The Musical Innertube - Volume 2, Number 147 - Art Caplan on the 2024 Olympics

DON

And once again, we are proud and honored - and just giddy - to welcome Art Caplan back to the Musical Innertube. Art is the head of the Division of Medical Ethics at NYU Grossman School of Medicine, and he has guided us medically, ethically, through the last couple of years, with all sorts of different items that have popped up, including, obviously, COVID and some other things. Art, first of all, welcome.

ART

Thanks for having me.

DON

And the second thing is, we want to talk to you about an article that appeared in Newsday that you co-authored with a couple of your friends about the Olympic Games, which start in just a few weeks. We're talking about public health on the Olympic Games, and there have been a lot of different things that have popped up about how Paris seems to be mishandling these games. The first thing is, obviously, swimming in the Seine, which has become a huge, huge problem. What can you tell us about that and why is it potentially dangerous?

ART

The government in France, and the government in the city of Paris, loved the idea of holding some of the free-swimming events, marathon type swimming events, in the river that runs through Paris called the Seine. The Seine is one of the filthiest rivers on Earth, but it does make a beautiful visual because in the background you can have the Eiffel Tower and Notre Dame and all the usual gorgeous French buildings and so on. It's absurd, then, to have this competition in a sewer, basically what is being proposed! I mean, there is no way that I can tell any young athlete go jump in the sewer and swim around for a couple of miles in the name of a good visual backdrop. I mean, I like the beauty at Paris as much as anybody else, very pretty city. But that one health issue is ridiculous. There are also people in France who are proposing to go poop in the river shortly before the Olympics start because they don't really want the Olympics there anyway. They think it's too disruptive, and a pain in the neck. So whatever was bad will likely be getting worse. But it's bad enough that there is - it's inexcusable. I can't believe the Olympic Committee has not stepped in and simply said move this to some venue where you’re not posing a direct health hazard to the athletes, by the way, and their coaches, some of whom will be in boats, you know, next to the swimmers, and this sort of thing.  Media is not doing a good job picking up on this. Occasional story pops, but they should be screaming that this is compromising the health of athletes for no purpose. None. It's all visual look and appearance. There's no reason. You could swim these events, there are plenty of bodies of water near Paris that are not a sewer, so if you want to be outside, you could do it. You just swim the rest of it in the pool. It may take you, you know, you have to swim 200 laps to get it. Done. But OK. There you are. So, for the past couple of months COVID's been coming back, right? We see the rates increasing. You know there's at least 2000 deaths a week from COVID, U.S. alone. France has them too. Is there any discussion when you bring together millions of people in a crowded place, Paris, athletes, staff, media, coaches. At least a million fans are all climbing into Paris and close by.  Well, we call that a COVID outbreak. Anybody masking? Anybody vaccinating? Anybody improving ventilation? No, no discussion. Politicians have run away from it. We're all tired of COVID. Certainly, the Olympic people don't want to hang COVID around this Olympics - and by the way, close friend of COVID, what I particularly love, for the past three years, Paris has had huge outbreaks of bed bugs. There's going to be an entire world sleeping in Paris, where they've had bed bug outbreaks at least the past three years, and then they're all going home to wherever they came from, probably carrying their little friends back with them to wherever they originated from. Any discussion of protecting the mattresses, good hygiene, taking showers, even simple steps like keep your luggage sealed, don’t put it on the floor. We know a little bit about how bed bugs piggy-back into you and your luggage and whatever. I'm thinking perhaps the young athletes are not the most fastidious, in terms of people taking care of their property and stuff. Any of them that are teenagers...

DON

Anyone who’s seen a teenager’s room...

ART

I have first hand, endemic knowledge of what teenage rooms look like, I'm sure the bed bugs are all having a party waiting for these people to show up. Other little issues:  heat. So, I don't know what the temperature is going to be there, but we know what it's like in the U.S. right now in July. It's pretty darn hot, and end of July, I have a feeling it's going to be pretty steamy. In Paris, I'm hoping they will shift many of these events to at least at night, but again, they're looking for the visuals because TV and media call the shots on these games, and that's a compromise I would never make. Other issues: just plain disease spread. If somebody shows up with let's say, oh, I don’t know, dengue. Or West Nile virus. These people come from around the world. You cram everybody together and you got a great kind of boiler to transmit disease. Would I call off the games? No. Would I start to at least stress that there are public health aspects that should be, at least we should know about them? Be alerted to them? If I was going to that Olympics, I would mask, I would just put a mask on for that week. If I was going to that Olympics, I'd make sure all my shots were up to date. And I would not put up with swimming in sewers, for example.

JOHN

You know, the thing about swimming in the Seine...

ART

The by the way, that's a good line, “swimming insane.”

JOHN

“It's insane to swim in the Seine.” OK, so much is wrong. With this, the first thing that's wrong with it is the, the French Government and those who are in Paris, this is not a surprise that they have the Olympics. They had four years or more to think about how to set this sucker up. They had enough time actually to clean the Seine. They could.

ART

Yes.

JOHN

And I mean, if you can clean the Delaware, and you know what I mean, Art, you know? And they have cleaned the Delaware. You could actually swim in it without catching the hepatitises.

ART

We probably could do it in the Hudson. I wouldn't eat the fish or drink the water, but it's probably swimmable without killing you, so yes, it can be done.

JOHN

Yeah. And I mean, if they had time, why didn't they do that?

DON

As I understand it, the government put up some sort of retention pond, or series of ponds near the river that is supposed to work to try to clean it. But as far as anybody knows, they're not working. They're not actually engaged in cleaning the river. And I've heard reports from independent sources who take readings of the river that it's just as dirty now as it was a month ago, and two months ago.

ART

My understanding too. I don't think they did nothing, John. But they didn't do much. They certainly didn't do enough. And anyway, it's a nice idea, but it's totally for show. It has nothing to do with the competition at the swimming events or anything. It's just a visual.

DON

I have noticed that both Paris's mayor and Macron said that they would swing it over and neither one has so far. So, I think that tells you a little something.

ART

And, I noticed very recently, they have started to round up all their homeless, put them on buses and send them out to the burbs, so...

Speaker 3

Hey, hey, that's gonna.....

ART

Another visual that I don’t know that it's good for people to be shipped out to these places where they have even less support than they were probably getting, if they were getting much in Paris, But again everything is being driven, I hate to say it, it's almost like everything's being driven for TV.

DON

And that there was a report I saw too, where in the effort to look “nicer,” France has decided that all the Olympic villages will be cooled by water pipes, because that's better than using air conditioning, which is worse for the environment. However, many countries, including the US, are sending in air conditioning units, because they don't want their athletes sitting in a room, that's cooled by a water pipe that may not wind up being all that cool.

ART

That's a good point. And related to that is, that's nice about the Olympic headquarters, but if you're able to afford to go to these Olympics, I’m sure, you're going to stay in places that have air conditioning running 24/7.

JOHN

I should think so.

ART

It's not like the poor of the world will assemble in Paris to cheer on these athletes. These are people that are well to do. I can't imagine that it's not going to have any significant, if short, environmental impact from doing the event. By the way, this lets me point out one other thing. This whole notion of moving the Olympics around, having to build facilities, prepare everything is also, in my opinion, ridiculous. You should pick two venues, neutral kind of sites. Pick one in Switzerland, put another one maybe back in Athens or something. Get the timing right so that it's not too hot, and all that sort of thing. And then just run the Olympics at these two sites. What is this craziness of, we’ve gotta build a facility for the bicycle race, and we have to build dorms for the athletes all of a sudden. And, you know, just if we're going to do it, then I'm not sure how long it's going to continue because most countries are getting a little nervous about the budgets. If you shifted it to fixed sites, and then the world in a sense paid a tax, to maintain them, we wouldn't have half of these problems. You could even fortify them a little bit with public health protections, you know, you can have control over who's where and have mandatory vaccination sites and whatever.

JOHN

Yeah, sure. You can make them the cleanest place in the world, and you could also require what we required during the pandemic, which is, you know, one week interim stays sort of, you know, before you got to stay proper, you know you'd have to have a -

ART

Say for different purposes go there and be quarantined for a week.

JOHN

That's what I meant, yeah.

ART

Do a workup just to make sure you're not carrying any diseases. Blah, blah, blah, blah, blah. You can make the dining - that whole thing makes sense to just pick your locations and do it. And if, you know, poorer nations say, “Well, we don't just want it run in Europe,” or something like that, I don't really care where the sites are. It's just, get them going, let's have hard silos for public health purposes. Stop kicking the homeless out.

JOHN

That's a big political issue, by the way, in sending the homeless to the outer suburbs of Paris, because the outer suburbs of Paris are where a lot of the unrest has been coming in the past couple of years. Where there are racial issues, where there's a lot of unemployment among people from the Arab countries. And so, boy, that looks, that's a really nice recipe. I'm already sick to my stomach, Art, but I thought I'd throw one more in. I was reading an article that was tracing what they felt was a spike in venereal diseases that you know, young people with beautiful bodies, you know, high on adrenaline because they're on this amazing trip, and they're competing, and maybe they're winning, or maybe they're not. But whatever it is, they come together, they congregate. And obviously there's going to be nice moments. And also it spreads into the lucky population around there. And that's just one of the things nobody ever talks about.

ART

One tiny bit of good news there is, I do know they’re supplying, huge numbers of condoms, in many, in all the facilities where people stay. the athletes. What they're doing for the tourists, that I don’t know. The athletes are certainly being encouraged to have safe sex. And I don't mean to imply that to being encouraged to have sex, but these condoms are around. And yes, you know, we've got small outbreaks of mpox, which has been sort of gurgling around in the background, and that's transmitted, usually sexually, and then there's our old friend syphilis, chlamydia, herpes. So, you're right, those are public health challenges that need to be managed. And I wish we would talk about them! It would be nice also if they would say to athletes coming, get your HPV vaccine, that cancer vaccine that prevents transmission of cervical cancer and so on. Again, our shyness or our unwillingness to believe that gorgeous 19-year-olds are not going to meet anybody and do anything, is probably a price to pay for that.

DON

Two things: number one, people in this country don't believe in vaccines, so... The second thing is, that, actually, when we talk about all this Olympic venue, just stuff that's going on, somebody could make a good deal of money by having Olympic-branded condoms that they pass out to everybody. That's a good cash cow for somebody.

ART

I mean, it may take capitalism to drive public health. OK, all right.

JOHN

You know, I'm glad that you talked about the HPV because there are a lot of women under 20 who are among this population, and they, especially, would benefit from being vaccinated in the first place, And they're, as you know better than I do, Art, the pushback against even having this vaccine in existence, you know, has been very hard to handle.

ART

Just to switch focus here for a second, if you watch commercials, the vaccine is primarily being promoted on American television by Merck. And the initial round of advertisement said, basically said, your daughter, you know, needs to be protected because of sexually transmitted cancers that are communicated by a virus. And as young as, I'll make up an age, 12, you want to make sure they get vaccinated before they start engaging in any sexual activity. So there's a lot of pushback, many parents said, “My daughter’s not going to engage in sexual activity until she's 48, so it doesn't really matter!”

DON

Yeah, it's very realistic.

ART

Without any reference to male sex, because the HPV vaccine helps prevent anal cancers and oral cancers, so they didn’t get into that. Now they're advertising it without mentioning sex. It's very funny to watch - “this disease, it might impact your daughter, you don't want her to get cancer, how that happens is unknown to apparently Merck or anybody else, get the vaccine.” So, we are so prudish, and also perhaps delusional about sexual behavior, that we can't even talk about it here.

JOHN

I was recently in Italy, where it was on the sides of buses. And the sexual connection was sort of, an “of course” kind of thing. But it was also being stressed that young girls at the very beginning of pubescence, should, it's just a convenient time to have it done, have it done when she goes for a regular checkup, and then you're done. You don't have to think about this.

ART

The vaccine prevents the virus from getting into your cells. It's a block. If you get it after the virus has infected you, it's too late. So, they want to get ahead of sexual activity, because that's the primary mode of transmission of this papilloma virus, and so then you have to discuss, what's the age at which sexual activity begins, so that I have to get ahead of it and that's where, at least in America, we lose our minds.

DON

And I seem to recall a series of ads that ran recently - I think Merck has replaced them with another series - but they were going for guilt.  It was kids in their 20s looking at the camera and saying, “Hey, Mom and Dad, you knew about this when I was 12 and you didn't give it to me. And now I'm in trouble.”  So, I wonder if that worked at all.

ART

I don't know. I apparently not, the uptake in the US of the HPV vaccine is not very good, it might hover around 20%. But in Australia, where they mounted a huge campaign and really pushed it, made it free, they have almost eliminated cervical cancer, with rates of vaccination above 90%, anyway, I don't know exactly what it is, but it's literally wiped it out. And for listeners who aren’t sure what we're talking about here, the way you managed this before the vaccine, was you got Pap smears, women know what they are, and you look for cancer cells. And if you saw, you probably had to go in and surgically remove part of your reproductive system, or all of your reproductive system. So, you know the vaccine is quite an improvement over Pap smears and surgeries.

JOHN

We'll return to our podcast in just a moment, but first, here's a soothing musical interlude.

DON

Art Kaplan is the Doctors William F. and Virginia Connolly Mitty professor, and founding head of, the Division of Medical Ethics at the NYU Grossman School of Medicine in New York City. Before that, Art was the Caplan Professor of Bioethics at the University of Pennsylvania Perelman School of Medicine in Philadelphia. There, he created the Center for Bioethics and the Department of Medical Ethics.

JOHN

Art is the author of 35 books and 800 papers in peer reviewed journals. His books include: Vaccination Ethics And Policy, The Ethics Of Sport, Replacement Parts: The Ethics Of Procuring And Replacing Organs In Humans, and The Case Of Terri Schiavo, Ethics At The End Of Life.

DON

To learn more, see Art’s page on the NYU Medical Faculty website at Arthur L. Caplan (nyu.edu)

And now back to the musical inner tube already in progress.

DON

Again, shifting focus as you said earlier, Art - before we came on and started recording this, we were talking about Art’s pending retirement, congratulations. But he will still be a professor emeritus. So, of course, he'll still be around and functioning. But we were talking about the problems that people have generally, in setting up retirement, and it is a terrible situation for most Americans. Most Americans are not in any way, shape or form ready to retire unless they have a pension that was set up in the 1950s, which took care of people, and fewer and fewer if not no Americans have that left. So, the ethics of retiring poor seem to be pretty nasty.

ART

Many, many Americans are facing exactly that. A pension plan that doesn't come with the kind of job they have. They have a part time job. They work 3 low wage jobs. Nobody's giving them a 401K or some kind of pension option. But I'm going to say this: first, I'm a sort of left-leaning centrist. I don't hear my side of the political spectrum discussing what to do about the burden on Medicare and Social Security enough.  I hear the right-leaning people discuss it frequently, and their solution is, get rid of it. Well, that's horrible. Minimal support from Social Security is what's keeping a good number of Americans at least eating. So, you can't just get rid of it.

JOHN

That's the reason it was instituted in the first place, was to sort of head off penury among the elderly, which is a terrible problem.

ART

And then, you know, we've got to create Medicare, we've got to get some kind of coverage, access to healthcare for our elderly. They have earned it, they merit it. OK, great. When the speaker of the House says, “These programs are insolvent,” I think that's rhetoric that really scares people, and that's what drives some of the idea in this Project 2025. You just shut down all these things or privatize them, anyway.

JOHN

Yeah, that always works, that always works.

ART

Yeah. Well, if I'm working at McDonald's, and as a doorman at night, I'm not sure what my savings are going to look like to build my retirement, but OK. But I'm going to say here's some ideas for more lefty-leaning, liberal types, four things to think about. One: The age for eligibility for Social Security was set back in the 1930s or something like that. Most people do not live more than a few years past 65. I'm retiring now. I'm 74. A lot of people, from guys who keep track of this, are living longer, And, you know, if you cut smoking and people do some basic lifestyle things, the average age expectancy I think is now for a male 77. A woman might be up to 79. Well, actuarially, we're not where we were when they set the eligibility rate. So maybe we have to boost it by a year, and so you don't get it until you're 63 or 66. A lot of people don’t want to hear that, but that easily would make everything solid, easily. We just shift that to be in line with where we are. By the way we talked earlier about France, and Macron proposed to do this. Riots broke out. People went crazy. You may remember that was his attempt to reform their pension system. So, I'm not saying everybody's going to stand up and salute, but we could at least debate it, rather than just scaring people into thinking you have to eliminate the whole thing in order to get rid of these debts. Second bright idea:  Medicare, we still are paying the highest prices in the world for drugs. Nobody can have a program that's affordable if you don't drive down prices. Think about our injectables for weight loss, $1000 a month, plus a couple of doctor's visits. Let's say conservatively $15,000 a year to be on weight control drugs, which I'm not opposed to. But at least for life. So, let's say you're going to be on these things. 20-30-40 years. If a third of the people in the U.S. who have weight issues or diabetes go on these things, we're going to be spending about one-point-two trillion. Nobody can afford that program. But here's a little secret. You know what they pay in Germany for the same drugs, not $1000 a month, $100 a month. Why is that? Because they have programs to negotiate prices with the drug manufacturers. If the Republicans and those on the right who want to get solvency, negotiate down the prices. If you're going to pay through the nose more than any other country, no wonder we go broke in Medicare. So that's point two.  Point three about these retirement matters: we're still subsidizing the rich. I mean, you know, for all I know, Bill Gates pulls down a $5000 check every month that I doubt he needs. I know people put the money in and they expect to get it back. It's not that they didn't pay for it and they say, well, I earned it, but look. You can have your money back. Just give it back and then say we're not going to subsidize you for the next 20-30 years of your life. Again, people living longer. Because you don't need it! Means test the stupid thing and come up with a system so that we don't have a bunch of wealthy people and upper-class people, and I'm going to include myself in that. I get Social Security right now and I could live without it. I could. And I'd be happy to take back any money they say I put into it. Fine. That would be, you know, a great bonus upon retirement. So, in any event, you've got to pay attention. And the last right idea, really, for handling all of this is long term care. A lot of the costs of nursing homes, home care and so on, nobody insures that, the industry is a for profit rip-off, there's private equity all over the place, driving up ridiculous charges. We should only have not-for-profit, healthcare, period, end of story. To have profit health care in the U.S. is, I believe, an ethical disaster, especially when you attract investors who just say, well, I'm going to gouge as much as I can out of this nursing home or this regional hospital, this rural hospital, and then I'm going to run away, take my profits! You know, I don’t know how many listeners know this, but some of these private investors show up and buy a nursing home or hospital and they know it's going to close. And they're hoping it's distressed ‘cause they get a big tax break. So that's another one.  There are things we could do, should do. I believe, to get this system solvent, but it's not closing it or privatizing it.

DON

Yeah, my wife worked for the government of Pennsylvania, advising elderly care for Pennsylvanians, and it it's true in this state, and I'm sure it's true in other states, too, that when you go into a nursing home, first they'll take all of your assets, including your house and your car and any savings that you have. And then there's a law that says when those are depleted, you can go to relatives and start sapping their assets in order to pay for it, and it's the law, there's nothing you can do about it. So, if I put my mother in a nursing home, and her meager assets are depleted, then they come looking for me, and they can tap into my savings. They can put a lien on my house. That sort of thing. So, it's a huge problem and it doesn't get any better.

ART

Let me just jump in to say remember, I was complaining about prices. You might put your mother in a nursing home, but you might hire a home attendant or an attendant and put your mother in the Ritz Carlton and save some money.

DON

That's true. That's true. That's definitely true.

ART

How good are the conditions in nursing homes? Well, I'll say two things about that. One, during COVID, the biggest number of deaths: in nursing homes. And you know, we can do a poll for the listeners. If you would get the option of staying five years in a federal prison facility, not a Super Max, but just a regular minimum-security prison, or a nursing home. Which would you pick?

DON

I think we know.

JOHN

I think I’d go out and kill somebody, you know, and plead guilty! I’d kill Don and plead guilty!

DON

But he's been wanting to do that for years, anyway, so it’s just wish fulfillment.

ART

Oh, he sends me notes periodically!  The VA is part of the healthcare for a lot of Americans. Many, many Americans. I don't know that people realize how big it is. It's the biggest socialized health system – socialized! - in the world!  Pays, you know, standard fees for what it does. It negotiates prices - by the way, they get cheaper drugs. But it's also clear that the VA is too big. Its resources are not distributed properly as to where the veterans are. It's got a World War Two map from where veterans came from, but it needs to downsize. I mean, even in the all the Northeast, there a lot of little hospitals, upstate New York, places like that, which, the only reason they're there is that the congressman is screaming that if you close them you’re going to take away my jobs. But it's not like the demand is there, it's just, they’re our last employer. OK, well, I get that. But that's a pretty expensive way to keep people employed is having them run a hospital where there aren’t enough people in it and, you know, keeping all the equipment maintained and all that sort of stuff. So, some downsizing and readjustment of the VA would save money too.

JOHN

Couldn’t you convert some of those hospitals into specialty research hospitals, or, the one hospital in the area that does certain kinds of cancer treatment?

ART

Or trauma, or PTSD.

JOHN

Or an or an imaging center. I mean, there's ways to rethink a hospital. It doesn't have to die.

ART

Some of it more long-term care. Which we were talking about, you know. Nice to have an acute hospital, but if what the vets need is long-term care, then you sort of shift over to that. By the way, in Don's world, in Pennsylvania, there are a lot of state nursing homes and state programs that are run for vets too, and they haven't been looked at for cost containment in a long time either. So, there's both a federal VA and then there are many state, like Pennsylvania, New York, Arizona type programs where the state runs veterans’ facilities. But let's take a look and see what we got there. Maybe we can move our people from private places into the VA places if they’ve got more capacity. Uh. I don't know. Out there I don’t know what I'm talking about exactly, but I'd like to look at.

DON

Discussions that need to be had. And one last thing I'll throw into this, and that is we were talking about healthcare in general for people. There are a lot of people now that are on a gig economy, where they're working Ubers or stuff where they're not covered by any kind of health insurance, and that is gaining more and more in the population. So, an idea again, and I know this, you know, the minute you broach the idea, you get “socialism!” thrown back into your face, but the idea of healthcare that is not tied to your employment, but rather is tied to the fact that you're a living, breathing human being, is probably a better idea. A better and better idea.

ART

Everybody ought to have to buy minimal insurance. It's not socialist because you can use the insurance in a private sector system if we want to keep that, we don't have to have the British or Canadian thing. You could have what we have, but everybody out of their income should have to buy a minimal health plan. The idea that some of us don't get it because it's not through our employer is a historical weirdism of America. Why should your boss give you health insurance, or negotiate it for you, or have anything to do with it?  I work for Tyson chicken, and they're going to decide my health insurance, what is that? Why are they better than me to do that anyway? So, I like it as a system that Germany has. Everybody has to buy minimal insurance, and every insurer has to sell a minimal plan. May not get a face transplant, may not, you know, wind up getting breast enhancement. But OK, you’re getting the minimum.

DON

I would think that the businesses would be 100% behind this, because nothing that drains the front office more than trying to figure out these health plans, and these retirement plans too. Again, these retirement plans might...

ART

Why are they devoting, you know, why is Ford Motor Company running a health insurance division?

JOHN

Right, right, right. Interesting.

DON

Thanks again for being with us today, tackling the Olympics and retirement, and if only everybody would listen to us, it'll be solved in in 10 minutes.

ART

We’ll see you at the Olympics in four years in Athens.

Speaker 1

Yeah! There you go! Thanks again, Art. And we'll certainly talk to you a number of times before your retirement becomes official.

ART

Very good. Thanks for having me.