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As the United States Surgeon General, Dr. Vivek Murthy is dedicated to keeping the public healthy and safe. But these days, that involves much more than just cigarette warning labels. Dr. Murthy knows health should be looked at holistically, and he’s used his position to spotlight topics you might not think of as health crises, like gun violence, loneliness, and social media. We discuss his values, the harrowing confirmation process when he first became Surgeon General, and how he defines success and fulfillment, no matter what lies ahead.

Please note: This interview was recorded prior to the Presidential election. In the time since, President-elect Trump has selected Dr. Janette Nesheiwat as his choice to be the next surgeon general of the United States. Dr. Murthy is still the current U.S. Surgeon General.

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Transcript

SPEAKERS

David Duchovny, Dr. Vivek Murthy

David Duchovny  00:00

Hi, I’m David Duchovny, and this is Fail Better, a show where failure, not success, shapes who we are. Vivek Murthy is a doctor father and the 21st Surgeon General of the United States, and he was also the 19th he served in the Obama and Trump administrations before being let go and was brought back by Biden in 2021 as the current Surgeon General. He’s the nation’s top doctor and makes recommendations to improve health for the whole country. You might know Vivek from all his TV appearances during the height of the pandemic, he was probably the only one talking about COVID while wearing a military jacket outside of COVID, Vivek has focused on unconventional topics. Just in 2024 he’s issued advisories and gotten backlash about things like gun violence, loneliness and the stress and burnout of parents. Those areas haven’t really been treated like serious health crises in the past, and that’s something he’s trying to change. But at the end of the day, a surgeon general doesn’t have much power, and we get into that. Another thing I should mention is that we recorded this interview a few weeks before the presidential election. In the time since President elect Trump has selected Dr Jeanette neshawt, a New York Medical Director as his choice to be the next Surgeon General of the United States. You’ll hear Vivek talk about how he tried to approach the job apolitically. You’ll also hear his thoughts on the risks of social media to our kids and what the government could do about it, and we even talk about the Affordable Care Act. The new Surgeon General will obviously have different priorities, but I still wanted to share Vivek’s perspectives, because I think they’re worthwhile. Toward the end of our talk, we get into what might be some of his next moves, but most of our conversation is focused on his journey and on all the work and advocacy he has done so far. I really enjoyed talking to Vivek. I found him very personable and vulnerable about his own personal journey about his own personal sense of failure, moments in his life that are away from the public eye, and I think that you’ll enjoy listening. Here’s that conversation.

 

David Duchovny  03:57

Hello.

 

Dr. Vivek Murthy  03:59

Hey, David, how are you?

 

David Duchovny  04:00

Hi, nice to meet you. Dr Murthy, how are you?

 

Dr. Vivek Murthy  04:03

I’m doing well, thanks. You can call me Vivek, David. I’m very informal.

 

David Duchovny  04:06

Okay, Vivek, you can call me, Mr. Duchovny. I’m kidding.

 

Dr. Vivek Murthy  04:12

I love that.

 

David Duchovny  04:15

Thank you for taking the time. But you know, the most pressing question the nation is facing is I want to ask you about my shoulder again, but I do kind of feel for you in your position, because I think you’re like this image of medicine for the country and everybody expects you to fix everything, and yet, you know, obviously, that can’t be done. But what I what I wanted to start with, because I kind of like to, I don’t know much about the origins of the position itself, you know, the of the Surgeon General, and it is one of those strange American traditions. I don’t know if there’s a i. A similar position in other countries, but, but I was wondering if you could, if you could just inform people, you know, because we kind of take it for granted. We know there’s a Surgeon General, but there’s a history of this, and it’s not an elected office, and it’s, it seems to be something unique to the American system. And I wonder if you’ve thought about that, or if it tickles you in any way.

 

Dr. Vivek Murthy  05:19

Yeah, you know, it’s interesting. I think you’re exactly right, David, a lot of people have heard about the position Surgeon General, but they don’t know exactly what it is, where it came from. It actually has a really interesting history. It goes actually probably back to close to the founding of the country. And it was in 1798 that Congress established something called the Marine Hospital fund, and that sort of became reorganized over time into the Marine Hospital service. And that service was was really vital, because it was a important part of our trade. Like in the United States, we had a lot of ships coming in at that time, bringing goods and all kinds of things into the country, and but they were also bringing disease. And so what the folks did you know in this service is they actually would go out to the ships and investigate if people actually had illness, and if they did, then they would quarantine the ship and to help protect people here, you know, in our country, from disease. And so that is sort of the earliest origins of the service, and over time, that became the United States Public Health Service, and the head of that service was, in fact, the modern day Surgeon General. And so this is one of the reasons why, you know, I wear uniform, is because the US Public Health Service is one of the eight uniform services in our government. So we have the Army, the Navy, the Air Force. People have heard of those, but one of the eight is also the Public Health Service, and we have 6000 officers who are nurses, doctors, public health experts, physical therapists, pharmacists, you name it, and we deploy them during times of emergency like earthquakes or tornadoes or outbreaks to actually help provide care and support the public health system. And during their day jobs, they help provide a lot of public health support to communities across America. So that’s the origin of the service. It actually came about sort of more you know, less you know, because of law and more out of sort of cultural evolution, that the role also came to provide public health information directly to the country. And that’s a role that most people are familiar with, that when there are critical public health issues that arise, the Surgeon General is responsible for communicating to the public and getting them the best possible information so they can make good decisions for themselves and their families.

 

David Duchovny  07:28

That’s That’s fascinating. Thank you for that. And I’m sure a lot of people don’t, don’t quite understand what the position is or or what it entails, you know, and I guess my next question would be, what were you doing in your life at the time when you were first considered for this position? Is it a position that you offer yourself up for, or is it something you get nominated for? Or what is the process by which you became Surgeon General? The first time around?

 

Dr. Vivek Murthy  07:28

It was actually quite by surprise. David, you know, I had not like anticipated I would ever go and work in government. It was ever a dream of mine. I admired people who did it, but it just didn’t feel, you know, like the right fit for me. And I was actually, at the time, I was working in a hospital up in Boston. I was providing direct care to patients. I was teaching medical students and residents

 

David Duchovny  08:19

What was your specialty?

 

Dr. Vivek Murthy  08:21

So I was trained in internal medicine, and I was specifically working in the within the hospital system, so when patients were sick enough to get admitted to the hospital, I was taking care of him there, right? So that’s I was doing. It was great. And I was building a technology company on the side that was going to help make research and clinical trials more efficient. I was doing some work and like advocacy and policy, because there’s a lot that was broken about the healthcare system. And healthcare system and a lot of people who didn’t have insurance and couldn’t get care, and I wanted to see if we could do something do better, basically. And so I was working with other doctors and policy advocacy. So it was all outside of government, though. And what happened is, on my interesting on my birthday in July 10, 2013 I was coming back from LA to Boston, got off a red eye, and was going to my my apartment, and I realized that I had left my dry cleaning for like, a week, uh, passing to you at the dry cleaners. So I went over to pick it up, and with my hand, sort of full of, like dry cleaning, I’m like, walking toward my car, my phone rings, and I was a 202, number, which is Washington, DC. I knew that, but I didn’t recognize the number, and I wasn’t going to pick it up, but it kept ringing, and finally I said, let me just pick this up. And that happened to be the call from the White House asking if I’d like to be considered for this position of Surgeon General. And I was quite surprised, because it felt like it was out of the blue. And I remember calling my my wife and then girlfriend, Alice. I said, Alice, you’ll never believe this crazy call I just got, and she said, was it the White House asking you to be Surgeon General? I was like, how on earth did you know that I was thinking? I wasn’t even thinking about that. She said, you know, women have better intuition than men do. So .

 

David Duchovny  09:53

Really it was just intuition?

 

Dr. Vivek Murthy  09:55

It was her intuition. Yeah, crazy. I know, I married, updated.

 

David Duchovny  10:04

We all do. I think that. Did you have any hesitation? I mean, it sounded like you were very involved and had a multi faceted kind of career going, not only as a doctor, but as an inventor or a businessman or somebody who had a vision for helping the system that you were involved in was, was there any kind of hesitation on your part to take it?

 

Dr. Vivek Murthy  10:26

You know, what’s interesting about that? David is six months before I had actually been asked by somebody who was close to, you know, the federal government at that time, if I wanted to serve in the federal government. This is somebody who was wanted to sit by my name for a position I might be interested in, and the truth is, I couldn’t think of a position that would be a good fit for me at that time. I just kept telling him I was like, I just I don’t think I’m made to work in government. I think I’m better off working outside of government. But interestingly, when I was asked about the surgeon general role, I didn’t have any reservations. My intuition just told me that this would actually be the right kind of role for me, but it was very different from most other roles in government. So the role of the Surgeon General, even though you’re appointed by the President of the United States, your goal is to it’s in a one in a political role, and your fidelity is not to politics or party, but to science and the public interest. And so if there’s a circumstance where, let’s say you think is something is really critical to share with the public, and let’s say your president of the White House disagrees, the right decision is to do what you think is in the best interest of the public, and what’s directed by science. And I actually like that independence, like, about the office as somebody who didn’t really grow up with a sense of like, party, and didn’t like, you know, think like, you know, along those lines, like, it sort of made sense to me. I was, like, raised in the sort of world of science and medicine and and I like that. So yeah, so I actually didn’t, I sort of had this intuition that would be a good fit from early on. But it didn’t necessarily mean it was an easy job, and it just turned out to be a challenging one. It also the if you go through a confirmation process, David, to serve in this role, which means the United States Senate has to vote on you. And yeah, and that itself can be, in my case, turned out to be a very long and harrowing process the first time around so.

 

David Duchovny  12:14

What was, if you don’t mind, what was harrowing about it for you, aside from, you know that process being harrowing in and of itself, I would imagine.

 

Dr. Vivek Murthy  12:23

Well, what was, what was, I think, challenging about it is my nomination got swept up into, sort of into a lot of politics.

 

David Duchovny  12:32

This is the Obama White House, the first one, right?

 

Dr. Vivek Murthy  12:35

This is, yeah, this is the first time when President Obama was in office. So got swept up into a lot of politics, particularly around, you know, around gun violence. And, you know, I had made some statements in the past that that I believe that gun violence was a problem and that it was a public health issue.

 

David Duchovny  12:51

Just as a private citizen, you had.

 

Dr. Vivek Murthy  12:53

Yeah, private citizen, I had said that. And sort of that sort of became sort of politicized later in the process. And people, sort of, you know, certain political figures took it to mean that I was somehow against, you know, the Second Amendment, or I was, you know, had extreme views or something. And I, you know, I understood at that time that it was actually not so much about me. But there was, like, a lot of politics going on, and I sure happened to be a sort of a convenient pawn in those politics, yeah. But regardless of what ended up happening, the result is that it delayed my nomination significantly. Didn’t just delay it, but most people thought it would never actually go through, because the politics were just so paralyzing, you know, on this particular issue of gun violence, which is really unfortunate, but it’s unfortunately how it’s been. So when I finally did get confirmed 13 months later, it was quite unexpected and after a very long, arduous process. But I’m, I’m grateful that it did work out, and it’s what gave me the opportunity to serve.

 

David Duchovny  13:49

Well you know, you mentioned that it’s a it’s a political appointment, but it’s an apolitical position. But it seems like that’s almost an impossibility in this day and age, as you went through, even knowing that this is a political game that’s going on, or something political about it, you know, were you feeling? Did you get to the point where, like, by hook or by crook, I’m gonna I’m gonna stay in this because I’m gonna win, or this is too much? Yeah, this is a year of my life I’ve already a sacrifice to this confirmation process.

 

Dr. Vivek Murthy  14:24

David, this is one of the toughest years that I had had in my life and at that point, and it was for a few reasons, one I had never had to deal with like that kind of public scrutiny before, sure, and especially with being caught up in politics, where, like, there are all these people saying terrible things about you don’t even know. You don’t even like, really, you know it’s not even about because it’s not about you, right? It’s just about like you having to be a pawn in that moment in a broader battle. But I had this weird sense of shame that I was carrying around. Me also, David, this feeling that I had somehow failed, and I had failed the people in my life that I really cared about, that I had let them down by not being able to figure out how to make this all work and and that was really hard, you know, somebody had told me at one point, you know, in the process, when it got stalled and it was unclear when, if and when it would work out, they said, you know, you should just, you should just forget about this all like, go travel around the world, just like, you know, just take some time, just for yourself. And I said, I can’t do that, because I feel just so consumed by this process and racked by these feelings of shame and guilt, yeah, and I know it’s not necessarily my fault, per se, but I still feel it. I don’t know what to do with that, and it was hard, you know, like at that time, I did what ended up doing during that time is, like, that sort of guilt and shame actually ended up contracting my circle of people I was interacting with, because, like, and, and that was probably not a good thing, you know, at the end of the day, I probably needed to do exactly the opposite. Was actually reach out more to people. But, you know, in that sort of cocoon of shame, it got tighter and tighter. I was just, you know, talking to my parents, talking to my wife, Alice, talking to maybe one or two close friends. But it took me over that I was really forced during that year to really dig deep and just to try to ask the question like, Well, who am I? What really matters to me in life? And what I fell back on David was this? This a lesson that my parents had taught me like early on, when they had gone through like some pretty significant hardships in their life. Which is they, they always taught me that, you know you might succeed, you might fail at things, but what you never want to do is to give up on your principles, is to compromise your values, is to not try as hard as you can, you know. And if that effort doesn’t get you what you want, then so be it. And I just realized at the end of the day, because there were times where people said you want to withdraw your nomination, because who knows. It could take for, you know, years, and then it still may never work out. Do you want to be in limbo for all those times, and I just like thinking about what my parents said to me. I just realized I I didn’t want to get up in the morning, look in the mirror and not feel like I did everything I could, and I didn’t want to feel like I didn’t stand up also for what I believed, because there were also calls for me to to recant what I had said, you know, just say that, you know, I don’t believe that gun violence is a public health issue, and to somehow apologize for that, and, like, try to placate, you know, the forces that were opposed to me, but that didn’t feel good either. I was like, at the end of the day, I need to be able to go to sleep at night. I need to be able to, like, look in the mirror and feel good about the person I am. I need to live up to these values of my parents instill in me through their own example, which is, you don’t give up, you try as hard as possible, and you speak your truth and stand by it. So that’s that was ultimately what got me through that, that very difficult year, and it’s why, like I just, I try to remember, you know, like everyone else, I get frustrated with my parents sometimes about this issue or that issue or whatever, or impatient with them, you know, when they don’t understand how to like work. Some technology that’s easy for me, or whatever, but I always try to remember like that moment in particular, because I realized that that what they’ve given me is really timeless and priceless, you know, which is an example of how to live life, you know, grounded in principle, grounded in relationships, grounded in community, and I needed all of that really to get through that really difficult year.

 

David Duchovny  18:30

That’s beautiful. What I love about that is that your parents advice and your interpretation of that advice as a son was not, I gotta win, you know? I gotta get this job because I’ve already fought hard, you know? And I’m gonna, I’m gonna win. It was something that I try to tell my kids and even tell myself, still, you know, that if I commit myself fully to something that I believe in, and I have found that even if I don’t win in those situations, I sleep very well at night. There’s a certain almost joy in winning or losing doesn’t matter. Doesn’t matter the fact that this situation, that life set me up to face, the situation in which I could fully commit how lucky. How lucky am I that I can have moments like that, and then winning and losing doesn’t, doesn’t matter. I mean, sure it matters, but it doesn’t really ultimately.

 

Dr. Vivek Murthy  19:27

Can I ask? I love that, and I love that you’re trying to instill that in your kids. That’s something I would like to do with with my own kids as well. But like, how did you come to that? That realization? Because I think for most people, it when they’re younger, and society kinds of tells us focus on the outcome, and yes, the outcomes which would drive your happiness, but yes, how did you end up shifting to focus on how you showed up?

 

David Duchovny  19:49

Well, because I came from the other side. I mean, like you, I think I was an excellent student, and I went to graduate school. I was studying English literature, getting a PhD at Yale. You know, I got into all the top schools, and I was achieving in that way. But there was something in me that wasn’t satisfied or wasn’t being fed, and it really took going out and being a conception of whatever an artist I am, where there aren’t A’s really, where it’s just like, it’s hazy, it’s not, you can’t grade it. And then I really started to realize, you know, this is about some conception of soul or or an intrinsic want or desire, and those are the, really, the strongest feelings. And I was lucky enough to be able to kind of reach out into another field. I know a lot of people don’t have that option. I did, and it was really by trial and error in my life, you know, to to go from being a good boy, you know, and getting patted on the head to a place where the only pats on the head were going to come from me to myself, if I knew I committed like you, If I knew that I gave my heart.

 

Dr. Vivek Murthy  21:03

I love that, the fact that you’re living your life trying to to focus on what you put into it rather than what you get out of it, yeah, and the fact that you’re also trying to connect deeply with yourself, know who you are, value who you are, and then connect with others. I just, I think those are great examples to set for kids, also in a world that’s constantly telling them that what matters are the things that they acquire, the achievements they have on their resume.

 

David Duchovny  24:52

What strikes me about your particular journey, which is very moving to me, is that you you describe a very lonely childhood, and it’s very clear, you know, that your your subject still is loneliness, which is not really considered usually a medical issue.

 

Dr. Vivek Murthy  26:09

When I was growing up, I don’t think I would have described myself as a lonely child, even though I once, because I don’t think I really even had a conception of what that meant. It was only later, in retrospect, that I sort of fully grasp just how lonely I was, like I was really shy, introverted kid growing up, and even though I knew my parents loved me deeply and I felt very secure at home when I would go to school, it wasn’t so easy to just break into conversation, you know, or build build friendships with others. One of the scariest times of the day for me was lunchtime, was walking into the cafeteria and wondering if there’d be somebody to sit next to, and that really weighed on me, sort of took a toll on my self esteem. I wasn’t very confident as a kid, and, you know, and of course, like many kids, I experienced some bullying and sort of some racism and harassment, you know, in school as well, and that didn’t help. But so for those reasons, I get I find myself wanting to be more connected to others, but not necessarily having like those, those deeper friendships. And it was, it wasn’t until probably high school, really that I was able to to find and build some of the friendships that really helped me feel like I belonged, helped me feel at home. But what’s interesting is that having had that experience, and even though I didn’t learn really anything about loneliness, when I was in medical school, when I started seeing patients, I realized that so many of them were struggling with loneliness, and there were times when people would come in with a really difficult, challenging diagnosis, where we had to, you know, break some really tough news to them. And I would often ask, you know, is there somebody you want me to call to be a part of this conversation? Yeah, and so often they would say, I wish there was, but there’s, there’s no one like, I’ll just do it by myself. And I came to see that even though people came in for various issues, a lot of them are struggling with loneliness. So I was attuned to it a bit because, in part, because of my own experience, but I’ve come to see it as an incredibly common predicament that people find themselves in today, but often not talking about it, because it somehow feels like to say, lonely, I’m lonely. It feels like saying I’m a loser, but I’m not likable, I’m not lovable.

 

David Duchovny  28:21

It’s an mission of failure of some kind. Yes, aside from just the existential question of loneliness, do you have thoughts yourself about the either the way you were taught, the way you figured out how to be a better doctor, the idea of giving a patient agency in their own cure, rather than here’s a pill or here’s a, you know, here’s what I’m going to do for you, which kind of sets up the doctor as either God or a failed God, which neither of those positions are are going to work out in the end. And I wonder if you have thoughts on that, the way, the way we teach medicine, which I don’t really know in this country.

 

Dr. Vivek Murthy  29:01

Yeah, gosh, I have so many thoughts on how we train doctors, but I think fundamentally, I think if you look at medicine as a profession that involves healing, and if you recognize that our job isn’t always to heal externally, but it’s to support people in their healing process, then that opens up our aperture for how we think about healing. The healing is more than just medicines prescribed and procedures done, but it can be in the time we spend helping people feel at peace and helping them know that they’re not alone. It can be in the time we spend helping people marshal resources within themselves and see a problem more clearly and sometimes like draw in the people around them who can be a powerful force for their own healing. Like, all of this is part of the broader healing process, but in medicine, typically, like much, the vast majority of the focus is on physical health, right? It’s on, okay? What is happening at a biological level. How do I interpret lab results? How do I administer the right medication?

 

David Duchovny  30:04

As if you can separate physical health from mental or spiritual health, as if.

 

Dr. Vivek Murthy  30:09

Yeah, that’s right. And I think the more we learn about just humans, the more we realize that these are all intertwined, that they’re really as I think of it, like four core dimensions of health, there’s physical health, there’s mental health, there’s social health, there’s spiritual health. Like these are these all feed off of each other, and so we know now, for example, if my social health is, you know, is in a bad place. If I’m isolated and lonely, that actually increases my risk of mental health conditions like depression, anxiety, but it also increases my risk of physical health conditions like dementia and cardiovascular disease and so and premature death. So however you look at it, these are all intertwined. And I think part of the work and my evolution as a doctor has been widening that aperture with how I look at healing, to recognize how much goes into a person’s health and well being, and honestly that that’s been a humbling experience for me, because you start to realize very quickly that no matter how much you learned in medical school, you don’t have the ability to control all those four boxes for a human being. What you have to do is sort of enter into a partnership with a patient and recognizing there’s some things you can provide. There are things that, hopefully your conversations and can catalyze but there’s also a lot of power just in the relationship that you have. One of my most important mentors in medicine is is a physician named Dr Rachel Naomi Reman, who lives out in California, taught for many years at the University of California San Francisco. Years ago, in her career, she began taking care of cancer patients who had largely been through the traditional system and told that there was nothing left to offer them, and so they had largely moved on from the traditional system. And when she encountered these patients, she realized that just because there are no more medicines to prescribe does not mean that there isn’t more healing that can take place. And through her conversations, through her relationship she built with them to the community that she created. She She not only helped them feel better, but it turns out, you know, she described to me, they actually live longer, you know, on average, than patients who did not have that kind of support in their lives, even though they both had similar diagnoses. And so, yeah, I do think that there’s a lot we have to do to continue to broaden that aperture of how we look at healing and to reflect that in our training of medical students. I think if we do that, we won’t just help patients. Will actually help doctors too, because when you see patients in this more wholesome light, it actually allows you to show up in a more wholesome way as a doctor, whereas right now, so many doctors feel like they have to check who they are such big parts of who they are at the door and show up in a very specific way. But when we bring our humanity to the table, I actually think it benefits us and the people that we serve.

 

David Duchovny  32:56

I couldn’t agree more. This is your second time around as Surgeon General, very different from the first time around. This is a very different world that you’re in. So you’ve served in the same position, and we went through COVID, and we went through the rise of social media and misinformation, and I think that those in terms of science and medicine are huge revolutions. Because I think what’s happened is people lost a lot of faith in science. You already started questioning science. You know, you know when I see you talking about things that are dear to my heart, like the dangers of social media for kids and stuff like that, not extremely a science based discussion, because it’s gonna you’re gonna have to bring in sociology, philosophy, economics, you know, the social media is a all encompassing kind of a beast that you got to address. You got to bring the four quadrants. You got to bring it all to bear. It’s not just science, but it seems to me, a very important thing at this moment in time is somehow restoring that faith in science, and science moves forward by trial and error. I was so frustrated during the pandemic when people would say, well, the vaccine is not 100% or whatever as well. You know, that’s not how it works, and some people got hurt or whatever. Yes, that’s, that’s how science works. It’s never and what an amazing story that a vaccine was created so quickly. And yes, I’m sure there’ll be bumps, but science really was heroic. And yet, on the other hand, science is taking a beating, you know, kind of with misinformation. And I wonder, as you choose issues, first gun violence and social media, which, again, are not completely science based, I wonder if you feel, oh, I’m kind of opening up the door again for debate here, where me. Maybe I should be just trying to restore faith in, you know, the trial and error and the march forward of science.

 

Dr. Vivek Murthy  35:08

Yeah, this is a really good question. David, I as I think about this, I think you were absolutely right that we have a lot of work to do to shore up people’s understanding of science, to show up their faith like in the scientific and public health system, more broadly, criticism has brought us a lot of life saving benefits and Life Extending benefits, but those only help if people are able to utilize and engage in those treatments and interventions, and if people don’t trust that they won’t and so I think part of that has to do with honestly, with how we communicate and build relationships of trust between people in medicine and public health and communities that they’re a part of, that they’re serving. Because what’s one thing that was interesting is, even though there was a lot of misinformation circulating during the height of COVID online, and that was, don’t get me wrong, that had a lot of really negative effects on people. And I issued a whole, you know, report on that, in fact, in december 2021 but what was interesting is that many people still ended up trusting what their individual doctor said, what the nurses who involved in taking care of them said. So trust is has ended up even though it may have diminished in large institutions and professions, it still is concentrated, actually, in relationships, right? And so if you, and that’s like, to me, that increases the responsibility and the onus and urgency for medical and public health professionals to be in communities and build relationships and get to know people before there’s a crisis, so that when you there is, in fact, a crisis, those folks know that they can trust you for information, right? But to your broader question, just about like, how we chose the issues that you know I’ve chosen, you know, in my mind, that a lot of these issues involve broadening, like, how we think about health. A lot of people wouldn’t have thought loneliness was a health issue. It turns out it is. Many people weren’t actually from a science and medical establishment. We’re not talking about social media’s impact, like on our on the well being of kids, even though does have, you know, a real impact. And the thing about it being scientific versus not is actually there’s a lot of science behind all of these issues. The problem is, a lot of science wasn’t known, right? And science was sort of defined in a very narrow way. But when you look at it just from a data driven perspective, there’s a lot of data on the impact of our mental health and overall health, the impact of our social health on our overall health. My I’ve seen my role as being to number one, widen that lens and help people see what data we do have that tells us that these are actually really important dimensions of our health and well being. And in the case of an issue like social media, help people understand what factors are affecting those different dimensions of our health, our mental health, social health, etc. And so that’s what I’ve tried to do, and that’s come so while continuing to focus on some of the traditional issues, we still do work on tobacco, we still do work on other traditional health issues. But in my mind, if we aren’t paying attention to mental health, to social health, some of these other dimensions of our well being, then it would be like taking care of your left arm, but not your right arm, and expecting that you’re going to be okay. We got to take care of all parts of the human that means taking care of all parts of our well being.

 

David Duchovny  38:22

Well, it’s such a moving target at this point, right? I mean, the phones have been with us for just a few years now, and social media has just been with us for a few years. But, you know, I think the greatest success of the Surgeon General’s office would have been the warning label on cigarettes. That’s a great success. A warning label on alcohol, not as big a success. I think that, I think in tandem with the warning label on cigarettes was, you know, denying them access to advertising. You know that that’s really, unfortunately, you can’t do that in your position. I mean, it’s something that you can think about, like, What would our world be like if you couldn’t advertise alcohol? Would that mitigate, you know, the power that alcohol has in our society, but let’s say, let’s look at social media and some kind of a warning label. Is this something that you’re investigating? Is this something that you’re thinking about? Is it even possible with something like social media to does it even make sense?

 

Dr. Vivek Murthy  39:23

It’s a good question, and I think that to make social media safer, we need to, number one, warn people about the harms that we see, but also make actual changes to the regulations that ensure that companies are going to make their platforms safer. And if you think about it, this is actually not a dissimilar approach to what we took with cars right back in the day when, yeah, like when, when I was growing up, there were a lot of car accident related deaths, yeah. And we didn’t just say, hey, that’s the price of modernity. Let’s just live with it, right? And we also didn’t. Say, Let’s go back to horses and buggies. We said, you know, let’s make these cars safer. And we, what we did in that regard, though, to make them safer, is we didn’t say, Okay, we’ll just ask the companies to do so, and just hope they comply, you know, because the cars have been around for years and we’re seeing these high rate of of car accident related deaths, we put in place, uh, government put in place safety standards that got us seat belts and, you know, and airbags and crash testing.

 

David Duchovny  40:25

But where did the pressure? Pressure came from consumer groups, or did it come from medical groups? I believe the pressure for that came from consumer groups no.

 

Dr. Vivek Murthy  40:32

Yes, yeah, and consumer and parents in particular, played a really important role there.

 

David Duchovny  40:38

So are you courting other sectors of power to help you approach this new problem as you see it in social media.

 

Dr. Vivek Murthy  40:45

Yeah, so when we put out, when I, when I put out the in 2023, a call to action, if you will, to help address this issue. I laid out a series of steps Congress needed to take. We have seen like uptake from parents groups. We have seen schools getting more involved in advocating for these changes. We’ve seen medical groups and public health groups now getting involved in advocating for these changes. And all those groups are really vital and ultimately making change happen. And we’ve now finally seen some progress on the federal front. Not enough progress. We still actually have to finish the passage of the bill that they’ve started to move forward or and find ways to implement these kind of measures more completely. But the bottom line is, like, the same types of coalitions that helped us make cars safer can help us make social media safer, but look, I don’t think that any of this is easy, which is why, you know, I think it’s going to take us continuing to press on this. And it’s why I, this year, issued the call for the warning label. It’s because a warning them on social media is not the solution entirely on its own. It’s, you know, we have to have the other elements that I called for last year, which are the regulations that protect, you know, kids, in particular, from harmful content. That protect them from addictive features that would seek to manipulate their brains into excessive use, that would also and regulations that would also require companies to be transparent about the data that they have about the mental health impact of their platform on kids, because right now, a lot of researchers, David say that they can’t get full access to that data, but what a warning label does is it helps clue people into the the data that we’re seeing about harms, and helps remind them that these platforms have not actually been proven to be safe. So many people, David, parents across the country ask me, Why would my child be allowed to use this if it wasn’t safe? How does that make sense? And I think it’s a very reasonable question to ask, right? Because for a lot of other products that kids use, right, we ensure that they have passed to some basic safety standard, right? We haven’t done that with social media.

 

David Duchovny  42:44

Well, it’s too new, I guess you know. But what are the negative effects that you have seen? Just so people listening can hear preliminary studies, I’m sure they’re shocking, and, I mean, I’m very stupid with this kind of stuff, but there’s no way we can put an age, an age, kind of guardrail on this thing, can we? I mean, I don’t know how that would work.

 

Dr. Vivek Murthy  43:06

Well, so here I’ll tell you the data that we have. And then a lot of this we published in 2023 but more has come out since then, which is number one, we know that adolescents who spend three hours or more on social media a day face double the risk of anxiety and depression symptoms. And by the way, the average amount of use today is 4.8 hours, right? So it’s well above that. And this is just social media. This is not even including all the time kids spend on other screens. The second thing we know is, if we listen to young people themselves, look at the studies that have have put together what their opinions are, and surveyed them, nearly half of adolescents say that social media makes them feel worse about body image. A third of them say they feel addicted to social media. A third of adolescent girls, a third of adolescents say they’re sitting up till midnight or later on weeknights, using their devices. Much of that is social media use, and we know David, that when you compromise either the quality or quantity of sleep, for adolescents in particular, it increases their risk of mental health conditions. Even you put all that aside, David and you, you look at just the stories and the reports that we get from young people and their parents. Yeah, I have sat with many of these families who have told me that after their child went through a difficult period in their life, like a breakup or, you know, in a relationship breakup or a disappointment, in turn, you know, in school that they went to social media looking for some sort of comfort and relief, and instead were served up by the algorithm, the videos that often suggested to them that they harm themselves, and in many cases, walk them through how they would take their own life, and in some cases, the children follow through with that. And I had sat with parents who have lost a child after that experience, and are asking me, how can we protect other kids from going through the same thing now, if we had David, even like three or four of those incidents. Decisions that it happened after a young person took a new medication that was put on the market. Can you imagine the reaction we would have paused things we have said, we have to investigate. No one else should take this until we understand what’s really going on. Yet, this happens on a regular basis on social media, and despite being around for 20 years as a country we have, I believe, failed in our responsibility to put forward the kind of thoughtful guardrails and safety measures to protect our kids.

 

David Duchovny  45:28

Do we see similar effects worldwide? Or is or are those? Are those numbers not in or are the countries not as involved in trying to figure it out? Or is this just an American issue?

 

Dr. Vivek Murthy  45:40

I think this is a broader global issue. David and I say this in part because I mean the data that that we have is most centered around the United States. But when I talk to when I travel to the United Kingdom and talk to kids there, when I, when I went to India, just very recently, I just got back from there and spoke to students in multiple cities, you know about mental health, even before I bring anything up, they all bring up social media, and they say very similar things across countries and cultures about its impact on their self esteem, on body image, about how it’s replacing a lot of their in person interactions online. And they end up feeling worse about their friendships as well, because they feel left out constantly as people are doing things without them. These are very consistent and common, and they also talk about how much time they spend and how hard it is to actually get off of social media. And by the way, that’s that’s not a bug, that’s a feature, right of the platforms they’re built to ultimately maximize how much time we’re spending on them. And what bothers me, David, is we’ve put the entire burden of managing all of this, all of the harms, on these rapidly evolving platforms, on the shoulders of parents and kids. And we’ve told kids, well, use the force of your willpower. But two things we have to understand. One is that adolescents are in a critical phase of brain development where they are more sensitive to social suggestions, social comparison, and haven’t developed as much impulse control, but we’re also asking them to manage these platforms, which have been designed by some of the best product developers in the world and engineers that have been done so with cutting edge neuroscience and by resource by some of the richest companies in the world. And that’s the definition of an unfair fight. We had kids pitted against some of the most well resourced operations in the world. So this is a global problem. It’s actually why I think it’s so important for countries to now work together to address this, to come up with the right regulations and rules.

 

David Duchovny  47:36

Is that something you’re involved in?

 

Dr. Vivek Murthy  47:38

It’s something absolutely that I’ve been pushing for Yes, and it’s the conversation I have when I travel abroad with policy makers and with groups in the public, and I have that conversation here as well with our institutions in the US, because, look, we’re all facing similar challenges here. The more we can learn from each other and build the right policies, the safer all of our kids can be.

 

David Duchovny  50:56

You have a megaphone, but you don’t have a pen to legislate. Clearly, you’re passionate about it and want to see some kind of legislation happen. Where is that pressure going to come from? If not, you know, can’t just come from the parents, right? You’re already saying they’ve got too much on their plate, you know, and they’re concerned. Where is this pressure going to come from, against the money that’s arrayed against it on the other side, and influence?

 

Dr. Vivek Murthy  52:34

Well, I think it can and should also come from the medical and public health establishment in this country, from people who are taking care of children and seeing the direct effects of social media in their clinics each and every day, and who can speak up and not just to legislators who have the power to enact the regulations we’re talking about, but can also speak up to the press and to the media. The more that people cover these issues, the more pressure generates, also for action. So I will say that one thing as challenging as this area is I do feel encouraged by just how much movement we have seen in all of these groups now pushing more publicly for change, and we’re seeing legislators respond as well. And there’s a lot that divides the country right now politically, but this is not one of those issues. This is an issue where I’ve worked with Republicans and Democrats, you know, who both deeply care about kids mental health and are worried about the impact of social media. And some of the bill that just passed the Senate not long ago was a bipartisan bill as well. And so I think that bodes well. But again, time is of the essence. This can’t be an issue where we just say, oh, you know, legislation takes years and years, and we’ll just, you know, have to be patient and wait on that timeline. Like, this is our kids health that’s at stake. You know, one year in the life of a child is a long time. You know, a lot of developments taking place, and so we can’t afford to treat this issue as business as usual. It’s one of the reasons why I’ve continued to press as much as I can for the urgent action that’s really required, and I’ll keep doing that for as long as it needs be.

 

54:04

Are you going to go back to private practice at any point? I’m wondering, is there anything about your experience in this job that you think will make you an even better doctor, an even better person, a better a better citizen, and what do you see yourself doing after this?

 

Dr. Vivek Murthy  54:25

That’s such a good question. David, I then the honest answer is, I really just don’t know. I used to have, like, some Okay, some vague sense of what I would do next. But as as I’ve gotten older, actually, my the road ahead of me that my visibility into that road has become, you know, shorter and shorter interesting. I was never really good at making five year plans anyway, and now I’m just, I sort of realized in my medical training that I needed to just focus on what I was doing now and then think about what was next. But I will tell you some things that that sort of do. You. Inform I think how I will think about that next step one is that I have come just doing this work, by the way, over two terms, has just been a blessing. It’s been such an extraordinary opportunity for me to connect with people across the country and get to know them and learn from them in ways that I just never dreamed as a young immigrant kid you know, who is incredibly shy and introverted that I would have the opportunity to do, and it’s taught me a incredible amount. But one of the things that it’s really helped me understand and see more clearly is that what we really need, I feel like, in society, is a realignment around what drives fulfillment. Like, when I think about my kids right, like, I don’t know what they’re going to do in the future. I don’t know where they’re going to live. I don’t know who they’re going to marry. One thing I do want for them, though, is for them to be fulfilled, however that may come about, and I think that parents across the board generally want that for their kids, right? They want them to be fulfilled. What I worry about, David is when I talk to young people across the country, I will often ask them, How do you define success? Or how is society defining it for you? And I usually get the triad of success, which is fame, fortune and power. And if you get involved three of that, then, Wow, you really made it. You know, really? No, yeah. And the lot look, it’s not that young people fully buy into that necessarily, but they feel like that’s what society is built around, and if they’re not playing that game, they’re going to be left on the sidelines, right. And a lot of parents feel that way too. What I actually think matters even more for what we want in life is a different triad, and that’s a triad of fulfillment, which is driven by relationships, by purpose and by service, those three elements, when powered by the fundamental virtue of love, drive us toward fulfillment. Right? They give us meaning and belonging in our life. And I want to think about what I can do in my life. You know, after this job is over, to help support society grounding itself in that triad of fulfillment. How can we make relationships and purpose and service part of the ecosystem that we live in? How can we bake it into how we raise our kids, how we educate our kids in school, how we design our workplaces to support those kind of ideals? How can it inform the leaders we choose, the policies we design basically, how can it become, once again, part of the DNA of society? Because I worry that the path that we’re going on now is not necessarily, it’s leading to the fulfillment that we want, even though people are working really, really hard and spinning faster and faster and faster. So that requires, what I’m talking about and calling for is not, you don’t achieve that by passing along, right? That’s cultural change that has to be driven at every level of society. And that’s about, you know, how do we, how do we have the right conversations about what we really want in terms of fulfillment? How do we have faith leaders engaged in this conversation? How do we design and, you know, cultural elements like music and documentaries and movies to help lift these themes up so the young people growing up can see that the model of fulfillment is one that’s worth chasing, that it’s one that’s worth investing in.

 

David Duchovny  58:14

Well, it’s also one that’s attainable, a lot more attainable than than the one that they’re being taught to to pursue. Now, I mean, the triad that you’re talking about is attainable, to to every person, to the other one, not so much, but yeah, I mean, just on the other side with, you know, just the way that our system seems to be set up these days, with the, you know, the lobbyists, whether it’s For big pharma, or for, you know, these huge companies, it’s very tough. It’s very tough when you when you look at it, you know, from the jaundice point of view that I have, you know, you got kids on this side, and you’ve got your billions of dollars on the other side of lobbyists and and, you know, you personally were exposed to the kind of stunts that that that happens with that when you were, you know, queried about your your your ideas about guns rights, so I want to believe too yeah.

 

Dr. Vivek Murthy  59:18

It is hard, and I think there are a lot of people who probably rightfully feel the same concern you do, which is, can change really happen in a system that’s so dominated by by the forces that you’re describing? Yeah, I, you know, I tell you, in all honesty, I worry about that too, you know. And I look at my kids and the future that’s ahead of them, and I ask like myself, like, Are Are people going to make the right decisions so that my kids and all of our kids have a healthy, supportive world to grow up in? And that’s an open question right now, but one thing that does give me hope David is I look even just in the last few years right at the fact that we were able in our country to to get. Certain health reform measures passed that have dramatically expanded insurance coverage that was done despite the opposition of money and interests, right? We look at the fact that we now have the ability, finally, after years of talking about it, for Medicare, the insurance program for seniors, to negotiate drug prices, right? And that means that, like now, millions of people across the country can get cheaper drugs right now. That was done despite intense lobbying, you know, from an industry that has billions and billions of dollars to put toward these kind of issues. So the fact that none of those were easy, those victories, but the fact that they happened like just I think about those because they remind me that at the end of the day, when you are able to bring together millions of voices calling for change, that that can actually break through it can push people to take action and ultimately do the right thing. And I just think we’re finally now seeing in a way we’ve never seen before, a lot of those voices start to come together and rise up, and we need more of that to ultimately get us over the finish line.

 

David Duchovny  1:01:07

Thank you, and thank you for for relaxing into the long form version of this. And thank you for your time. And it’s been a pleasure to meet you.

 

Dr. Vivek Murthy  1:01:15

So good to meet you too, David, thank you so much.

 

1:01:18

I thought it was really fascinating conversation. Again, the most interesting thing to me to talk about with Vivek is in his position trying to regain the trust of the public in medicine slash science after the pandemic and in the world of misinformation on the Internet. So how can that be done? I’m sure he’s doing it. But is this a genie out of the bottle situation? Can  we get back to a fact based discussion when it comes to science, when it comes to medicine, when it comes to vaccination? You know, the average person’s belief in science is, you know, let me go on the other side of what I’m saying, you know, I’m saying believe in the science, please, people, let’s do that. But on the other hand, and I wrote about this a little in my book The reservoir, the average person, me, the person of average intelligence, or average science intelligence, our belief in science is very much like somebody who believes in God, because I don’t know how that science works. Most of us don’t know how that science works. We believe in it. So when other people say, you know, I don’t believe in the science, as frustrating as that might be to me, I can’t turn around and say, Well, look, this is how it works. I have to say, yeah, kind of science is my God. And that’s an uncomfortable bargaining position to be in, especially when you want to say, at times, you know, is God telling you to do this terrible thing. God’s telling you to do that thing. You believe in that God. And I’m saying, don’t believe in that God. And they’re saying don’t believe in science or God. Trying to see both sides, I guess

 

CREDITS  1:03:46

There’s more Fail Better with Lemonada Premium. Subscribers get exclusive access to bonus content like more of my behind the scenes thoughts on this episode. Subscribe now and Apple podcasts. Fail Better is a production of Lemonada media in coordination with King Baby. It is produced by Kegan Zema, Aria Bracci, and Dani Matias, Paula Kaplan   . Our engineer is Brian Castillo. Our SVP of weekly is Steve Nelson. Our VP of new content is Rachel Neil. Special thanks to Carl Ackerman, Tom Karpinski and Brad Davidson, the show’s executive produced by Stephanie Wittels Wachs, Jessica Cordova, Kramer and me, David Duchovny. The music is also by me and my band. Lovely Colin Lee. Pat McCusker, Mitch Stewart, Davis Rowan and Sebastian […]. You can find us online at @LemonadaMedia and you can find me @DavidDuchovny. Follow Fail Better wherever you get your podcasts or listen ad free on Amazon music with your Prime membership.