0:02

This is Alec Baldwin and you're

0:04

listening to Here's the Thing from

0:06

iHeart Radio, a

0:09

chocolate chip cookie, a bite of Devil's

0:11

Food cake, or a gigantic

0:13

cup filled with your favorite soda. Sugar

0:17

is a simple chemical compound, yet

0:19

so powerful and so hard to refuse.

0:22

The traditional advice about avoiding

0:25

sugar seems simple put

0:27

down the doughnut, but few people

0:29

know how much the deck is being

0:32

stacked against them. Food

0:34

and beverage corporations spend billions

0:36

of dollars to ensure their customers

0:39

remain addicted to their products,

0:41

which has contributed to an epic

0:44

surge in type two diabetes. In

0:47

order to reverse these rising rates,

0:49

my guest today believes we need to embrace

0:52

deep legislative and societal

0:55

change. Physician and

0:57

public health expert, doctor Dean

0:59

Schillen is a professor of

1:01

medicine at the University of California,

1:04

San Francisco. He is the

1:06

co founder of the UCSF

1:08

Center for Vulnerable Populations.

1:11

I was featured in the PBS documentary

1:13

on Type two diabetes Blood

1:15

Sugar Rising. As

1:17

someone with type two diabetes, this

1:20

issue hits close to home for me.

1:23

I wanted to begin my conversation with

1:25

doctor Schillinger, learning how he

1:27

went from simply treating individual

1:30

patients to calling for a public

1:32

health war on diabetes.

1:35

I work at San Francisco General Hospital,

1:37

which is the city and County of San Francisco's

1:40

public hospital, which is for the New Yorkers

1:42

on the call, sort of like a small.

1:44

Version of Bellevue.

1:46

And if you had told me thirty years

1:48

ago that I was going to become a specialist

1:50

and expert in diabetes when I was coming

1:52

out of medical school, I would have laughed at you. It was

1:54

not something that I was interested in when I was training.

1:57

And when I started out as a primary care

1:59

physician general internest this Stan Africa General

2:01

Hospital, I'd say about one out of fifteen

2:03

of my patients had type two diabetes.

2:06

And now I just think about the clinic that I had

2:08

on Monday, one out of two of my patients

2:11

has type two diabetes. So in one generation,

2:14

we have seen an absolute explosion

2:17

in type two diabetes in America, and that

2:19

can't possibly be managed by endocrinologists.

2:21

There just aren't enough of them on the planet. And

2:24

truth be told, most of diabetes can

2:26

be handled by family doctors.

2:27

In general interness but it.

2:28

Has become the proverbial

2:31

bread and butter of my practice, and

2:33

it has also led me to try

2:36

to combat the illness not only in the clinic, but also

2:38

outside in society, this diobetogenic

2:41

society, to move the fight

2:43

sort of beyond one patient at a time to sort of

2:45

the general population.

2:47

Where'd you grow up, where you from originally?

2:49

I'm originally from Buffalo, New York.

2:52

And where did you go unto grad?

2:53

I went to Brown University.

2:55

And where'd you go to medical school?

2:57

University of Pennsylvania in Philadelphia, Which is

2:59

interesting because the University of Pennsylvania in Philadelphia

3:01

was home to the country's largest

3:04

public hospital, Philadelphia General. But

3:06

you know, it lost a lot of money, as you can imagine,

3:09

and so they shut it down just a few years

3:11

before I entered the medical school, And

3:13

so I had never had exposure to working

3:15

in a public hospital as a medical student. And

3:18

you talk about the high level hospitals

3:21

that New York and San Francisco have,

3:23

and that indeed is true. But until

3:25

you've worked in a public hospital, you don't realize

3:28

the fact that we really operate in a

3:30

two tier medical system, and that

3:32

a lot of the consequences

3:35

of our social ills end up

3:37

at the door of public hospitals. So if you're only working

3:39

in private hospitals or nonprofit hospitals, you

3:41

don't see what's really going on in society

3:43

until you set foot in a public hospital. And it's

3:46

really it's transformative as a clinician. And

3:49

what I try I have been trying to do in the

3:51

last few decades, has been to share

3:53

the stories that I've been witnessed to in the public

3:56

hospitals to the general public so we can begin

3:58

to understand how public health

4:00

happens or doesn't happen in this country. And that's sort

4:02

of what you saw in Blood Sugar Rising.

4:04

And the fundamental difference between the two is what.

4:07

Well, the fundamental difference between the two is the

4:09

burden of disease that we

4:11

see in low income communities and people

4:14

of color far outstrips

4:17

that which we see in the private hospital.

4:19

So the reason that the waiting

4:21

rooms are so packed in public

4:23

hospitals is not just because we don't have enough doctors and

4:25

nurses, but because the demand for healthcare

4:28

is so logarithmically exponentially

4:30

higher because of the burden of disease

4:33

that comes with poverty. Think about what

4:35

it's like to be a poor person working two jobs,

4:37

the stress that they have in their daily lives, and

4:40

all that is around them in the every

4:42

corner store, every advertisement,

4:45

every billboard is pushing the food

4:47

that you appropriately described is causing

4:49

your diabetes. And it's the same

4:52

for people who are poor but really

4:54

on steroids, no pun intended.

4:57

Well, what's interesting to me? You know,

4:59

I'm some and this is just my belief

5:02

that when you abuse alcohol, when you wake

5:04

up in the morning and you look at yourself, you don't like what you

5:06

see. Maybe if you smoke too

5:09

much, you know it's wrong. Sugar

5:11

is something that is indoctrinated into our

5:13

lives from day one. We

5:15

have appended the consumption

5:17

of some sugary product with nearly

5:20

everything we do. Birthday caicks. You

5:22

don't have a birthday salad, you have a

5:24

birthday cake. Everything has

5:26

their designated sweets.

5:29

I mean, the holiday is just that

5:31

it's a holy day and we are meant to

5:34

celebrate it as a very special

5:36

and unique day in the year for whatever

5:38

ritual, whatever reason, And so the introduction

5:40

of sweets into that holiday was

5:43

a signal, a symbol

5:46

of the sweetness of life that we celebrate

5:48

or whatever the memory is that we're trying to celebrate. And

5:50

you're absolutely right that what the food industry

5:54

and the hallmark industry has done is

5:57

take this natural joy

6:00

we feel when we consume added

6:03

sugar and essentially

6:05

make it such that every meal

6:08

now has to have that endorphin

6:11

and dopamine rush experience

6:13

that we used to only experience two or three times a year.

6:16

And what we've learned increasingly from

6:19

both basic science and behavioral science, is

6:21

that added sugar, particularly liquid added

6:23

sugar in the form of sugar sweetened beverages.

6:26

Are addictive.

6:27

They have all the characteristics in

6:29

terms of brain response that we see with

6:32

alcohol, cocaine, etc. And

6:34

I am not exaggerating

6:36

when I say this. The cravings,

6:38

the joy, the withdrawal,

6:41

all of these things the food chemists

6:43

have learned and have then implemented

6:46

into marketing strategies and distribution strategies.

6:49

And for those who are under stress or depressed

6:52

or down and need to pick me up, this

6:54

is the perfect drug. And the

6:57

modern food system has

6:59

trained, has formed itself, to deliver high

7:02

doses of added sugar, particular liquid sugar

7:05

on an ongoing basis and we create

7:07

the false belief that this is part of our culture,

7:10

and I think that it indeed is,

7:12

but it's based on a model

7:15

of addiction and the

7:17

corporate takeover of the food system

7:20

by harnessing the addictive properties

7:22

of their foods. It's not a

7:24

level playing field. Your body has

7:26

natural hormones and chemical

7:28

messages that say my appetite

7:31

is satisfied, I'm going to stop eating. But

7:33

the food chemists have created foods

7:36

that do not stimulate the

7:38

appetite suppressant hormone. I mean

7:40

specifically that so that

7:42

we're being played, so

7:45

that you feel that you and

7:47

your willpower are inadequate in

7:49

terms of your question as to when we

7:51

should be screened. This is highly controversial,

7:54

and I can tell you what I do in my practice

7:56

and my practices, I take care of low income people

7:58

who have a very high point revalence of type two diabetes.

8:01

If you take the average adult

8:03

who is a person of color in the United States, there's

8:06

about a twenty twenty five percent chance that that person

8:08

off the street's going.

8:09

To have diabetes at one age.

8:11

That's the average age, so we're talking about in their fifties.

8:14

But we see the incidence of

8:16

diabetes occurring younger and younger, and

8:18

particularly in people of color. In fact, we're seeing

8:20

it now in children. We're seeing

8:23

type two diabetes emerge.

8:25

If I had said twenty five years ago, I've got a

8:27

child with type two by diabetes as supposed to

8:29

type one, people would you know, laugh

8:31

me off the stage. But now this

8:33

is this is just an everyday

8:35

phenomenon, and the rates of type two diabetes

8:38

and children of color has gone up

8:40

three four fold over the last decade.

8:43

The young man you see in the film who you're taking

8:45

care of, the black guy who's going to

8:48

be lose his foot, Yeah, Montille,

8:50

Montille. Now he looks pretty whippity

8:52

and pretty lean. So I'm assuming

8:55

you don't have to be morbidly

8:57

obese to qualify for this.

8:58

Correct, That's absolutely true. I think

9:00

there is a there. Of course, obesity

9:03

and high BMI is a risk factor

9:05

for the development of type two diabetes. But I have plenty

9:08

of patients, particularly young patients, who

9:10

have type two diabetes who are not overweight. So

9:14

yes, he developed diabetes

9:17

in his late twenties. He

9:19

was born in poverty and raised in poverty,

9:22

severe food and security. He grew

9:24

up eating what he told me were syrup sandwiches,

9:27

which is syrup put in between

9:29

two pieces of wonderbread. For

9:31

much of his childhood, his father was incarcerated.

9:34

He raised himself and his younger

9:36

brother, and they would drink you know,

9:39

high Sea and the fruit, you know, the powder

9:41

mixes of sugar, sweet and beverages, three meals a day.

9:43

So he was really addicted,

9:45

if you will, but also overly exposed

9:48

to added sugar, particular liquid sugar. And in

9:50

his twenties he came in at a diabetic coma.

9:53

And you know, in the old days, we would have thought that

9:55

was type one diabetes, the so called

9:57

autoimmune disease where you you know, children,

10:00

juvenile onset diabetes, where

10:02

the body attacks itself, you know, the pancreas

10:05

stops producing insulin. But what we're

10:07

seeing now in these younger people is type two

10:09

diabetes, which I like to think of as the body

10:11

politic attacking the child or the young

10:13

person. It's not the body attacking itself, it's

10:15

our society attacking the body of that young

10:17

person. And that's what happened with Montille,

10:20

and he has suffered all of the consequences

10:23

of uncontrolled type two diabetes.

10:25

He's now forty, and he just sustained another

10:27

amputation.

10:28

The sugar consumption in my family

10:31

as a child was habitual.

10:33

My mother was diabetically. Yeah, it

10:36

was diabetic, and she did had no

10:38

amputations. But she was really very sick

10:40

from diabetes for many, many years.

10:42

But how old was she when she developed diabetes?

10:44

I'm interested to her.

10:45

I would say that she was identified and treated when

10:47

she was She died at ninety two last year.

10:49

Do you remember how old she was when she was

10:51

sixty?

10:52

I'd say, okay, probably sixty.

10:54

Yeah, it's interesting because you would say

10:56

to your doctor, I have a family history

10:58

of diabetes. It's interesting. Many of

11:00

my patients say, oh, this is happening

11:03

because of my genetics. I have a family history

11:05

of diabetes. And I say, well, that's interesting.

11:07

How old was your grandmother when she got

11:09

diabetes? Oh she was eighty okay.

11:11

And how old was your mother when she got diabetes?

11:13

She was seventy. And how old are you

11:15

now? Oh, I'm forty five. And

11:18

how about your son who has diabetes? Oh he's twenty

11:20

one. I have patients who tell me the story and so

11:22

say, yeah, you have a family history. We are all

11:24

vulnerable to getting diabetes. But your

11:27

history went from ninety to seventy to fifty

11:29

to thirty. And it's very different to have diabetes

11:32

at a young age than it is to have an old

11:34

age. And so something has gone

11:36

on in our environment, something pathologic

11:39

has gone on our environment. To unmask

11:41

this nearly human, universal

11:44

human tendency, we have to acquire

11:46

diabetes such that it's happening

11:48

at younger and younger ages, with tremendous implications

11:51

for work productivity, raising

11:53

a family, sexual activity,

11:56

you know, and all of those things. And

11:58

so it's really you

12:00

know, in the context of the COVID pandemic,

12:02

of course that's gotten all the intention. But

12:05

what's happening at a much more chronic,

12:07

slow growing, and insidious

12:11

pace is the diabetes

12:13

epidemic. And the two of them together,

12:15

of course, were a disaster, you know, the

12:17

so called syndemic of having

12:19

diabetes making you much more likely

12:22

to die of COVID than you see how these two

12:24

things interact with each other. So it's

12:26

a very important national urgent

12:28

problem. And you know, we've recently had some

12:30

federal policy work around this that I

12:33

hope will change the conversation such as

12:35

well, the conversation is focused very much on you

12:38

know what you and I have been talking about, which is people's

12:40

individual choices that they make in their day to day

12:42

lives, right the intimates and donuts that your

12:44

mother served you and that you enjoyed. Really

12:48

much of this exposure is

12:50

occurring in the context of federal policy

12:53

that in many ways promotes the diabetes

12:56

epidemic.

12:56

Let's take, for.

12:57

Example, the most important nutrition

12:59

assistance program, the SNAP Program Supplemental

13:02

Nutrition Assistance Program

13:04

formerly known as food stamps. Something like

13:06

forty forty five million individuals receive

13:09

SNAP benefits every year, and

13:11

because of the efforts of the junk

13:13

food industry in particular, we have never

13:15

been able to actually make that a nutrition assistance

13:18

program. Rather, what it is is it gives

13:20

people a little bit of money to buy food,

13:23

including junk food. So last

13:25

year we spent maybe eighty billion dollars

13:27

on providing SNAP benefits to low

13:30

income America. It's very important program to

13:32

reduce poverty and food and security. Four

13:34

billion dollars four billion of the eighty

13:37

billion was spent only on sugar, sweet

13:39

and beverages.

13:40

And any attempts we've made to

13:42

attach restrictions to that money have been

13:44

rebuffed by even

13:46

civil rights activists who are saying, don't

13:49

tell us what.

13:49

To eat, right.

13:51

We have the misconception that this freedom

13:53

to eat in some way restricts

13:55

our freedom of life. And you

13:58

know, we're not saying you can't drink a sugar sweet

14:00

and beverage. What we're saying is that the government funding

14:03

should not be used in a nutrition assistance

14:05

program. And just by way of comparison,

14:08

with the four billion dollars in that same

14:10

year, the CDC would have spent six

14:12

hundred million dollars on all chronic

14:15

diseases in America.

14:16

So what is that like?

14:17

A sevenfold greater expenditure

14:20

on sugar sweet and beverages than the prevention of all

14:22

chronic diseases.

14:27

Doctor Dean Schillinger. If

14:30

you enjoy conversations on public

14:32

health, check out my episode

14:34

with doctor Robert Lustig, a pediatric

14:37

endocrinologist who studied the

14:39

link between sugar and childhood

14:41

obesity.

14:42

Sixteen percent of all of the corn

14:45

grown in America today ends up as high

14:47

fructose corn syrup. We have boatloads

14:49

of it, and it's cheap, and because

14:51

it's cheap, it started finding its way into

14:53

things that never had sugar before. Like hamburger

14:56

buns, hamburger meat, barbecue, sauce,

14:58

ketchup, salad, dressing. I mean pretty

15:01

much everything you can imagine in the store.

15:03

Indeed, Barry Popkin at the University

15:05

of North Carolina has just done a study

15:07

that shows that eighty percent of the food

15:10

items there are six hundred thousand food items

15:12

in America, eighty percent of them relays with sugar

15:14

added sugar.

15:17

To hear more of my conversation with

15:19

doctor Lustig, go to Here's Thething

15:22

dot org. After the break,

15:24

Doctor Dean Schillinger shares how

15:27

conflicts of interest in scientific

15:29

studies and lobbying prevent

15:31

change from within the sugar industry.

15:45

I'm Alec Baldwin, and you're listening to

15:47

Here's the Thing. Doctor

15:49

Dean Schillinger served as a co

15:51

chair of a federal Advisory Commission

15:54

on Diabetes policy and Chief

15:56

Medical Officer for Diabetes Prevention

15:59

for the State of care California, among many

16:01

other high profile appointments.

16:04

I wanted to learn about his approach to

16:06

advising elected officials and

16:08

trying to bring about real legislative

16:11

change.

16:12

You know, we've gotten to the point now where

16:15

one in seven adults on average has

16:17

diabetes in America one in seven, and in

16:19

communities of color, it's, like I said, one in four,

16:22

sometimes one in three. We

16:24

can't avoid hearing stories

16:26

of the consequences of diabetes.

16:28

And what I've realized, I've stopped giving talks

16:31

on the statistics and the p values

16:34

and the you know, and graphs, and

16:36

I've just started telling real stories

16:38

from my own practice that sort of

16:40

give people a wake up call around like this

16:42

is like really important shit here. These

16:44

aren't just numbers. And this

16:47

sort of happened to me when I was working

16:49

as chief of the diabetes Prevention Control Program

16:52

in the state of California. So when I started the

16:54

job in two thousand and eight, two and a

16:56

half million Californians had diabetes,

16:59

and when I left twenty thirteen to four million

17:01

Californians had diabetes.

17:03

So I'm like, gee, I did a great job, right,

17:05

what a fantastic job I did.

17:07

And the reason I wasn't able to do my job

17:10

is I couldn't get into the heads of legislators

17:12

how important this was. And then I quickly

17:15

learned, probably too late, that I needed

17:17

to tell them real stories. And

17:20

the story that I told them then

17:22

and I've told another regulatory

17:25

in policy settings was a story of Melanie,

17:27

a lovely forty year old African

17:30

American woman who had developed diabetes

17:32

just like Montelle in her late twenties

17:34

and had been addicted to a number

17:37

of things, smoking cocaine, sugar

17:39

sweeten beverages, but the addiction she could not kick.

17:41

With sugar sweeten beverages, she loved seven ups.

17:43

She just could not give up the seven up

17:45

and she was desperate. And I

17:47

remember on her fortieth birthday,

17:49

I came into clinic and I

17:51

saw her hospital card, like, it's

17:53

your fortieth birthday, Why are you here? You

17:56

should be celebrating, And she said, oh,

17:58

don't worry. You know, my girlfriend going

18:00

to take me tomorrow to the water park,

18:02

my favorite thing to do. I'm going to go to the water park and

18:04

do the water slides. I haven't done it in fifteen

18:06

years. I was like, oh, that sounds like a great birthday.

18:09

And then a couple months later, at her follow up appointment,

18:11

she didn't show, but her girlfriend showed and I said,

18:13

where's Melanie And she said I it was

18:15

horrible. We went to the water park

18:18

and you know Melanie who can't feel

18:20

her feet because of her. The nerve damage from

18:23

the diabetes burnt the bottom of her

18:25

feet while she was standing on the hot staircase,

18:29

and she developed gangreen

18:31

in both feet, hospitalized

18:33

and had amputations, and then the

18:36

gangreen spread to her body and she died.

18:39

And this is what I learned, you know, at her

18:41

follow up visit.

18:43

And for those people that don't know, for

18:45

those people who don't have a real sense of

18:48

the diabetic neuropathy where

18:50

and for some of my friends, that neuropathy

18:53

came on in somewhat rapid surges.

18:57

Yeah.

18:57

I had friends of mine who had along that

18:59

outer pad of your foot, the

19:02

balls of the feed and then the heel. They

19:04

had a neuropathy like sensation

19:07

for an extended period of time, like

19:09

let's say a year, and they felt the tingling

19:12

right, and then all of a sudden, it seemed like they told me,

19:14

like overnight he went to burning

19:16

and numbness.

19:17

And then numbness. Yeah.

19:19

You know, the statistic that I think is

19:21

most compelling is, you know, we

19:23

think of amputees, We think of soldiers, right,

19:25

we think of the Iraq War and IEDs

19:27

and people getting their leg blown off, and that

19:29

indeed happened in the fifteen years of

19:31

that conflict, twenty five hundred

19:34

soldiers lost a limb and it's a

19:36

catastrophe. It's devastating. In

19:38

that same period of time, one

19:40

million people with diabetes in the United States

19:42

lost a limb. And we think

19:45

of amputation as like this most catastrophic

19:47

thing, but it is happening. If you go

19:49

into low income neighborhoods, you see people in wheelchairs.

19:51

Why are they in wheelchairs? They've lost a

19:54

limb. So I mean, at some

19:56

point, and I think we've hit this

19:58

point, the discourse begins to change

20:00

around, just like we saw with tobacco

20:03

use, that maybe this is something we need

20:05

to do in moderation, and we

20:07

have to recognize it's not

20:09

only we who have to change, it's the businesses

20:12

that are pushing this at us that need

20:14

to change.

20:15

I was told by people years ago when

20:18

I was more active on

20:20

an ongoing basis in

20:22

advocacy work in the nineties and so forth,

20:25

the sugar lobby is like borderline,

20:27

like the Mediine cartel. You know, the

20:30

biggest sugar producer I was in Brazil. The

20:32

great families that are some of

20:34

them Cuban expatriates in the Miami area

20:37

Great Miami Fortunes logged

20:39

countless millions of dollars in federal subsidies

20:42

for these products. You know, it's

20:44

almost like they look at sugar like

20:47

oil, Like if we don't have a steady supply of this

20:49

stuff, the country is going to grind to a halt. You know, sugar

20:51

is a heavily What do you think

20:53

about that? In terms of this idea, people

20:55

was talking about putting warnings on candy labels.

20:58

Yeah, I think this is a critical, critical

21:01

issue. The outsized influence

21:03

in this case of the American Beverage Association,

21:06

which is, you know, in cahoots with the sugar

21:08

industry. It's part of it, and I mean

21:10

I've had firsthand experiences with

21:12

them.

21:12

I'll give you example.

21:13

So in twenty fifteen, the

21:16

City and County of San Francisco passed

21:18

an ordinance because we've had this explosion

21:20

of diabetes, that would place warning

21:22

labels on billboards that advertise

21:24

sugar, sweet and beverages, you know, warning

21:27

consuming one or more of these. The City County

21:29

of San Francisco that consuming one or more of these may

21:31

contribute to OBEs, diabetes, tooth decay,

21:33

and heart disease.

21:35

Pretty reasonable and this went

21:37

to court.

21:38

The American Beverage Association sued the city

21:40

and county for breach of

21:42

their First Amendment rights, so called compelling

21:45

their free speech making them say something

21:48

that they claimed was misleading, scientifically

21:51

false, and controversial.

21:52

And so this went to of all places.

21:54

Of federal court, the Ninth Circuit Court because it's

21:56

a constitutional case.

21:58

And who were the litigants again, the the.

22:00

American Beverage Association, the City

22:02

and County of San Francisco to plaintiff with you.

22:05

And so I was asked to be the expert scientist

22:07

to develop a report around, Okay, is this warning

22:09

actually scientifically factual? And

22:12

I provided that report and that case

22:15

was one but was interesting. In

22:17

the research that I was doing to try to determine

22:19

whether sugar, sweet and beverages were causally

22:22

associated with these outcomes, something

22:25

sort of interesting happened,

22:27

which is about half of the studies showed

22:29

that, yes, there is a causal relationship

22:32

between these products and these outcomes,

22:34

but half of them found no effect. I

22:36

would say fifty to fifty was kind of, you

22:39

know, coincidental. And so

22:41

after that court case happened,

22:43

I went back and I very carefully

22:45

went through the funding sources of each

22:47

of these studies there were something like sixty studies

22:49

in a fifteen year period, and looked at the funding

22:52

sources of the scientists who

22:54

had written those coursers. And

22:56

as it turned out, not surprisingly

22:59

those studies that were funded in

23:01

some way by the American Beverage Association or

23:04

the scientists had been sent on trips

23:06

to Hawaii or whatever. It was almost

23:08

universally, with only one exception, thirty three

23:10

out of thirty four found no association between

23:12

their product. No diabetes is zero,

23:15

right, And every study that was

23:17

independently funded founded, and so the

23:20

likelihood of having an association

23:23

found if you were funded by the industry was basically

23:25

zero.

23:26

And so I wrote up these findings because

23:28

that, I mean, everybody.

23:29

Knows there's conflicts of interest, right the chemical

23:31

industry and the tobacco industry. But this

23:33

strength of the conflict of interest essentially

23:36

entirely determining the result of the study, showed

23:39

how the industry controlling the

23:42

scientists, controlling and hijacking

23:44

science itself. Being on the editorial

23:46

boards of nutrition journals, for

23:48

example.

23:50

Really was unprecedented.

23:52

And so I wrote this up in the Anamals of Internal

23:54

medicine, and needless to say,

23:56

the American Beverage Association responded

23:58

immediately and quote a scathing

24:01

letter to the editor saying that Okay,

24:03

yeah, he claims doctor Schellinger claims

24:05

that there are conflicts of interest at play here.

24:08

He needs to understand that they are intellectual

24:10

conflicts of interest that he is subject to.

24:12

In other words, saying, I somehow

24:14

religiously believe that sugar sweeten

24:17

beverages are cause of diabetes, and therefore

24:19

that belief is a conflict

24:21

of interest that undermines the

24:24

scientific study that I did, and intellectual

24:27

conflicts of interest.

24:28

The last time I saw.

24:29

That raised was when the tobacco industry, you

24:31

know, went against the scientists

24:33

who found the relationship between tobacco and lung

24:35

cancer. So then about a

24:37

year later, two years later, a study

24:40

came out in that same journal, the Annals of Internal

24:42

Medicine, that claimed that all of

24:44

the national guidelines internationally

24:46

that said that we should have less than ten percent

24:48

of our caloric consumption from added sugars are

24:51

fraudulent, They're bad science.

24:53

You know.

24:53

It was a very well done systematic review

24:56

funded by the International Life

24:58

Science Institute, which is the Americ Beverage Association,

25:01

Snickers, Mars Bar, all of these people.

25:04

And I was asked to write an editorial about

25:06

this study, and I basically called

25:08

them out in the editorial, and then The

25:10

Atlantic Monthly said, well, wow, what's

25:13

going on with this sugar controversy. We're going

25:15

to have a story about the sugar controversy,

25:17

and they interviewed me, and they

25:19

interviewed the editor of the Anamals of Internal

25:21

Medicine, an esteemed physician colleague of

25:24

mine, and they said, you know what, why did

25:26

you publish this study funded

25:29

by the Beverage Association? And

25:31

she said, well, I felt like it was really important

25:33

to have two sides of the story. And I

25:35

learned that yes, there are financial conflicts

25:37

of interests, but they're also intellectual

25:39

conflicts of interest. So this idea

25:42

of intellectual conflicts of interest is

25:45

being pushed by the industry and is finding

25:47

its way into scientific discourse

25:50

and really creating another

25:53

mechanism for disinformation.

25:55

Now, in the time we have left, I wanted

25:57

to highlight the fact that your wife is

25:59

a public interest attorney who serves

26:02

a director of the Program and Advocacy at

26:04

Bay Area Legal Aid. So

26:06

both of you did your wife's and

26:09

your own public service

26:11

mindedness, your civic mindedness, your

26:13

commitment to helping the less fortunate. Is

26:16

that a glue that drew you to your wife,

26:18

something you admired about her?

26:20

Yeah, absolutely, it's something that I think she's been

26:22

an inspiration for me. She I

26:24

mean, we often joke that we serve the same clients,

26:27

you know, and I'm trying to promote their health and she's

26:29

trying to promote their rights, and in

26:31

some cases we have shared clients coincidentally.

26:33

That's funny.

26:34

But I grew up in a public

26:36

housing project actually in Buffalo in my

26:38

early years, and I saw what poverty

26:41

was like, and then we came out of

26:43

that, and I saw how different life was for

26:45

me, you know, once we had some money, and

26:47

how that impacted my health. On

26:50

the other side of my family, my uncle

26:52

was running science education

26:55

for UNESCO in Paris, and my aunt

26:58

was a radio broadcaster in

27:00

Israel for Colistrael. And so

27:03

this idea of communication and

27:05

science and health all sort of I think

27:08

I grew up with somehow, and so I'm

27:10

able now to try to

27:13

harness science and communication

27:16

to make the world a better place. And it's

27:18

extremely gratifying. To be able to work in a public

27:21

hospital where you're working side by side with others

27:23

who.

27:24

Who they're not in for the money. I mean we get

27:26

paid, we get.

27:26

Well paid, but really get

27:28

to see their efforts returned.

27:31

You know, so many times.

27:32

Over, Doctor

27:36

Dean Schillinger. If you're enjoying

27:38

this conversation, tell a friend and

27:41

be sure to follow Here's the Thing on

27:43

the iHeartRadio app, Spotify

27:46

or wherever you get your podcasts.

27:49

When we come back, doctor Dean Schillinger

27:51

shares the most important change

27:53

you can make to help fight diabetes.

28:06

I'm Alec Baldwin and you're listening

28:09

to Here's the Thing. Doctor

28:11

Dean Schillinger co founded a nonprofit

28:14

campaign, The Bigger Picture,

28:16

to help young people of color tell

28:18

their stories about diabetes. They

28:21

share how the issue affects their families,

28:23

their communities, and themselves

28:25

through poetry, song and film.

28:28

I wanted to know what was behind the campaign

28:31

and how it might change the public perception

28:34

surrounding sugar. Well.

28:37

I mean, I think there are two parts

28:39

of the conversation about diabetes. The first

28:41

part is the individual patient

28:44

right, get your A one C, get tested,

28:46

treat your diabetes, eat right, exercise,

28:49

I think we do a really good job of that in the United

28:51

States. The American Diabetes Association is

28:53

front and center where we don't

28:56

have the megaphone. However, is

28:59

ref framing the conversation about diabetes

29:02

to be not just a biomedical problem at the individual

29:04

level, but that it is a societal problem.

29:06

That needs societal fixes.

29:07

And that's where this Bigger Picture campaign, with these

29:09

young poets of color basically

29:12

speaking truth to power about what's going on, has

29:14

really changed the conversation away

29:17

from this individual blame and

29:19

shame kind of narrative to

29:22

actually, we're kind of being victimized here, and

29:24

it's not just people of color being victim but we're

29:26

all being victimized by these

29:28

insidious practices around the food

29:30

industry. And this requires

29:33

a movement alec if we are

29:35

going to change the course of the epidemic, and we've

29:37

begun to see that. As I mentioned earlier, it's

29:40

going to require a social movement. And

29:43

you know that the impact of these young people in the

29:45

Bigger Picture campaign, when they get

29:47

in front of policymakers and bang

29:49

out a poem in front of them, far

29:52

outstrips the impact that I've been able to

29:54

make as and so.

29:55

I wouldn't have thought that.

29:56

I think bringing together the arts and public

29:59

health in terms of a megaphone around

30:01

changing the conversation around diabetes to

30:03

be reframed as a social

30:06

problem that we can get our arms around.

30:08

Is where the money should be. It's

30:11

where the money is. So it's where the money should be.

30:13

And I mean, you have a tremendous

30:15

megaphone at your disposal, and I hope

30:18

you use it in that regard. But there

30:20

are many gifted members,

30:22

particularly of disproportionately affected communities,

30:25

who can do a much better

30:27

job representing the experiences

30:30

of individuals and communities more

30:32

than the public health expert can. So bringing together

30:34

the public health experts with vocal

30:37

community members, who's.

30:38

Doing the talking and who's delivering the message

30:40

exactly?

30:41

And what is that message? Yeah, I mean my

30:43

message.

30:43

If I had said, oh, go do a diabetes campaign, it

30:45

probably would have been far less

30:48

effective than what you heard Obassi Davis

30:51

and Joker Rosco's say.

30:52

In their poems.

30:53

Joker Orosco's poem, you know he's a kid

30:55

who grew up in Central Valley

30:57

of California, which is, you know, the fruit basket

30:59

of the world, world growing fruits

31:01

and vegetables, and all the kids exposed

31:04

to his junk food. He can't you know, his

31:06

family's farming the Bounty

31:08

of America and everywhere in Stockton

31:11

is just junk food, and everybody's got diabetes.

31:13

But you always see,

31:16

I mean I did for a period of time. You always see

31:18

where they're going into the school lunch program

31:21

and they're taking the administrators of the school

31:23

district, and they're taking the administrators of the individual

31:25

school, and they're saying, you got to get the soda

31:28

machines out of the school. You got to

31:30

get the high fructose vending out of the school.

31:32

How do we not have federal legislation around

31:34

that?

31:35

I wonder who can defend that? Who

31:38

wasn't just completely in the pocket of the beverage

31:40

lobby or the sugar lobby. You're

31:42

sitting there saying you want your children,

31:45

don't condemn your children to what you

31:47

have.

31:48

Right, Well, that's why we need a social movement. I mean,

31:50

we don't have cigarette vending machines

31:53

in high schools right anymore?

31:55

We don't. That's true that we used

31:57

to.

31:58

Now one last question, which is that so

32:01

you're not an endoquinologist and I'm assuming

32:03

you're not a nutritionist either. So when

32:05

people come to you, whether it's the

32:08

young man who lost who was the subject

32:10

of the film who had the amputation, very

32:12

sad case. And when people

32:14

are coming to you, I'm assuming within your body

32:16

or your network of your organizations you work with in

32:18

hospitals, there's a nutritionists you pass them

32:20

on to who can give them some guidance about what

32:23

to eat, not eat. Eat.

32:24

Yeah, I provide basic nutritional

32:26

counseling. Often it's not rocket science.

32:29

When you hear what people are you just have to take a good

32:31

history. You have to hear the story. Tell me what you ate yesterday,

32:33

Tell me what It doesn't take long to

32:36

figure out that they're having four bowls of rice with

32:38

every meal, or you know, having

32:40

three sugar sweetened beverages a day. And

32:42

you know, a lot of this is pretty out

32:44

there and obvious. But yes, we do have

32:47

nutritionists who work in the outpatient's setting,

32:49

and they're very effective. I think the most effective

32:52

thing that they do is they have the person keep a food diary

32:54

and then they review the food diary.

32:56

Because I'm always saying to people it's

32:58

an incremental change. I

33:00

said, just give up one thing. I had a doctor sit me

33:02

down when I was fifty years old, so it's

33:04

fifteen years ago, and he said, here's my philosophy.

33:07

He said that is, once you turn fifty,

33:09

start to minimize or completely give up

33:11

one of each category gradually every

33:13

five years.

33:14

I mean, I do think certainly individual

33:16

decision making is really important, which is what we

33:18

do with an attritionness. At the same

33:21

time, we have to ensure that when the person

33:23

walks out of their home that within

33:25

a mile or two miles there's some place.

33:27

That's option go, there's oppositation that

33:30

you can get.

33:30

And the price of healthy food over the last thirty

33:33

years has exorbitantly

33:35

increased relative to the price of junk food,

33:37

which has declined adjusted for inflation.

33:39

So the stress on

33:41

the pocket is real. And you

33:44

know, a lot of that is subsidized by the farm

33:46

bill. Paradoxically, so if we could

33:48

have a farm bill that subsidizes the growth of

33:50

healthy food, which we do not have a

33:52

program to do, we could

33:54

turn that around to.

33:56

Well, let's just say this, which is when you're

33:58

ready to go to Washington and fight

34:00

the fight about school lunches and vending

34:03

and lunches, when you're ready to do the

34:06

next charge up that hill. Count me and I'll

34:08

go with you.

34:09

Thanks, So I appreciate it.

34:10

Your kids are how old?

34:12

I have twins who are twenty four.

34:13

They're jazz musicians in New York actually, and

34:15

then I have a sixteen year old daughter.

34:17

So your daughter, And what's the shill

34:19

in your house on a dietary

34:21

basis cooking at home?

34:23

Yeah, we mostly cook at home.

34:25

Occasionally we order in, you know, when I'm lazy,

34:27

and we have desserts. I mean a

34:29

lot of fruit, a lot of fruit. But well,

34:31

we'll have desserts every now. And that we do not have sugar,

34:33

sweet and beverages. That's something that's very different

34:35

from my chi. And we didn't have the

34:38

fruit loops that I grew up with, you know, the

34:40

pop tarts that I grew up And my kids,

34:43

my boys are like five or six

34:45

inches taller than me and look

34:47

a lot better than I did.

34:49

Well, listen, I enjoyed so much seeing

34:51

you in the film, and I was so captivated

34:54

by the work you're doing and your articulation

34:56

and your just your whole energy in terms

34:58

of you're caring for your your constituents

35:01

there that I was dying to talk with you, and thank

35:03

you so much for doing with us. Okay, thank you,

35:09

my thanks to doctor Dean Schillinger.

35:12

This episode was recorded at

35:14

CDM Studios in New York City. Were

35:16

produced by Kathleen Russo, Zach

35:19

MacNeice, and Maureen Hobin. Our engineer

35:21

is Frank Imperial. Our social

35:23

media manager is Danielle Gingrich. I'm

35:26

Alec Baldwin. Here's the thing is brought

35:28

to you by iHeart Radio