Transcript

Tom Frieden | Public Health is like the Mythical Cassandra

From The BMJ · Episode page · Watch on YouTube

· 16 min · 2,522 words · 21 timestamped sections

This is the full, timestamped transcript of "Tom Frieden | Public Health is like the Mythical Cassandra", an episode of The BMJ published December 10, 2025 (16 min, about 2,522 words). It mentions 7 people, works and ideas, including Dr. Tom Frieden, The Formula for Better Health: How to Save Millions of Lives, Including Your Own, Resolve to Save Lives, US Centers for Disease Control and Prevention, John Grant.

What this episode is about

In "Public Health is like the Mythical Cassandra," Dr. Tom Frieden discusses the disparity between known preventive measures for illness and the inadequate actions taken to implement them, likening the field of public health to the cursed priestess Cassandra, whose warnings go unheeded. He emphasizes the importance of a new approach to public health, focusing on six key strategies that can significantly enhance longevity and health outcomes, and advocates for a more proactive engagement with the challenges posed by modern communication, particularly social media.

Key takeaways

  • Cassandra saw the future; public health just needs to convince the skeptics of today’s preventable crises.
  • Measuring under-70 mortality as system failures could revolutionize our approach to public health.
  • Invisibility of public health issues compounds the prevention paradox: benefits often go unnoticed while industries resist change.
  • To save lives, focus on concrete metrics: preventable deaths, smoking rates, and hypertension control—it's a data-driven prescription for health.
  • Despite knowing how to prevent illness, we often let profits and complacency eclipse public health’s undeniable truths.

Who speaks in this episode?

What is discussed, and when

  1. – 3:00: Dr. Tom Frieden, The Formula for Better Health: How to Save Millions of Lives, Including Your Own, Resolve to Save Lives, US Centers for Disease Control and Prevention
  2. – 6:00: Jeffrey Rose, Sir Richard Doll
  3. – 9:00: Resolve to Save Lives
  4. – 12:00: Resolve to Save Lives, US Centers for Disease Control and Prevention

Notable quotes from "Tom Frieden | Public Health is like the Mythical Cassandra"

  • Bringing a knife to a gunfight when it comes to the social media world, and we need to up our game. I feel that this book is necessary because there is this enormous gap…
    about The Formula for Better Health: How to Save Millions of Lives, Including Your Own · at
  • I'm also president and CEO of Resolve to Save Lives. I'm also former director of the US Centers for Disease Control and Prevention and New York City Health Commissioner. You argue in your book that we already know how to prevent most.
    about Dr. Tom Frieden · at
  • Was first discovered in London in 1662 by John Grant. Now many people know that this is you know a classic text. I went back and read it for the first time for the research for…
    about John Grant · at
  • What it means is that the people who will benefit may not recognize that they're benefiting, but the people who have to pay the price, whether it's the tobacco industry or junk food industry.
    about Jeffrey Rose · at
  • Evidence-based. we have seen quite a few political appointees take over the CDC. We've seen more than a quarter of the leaders and the staff of the organization either fired or…
    about US Centers for Disease Control and Prevention · at
  • Really lose the ability to track everything from influenza to toxins around the world. One of the things that my organization, Resolve to Save Lives, has advanced is a 717…
    about Resolve to Save Lives · at

Who and what is mentioned in this episode?

People

  • Dr. Tom Frieden — Person · Main guest · 3 mentions · first at
    Interview subject presenting his prevention-focused framework ('see, believe, create') and arguing that most premature deaths are preventable with existing tools.
  • John Grant — Person · Referenced historical figure (early epidemiology) · 1 mention · first at
    Cited as an early pioneer of population health measurement—used to support Frieden’s theme that public health’s 'superpower' is making invisible risks visible through data.
  • Jeffrey Rose — Person · Referenced expert (population prevention theory) · 1 mention · first at
    Credited with the 'prevention paradox,' used to explain political/economic resistance to prevention: benefits are diffuse while costs to affected industries are concentrated.
  • Sir Richard Doll — Person · Referenced expert (epidemiology/public health) · 1 mention · first at
    Invoked to reinforce the episode’s normative benchmark: deaths under age 70 are often preventable and should be treated as system failures rather than inevitabilities.
    Indicator of how healthy a community is, the proportion of people who survive to age 70. And he said if any community has a higher proportion than we, they're healthier than we…

Books & papers

Companies & orgs

Full transcript with timestamps

For all too long, we as individuals and public health as a field have been like Cassandra the priestess from Greek mythology. She could see the future, but she was cursed. Nobody believed her warnings. Um, I think we're sometimes bringing a a knife to a gunfight when it comes to the social media world, and we need to up our game. I feel that this book is necessary because there is this enormous gap between the illness, disability, injury and death that we can prevent with our current tools and what we actually do.

What do we know for sure will help you live a longer and healthier life? And how much will each of those things help you? And I come down to six things that really make a lot more difference than everything else for healthy longevity. I'm Dr. Tom Frerieden. I'm author of The Formula for Better Health: How to Save Millions of Lives, Including Your Own. I'm also president and CEO of Resolve to Save Lives. I'm also former director of the US Centers for Disease Control and Prevention and New York City Health Commissioner. You argue in your book that we already know how to prevent most premature deaths, but we routinely fail to act. What in your view is genuinely new in this book um compared with earlier calls for prevention and why did you feel the need to write this book now rather than five or 10 years ago?

I feel that this book is necessary because there is this enormous gap between the illness, disability, injury and death that we can prevent with our current tools and what we actually do. And what I hope the book provides is a new approach, a new way of thinking and working about this. It's a proven approach and it starts with seeing the invisible. Seeing the invisible is the superpower of public health. And you know monkey really interestingly this was first discovered in London in 1662 by John Grant. Now many people know that this is you know a classic text. I went back and read it for the first time for the research for this book and it's really quite fascinating. This is the first ever analysis of rates and proportions and trends. The first real epidemiology. It's the birth of epidemiology and it's quite brilliant.

He for the first time analyzed things like maternal mortality rate, infant mortality rate. He showed emerging infectious diseases. He discussed the impact of different types of diseases on the economy. And he suggested a summary indicator of how healthy a community is, the proportion of people who survive to age 70. And he said if any community has a higher proportion than we, they're healthier than we are. It's a great thing. And if you go back to Sir Richard Dole, he talked about death over 70 is inevitable, but deaths under 70 are not.

And that core focus, see the invisible, see the microbes, the toxins, the trends that are harming people and also see the technically rigorous process to confronting those threats. That's the first part of the formula. And that requires everyone. It requires public health. It requires doctors and the medical profession. It requires academic universities to see the path to progress, but also to see why we don't act. This is another really important aspect of seeing the invisible because for all too long we as individuals and public health as a field have been like Cassandra, the priestess from Greek mythology. She could see the future, but she was cursed. Nobody believed her warnings. So the tragedies that she foresaw came to pass. And again in the research for this book, I looked into why does the Cassandra curse exist? And I go through six different drivers of the curse in the book. But one of them

is particularly important and it comes from another British thinker uh Jeffrey Rose, brilliant and profound thinker who coined the term the prevention paradox. What it means is that the people who will benefit may not recognize that they're benefiting, but the people who have to pay the price, whether it's the tobacco industry or junk food industry or the coal industry, they are quite concentrated on stopping the actions that will promote the public good.

I want to follow up about the well on two points really, but I want to follow up first about the uh the seeing point. I mean a big part of the seeing is what do we measure whether it's you know air pollution or ultrarocessed foods or or or whatever. Um you were running a if you were running a typical health system serving you know a few million people um what are the three things the first three things that you would you would measure properly um and what are the things that we currently measure a lot of that you think we pay a bit too much attention to. So I would measure if I were just given three things I would look at mortality uh the deaths and causes and preventability of deaths and I would consider every under 70 death as a failure of the system. Uh now some of them are truly um not preventable with current means pancreatic cancer and things like that but many of them are quite preventable

and I would use each of those preventable events to try to improve the system. Second I would measure um the smoking rate because smoking remains the leading preventable cause of death. And third, I would measure much better than we do now the hypertension control rate because high blood pressure is the leading uh underlying cause of death and systems do really poorly at attacking it. And this is one thing that my organization resolve to save lives works on with more than 40 countries. If I had a fourth, I would measure primary health care. What is the access to, acceptability of, and impact of primary health care? And you could do that partly by looking at hypertension control. I mean, the last one is definitely music to our to our readers ears for sure. There's a lot of talk about primary health care every week in the BMJ. Um, in terms of I mean, you mentioned you you mentioned uh smoking

rates for example. I mean one thing that strikes me about metrics like that is that do you think it's the case that we have we're already measuring a lot of data quite diligently but are we not really doing enough with the data that we have here or are people kind of ignoring it willfully out of that or because of political kind of influences what are your thoughts on that

so this gets to the second aspect of the formula the formula again is see believe create believe means first believing that what may seem inevitable is not to shatter that illusion of inevitability. And you do that in at least three ways. The first is by documenting and reminding people of past progress. Now, often in public health, we're really reluctant to do to do that because we feel like, oh, if we say there's been progress, people will think we've done enough. Uh I think the opposite. I think that past progress should give us the confidence that we should be able to do more. But there's another thing that's really important in strengthening belief in the possibility of progress and that's optimism. Optimism is a force multiplier. Optimism is enormously important because without optimism it's very hard for people to marshall the efforts because all health progress does require some degree of struggle and if

you don't believe you have a good chance of succeeding uh you're not likely to uh undertake the effort needed to succeed

and I mean that that takes us to to today of course you've written recently that the US is dismantling its own health infrastructure and retreating from global health uh leadership. From your vantage point, how has the current administration's approach to certainly your former organization, the CDC and HHS as a whole, with its budget cuts and restructuring and layoffs and withdrawal from the WHO? In fact, um how is it changing the the United States's capacity to detect and respond to outbreaks?

Well, what we're seeing is unprecedented. Uh there has never been a CDC director fired by the Secretary of Health and Human Services. And this is someone who was hired by that same individual less than a month earlier. And that firing was reportedly because of her refusal to rubber stamp recommendations on vaccines that are not evidence-based. Uh we have seen quite a few political appointees take over the CDC. We've seen more than a quarter of the leaders and the staff of the organization either fired or forced to resign. Um we've seen half of the CDC programs or centers uh essentially stopped or disbanded. This is really really damaging and dangerous. Uh we've also seen the US uh abruptly stop a lot of global health programs uh ranging from the closure of USID to the pull out of the from the World Health Organization. And that effort included for example half of the World Health Organization's immunization staff who

were secunded from the CDC having to leave from one day to the next. some of the um approaches, some of the measures uh have an important kernel of truth that countries should be in control of their own health, that countries need to take over the systems, that some of the systems were built in ways that were not likely to be able to be sustained effectively. But making these changes very rapidly um without planning without a clear way forward uh is resulting in a lot of disruption to life-saving systems. I mean there was there's been a lot of talk about the in the media recently about um whether the US is able to get as much surveillance data for monitoring uh outbreaks that that could affect it whether it's EMPOX or COVID or or or anything like that. I mean, do you see do you see anything on the domestic front that is resulting from this kind of the clashing in I'm going to say international ties because of course

it's not just on the health care space, it's tariffs and everything else of course as well. Do is there anything that worries you from what you see?

Well, first off the World Health Organization which like any organization isn't perfect, the World Health Organization is essential for tracking of health threats. So, by all means, let's figure out how to make it better, quicker, more effective, uh, more focused. But without that partnership with the World Health Organization, we really lose the ability to track everything from influenza to toxins around the world. One of the things that my organization, Resolve to Save Lives, has advanced is a 717 target. That every health threat should be found within 7 days, reported to public health within one day, and all essential control measures in place within 7 days. That approach has been adopted by the World Health Organization, by the global fund, by the pandemic fund, by the World Bank, and most importantly by 50 or more countries around the world that are using it to find threats faster and stop

them sooner. And that kind of approach is part of the create part of see, believe, create. Because to create a healthier future, we need to be able to have clear outcomes that we use. And the importance of that metric is not as a way of saying, "Oh, you failed," but of using every outbreak as a a learning experience so that we do better next time around.

Uh, one one thing that strikes me in in what you just said is that trust is a major part of this. And that was something else that I wanted to ask you about, too, because it's it's obviously a big part of getting the the public to to trust us. It's obviously a big part of of keeping clinicians on board in terms of what the wider framework of the public health system and the health system as a whole is doing. Um how how do we build or rebuild public trust at a time when there is a lot of there is a lot of clashes between public policy, between politicians, between experts, between agencies even. Well, first off, I do think that doctors, especially, but not only primary care doctors, can play a really important role in rebuilding trust in interpreting for patients what the data actually shows and what it means for them in their life. Uh, trust isn't going to be built quickly.

Communication is going to be enormously important and delivering on things that matter to people is going to be really important. So I I don't think there's a quick and easy answer to that. The misinformation and disinformation ecosystem moves very quickly. It's driven by economic interests that are important to reveal and counteract. Um, I think we're sometimes bringing a a knife to a gunfight when it comes to the social media world and we need to up our game uh in providing factbased non-conlict of interest information. One of the things that I outline in the book is that we need to be clearer on our level of certainty with uh the scientific findings and on how important they are. So I outline for personal health and wellness, what do we know for sure will help you live a longer and healthier life and how much will each of those things help you? And I come down to six things that really make a lot

more difference than everything else for healthy longevity. Blood pressure ideally to less than 120 over 80. Lipids ideally with an LDL and an APO less than 70. Third is physical activity. Physical activity actually is better for you than any single pill and it doesn't have to cost anything. So that's the third. Fourth and underemphasized is enough sleep. Fifth is um avoiding toxins. uh making sure that we reduce smoking and alcohol and addressing PM2.5 and potentially the newer toxins uh endocrine disruptors, nano particles, uh things that disrupt our microbiome. And finally, and perhaps most controversially, healthy nutrition. So, when you cut through all of the the fog and the grifting and the misinformation and the sloppy thinking, they're really just a few things that make a a big difference. There's a longer list of things that can prevent dementia and disability that are really important and

I review all of those in the book as well. I tried to bring epidemiologic reasoning and data into the personal health and wellness space to cut through the the misinformation and the sloppy thinking that's out there.

Questions about this episode

Who speaks in "Tom Frieden | Public Health is like the Mythical Cassandra"?

Dr. Tom Frieden (Host).

What is "Tom Frieden | Public Health is like the Mythical Cassandra" about?

In "Public Health is like the Mythical Cassandra," Dr. Tom Frieden discusses the disparity between known preventive measures for illness and the inadequate actions taken to implement them, likening the field of public health to the cursed priestess Cassandra, whose warnings go unheeded. He emphasizes the importance of a new approach to public health, focusing on six key strategies that can…

What is mentioned in this The BMJ episode?

7 people, works and ideas are mentioned, including Dr. Tom Frieden, The Formula for Better Health: How to Save Millions of Lives, Including Your Own, Resolve to Save Lives, US Centers for Disease Control and Prevention, John Grant, Jeffrey Rose. Each one on this page links to its own page with every episode that mentions it.

How long is "Tom Frieden | Public Health is like the Mythical Cassandra"?

The episode runs 16 min; the transcript is about 2,522 words in 21 timestamped sections.

More from The BMJ

About this transcript: the episode's spoken words as captioned on YouTube, split into timestamped sections. Reclip.Me locates every person, work and idea in the text, keeps the time it is first named, and quotes the words around it verbatim. Last updated January 24, 2026.