A Second Opinion with Dr. Margaret Hamburg – A Second Opinion Podcast

A Second Opinion with Dr. Margaret Hamburg

In A Second Opinion we engage with the leading minds in healthcare at the nexus of medicine, policy, and innovation. In the current series of four episodes, we’re hearing from four leading women in healthcare. In today’s episode we have with us my good friend and colleague, Doctor Margaret Hamburg, an internationally recognized physician and public health expert, who is currently serving as the foreign secretary of the National Academy of Medicine and president of the American Association for the Advancement of Science.

Senator Bill Fr:              Peggy, when I look at your background and all the things that you have done, but equally important what you’re doing now, it reminds me of a great book. The book I’m just finishing. It’s a book recently out. The book is called Range. You probably have not read that, it’s just out. It’s by David Epstein. The title’s interesting, Range, you can see where I’m going broad range, and subtitled is Why Generalists Triumph in a Specialized World. I begin with that just because your background is so fascinating in terms of your commitment to public policy, which is the sort of foundation to everything that you do. Then also, the various realms you’ve been into the nuclear world, the global health world, the public health world, you’re a physician. You put that together and you’ve operated as a specialist in each of these fields, but it comes from this generalist approach, which I think is the real beauty and the real sort of foundation of the contributions you continue to make every day.

Senator Bill Fr:              So let’s start with the issue that is very current today, and that is the whole vaping issue. With recent data that then the K through 12, you have as many as 30 percent of people who are actually vaping today. As a physician, and as scientists, we know that is not healthy. Talk a little bit about your past experience with smoking, both as FDA commissioner and as the city health commissioner in New York. Also about vaping today, what kind of perspective the past plays for the [crosstalk 00:02:45].

Dr. Margaret Hamburg: Yeah. The whole issue of smoking, in our country and around the world, has been a huge one for decades longer. In recent history, we of course have made great strides at reducing smoking. That is reflected in health. Smoking remains the leading cause of preventable death and disability around the world. We cannot let up our attention on this issue. Back when I was health commissioner in New York City in the 90s, we actually were at the forefront of restricting smoking in public places, to bring new attention to the dangers of smoking, and to also prevent the harms of second hand smoking and the smoke exposure to others. It was actually under Mayor Rudy Giuliani, we put in place early restrictions on smoking. That was controversial.

Senator Bill Fr:              How much resistance was that? Because I know in Nashville, where I am, we have about 22 percent people who smoke. I mean, it’s unbelievable today [crosstalk 00:03:54]-

Dr. Margaret Hamburg: That is, that’s higher than the norm.

Senator Bill Fr:              … it’s the number one killer in Nashville, and in the state, still today. In terms of public law, there is resistance there. How much resistance was there [crosstalk]

Dr. Margaret Hamburg: There was resistance, particularly the restaurateurs because the restaurants were a focus of our efforts, were very concerned that it was going to damage their business. In fact, their business thrived because people liked to be able to go to a nice restaurant, enjoy good food, without being smothered in other peoples smoke. The early laws that we put in place in New York City did allow an area for smoking in bars, but there were specifications about where and how people could smoke. Mayor Giuliani wanted to protect the ability to smoke premium cigars in certain places as well [crosstalk 00:04:53].

Dr. Margaret Hamburg: That was important work back in the 90s and, of course, much more has happened since. When I was FDA commissioner in the Obama administration, we actually, for the first time, got the authority to actually regulate cigarettes. That was very, very important. The law enabled FDA to extend to other tobacco products as well, as the market evolved. That really put FDA in a new position, an appropriate position to address an issue of such importance to public health, and to disease. It was a big undertaking, and we started to build a new tobacco center within FDA, put in place programs both to better understand the issues, the health concerns around tobacco and tobacco products, but also how to regulate it.

Dr. Margaret Hamburg: One of the things that FDA did that I’m very proud of, that most people aren’t aware of, is we actually started to fund a lot of research around tobacco, its harms, and its patterns of use, and also to understand what’s actually in cigarettes. Because for a long time, that wasn’t as well studied as it should be, it of course turns out that there’s thousands of constituents-

Senator Bill Fr:              This is really on A Second Opinion, our podcast, we look at this intersection of health and well-being, and policy. I think, for our listeners, it’s useful for us to spend just a few minutes on this because in the 1990s when I was in the United States senate, we had a huge tobacco settlement. The FDA at that point … because cigarettes and tobacco weren’t a drug, they weren’t classified a drug, they weren’t a device. The FDA did not regulate, at all, tobacco or cigarettes even though it was the number one killer in public health, at the time.

Senator Bill Fr:              I fought for it, but was unsuccessful. So, not until you came in …You were commissioner 2009 to 2015?

Senator Bill Fr:              Right through that period of time, did the FDA have the authority, which you led on, to regulate tobacco. I think the importance of that is that the research, number one. Number two, the regulation of being able to comment and regulate. Then today, with vaping … you, under that what you established in that 2009 to 2015 period, for vaping … I’m asking you to a certain standpoint, but I understand those same regulations do allow you to come in and regulate the vaping. Is that correct?

Dr. Margaret Hamburg: Yeah. The law actually gave FDA the authority to extend its oversight to tobacco products. It recognized that the world was always changing, technologies evolving. The ingenuity of industry, going forward, and that there were starting to be new tobacco products and there would be others, including lozenges, and chewable forms, and e-cigarettes. Which, when I started as FDA commissioner, the marketplace for e-cigarettes was not what it is today. We did start trying to do research on what it would all mean, and think about policy implications, as well as the regulatory process to extend actual authority. So, that’s all been moving forward.

Dr. Margaret Hamburg: In the meantime, of course, we have seen that vaping has taken off at incredible rates. It’s taken off in both adults, and in youth. I think those are different populations in terms of the issues and concerns. In adults, one can certainly argue that vaping is less harmful to health than smoking combustible cigarettes with all of its other components. It’s not the nicotine, but the carcinogens and the tobacco mix in the cigarette composition, and the combustion, that is actually producing so much of the harm.

Dr. Margaret Hamburg: In the situation with young people the concern is, vaping, especially flavored e-cigarettes, is much more fun and pleasurable. It seems less harmful to kids-

Senator Bill Fr:              Yeah, the bubblegum flavor [crosstalk]

Dr. Margaret Hamburg: … so they take up the vaping, get addicted to the nicotine, and then their world also will potentially include smoking cigarettes. So for adults, you can argue it can be harm reduction, moving people off of-

Senator Bill Fr:              The data’s pretty good, it’s mixed, but I think most people would say in the large studies, e-cigarettes can be useful, are useful, for certain people to get off of cigarettes, to get off of tobacco.

Dr. Margaret Hamburg: Right, exactly. Some also argue that it’s a way of helping people maintain their addiction, so when they’re in settings where they can’t smoke a combustible cigarette, they’ll vape. I think there’s a lot of reason to believe that e-cigarettes can play a role in shifting people from the more harmful, combustible cigarette smoking. It’s extremely worrisome in terms of the uptake of vaping in youth, and what that will ultimately mean for patterns of cigarette smoking and other tobacco use throughout their lifetime. Certainly, we know that with traditional cigarettes, if you start smoking young, you’re much more likely to have the addiction for a lifetime, with all of its consequence, health implications.

Senator Bill Fr:              A lot of people don’t know that data. The data is that smokers today, 95 percent start below the age of 21. Your brain, because development’s not complete until about age 25, means that you’re more likely to become addicted if you start smoking at age 18 or 19, then you are if you start smoking at 22, 23.

Senator Bill Fr:              People listening right now, if you have a sixth grader, there’s greater than a 40 percent chance your sixth grader now is smoking, vaping, e-cigarettes of some sort. A 40 percent chance, we know from public health, that it is harmful. A lot of the studies haven’t been done just to how harmful, but also, your child may be addicted for life.

Senator Bill Fr:              Anyway, again, you’re on the cutting edge. Because if you hadn’t done that at the FDA, it wouldn’t have opened up, from a policy standpoint, the ability to study, to get more information, to look at what scientists actually study, as well as to help [inaudible] regulate. That’s one of the fun things, again, about looking at the past, and how it goes to the future. 1998, as the United States senator, I couldn’t do it. You came in and did it under a different administration-

Dr. Margaret Hamburg: With huge support from congress [crosstalk] bipartisan support.

Senator Bill Fr:              Then, you also wrote the policy broad enough that as technology in this rapidly changing world comes in, it can adapt to it. So, I think it’s a great model. Let’s jump back, quickly, to the days of being health commissioner of New York. It’s interesting to me because I’m aware, and really the world is aware of the work that you did on bio-terrorism. It wasn’t until I went to Washington, in sort of the mid 1990s, but really not until anthrax hit in 2001, 17 people died from that, did the world pay attention to bio-terrorism.

Senator Bill Fr:              It was really eight years before that, that you put in a landmark bio-terrorism preparedness program, that got global recognition. Tell us a little bit about that.

Dr. Margaret Hamburg: That’s interesting. Working in New York City as health commissioner, I dealt with a lot of infectious disease threats, emerging new infectious diseases, and going back to the 90s, HIV/AIDS was an emerging infectious disease threat then. The resurgence of tuberculosis, and importantly drug resistant tuberculosis. We dealt with imported diseases from travelers coming into New York City, bringing diseases that we didn’t normally see. Of course, the garden variety of infectious disease threats that you see in any place across the country.

Dr. Margaret Hamburg: But I never thought about microbes as weapons, that, and being deliberately used to cause harm. Then I was health commissioner the first time the World Trade Center was bombed. I started to think about domestic terrorism, in the United States, as a real issue. It was always something that happened somewhere else, but I had not felt vulnerable as a person, as a citizen. I certainly had not thought about the implications of domestic terrorism in terms of my responsibilities as health commissioner for New York City.

Dr. Margaret Hamburg: Boy, when you start to think about the vulnerabilities, there are a lot of them. So, it wasn’t just biological terrorism that I worried about, but how would we prepare to respond to a major domestic terrorism event, in terms of protecting health and [crosstalk 00:14:34]-

Senator Bill Fr:              I remember, looking back in 2000 when I was doing the same thing at the federal level, and kept saying bio-terrorism preparedness, and using DARPA, and others to address it. At the time you did, was sort of the first person to bring up bio-terrorism. I see that when the World Trade Center was hit, and therefore, [inaudible] external threats, but where did your interest in biological terrorism, the fact that something that you can’t touch, can spread quickly. A single back of anthrax could wipe out a quarter of New York City within a day. That sort of thinking wasn’t going on. Where did it come from? You’re a physician, you’re a doctor …

Dr. Margaret Hamburg: I was interested in infectious disease [inaudible] had seen the vulnerabilities in terms of naturally occurring threats. Very importantly for me, when I was New York City health commissioner, was a personal connection and a mentor, and that’s so true in so many aspects of life. There was a very distinguished microbiologist, Doctor Joshua [inaudible 00:15:34], a Nobel prize winner in his 30s. He was president of Rockefeller University. I spent a lot of time with him, and he was, in fact, a student of biological weapons and biological threats. He was an advisor to many, many governments and presidents over the course of time.

Dr. Margaret Hamburg: He opened up a whole world that I didn’t know about, that there were biological weapons programs. Of course, the United States had had a biological weapons program that I had been completely unaware of, but President Nixon was the one to actually end it, saying that he felt there were enough weapons already to destroy the world many times over. I learned about the Russian biological weapons program-

Senator Bill Fr:              Did you do all that while you were health commissioner, or did you come in with that knowledge?

Dr. Margaret Hamburg: No, I didn’t come in with that knowledge. I had never though about … I mean, I should have probably known something about it, but I didn’t. So I started to learn. He brought me into activities that he was doing with the intelligence community, and with law enforcement. So, he really was my tutor in these areas, and of course it resonated. I realized we needed to start thinking about this, we needed to begin to prepare, we needed to look at capabilities across the city, we needed to bring in other sectors to be aware of the potential threat, and how we would respond.

Margaret Hamburg

Dr. Margaret Hamburg: The nice thing was that most of what we needed to be thinking about and preparing for in terms of deliberate biological threats, aligned with better preparedness against naturally occurring threats. So, we were building public health capabilities in new ways, but it was very, very useful. We had already prepared and practiced around certain threats before we started to see events occurring in the real world.

Dr. Margaret Hamburg: You may recall in Tokyo, when there was the [inaudible] attack in the subway system. When that happened, we had already been thinking about the vulnerability of our subway system. We had already been sort of modeling how to address it. You can never really truly prepare, it’s such an unknown, but I think real progress has been made. It wasn’t until the anthrax letters, really, the public health community at large got engaged. When I first started working on these issues, it was a very small group of people in the life sciences, medicine, and public health, that really took it seriously and cared.

Dr. Margaret Hamburg: I got mocked all the time. A very distinguished head of the National Institutes of Health, when I started doing this work, said to me, “You’ve been reading too many Tom Clancy novels.” Another infectious disease expert said to me, “You really ought to be working on real world problems.”

Senator Bill Fr:              Just as we’re talking, it’s amazing to me, your interests always and your action always, in the public policy world, seem to be very forward looking and futuristic. We talked about the tobacco and regulation of tobacco, on your watch, your leadership. But it was done in a way that was broad enough that it could include things like technology, and the e-cigarettes, and vaping.

Senator Bill Fr:              If you look at bio-terrorism, you were ahead of the curve there. After you got national recognition for the program in New York, we actually had the bio-terrorism, and most of it centers on the anthrax, but opened the world to the threat. [inaudible] very futuristic. The FDA totally did a pivot on your watch, [inaudible] have been a very long, regulatory process for devices and drugs. Safety and efficacy always great there, but you modernized it in a way that streamlined the FDA. Made it science friendly, made it clinician friendly, research friendly. In a way that, again, has shaped it for the future.

Senator Bill Fr:              Where do you think this … it maybe just all be innate. Where’d this … Is it instinctual? This sort of forward looking … Because it’s policy at its best. Addressed, based on the past, but giving good science, like your story with bio-terrorism, building for the future. Where does your futuristic policy perspective come from?

Dr. Margaret Hamburg: It’s interesting. When you were starting our conversation, and introduced me to this new book, Range, about the role of generalists. I was thinking, it’s generalists, but it’s also, I think, taking a multi disciplinary perspective that matters. It’s putting together both pieces from past experience, but also from different disciplines and walks of life, and trying to create a synthetic sort of picture of where we are, and where things are going.

Dr. Margaret Hamburg: I guess, always being willing to think a little bit out of the box also, which sometimes gets you criticized or mocked, like with the bio-terrorism at the time. I mean, people used to make fun of me. “Do you have a gas mask in your purse?” Things like that. When I look back at my career, I am very proud of being able to sort of push the edges of certain issues. I think my background was unusual. I never planned to pursue the career that I’ve pursued. It was really a question of opportunity knocking, and then taking it advantage of it and moving forward.

Dr. Margaret Hamburg: I think it’s always been because I care deeply about science. I’ve done basic science research, and clinical research. I love medicine and healthcare. It was actually after medical school, that I discovered the world of public health. The notion that I could take my appreciation and study of science and medicine, and apply it not just in an individual lab, or for individual patients, but to whole populations, that has sort of animated and motivated my whole career. Always thinking about, “How do you serve those people? How do you harness the advances in science and technology to make a difference in lives of people, in communities, of society, and ultimately make the globe a better, safer place.

Senator Bill Fr:              You’ve really done just that. The globe itself … As health commissioner, what you did there in New York in the 1990s with TB, tuberculosis. That curbing of the resurgence of TB was globally recognized, but also it has global interest. Your work, which we haven’t talked about, in the nuclear threat world. Again, it’s a threat here at home, but it’s also a threat around the world.

Senator Bill Fr:              You do a lot of work with HIV/AIDS and vaccines now that we just haven’t had time to talk about. This oneness of what happens here at home with global interest, is that innate to you as well? Most people just say, “Okay, let’s do domestic policy.” In everything that you do, including the FDA, in your modernization of the FDA, you were the first to really take it globally, or really accelerate that. Everything that you do seems to have this micro, you can touch it, you can [inaudible 00:23:22], but to have global implications. Is that something that’s conscious or does it just happen?

Dr. Margaret Hamburg: I suppose it goes back to my early years. I was very fortunate at having two wonderful parents who were role models, who actually were trained physicians as well.

Senator Bill Fr:              Where did you grow up?

Dr. Margaret Hamburg: I grew up on the Stanford campus. I was fondly known as a faculty brat. My parents were both trained in psychiatry. My mom in pediatrics, and child psychiatry, and my dad chaired the department of psychiatry there. Both of them were incredible examples for me. Both of them had careers that began with a strong academic focus, but then extended.

Dr. Margaret Hamburg: My father, interestingly, as an academic psychiatrist, was one of the first biological psychiatrists really trying to understand how neuro pathways in the brain, and receptors, and neurotransmitters, and our whole biology over the course of evolution shaped current behaviors, and then the broader implications. So, he was interested, as a psychiatrist, in stress and coping, and violence. Then because of the whole set of exposures and experiences, he ended his career. He was actually a foundation president, doing work addressing nuclear nonproliferation, preventing genocide, other things where his early focus on stress, and coping, and aggression was manifest [crosstalk]

Dr. Margaret Hamburg: It was a trajectory that I then followed. My mother was sort of the same, where she was initially interested in child behavior, and the connection between mental health and physical health. She ended up also ending her career as a foundation president, funding research and policy initiatives in the child health arena. So, I was steeped in much of this kind of thinking. Part of the challenge for me, speaking on a more personal level, was with two distinguished and accomplished parents, carving out my own path. Which I think I was able to do, but very much affected by their commitment to education and scholarship, but also to public service.

Senator Bill Fr:              That integration is challenging to do because the academic world is an academic world, is easy to be in this sort of ivory tower, we call it. Then the world of application and execution is a messier, bigger [inaudible] world than integration. For young people, and you’re teaching all the time. I know. For young people coming through, if there’s a young person who was Peggy Hamburg before medical school, and you’re giving advice to them. They say, “I have an interest in public policy. I have an interest in application. I have an interest in health and well being. I have an interest in public policy.” Is there any advice that you would give them?

Dr. Margaret Hamburg: I think a lot of my advice is really to expose yourself to new ideas, new issues, new opportunities. Don’t be afraid to take risks. Also, follow your passion. Pursue the things that really interest and excite you, rather than the things you think you ought to be doing, even though sometimes it’s a little scary. When I worked as health commissioner there was in the lobby, carved into the wall actually, a quote from Louis [inaudible 00:27:17]. Which I thought about a lot during the course of my career, and I often refer back to, which was, “Chance favors the prepared mind.”

Dr. Margaret Hamburg: I always encourage people to be well educated, and to learn as much as they can. Then when opportunity knocks, when a chance to do something exciting and impactful arises, step through that door and make a difference. I certainly feel that in my career I took some big risks, and I was plenty scared. When I was health commissioner, I was not prepared. I had never run a major agency, had very little exposure to public health, in fact. The mayor then was Mayor Jenkins, and he did take a risk. In fact, he had to go to city council and get the charter changed because the charter said that the commissioner of health had to have a master’s in public health, which I didn’t have. He argued that the work I’d done on HIV/AIDS, and infectious disease research and policy at National Institutes of Health was equivalent experience. He took a risk with me, and that changed my whole career trajectory.

Senator Bill Fr:              In this career, is there a pivotal moment for you? I mean, your career has been not even just one public service science base after another, but really an amalgamation from this integrated application of coming together of public policy and well being, in the broadest sense. Safety, security, and [crosstalk 00:29:02].

Senator Bill Fr:              Was there one pivotal moment in your life? I’m sure there were many. Was there one that you could share?

Dr. Margaret Hamburg: I would say that what really changed the trajectory of my career, and really made me rethink of how I could make a difference as a physician in the world, and how to think about this broad area of science, medicine, and public health, was as a medical student, watching the emergence of HIV as a threat, and AIDS as a disease.

Dr. Margaret Hamburg: When I started medical school, it was really during a period when the advances in antibiotics and vaccines had created an environment where we thought that the era of infectious diseases was sort of going to come to an end, and the future of medicine was going to be chronic disease. So, the impact of chronic disease is huge.

Senator Bill Fr:              The surgeon general even said that “infectious diseases are”-

Dr. Margaret Hamburg: That we’re “closing the book.” I remember being taught that as a first year medical student, at our shared alma mater, Harvard Medical School, not a bad school. Then in the course of those years, hearing about these cases of an unexplained immune deficiency syndrome devastating and killing people at the prime of their lives. Nobody knew [crosstalk] what was causing it, it had different names, it seemed to be targeting homosexual populations, but also heroin users, and Haitians, and hemophiliacs. It was called GRID, gay related immune deficiency syndrome. It was called 4H syndrome because of the people-

Senator Bill Fr:              Wasting disease.

Dr. Margaret Hamburg: Wasting disease. Then I went on to do my residency training in New York City, and the New York Hospital of Cornell. By that time, we understood what caused the disease, but we still didn’t have any meaningful tools to treat it. I had a lot of HIV/AIDS patients. In fact, one of my fellow residence developed HIV/AIDS and died from it. We were never able to offer much medically, a supportive care, to these individuals. Yet, it was raising all of these social, and legal, and ethical, and political issues.

Dr. Margaret Hamburg: That was when I really began to think about the intersection of all these different forces, and how they come together in a society. Realizing that both I wanted to work on trying to develop the medical tools needed to better treat, maybe some day cure, this devastating disease, but also work at that [inaudible] intersection of politics, and public health, and science, and healthcare to try to create a more productive and supportive environment to make thoughtful policy and develop meaningful programs against a threat like HIV/AIDS.

Senator Bill Fr:              It is so interesting to hear you say that that had such a dramatic, pivotal impact on your life. It is probably the best example I can think of in recent times, that captures at that intersection of health and well being. We had three million people dying every year of this little virus. Initially we didn’t know it was a virus. We really didn’t do very much about it. Then from the innovation side of it, coming back to our nexus, developed drugs that were able to manage it. Initially expensive. Even today, we don’t have a cure for HIV/AIDS, we still have a long way to go.

Senator Bill Fr:              Then the policy, which as you said [crosstalk]

Dr. Margaret Hamburg: So much has changed. You look at it now. I literally never got a patient off the respirator when they developed [inaudible] pneumonia, back in those days of taking care of patients in New York, as a medical resident. Today, you don’t see [inaudible] pneumonia [crosstalk] in this country because we’ve got preventive therapies. People, instead of having this devastating, terminal course with the disease, are living long, productive lives. We’ve seen the ability just in our medical careers, to transform the face of a disease. Still much more work to be done.

Dr. Margaret Hamburg: I also have to say, relating those experiences to my later days at the FDA, it was a huge wake up call to me in those early days of HIV/AIDS, when I had the great good fortune to go work at the National Institutes of Health with Tony [inaudible 00:33:57], one of the great leaders in infectious disease research and policy in this country, and at the forefront of HIV/AIDS research.

Dr. Margaret Hamburg: It was back in the days when the first treatments were being developed, and the AIDS activists were sort of pounding at the door, demanding access, and furious that there wasn’t more work being done. One group, as you probably recall, was aptly named Act Up, and they were very loud and very forceful. It was scary in our sort of ivory tower, doing our research, to have this advocacy that was so pointed and tough. We opened the doors, and started talking to them, and we all sat around the table.

Dr. Margaret Hamburg: The FDA actually came in, they initially were screaming and kicking a little bit, and the companies that were developing drugs, and the academic researchers who were going to do the clinical studies, and we actually all sat around the table and talked about what needed to be done, what the research agenda should look like. FDA really stepped up to the plate and started thinking about more flexible clinical trial designs, and how to speed the process. Progress was made in ways that wouldn’t have happened otherwise. This notion of really engaging all the stakeholders, and really being willing to think in new ways to make progress, was sort of instilled in me at that time. I certainly brought that with me to the FDA and my work there.

Senator Bill Fr:              It is the integration of science because everything you’ve done does kind of go back, and maybe started with your parents, but this appreciation of science. I think it’s important, again, for us to talk about that, which we have. Because science is, like every other institution, it’s being questioned today. That, unfortunately, how Washington is being promoted, I think.

Senator Bill Fr:              Everything that you’ve done in terms of these sort of existential impacts … I’m not really overstating that. The fact that in HIV/AIDS, people like you, Tony [inaudible 00:36:17], President Bush, all of our presidents since, they’re 20 million people alive today in large part because of a policy, PEPFAR, this President’s Emergency Plan For AIDS Relief. That from 2001 there are 20 million people alive today that otherwise would have died if you didn’t have this mixture and this integration that you talked about as scientists, and yes, industry and public policy makers.

Senator Bill Fr:              I think all of our guests we’ve had in the past and will have in the future, you probably best embody this integration and this nexus of innovation of science with health and well being, and with policy. One final question is, again this is not really a fair question, but if there’s a policy out there today given your breadth and across the policy world. Is there a policy out there, or a piece of legislation, or one thing, if you had this magic wand and you wanted to improve health and well being, what would be one that would have a big impact?

Dr. Margaret Hamburg: Of course there’s never one single answer [crosstalk] to most of the problems before us. Sadly, most of the problems before us are multi determined, and require complex solutions and answers. So, if I can sort of … I mean, there are a couple of things. Number one, science and data matters. We need to really be both investing in science for the future. Both basic and clinical science because that drives our ability to truly make a meaningful and sustainable difference on the problems before us.

Dr. Margaret Hamburg: I think we also need to put more emphasis on preventing problems before they really, fully emerge and become entrenched. We still are so reactive. We still wait for problems to declare themselves. We still wait for a disease to be in place, when we in fact know a lot more about how to prevent the problems from occurring in the first place. We do need to take a global approach on problems that are simple and complicated. There’s so much we can learn from each other in terms of science as a global enterprise.

Dr. Margaret Hamburg: The strategies to address problems don’t only come from the high tech communities and more sophisticated scientifically parts of the world. I mean, our strategy to address tuberculosis in New York City was actually based on approaches that were being used in Peru and other parts of the developing world. They worked in New York City and they were the strategies that were needed.

Dr. Margaret Hamburg: In addition, we know that a problem anywhere in the world can be in our backyard tomorrow. So, I think also having this global perspective is important. All of these things clearly are straightforward principles, but they are also principles that I think are challenged in the modern era. As you said, there’s increasing skepticism about the value and role of science, and the value and role of experts and expertise. We’re seeing increasingly nationalistic approaches to problems. When in my view, we need to think and act both locally and globally.

Dr. Margaret Hamburg: We sadly are putting off addressing problems that we know are before us when we need to do everything we can to prevent those problems now, or at least limit the damage that they will bring over time. Yet, we kick the can down the road.

Senator Bill Fr:              I think you and I could … In our next sit down, let’s go through some of those issues [crosstalk] things. Whether it’s the climate, what is the science behind it. Where is it going? Confusing to people, probably.

Senator Bill Fr:              Peggy, thank you for taking time to be with all of our listeners today. It’s really inspiring. I say that very sincerely as one who has operated in the public policy arena, and in the science arena, and the innovation arena. When I look at somebody like you, I see a great object of inspiration for our listeners as we go forward, addressing these seemingly instrumental problems out there. I think it comes back to doing exactly what you embody, and that is that operation at the nexus of innovation, and health, and public policy.

Senator Bill Fr:              Thank you very much for being with us. [crosstalk]

Dr. Margaret Hamburg: Thank you, thank you. It was fun.

Senator Bill Fr:              This episode of A Second Opinion was produced by Todd [Schloser 00:41:18], [inaudible] Creative Group, and Snapshot Interactive. You can subscribe to A Second Opinion on Apple Podcast, or wherever you’re listening right now. Be sure to rate and review A Second Opinion, so we can continue to bring you great content. You can get more information about the show, and our guests, and sponsors at asecondopinionpodcast.com. That’s one word, asecondopinionpodcast.com.

Senator Bill Fr:              Be sure to join us for our next episode with Mary Greeley, president of the healthcare leadership council. The coalition of CEOs that lead our nations largest healthcare companies.

Senator Bill Fr:              A Second Opinion podcast from Nashville, Tennessee, the nations Silicon Valley of health services. Where we engage at the intersection of policy, medicine, and innovation.