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[Bill Phillips] Hi everyone.
I'm Bill Phillips, Editor-In-Chief
of Men's Health magazine.
Welcome to National Men's Health Week 2013.
Also, welcome to our first ever Google Plus Chat.
Hanging out with us today is Dr. Thomas Frieden from the CDC.
Dr. Frieden's been there since 2009.
You may also know him from his previous role
as the New York City Health Commissioner.
Dr. Frieden, in that role, made it his mission
to reduce the prevalence of smoking in New York and,
you know, what was first considered a very controversial
initiative, you know, banning smoking in bars and restaurants
and workplaces, is now,
basically been termed an epic success.
He cut New York City's smoking rate by 25 percent and,
perhaps more importantly, the teen smoking rate by 50 percent.
It's still half the national average.
So it's been a huge success there.
Dr. Frieden is also Men's Health's newest contributor.
This is our July/August issue, on newsstands next week,
and Dr. Frieden wrote this piece - "How to Save the U.S. Male,"
so we're going to talk to him about how guys can live happier,
healthier, longer lives.
Dr. Frieden, welcome.
[Dr. Tom Frieden] Great to be here.
Glad to do this with you, and thanks for putting attention
on health issues; they're so important.
[Bill Phillips] You're very welcome, very welcome.
Let's start at the top, the top being the number one health
threat for men, which is heart disease,
and the thing I've always wondered.
It is the number one killer of men.
I've always wondered why the medical establishment hasn't
been more proactive in testing for heart disease.
You know, like with prostate cancer, we have PSA testing.
Shouldn't there be an equivalent for heart disease?
[Dr. Tom Frieden] Well, there is, really.
Several, simple questions.
First, do you smoke?
Second, what's your blood pressure?
And third, are you physically active?
If you can get those three things right,
you can cut your risk of heart disease more than in half.
So, a lot of the things that guys can do to feel better
and live longer really aren't that complicated
but they're very important.
[Bill Phillips] You mentioned smoking
and that's obviously been a huge issue for you,
just because of the health consequences.
If you smoked, what would you do?
How would you go about quitting?
[Dr. Tom Frieden] Well first, to understand that if you smoke,
quitting is, by far, the single most important thing you can do
to improve your own health.
And, in addition, to know that every American - first off,
most Americans who've ever smoked have already quit.
So, if you're still smoking,
you're not in the majority there; you're in the minority.
Most people have already quit and you can, too.
Anyone who smokes can quit,
but there're certain things that make it easier.
So, quitting with a buddy; using medications, which double
or triple the likelihood that you will quit successfully;
identifying what your triggers are
so you can eliminate those triggers; doing things
that support yourself during the time that you want to quit,
so get a buddy, use medications, have a quit date,
eliminate ashtrays and other triggers, maybe spend your time
with people who don't smoke for a few weeks
until it gets solid in, and understanding that,
for most people, quitting smoking takes a few tries.
So, be good to yourself.
If it doesn't work the first time,
try again because you can succeed.
And it's not only important for you, it's important
for everyone around you.
Smoking not only makes it more likely
that you will get bad diseases, it also makes it more likely -
twice as likely - your kids will smoke, more likely that people
around you will get lung disease or heart disease or cancer.
So, lots of really serious health problems from smoking.
You know, I think we're all still kind of have the allure
of the Marlboro man, right?
The sexy smoker, rugged individual.
I'm a doctor.
I've taken care of so many patients who've had
such awful experiences with smoking.
People who are gasping for every breath with emphysema,
people who've had their leg amputated,
one man who desperately wanted to live to see his son graduate
from college and didn't because of his smoking,
another guy who ended up dying while waiting
for a heart transplant.
So these are terrible problems and we can prevent them.
It's not easy to quit smoking but you can do it.
[Bill Phillips]If you have, you know, someone close to you,
a spouse, a family member, who's a smoker,
like how would you go about, you know,
inspiring them to try to quit?
Any tips you can give the folks watching?
How they might go to someone they care about to get them
to give it up or at least give it a try?
[Dr. Tom Frieden] There's a lot that you can do
to help someone else quit.
So, for example, you can encourage them to see the doctor
and get medications, you can help them identify other smokers
who also want to quit with them because going
through it together is really helpful.
You can understand that some people may not be ready to quit
and just come back at it and come back
at it until they are ready.
So, just keeping in mind
that smoking remains the number one preventable cause of death
in this country and it causes, not only death,
but really terrible disability, disfigurement, inability to go
about and do the things that you want to do.
So if you quit smoking, you're going to feel better,
you're going to live longer, and you'll be happier.
[Bill Phillips] Thanks.
One of the more interesting things I read about you is
that you spent time in India, I think prior to your stint
as New York City Health Commissioner, sort of working
on initiatives to reduce the prevalence of tuberculosis.
And according to the World Health Organization,
that initiative - those initiatives -
saved 1.4 million lives, which is amazing.
I'm wondering what that experience taught you, you know,
about, you know, your role as a public health advocate and,
sort of, how you govern today, you know as part of the CDC.
[Dr. Tom Frieden] India has an amazing history
on tuberculosis control.
In fact, a lot of the world's knowledge
about tuberculosis came from India.
But until the mid-1990s, it hadn't been applied in India.
It's not enough to know; we have to do it.
It's not enough to talk about it;
we have to actually make it happen.
And the work in India was enormously challenging
but enormously rewarding.
I travelled to hundreds of districts and thousands
of villages, met with health workers, talked with leaders,
and really, we were working to help people
who have a terrible disease - tuberculosis - get cured.
Because we know that virtually everyone
with tuberculosis can be cured.
At times, it looked really hopeless.
There were many, many, many barriers.
But I had kind of one simple saying which was that
"Irrational optimism is a prerequisite for success."
It didn't seem very logical
that we'd be able to succeed, at times.
It didn't seem like it was reasonable to expect,
given how really hard it was.
But little by little, by focusing on empowering people,
training people, supporting the really dedicated,
hard-working people at the national, state,
and district levels in India, keeping in mind
that the patient has to be the V.I.P. of the program,
we were able to help India drastically improve
tuberculosis control.
They still have a long way to go.
It's not a finished product
but they have saved well over a million lives.
[Bill Phillips] So it's empowering the patient to want
to make the right choice for themselves?
[Dr. Tom Frieden] You know, a lot of times,
what we do in public health is try
to make the healthy decision the default value.
So you don't have to work hard to get at it, you just have
to do what comes naturally.
Right now, in the U.S., if you 'go with the flow',
you will become overweight or obese, as two-thirds
of adults in this country are.
So we need to make it easier for people to live healthy.
[Bill Phillips] Excellent.
I want to talk a little bit about the Affordable Care Act
which goes into effect in 2014.
The Affordable Care Act, of course,
some people know it as 'Obama Care.'
You know, what do we need to know
about the Affordable Care Act?
How do we prepare for it?
What are the benefits to be looking for as we come
into fall and open enrollment?
[Dr. Tom Frieden] Well, first off,
the Affordable Care Act is already in effect
and there are many components of it
that are already helping people.
First, our own data from CDC show that more
than three million additional 19-
to 25-year olds have health coverage
because of the Affordable Care Act.
You can stay on your parent's plan which you couldn't before.
Second, we just released data in the past week that shows
that fewer people are having problems paying
for medical care.
Now, it's still far too many and we're not sure
of all the reasons for that decrease, but some of the things
that the Affordable Care Act does is
to eliminate cost sharing for preventive measures.
So there's lots of things, like a colonoscopy, like a check-up
for blood pressure, like a variety of preventive services -
vaccinations - that, right now, are without co-payment,
whereas before, you had to have a co-payment.
[Bill Phillips] I think you also wrote in your piece
in Men's Health that also, smoking cessation, you know,
is covered, as well with the new program - the new Act.
[Dr. Tom Frieden] You can absolutely get help
with cessation.
The big new thing that will happen, starting in October
of this year, is that people can sign up through a marketplace
or exchange for health insurance and over the next few months,
you'll be hearing more about that.
Stay tuned because it's crucially important
to have health insurance.
That's a critical step to having access and improving your health
and getting preventive care.
One thing that we know is
that men see doctors less than women do.
Men are less likely to seek care and, in many situations,
less likely to follow-up.
And some of the things that are so important are things
like blood pressure control - very simple
but crucially important -
literally a life and death issue.
It's not hard to get your blood pressure controlled
but if you don't see your doctor, if you aren't
on medications, if you aren't doing things
to control your blood pressure,
not going to happen [Bill Phillips] Right.
Dr. Frieden, I know you're an avid squash player and you write
about how, just, you know,
an hour on the squash court cheers you up and gets you ready
for the rest of your day.
And, you know, at Men's Health, we talk about, you know,
exercise is sort of our performance-enhancing drug
of choice, and I hear so many people say, "I'm too tired
to exercise, I don't have time to exercise," not realizing
that if they exercised, they wouldn't be so tired.
You know, what can we do to convey the idea that, you know,
working out, that doesn't have to be work in working out.
You write about it in your story that, you know,
it should be about fun.
Like, what are some of the things that you advise folks
to kind of take the work out of working out?
[Dr. Tom Frieden]Find things
that you love and do more of them.
Whether that's walking, bicycling, jogging,
playing basketball with your kid, dancing, playing a sport,
going to the gym, doing things with friends,
swimming - whatever's active.
Physical activity really is the closest thing we have
to a wonder drug.
Even if you don't lose an ounce of weight,
it'll help you control your blood pressure,
not have diabetes, be less likely to have cancer,
improve your mood, reduce your cholesterol.
It really has a tremendous number of positive effects,
so the challenge really is to get started, keep it up, and,
just as with quitting smoking, if you do things with buddies,
it's more likely that you'll stick with it.
So, over the years,
I've probably had 50 different squash partners
in the different towns I've lived in, cities I've lived in,
countries I've lived in.
And, you know, they're people I got to know, they were fun
to get to know, you learn a lot about someone
when you play squash with them.
[Bill Phillips] I don't mean to put you on the spot,
but we're going to have a little rapid fire round here, okay?
We're going to see if you're walking the talk,
how about that?
When was the last time you exercised?
[Dr. Tom Frieden] Well, honestly,
playing squash last Monday I sprained my ankle badly,
so I'm in an ankle brace and I'm doing physical therapy a couple
times a day so I can get back on the squash court
by the time I get back
from a trip I'm making to Asia next week.
[Bill Phillips] Alright, well, we'll give you that one,
we'll give you that one.
What'd you have for breakfast today?
[Dr. Tom Frieden] A bowl of cereal with strawberries.
[Bill Phillips] Okay.
That's pretty good.
How much sleep did you have last night?
[Dr. Tom Frieden] Not nearly enough.
I woke up way too early and actually worked for a couple
of hours and then went back to bed.
I don't do that often but I'm being honest.
[Bill Phillips] That sounds like, that sounds like,
that's an "F" for that one.
When was the last time you visited your dentist?
[Dr. Tom Frieden] About six months ago;
I'm due for a cleaning.
[Bill Phillips] Alright.
When was your last cigarette?
[Dr. Tom Frieden] I had a few cigarettes
when I was a high school kid and not since,
so that would have been in the mid-1970s.
A long time ago.
[Bill Phillips] You get an "A+" for that one.
And what about flu shot.
Did you get a flu shot this year?
[Dr. Tom Frieden] Absolutely.
Every year.
[Bill Phillips] How important is the flu shot?
There's always some debate.
People worry that the flu shot's going to give them the flu.
Is there any truth to that?
[Dr. Tom Frieden] There's no way you can get the flu
from a flu shot.
On the other hand, it's not as good as some vaccines
that we have, so other vaccines have effectiveness ratings
in the 90-95 percent range.
Flu is more around the 60-70 percent range,
maybe even lower for certain people.
But it is the single best thing you can do to protect yourself
against flu, and I think people have misconceptions
about what the flu is.
About one out of five adults in this country,
one out of five Americans, gets the flu each year
and it really can knock you out.
It's not the common cold.
There's a range of illness with flu but it can be quite serious.
You can miss a lot of work or a good weekend,
so flu shot just takes a couple of minutes.
It's covered without co-payment, as per the Affordable Care Act
and most insurance plans, but get a flu shot every year.
It protects you and it will protect people
around you, as well.
[Bill Phillips] Excellent.
One last question.
I just wanted to go back to something you said earlier
about making, you know, the sweet spot
in public health you've said is
to make the healthy choice the default choice.
And, you know, for so many people,
that's really the biggest challenge.
They want that extra dessert, you know, they have that craving
for the candy bar or a donut or a cigarette, for that matter.
Like, you know, just in those moments everyday
that we all sort of have those urges, you know,
how can we sort of tamp them down?
Like, any tricks or tips you can give us just to kind of like get
through our day with making the healthy choice the
default choice?
[Dr. Tom Frieden] Well, there are things that you can do
to arrange your environment to make it easier.
So make it easier to drink cool water rather than something
that has a lot of calories in it or zero calorie drinks.
Make it easier to get physical activity by using the stairs.
One of the things that - figuring out what works for you.
I'll give you two examples for me.
One thing that I mentioned in the article I learned
from my father was, he had a big sweet tooth,
I have a big sweet tooth.
I could eat a half a pie, easily.
So after dinner, I have a - or after lunch -
I have a big plate of fruit.
If I have a plate of fruit, I'm filled up, it was sweet,
I enjoyed it, and then I can get by with less dessert,
maybe one slice instead of two, maybe no dessert sometimes.
So find things you love doing that are healthy
and also find things that you do
that are routines whether it's getting physical activity,
it's really tough for me to make time for squash,
given how busy my life is, but I make that time and once you have
that kind of self-reinforcing pattern
and habit, it can continue.
And so finding the things that you love to do and making time
for them because that's going to be incredibly important.
[Bill Phillips] Excellent.
Thank you.
I just wanted to thank you for joining us, Dr. Frieden,
and thanks for all your work advocating for the health of men
and women and, you know, I hope to speak to you again soon.
[Dr. Tom Frieden] Great.
Thanks very much for doing this.
[Bill Phillips] You're welcome.