation in your, uh, respiratory tract, in your throat, in your nose. It's destroying the integrity of that layer that protects you against all the bacteria that are hanging out there. And they take that opportunity to invade, to cause pneumonia and serious bacterial infections.

Now, that is one thing to be concerned about, and I, I do believe both of the children who died from measles had severe respiratory disease. So really labored breathing. They're struggling to breathe. They need antibiotics, for instance, to help with that. They may need, you know, a ventilator to help. So that specifically is someone's not following the traditional arc of illness.

You know, few days of having fever, rash starts, fever starts to fade, and then you recover, right? Thank God many kids are recovering, many, even people getting measles are recovering. Praise be.  And at the same time, this is when you can start to see some of those neurological complications as well. You can get brain swelling, you can get mental status changes, you know, essentially delirium if you will.

It's like kind of a word I think a lot of people understand is don't know where you are, what's happening, um, and you're out of it, right? And so that would be sign of one of the more severe, uh, consequences of measles. But so we're definitely looking for those things. Even since we've had our case of measles, we've had at least three or four cases where we've highly considered it because that rash starts on the head and sometimes even behind the ears and the forehead, and then it moves down the body.

So it's a very specific pattern of how the rash appears. It doesn't start in the groin, it doesn't start on your hands, it starts at the head. And so some other viruses can do that too. So we've had some cases where we're like, man, this really seems like measles. So we at work closely with our Department of Health.

We get that test done. We often have that test within a few hours to figure out whether 1 that's a patient with measles or not. But I could tell you on the, on the back end of that, I understand what these public health agencies are going through, which have unfortunately been, you know, now they're down to the bare bones.

Even when you look at somewhere like, you know, Minnesota's lost more than half of its, you know, department of Health. So in these areas where they're trying to deal with outbreaks, which we know they can happen anywhere, jumped from, you know, from Texas to, to Kansas, and, and, and we see that, uh, epidemiologically, right?

It looks like the same measles, uh, fingerprint. The problem is you've gotta now do contact tracing and you've got 72 hours for people willing to accept the vaccine, to get the vaccine for protection. Right? You have a little window there to start protecting people. So you gotta find out when you have measles right away so that you can start to offer that protection.

Yeah. And then certainly anybody who's immunocompromised or pregnant persons, they may even need things like what we call immune globulin, which is our body's sort of natural antibodies that we make to help fight infection. They may need an infusion of that 1 to help protect them, to make sure that they don't, uh, die from measles.

Right. Because it, it is both a, uh, highly fatal disease, three in a thousand die. And in fact, when we look at the numbers. Out of Texas, it's three out of, you know, five, 600 Texas, New Mexico, combining them, you know, three people already out of, out of 500 people. That's much more than three out of a thousand.

Ken: Yeah. And you know, from our work, we have a level of concern if a toxic chemical causes over a lifetime of exposure to say a contaminant water, if it's one extra cancer in a million people, right. That triggers concern for carcinogens and air and water and pesticides and so forth. It's a fairly standard measure, one in a million excess cases over a lifetime of exposure.

So I think when some people hear, well, you know, three kids out of a thousand, that is actually blinking red light 

Dr. Koster: level of a public health problem. Right? Yeah.  It's interesting, you know, somebody asked me this question the other day. It's like, why do only kids get measles? And what, or, and or why, you know, why don't our adults do they handle measles better?

You know, like if they get measles? The reality is in, in the 1950s and before measles is the most contagious disease known to humankind, 90% of the people who are susceptible, if they're exposed, they will develop measles. 90%, right? Yeah. So no one got it as an adult because everybody, especially before 1957, before we had any vaccines, every single person got measles in the first few years of their life.

Yeah. And then we knew at least 500 kids every year died from measles in the United States. And that's when we had fairly robust epidemiology to try to understand, you know, what's going on. Our medicine wasn't bad in the 1950s and sixties. Right. We had an antibiotics were being discovered, et cetera. We were taking pretty good care of people at that point.

So even now to this, you know, to this day, for instance, when you look at the, uh, measles outbreak just before, uh, 2000, when it was de  declared, eradicated in the United States in the 1990s, there was a huge outbreak in Philadelphia in a small pocket of, you know, a faith-based community that really wanted to put their faith Yep.

In their God to say, we don't even need treatment. If our kids get infected, right, God will take care of it. And in those settings, the mortality rate was eight to nine kids. Out of, uh, 800 kids died. Right. So a very high mortality rate because you're not getting those antibiotics for that super infection.

You're not getting, uh, IV fluids if you're dehydrated. And so even the care that we can provide for patients getting measles, now, that particular community didn't want those interventions. And to me, as a child advocate, I think it's fine for parents to make decisions for themselves. You know, in some ways I'm a libertarian about those things.

You should decide what you want for yourself as an adult, but for children to be subject to, you know, withholding life-saving treatment, to me, that that's immoral. Right? Yeah. And so I feel pretty strongly about that.  And, you know, vaccines are a public health importance. And at the same time, I have to be able to connect with a parent who's worried about this.

Explain the ingredients, Ken, right? Yeah. Explain the risks of the vaccine. Explain the risks of not getting the vaccine and help them come to an informed decision, centered around the fact that we both care about their child, and I'm not recommending a vaccine to protect the United States of America. I'm recommending a vaccine to protect their child from death.

And so when you can start to have those conversations and build that trust, it's really helpful. And at the same time, the current climate with easy access to information and non, you know, expertise, advice offered on every YouTube channel, Instagram  post, et cetera. And these are predatory often, you know, predatory information and whether it's someone with stock and you know, cod liver oil or in non-pharmaceutical supplements that are not.

We don't even actually know what's in them if they're not redline, for instance, that people are willing to take those things because they're afraid. They're afraid. And so that's the real thing. That's the problem here is we have made parents afraid of vaccines by giving mis and disinformation. They need to hear how they're life saving.

And typically when there's outbreaks, people tend to start to line up for vaccines. Whether it was Yeah, polio in the sixties and seventies, your friend in the neighborhood went on a, you know, an iron lung. Everybody lined up for their polio vaccine. Yeah. Right. And then now polio rates go down and people start saying, why do we take this vaccine?

Yeah. And is it worth the risk?  Well, we've seen that again in the last couple years in New York resurge with, you know, oral polio vaccine can revert and, and we've seen it in wastewater. So we need to do the right things though as vaccinologist, which is moved to the injectable polio, which doesn't cause any of those symptoms.

Yeah. And so even as VA as a vaccine expert, I sometimes don't agree with every policy such as oral polio vaccine. Right. Currently, I think everything should be injectable polio vaccine because there's no reason for us to take on any of that risk. Right. Especially in a transnational world. We're all connected until everyone's safe.

No one's safe. Yeah. 

Ken: So let me just ask you, so a parent comes in with a child and it's time for, uh, the vaccine schedule. Mm-hmm. How do you talk through with them, Mike, if they're hesitant, how do you talk through that and really let them explore and understand what we know about VA actual vaccine risks  from studies without scaring them off?

What's the process? What has been successful 

Dr. Koster: for you? I think the pithy response is you have to create. Alliance and trust. There's lots of ways to do that. Right. My pathway to that is loving kindness. Right? Like I, I love kids. That's why I'm a pediatrician. Yeah. I mean, I, I love my kids. I love every kid. I especially love and care about kids who may be disadvantaged or if they, if they're coming from a situation where they don't have resources or access to medical care, for instance.

Yeah. I care even more about those. Not that I care less about kids with privilege, but I care more about trying to make sure that we have health equity. Right. Totally. So health equity comes also with education and information. There's different levels of this, right? The first level is just a family's hesitant.

They just need to hear me say, I recommend it, and that's it. We're done. They know me. Yeah. That maybe I've taken care of their other kids,  right? Yeah. So, and now they're hearing new information. They're coming to me for that. Dr. Koster, what should we do? What's your recommendation? And you know what, Ken? I gotta stand behind the things I recommend.

Right? So I do know the risks and benefits of everything because if I don't, then I wouldn't know whether I think it's a good thing for their child or, or for my child, for that matter, right? So the, of course, it just first starts with loving kindness and caring, and when you start from there with the best intentions of the child, you're gonna start a very different conversation.

So the second level is generally a family that needs more information. They know me, they may not know me, and they're concerned about information that they've heard. I just have to, the second thing I do in those situations, I just stop and listen. Tell me about it. What information have you heard? What are you coming to me with?

Yeah. Where did you get it from? Yeah, tell me not just that this, uh, particular ingredient, for instance, may  make you worried. Tell me what you're worried about from that ingredient. Then there's maybe that opportunity to explain the harms of the virus. Like we just talked about, all the harms of the measles virus, right?

Rubella for instance, not a big deal. German measles, three days, little fever. What's the problem? If you're pregnant and you're exposed to rubella, you'll lose your fetus. No one wants that to happen. So we wanna live in a world where people can be safely pregnant. Right. And that's why we care about rubella.

We don't want congenital rubella syndrome, and we don't want pregnant people to lose their fetus. Right. I, I think everybody would say that's true. So you just start by explaining what those viruses are and what they do, because oftentimes there's a paucity of knowledge there as well. Oh, well I heard measles is just a fever for a few days.

No, actually, kids die from it. And we have data from before we gave vaccine that shows that 500 kids every year died 2 from measles every year. Yeah. And once we eradicated it, zero, except for now and and times where we have outbreaks, right? When we have outbreaks, we're going to have fatalities. And so when you can start to help them see that, oh yeah, getting the virus isn't, it's, it may be actually a little Russian roulette.

It's not necessarily the best way to develop immunity. And when we have vaccines, especially live vaccines, they are the closest to mimicking real infection that provide your body with a super robust reaction. So that basically you have that lifelong immunity and you have that protection. It's not like a pertussis vaccine, which is gonna wane over time.

Right. Where you have to get boosters or you have to do other things, or tetanus even. Right? Right. So this is a, these live attenuated vaccines are very protective. They're as close as you can get to natural immunity. Right. And you know, I think there's a lot to be said. You know, 2 Ken, I've dabbled in veganism myself.

Like I look at labels. I don't wanna give my kids Esther of wood rosin. Right. I wanna make sure I'm doing the best thing I can for my kids. Yeah. And so I can unders, I wanna make sure I understand from parents' perspectives if that that sort of second level of hesitancy is about ingredients. Letting them know these are tried, tested, true vaccines we've been giving them for decades.

Most vaccine reactions we see within the first six weeks and we don't have long-term complications from vaccines. You know, it's interesting because for doctors stay, my infection, preventionist gave me a coffee cup. It took me a minute to figure it out, but it says vaccines cause adults. And I was like, what?

What does that mean? Basically they save kids' lives, right? Yeah. So that's oftentimes that conversation that needs to happen. But I do, I never go into a conversation. Believing I'm going to change the parent's mind at that moment. So I, if they, if they're not there and I can't  get them there, I say, Hey, can you come back next week?

Let's talking. You can come back in two weeks. Keep, let's talk more. I might give them some references that I find reputable. So I like the Children's Hospital of Philadelphia Vaccine Education Center, the VEC mm-hmm. Great website. A lot of FAQs there. Like, do I need to worry about, uh, mercury? Do I need to worry about egg?

Do I need to worry about all these ingredients? And you know, for some people who are very fundamentally religious is, are there fetal cells used in this vaccine? You know, sure. Were they used to help create this vaccine? Are they still in there now? Or were they used from the very beginning? Yeah. Et cetera, et cetera.

And help them direct them to, uh, expertise and knowledge about that. And there are also people with fixed belief systems. So maybe it's a faith-based, uh, perspective on things, right? Or there may be, um, people who just, there's no way I'm going to change their mind o over time anyway. I still do the same things I say.

I just wanna help you  make the right decisions. Tell me what you know, what you're worried about. Here's what I know. I was worried about that too, so I investigated it myself. Here's what I found on it. Give me more of your concerns. Let's list them. Let's understand them better, and then let's talk about them again next time.

I think that's really where the rubber hits the road is that it's okay to expect that the conversation's not always gonna end in a vaccine, but if the conversation can continue, I find that a win. We hear this all the 

Ken: time from people. Isn't it crazy to be worried about pesticides in produce? The most important thing is to eat the produce, which we always say that's right.

The risk of not eating fresh fruits and vegetables is much greater than the risk of the pesticides that might be in there. But we never wanna discourage people from thinking on their own and asking these questions. You're not crazy to ask questions about medication. And I feel like maybe how some, uh, professionals  in public health, uh, speak about vaccine deniers and vaccine hesitancy in a way that I think turns people off and doesn't, doesn't give them that bedside manner that I think any of us who interface with people, and we, you know, we have tens of millions of people coming to our website every year.

We try and tell them about our uncertainties. We try and tell them when we, you know, look, uh, not everyone who smokes is, is going to develop lung cancer. You shouldn't smoke. It's, there's, you know, um, and part of what we're dealing with now is a residue of a, a bit of maybe a. Shall I say arrogance from the public health community?

A little bit of talking down to people. 

Dr. Koster: You know, Ken, gosh, I have so many things I want. Thank you for saying all that and, and absolutely you're right. You're never gonna get anywhere being adversarial. Right? You need to be collaborative. Yeah. And that's my  whole point when you can start with the fact that we both want what's best for the child.

Like that is a better footing than pointing a finger and saying, you're wrong. Now, having said that. I don't know how much that's the problem. As much as the problem is disinformation related to vaccines, of course. Right. But there's no disinformation campaign out there about, you know, some, like an even antibiotics or say chemotherapy agents.

Like no one's out there actively trying to tell you. I mean, chemotherapy agents for cancer destroy your body. I mean, they just, they, you lose your hair, you lose all your bone marrow. Yeah. And like no one's out there saying, man, you better avoid that stuff. It's toxic and it is. That's all true. But there's not an active campaign to get people to stop taking cancer treatment.

Right. So that's the difference I think between, yeah. What's happening now is that parents are truly being fed information like you could die from this vaccine a hundred  percent categorically untrue, and that you could develop autism 100% categorically debunked. In fact, there were profiteers from that.

So the problem I see for the families is that they're coming to me with fear. Yeah. They're coming to me with concerns that are from the disinformation campaign. From people profiteering, right? Yeah. So the physicians that were involved with the Wakefield scandal in the 1990s, they would testify at every court case and make tens of thousands, hundreds of thousands of dollars as experts linking autism and vaccines and how the child was harmed.

And all these lawsuits, I mean. Uh, sure. I don't want big pharma to make a lot of money. I'd rather we have a universal health policy in America and, and, and, and take out all of these insurance companies making billions of dollars. I'm all for that. I don't think  I want pharma to have some money so we can have research and development.

But the reality is it these people who were telling you, be careful, were making money off of this. These are called false profits, right? Yeah. Spelled both ways. Yeah. Yeah. And if you look at the, uh, supplement industry, right? It's a multi-billion dollar industry. And I was making this point earlier about something called redline.

Like if you're gonna take echinacea, I'm fine. But if you're taking it and it's a non red line, something, it doesn't even have to have echinacea in it. You know what I mean? Like it's not a regulated, uh, space, super unregulated area. So to assume that that's what's gonna make America healthy again is fictitious.

And it's deceptive and, and it's quackery from a medical perspective and in, in so many ways, it's profiteering off of people's fear. And I think that's what, that's the message that public health officials need to be given, is that you are being told to be afraid. So I can make money off of  your fear.

Totally. This is a huge problem now as our entire, you know, human health services is being dismantled, you know, machete style. Yeah. Of course we'll make mistakes and we'll rehire some people. And I'm not trusting that process. I'm not feeling good about that process. So, you know, that's my perspective on it.

Start with love with the patients and families because they are the ones being torn in every direction here. Public health officials need a better message that and, and call out the bulls and strikes. Show the profiteering. Yeah. Show the fact that people are deceiving you and less so about them being duped.

We shouldn't demonize. The families for their misinformation, no disinformation and for caring about their children. No. We should love them for that and help guide them to the right decisions to keep their kids safe. 

Ken: Yeah. What I find really, uh, worrisome about the vaccine area is that as soon as you raise questions  about, say the link between autism and vaccines, if you, if you say, look, the, it's been looked at pretty thoroughly.

We don't see a link there. People immediately jump to the conclusion. I mean, I've had people tell me that we must be taking money at Environmental Working Group from pharmaceutical companies. Why would you go there? And the reason you would go there is that means that's a whole set of information you don't have to listen to because you've written off the source.

And a lot of people have written off their family doctor. Right. That's the scary thing now is these all enveloping conspiracy theories that by design explain the whole world so you don't have to think on your own. 

Dr. Koster: Yeah. It's tough to reach, uh, folks who, uh, you know, I think, I think when you can make these kind of flippant, you know, defamatory statements, it's a, yeah.

It closes things down. It closes conversation. I think when you wanna know something, you gotta start with conversation. And I think the, the real problem for me with the autism piece is 3 actually the biggest conspiracy was the fact that the link was made up. And it's been proven Yeah. And exposed. Yeah. And now the conspiracy is known.

That was the conspiracy. And so, yeah. I mean, it wasn't actual conspiracy. And so I think to me it's like you've gotta, you have to be open to hearing both sides. And, you know, uh, two things I'll say about this. One is I work in academics. You know, I'm at Brown University, I'm a professor Yeah. Uh, of pediatrics, and I'm a clinical professor.

And anytime I give a lecture that someone's gonna get educational credit for, I have to list every conflict of interest I have. So if a pharmaceutical company's paying me to, you know, talk on behalf of their product, which honestly, some of my colleagues do that because they believe in the products, right?

Yeah. I mean, we we're still integrated and academics is a beautiful place because we aren't the government, you know, we can have conflicts. We just need to tell people what they are, right? So number one is we have transparency in that in 3 academics, and any physician should have transparency in any conflict that they may have with any product, any stock, anything that they may own or be reimbursed around or remunerated from.

So I think that's important for people to, to know that physicians are, course they have to, we, we are obligated to, uh, be transparent about that. The problem with negotiation is people dig into a fixed position. If we could just stop and talk to each other. Yeah, that's, and understand why we have those positions.

Tell me why you believe that's a conspiracy. Tell me the examples that you can give. Right. Because I can tell you from my experience, the epidemiology of vaccines is that in this decade alone, we will have saved 50 million lives from vaccines. From 2020 to 20 20 32, we will have saved 50 million people to tell me anything.

That's that good. Yeah. So you, there better be a whole lot of reasons why we  shouldn't do that. Beyond something that's a, uh, theoretical concern or that's already a debunked conspiracy theory in the other way. But I will tell you is that it is disheartening to, uh, see the backlash against medical expertise because I agree.

I didn't even finish my training till I was 33 years old and I still train to this day. Right. I'm still learning from colleagues, from patients, from my mentors, right. Who've always told me too, you know, if you have an underlying illness too, that puts you at risk. You know, and a vaccine can protect you against that, even if there could be some side effect of the vaccine that is so mild compared to what the, the wild type illness will do to you.

Right. Yeah. My, uh, my mentor told me about chickenpox parties where a kid showed up, died. You know, parent thought they were doing the right thing. A child who was a teenager who hadn't had chickenpox yet, who was star pitcher, lost sight in one of his eyes, lost step perception, couldn't pitch anymore.

Right? Yeah. So I've heard all these stories from my predecessors from the time where they practiced before chickenpox vaccine was routinely available. We're gonna do everything to protect our community, to protect our patients, and uh, to advance science in those situations where we're, we are confronted with the unknown, the unexpected, and the pandemic situations.

Uh, but right now we are bare bones and we are continuing to lose the infrastructure we need, uh, to protect America, to protect people. Yeah. And I'm losing ability to, you know, losing that opportunity to be able to protect the patients in front of me as well. 

Ken: No, there's no question about that. And these aren't victories that we're slashing these agencies.

We may not know it yet, but we'll find out just how much we. This will cost us when the next covid, the next pandemic, the next terrible outbreak strikes. Yeah. We'll know what price we're paying and we'll know how inefficient it  was. 

Dr. Koster: I have to also just mention too, is like, if you look at the HHS and the budget there, I mean 1% is salaries to all the people, all 80 plus thousand employees there, they account for, for 1% of the budget.

That is not where cost savings is gonna happen. There's no way, you know, anybody from a business school would take this as an example of, uh, of fantastic CEO decision making, right? It's, it's just the worst possible way to, uh, look at efficiency. To make America great again, is not gonna be removing our world's leading experts in these fields.

And thank goodness for the advocacy of folks like Peter Marks who, you know, wrote their resignation letter and published that for us to see. Right. It's definitely not gonna help us in the end, and that's obvious. And so unfortunately, it's not, these kinds of changes aren't as easy as, uh, on and off tariffs, right?

These are, these are people's jobs. These are people's lives,  and they are people who dedicated their lives, public servants to, you know, really protecting us and keeping us safe, as you mentioned, regarding all of the environment, total pollutants and, and, you know, to the head of tobacco being removed, et cetera.

I mean, we don't stand a chance at being healthier than we are, uh, now by, uh, these changes. That's for sure. 

Ken: Yeah. There's, there's no question about that. Well, Dr. Mike Coster, thank you so much. This has been, I've really enjoyed this conversation. I am so glad. That there are medical professionals like you out in the world.

I, I think there are lots of them. Thank you for your service, research, seeing kids, seeing parents talking through these difficult issues and doing it from a place of love. I, um, love and humility, I'm gonna take away from this conversation. Mike, thank you so much for joining the show. Thank you, Ken. Dr.

Koster, folks, that's the kind of family doctor we all want at our bedside. My next guest is someone I'm  really excited to speak to. Jessica Meti. Rivera is an infectious disease epidemiologist. She studies the disease in human populations and an award-winning science communicator. I'm a big fan of her social media where she has dedicated herself to educating the public by translating complicated scientific concepts into language everyone can understand.

I really admire the work she does, even though she's been very critical of EWG at times, and we got a chance to talk about that. I think in these fraught times, we have more in common than what's separating us, and in these times, we need all of us to stand together at the barricades. Given the leadership in Washington today, this is a difficult and scary time for folks in the world of science and public health.

Some things Jessica and I have in common are our concerns over what's happening at the Department of Health and Human Services, the CDC, the  NIH, and all of our agencies that are central to having us have public health policy based on strong science. Our public health is being weakened through budget.

And staff cuts through misinformation and deception at the worst possible time. No one has spoken out about this issue more resolutely than Jessica. She's a rigorous defender of vaccines. We were both very concerned about RFKs nomination to be HHS secretary, and our concerns have only grown since his appointment.

Jessica, thank you for taking time to be on the program despite our differences. And thank you for standing up for your convictions and for science-based public health policy. 

Jessica Malaty Rivera, MS: Thank you, Ken, for that very gracious intro. And and thank you for the opportunity to even talk, you know, the way you introduced it I think is very fair and I'm, I'm glad to have this conversation.

Ken: So let's, let's jump right in. And I know you've spoken out on, on social media about this, but my breath is taken away by this administration on a, almost an hourly basis. Yeah.  With respect to the, some of the decisions they're making. But I think one of the standout moments was when I. Uh, RFK Junior said at a cabinet meeting, no less, that he had initiated a, a very ambitious study of the causes of autism.

Mm-hmm. And that we would have our first understanding of it by September. Yeah. Actually gave a date a month, a window when we would, after hundreds and hundreds, probably billions of dollars spent trying to understand autism. Its biology, it's etiology, the genetic contribution, potential, environmental contributions, all that complexity.

All these scientists who've looked at it and somehow there's now a plan that's being worked on, supposedly. Yeah. That's gonna give us answers by September. Did you fasten your seatbelt when you saw that, or how did you react? 

Jessica Malaty Rivera, MS: It, it was equal parts  rage. And of course he said this, and of course he's gonna do this because.

He came in with an agenda, which was to confirm previously held biases about vaccines since day one, it is no shock that he came in. Yeah. With an even skewed understanding of the scientific process, that you have an answer and then you do tests to prove that answer, but you've already decided that the answer is the answer.

Yeah. It's, it's an, an insult to the scientific process. It's an insult to the decades, literal decades of research that has reached consensus. On the fact that vaccines do not cause autism. He denies the fact that that ex, that data exists, uh, and continues to spread misinformation that has been unstudied, uh, that we've never compared vaccinated to unvaccinated children while investigating autism incident incidents and prevalence.

That's simply not true. There are so many papers that include giant cohorts, like millions of children who have been assessed. Yeah, you know, there's a 2019 Danish study that everybody refers to that and had almost 4 700,000 children. There's another meta-analysis from 2014 that had over 1.25 million children assessed and compared to understand the, the incidents and prevalence of autism related to vaccination status.

And so there's something very deliberate, I think about. Presenting these as, I'm just asking questions. I'm just here for the sincere, altruistic view of wanting answers for kids, but he's also presenting himself as this like lone hero with the sole opportunity to answer those questions, and that is very disingenuous.

Ken: Yeah. Let's talk a little bit about this confirmation bias. Here's how bad I, I think we are. Here's the situation we're in now, and you see it from some of the reaction from the anti-vax. Yeah. You know, advocates, whenever Kennedy even gives a slight nod in the direction of vaccines as being in the case of the measles outbreak, now he's said a few times, vaccination is the best way to go to prevent measles.

He's then gone 4 back and undermined what he said. But even saying that much. Has gotten a ferocious response from the community he helped build. Yes. I think if he came out with a study that exonerated vaccines with autism. Mm-hmm. Mm-hmm. Which I think it's unlikely. I, I think I know the direction his confirmation bias goes, but I think even if he did that, the movement that he's helped create, I think people would still reject even Kennedy saying Absolutely.

That we, we have found that there's no link. 

Jessica Malaty Rivera, MS: Absolutely. It, it, it just, I mean, just four years ago there was a Cochrane review of 138 studies, so it was a study of the studies and that reviewed 23 million children in those studies, and in it it said there's no evidence supporting an association between MMR immunization and autism.

That is such an enormous amount of data. Even still, it doesn't matter that the originator of the claim had his paper retracted from the Lancet. He's had  his medical license revoked. That all these mountains, mountains, literal mountains of data exist. The bias is so deeply held. And honestly, Ken, I can, I can even have some empathy and I think folks might be surprised to hear this because the human brain is really difficult at understanding the nuance of causation and correlation.

And I think when they see two things happen in close succession from each other, it's really hard to say that one thing didn't cause the other, uh, an anecdote is going to be much more compelling Yeah. Than the totality of evidence and data. And so that's why I think he's being so successful is that he's using emotional storytelling.

I. To get people to continue to believe it, even if it's easily debunked. 

Ken: Yeah. 

Jessica Malaty Rivera, MS: All it takes is one story, right? It's why somebody can go on another podcast and say, I know four people who had stage four cancer and now they don't have stage four cancer because they took X, Y, Z. 

Ken: The confirmation  bias is a critical thing to, to understand.

So how do you begin to unlock it for a regular person who doesn't have time, uh, or maybe not familiar with all these scientific journal articles, uh, with, you know, clinical trials and, and how they can be constructed in different ways. How do you talk to a, a regular person and just say, Hey, you know, just be open to the possibility that not everyone who thinks there's no link is working for the pharmaceutical industry, 

Jessica Malaty Rivera, MS: right?

It's not easy. What's often missing in this whole space is empathy and humanity. I. If you listen to what Yes, RFK Jr is saying it's very cruel. I mean, he's, he's speaking in such a hateful and ableist way about people who live beautiful lives and who contribute wonderfully to so many communities and our society as a whole.

But it's almost as if he'd rather have a world without autistic people and the autistic community is not asking for this. Yeah. The autistic community is not saying, we wish we didn't have autism.  The autistic community is, we wish we had a world that knew how to support us, that made it possible for them to have access to the resources that they need.

That healthcare and therapies were not so cost prohibitive. He is trying to eliminate it as if it were a disease, but it's not. And that's where this hero complex comes in. And so I try to remind folks of the basics of, of even just public health 1 0 1, autism is not a disease. There is no pathology here.

That is something that can be cured, right. He's spending his energy and our taxpayer dollars on something that is so misguided. And so it's doing that. It's also teaching people how to read and, and, and interpret papers. It's helping them to be better consumers of the digital landscape, helping 'em to check if there are, you know, predatory journals that are saying these things.

I mean, I, I flagged multiple times that his former running mate famously posted on X, that her foundation was going to pay  people to write papers, not conduct studies, to write papers to show the association between Yeah. Neurodivergence and vaccination. Yeah. And I thought this is a perfect example of how to not do science.

Let me show you. When you talk about people getting paid Yeah. Or people being shills. This is how it happens. You know, when somebody says, I'm gonna pay you to write the thing that I believe to confirm that I, what I believe is right. That's the science. Yeah. That should not be trusted. And I use science only as a label.

Yeah. Not as an actual fact. Um, because they wanna make it seem sciencey. They wanna make it seem robust and, and believable. 

Ken: Sure. Yeah. And she herself has a, a, a child on the spectrum. Often the case with some of the folks that are working in this field, uh, who have become convinced and are unwavering in their conviction that it came down to, to vaccines despite the overwhelming evidence that has been amassed.

That it's, that's not the case. And you know, I think if people  found a link, they'd, they'd say, so it would make your career if you found such a link. Yeah. If you did a study that was a breakthrough and. It hasn't happened. Why hasn't it happened? Well, I think because it's been rigorously studied and people have concluded, you know, that ain't it.

Jessica Malaty Rivera, MS: Well, the irony too, Ken, is that we often get accused of doing this for money and for profit, but if you actually look at the folks who are the antagonists, the folks who make claims that are so erroneous, I mean, I, I'm thinking even specifically of this claim that vaccines have never been studied against placebos.

That is a very easily debunked lie. Right? Rubella, HIB, HPV, polio, measles, the COVID-19 vaccine have all been tested against placebos. It is an easy thing to debunk. It doesn't matter though. It's easy to say those inflammatory things and then also lure them in and sell them something else. As an  alternative, when we say the anti-vaccine movement has evolved from a movement to an industry.

We mean that with our whole chest. It is such a well-funded, well-oiled machine that is lucrative. Vaccines are not that. Right? Yeah. I mean, I think COVID-19 is a bad example because it was so lucrative for a few companies, and we can talk about how two things can be true. Pharmaceutical pay structures are really corrupt and patents are really unjust, but they also make life-saving tools.

Those two things can be true, but it's, it's not true to say that these things have not been tested, that they've not been evaluated. And then also say, but let me sell you my cleanse. Let me sell you my detox. 

Ken: I think that's exactly right. And if we could just spend a moment going over this question of, uh, how these vaccines have been evaluated.

How does an epidemiologist look at how well studied something is and what's the nature of a. The  actual trials, for example, with COVD where we had, we had an easy way to test because we had a lot of people out there who didn't, there was no vaccine. Yeah. And we could compare them to people who took the vaccine, but there comes a point where it's unethical to not give a vaccine that, you know is, has already shown some efficacy for the sake of an updated vaccine that might be more efficacious.

Yeah. Can you talk us through that a little bit, Jessica, how that works? 

Jessica Malaty Rivera, MS: Yeah, I mean, and you partially answered the question I Covid to 19 vaccines are, and by far the most studied vaccines in history. They're the most scrutinized that we've ever seen. And that is because it had to be, we were in a historic pandemic.

Yeah. We had to figure out the quickest way to find a safe and effective vaccine. When I say quick, I don't mean rushed or hasty. I mean, we had a long runway, decades long runway of  mRNA vaccine research to understand how we can use this modality because it is cost effective and quick to produce in bulk.

And so when we had the opportunity to deploy this type of technology while understanding that one of the biggest hindrances in clinical research is funding, think about all the researchers who are just sitting there waiting for their grants to be filled. I mean, I'm thinking, thinking about that right now, the, the biggest barrier to go from phase one to phase three is money and red tape operation warp speed eliminated those barriers.

It deeply funded it and it made it so that those pathways would not have bureaucracy in the way. And so. When we look at what endpoints are, which are essentially goals of, of vaccine trials, you are looking for two things. You're looking for safety. Is it safer to take this vaccine than to not take it?

And is it effective? Is it going to prevent the thing that we want to prevent? And in the case of COVID-19, we want it to prevent hospitalizations, severe illness and death. I think a lot of people forget that those were 5 the endpoints, not infection. Infection was a potential byproduct if enough people took the vaccine, but we wanted to make sure that people were not dying from what could be a vaccine preventable death.

These clinical trials are intended to measure them with very specific, um, you know, tolerability standards, you know, and. All of the adverse events that happened were publicly disclosed. I mean, it had to be. And I remember talking ad nauseum. Yeah. About all the different reactogenic reports, about all the different, you know, indications of, or signals that we saw from myocarditis or pericarditis if they happened in, you know, increased rates, um, or decreased rates in different cohorts, what it could mean for people who were trying to be pregnant, et cetera.

It was so, so, so scrutinized. Yeah. But if there is something like the polio vaccine right now that is so safe and effective and has been used for decades to go back and re-litigate the evidence of that because 5 of how it was first developed is unethical. Right? It does mean that people will then have to be forcibly disabled and potentially dying of a vaccine preventable illness.

And so going back, public health ethics won't allow us to do that. You cannot withhold a known. Treatment. Right. You cannot withhold a known vaccine that will prevent it. So we've just lost the plot on even understanding vaccinology and vaccine and clinical trial structures. They're kind of playing word gymnastics with how study was designed and whether or not it was a randomized, double-blinded, placebo controlled trial is not the question right now.

It really isn't. And for the ones that need to be, they were. 

Ken: Yeah. What's the difference between a phase one and a phase two trial for a pharmaceutical? Where does it start? 

Jessica Malaty Rivera, MS: Yeah. So phase one is a small cohort, right? It's the smallest group of people that you're just testing primarily to  see is it safe?

Because that's gonna be the first signal to not continue doing it, right? The first thing you wanna do is get a smaller group of people and say, right, is this tolerable? When you advance to phase two, it means that you met the endpoint of phase one. You pass that first test. That means it is safe. So let's broaden the group.

Let's maybe potentially make it more diverse and let's see if it's also effective. How is it metabolized? How is it affecting people's bodies? What are the effects that are happening? And then phase three is even larger. Phase three is going to have much bigger cohorts, much more diversity and say, okay, what's the longevity here?

Is it really actually working for longer periods of time? Now, we advanced from phase one to phase three quickly because we were able to get to those endpoints in COVID-19, because there was so much disease. A lot of times you don't have as many cases that you're testing for in a population because it's not a pandemic, right?

It may be hard to enroll people because the incidence of that disease is not as prevalent. And so it, it's interesting when people look at it as. Oh, it was just haphazard. We got to the reach the end points because we were in the middle of a global pandemic. That's why. 

Ken: That's exactly right. So we know, and you've referenced that there are economic considerations embedded in the way we handle our, our healthcare in this country, and pharmaceutical companies are at the center of it.

We do bring drugs to the market that end up getting through all those trials and still we find in the end, are causing harm. Mm-hmm. There are also cases where pharmaceutical companies have acted, um, you know, inappropriately, to put it mildly criminally, to put it bluntly, uh, with some of the way they've, uh, marketed and developed some of their, uh, products, uh mm-hmm.

Oxycontin comes to mind and the litigations, the criminal litigation, uh, around uncivil around all of that. It's reasonable to expect that people might come in with this massive mistrust of anything to do with that industry and that also. Plays into the hands of people who are simply going to say anything that comes out of this industry can't be trusted.

Yeah. And the government entities that regulate this industry, they've made so many mistakes. They've let these, this industry get away with problems in the past. Yeah. Why can we trust them? 

Jessica Malaty Rivera, MS: It's a fair issue. And so first, I'll address the fact that there is a difference between efficacy data and effectiveness data.

So efficacy is measured in the context of a clinical trial, and it is really controlled because you're looking at a specific population. Effectiveness is real world data. So after it's been approved and then you see it out in the wild. How is it affecting? Yeah. Much more heterogeneous populations in potentially different circumstances, like not a pandemic, you know, after disease rates have gone down.

So comparing efficacy data to effectiveness data is something to note. It's something they will be different. And a lot of times you'll see efficacy percentages drop with effectiveness because it's the real world context and you're not getting those kind of very controlled, um, variables that said, that itself does not make it untrustworthy.

Um, and I think I have been very, very open about the duality of being a public health practitioner and believing that CDC is a premier public health agency in the world, but they are not without fault. I can recognize the fallibility of an agency that is a political. You know, agency and say they don't always get it right.

I said it multiple times during Covid that they had their arm twisted. Yeah. By the White House. Even though the data did not support a shortened isolation quarantine period, corporations who were really stressed out about people being out of work for so long pressured them to shorten it. Even though we know that rapid antigen tests are a proxy for Infectiousness, people were saying, well, if you're [01 symptom free, you're probably fine.

We know that's not true. You're still shedding infectious virus if you're testing positive on an antigen test. Yeah, it, it doesn't mean that you throw the baby out with a bath water. There are fallible people, infallible institutions. It's not all bad, but you have to have the discernment to know that sometimes other factors are pressuring it, which what I'm saying can be used for both arguments.

It can be used to say, well then if you, you have to like figure out what's trustworthy then. Yeah. And I understand that I am not here defending pharma. I am here recognizing that what pharma did for tuberculosis is horrific. The fact that there were patents that prevented antibiotics from being distributed in places that are now suffering from extremely drug resistant tuberculosis because they were too expensive.

That's unethical, but they also created the drugs that are now working to save people's lives. Yeah. Like both things can be true. 

Ken: That's the big challenge is getting, uh, getting people to have, uh,  enough of a sense of, yes, I'm gonna do my own research. Uh, which I, I think is a positive thing. I think it's good that people are looking into things for their.

You know, for themselves, but when your search is regimented by these biases and you can't be open to new information, it's shocking. I mean, I, I'm sure you've had this, I've certainly encountered it on social media when I've raised concerns about, about Kennedy. People have said, well, uh, you know, COVID was fabricated.

You can't trust the CDC data on covid mortality because these numbers were all made up or people died of something else. Not covid people, uh, you know, push away evidence and information. And that's not doing your own research. No, that's, that's moving the goalpost. Yeah, that's, that is, that is looking for confirmation of your bias.

And that's not the same as research. 

Jessica Malaty Rivera, MS: It's reasonable to ask questions. It's reasonable to want to be  informed and to look into the research. I'm a parent of three children. I have done so much of my own research because I want to know what's best for my kids. That is not unreasonable. When it becomes unreasonable is when people are asking questions that already have answers and not accepting the answers because they don't confirm their bias.

That is the problem. It it, it's not a new phenomenon either. Right. You know, the, the, the debate of dying with covid or dying from covid is now happening with measles. People are saying, oh no, the kids who died didn't die of measles. They died of the care that they got. 

Ken: Or pneumonia. 

Jessica Malaty Rivera, MS: Yeah. Yeah. Pneumonia is the leading cause of death of measles.

Like that is a fact. We know this. That's why it's so acute. Yeah. It is a respiratory virus. It is not just a rash, but people think, oh, it's just a rash. How can they be dying of pneumonia? You know, people are doing it right now with, with the measles cases and how they're being treated and they're saying things like, oh, uh, they potentially got this type of thing that was too exhaustive on the body, or they potentially  were vaccinated in the hospital and the vaccine actually killed them.

There's no evidence of that. That's not standard of care, but it's just moving the goalpost because people can't accept what they don't wanna believe. Even this whole debate about vitamin A, somehow vitamin A is okay, but vitamin K is not. Yeah. You know, somehow, you know, taking medication that is off label is totally fine.

You've seen that with Ivermectin Hydroxychloroquine Vitamin A now. Yeah. You know, those things are, you know, available because of pharmaceutical companies, the same pharmaceutical companies that they don't trust for vaccines. But somehow those things are okay. It just doesn't make sense. 

Ken: Yeah. And if you applied the same standard to dietary supplements.

Of course the dietary supplement industry has fought hard to not have any rigorous standards applied to them. They want to be, they treated as food, and we've seen terrible mistakes made there too, where people have taken dietary supplements  that haven't gone through careful testing and they've been injured or worse.

Jessica Malaty Rivera, MS: Absolutely. The supplement industry is a trillion dollar industry and it is unregulated and it is a profit machine for so many of the people who are pushing out vaccine misinformation and food misinformation. It is a lucrative, lucrative grift that is getting people to buy expensive powders, fooling people, duping people into, into having, you know, somehow magical collagen that's gonna know how to get to your fingernails and to your hair.

Instead of just saying, have a high protein diet, your body's gonna metabolize it to amino acids anyway. Your body doesn't know this like fancy collagen supplement from a really high protein diet. They get away with claims that are completely unchecked because it is an unregulated space. And so they both want regulations and then they want to deregulate.

So I, again, it doesn't really make sense to me is I'm trying, which is it really hard to understand, which is 

Ken: it, it's very puzzling,  it's very selective and it's, um, it's dangerous on top of it, right? Because in the case of vaccines, in the environmental context, I would think Kennedy would understand it.

They're, they're kind of pollution sources, right? If you, if you're infected, uh, with measles and you're capable of infecting lots of people very quickly, if they're in proximity, that's a social problem that we need to, need to adjust to and, and deal with. And if vaccines can prevent it, just like pollution controls, why wouldn't we do it?

I just don't understand. 

Jessica Malaty Rivera, MS: I think this is where individualism has really taken over and we have forgotten the fact that we live in community and so many of the decisions that we make. Because of these, you know, social contracts that we've all signed to live in harmony and live in collective safety and collective health.

Every time we put a seatbelt on, every time we don't drink and drive, every time we cook food to the correct temperature at a restaurant, those are all  part of the social contract to not cause harm to other people. Vaccines are no different. Vaccines are part of a social contract. They are an essential part of keeping people who are immunocompromised and medically fragile, who rely on other people to be vaccinated, to stay healthy and to thrive in this community.

It's only been in the last few decades that we've seen that concept become a red and blue issue. It's very, very sad to think about the fact that people don't look at health beyond themselves. 

Ken: I mean, we, we have done a lot of work at EWG trying to basically get food additive policy here in the US to align with European, uh, policy and, uh, eliminate some of the chemicals that are added here that aren't added elsewhere.

We probably have a, a disagreement on, on this. We may have to have a separate conversation about it, which I, I would welcome. We see a lot of people in the Maha Make America Healthy again  movement, so focused on these food additives, the law that started it all in the us We were, this, we were the sponsors of and helped, uh, push through.

Here in California, we're all about that. But this myopic take that I think does relate to what I can control personally. I'm going to, uh, stay away from additives in processed foods, and this is going to confer enough benefits that I don't have to get vaccinated. I hear this from people, basically a all the time.

My immune system's strong. Um, I have, I don't have inflammation because sometimes I've, you know, they'll say I followed EWG's advice. Our advice is not that, that means you don't need to be vaccinated. And our advice is also that we can now ignore what else is happening in the Trump administration that's compromising public health, not just the science and, uh, and surveillance that's under HHS Control.

But what's happening over at EPA, this is not making America healthy again. No.  In, in ensemble fashion. Uh, this is assuming right? We can just take, we, let's just get a few food additives out, which I wanna point out, Kennedy hasn't gotten any out yet. Just for the record, it's a level of medical freedom and self care that has gone haywire.

Jessica Malaty Rivera, MS: Yeah, you're right. You and I are not gonna agree on, um. A lot of things related to food regulations in the us but on that topic, we just lost Kevin Hall who was doing unbelievably important work. Yeah. On nutrition, science, specifically on ultra processed food. So again, make it make sense to me. I don't understand how you're both going to Yeah.

Do that and somehow fix our food issue. I don't understand how you are going to manage the chronic disease epidemic while also taking fluoride out of water. Which last I checked, one of the leading causes of chronic diseases among  children is tooth decay, if not the most. 

Ken: So yeah. So dental caries. Yeah.

Jessica Malaty Rivera, MS: It's unbelievable to me, honestly, the talking out of both sides of their mouth. I think it's also intentional. I think it's how RFK Junior gets away with saying, I'm not anti-vax. Because in both sentences I can say the mm MR vaccine is the safest way to prevent measles, but also cod liver oil, vitamin A, diet, nutrition, et cetera, et cetera.

It's how he can say, you know, I wanna find an answer to autism. But it's not because of genetic testing. Even though the paper he's citing is literally saying it's because of better screening and, and genetics and testing, uh, I'm going to say it's exposure to pesticides and other environmental toxins. He intentionally uses those word salads so that he appeases both sides.

He's wanting to make everybody happy. The people who got him in office. Yeah, and the people who are. You know, around him in office. 

Ken: Yeah. And he is trying to, you know, uh, at the same time stiff  arm, the criticism that he's anti-vaccine. 

Jessica Malaty Rivera, MS: Yeah. I think it's a lot of CYA. Yeah. I think it's liability catching up to him because we now have two pediatric deaths from measles for the first time in over 20 years.

You know, that first death was the first time in 10 years, but it's actually the first in pediatric deaths in 20. Now we have two. And that is really, really damning as your initial tenure as HHS secretary. This is unprecedented. This is completely preventable. And I think we're now approaching the point where it should wake up everybody to say, this is not making America healthy again.

In fact, it's going to make us sicker and it's probably gonna cause a lot more harm. 

Ken: Yeah, that's right. I mean, we live streamed the, uh, the Kennedy hearings. We were watching Kennedy's performance and we were startled. By the, um, the free pass he got. Yeah. From one side of the aisle. Yeah. On almost everything.

With the exception of Cassidy. I can  only imagine what Dr. Cassidy, Senator Cassidy is now thinking about the decision he made to cast the decisive vote when everything Kennedy told him. Basically, he's gone back on. What do you think about that, Jessica? 

Jessica Malaty Rivera, MS: I think about it all the time. I think that Cassidy is responsible for this, the situation that we're in.

It shows just how ugly politics can be, that we've become so vitriolic and so polarized that it's about the red team winning at any cost. 

Ken: Yeah. 

Jessica Malaty Rivera, MS: It, it was not about a person who has taken a Hippocratic oath to do no harm, to protect children, to keep people healthy. None of those things were top of mind.

His reelection was top of mind, uh, and the red team winning was top of mind. And now we're reeling from that. And I have had some very discouraging conversations, um, with folks who have met with Cassidy's team. Um, there's not a lot of ownership there. There's no regret, there's  no, no. Um, shame. In fact, it's more defensiveness and it's more we're gonna work together.

Despite every single promise that he, you know, shook hands with him to, to commit to has been broken. He said he wouldn't go after the pediatric vaccine schedule. He's going after it. He said he wouldn't go after the autism debate. He went after it. He said he would not do so many things, and he did them the second he was confirmed.

And so to me, it's it, we are now in a very dangerous time. Yeah. And I've always said science is political because we need good data and evidence to inform good scientific policy. But this is a politicization of science. This is now, it's being used as a weapon. On both sides 

Ken: a hundred percent.  

Jessica Malaty Rivera, MS: But on the side right now to just be antagonistic for the sake of one team winning.

And unfortunately this is going to mean more death, more disability, and more disease for no reason. 

Ken: So what do you think  is next? How do pe-people take a stand? I hear from people all the time, including people who are losing jobs at NIH people we've worked with for, in some cases for decades. At CDC, they worry about, uh, the attack on science.

Mm-hmm. And my concern here is that this is a more sophisticated way to go about, uh, policy by making the, making the problem go away or, or asserting that we found a solution. Let's just, uh, stop vaccinating people. We won't have autism. We raised concerns about thy Marisol early on because there's a complex story there.

We concluded from the very beginning that if th aerosol was removed and you didn't see a drop in autism, then it was kind of case closed. Well, autism diagnoses continued to go up for the very reasons explained in the CDC report better, you know, more aggressive diagnosis, a more,  uh, expansive set of criteria for receiving the diagnosis.

You know, once that happened and once THS was removed from, from infant vaccines, we thought, well, that case closed if it wasn't closed before. But if you cut off that kind of basic scientific research, Dr. Hall is a perfect example. One of his studies had such an influence by showing that highly processed food leads to weight gain.

But his latest study that apparently raised objections from the leadership at HHS didn't show addictiveness. And so that didn't fit in with the orthodoxy and. He felt like he couldn't continue in that role if he was going to be censored as he was. So just going at the basic science, the data collection, the surveillance, if we lose that capacity as a result of needing to conform our scientific findings with, uh, Kennedy's avowed beliefs and  confirmation biases, we really are in trouble then for the long term.

Jessica Malaty Rivera, MS: Yes, there's a, there's a lot to unpack there. You know, thy Marisol is a, a complex story, but I, I think it's worth clarifying that thy Marisol was brought into question because of an erroneous claim that it was metal toxicity in the MMR vaccine that could potentially be causing autism, when at the end of the day, thy Marisol was never in the multiple, in the measles moms and rubella vaccine.

It was never in the vaccine in question. It was in other vaccines. Right. But it was never in mm r right? It was never in Varicella. It was never in IPV, the inactivated polio vaccine. It was never in the pneumococcal vaccine. But at an an abundance of caution, that decision was made. What we miss in that story is that the original claim that was a causal claim between those two things, um, affecting childhood outcomes was debunked.

Uh, the paper was retracted. The person who made the claim had their license revoked. Yeah. But that gets  lost in the story. 

Ken: This is the Wake the Wakefield paper. Andrew Wakefield. 

Jessica Malaty Rivera, MS: Exactly. Yeah. And so the EPA is a very reactive agency. The EPA is always trying to make decisions out of an abundance of caution.

That's why we have things like reference doses. That's why we have a whole very complicated, and I encourage anybody who doesn't, has never looked at public health toxicology to look at how complicated public health toxicology is. It's the hardest thing I've studied in my public health training, um, to understand things like, yeah, what dose is the poison?

Right? It's very easy to find a villain when you don't like a conclusion. And right now the villains in this case are scientists who have been public servants for decades at NIH and CDC, who have been working tirelessly for the sake of the betterment of society and the, and the, and the, you know, prolonging of people's health outcomes.

Maha is completely misguided. It has no intention of making America healthy again based on who they've put in power to control. Maha,  you don't make people healthy again by defunding clinical trials, canceling study sections at NIH, defunding and gutting public health at the CDC, you know, making it so that when there are active outbreaks, you don't have enough people to go to respond when there are active concerns for lead exposure.

Yeah. The entire team has been gutted. That's not making America healthy again. 

Ken: I agree. And then in the same administration over at EPA, all the steps that are being taken to relax. Pollution controls, uh, industries have been invited now to email EPA and ask for exemptions or delays in the implementation.

You can do that by email now because they're cutting EPA dramatically. The ability to detect contaminants in the environment, the evaluate them, go through the risk assessment and toxicology reviews that you described. Yeah. 

Jessica Malaty Rivera, MS: I mean, it's, it's, um, we're not looking at evidence-based science. We are looking for an  agenda to be justified 

Ken: Yeah.

Jessica Malaty Rivera, MS: By any means necessary. And that's not science, that's not public health. 

Ken: Yeah. So we sort of feel like the Maha moms, uh, are, are people, but we've lost them on this particular issue. You have may have a different view that we helped create them. Uh, and so we're part of the problem on some issues and that, that, that's certainly a conversation worth having.

Mm-hmm. Our view is that. You know, I'm vaccinated. My son's been vaccinated from the very beginning, and everyone pretty much in the EWG family's been vaccinated. But there's this whole notion that the only right solution for the Maha movement is to support whatever Kennedy says. I have, you know, seen Maha prominent Maha figures, um, support the cut of 10,000 people from hhs.

Yep. And these are people who know nothing about Yep. These decisions. Um, Kennedy has not been required to show his work. No one's shown us why these cuts are going to lead to greater  efficiency or advances in public health. The opposite is more likely. What do you say to people who, you know, are maybe listening to this will say, well, maybe, maybe I, um, maybe I ought to speak out and say something about this current leadership at HHS.

Yeah. What's your advice on something like that, Jessica? 

Jessica Malaty Rivera, MS: Well. Whether it was the intention of EWG or not is a different conversation. But unfortunately, the folks who have been drawn to EWG content are the MAHA movement. And it has contributed, I think, in part to the rise of the MAHA movement. Because if you look at, and I, and I say this as somebody who studies information's, ecosystems, I mean, my work is specifically to understand how people talk about health and why those information ecosystems create, you know, public health decision making trends.

And I would say that vaccine food fear based messaging  is, is so prolific online. It is probably the gateway to vaccine misinformation. And unfortunately, it has become very difficult to disentangle those two. A lot of times you'll see the people who are believing that RFK Junior has the best intentions for, uh, their children are also believing a lot of fear-based, shame-based messaging about.

Food and ingredients and pesticides and GMOs and, and they lack the kind of discernment to know what's the truth in the middle of all of that. And so my advice is for people to lean into the opportunity to be wrong about something. Right? To be co course corrected, uh, to follow evidence-based science communicators to follow, you know, scientific consensus.

Because at the end of the day, you are often being led astray by somebody who is actually trying to sell you something. It's almost a given. Yeah, for sure. That the  people who are sending you to outside of scientific consensus, outside of evidence-based research have something instead that will also make them money.

I have nothing to sell. The people that I work with have nothing to sell. We are in this because of what. Public health is, it is the sake of reducing people's harm to promote health, to eliminate disease, to control people's, you know, struggle on this planet with all of the things that are trying to make us sick.

That's a very, um, uncomfortable position to tell people to lean into, to lean into potentially being corrected. Yeah. But I've seen it happen. I've seen a lot of people change their minds. I think a pe I think people presumed that everybody's just on either extreme. There is a very movable middle, and that movable middle is larger, wider than most people give credit to.

And I have seen transformation happen. I've seen people say, you know what? Absolutely. I used to believe these things and now you've made it made sense. I'm going to change and, and  pivot. And so I continue to do the work that I do because I've seen that transformation. It is the hope and the optimism that keeps me going as somebody who doesn't often lean into optimism because of how doom and gloom my feet is.

Um, but I know it's possible because I've seen it happen. 

Ken: No, I think that's right. I feel like the tide is turning. Unfortunately, it's taken some pretty extreme things for people to realize that maybe the whole point of Maha and act, and let's just remember Maha was about electing Donald Trump. I think now people are beginning to say, well, wait a minute.

Um, I, and this is where you and I may differ. Uh, yeah. I think it is a problem that we have a grasp, uh, generally recognized as safe loophole for all these food additives that food companies have exploited. We should try and close it. And if we can't, we should maybe take on the chemicals that seem to have the, the greatest concern, or we don't have to choose between, uh, health and eating pesticides.

We have, we have options. Um, and there isn't often consensus  about pesticide safety for us anyway. My appeal to the Maha moms is, look, you, you're, you're, you're accepting. Not, uh, evidence that you've reviewed out of the sake of yourself or your family's health or your community's health. You're following along regardless of evidence what one person is saying at the top.

Mm-hmm. And that's the danger. You've actually given up your critical faculties in support of this so-called movement, and that's worrisome. 

Jessica Malaty Rivera, MS: Yeah. I mean, MAHA is successful because it preys on people who aren't wanting in earnest to make good choices for themselves and their families. I mean, it's, it's clever.

Like who doesn't wanna be healthy? Who doesn't want to be healthier? 

Ken: Yeah. But 

Jessica Malaty Rivera, MS: think even about what Maha actually stands for. Make America Healthy again. When were we healthy?  When, when is the standard we're comparing this to? Yeah. Because that has not been answered to me either. Is it 2019 before covid hit?

Is it a hundred years ago when people were having 15 children out of the luck that maybe three would survive? Because there's never been a time in America when we've been thriving. 

Ken: There's no, again, to go back to, 

Jessica Malaty Rivera, MS: there's no, again, to go back to. So let's, let's make America healthy. Let's use evidence and science to do it.

Ken: Yeah. Let's let that be the closing thought. Jessica, you've been so, uh, gracious with your time. I know we've disagreed on a number of issues. Um, I have nothing but respect with how you go about disagreeing and, um, and yet the, the common thing I think we have that we're talking about today is that we we're facing a real crisis.

Yeah. In public health now, uh, we're turning back the clock. We are promoting crank cures. If anyone who follows EWG thinks this is our worldview, you wrong, this is the wrong direction for our  country. It's the wrong direction for. Environmental health. If you're really interested in doing your research, then do research.

Don't just abide by what, what Kennedy is saying with all the contradictions and all the, I mean, all the dangers that he's posing right now. Yeah. And God bless those folks, uh, who are trying to figure out what do I do about if I live in an area that has a measles outbreak. Yeah. Kennedy's not your guy. 

Jessica Malaty Rivera, MS: No, that's for sure.

Ken: Jessica, thank you so much and, uh, look forward to continuing this conversation. I very much appreciate it. 

Jessica Malaty Rivera, MS: Thank you, Ken. I appreciate the invitation. 

Ken: Jessica Malti Rivera, Dr. Koster, thank you so much for all the work you do and for joining us today, and I wanna thank all of you out there for listening. If you'd like to learn more, be sure to check out our show notes for additional links For a deeper dive into today's discussion, make sure to follow our show on Instagram at Ken Cook's podcast.

And if you're interested in learning more  about EWG. Head on over to ewg.org or check out the ewg Instagram account at Environmental Working Group. Now, if this episode resonated with you or you think someone you know would benefit from it, send it along, please. The best way to make positive change is to start as a community with your community.

Today's episode was produced by the extraordinary Beth Rowe and Mary Kelly. Our show's theme music. Thank you, Moby. Thanks again for listening.