[00:00:00] Welcome. I'm Erik Fleming, host of A Moment with Erik Fleming, the podcast of our time.
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[00:01:21] Hello and welcome to another moment where Erik Fleming. I am your host, Erik Fleming.
[00:01:41] And today I have a couple of authors on to talk about their books.
[00:01:47] And it's going to be typical of what I try to do because initially one of the books is very, very...
[00:01:59] You'll understand the politics of it. The other one, not initially. If you bought this book, you'd be like,
[00:02:06] where's the politics in this? But once we get into the interviews and you know me that I'm going to have people on
[00:02:16] to discuss things because politics is in everything that we do.
[00:02:24] So I hope that you enjoy these guests and I hope that you get their books after you listen to them on the podcast.
[00:02:33] And right now it is time for a moment of news with Grace Cheat.
[00:02:46] Thanks, Erik. The Arizona Supreme Court reinstated a near total abortion ban from 1864, criminalizing abortions in the state.
[00:02:56] Donald Trump re-emphasized that abortion laws should be left to individual states rather than proposing a national ban.
[00:03:03] Allen Weisselberg, the former Trump Organization CFO, received a five month jail sentence for perjury related to Trump's finances.
[00:03:11] Donald Trump faced legal setbacks with judges dismissing his attempts to drop charges related to the 2020 Georgia Election
[00:03:19] Interference case, the upcoming Hush Money trial and holding classified documents.
[00:03:24] The centrist group, No Labels decided not to run a third party presidential campaign after failing to find a viable candidate.
[00:03:32] The Biden administration issued rules to protect the jobs of 2.2 million civil servants from being replaced by partisan appointees.
[00:03:41] The parents of a Michigan teen who killed four classmates were sentenced to 10 to 15 years in prison for manslaughter.
[00:03:48] President Joe Biden announced a plan to ease student debt, which could eliminate a crude interest for 23 million borrowers.
[00:03:56] The U.S. House has delayed sending impeachment charges against Homeland Security Secretary Alejandro Mayorchis to the Senate.
[00:04:04] Norfolk Southern agreed to pay $600 million to settle a lawsuit over a toxic chemical spill, resulting from a train derailment in East Palestine, Ohio.
[00:04:14] Jacob Wall and Jack Berkman will pay $1.2 million in damages for a robo-call campaign that sought to discourage black voters from voting by mail in the 2020 election.
[00:04:27] New York City agreed to pay a $17.5 million settlement with two Muslim American women over forced removal of hijabs by police after arrest.
[00:04:38] A 4.8 magnitude earthquake hit central New Jersey, close to New York City, causing buildings to shake along the East Coast.
[00:04:46] A total solar eclipse, the first in North America since 2017, was witnessed by many across the continent with reactions of awe and celebration.
[00:04:56] And OJ Simpson, known for his football prowess and legal troubles, died at the age of 76.
[00:05:04] I am Grace G., and this has been a moment of news.
[00:05:16] All right. Thank you, Grace, as always for that moment of news.
[00:05:22] And now it's time for my first guest.
[00:05:26] And his name is Stephen M. Cohn.
[00:05:31] Stephen M. Cohn M.D. is a former surgeon in the U.S. Army Medical Corps in Desert Storm.
[00:05:39] Past division chief of trauma and surgical critical care at Yale University School of Medicine, past medical director of the Rider Trauma Center in Miami,
[00:05:51] past chairman of the Department of Surgery at the University of Texas Health Science Center, and current practitioner in New York City.
[00:06:00] He has also lent his knowledge as an educator and researcher.
[00:06:05] Having produced more than 300 scientific publications, edited eight surgical textbooks, conducted extensive funded research,
[00:06:14] participated in many professional organizations, and served as an editorial reviewer for numerous journals.
[00:06:21] He is the recipient of the Teacher of the Year Awards at Boston University, University of Massachusetts, Yale, and Northwell Health,
[00:06:31] and a Lifetime Achievement in Education Award from the University of Miami Department of Surgery.
[00:06:38] He is the author of All Bleeding Stops, Life and Death in the Trumman Unit, which was published by Mayo Clinic Press.
[00:06:46] Ladies and gentlemen, it is my distinct honor and privilege to have as a guest on this podcast, Dr. Stephen M. Cohn.
[00:07:09] All right, Dr. Stephen Cohn, how are you doing? My friend, are you doing good?
[00:07:15] I'm doing good. Thank you for having me on the show.
[00:07:17] Well, it's an honor for me to have you on because one of the things I try to do with this show, even though it's a political show,
[00:07:29] it's not typical in that I'm always going to have elected officials or talking heads, all that stuff.
[00:07:37] Public policy is determined by people that do the work.
[00:07:42] And because of your book, All Bleeding Stops, I think it's an important conversation to have as far as what you deal with as a doctor dealing with trauma care
[00:07:55] and how from a public policy sector we can make that better.
[00:08:01] So I really, really want, I'm really, really honored to have you on.
[00:08:07] Now, what I'd like to do with guests is that at the beginning, I always throw a quote at them and it may be something they said,
[00:08:16] something that relates to the work, what have you.
[00:08:20] So your quote is, a good surgeon doesn't just concentrate on technical ability, but also on the appropriateness of what you're doing.
[00:08:32] What does that quote mean to you?
[00:08:35] Well, I think a lot of people have the misunderstanding that even though there are some technical aspects of surgery,
[00:08:48] how we suture up a wound or a blood vessel,
[00:08:53] that it's mostly a technical skill and not one where it's about the thought process.
[00:09:04] Sorry.
[00:09:07] And let me just turn this off, sorry.
[00:09:10] And the fact is that surgery is mostly about who to operate on, when to operate and what to do.
[00:09:21] And unfortunately, or I should say fortunately, the technical aspects of it in most areas of surgery are minimal consequence.
[00:09:33] So that if you look at 100 surgeons, I always say three or four of them may be technical geniuses and three or four of them may be unable to tie their shoes.
[00:09:48] And in between, everybody's competent enough, that's the process of training.
[00:09:53] Everyone's competent enough to get the job done.
[00:09:56] But it's more about what to do when you're there and whether or not you should be there in the first place.
[00:10:03] And there's a lot of judgment in surgery.
[00:10:07] We can't have the attitude, everyone is pre-op or, you know, he's kind of on my hammer, the whole world looks like a nail kind of thing.
[00:10:18] You know, surgeons have to use a lot of judgment.
[00:10:20] So as you get more senior and you develop a little bit more wisdom based on your experiences, you're a lot less anxious to operate on people the more complicated they are.
[00:10:32] Yeah.
[00:10:33] So what exactly is a trauma surgeon as opposed to any other specific type of surgeon?
[00:10:40] Sure.
[00:10:41] Okay.
[00:10:43] So a lot of people kind of misconstrued that trauma people to do trauma or emergency room doctors and emergency room doctors are essential parts of the hospital environment.
[00:10:57] They take care of everyone who has a stroke or a heart attack or comes in with any kind of bad problem.
[00:11:03] And sometimes they do some trauma care also.
[00:11:06] But trauma surgeons are general surgeons who are trained and do a full surgical residency and decided to specialize generally by doing a fellowship.
[00:11:17] And we take care of all of the really bad surgical emergencies, general surgical emergencies typically.
[00:11:26] We run the ICUs and almost always were trauma big trauma centers where regionally all the worst car crashes and unfortunately in this country gunshot wounds and falls and everything else people who are really badly hurt.
[00:11:44] Are brought by the pre hospital, you know, paramedics and EMTs to the trauma centers. And we go downstairs to the ER when those folks come in.
[00:11:56] When did you realize that that's what you wanted to do to be a trauma surgeon?
[00:12:03] Well, I'm not exactly sure. I know that the world decided when I got to medical school everyone told me I was going to be a surgeon long before I ever knew that.
[00:12:13] And then I did my first rotation on surgery and sit after like two days I went like, okay, this is it. I get it now.
[00:12:21] And then I always sort of gravitated and enjoyed taking care of people that were really sick. And during residency, I got more and more interested in that and then went on to do a fellowship and have a career and now I've run a number of trauma centers and surgery departments.
[00:12:42] Yeah, I understand about the predetermined stuff. My dad, my mom made me take piano lessons because my dad always noticed when I was playing baseball you got steady hands you should be a doctor needless to say I didn't follow his advice on that.
[00:12:55] But, you know, but I definitely understand that predetermined stuff. And you kind of touched on some of the stuff that's more prevalent in trauma centers as far as gunshot wounds, car accidents.
[00:13:12] Anything, particularly you want to add to tell people what you normally see.
[00:13:19] Yeah, so let me just say two things specifically about that. One is that people are doing much better because the roads are safer. The cars are safer.
[00:13:34] The organization, the paramedics and EMTs are better trained. They get people to the hospital faster. We have lots of great folks out there bringing us the patients fast.
[00:13:50] And the hospitals are better. They're better equipped, better trained. The nurses and the rest of our team. The whole team functions much, much better than it did 40 years ago when I started out all this stuff.
[00:14:04] Unfortunately, what hasn't changed is the people we're seeing. It's deja vu all over again every time we're on. It's people drunk driving, people not wearing helmets getting hit by cars, riding around on motorcycles.
[00:14:19] And mopeds. It's people getting shot and just general high level of violence. People don't realize that the number of folks getting per capita dying in car crashes related to alcohol, which is about half of them, hasn't changed in the last 35 years with all the efforts that have been gone.
[00:14:46] We haven't slowed that down. Obviously, I don't have to tell you about gun violence increasing and faster. The number of mass shootings has gone up dramatically. I think last year we had more than two per day over the course of the year.
[00:15:02] And you guys hear about or the public, I should say, we all hear about the big ones, the bad ones, the multiple shootings. We don't hear about just the every day this guy got shot through the head that guy got injured this way or that way.
[00:15:18] Those are just a steady stream. We have more people dying related to guns than died in the entire every year than died in the entire Vietnam War.
[00:15:31] That's the volume. It's and it's our country is all by itself in this none of the other.
[00:15:38] No other country in the world, certainly not in the developed world has anything like what we have terms of gun violence. You know guns are much more lethal than a knife or a fist.
[00:15:52] Well, let's let's let's explore that since you brought that up. What what what are your thoughts about gun violence? What do you think can be done to try to minimize that as far, you know, from from your perspective?
[00:16:08] Is there anything that you can do? Even if you can't really think of anything policy wise to try to minimize it. Is there anything that you think can be done on your end on the medical end to try to minimize casualties of it?
[00:16:24] Sure. Well, obviously medically we're you know, we've made progress in terms of our our knowledge about you know how to treat a particular kind of wound. Those things have progressed so more people with the same wounds may be living now that didn't live 50 years ago.
[00:16:45] Let's say, okay. But unlike, you know if you said to me what can we do about making people better with appendicitis? I could say you know I happen to know this as of March 2024 there were over almost 29,000 articles written about that.
[00:17:03] But you know there's nothing written about gun violence. So I don't really have much. Why is that? Because in 1996, there was a mass shooting in Australia Tasmania. And in response to that, the country, Australia put in a bunch of rules and buyback programs did a lot of different things to try and control their their gun availability and they had not a single mass shooting for the next 20 years.
[00:17:33] And their number of suicides and homicides dropped dramatically and stayed really, really low. Well the response in this country was to put through legislation that closed down the gun, the you know, the injury, gun injuries section of the CDC.
[00:17:53] And to make it basically illegal to do research on on guns in this country. In other words, if I decided to write a paper or do research in the in as to whether or not it's better to have a gun buyback program or to have a longer period of a wait period before you could purchase a gun or the impact of mental illness or magazine size
[00:18:23] assault rifles or any of the things that we might want to study. And there's a long, long list.
[00:18:29] If I did that, it wouldn't be just me that lost my funding the university would lose all federal funding, all NIH funding for cancer research for lung, for lung disease for heart disease and everything.
[00:18:44] So, so needed to say we all stopped doing research and guns and all the information that we have is from other countries. We don't have any from the United States. There's no there's no information, almost none.
[00:18:57] And that really ties your hand on how to recommend to a public or to each other, you know what should be what should we be doing.
[00:19:10] You know, because we don't really have any information. Now, I believe that recently that that was reversed but for a period of 20, 20, 25 years, nothing just just crickets, you know, nothing just empty space.
[00:19:26] So, I think that there are some obvious things in terms of the public having military type weapons. I mean, I think there's really not much justification for a lot of these different things but it makes it very difficult for us to be doing the same thing.
[00:19:44] I work at a safety net hospital and have done that for most of my career, and they'll see the same problems that we did way back. You know, maybe the gun velocity is a little higher. Also your public should know that gun violence is kind of a bimodal thing.
[00:20:04] It's it's middle age and elderly rural Caucasian men committing suicide. That's about half. And it's inner city, typically young men of color involved in homicide.
[00:20:27] Those are the populations that that comprise something like, I don't know, 95% of all the gun deaths are those two populations are pretty equal number, which is, you know, very unfortunate.
[00:20:42] Yeah, it's a tragedy either way. And that kind of explains why it's now being talked about as a public health issue. But, you know, like you said 20 some years ago, it wasn't because basically the powers that be said those folks that had those resources in the public health industry
[00:21:07] couldn't, you know, whether it's in academia or, you know, in the hospitals or whatever they couldn't do anything to to study, or they would lose federal funds.
[00:21:21] And that's a good point to bring up now.
[00:21:25] When I was in go ahead.
[00:21:28] One more thing. Imagine that in 1960, the tobacco industry all got together and they lobbied on the Congress Congress and they put in a regulation that said, if you do any kind of research on smoking and stroke heart disease or lung cancer, you're
[00:21:50] going to lose all your federal funding.
[00:21:53] That's what happened in 1996.
[00:21:56] That's what happened in 1996 97 here is the gun manufacturers went out went out and bought a whole bunch of congressmen and put this rule in and we are we the community we were paying the price.
[00:22:11] Yeah, awful.
[00:22:13] That gets me to when I was a member of the legislature right and I guess for lack of a better term I was an advocate for safety.
[00:22:24] You know, I was pushing for more railroad gates, you know, great at crossing the railroad crossing.
[00:22:35] And, you know, I was an advocate about seatbelt laws and life jackets and motorcycle helmets.
[00:22:44] When I made my arguments against those who stated that individuals to decide their own safety.
[00:22:52] I reminded them that the taxpayers paid for the best trauma set in the state and in Mississippi that's UM, UMC the University Mississippi Medical Center.
[00:23:03] And so it was best interest for the common good to legislate safety measures.
[00:23:09] What is your take on that and why do you have that position.
[00:23:14] I'm totally lockstep with you there. I believe the thing that the we all until I was reading about it, I didn't really understand was that, you know, when you don't wear a helmet.
[00:23:27] Most people don't, for example, they're riding a motorcycle without a helmet. If they crash their motorcycle, they usually don't die.
[00:23:36] They usually end up vegetative, you know, with minimally responsive in a nursing home and essentially nobody's insurance pays for that long term disability.
[00:23:48] It's all the taxpayers money.
[00:23:51] Excuse me.
[00:23:52] That's going to pay for long term care.
[00:23:57] And in many cases it's the you run out of your catastrophic medical coverage in just a short period of time.
[00:24:05] And so even the hospitalization millions and millions of dollars.
[00:24:08] So years ago, folks up in Connecticut looked at in this small state of Connecticut, what the cost was of not having a helmet law or would be if they repealed the helmet law.
[00:24:22] And it was literally multiple billions of dollars a year in that small state in uncompensated medical care.
[00:24:29] So it isn't a matter you don't if you don't wear your seat belt and you end up Bradley had injured.
[00:24:37] If you fall off your motorcycle and smack your head and end up in a nursing home.
[00:24:44] It's not the individual that's covering the cost of that.
[00:24:48] So it's one thing if we, you know, you're on a desert island and you want to climb the palm tree in fall.
[00:24:54] It's just you know, but unfortunately we all in society have to pay for this.
[00:25:00] So I think these safety measures make a lot of sense.
[00:25:03] And when it comes to seat belt laws, people are really compliant.
[00:25:08] There's there's a primary or secondary seatbelt law in every state, but New Hampshire.
[00:25:13] And New Hampshire, you know, live free or die is their motto.
[00:25:18] Last time I checked they had only a 45% wear rate and which is terrible.
[00:25:27] You know, the rest of the states are all well over 90%.
[00:25:31] Helmet laws are ultimately enforceable because you can't ride past a police officer with a fake head.
[00:25:37] You know, you have a helmet on or you don't, you know, and they have huge positive impact.
[00:25:43] You know, and in the book I had a number of examples of people who had or did or did not wear a helmet.
[00:25:50] And so it's just really not, it's not a personal choice.
[00:25:55] You have you're making a decision that impacts on all of your neighbors and relatives and everyone.
[00:26:00] Yeah.
[00:26:01] And then the other thing is the insurance rates because when I was in the legislature Mississippi had the highest motorcycle insurance rate.
[00:26:12] And, you know, every year was a group of motorcycle riders that would come up and they would was a particular group of them that would push to make the helmets law.
[00:26:24] And it just seemed like it was just going through the motion so the work around we ended up doing was creating motorcycle safety classes and getting the Department of Public Safety to a credit.
[00:26:41] And so we ended up getting those motorcycle safety classes.
[00:26:45] And, and that and people were able to get their rates reduced if they went through one of those classes because it ended up I think three particular organizations set up classes statewide.
[00:27:00] And that was able to help mitigate the cost until they dealt with the actual helmets.
[00:27:06] So yeah, it's it's it's a public policy thing.
[00:27:10] And I just, you know, people, people don't get it, you know, all they get is what they see on Graves Anatomy or ER, which reminds me because I asked an FBI agent what does television and movies get wrong about, you know, the FBI and all that.
[00:27:30] I'm going to ask you what do movies and TV shows get wrong about trauma center.
[00:27:36] Most everything.
[00:27:39] I have to say, you know, the fact is that, you know, it's like in anyone's business.
[00:27:45] If you were going to try to take whatever any of us does and put it on a 30 or 60 minute television show and keep everyone's interest, it has to be exciting and entertaining and funny or sad or whatever.
[00:27:58] And it has to move fast because if it was depicted in the way that it really is where everybody's super calm and collected and professional just wouldn't sell tickets.
[00:28:11] So, you know, the trauma center is always depicted as this slam bang someone's crashing and they're rolling a guy down the hall from a car crash.
[00:28:21] While someone yells out he's got a ruptured spleen and a head injury and I don't know how he knows that the guys on a stretcher.
[00:28:28] You know that right.
[00:28:30] It just just start name your stuff prepare the OR give me four units of blood.
[00:28:34] I mean, that's just not the way it is.
[00:28:36] There's a very kind of, I won't say it's boring.
[00:28:40] It's not boring, but there's a very it's a very methodical approach that we have.
[00:28:46] It's called the ABCs where we, you know, we check their airway and their breathing and there's a whole language that we use.
[00:28:53] And honestly, the sicker the person is the more quiet it should be.
[00:29:00] And the more calm everyone needs to be obviously that the leader has to set the example and and remain like, you know, a Sphinx very calm and very thought thoughtful.
[00:29:13] But but anyway, so yeah, there's all kinds of things that we actually talk about the whole TV thing a little bit.
[00:29:20] And one of the things that always bugs me is like everybody's always fishing around for bullets, you know, like down a deep hole with a clamp or something and they pull the bullet out like, oh he saved now and they drop it in a little can and it's nonsense.
[00:29:35] We rarely go and find a bullet.
[00:29:38] We rarely go fishing for bullets.
[00:29:40] And we don't would never go down a hole might be in the operating room with a belly open that you'd feel the bullet and take it out but so that's one.
[00:29:48] The other is that on television, everybody that dies seems to do though and do so in like 10 seconds. People don't usually, you know, it takes you a while but that wouldn't really be entertaining if you know you watch someone, you know, exsanguinate over over 15 minutes or something.
[00:30:07] So.
[00:30:08] So I think there's they take liberties, but it's generally done. And the other thing is that people seem to have remarkable abilities. I made the mistake of turning a medical TV show on the other day that one of my friends who's a doctor recommended and I'm watching as this person makes a diagnosis as usual with no information at all.
[00:30:29] He just makes a diagnosis and then the ER doctor goes into the cardiac cath lab and does the cardiac cath like he's not a cardiologist. He's just, you can just do anything right so we actually have kind of different lanes and you know we all work together that when it comes to trauma and general
[00:30:48] surgery that quarterback is usually that trauma slash general surgeon. But you know we all have our specific expertise, you know, it's not like one guy knows how to do everything. Yeah, and you know I am my in my role in law enforcement I was assigned to Grady Hospital here in Atlanta.
[00:31:07] And so I can definitely attest to what you're saying. As a matter of fact, most people coming in there when their loved ones are being brought in they're expecting the frenetics and they're like thinking that the doctors are not really caring about their particular love one because they're not panicking.
[00:31:24] You know what I'm saying? They just calmly doing their thing and it's like, but y'all got to do some we're taking care of them and don't worry. You know what I'm saying?
[00:31:32] So I definitely can attest to that.
[00:31:37] One of my partners was the chief of surgery at Grady. Okay, and it and you know, both of us are had did, you know, we both ran.
[00:31:50] The training centers for military. So when I was in Miami when he was in LA, he ran the Navy trauma training center and I ran the army one.
[00:32:01] And basically all the teams that 24 person teams that would get deployed.
[00:32:07] They would come through the centers and kind of have a tune up before they left.
[00:32:14] And but yeah, so we're we try to maintain a calmness. Yeah.
[00:32:21] One thing I wanted to get to before closing out there's a couple of questions I want to ask you.
[00:32:28] But before I get to the ultimate public policy question in a chapter managing the public you talk about Americans getting bigger, bigger.
[00:32:37] And as sometimes you put patients on diets before surgery.
[00:32:41] Tell tell the listening audience why that is important.
[00:32:46] Sure. So there is in my mind no question that operating on people who are substantially overweight. I don't mean like 10 pounds.
[00:32:56] I mean, they're 100 pounds or more overweight is much more challenging for the surgeon things that would be relatively easy operations become very, very difficult.
[00:33:07] Because it's harder to get to the organs that you're trying to deal with.
[00:33:12] The try it's harder to fix things or remove things.
[00:33:15] It's also more stressful on that individual because they they often have underlying medical conditions that make them sicker and just the recuperation phase is harder.
[00:33:32] Because it's harder to get them up and moving sometimes and and.
[00:33:39] You know, it puts a lot of stress on wounds, for example, being overweight and there was a higher risk of infection because the guys there's more radicals tissue and there's a there's a number of different issues.
[00:33:51] There's sort of there's sort of the getting the operation done and then there's the recovering from the operation and both those things can be made.
[00:33:59] Much more difficult in the patient who is substantially overweight.
[00:34:05] Yeah.
[00:34:07] So that's that should be encouraging to my folks listening, including myself.
[00:34:11] You know, it's one thing to get in shape to try to stay healthy and all that but if something does happen to you.
[00:34:18] It'll be a lot easier for you to recover and to be treated if you're more in shape.
[00:34:26] Correct.
[00:34:27] Right.
[00:34:28] So now you have the doctor confirmed that so okay, so let's close this out.
[00:34:34] Why what are your hopes for the future of trauma care here in America?
[00:34:41] Well, one of my hopes is that we have more folks like yourself advocating for safety measures.
[00:34:49] Those of us in trauma, we have plenty of work to do. And if we didn't have trauma, we have lots of general surgery patients that are sick people with appendicitis and gallbladder attacks and colons that are instructed.
[00:35:02] We would love to have half the volume of trauma that we see, you know.
[00:35:07] So I think it's all about injury prevention. And that's what I'm hopeful in the future that there will be more things, more efforts towards that in the area of cars.
[00:35:21] Cars are remarkably safer than they were in 1960.
[00:35:25] The likelihood of dying per mile driven was six per 100,000 miles.
[00:35:30] It's now down to like one down to one. It's dropped by over 500%. That's amazing, right?
[00:35:38] But so cars are safer roadways are safer. We're doing better.
[00:35:44] You know, some of these obvious safety things like you mentioned before like seatbelts and helmets that those need to be widely, you know, part of our life.
[00:35:54] And then when it comes to wounding each other, the lethality like I said before of your fist is way, way less than it is from a gun.
[00:36:04] And we need information. We need to be doing research to better understand what are the kinds of policies that need to be in place to get this under control because, you know, we have way too much gun violence in this country.
[00:36:21] And I'd like to see it be gone.
[00:36:25] Is there anything that can be done from the hospital end?
[00:36:34] Is there anything that you think needs to be done or you think that the technology has improved and the quality of the staff, the number of people, you know, going to medical school and graduating and getting into profession.
[00:36:51] Are those things okay or are also things that need to be improved upon?
[00:36:57] I don't, I don't think there's any question. All those things can be approved upon. I mean, I think that, you know, the quality of education is high. It could be better.
[00:37:07] The quality of our hospitals is high. They could be better, you know, resource wise. And there are models in the country of real, real excellence.
[00:37:16] I mean, like not necessarily more costly but more, but better use of their money. And the best example I can think of is like University of Maryland, Maryland shock trauma.
[00:37:30] In the state of Maryland, which has about 6 and a half million people, essentially all the adult trauma goes to one big trauma center and all the pediatric trauma goes to one big, no, they have like maybe a couple of smaller trauma centers,
[00:37:44] but really they've regionalized it and elevated the quality immensely. In contrast, you have places like Boston where you have six trauma centers serving a city of like 750,000 with eight and a half million around it.
[00:38:00] And you think of how diluted the number of traumas are there relative to in Maryland. So, you know, when I was down in Miami, we were the only trauma center for Miami Metro day.
[00:38:10] And we were the one of the busiest places in the whole country, probably the whole world. Really high level, high quality and they had a rule that had been put in before I got there, which was that a half cent sales tax went to pay for Jackson and the trauma center and and the helicopter service and everything else so that we had enough money to take care of things and to take care of the people that couldn't afford it or whatever.
[00:38:36] And care was really excellent. So I think the regionalization of care could be better right now it's kind of financial and politically motivated. I think that there are some areas of the country that that could benefit from more trauma centers and others area areas that could benefit from less trauma centers and more regionalization but I think
[00:39:06] more efforts should go into injury prevention, safety measures, public awareness and maybe some intelligent, you know, constriction of the gun availability.
[00:39:20] Well, Dr. Cohn.
[00:39:23] Dr. Stephen Cohn.
[00:39:25] I am really, really glad that you came on this podcast to talk about this particular issue and to talk about your book.
[00:39:33] The book is called All Bleeding Stops.
[00:39:36] You can get that anywhere I take it.
[00:39:39] Yeah, the usual places Amazon and Barnes & Noble and through the Mayo Clinic press.
[00:39:47] It's a good book. It's a combination, you know, where you can see Dr. Cohn's expertise in the and his thoughts into the matter but it's also very entertaining because he's got all sorts of antidotes.
[00:40:04] Sounds like him and his family have been trauma patients.
[00:40:08] They're own.
[00:40:10] Unfortunately, you know, he's got some pretty cool quotes in there so it was a real good read y'all.
[00:40:15] So I encourage y'all to get it.
[00:40:18] How can people get in touch with you outside of buying the book?
[00:40:23] Well, I guess they could email me.
[00:40:26] I mean, it's not, I'm right now.
[00:40:30] I work at a part of his hospital in Bronx, New York.
[00:40:34] I don't have a website so that would have to be the way they get a hold of me but I'm happy to help anybody that needs me.
[00:40:43] What's the email?
[00:40:46] It's SM Cohn COHN911 at gmail.com.
[00:40:53] All right. So Dr. Steven Cohn, ladies and gentlemen, thank you for coming on.
[00:40:59] I appreciate you and what you're doing.
[00:41:02] We even get into talking about COVID and all the drama that you had to deal with there but, you know, I greatly appreciate your dedication.
[00:41:13] And like you said, you've been doing this for over 40 years.
[00:41:17] So just keep up the good work as long as you're willing to do it and thank you for coming on the podcast.
[00:41:24] Thank you so much for having me, Eric.
[00:41:27] I appreciate it and enjoyed the time with you.
[00:41:30] Yes.
[00:41:31] Thanks a lot.
[00:41:32] All right guys and we're going to catch y'all on the other side.
[00:41:34] Okay.
[00:41:35] Bye bye.
[00:41:36] All right, doc. Thank you.
[00:41:38] Thank you.
[00:41:39] That was great.
[00:41:40] Yes, sir.
[00:41:43] All right, sir. Have a good one.
[00:42:08] All right and we are back.
[00:42:10] And so now it is time for my next guest.
[00:42:14] Suleja Mosin.
[00:42:17] Suleja Mosin is the senior Washington correspondent for Bloomberg News and host of Big Tech DC podcast covering policy, politics and power in Washington, D.C.
[00:42:32] In Ohio native, she previously lived in Oslo, Norway and in London.
[00:42:38] And today we are going to talk about her new book, Paper Soldiers.
[00:42:44] So ladies and gentlemen, it is my distinct honor and privilege to have as a guest on this podcast, Suleja Mosin.
[00:42:52] All right, Suleja Mosin. How are you doing, ma'am? You doing good?
[00:43:11] I'm doing great. Thanks for having me on.
[00:43:12] Well, I am really, really honored to have you because I want to get into your book and hopefully we'll have enough time to do it.
[00:43:22] But we'll get some things done.
[00:43:25] But I also want people to kind of understand a little bit about you.
[00:43:29] So first thing I usually do is offer a quote to the guest, something that they may have written or something that relates to what they're doing.
[00:43:39] So your quote is, faith in democracy and faith in markets go hand in hand.
[00:43:47] What does that quote mean to you?
[00:43:49] So that is actually one of the lines from former secretary Bob Rubin from the Clinton era that he wrote after the January 6th insurrection.
[00:44:02] And it was right around the time that I also was thinking about writing a book on the Treasury Department and on the dollar.
[00:44:09] And it's the sentence that really helped me hone in to why writing about this agency, the Treasury Department is so important because in that moment our faith in democracy was being shaken and tested.
[00:44:29] We saw that kind of play out on January 6th and Capitol Hill, on Capitol Hill.
[00:44:36] And it made me realize that if democracy is under question, then markets that are underpinned by the American financial system are also under some kind of threat.
[00:44:50] And so when I started writing paper soldiers, that's the overarching narrative.
[00:44:57] One of the overarching narratives of the book that we need a strong democracy to maintain the faith in markets that gives our country so much economic and geopolitical strength and all that is kind of underpinned in the dollar.
[00:45:14] So was that your main motivation for writing a book?
[00:45:19] It was one of the key ones. It was one of the ones that triggered the way I started thinking about the Treasury Department's importance in our daily lives and how we are able to at least pursue if not achieve the American dream.
[00:45:37] Okay. Now, I want to ask you a personal question before we get back into the book. Why did your mom say to you at the age of 15, I think you're going to be a journalist?
[00:45:46] That's a great question. Yeah, and you know the funny thing is that when my mom said that to me I kind of rolled my eyes and thought, oh well you don't know me very well like a teenager would.
[00:45:58] I look, I wasn't great at math science was hard for me.
[00:46:04] But I did show a writing talent from a pretty young age. In fifth grade I won this little this essay contest if you remember Dare the anti-drug program from the 90s.
[00:46:18] They had a contest. I entered it because I wanted the free teddy bear or the award that was the teddy one, the award. And then in eighth grade, so when I was about 13 or 14, I wrote an essay and the teacher really liked she kind of held it up to the class as the standard of which we should be writing in.
[00:46:37] And I think my mom kind of realized as mothers do now I have a teenager of my own that you should cultivate this talent and here is one job that could work for you.
[00:46:49] Yeah, and you've had a pretty interesting life but we won't get into all of those details but I did want to get that question in there.
[00:47:00] Why and one of the a lot of the questions I'm going to ask you kind of lean toward my love for history. Right.
[00:47:09] So why was America referred to as Hercules in a cradle? And what does Bretton Woods, New Hampshire have to do with that?
[00:47:20] Yeah, so when the country was first established in the 1770s there was a lot of the world, you know many of the world powers at the time were looking at America thinking this tiny little new democracy.
[00:47:36] It's a couple of colonies that broke off from Britain. It's not even going to last right everyone kind of just waited have waiting it out thinking at some point they're just going to fall back into the Britain the British Empire they were ruling the world.
[00:47:49] Their currency was the supreme their economy was the largest in supreme and so and this new family nation with such big talk but also kind of exciting there was so much hope and excitement about what was happening and then the states were expanding
[00:48:06] and economic growth through the 1800s was booming in 1880 the US overtook Great Britain in economic size and so it really was about to become Hercules but you kind of knew from its infancy that it was either going to be huge or was going to go bust very quickly.
[00:48:26] Bretton Woods. This is right toward the end of World War two.
[00:48:32] 40 the economic policymakers of 44 allied countries came together in the US to create a new economic brotherhood so that the world was so deeply integrated that we wouldn't go to war with each other and there wouldn't be world wars because this was the second one back to back that the world had faced.
[00:48:52] And by design the US currency was crowned King dollar to be at the center of the global financial system of all commerce and trade and that is just the moment that the US was no longer in the cradle it was the largest by economic size and also now the steward of the world's most important asset.
[00:49:13] Yeah and that's one of the things I've tried to stress on my show and throughout my political career when people talk about why does the United States have to have all this international involvement.
[00:49:25] I explained to him that was the deal we made after World War two we agreed to be the policeman of the world and we agree that the dollar would be the basis of currency in the world so I'm just glad I got somebody smarter me to validate that.
[00:49:40] How revolutionary of an idea was the concept of paper money, not backed by gold or any other precious metal but by the full faith and credit of United States government.
[00:49:52] Yeah what you're referring to is a concept from the 1860s right when the US was in the midst of a civil war treasuries coffers were empty. We needed cash the country needed cash and so the Treasury Secretary Sam and P Chase saw a little bit of a wild idea someone had proposed that we should have a paper currency that's just backed by credit that yeah if you need the gold will give it to you will give you goods for it for in exchange for this piece of paper and there was a long period of time when the US was in the middle of the
[00:50:22] middle of the war and the US was a filmmaker who called it quote immoral that to have a piece of paper, rather than a, you know, a commodity like a metal silver gold created by God underpinning currency that just seemed wild that paper can be burned up.
[00:50:42] And it you know at the time it's kind of like we're seeing this new country still not 100 years old. Maybe this is going to be the moment of demise when they create this paper currency.
[00:50:54] Right and and the big momentum was during the Civil War, I guess with Mr chase as a treasure that was kind of the scenario.
[00:51:04] Yeah, that's when he realized that he needed to do something creative to find a way to print some money to keep the war efforts going and it actually helped the north.
[00:51:14] It is, you know, it assisted the north in winning because very quickly, the southern states that had a couple of different currencies in play started using the northern dollar currency.
[00:51:29] The first time it was printed, you know, green on one side without quite the sophisticated watermarks and everything that we have in need now.
[00:51:39] But that infiltration of that currency into the south helped to tip the scales as the north started to win.
[00:51:48] So you mentioned in the book that one of our US treasures James Baker failed an economics exam.
[00:51:55] I barely survived my econ class so I need you to break down some things to me in my audience. One, what are the pros and cons of a strong US dollar.
[00:52:09] So a strong US dollars first of all there's two definitions to a strong dollar.
[00:52:14] The first one is dollar hegemony so it's centrality in the world that everyone needs the dollar in order to engage in global commerce.
[00:52:23] That's one definition. The one that we're going to talk about now is the definition of its exchange rate value.
[00:52:30] So how many goods it can buy in a foreign country or how many goods we can sell to someone purchasing in a foreign currency.
[00:52:37] So a strong exchange rate for the dollar is good for American consumers in a couple of different ways.
[00:52:45] The key one being that then we are able to as American consumers buy more overseas goods.
[00:52:52] American consumers drive the US economy which drives the global economy so our purchasing power is stronger.
[00:53:00] We can buy more goods because we get more foreign goods because we have a strong exchange rate.
[00:53:07] So anyone selling anything in Japanese yen or the Vietnamese dong or the Chinese Yuan we can buy more of it.
[00:53:16] Now the negative side also has to do with the American manufacturing sector and the consumer because a strong exchange rate for the dollar means that the American export industry.
[00:53:30] American made goods struggle in markets to sell their goods.
[00:53:36] If you think about it in the early 2000s and teens Walmart didn't stock a lot of made in America goods because they were too expensive to buy.
[00:53:46] And foreign countries also weren't buying American made goods because the dollar was so strong they couldn't afford those goods.
[00:53:52] And so the negative is that you have a bunch of states that used to thrive.
[00:54:00] You have local economies that were company towns built up around manufacturing and those plants and factories rusted and so amazing places like Ohio which is where I'm from and Pennsylvania and West Virginia became called the rust belt states.
[00:54:17] Right. And you tell the story about a particular company that had been one of the largest 10 10 steel making companies in the world and how the strength of the dollar had a negative impact on that particular company.
[00:54:40] And that's an aspect you know that a lot of people regular people don't understand.
[00:54:47] But yeah just kind of expound real quick on that particular instance.
[00:54:52] Yeah.
[00:54:53] So in the town of Weirton West Virginia you had a company that made anyone in the 60s or 70s you pull out a tin can can peaches can beans whatever that tin was most likely made in Weirton West Virginia.
[00:55:10] And so that town was built around that economy.
[00:55:14] You had people who worked in the factory and then those people needed to go to the grocery store get their cars fixed by a car by a close have dinner out go to the movie theater.
[00:55:23] So that whole economy was a company town was built up around this and slowly as steel making moved overseas because it was cheaper to produce the product overseas.
[00:55:38] Then American jobs started to disappear that those plants needed to shut down they couldn't keep up.
[00:55:45] Those companies didn't have enough cash on hand to invest in upgrading infrastructure and technological advances that other that companies similarly like similar companies and other countries were able to tap into as they slowly just got further and further behind the curve.
[00:56:04] So the very first chapter of the book is entitled surviving Donald Trump.
[00:56:10] We understand we survived his style of governing and his handling of the pandemic and January 6 what did America survive as it relates to the US dollar.
[00:56:25] Yeah, the president president Trump.
[00:56:30] He he really did hear the cries and realize that there were so much economic scarring in parts of America that had been ignored for a long time.
[00:56:39] And so he realized that a weaker exchange rate would actually be a quick fix and a necessarily necessary fix for these.
[00:56:52] For these companies and so he talked about intervening in the currency about aggressively using government cash to affect the rules of supply and demand of the dollar and that would actually shake the world's faith.
[00:57:14] In the currency that underpinned so much of global trade and so that would is that sort of politicization of the dollar would actually not be good for the country itself.
[00:57:27] And in the first chapter I lay out how Stephen Mnuchin actually was the person who kind of stood in the way Treasury Secretary Stephen Mnuchin at the time stood in the way of some of those instincts that Trump had.
[00:57:39] And you know to be fair and to be transparent as probably the first positive thing I've ever heard about Steve Mnuchin during my time and that your reporter you deal with these folks on a daily basis.
[00:57:54] But to read that he stood in the gap to make sure that Trump didn't overreact which he tends to do, in my opinion.
[00:58:09] And basically he did his job to make sure that the dollar remained viable and stable.
[00:58:18] Yeah in the book I do lay out that that plan did not go outside of the Oval Office. So Trump did not take any further steps was not able to and did not take any further steps, but he did very seriously consider it and after decades of the US trying to maintain a very stable rhetoric and
[00:58:38] activities and dialogue and economic diplomacy around currency policy it would have been very very disruptive.
[00:58:47] All right, so the part of the book that's gotten you the most attention is dealing with how the US dollars weaponized when it comes to sanctions.
[00:59:00] So explain that process and in your opinion are sanctions effective for the most part.
[00:59:10] Yeah that the dollar. It was 911 when the US kind of really honed in on the fact that the dollar gives the US the power to export its own foreign policy and geopolitical objectives.
[00:59:25] And the Twin Towers came down two weeks later George W. Bush came to the Rose Garden and he stood next to his Treasury Secretary Paul O'Neill, and he told the world that at midnight the night before with the stroke of a pen he
[00:59:41] launched the war on terror. Now that launch did not start with a military tank rolling into a foreign country it started with economic sanctions and the Treasury getting unique authorities to track financial footprints to see how was it that terrorists were able to
[01:00:00] finance that attack and how can we choke off access to money for these terrorists so they can't finance anymore or how can we see the way you're there using the global financial system the way they are using and maybe abusing the dollar in order to engage in these malign activities that threaten American national security
[01:00:22] and our borders and global security. And since then the US has turned to the to sanctions more and more because it is a space between war and words by by words I mean diplomacy when talking to another country over disagreements
[01:00:40] often the next step has been war kinetic action, but with sanctions you have this very large space in between that you can slowly tighten like a vice to force another country or an adversary to change its alleged bad behavior and that's been used to sort of curtail nuclear programs and other things
[01:01:04] and humanitarian problems. And now we saw you know in 2022 in February 2022 that the US led the world in imposing the harshest sanctions ever seen on Russia.
[01:01:19] And those sanctions it's been two years, I get asked a lot like you said about the efficacy of those sanctions and the way I look at it is actually that sanctions. Okay so yes the sanctions came down for a while it was really painful for the Russian economy, and it was actually
[01:01:36] painful for the American economy because our gas prices did go up when all that Russian oil had to come off markets. Russia adjusted, it basically transformed from a regular economy to a war economy, and China and a couple of other countries have helped Russia
[01:01:56] survive way more than I think the US led coalition initially had expected.
[01:02:04] What people forget is that when the war started, there was thinking in the US intelligence community that it's a 72 hour operation in Kiev could fall and two years later, the war is ongoing yes but Kiev has not fallen.
[01:02:19] On the other hand, you can't ignore the fact that Russia has imported a billion dollars worth of microchips from the US and from Europe that is that supports its war technology. And that's all without violating sanctions.
[01:02:35] So, the thing is though that sanctions are a tool, not a policy. So you can say that the US is foreign policy has succeeded or failed, but to say it this sanctions failed is kind of like saying my house fell apart, the hammer failed.
[01:02:53] I'm glad you're asking this question about hope.
[01:02:58] So, I do, I do like to highlight that for there's a lot of foreign threats that we have to deal with.
[01:03:04] And I think that's one of the things that we need to do is to make sure that the US government is not going to be able to do anything about it.
[01:03:14] Yeah, I'm glad you're asking this question about hope.
[01:03:18] So I do, I do like to highlight that for there's a lot of foreign threats that people talk about Russia, a China led coalition other countries coming together and trading in their currencies jointly outside of the US dollar and if that means Oh,
[01:03:32] D dollarization the power has waned or flattened. But what I think, and what I see is that no foreign threat is going to be as bad for American dominance and dollar dominance as our domestic problems, because in order to address our biggest threat to our superpower status and the
[01:03:55] dollars centrality, we need to bring down our deficit it's at $34 trillion right now you cannot possibly bring that down. Unless you have bipartisanship in Congress right now we have a Congress they can't agree on what color the sky is.
[01:04:10] They see different shades of blue green and pink I think so.
[01:04:15] So until we can come together.
[01:04:18] You know, we will continue to look uncertain overseas now. The reason I'm hopeful is that one were a strong democracy. We are so because we're not afraid to become very self critical.
[01:04:31] And while it feels really painful we're in that moment now it's very nasty.
[01:04:36] We've been here before in previous decades and our 200 year history had some very ugly moments they play out in the world stage, and at some point we fix it and become stronger so I do have hope that as long as we're a strong democracy.
[01:04:51] We can maintain rule of law independent institutions pre and for elections.
[01:04:56] We can continue to be a leader in the world, and actually have factoid just from today's markets to point to you that reveals that the US dollar remains important and remains a strong worlds reserve asset if you look at markets right now there is some angst everywhere that Iran could strike against Israel and because
[01:05:19] of that investors are fleeing to the dollar because it is a safe haven and that right there shows that when there is crisis people still trust in the dollar its credibility its integrity the government that backs it because it is still a dominant currency.
[01:05:36] So I think paper soldiers should be required reading for every business and finance major in the United States.
[01:05:44] Having said that how can people get your book and also how can people get in touch with you, other than watching you on Bloomberg.
[01:05:54] So the book is called paper soldiers how the weaponization of the dollar changed the world order it's available wherever you can buy books and audio books your favorite retailer Amazon books a million all the independent places that you can get books.
[01:06:09] And I am frequently on Twitter and LinkedIn that is the best way to get my attention.
[01:06:14] All right, so Salaia Molson.
[01:06:17] I am so honored that you were able to take the time off your schedule to come on the podcast.
[01:06:23] Talk about this book and talk about something that a lot of people need to understand that is more than just certain issues that you see.
[01:06:33] But there's some other things that are going on and if you read this book you'll you'll understand there's a lot of stuff that goes on behind the scenes.
[01:06:40] So I appreciate you taking the time to come on the podcast. Thank you.
[01:06:44] Appreciate you having me on.
[01:06:46] All right guys we're going to catch up on the other side.
[01:06:49] All right, and we are back.
[01:07:02] So I just want to thank Dr. Cohn and Miss Molson for taking time out of their busy schedules.
[01:07:10] Not just in promoting their books but also as far as their day to day lives as you heard Dr. Cohn was getting calls while we were doing the interview.
[01:07:20] I mean he is a doctor for all practical purposes and you know Miss Molson, I'm really really honored and thrilled that she took the time to put our podcast on her schedule because her book is like one of the New York Times bestselling books.
[01:07:39] She's basically been on demand.
[01:07:44] So again I'm honored for both of them to come on and I hope that y'all got something out of that.
[01:07:51] OJ Simpson passed away as we were putting this show together and you heard Grace mention it in the news thing.
[01:08:05] And I did something on that.
[01:08:08] I basically stated my opinion about his life and times on Patreon.
[01:08:15] So if you want to hear what I have to say, subscribe to patreon.com slash a moment Eric Fleming and I had something to say.
[01:08:29] So anyway y'all do that, y'all keep listening to the podcast and until next time.