Northwest now is supported in part by viewers like you.

Thank you.

Vaccinations, fluoridated water, food safety and public health transformed the world from a dirty, disease ridden wasteland where people died young to a relatively healthy and prosperous city on a hill.

Want to go back in time?

Try traveling to exotic or even some not so exotic locations.

But beware, illness may be lurking, keeping the germs and the worms away is the topic of a travel podcast produced by two University of Washington doctors you're going to want to hear.

We're talking about the Germ and Worm podcast next on northwest.

Now.

You.

Today we live in a clean and healthy world, never even imagined by the 12,000 generations before us, who suffered and died at the hands of a gallery of horrors we don't even think about today.

But we might soon be thinking about them again as a wave of anti-science, anti civilization.

Nihilism brings back diseases and maladies we thought were long gone.

Want a taste of our brave new tomorrow?

Travel to the Third World and catch an exotic bug.

Of course, most people don't want to catch an exotic bug, and that's where doctors Paul Pottinger and Chris Sanford step in with their Germ and Worm podcast.

Hey, everybody, this is Jer.

I'm worm.

Welcome to episode 27 of the German Worm Travel Health podcast.

It's a big planet.

See you in good health.

I'm doctor Paul Pottinger.

You can also call me germ.

I'm a professor of infectious diseases at the University of Washington in Seattle.

I'm Doctor Chris Sanford, also known as worm.

Associate professor in the Department of Family Medicine and Global Health, also at the University of Washington.

As always today, worm, we have so many great questions to answer from listeners coming to us from across the country and around the world.

Questions like why is Cryptosporidium getting hot again?

What health tips can we share for a trip to Vietnam?

Raw milk and bird flu?

Is this a real problem?

And cuddling koalas.

Great photos, but is it a great idea?

These know you, Chris, you've been a guest here on northwest now before, especially during the pandemic.

We were talking about the progression of the disease and whatnot.

Give us a refresher on how you came up and what your background is.

You bet.

I'm a family practice doc, and I've been at the University of Washington since 2000, and I have a bit of a rare subspecialty, which is travel medicine.

So I see travelers before they go abroad.

I see them when they come back if they get sick.

This gave me an idea for a podcast.

There's a lot of misinformation out there, which we'll get to in a minute.

But in a nutshell, family medicine doc U-dub, give me a little bit of your background.

Paul.

Talk to me about how you came up in the medical field and, and and how you connect to this idea for the podcast.

Yeah.

Thanks.

I'm Paul Pottinger.

I'm a doctor of infectious diseases.

Professor at University of Washington in Seattle.

That's where my clinical practice is.

And, you know, I specialize in the prevention, diagnosis and treatment of infections.

That's diseases that come to us through microorganisms.

That includes things people pick up bugs when they travel.

So travel medicine is part of my practice.

And I've been friends with Chris for many years.

Since we have a lot of shared interests and shared efforts.

We started thinking about this a while ago.

How can we get high quality information out to people in a way that's easy to digest, that makes sense, and that anybody could listen to it in half an hour, come away with something that is fun to hear.

And also, we think high quality and reliable information.

That's the real tension, isn't there, to try to make something entertaining and good.

Hey, let's give it an interesting name German Worm.

And now I regret putting germ close to me.

But but at any rate, you know, getting that balance right between, you know, research based, taking us all to class and putting us asleep, but also providing quality information.

Chris, how do you how do you get that?

Right?

Good question.

Paul and I suffered through many, many years of primarily boring medical education, but it's not mandatory that this information be boring.

You know, Paul and I, luckily we have a similar sense of humor, and we thought, wouldn't it be wonderful if we made this entertaining, if we made some jokes, if we got silly along the way?

A big part of the motivation is there is so much misinformation out there on the internet, on social media, which actually ultimately can be harmful to people.

But if we're dry and boring, no one's going to listen to us.

So we think there's no harm in being a little silly along the way.

I think it'll make us a little more accessible.

Yeah, and I think it's such a great concept, to try to deliver, you know, evidence based, high quality information.

We were talking before we even started taping about what people call Research Now, which is sitting on Twitter with your phone.

There are people if you ask them, they'll tell you they've done their research.

Paul, how do it?

How do we how do you tactfully explain to people that the quality of information they're getting that way isn't sufficient to manage their health care?

I mean, it may be sufficient, but usually not typically, but typically, I think you just approach it with a state of humility.

As a medical doctor, there's a lot that I'm still learning, actually.

That's why medicine is the best profession, because we learn every day.

You have to be humble about that.

But we should also own the fact that we have trained for many, many years to get to the level where we feel comfortable interpreting the data and being the guide for that person.

That's why I would say I'm your doctor.

I'm your guide.

If you've done research, that's great.

That tells me that that person is interested in staying healthy and they want high quality information.

Thank you for coming to me.

Let me give you my interpretation.

Yeah.

The information based on my training and based on my clinical work, taking care of many, many people in similar situations.

And I would I would posit to that you don't necessarily have to be a trained clinician in any particular field.

It helps.

It gives you background, it gives you context, it gives you knowledge.

But you also know who the credible sources are.

And and one of my problems with sitting on the toilet doing your research on online is there's been this great flattening between, you know, the NIH or Johns Hopkins.

And Bob, who has some ideas about what's going on with vaccines, makes me crazy.

Chris, do you are you able to get into that with people at all on the podcast and say, hey, there is a there's a right way and a wrong way, not just to know, but also to find out very much.

So one publication that I really like and to some extent we imitate is Consumer Reports.

And I try to be sort of say, these are the good sites, these are the bad sites.

This is reliable like the CDC.

We love the CDC.

And I don't mention the bad ones by name, but I kind of give hints as to how you might find them.

But we definitely try to empower people because there's so much in travel medicine, there's no way we can give all the information ourselves.

So we have to tell people to be better researchers themselves.

Yeah.

And I think empowerment.

I think that's a great idea and a great word, that that goes along part and parcel with this idea that you have talk a little bit about where do you record, how do you run it?

How do you figure out what the questions are?

What are some of the words German worm originate from?

Is it a basement somewhere in Seattle?

A little German worm world headquarters is literally a Christmas basement.

And, I should send you some pictures.

Maybe we shouldn't.

It's it's a little bit threadbare at the moment, but it works.

And it's part of that flattening.

As you mentioned, we don't need to have a lot of infrastructure to make it fun, exciting and high quality information in a way that's fun to digest.

We got into this.

I mean, one of my favorite podcasts actually goes back to NPR, Click and Clack, the The Tappet Brothers.

Car Talk.

And so this was meant to be, in a way, car talk, but for travel medicine, I got it.

Now, we're not as necessarily as funny as the, click and clack, but we try to emulate that idea of having a conversation as old friends.

We can poke fun at each other and ourselves, but always stick to the truth as we understand it, and to understand that people are listening to our podcast.

It's a responsibility.

They want to stay safe and have a great travel experience.

As doctors.

That's what we do in our practice.

Here's a way to amplify that voice and share that information.

Are you guys able to monetize this at all, Chris?

Or is it something that UW is supporting?

Is that it coming out of your pockets?

What's the what's the is there a business model?

Yes.

We pay.

It's out of our pockets and we're losing money.

There you go.

But we're getting more listeners week by week.

And so we hope at some point to monetize it.

But luckily it's a small scale.

The expenses are small.

We do most of the work ourselves, so it's not a lot of money.

We're out.

You asked about where the questions come from listeners okay.

We ask, everyone from friends and relatives to the people on the podcast for questions.

And that's the variety of questions we get is wonderful.

It's one of the real fun things in this, for example.

And I thought we would just get ordinary things like, oh, I'm going here, do I need to take a malaria pill?

And we do get that.

But for example, we got a question recently.

Hey, I was hiking with a buddy in Central America.

He got bit by a venomous snake.

He had a taser with him.

He tased the snake bite because he said it would neutralize the venom.

Is that a good idea?

It's not a good idea.

It's a great idea.

It was a great question.

I question it, I mean, in a word, no.

Never tased yourself for any reason.

But there's an infinite number of things that people do that are both clever and less so that we can address.

So get sort of seeing the variety of what people do abroad and their questions is just fascinating.

If there is a business model, we haven't found it quite yet.

We're doing it because it's fun, you win best friends, and it's a way for us to stay connected to each other.

I would say you and 999 out of every other thousand broadcasters, are podcasters the same thing?

You know, they called it the travel bug for a reason.

And international travel and international sickness, if you will, has always been a problem.

And we're going to get to a point where we're going to contrast what's been happening traditionally in the world, what's traditionally happened in America, and how we there may be some flattening happening there, too, in the not too distant future, but start with the international peace.

Why has why has international health always been a challenge?

You, you know, you got to get immunized, you might get sick.

You might get food poisoning.

All.

Why.

So I think all those things can happen.

By the way, no one travels internationally to get sick.

I should hope people want to have a great experience.

They're focusing on the joy and the excitement of the trip.

The health and safety side may be an afterthought.

So one of the challenges we have is folks who just don't reach out to us in time in advance of a complicated trip.

So we're trying to get people in the habit of reaching out for high quality evidence in advance.

So some of it's just logistics and also the fact that the, well, some of the health challenges that they see overseas will be different from what they're accustomed to here in the United.

And that was that was my point is that it's always there's a reason it's different overseas.

There's a reason it's different overseas, by the way.

There's also health challenges domestically.

But yes, when people travel overseas, they may come up against situations that they're not familiar with infections or other health safety challenges that they just don't think about when they're here.

That's our job in travel health.

Any travel health specialist should be able to say, hey, you can do this safely.

Here are the steps to take to have a great experience.

What are the big threats out there, Chris?

I mean, I realize every country and every region has got its own specific things, but if somebody is going to travel internationally, traditionally, what are the things they need to be concerned about?

Super question in that sense, German worm or something of a misnomer, because when people think about health and travel, the first thing to think about are infectious diseases, which are important and vaccines are important.

But actually the biggest threats by far are things like motor vehicle accidents, drowning, homicide, suicide, fall from heights and actually infectious diseases are there on the list.

But if you look at the deaths of Americans who travel way more are killed in motor vehicle accidents and drowning.

So we talk about vaccines and malaria pills, but we also talk about things as mundane as helmets or motorcyclists and seatbelts and personal floatation devices.

Yeah, that's one of the reasons I've always been afraid of going to Britain and trying to rent a car, because I'm afraid I would just, if I have it, be in a 70 mile an hour head on collision.

Well, you and me both around the world, that's a bigger threat than something infectious.

Isn't that something?

Yeah.

Counterintuitive.

Why so many efforts, do you think, over the years, and especially in more recent years, to discredit global health initiatives?

And I know that's a big policy question, but it really seems like if people are talking about global health, they're not connecting the dots between over there and what could happen over here.

And I'm not sure why that is.

What's your take on that?

I'm not sure either.

I think that's our job as a society, a professional society, to explain that we are all connected.

It is one planet.

We're all connected and just 1 or 2 jet rides away from each other.

So the decisions that we make with our own resources, we should be mindful of the fact that if we invest in the health of people who happen to live across a particular arbitrary border, that can have great benefits not only to them but to us as well.

So I think global health is a terrific way to say it.

There's one globe we should all be healthy.

We are not.

And there's huge differences, disparities between the way public health is approached in one area or another.

That's unfortunate.

And that's one of the reasons I'm a big fan, for example, of World Health Organization.

Let's get organized for world health.

It's a terrific thing that we should all be part of and and sponsor and support.

So we're big fans of public health initiatives that can cross time and space, and that includes political boundaries.

The people who are getting sick in one part of the world can easily impact our experience here, and likewise, we can actually make a big difference on their behalf.

Together, we all do better that way.

So we think about the importance of the W.H.O.

and the CDC here and domestically and other organizations like it.

But Chris, as you darn well know, there's a percentage of the population that thinks that they are a conspiracy to take over the world to dominate, democracy.

You name it, you put you can name the conspiracy theory, and the idea can be shoved into those boxes with World Health.

How do you combat that?

And in, in this whole anti-science movement, I see wrapped kind of in with it, it's hard.

One misconception is part of that is most Americans, when they do surveys, think that we spend a tremendous amount of our tax money on foreign aid.

All foreign aid, like people say, oh, we spend 10%, 20%.

We spend less than 1%.

We spend much less than most developed countries.

So information is helpful.

There is the huge anti-vaccine pushback now.

And I think, being frank, I think the truth ultimately wins.

But you need to say what you know.

Yeah.

The easy way or the hard way, right?

Yeah.

The hard way can happen.

What I worry about, of course, with the coming administration, the vaccine rates are going to go down, deadly disease rates are going to go up, and people realize the value of vaccines.

It's a tragedy that that's going to have to happen to make people realize how important vaccines are.

Back to your question.

Say what we know.

Be frank about side effects.

Be frank about what doesn't work.

And I think that kind of in-depth truth ultimately will prevail.

But why exactly there's so many people who don't like being told the benefits of things like vaccines.

I'm not sure I fully understand.

Yeah, I think they've lived in a world where they haven't seen the devastating effects of things.

You name the disease and everything's fine.

Why do we need to do all these things?

They don't understand that they're they are seeing a distorted view of history and of of man's story on this planet.

Yeah.

They should talk with their grandparents more.

I just look at in the peak year of polio in the U.S, 1952, 20,000 kids were paralyzed.

Yeah, yeah, about 15% of them died.

That's a lot of paralyzed kids.

That's terrible.

No parent today has seen an iron lung.

Right?

Right right right right right.

Right.

Now we're down to zero.

In the U.S, people have forgotten about it.

And what we know through hard one experience is that if we give these germs any quarter, give them a chance to rear their ugly heads again.

They always do.

They always, always do.

So our new you gestured at this.

I'm going to bring it up again.

Our new HHS director, at least the one who's been possibly nominated for the job, apparently had a pork tapeworm infection in his brain, so I figured that's both germ and worm.

And that might explain a lot.

Really?

When combined with a case of mercury poisoning that he talks about, too.

So I'm going to ask you point blank, is JFK the right guy for this job?

I mean, in my experience, the job that we're talking about to direct HHS, it should be someone who's qualified, who understands, or is that public health care is about who has some training and compassion for people.

He may have compassion, but in my opinion, no, we're not talking about a candidate who actually has the qualifications to do this job in a way that that it should be done.

I think it can be done in many ways, but there's a certain way that it should be done where we help keep people safe and give them the right information they need.

You talked about not giving germs and worms just to use pump the podcast a little bit any quarter because they can come back.

Chris, what is out there now domestically that doesn't have a long time horizon?

In other words, if we radically changed health protocols, some of these things are five years out, down the road, ten years down the road.

By the time they propagate whatever.

Is there anything that's like right on the doorstep, like, wow, we need to be careful with that one because it could it could jump up quick.

There's a long list.

I'll start it and Paul can finish it.

Measles, diphtheria, pertussis they're all out there.

We're all we're getting a low level of those now.

But the reason we're getting a low level is due to vaccines.

Influenza could take off more.

Even bigger.

Covid could get much bigger.

I mean, the list goes on and on.

And these are the things that we currently know about.

What we've learned is that nature is always changing.

There's always something new that is a potential threat.

We should invest in our public health infrastructure, including centers for Disease Control and local state departments of health, to do the epidemiology, the surveillance and keep us prepared.

Let's be prepared.

I'm not a doomsday prepper.

I'm a public health prepper.

And I think that really means that we need to have a good partnership between local and state and national.

Even international health authorities.

I guess ultimately the question I have is, do we run some risk, potentially, if things are significantly mismanaged, of being one of the third world countries from a health perspective, that you guys go and visit?

Yeah, the germs certainly don't care what our GDP is.

We are always at risk of having novel infections come in.

That could be something new, that could be something ancient that we thought we had in the can and on the shelf.

We have to stay vigilant.

And I think you're right.

If we fail to invest our hard work, our hard won, treasure and and influence.

And that includes knowledge, compassion and a trust in science.

If we don't do those things, we will certainly take a step backwards.

I, I'm speaking on behalf of myself, not the University of Washington, but also as a physician and a human being.

I really care a lot about our patients and the people I interact with.

I want them to be safe, and I think that's the way forward.

Chris.

It's got to be frustrating.

Being a medical doctor, having traveled the world like you have seen, the ravages of some of these thought to be long gone.

Disease is seeing the effects of that on people and thinking that people here might just be bringing that upon themselves for ideological reasons.

Phenomenally frustrating.

I was in Ethiopia recently in Harare, and there's a hospital.

They have a whole room, which is children with tetanus, many of them who go on to die.

And the reason we don't see that here is because we have vaccines and it's tragic there.

It's tragic for the kids and for their parents, and it's so easily preventable by a low cost, safe vaccine.

And the thought that we may increase the risk or polio, as I've just mentioned, how common it was in the 1950s, you know, that could come back.

And the idea that such a proven methodology could be thrown aside for political reasons drives me nuts.

It's tragic.

If the death rate from Covid, it was higher in anti-vaccine states than in pro-vaccine states.

Again, people were dying because of political ideology.

I think that should not happen.

Talk about the politics a little bit.

You know, to me it seems like there's a real political risk that goes along with watching the public health system fail.

I mean, if you're if you're promoting these ideas or promoting people who are promoting these ideas and you're in charge or in power at the time, a lot of kids start dying from, you know, you pick the germ.

That seems like it seems like miscalculating to me politically even.

I mean, I it doesn't make any sense to me whatsoever.

We should all be on the same page that people should be safe, healthy and empowered.

And so if somebody has an idea that they may be able to game the system or come up with a different dark narrative that doesn't fit that, I assure you that will fail.

But the problem is that in that failure, we may lose a lot of innocent, healthy people caught in the crossfire speaking on behalf of myself and not my university.

It's very, very, very, very discouraging and I hope we can do better.

This is a hard question.

If you had the answers to this, you'd be multimillionaires, the CEOs of your own health care companies.

But, you know, recent events have have once again, you know, brought to the fore, the notion that the health care system in America, and particularly in particularly the insurance model, just may be the wrong model.

The only way to make a profit is in insurance companies is to pay fewer claims than you collect in premiums, and maximizing that delta is what America is about, how capitalism works, which is fine in some enterprises.

In public health, maybe not so much so like I said, it's a tough question.

Worm, I'll start with you.

What is the answer, do you think?

Is our model broken?

Can we ever get to a model that does work that is acceptable in a democracy and in a capitalistic society?

I think a good way to go forward is to look at countries that do health care better than us, and one clump of countries that does it very well, or the Nordic countries, they have single payer systems.

They basically have the government run the health care system.

There's flaws with that.

There's drawbacks.

People in England and Canada are not entirely happy, but overall, a long wait list.

Long wait list.

So it's not perfect, but it maybe is less probably is less problematic than what we have now.

I think a single payer system is superior.

It would be.

However, the resistance to that would be phenomenal.

You know, these companies making billions and specialist doctors making a lot more than primary care doctors.

There's political and financial pressure from that end.

So I think will that ever happen in my lifetime?

I have no idea.

I think if it did, it would be an improvement.

I mean, I do think there's something wrong with the model of you're sick, pay me and we'll deal with it.

How about I kept you healthy?

Let's keep this going.

Yeah.

So whether it's the Nordic model.

No, honestly, I don't know.

America, I think is an exceptional country, but I don't know that that means we should be so completely different from most any other country.

Yeah.

The model that we ultimately come to, I hope will be different from others, but it it can't stay this way.

It has to change.

That was my Segway.

Is is it almost just as to some degree, I think vaccine hesitancy will be self-correcting in the future, either the easy way or the hard way, I would say.

Is it would it be fair to posit that the health care situation in America is going to be solved because it's either going to come crashing down, it is a solution and therefore or inevitable?

In other words, I sure hope so.

I mean, that's part of the reason I get up each morning to do this work at the faith that people will ultimately make the right choices if we support them in doing that.

The events that we're seeing nowadays with these very, very huge gaps between the administrative cost, executive pay and what physicians and nurses are making, it's not sustainable.

That will have to change what the ultimate solution looks like.

I'm not sure, but I do think we'll have to do something that's much, much better than what we're doing now.

And people are hungry for that and I support them.

What?

That's one of the good things I do see when I am doomscrolling, as I'm forced to do in my job on social media and things, I don't see anybody holding their physician, their provider out as the bad guy in the thing.

Everybody loves their provider.

I think I think people I, you know, I hope they know that their provider is, is the one guy in the world who cares about their health as much, if not more than they do.

They really do see the system in the in the insurance model and the bureaucracies built on top of that doctor patient relationship is being the problem.

Chris, do you see that as well?

And is that is that accurate?

What what are your thoughts on that?

People in general don't blame us.

But I do see patient frustration going up.

And they do occasionally.

We're the first person who can listen to it and they can take it out on us.

So we are not as disliked as, say, insurance.

You know, health executives, but know in general, people appreciate what we do.

It's a really rewarding line of work.

Last 30s here.

Shameless plug.

If people want to learn more or listen to German Worm, what do they do?

Please, see us wherever you happen to go for your podcast, just look us up.

Germ and worm.

And if you have questions that you want to send to us on the podcast, we would love that.

Just send us an email.

Germ and worm at gmail.com.

Apple podcasts Spotify.

All right germ thank you worm.

Thanks as always.

Thank you Thompson.

Yeah thank you so much.

All best.

I wish a pioneer could come back from the grave.

And describe the spectacle of watching a beloved child die from whooping cough.

The bottom line that opportunity may soon be coming to a society near you.

I realize German worm is supposed to be fun, and it is, but underlying anything on this topic is a very serious global issue that won't be addressed by opinion, beliefs, or politics.

Only progress through science and industry, whether the nuts believe it or not, I hope this program got you thinking and talking.

You can find this program on the web at cbc.ca.

Org.

Stream it through the PBS app or listen on Spotify and Apple Podcasts.

That's going to do it for this edition of northwest.

Now until next time, I'm Tom Larsen.

Thanks for watching.

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