The US leads the world in biomedical innovation, with about 40% of patents being filed by US scientists and companies. The FDA plays a critical role in supporting and enabling this innovation pipeline and our guest Dr. Robert Califf was commissioner of the agency not once, but twice under Presidents Obama and Biden. He joins us to talk about what Americans should know about FDA’s critical role and the threats to its functioning from the dramatic cuts the Trump administration has made over the last three months.

We discuss:

• The broad sweep of FDA’s purview from drugs and medical devices to cosmetics, food, tobacco and dog food
• Concern that the FDA is now “decapitated and eviscerated” from the massive and multiple rounds of dismissals
• While most industries want less regulation, the pharma industry wants more information and guidance from the FDA
• Califf has been affiliated with Duke for 50 of its 100 years, but a part of his heart is still with Clemson

What would Califf’s “Make America Healthy Again” agenda be?

“We need to develop reliable, repetitive sources of information that help people do things that are healthy and beneficial. That part of MAHA I like a lot…The second thing is… I'm developing connections with people who are thinking differently about primary care because I think everybody agrees there's no way you can take the current workforce and deliver what's needed. So it's got to be linked up with AI and digital technologies, but also with a very different looking workforce that gets paid differently, has more respect.”

Relevant Links

• Read Califf’s WSJ opinion letter: “Work with the Bureaucracy, Not Against It”
• Peter Marks’ resignation letter
• NYT article on the impact of FDA layoffs
• Califf’s “Public Health on Call” podcast episode on the state of the FDA
• Opinion article from 7 previous FDA commissioners on how recent changes are undermining credibility of the FDA

About Our Guest

Robert M. Califf, MD served as FDA Commmissioner under Presidents Biden and Obama. Califf is a nationally recognized expert in cardiovascular medicine, health outcomes research, health care quality, and clinical research, and a leader in the growing field of translational research. Prior to rejoining the FDA in 2022, Califf was head of medical strategy and senior advisor at Alphabet, contributing to strategy and policy for its health subsidiaries Verily Life Sciences and Google Health. Prior to Alphabet, he was professor of medicine and vice chancellor for clinical and translational research at Duke University, director of the Duke Translational Medicine Institute, and founding director of the Duke Clinical Research Institute. Dr. Califf is a graduate of Duke University School of Medicine. He completed a residency in internal medicine at the University of California, San Francisco and a fellowship in cardiology at Duke.

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Could primary care at home unlock better health and lower costs for American families? Rebekah Gee, a physician and policymaker turned entrepreneur, joins us to talk about the big bet her company Nest Health is making on home-based primary care. It’s a model that makes sense for families and delivers results. In the first year of operations Nest doubled primary care visits, reduced ER visits, and increased childhood immunizations.

We discuss:

• The sound economics behind the Medicaid expansion in Louisiana
• What she learned from her mentor, astronaut John Glenn
• How to close the primary care gap for children and parents
• Whether ultra processed foods are the next tobacco

Rebekah shared about an exchange with Elon Musk on the short sightedness of Medicaid cuts:

“So Nest came out with our savings numbers. We put out some really good information about the health of children and the opportunities. And Elon Musk retweeted it. So as a result of that, we actually got a lot of press. But I wrote back to him and said, ‘I'm glad you like this concept. And just remember, don't cut health care for children because we'll be paying far more for that than you will ever save.’ ”

Relevant Links

• Read more about Nest Health
• Watch: Dr. Rebekah Gee on what entrepreneurs need to know about Medicaid
• Learn about Alaska’s Nuka system of care
• Evidence from the Nurse Family Partnership about the impact of home-based care

About Our Guest

Dr. Rebekah Gee is the founder and CEO of Nest Health, a technology-enabled whole-family primary care provider providing care at home and virtually to Americans who struggle to receive comprehensive care. Previously, Dr. Gee served as Secretary of Health for the State of Louisiana. In that cabinet-level role, she led the expansion of Medicaid. As Secretary, she was responsible for nearly half the state budget including Medicaid, public health, aging and adult services, licensure, sanitation, disability services, and a nearly 2,000 bed state hospital system. As Secretary, she developed a first-in-the-nation subscription model for the drugs that cure Hepatitis C that is being used as a national and international model for increased drug access and affordability.

Dr. Gee has served as an advisor to multiple Governors, presidential campaigns, and policy efforts at the state and national level. Her board service includes medical advisory support of public companies Select Quote and 3D systems. She has also served as a board member or advisor to Ready Responders, Ouva, Noble, NCQA, NQF, IHI, the Penn Center for Behavioral Economics, and the Duke-Margolis Institute.

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams and LinkedIn

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Whether it's the civil rights movement, marriage equality or even seatbelt laws, community organizing is how change happens in America. In this encore episode, Dr. Tony Iton shares a masterclass in how social, political and economic power shape health outcomes and how to meaningfully shift those dynamics when it matters most. Tony argues that reinvigorating democracy at the community and local level is where we should be doubling down. This episode was impactful when it was first released but is even more relevant and timely now.

We discuss:

• The ABC’s of health for all: agency, belonging and social contracts
• How California communities applied this framework to dramatically change school climate and reduce suspensions
• The role of narrative in shaping policy choices towards belonging or exclusion

Tony digs into why power matters in health:

“We're talking about essentially community-level power, what we refer to as community agency, and we basically theorized that if we could build social, political and economic power in a critical mass of people in 14 low-income communities that have documented health disparities, that we could improve the health status of those populations over a 10-year period… We weren't thinking that there was something that we needed to do to people. In other words, it wasn't like increasing access to healthcare or, you know, enhancing the quality of public health education. This was fundamentally about unleashing the power of communities to [determine how resources are distributed].“

Relevant Links

• Read about our UC Berkeley School of Public Health Social Impact Fellows (Tony included)
• Learn more about the California Endowment
• Visit Dr. Tony Iton’s website
• Read Dr. Tony Iton’s “Understanding How Health Happens – Your Zip Code is More Important Than Your Genetic Code” by Dr. Tony Iton, MD, JD, MPH and Robert K. Ross, MD.
• Order “Advocacy for Public Health Policy Change: An Urgent Imperative” which is co-authored by Dr. Tony Iton

About Our Guest

Dr. Tony Iton is a Social Impact Fellow and lecturer at UC Berkeley School of Public Health. He was the Senior Vice President of Programs & Partnerships at The California Endowment from October 2009 to June 2024.

Prior to his appointment at The Endowment, Iton served from 2003 as both the director and County Health Officer for the Alameda County Public Health Department. In that role, he oversaw the creation of an innovative public health practice designed to eliminate health disparities by tackling the root causes of poor health that limit quality of life and lifespan in many of California's low-income communities.

Iton also served for three years as director of Health and Human Services and School Medical Advisor for the City of Stamford, Connecticut. Concurrent to that, he also served as a physician in internal medicine for Stamford Hospital's HIV Clinic. In addition, Iton served for five years as a primary care physician for the San Francisco Department of Public Health.

Iton's varied career also includes past service as a staff attorney...