Dr. Leana Wen on the Pandemic and the ‘Fight for Public Health’

Leana Wen

Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter. A show where we speak to the top thought leaders
in health innovation, health policy, care delivery and a great minds
who are shaping the health care of the future.

T his week Mark and Margaret speak with Dr. Le a na Wen, e mergency
room physician, former Baltimore Health Commissioner and Medical
Analyst at CNN who has been helping them cover the pandemic. Dr.
Wen has a new book out Li felines: A Doctor’s Journey in a Fight for
Public Health, in which she shares her quest for improving public
health to address everything from the pandemic to gun violence,
opioid and other addiction issues in health and equity.

Lori Robertson checks in the Managing Editor of FactCheck.org lo oks
at misstatements spoken about health policy in the public, separating
the fake from the facts. We end with a bright idea that’s improving
health and wellbeing in everyday lives. If you have comments please
email us at [email protected] or find us on Facebook, Twitter or
wherever you listen to podcast. You can also hear us by asking Alexa to play the program. Now, stay tuned for our interview with Dr. Leana Wen here on Conversations on Health Care.

Mark Masselli : We’re speaking today with Dr. Leana Wen, Emergency Physician and Professor of Health Policy and Management at George Washington University School of Public health. She’s a senior fellow at the
Brookings Institution and previously served as Baltimore’s Heal th
Commissioner.

Margaret Flinter: Dr. Wen is a Medical Analyst for CNN and she a contributing columnist
to the Washington Post. She is the author of many papers and several
books including her most recent Lifelines: A Doctor’s Journey in the
Fight for Pub lic Health. Dr. Wen we welcome you back to
Conversations on Health Care today.

Dr. Leana Wen: Thank you very much. It’s great to be back. Thank you for the work
that you both have been doing during the pandemic.

Mark Masselli: You know, there were so many powerful quotes in the book, but the
one that really grab me was “public health save your life, you just
don’t know it.” You know, that if the COVID - 19 pandemic did
anything, it made the general public far more aware of the public
health and how integral i t is to staying healthy and even life. Wonder
if you could just talk to our listeners about public health awareness
the pandemic has brought us through some of its success and also
some of the epic failures as this public health crisis unfolded.

Dr. Leana Wen: I believe I heard the quote “public health save your life today, you just
don’t know it” from Dr. Karen DeSalvo, the former Assistant Secretary
of Health at HHS. It just really stuck with me because in a way that

Leana Wen

encapsulates all the problems that we have with getting people to pay
attention to public health. By definition, public health is invisible. We
have succeeded when we prevented something from happening, and
so you don’t see it, there is no face of public health. But as a result of
been invisib le, it often becomes the first item on the chopping block
when it come to budget time.

We have seen that local public health, for example, local and state
public health has lost something like 30% of their workforce in the last
20 years. It is not somethi ng that is reimbursed, right, when we talk to
our patients addressing the social determinants of health, it’s not
something that is reimbursed in the same way that a cardi extent is
going to be. It remains a major challenge well before the pandemic. I
mean , the pandemic did not create the problems of health disparities,
it didn’t create the problems of underinvestment in public health.

But I think to your point that the pandemic has really brought to light
what happens when we do not invest in public healt h. I hope that
coming out of this, that hopefully coming out of this there’s going to
be renewed attention and impetus to addressing these issues.

Margaret Flinter: Well, Dr. Wen, you don’t miss words when talking about the
pandemic, and even though we’re beginning to have a little bit of
perspective, maybe I’m being able to look back and understand some
of what went wrong. Many things were done wrong and it led to an
enormous loss of life in this country.

When you look back outline what you see as some of the biggest
missteps that we made. What are the opportunities we might be
missing now to continue to turn things in a direction that leads to less
loss of life going forward?

Dr. Leana Wen: In terms of the lessons learned I think there are at least three k ey
lessons. The first is the importance of having a national coordinated
strategy. It did not make sense that in the beginning that states had to
figure out how to procure their own PPE, their own testing. It did not
make sense that there were states right next to one another that had
very different protocols when it came to the types of masking
procedures as an example that were there. We are not an island
public health doesn’t work in isolation.

Second thing that we’ve learned is the importance of commun ication
that when there are elected leaders whom differ from the words of
their public health officials that that leads to confusion, and it leads to
erosion of public trust. When that trust is eroded, when the public is
really confused about who to believ e, it’s really difficult to get that
back. Also public requires getting people to do things that they
otherwise don’t want to do. It’s hard to get people to quarantine if
exposed or wear a mask when we don’t have a mask wearing culture,

Leana Wen

and so having that lack of trust was a substantial issue.

The third thing that the pandemic has shown us is about the rampant
disparities that we see. Again, COVID do not create disparities, that
we’ve also seen that unless we are intentional about addressing
disparities th at they are going to perpetuate. Those who are
privileged are going to have more resources, those who are under
resourced are going to get fewer.

Now, coming out of this I think there’s an opportunity to address all of
these aspects, and in some ways the Biden Administration has already
done a lot of work. They’ve certainly done a lot of work to bolster the
federal health infrastructure to get vaccines out as we’ve talked
about. They’ve really committed to health equity, which I commend
them for. I never t hought that we would see an administration that
embeds health equity in every aspect of their work. But I think there’s
still a lot more to be done when it comes to rebuilding that public
trust.

Actually, if there’s one criticism that I would have of the Biden
Administration, it’s maybe not recognizing that public health is not
just about the science. You could have one set of data but five
different interpretations of it. Public health is also about values, and I
actually thought it was a major problem wh en the CDC came out with
their guidance that essentially led to the lifting of all indoor mask
mandates, because they in that sense they were saying that the value
of being able to be unvaccinated and unmasked is greater than the
value of protecting the mo st vulnerable.

Mark Masselli: You become a very familiar face of the pandemic as a medical analyst
at CNN. One thing you talk about in your book was the need for this
honest clear communication about the public health crisis. Pfizer the
other day was talki ng about the need for a potential booster shot. It
becomes very confusing in public’s mind, particularly some of the
more elderly and vulnerable populations who are early on in
December getting this. I just wonder if you could shed some light on
the need f or a booster shot. Share with us your thoughts about
knowing whether or not the population will need to start queuing up
for a booster shot.

Dr. Leana Wen: Yeah, I mean if there’s any question that I get asked the most
probably from my vaccinated patients, it’s this one of when is it that
I’m going to need a booster, which is very interesting because while
we have a third of the population that’s just is not getting vaccinated,
there is probably another third that’s saying the moment that I need a
booster I want to get that booster. I think that we’re seeing a lot of
conversations play out in the public that normally would have
occurred maybe even behind closed doors. But I don’t mean in a
secretive way, I just mean that people just didn’t attention to it. B ut

Leana Wen

those were conversations that scientist normally would have with one
another.

As clinicians you definitely understand this. Now, we clinicians
understand that there is nuance. There’s a lot in medicine that exist in
the gray area. For example, when it comes to booster shots, we
always thought that at some point one of two things may happen,
immunity might wean, or two there might be variants that developed
that evade the protection of the existing vaccines. We also know as
clinicians that probably if ei ther of those things were to happen, it
wouldn’t be that one day you go from 90 some percent efficacy to 0%
efficacy. Maybe it weans as a 90% to 60% to 40% I mean something
like that.

Maybe there are some patients who may have benefit from a booster
even now. For example, patients with severe immunocompromised
actually may benefit from a booster now. There was a study done that
looked at patients with -- who are organ transplant recipients on
immunosuppression, it might actually make sense for them to rece ive
a third booster shot now. Older individuals who received the vaccine
early on, it is important for us to get those data on when those
individuals might need to get the vaccine or people who got the
Johnson & Johnson one dose vaccine might there be less efficacy. If
they choose to, might there be some patients who are particularly
vulnerable and to severe outcomes who should get a booster. Again
that exist this gray zone of medicine where clinicians have to make
nuanced decisions that when that’s put int o t he public discourse
sometimes it’s understood as or nothing. I actually think that we need
to change just the way that we are looking at this and advising people.

One thing that has been problematic was the CDC’s decision to stop
tracking mild breakthr ough infections. We need to know, first of all,
do they still result in long COVID, also at what point are these
breakthrough infections happening. If we know that after six months,
suddenly we’re seeing all these breakthrough infections that are mild,
tha t’s still important data and we should know, or if we’re seeing that
Johnson & Johnson, people who got that vaccine have more
breakthroughs than Moderna or Pfizer, also important information. In
a way it’s a repeat of what we’ve seen at the beginning of th e
pandemic. Just because we’re not testing for something doesn’t mean
it’s not there. In fact, I don’t think that lack of data is a problem, we
need more information and not less.

Margaret Flinter: Well, Dr. Wen it’s clear to us you’ve had a frontline seat almost your
whole life looking at the issues of health and equities in our society,
starting with your early days in your own family trying to access
health care certainly during your training to be a physician and seeing
how much of what appears in t he emergency room are things that

Leana Wen

didn’t need to happen and Baltimore as the commissioner. When you
look around the country and think about what needs to be done to
get that last third. It seems that public health approach of going to the
streets as you di d in Baltimore with Narcan or to try and combat gun
violence is the way to go. Are we doing enough in that arena? What
are you seeing to try and prevent if something bad happening next fall
or next winter as we keep hearing.

Dr. Leana Wen: Yeah, it’s a gre at question. Actually, here, I really want to commend
the Biden team Bashar Shaker (PH), Vivek Murthy, so many people
have done. It’s just incredible work, spreading information and really
relying on trust and messenger. This is hard work, right, let’s mak e no
mistake on this, this is the hard work of hitting the ground. In a way
the mass vaccination sites we’re the low hanging fruit, there are
people who are --- if you build it they will come. Now, it’s answering
people’ s questions, it is --- it’s reaching people who may not have a
primary care physician and trying to get trusted messengers to talk to
them about the importance of getting the vaccine, the seriousness of
Coronavirus, the safety of the vaccine, overcoming misinformation,
that’s hard.

By the w ay, I really think that the ground game at this point, it’s going
to rely on primary care doctors and nurses and pharmacist and nurse
practitioners, physician assistant, people who are health care
providers on the frontlines and have the trust of their pat ients. I
actually think that what the Biden team can help to in aide in this way
is to reimburse for it. Reimburse for the time of all these
conversations that really take time. But actually there’s one more
thing that would help a lot and would really dra matically increase
vaccine uptake, and that is for more private entities, companies,
universities, schools even, just start requiring vaccines.

You could still have an opt out, you could say if you don’t want to be
vaccinated, okay, sign this piece of pap er and then go for twice
weekly testing. If we did that, we would make vaccination the easy
choice and make stay unvaccinated the hard choice. Right now we
have it backwards, right now it’s just as easy to be unvaccinated, and
so people who are on the fenc e are staying unvaccinated. We have to
switch that around, and I think that would make a big difference.

Mark Masselli: You know, we couldn’t agree with you more. We’ve done that,
certainly we’re a health care organization but we’ve done with all of
our ve ndors as well. We think it’s important for everyone to be
vaccinated, and I think the institutional players will make a big
difference. We’re speaking today with Dr. Leana Wen, Emergency
Physician, CNN Medical Analyst and author of Lifelines: A Doctor’s
Jo urney in the Fight for Public Health.

You know, Dr. Wen in your book you described public health as a

Leana Wen

discipline that’s straddles the worlds of science policy medicine and
advocacy. There’s often a lot of friction at this points of intersection.
Wondering how do we build a health system that’s more efficiently
integrated at this elements, ideology can be a powerful adversary
when seeking to do public health and I’m wondering if you could talk
about the inherent challenges and what do we do about it?

Dr. Le ana Wen: Well, two things that I want to mention here. One is I want to quote a
friend and colleague, Dr. Boris Lushniak who often says that, “The
work that we do in public health and health policy is political but not
partisan.” Certainly there are clinic ians who also run for office are
very involved in partisan politics and hats off to them, we certainly
need more representation. This is not a criticism but rather to say that
my own philosophy aligns with what Boris says which is that there is a
way to be political, understanding a politics and policies.
Understanding that public health also you need to navigate the
political system, you have to navigate public policies, but that you
don’t need to be partisan.

Certainly, I’m very careful to stay away from being labeled a member
of any political party. I just don’t think that it helps with our work
which actually is about striving for common ground, or as the late
Congressman Elijah Cummings would say this is about not just striving
for common ground, but h igher ground. I think you don’t get there by
digging into your entrenched ideology, but rather looking for common
ground that everyone can start from. Then there’s another element
that public health is by definition also very local. Actually on the local
l evel there isn’t a lot of partisanship, I mean whether you are getting
your house remediated for lead or getting a restaurant inspected for
food poisoning, that’s not a partisan issue.

I think the more that we could really focus in public health about
del ivering services to people, delivering value to people in their lives
and making a difference to their everyday lives, the more that we can
actually focus on getting the work done and not be caught up in
ideological battles.

Margaret Flinter: Well, Dr. We n that makes me think about inspiration, and you’ve
noted some mentors who have inspired you in your career, in your life
and at least some of them are people well known to us as well, the
late Dr. Jack Geiger and the late Dr. Fiju (PH) who just inspired p eople
to do things they never thought were possible. You talk about patient
advocate Regina Holliday who’s painted jackets to become a walking
gallery of stories of inspiration for patient activist. How have these
people inspired you and how do we weave th at kind of, I don’t know,
inspiration, hopefulness into our narratives and our fights for
improving health and public health as we train the next generation of
people that are going to carry on this public health work?

Leana Wen

Dr. Leana Wen: Well, I think it --- I ’m going to give you three, three things that came
to mind as you are naming some of these people who are very
influential in my life and in yours, because I came from a humble start,
my parents and I were immigrants. We came to the US with less than
$40 t o our name, as I was writing about in Lifelines. I didn’t know that
I could become a doctor. I had this dream and was really terrified of
even sharing this dream with anyone, because I thought who was
going to believe me that I could do this. I was very fo rtunate to have
mentors who believed in me when I didn’t believe in myself.

I think that all of us recognizing that we are an inspiration to
someone, we may not know who that someone is, but there is
someone out there who is looking up to us and is depend ing on us
and what we say will have a big impact on the course of their lives. I
think it’s one thing that really stays with me. The second thing is
Congressman Elijah Cummings, the late congressman from Baltimore
used to talk about pain, passion and purpo se. But it’s the pain that is
the guide for our passion that then becomes our purpose. Whatever
bad events that may have occurred in our lives that were extremely
painful and challenging as a country as a world, that there’s a way for
us to move forward an d channel that pain into our passion that is our
purpose.

The third thing that I learned from my mentors and I hope is an
inspiration moving forward is to not wait, that there are so many
things that sometimes in public health you can be caught in this
pa ralysis of sorts, because public health is about everything, and so
where do you even begin. But just as we as clinicians if a patient came
to us and had many medical issues, it’s never an option to say, well,
let somebody else deal with it. It’s not an op tion. We always have to
start somewhere. Don’t wait to take action, now. I think it’s
something else that I’ve taken away from all these really inspiring
advocates in my life.

Mark Masselli: Well, and you are an inspiration to us, your story. This is such a
compelling book, really walks through thing that I --- we had never
known about you in terms of your journey, your family journey here. I
think what’s so powerful about it is you were able to translate that
experience into action, certainly becoming a ph ysician but the work
that you did in Baltimore was so important and re ally as we try to
improve our national and our global health infrastructure, things build
up from the bottom, right.

You did such incredible work on the opioid issue, but you also talke d
about improvement of health services starts with our children. You
talked about school based health centers which are near and dear to
our heart. I forget how many --- you ended up setting up a 120 or
more. Talk about why that model is so powerful and so important at

Leana Wen

this moment in this crisis as we’re starting to see young people
experiencing behavioral health issues in significant numbers. We need
these building blocks put in place locally for the national health
system and then certainly you’ve been ad dressing the international
role that America needs to play.

Dr. Leana Wen: Yeah, so when I was the health commissioner of Baltimore we had
health suites in all of our 180 or so public schools and a school based
centers in, I believe, 13 of our schools that had a comprehensive
model. Actually, I was hoping that we could expand it even more --- I
thought the school based I’m sure could be the primary care medical
home, not only for the child but ideally for the family. I mean how
amazing of a model would that be. But it is something that --- and I
know you have done a lot of work with this too and so would agree
that for so many of our children this is where they access health care.

I live now in Baltimore, I don’t work and live in Bethesda, right. I mean
it’ s just a very different environment of maybe in other places there is
more privilege and more opportunity, it’s just a very different kind of
environment where so many of our children if it were not for the
services that we provide in our schools, if it we re not for our meal, if it
were not for our health care that they might go without. Also, why
should kids have to leave school in order to seek services that actually
can be done there? Why should kids have to miss school and parents
have to miss work to t ake them to see the doctor for (inaudible
00:20:26) which is bread and butter that can be done right in their
schools, or we set up a program for glasses for every child based on a
similar model.

We found out that we just lost a lot of kids between the ti me they got
their vision screened to been identified as needed glasses. But that
doesn’t have to happen, we can remove those barriers and get glasses
to every child who needs them right in their schools without having
the barriers of insurance and all thes e other things that actually
sometimes get in the way of actually our patients --- our students
getting the care that they need. Mental health you mentioned, such a
neglected area. I mean we as a society do not treat mental health the
same way that we rega rd physical health. Of course, it’s long pastime
for us to do so. But I think that’s something else that when I was the
health commissioner, we also did a lot when it came to improving
mental health and trauma services in our city.

I’ve detailed, actually , one of the reason, not even one of the reasons
but the reason I wanted to write the book was how do we decide
what issues to focus on. Of all the public health issues there are, how
do we decide to focus on this, and what specifically did we do? So
much of time I feel like I read about programs that happened, and I
read about the outcome, which is great and really important. But,

Leana Wen

what were the struggles that you went through? What programs did
you reject in the process of trying to figure out these ones? How are
they success for? What were the decision points along the way? I
hope that explaining why we chose to focus on schools and mental
health, for example, would also be important parts of the
conversation.

Margaret Flinter: You’ve certainly spoken to t he dilemmas of health care leaders
everywhere, and thank you for that. We’ve been speaking today with
Dr. Leana Wen, Medical Analyst for CNN and author of Lifelines: A
Doctor’s Journey in the Fight for Public Health. You can learn more
about her work by go ing to Leanawen.com or follower on Twitter
@Dr. Leana Wen. Dr. Wen we thank you for your quests to improve
public health in this country for providing a clear voice to the public
throughout this entire pandemic and for joining us again on
Conversations on Health Care.

Dr. Leana Wen: Thank you very much. It’s a pleasure to join you and I want to thank
you and everyone watching and listening for the incredible work that
you have done over the last year and a half and just in general, so
thank you.

[Music]

Mar k Masselli: At Conversations on Health Care we want our audience to be truly in a
know when it comes to the facts about health care reform and policy.
Lori Robertson is an award - winning journalist and Managing Editor of
FactCheck.org a nonpartisan, nonprof it consumer advocate for voters
that aim to reduce the level of deception in US politics. Lori what have
you got for us this week?

Lori Robertson: Falsest about the COVID - 19 vaccines have been widely disseminated
on social media. Two recent claims concerne d the airline industry.
Airlines which suffered a steep decline in air travel last year due to the
COVID - 19 pandemic are encouraging people who have received a
COVID - 19 vaccine to fly once again. Yet, social media posts falsely
claim that airline executive s around the world are discussing banning
vaccinated passengers due to a risk of blood clotting at high altitudes.
Medical expert say there is no evidence of an added risk of blood clots
for vaccinated air travelers.

Airlines are actually providing reward s for vaccinated travelers. United
Airlines, for example, hosted a sweepstakes in which COVID - 19
vaccinated United members had a chance to win free round trip
flights everyday in June. A spokesperson for the International Air
Transport Association told us the organization is not aware of any
airlines considering a ban on vaccinated passengers due to a blood
clot risk despite an Instagram video that makes the claim. Unrelated
to vaccines, long distance travelers can develop a type of blood clot

Leana Wen

known as deep vein thrombosis or DVT after extended periods of
immobility. The risk of DVT during sedentary travel has been a
concern of the CDC.

A DVT typically forms in the leg and is a different disorder from the 38
rare blood clot cases in the United States that h ave been associated
with the Johnson & Johnson COVID - 19 vaccine. The individuals in
those rare cases suffered from a combination of a type of blood clot
called cerebral venous sinus thrombosis and low levels of blood
platelets. Again, medical expert say th ere is no evidence that
vaccinated travelers face an increase risk for blood clots at high
altitudes due to the COVID - 19 vaccine.

Other viral claims said without any evidence that the deaths of four
British Airways pilots and five Air India pilots were a result of receiving
COVID - 19 vaccines. Air India said its pilots died from the disease
COVID - 19. British Airways said, “There is no truth whatsoever in the
claims on social media speculating that the four deaths are linked.
None of the deaths were linked t o vaccines.” That’s my fact check for
this week. I’m Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Poli cy
Center at the University of Pennsylvania. If you have a fact that you’d
like checked, email us at chcradio.com, we’ll have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health Care.

[Music]

Margaret Flinter: Each week Conv ersations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. If music sooths
the savage beast, the question I wanted to answer at the Sync Project
is how exactly?

There are lots of anecdotal studies supportin g music’s ability to
trigger memory or boost endurance or focus, but virtually nothing is
known about how much truly impact our physiological and
neurological state. This is the question that intrigue scientist Keiki
Kuranam ( PH ) a systems biology PhD from Harvard who wondered,
how could music be scientifically harnessed as a powerful precision
medicine tool?

They formed the Sync Project with a cross - section of neuroscientist,
biologist, audio engineers, even some rock stars like Peter Gabriel and
started by using artificial intelligence systems to analyze existing
playlist that purports or promote relaxation, induce sleep, enhance
focus or athletic performance.

Female : And once we have set of songs that our machine learning algorithms
predict to be effecti ve for a specific activity, we can then draw on

Leana Wen

studies using these devices like in a heart rate monitor, your smart
watches, your activity trackers and actually look at how effective
indeed is that song for that purpose.

Margaret Flinter: Kuranam met her colleagues note that most of us self - medicate with
music already s o why not harness this ubiquitous tool that's available
to all of us and develop strategies and systems that might replace
pharmacological interventions with musical ones.

Keiki Kuranam: So we’re literally walking around with 14 million songs in our pocket
every single day. W e saw a great opportunity on really being able to
und erstand how music was affecting, how different types of music
effect both our psychological h ealth as well as our phy siology.

Margaret Flinter: Kuranam and her team seen vast potential for reducing reliance on
drugs by crafting personalized music interventions and the
management of a variety of complex conditions such as pain
management, PTSD, even Parkinson's disease.

K eiki Kuranam: In Parkinson's disease, patients have trouble coordinating
movements. B y playing them the right kind of music, it can be an
external auditory support they have that's going to help them walk
more smoothly.

Margaret Flinter: The Sync Project , combining computer technology and neuroscience
physiology and musicology to harness the healing powers inherent in
music to help manage a variety of human ills. Now that is a bright
idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Hea lth Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health .

[Music]

Female : Conversations on Health Care is recorded at WESU at Wesleyan
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