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Professor Kristie Ebi Discusses The Lancet Series, "Heat and Health" (November 23rd)

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The climate crisis threatens human health in innumerable ways including injury from extreme weather events, respiratory illness, zoonoses, water-borne, vector borne, and non-communicable diseases, malnutrition, behavioral health and psychosocial problems and finally heat related illnesses and death. Climate crisis-related health effects are and will be particularly be hard felt by the elderly and children and within minority communities.  For example, The Lancet's most recent “Countdown on Health and Climate Change” report found heat-related deaths in people older than 65 reached a record high of 345,000 in 2019, or 81% higher than the 2000-2005 average. Children under one year of age experienced an estimated 626 million additional person days of heatwave exposure in 2020 comparted to a 1986-2005 baseline average. Despite these numbers, a recent World Health Organization (WHO) report found countries’ Nationally Determined Contributions (NDCs), or pledges by governments to reduce their carbon emissions, found that only 13% of NDCs commit to quantifying the health co-benefits of carbon emission reduction policies. Listeners may recall I interviewed Professor Ebi in November 2018 concerning the UN IPCC's landmark report, "Global Warming at 1.5º C."  At:

During this 3o minute interview Professor Ebi begins by making brief comment on the just concluded COP 26 meeting. Professor Ebi then explains the impetus for the "Heat and Health" series,  explains the physiological responses to heat stress, discusses health threats via occupation and the urban heat island effect.  She next discusses the second article in the series that identified strategies to address heat extremes in senior care settings and in hospitals and nursing homes ,or the importance of response planning for heat waves including the use of action plans and early warning systems by among others emergency and public health departments.  The discussion concludes with comments concerning related core competency education efforts at the University of Washington and the economic benefits resulting from climate crisis mitigation efforts.               

Kristie L. Ebi is Professor in the Center for Health and the Global Environment at the University of Washington. She has been conducting research and practice on the health risks of climate variability and change Kristie_Ebi - Marci Burden for nearly 25 years, focusing on understanding sources of vulnerability; estimating current impacts and future health risks; designing adaptation policies and measures to reduce the risks of the climate crisis in multi-stressor environments; and estimating the health co-benefits of mitigation policies. She has supported multiple countries in Central America, Europe, Africa, Asia, and the Pacific in assessing their vulnerability and implementing adaptation measures. She has been an author on multiple national and international climate change assessments. She has more than 200 publications and has edited fours books on aspects of the climate crisis.  Professor Ebi earned her BS at Michigan State, her MS at MIT and her MPH and Ph.D. at the University of Michigan. 

The Lancet's recently published "Heat and Health" series is at:

The World Health Organization's (WHO's) recent report, "The Health Argument for Climate Action," referenced during this interview, is at:



250th Podcast: Harvard's Dr. Aaron Bernstein Discusses COP 26, the National Academy's Climate Crisis Effort and Related Issues (November 19th)

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Concerning the recent United Nation’s COP 26 meeting in Glasgow, again unverifiable pledges were made moreover to cut methane gas emissions by 30% by 2030, limit deforestation and adequately finance converting to a green economy.  The US continued to exhibit intransience and/or fecklessness moreover by refusing to sign a pledge to phase out coal despite the fact it is the single biggest source of CO2 emissions worldwide and the fact the US still generates 20% of its electricity from coal. The US also continued to oppose adequately funding countries to recover (termed "loss and damage") from climate-fueled disasters - disproportionately caused by US carbon emissions.  The US is responsible for 40% of excess carbon emissions since 1750. Concerning the US's performance, the Third World Network's Meena Raman commented, "You walk out of the Kyoto Protocol [1997].  You walk out of Paris.  You come back and want us to think you're doing more?  What you're actually encouraging is people to walk out and then come back.  And then you're applauded."  Concerning the credibility of the US "doing more," earlier this week the Biden administration announced it would launch the largest ever auction of oil and gas drilling leases in the Gulf of Mexico. A decision Earthjustice defined as amounting to a “climate bomb.” As a related aside, the Biden administration has been to date issuing oil and gas drilling permits at a faster pace than the Trump administration. In sum, based on an analysis of countries’ 2030 GHG emissions goals, the latest Climate Action Tracker finding shows global warming doubling to 2.4 Celsius above pre-industrial levels, considerably warmer than the 2015 Paris Accord goal of 1.5 Celsius of warming - that substantially runs the risk of causing runaway global warming, or what's been termed Hothouse Earth.  As for the US healthcare industry’s considerable contribution to the climate crisis, the industry has still not taken any meaningful action.  This past Friday the House passed the Build Back Better (BBB) Act that would in part provide $550 billion to address the climate crisis, or in sum allow the US to get halfway to the Biden administration's goal to reduce emissions by approximately 50% (over a 2005 baseline) by 2030. Passage of BBB in the Senate is, as widely reported, in doubt.

Listeners may recall I interviewed Dr. Bernstein’s colleague, Dr. Renee Salas, in June and again in December 2019 regarding the climate crisis.

During this 33 minute conversation Dr. Bernstein begins by commenting on the COP 26 meeting and its results, comments on the clinicians' knowledge of the climate crisis (i.e., the John Kotcher survey that I discussed with Professor Kotcher on May 27th), C-CHANGE's policy work, use of Conditions of Participation and/or a value based payment system to regulatorily require hospitals to limit their carbon emissions (and the financial benefit thereof to hospitals), argues regulation is unnecessary to decarbonize healthcare if legislatively carbon fuels can be appropriately priced (i.e., externalize costs are accounted for), if not, use of regulatory payment incentives can be used to persuade providers.  Dr. Bernstein discusses the National Academy of Medicine's Action Collaborative's effort to decarbonize the healthcare industry and concludes with comments regarding the climate crisis in context of the current sixth mass extinction and in context of improving health equity.              

Dr. Aaron Bernstein is an Assistant Professor of Pediatrics and the Interim Director of Harvard's Center for Climate, Health and Global Environment (C-CHANGE) at the T.H. Chan Bernstein-Aaron School of Public Health. Dr. Bernstein has been a member of the Harvard President’s Climate Change Task Force and co-Chairs the University Food Standards Committee. He serves on the American Academy of Pediatrics Council on Environmental Health Executive Committee, the Board of Scientific Counselors to the CDC’s National Center for Environmental Health and Agency for Toxic Substances and Disease Registry and is Chair of the Board of Directors of the U.S. Green Building Council. In 2015, he was awarded a Lokey-Businesswire visiting professorship at Stanford University and has also been a visiting professor at Columbia University.  After receiving his bachelor’s degree in Human Biology from Stanford University, he received graduate degrees in medicine (MD) and public health (MPH), from the University of Chicago and Harvard University, respectively. He is a recipient of Stanford University’s Firestone Medal for Research and a Harvard University Zuckerman Fellowship. An avid bicyclist, Dr. Bernstein pedals to and from work year-round

Information on Harvard's C-CHANGE program is at:


Brookings' Carol Graham Discusses America's Crisis of Despair (November 8th)

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Last November 9th I discussed declining life expectancy in the US with Dr. Steven Woolf, i.e., US life expectancy stopped increasing in 2010 and had been decreasing since 2014.  This is significantly due to increasing mortality rates among men, disproportionately white men aged 25-64, for approximately 30 disease conditions ranging from cancer, cerebrovascular, circulatory, genitourinary, infectious mental and behavioral, musculoskeletal, nervous, and respiratory diseases.   These premature deaths have become popularly termed, "deaths of despair," a phrased coined by Princeton's Anne Case and Angus Deaton and is the title of their 2020 book, “Deaths of Despair and the the Future of Capitalism."  These authors define these deaths, numbering on average 70,000 per year, as those resulting from alcohol and drug abuse and suicide.  For example, per CDC findings in July drug overdoses increased to 90,000 in 2020, or by 30% over 2019.  While deaths of despair have been identified at least since the 1890s, federal policy makers have yet to seriously address this issue. 

During this 35 minute interview Prof. Graham begins by recognizing Émile Durkheim's related anomic suicide work from the 1890s, she goes on to discuss why poverty is different or more hopeless in the US, moreover among white poor, and what explains this difference between races, discusses what helps to explain why deaths of despair, or diseases of despair, have not been addressed by federal healthcare policy makers, discusses her recommendation for the creation of a federal, interagency task force to address this problem and metrics to track, for example, anxiety, depression, life satisfaction and well being.           

Dr. Carol Graham is the Leo Pasvolsky Senior Fellow at the Brookings Institution, a College Park Professor at the University of Maryland and a Senior Scientist at Gallup.  She is the author of numerous books including : “Happiness for All? Unequal Lives and Hopes in Pursuit of the American Dream” (2017); “The Pursuit of Happiness: An Economy of Well- Download
Being” (2011); “Happiness Around the World: The Paradox of Happy Peasants and Miserable Millionaires” (2009); and, “Private Markets for Public Goods: Raising the Stakes in Economic Reform” (1998).  She is also the author of numerous articles in journals including Science, Social Science and Medicine, the Journal of Economic Behavior and Organization, the Journal of Population Economics, Economica, Perspectives in Psychological Science, the World Bank Research Observer, Health Affairs, Health Economics and  Foreign Affairs.  She is senior editor of Behavioral Science and Policy, and an associate editor at the Journal of Economic Behavior and Organization and on the editorial boards of numerous other economic journals.  She served on a National Academy of Sciences panel on well-being metrics and policy and won the Pioneer Award from the Robert Wood Johnson Foundation and a Lifetime Distinguished Scholar award from the International Society of Quality of Life Studies.   She has served as a Special Advisor to the Deputy Managing Director of the International Monetary Fund and served as a consultant at the Inter-American Development Bank, the World Bank, United Nations Development Program, and the Harvard Institute for International Development.  Born in Peru, she received her A.B. from Princeton, her M.A. from The Johns Hopkins School of Advanced International Studies, and her Ph.D. from Oxford.  She is the mother of three children.

Professor Graham's Brookings' writings discussed during this interview are at:  

(Please excuse this interview's varying sound quality.)    


Opportunity to Respond to AHRQ's Climate and Health RFI (October 31st)

I wrote this to call attention to the Agency for Healthcare Research and Quality's (AHRQ's) first ever solicitation regarding the agency, finally, addressing the climate crisis.  Please review and moreover please forward your comments to AHRQ - that are due December 13th.  

Over the past several decades federal healthcare policy makers, aided and abetted by the healthcare industry, have ignored the climate crisis.  Because the US is historically the largest emitter of greenhouse gases at 25%, US climate nihilism largely explains why today all life on earth is exposed to irreversible harm for the foreseeable future.  Though AHRQ, or AHCPR, should have addressed the climate crisis 30 years ago, on October 13 the agency posted a one-page RFI titled, “AHRQ’s Role in Climate Change and Environmental Justice.”  Considering the late date, the RFI’s publication is heartbreaking.  Simultaneously, however, it is impossible to overstate the opportunity the RFI presents for the healthcare industry.   

Current State of Federal Climate-Crisis Programming

First, it is important to note the US healthcare industry’s carbon footprint accounts for 550 metric tons of carbon equivalent emissions, or 8.5% of total annual US carbon emissions.  The health harm caused by the industry’s emissions is commensurate with upwards of 98,000 US deaths annually and three times this number globally.  If US healthcare was its own country, it would rank 13th worldwide in carbon emissions. 

On balance, the federal government today is nowhere regarding climate crisis-related health policy.  Among other realities if you search CMS’s website for “climate change” you get zero results.  This is true in part because despite the all-of-government rhetoric about addressing racial equity, CMS made no mention of the disproportionate effects the climate crisis is having on minority communities in its ubiquitous use of health equity RFIs in this year’s rulemaking.  Like COVID, the climate crisis, in effect environmental racism, significantly worsens health inequality.  Nevertheless, the HHS Office of Civil Rights has also done nothing to protect Medicare and Medicaid beneficiaries right to a healthy environment.  This assumes they have this right since in 2020 the 9th Circuit ruled in the Juliana case that Americans do not have a constitutional right to a survivable climate.

NIH’s interest in the climate crisis has been only slightly better.  Between 2013 and 2020 NIH spent a cipher of its budget, 0.55%, on climate change and climate related exposures and conditions.  MedPAC and MACPAC, both with broad authority to recommend Medicare and Medicaid policy improvements, have never discussed the issue.  Neither has PCORI.  As for related others, healthcare foundations, for example the Commonwealth Fund, Kellogg and RWFJ with $20 billion in total endowment funds, ignore the topic.  As have many health research journals and media outlets.  When two hundred health journals throughout the world recently called on world leaders to address climate crisis-caused catastrophic harm, Health Affairs and JAMA were not among themHealth Services Research has never published a single related article and Kaiser Health News, Politico Pulse and related others are indifferent.  As for clinician involvement, a recent survey found 41% said they lacked subject knowledge expertise to communicate with the public.  This is in part due in part to the fact that only 15% of medical schools include climate crisis health effects in their curriculum. 

Addressing the Problem

The only ongoing HHS program addressing the climate crisis is the CDC’s Climate and Health Program that currently funds just eight states to improve their climate resiliency.  Leaving aside the considerable financial challenged associated with successfully building resiliency, recognizing the need for more expansive programming HHS announced in late August it was standing up the Office of Climate Change and Health Equity (OCCHE).  One month later, the National Academy of Medicine publicly launched an action collaborative, co-chaired by OCCHE, to decarbonize the healthcare sector and to strengthen the sector’s sustainability and resilience.  To support these efforts, AHRQ has now followed up with its RFI.   

Again, AHRQ’s RFI presents a significant opportunity for the healthcare industry.  The RFI requests comments on 11 questions regarding climate-related health effects including: what role should AHRQ play in identifying, gathering and disseminating climate-related health risks and impacts; what are the most pressing health care-related research and actions AHRQ should address; and, what role should AHRQ play in developing related practice improvement resources and education and training tools.  Comments in response to AHRQ’s RFI are due December 13.


Oostra Letter to CMS Administrator Chiquita Brooks-Lasure and CMMI Director Liz Fowler (October 22nd)

Listeners may recall this past January through March Promedica's CEO Randy Oostra (a client) introduced eight interviews I conducted in a series regarding substantive healthcare issues, i.e., interviews with Dr. Steve Woolf, Dr. Bob Berenson, Dr. Amol Navathe, Dr. Michael Chernew, Dr. Mark Miller, Dr. Judy Feder, Dr. Kate Goodrich and Drs. Braveman and Gottlieb. 

If you go to the Blog link at the top of the website page you'll see pasted an 8-page October 13th letter Mr. Oostra recently forwarded to Ms. Brooks-Lasure and Ms. Fowler noting several substantive issues needing CMS' attention: the climate crisis; economic inequality; CMMI reforms; social determinants; long term care; and, population health.  Please read and offer comment.

As a related aside, this year's Lancet "Countdown on Health and Climate Change " report was released two days ago.  It is at:

Thank you.     


NAM's Climate Crisis Effort Must Turn Words Into Action (October 15th)

Today, STAT News published my 8th climate crisis-related essay over the past few years.  It's titled, "The National Academy of Medicine's Climate Crisis Effort Must Turn Words Into Action."  

It's at:

As I note, on September 28th, or after a year of preparation, the Dr. Victor Dzau, President of the National Academy, announced an action collaborative to decarbonize the health sector.  Earlier or in late August DHHS announced the creation of the Office of Climate Change and Health Equity.  The OCCHE is a co-sponsor of the Action Collaborative.   Action collaborative information is at:  

Listeners may recall this past June 29th STAT published a related article I wrote with Walt Vernon.  It's at:


Eric Reinhart and Prisons as Epidemiological Pumps (October 6th)

Listeners may recall interviewed Dr. Eric Reinhart this past June 24th regarding prisons and jails as epidemiological pumps in the spread of COVID-19.   Yesterday, STAT News published Dr. Reinhart's summary of his  research.  Eric's article is titled, "Why US Pandemic Management Has Failed: Lack of Attention to America's Epidemic Engines."  At:     



Austin Whitman, Climate Neutral's CEO, Discusses Climate Crisis-Related Greenwashing (September 27th)

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Greenwashing is generally defined as a public relations or marketing practice used to deceptively persuade the public an organization is environmentally responsible.  In recent related news, after an Exxon lobbyist was caught on tape admitting efforts to undermine the Biden administration's efforts to address the climate crisis, last week the House Government and Oversight Committee requested documents by Exxon and others regarding the industry’s long running campaign to spread disinformation about the climate crisis and requested Exxon and other oil companies to testify before the Oversight Committee on Oct 28th.  Earlier this month NEJM published an editorial calling for emergency action to limit global temperature increases.  The editorial, intentionally or not, incorrectly stated the “health institutions have already divested more than $42 billion in asses from fossil fuels.”  This statistic is wildly incorrect.  Per the source NEJM cites, the $42 billion figure constituted the sum total of assets held by 23 international health institutions that had pledged to divest in fossil fuels.  The actual divested amount by these 23 organizations totaled $886 million total for 2018 and 2019.   Today, the National Academy of Medicine announced its "Action Collaborative on Decarbonizing the US Health Sector" (at:  There is concern the action collaborative, composed of industry executives, will result at least in part in greenwashing whereby the industry reverts to form by pledging net zero emissions by some distant year.  

During this 32 minute interview Mr. Whitman begins by providing overall comments regarding greenwashing.  He moves on to offer an explanation of why the healthcare industry significantly lags behind other economic sectors in reporting its carbon footprint (see the Senay and Landrigan study cited below), discusses avoided emissions as part of a net zero formula, the value of the US adopting something akin to the EU's proposed Corporate Sustainability Reporting Directive (CSRD), other solutions to counter greenwashing, i.e., what constitutes more meaningful or genuine effort and his hopes for the upcoming UN COP 26 meeting in November and the DHHS's newly-created Office of Climate Change and Health Equity (OCCHE).         

Mr. Austin Whitman is the CEO of Climate Neutral.  Previously Mr. Whitman served as Vice President of Climate Change Capital, and as Vice President of M.J. Bradley & Associates, two leaders 2__KY38mFrbkEnuPhEtTwJAA in climate-focused investing and asset management.  In 2019, Austin started Climate Neutral, a 501(c)(3) nonprofit aiming to accelerate the decarbonization of global emissions through its achievable certification framework.  The framework certifies brands who measure their carbon footprint, offset it with verified offsets, and create future reduction strategies.  Mr. Whitman is a graduate of Dartmouth College and Yale. 

Dr. Emily Senay and Philip Landrigan's 2018 JAMA-published research article, "Assessment of Environmental Sustainability and Corporate Social Responsibility Reporting by Large Health Care Organization," discussed during this podcast, is at: 

Listeners will recall I interviewed Mr. Whitman in September 2020 about entities attaining climate neutral certification.  Information on Climate Neutral is again at:


Professors Gibson-Davis and Hill Discuss The Effects of Wealth Inequality on Child Development (September 21st)

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This interview discusses the recently published series of ten articles edited by Professors Gibson-Davis and Heather D. Hill titled, "Wealth Inequality and Child Development: Implications for Policy and Practice," appearing in the August issue of The Russel Sage Foundation's Journal of the Social Sciences

The US suffers both extreme economic inequality.  For example, per June Federal Reserve data, the wealthiest 1% of Americans control approximately $42 trillion in wealth compared to the bottom 50%’s $2.6 trillion.  Children represent the poorest age group, nearly half of all children live in poverty or near poverty.   A disproportionate percent of poor children are minorities, e.g., 30% of Black and 27% of Hispanic children live in poverty.  According to the American Academy of Pediatrics children who suffer poverty experience numerous health harms through their life course including infant mortality and chronic illnesses, among others, cardiovascular, immune and psychiatric disorders and related lifelong hardships including unemployment, poor education, housing and healthcare.  

During this 39 minute interview Professors Gibson-Davis and Hill editors begin by defining and discussing extremes or vast disparities in wealth inequality among families with children, e.g., the top 1% of families with children have 43% of all wealth among families among children, the bottom 50% have less than 0.1%, or  the difference between $29.5 million versus $300.  The authors discuss next childhood health effects, specifically the negative correlation between family wealth and children's BMI (the Boen, et al. article) and what explains this correlation, discuss the Conwell and Ye study, "All Wealth is Not Created Equal," i.e., Black families may not or do not enjoy the same economic standing of White families, e.g., Black families are less likely to own a home, and this translates to fewer opportunities for the Black family children.  The authors discuss next policy solutions, i.e., the Huang, et al. article concerning Child Development Accounts (CDAs), the Michelmore and Lopoo EITC article and the Jackson, et al. article regarding the dissimilar effect Medicaid expansion has on White family wealth versus Black family wealth.             

Heather D. Hill is a Professor and Director of the PhD Program in Public Policy and Management at the Evans School at the University of Washington.   Professor Hill is also a faculty HeatherHill_094-1-e1597105338787-300x300 affiliate of the West Coast Poverty Center and the Center for Studies in Demography and Ecology at the U of WA and the Institute for Research and Poverty at the U. of Wisconsin and a member of the Executive Council for the U of WA Population Health Initiative.  Previously, Professor Hill worked as a research analyst at Mathematica Policy Research in Washington, DC and spent two years as a Peace Corps volunteer in the Ivory Coast.  Professor Hill received a Ph.D. in Human Development and Social Policy from Northwestern University in 2007, her MPP from the University of Michigan and a BA in Political Science from the University of Washington.

Christina M. Gibson-Davis is a Professor in the Sanford School of Public Policy with a secondary appointment as a professor of Sociology at Duke University.  She is also a Faculty Image_6808062 Reearch Scholar of DuPRI's Population Research Center and an Affiliate of the Ctner for Child and Family Policy.   Her research interests concern social and economic differences in family formation patterns.  Her current research focuses on the how divergent patterns of family formation affect economic inequality.  She earned her Ph.D. at Northwestern and her BA at Bates College.   

The Russell Sage Foundation's Journal of the Social Sciences August issue, again titled, "Wealth Inequality and Child Development: Implications for Policy and Practice."  is at:  


Daniel George and Peter Whitehouse Discuss Their Just-Published Book, "American Dementia, Brain Health in an Unhealthy Society" (September 14th)


Ken Langa's dust jacket summary appropriately states, the authors, "make clear that, in order to understand health and cognitive decline more fully, we must consider the quality and inclusiveness of the environment through which we travel from birth to death."  Alzheimer's or brain health should not be simply conceived or understood, the authors' argue, at a biological level but also the result of material conditions of life mediated by political-economic organizations that dictate public policy - and these from a brain health perspective are what's demented.   The work should remind listeners of my May discussion with CUNY Professor Nick Freudenberg regarding his work, At What Cost, Modern Capitalism and the Future of Health.  Dedicated listeners may recall I interviewed the Alzheimer's Association's Robert Egge in April of 2015.)

This 33 minute conversation begins with the authors explaining the problems associated with the paradigm used to define or understand Alzheimer's, i.e., the so-called amyloid cascade hypothesis - made evident by the recent, and very controversial, FDA approval of Biogen's drug, aducanumab (brand name Aduhelm).   The authors go on to discuss/define an alternative definition or paradigm to define Alzheimer's and brain health, one that recognizes or appreciates or accounts for the material conditions of life shaped/determined by socio-economic policies and how these have changed over the past 50 years via the advent of neoliberal policies (deregulation, etc.) compared to just previous post-WWII policies that included comparatively more progressive taxation, education, environmental and public health policies.  Among other comments the authors weigh in on the adequacy of healthcare industry efforts to address or counter-act the adverse brain health effects of neoliberal policy.                  

Prof. Daniel R. George, PhD, MSc, is a medical anthropologist and associate professor in the Department of Humanities and Professional-picture-25cp79p-300x276 Public Health Sciences at Penn State College of Medicine.  His research on intergenerational issues in dementia care has been recognized by the global advocacy group Alzheimer’s Disease International.  In addition to teaching and research at Penn State, Dr. George has co-founded the Farmers Market in Hershey, PA and a Community Garden on the hospital campus.


Prof. Peter J. Whitehouse, MD, PhD, has a primary appointment as Professor of Neurology, with secondary PeterWhitehouse2018-01-04 positions as Professor of Psychiatry, Cognitive Science, Neuroscience, and Organizational Behavior at Case Western Reserve University. He is also Professor of Medicine at the University of Toronto. Dr. Whitehouse founded, with his wife, Intergenerational Schools, unique public, multiage community schools in Cleveland. He has served in national and international leadership positions in neurology, geriatrics, and public health.

For more information on the book and the authors' related work go to:

Noted during this interview is the authors' August 25th Scientific American article titled, "Alzheimer's Inc.: When a Hypothesis Becomes Too Big to Fail."  At:

Drs. Whitehouse and George are the coauthors of The Myth of Alzheimer's (St. Martin’s Press, 2008).