The Daily - The Booming Business of Cutting Babies’ Tongues

Episode Date: February 19, 2024

A Times investigation has found that dentists and lactation consultants around the country are pushing “tongue-tie releases” on new mothers struggling to breastfeed, generating huge profits while ...often harming patients.Katie Thomas, an investigative health care reporter at The Times, discusses the forces driving this emerging trend in American health care and the story of one family in the middle of it.Guest: Katie Thomas, an investigative health care reporter at The New York Times.Background reading: Inside the booming business of cutting babies’ tongues.What parents should know about tongue-tie releases.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday.

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Starting point is 00:00:00 From The New York Times, I'm Sabrina Tavernisi, and this is The Daily. A Times investigation has found that doctors are increasingly performing unnecessary medical procedures that generate huge profits while often harming patients. while often harming patients. Today, my colleague Katie Thomas on the forces driving this emerging and troubling trend in American health care and the story of one family caught in the middle of it. It's Monday, February 19th. So Katie, tell me about this investigation. So I am a healthcare reporter who writes about the kind of intersection of healthcare and money. And I was working with two other colleagues,
Starting point is 00:00:58 Sarah Cliff and Jessica Silver Greenberg. And together, the three of us had long been interested in, are the medical procedures and the tests and other things that we get when we go to the doctor or into a hospital, are they always necessary? But what we were really interested in exploring was not just, are these procedures and are these tests, et cetera, are they necessary? But in some situations, could they actually be harmful to patients? And so that's what we decided to try and take a look at. And so we had gotten started in our reporting when we got a tip. And it was from a mom in Boise, Idaho. And her name was Lauren Lavelle. Hi. Nice to meet you. Hi. How are you? And my colleague Jessica Silver-Greenberg
Starting point is 00:01:48 and I went to her house to meet with her. And where does her story start? I am a mom of two. I live in Boise. My daughter June is four and I have a 17-month-old Flora. Her story starts when Lauren gets pregnant with her daughter, June. So by the time we got pregnant with June, November of 2018, about eight months after we had the miscarriage, I think I was just more hesitant and nervous than anything.
Starting point is 00:02:15 Lauren and her husband had had trouble conceiving, and so they were so happy when they learned that they were going to have June. And like both first-time parents, they were also a little bit nervous. But being type A and super prepared, I did all my homework. We hired a doula. I wanted an epidural.
Starting point is 00:02:34 Having an actual childbirth absolutely was not for me. And Lauren is very organized. She's always on top of everything. And she makes all sorts of plans. And she gets a lot of different providers lined up top of everything. And she makes all sorts of plans. And she gets a lot of different providers lined up ahead of time. I didn't know anything about breastfeeding, like zero things. Including one that she has hired to help her with breastfeeding.
Starting point is 00:02:56 Where did you find out about her? So I asked our doula for a list of recommendations. And she gave me a very short list. At the time, there were very few lactation consultants in the Valley. And Melanie was one of them. She ended up deciding to work with Melanie Henstrom, who is a local lactation consultant in Boise. She sold this package at the time.
Starting point is 00:03:18 I don't know if she still did, but it was like prenatal visit, breastfeeding class. And then she'll come to the hospital and help you latch. And then she'll come to the house a couple times after. And I thought, well, this sounds perfect. Great. You know, I'm covered there. So one week after her due date, she gives birth. And it was a difficult labor. It took 24 hours. Lauren was completely exhausted. But once June arrived, the family was very, very excited to have her.
Starting point is 00:03:40 And I remember June coming out and that surreal feeling you have when you see your first baby for the first time. Like, oh my God, like there's a baby in the room. And June was a healthy baby, but she was having trouble breastfeeding. She would not latch. Like she wouldn't even attempt. She would scream. It was the only time she ever cried if you tried to make her breastfeed. And so as her pediatrician was making the rounds, they noticed that June was having trouble and said that June's tongue is really tight. We can clip it if you'd like.
Starting point is 00:04:12 And that they could clip it. What does that mean exactly, Katie, clipping her tongue? What it means is that there's a small percentage of babies whose tongue is very tightly tethered to the bottom of their mouth. And for a very small percentage of babies, their tongue is almost tied so tightly down that they can't nurse well. So it makes breastfeeding very difficult if a baby has a tongue like this. Exactly. If you bottle feed your baby, the baby can basically adjust and make do. But if you want to breastfeed, some babies have trouble basically latching on to their mother when they don't have that tongue motion. And so some version
Starting point is 00:04:53 of clipping these tongue ties has been done for centuries. Midwives have been doing it, pediatricians do it, and traditionally what it's been is a very quick snip right underneath the tongue just to loosen up the tongue. And traditionally that procedure is extremely straightforward. There's little to no follow-up care. And basically the baby naturally heals as it learns to breastfeed. And so we said, okay, you know, they explained that it was completely painless. They do it with scissors. She wouldn't even feel it. And all of that was true. They clipped it. I don't even think she woke up. But in June's case, it didn't seem to help much.
Starting point is 00:05:30 And she and Lauren were still having problems breastfeeding afterwards. So while she's still in the hospital, she calls up the lactation consultant that she had hired, Melanie Henstrom, just to let her know what was going on. And from talking to her on the phone, Melanie said that the situation was actually much worse than Lauren had thought, and that Lauren's baby needed another tongue tie procedure, a deeper cut under the tongue. How did she make this diagnosis, Katie? Was it over the phone? How did she know this?
Starting point is 00:06:01 Yes, Lauren told us that it was from a phone conversation. And in addition to that, she also warned her that basically, you know, Lauren and her husband should really take this seriously and consider getting it done because if she doesn't get it fixed, it could lead to a whole host of problems beyond just problems breastfeeding. She'll have scoliosis and she'll suffer from migraines and she'll never eat and she'll have a speech impediment. She won't sleep. I mean, just like the long list of things over the phone. And Lauren starts panicking. I mean,
Starting point is 00:06:33 first of all, I felt I've never felt more terrible in my life than that first day or so after giving birth. Like the come down from the hormones, the drugs, all of it, the sleep deprivation. And then, you know, here was this baby we'd wanted, we were told we probably would never have after one miscarriage. And she's so perfect. Like, the most beautiful baby I'd ever seen. And you think that she has some deformity that's going to ruin her. But Melanie says it's okay.
Starting point is 00:06:58 You know, she has a solution. And she tells Lauren that there's a dentist in town who can handle cases that are as severe as June's. A dentist? Why a dentist? Well, there's a procedure that's done in a dentist's office that's a laser surgery. And dentists use this high-powered laser machine that can quickly cut the flesh that connects the lips and the cheeks to the gums. So according to Lauren, Melanie tells her that by chance, this dentist has an opening
Starting point is 00:07:29 because she said a family coming in from Oregon had just canceled their Saturday appointment. So I thought, okay, wow, you know, people are coming in from Oregon to see him. So we talked about it. We both felt unsure, but we said, well, let's at least take the appointment and then we can at least meet with the dentist. And also someone can look at our mouth and assess. And so Lauren agrees to go in and meet the dentist.
Starting point is 00:07:56 Like, I think some people, when they hear this story, think like, why would you believe that? Like, it just sounds so scammy. But to me, there's a lot of things that you hear in the hospital that sound insane. Like, it's no different than someone saying, like, your baby's orange because their Billy Rubin's lovers are too high. So we got to go put them under these lights. Like, that sounds insane. That sounds more insane than, you know, your baby's having a hard time eating because their tongue is too tight and it needs to be cut. Like, that seems rational, actually. And all of this seemed really weird to Lauren at the time. But, you know, in the context of
Starting point is 00:08:31 the hospital and having a baby, lots of things about health care are weird. So one day after they got back home from the hospital, Lauren and her husband pack up the car and go to the office early in the morning. You know, I was wearing my hospital diaper and an ice pack up the car and go to the office early in the morning. You know, I was wearing my hospital diaper and an ice pack. Took the elevator up to his office. And what happens? So Melanie greets them at the door. They sign some paperwork.
Starting point is 00:08:58 And pretty soon the dentist, Dr. Samuel Zink, arrives. And then he like very briefly, you know, very briefly looks in her mouth and is like, yeah, she's got, you know, whatever, however he classified it. Grade four, whatever he says, class four. And she has a lip tie, which, you know, that had never been mentioned to us before. So it's very much like on the spot, like this new piece of information. You know, pretty quickly, the dentist diagnosed June as having a couple of ties. He confirmed that she had a tongue tie, and he said it was severe. He also said that she had tightness under her top lip called a lip tie.
Starting point is 00:09:34 And so the baby actually needed to get two cuts. And again, Lauren said that the dentist and the consultant told her how important it was for her to do this for her baby. One of us says, like, you know, what happens if we don't do the procedure? Like, what are our alternatives? And it was, like, basically, like, there's no alternative. Like, you have to do this. Otherwise, like, again, long, long... So Lauren and her husband decided to do it. But before the procedure starts,
Starting point is 00:10:00 Melanie actually stopped Lauren from coming into the room. Melanie turned around and put a hand on my shoulder and said, oh, no. And I said, oh, am I not going with you? She goes, well, we can't tell you no, but, you know, if you hear her cry, it'll impact your milk supply, like adversely. What do I know? So I said, oh, okay. And she pulled out the white noise machine and said, what do you want to listen to? And I had no idea what she was talking about. I had no idea what it was. And so then she just turned it on, white noise, and left.
Starting point is 00:10:35 What happens next is Melanie turns on a white noise machine in the room. And that was the moment that I was like, get your baby and get out of here. And I didn't listen to it. It was like all of my mom intuition firing, being like, this isn't right. You know, it's like, I don't know how to describe it, but like a full body, you have to get your baby and get out of here. And I just ignored it. She said her maternal instincts really kicked in and she just had this instinctive fear about the procedure and whether June would be okay. But the procedure itself was very quick. Within just a couple of minutes, Melanie returns with June. And she was screaming, like screaming, and so worked up. This was like. Like, screaming. And so worked up. This was, like, hysterical, inconsolable.
Starting point is 00:11:29 And she was also choking on something, like, gagging. And June was so worked up. Lauren had only had her for a couple of days, but she said that this was on a different level than any other way she had ever seen June crying. And June just wouldn't stop crying. And she looked over to Melanie and Lauren said that she remembered Melanie saying this was very typical. And so they pay the dentist, they pay $600 for the procedure, and then they go home.
Starting point is 00:12:02 And what happens? and then they go home. And what happens? Over the next several days, June did not get better, you know, as Melanie had assured them. You know, she was basically inconsolable, Lauren said, just crying hysterically. And Lauren and her husband, you know,
Starting point is 00:12:19 they don't know how to comfort her. They're new parents. They've only had a baby a couple of days. And, you know, they're almost beside themselves. There was nothing we could do. And I remember finally I said, like, this is not normal. We're going to the emergency room. And they decide to go to the emergency room where a doctor looks inside June's mouth and finds a large sore in her mouth that he says is probably causing her so much pain.
Starting point is 00:12:46 And so he said, you know, it breaks my heart to see a sore that big in a baby this small. It was like the floodgates opened and like there was nothing but guilt and shame, like unmanageable guilt and shame. Like what have we done? Who are these people? What have I done to my baby? Will she ever be the same? Like, what did I do? So at this point, Lauren is really understanding that her intuition about this surgery was probably right. And that she and her husband may have really made a mistake with this.
Starting point is 00:13:23 What does June's recovery look like? So June never did end up breastfeeding successfully, which was the main reason why Lauren and her husband had decided to do this procedure. That was the whole point, right? That was the whole point, right. And over the next couple of years, June had a number of issues that, you know, there's no official medical diagnosis for, but Lauren has attributed a lot of her behaviors to what had happened to her when she was just a few days old. I mean, you couldn't close the fridge door too loud or else it would like set her off or, you know, we would attempt to take her for a stroller walk on the green belt,
Starting point is 00:14:01 which is the walking path. And she'd be asleep in her car seat, you know, stroller, and someone would try to pass this on their bike and like ring their bell, and it would startle her and it would just like set her off. So she just was very, very, very fragile. So Lauren just wanted to get answers. And she really wanted to hold Melanie and the dentist accountable. So she gathered all of the paperwork that she had, texts, emails, other correspondence, and she went to the Idaho Board of Dentistry where she filed a complaint against the dentist. And then she also went to a professional organization
Starting point is 00:14:39 that certifies lactation consultants and filed a complaint with them as well. And did she get anywhere with either of them? At first, no. The Idaho Dentistry Board didn't want to investigate, and Lauren appealed, and she lost her appeal. And she didn't initially hear back at all from the lactation board.
Starting point is 00:14:58 No one wanted to take responsibility. That's the thing. No one wanted to stick their neck out there. What's the alternative? The story never gets told. And that's when she decided to reach out to us. And after our story came out, the lactation board finally told Lauren
Starting point is 00:15:14 that they were investigating Melanie. And Katie, you guys were reporting the story. I'm assuming you reached out to both the dentist and to Melanie. What did they say? Beyond a very brief phone conversation that I had with Melanie in which, you know, she defended her work and she said that she had a number of very satisfied customers, she didn't respond to detailed questions about Lauren's story or the stories of her former clients. And Dr. Zink did not respond to our
Starting point is 00:15:46 request for comment, but he did tell the dentistry board that Lauren's baby's procedure was uneventful and that an extremely small percentage of patients do not respond well to the procedure. And how big of an issue is this, Katie? I mean, how common is it for mothers to have an experience like Lauren's? So after we got the tip from Lauren and we dug deeper into her story, we found ourselves really surprised by how big this industry was for tongue tie releases. And in part, it's been driven by this movement for breastfeeding and the Breast is Best campaign and a growing number of parents who are choosing to breastfeed their children. In turn, that has sparked this big boom in tongue tie releases. campaign and a growing number of parents who are choosing to breastfeed their children. In turn, that has sparked this big boom in tongue tie releases. One study that we found showed that these procedures have grown 800% in recent years. Wow.
Starting point is 00:16:38 Yeah. And also, as we started talking to other parents around the country, we learned that some of them had similar stories to what Lauren had told us. There's plenty of instances where there's no harm done to the baby at all when they get these procedures. But we also found cases where babies were harmed, you know, where they developed oral aversions, which basically means that they don't want to eat because they fear having anything put in their mouth, including a bottle. We found cases where babies became malnourished, had to be hospitalized. We found more than one instance in which babies had to be given a feeding tube just weeks after the procedure.
Starting point is 00:17:21 So these sound so painful and awful for a newborn, these problems. But I guess, you know, there's always a risk, Katie, in any medical procedure, right? I mean, how much of this is just the risk you sign up for when you agree that your baby should have a surgery? Well, that's true. I mean, there's always a risk. But what you're supposed to do is weigh the risks against what the potential benefits of a procedure are. And when we really started drilling down into what those benefits were and into the medical research, we found there just wasn't a lot of potential benefit for these procedures, you know, if at all in many cases. Really? So the procedures don't have a medical reason to exist? That's right. We reviewed all of the best quality medical research on this. And, you know, other
Starting point is 00:18:14 than that old-fashioned snip under the tongue, which does show that in some cases it can reduce pain for breastfeeding mothers. But otherwise, all of this growth and all of these other more invasive procedures, we found there just wasn't good evidence that they help babies. And the more we looked into tongue ties and started to connect it to the other reporting we were doing, we started to realize that it was driven
Starting point is 00:18:38 by some really big forces in our healthcare system that really had the potential to harm patients. We'll be right back. So Katie, we talked about this new surge in a procedure that surgically unties infants' tongues from the bottom of their mouths, often needlessly, sometimes even harmfully. And you said your reporting found that this surgery was actually part of a broader trend. Tell me about this trend and what's driving it. So that's what this investigation was really about, to find the procedures that are doing unnecessary harm to patients
Starting point is 00:19:23 and to really kind of understand why this is happening. You know, like what's driving the prevalence of these procedures. And, you know, there's just a lot of unnecessary surgeries out there. But we decided to center our reporting on three particular surgeries that had the potential to harm patients in addition to tongue ties. We focused on a particular hernia surgery, a bariatric surgery, which can be overdone and cause harm, and a vascular surgery done on patients' legs to help us understand the forces that were at work that were driving all of this. And what did you find when you dug deeper into those surgeries?
Starting point is 00:20:02 Well, it's very complex, but we ultimately found three main drivers that were underlying all of these. First, there's a financial incentive for the doctors to perform these surgeries. There's also a real push from the medical device companies that make these surgeries possible. And last, there's a huge information void for solid medical advice that a lot of these doctors and companies take advantage of in order to push the surgeries. Okay, so let's start with the money, Katie. How exactly is that incentivizing doctors to perform a lot more of these procedures? Like, what are the mechanics of that? So the reality of our healthcare industry today is that in many places, you know, even in
Starting point is 00:20:42 places like nonprofit hospitals, the doctors who work there are not getting a salary, a straight salary that's just kind of you get paid for showing up to work that day. Instead, they're actually getting paid based on the procedures that they're doing, how complex those procedures are, possibly how lucrative. And it's not every doctor. There are still doctors that get paid salaries. But it's increasingly the case that doctors have at least a part of their pay is tied to the procedures that they're doing. Interesting. So the procedure is growing in importance in terms of actual compensation for doctors. Right. I mean, in part, it's kind of baked into the healthcare system that we've always had. You can even think about it as the small town doctor who operated his own independent
Starting point is 00:21:33 practice or her own independent practice. It's essentially a small business and they would get paid based on the patients that they saw. like increasingly, even in, for example, large hospital systems where you might think that a doctor is just getting paid a salary to work in a hospital. In fact, you know, a chunk of their bonus, for example, can sometimes be tied to the procedures that they're doing. And that is increasingly the case. Interesting. And so one particularly egregious example of this was at a hospital that's in New York, Bellevue Hospital. And basically what my colleagues found there was that they had basically turned their surgery
Starting point is 00:22:15 department into an assembly line for bariatric surgery, which makes your stomach smaller and can lead to weight loss. But what we found was that they were greenlighting patients that basically didn't meet the qualifications for the surgery, which is a serious surgery. And what they found was that there were several situations where people had very serious outcomes as a result of getting the bariatric surgery there. Okay, so this is an extreme case of a hospital turning to a particular surgery to drive profits. And it wasn't uncommon in your reporting, it sounds like.
Starting point is 00:22:48 No, it wasn't the only example, but it was the most striking. And when we reached out to Bellevue, they defended their work, and they said that their practices were helping patients who wouldn't otherwise get care. But, you know, our reporting was pretty conclusive that the program was turning through a record number of surgeries. So what else was driving this increase in harmful surgeries that you guys found? So we found it wasn't just the hospitals who were benefiting. The other major player that benefits are these companies that are making the tools and the products that doctors are using during the procedures.
Starting point is 00:23:21 And in order for them to sell more of their products, a lot of time what they end up doing is promoting the procedures themselves. So like medical device makers, like the company that made the laser in June surgery. Right. And, you know, they do this in a number of ways. They're giving them loans to help them buy the equipment. And in some cases, they're even lending them money to help set up those clinics where the procedures are performed. They're even lending them money to help set up those clinics where the procedures are performed. So they're really underwriting these doctors so that they can perform more surgeries and ultimately sell more machines. Yes. And the other things that they do is, you know, the laser companies, for example, they will host webinars where they will have dentists who frequently perform these procedures show other dentists how to do the procedures. We even discovered this conference that was created by one of the laser companies,
Starting point is 00:24:12 and it had kind of a wild name. The name of the conference was Tongue Ties and Tequilas. Oh, God. Right. It brought in dentists to talk about how to make money off the procedures, how to promote themselves on social media, how to actually perform the procedure. And, you know, of course, when they were all done, they got to celebrate with an open tequila bar. Okay. So a lot of this really amounts to these companies trying to popularize these procedures, basically, like to get the word out, even if the procedures don't really work or in some cases cause harm. Right. But they also play a big role in the other factor that's driving a lot of this, which is the information that they put out there about the surgeries. These companies often sponsor research, which doctors often rely on to guide
Starting point is 00:25:00 their practices. And part of what we found is that it can kind of create this echo chamber where doctors feel more comfortable and justified in doing these procedures when they have kind of this whole alternate universe that is telling them that it's okay to do these procedures. And in fact, it's beneficial to patients. So tell me about this echo chamber effect. The best example of this we found was a doctor in Michigan named Dr. Jihad Mustafa. He calls himself the leg saver.
Starting point is 00:25:33 And what we found was that he and several other doctors do these procedures called atherectomies, which is basically like inserting a tiny rotor rooter inside an artery to get the blood flowing. Dr. Mustafa in particular was not only a very prolific performer of these procedures, but he actually founded his own medical conference and even helped start a medical journal that was devoted to using these procedures. And like tongue ties, there's really no good evidence that these are actually beneficial to patients. And in fact, despite his
Starting point is 00:26:05 nickname as the Leg Saver, one insurance company told Michigan authorities that 45 people had lost their limbs after getting treated at Dr. Mustafa's clinic over a four-year period. 45 people lost their limbs? Yes. I mean, that is the ultimate version of harm, right? Right. Now, he did speak to us and he defended his work and said that he treats very sick people. And despite his best efforts, some of these patients are already so sick that they sometimes lose their limbs. And how much did he receive for each procedure? Doctors like him typically receive about $13,000 for each of these atherectomy procedures. Wow.
Starting point is 00:26:55 But we found that that misinformation or poor information also applied when doctors were learning new types of surgeries. Really? Like how? So one of the areas we looked at was the area of hernia surgery that I mentioned. And there's a particular type of surgery. It's a very complex version of a hernia surgery called component separation. And the expert surgeons that we spoke to said that it's difficult to learn and you have to practice it over and over and over again to get it right. But one recent survey of hernia surgeons said that one out of the four surgeons had taught
Starting point is 00:27:38 themselves how to perform that operation. Really? Yeah. Not by learning it from an experienced surgeon, but by watching videos on Facebook and YouTube. I mean, how unusual is that? I guess to me, it strikes me as very unusual. I mean, I think of, you know, learning about how to take my kitchen faucet apart on YouTube, but I do not think of a doctor learning about how to perform a surgery on YouTube. Right. And, you know, it has actually become increasingly popular in recent years, and there's not good vetting of the quality of the instruction. We even found videos on a website run by a medical device company that was intended to be a how-to for how to do these surgeries,
Starting point is 00:28:21 but the video contained serious mistakes. Wow. And Katie, all of these videos, some of them with serious mistakes, I mean, is this something that would be subject to medical regulators? Like, is there any kind of rules of the road for this stuff? You know, there's less than you would expect. Sometimes hospitals have rules about what sort of education their doctors need before performing a surgery. But we were surprised that there was a lot less regulation than we thought there would be, and much less vetting of these videos than we anticipated. So essentially what you found was this complex, oftentimes interconnected group of forces.
Starting point is 00:29:04 Device companies pushing their products, hospitals bolstering their bottom line, and rampant misinformation that, as you said, all really trace back to the same motivating factor, which is money. But wouldn't the fear of being sued for medical malpractice prevent a lot of this behavior? You know, this kept popping up during the course of our reporting. I do think we have this idea that anytime a doctor does anything wrong, they're going to get sued. But that just wasn't always the case in our reporting. You know, there's a lot of statutes of limitations, time limits on when somebody can file a lawsuit, and other ways that make it somewhat hard to
Starting point is 00:29:46 really hold a doctor accountable. One example is the regulatory organizations that oversee doctors. The one doctor that I mentioned earlier, Dr. Mustafa, state investigators had found that his overuse of procedures had led people to lose their legs. And yet he ultimately settled with the state and he was fined $25,000. That actually adds up to about two of these atherectomy procedures. So it sounds like malpractice is not necessarily going to be the route to rectifying a lot of this. But I guess I'm wondering if the federal government could actually rein some of this in, you know, before the patients are harmed. You know, it's possible, but this is just a very difficult issue. Some of the themes that we
Starting point is 00:30:33 explored in this reporting are really just firmly embedded in our healthcare system and the way that it works. The fact is that we have a for-profit healthcare system, right? So everyone from doctors to hospitals to the device companies benefit when more procedures are done. All of the incentives are pointing in the same direction. And so trying to find one or two simple solutions will probably not easily fix the issue as much as we all hope that it could. So is the lesson here be much more discriminating and vigilant as a patient? I mean, to get a second opinion when you're standing in front of a doctor or a dentist who's telling you that you or your baby needs a procedure? reporting on all of this was risky because people could hear about these harmful surgeries and start wondering if everything that their doctors tells them is a scam. And of course, while some of these procedures are harmful, a lot of procedures are life-saving. But ultimately for now, patients
Starting point is 00:31:36 are kind of left on their own to navigate what's a pretty complex and opaque healthcare system. When you have somebody standing in front of you saying, you should do this, it can be very confusing. Right. And this is something that Lauren talked a lot about, just how confusing all of this was for her. There's a lot of information that you're getting that is truly like someone is speaking a foreign language. And because they do it all day long, it's not user-friendly.
Starting point is 00:32:04 It isn't designed for the comfort or understanding of the person receiving the information. There is so much blind trust and faith that you have in the system, in the providers who are giving this information. You trust, like, this is what they do all day long. So there is no real reason to question. That is the system that we have in this country. Katie, thank you. Thank you. We'll be right back.
Starting point is 00:32:59 Here's what else you should know today. On Friday, the Russian authorities announced that opposition leader Alexei Navalny died in prison. He was 47. Navalny, a charismatic anti-corruption activist, led the opposition to Vladimir Putin for more than a decade. His popularity was broad, extending far outside the realm of liberal Moscow, and that proved threatening to the Russian authorities, who attempted to poison him in 2020. Navalny survived, and later extracted a confession from his would-be assassin on tape. Navalny believed that Russia could be a free society, and he had the extraordinary ability, through sheer force of his personality, charisma, and confidence to get others to believe it too. Though he had been in prison since 2021, his death still came as a shock. His wife, Yulia Navalny, made a surprise appearance at a security conference in Munich shortly after the Russian authorities announced her husband's death.
Starting point is 00:34:09 And I'm sure he would be here. He would be on this stage. She received an emotional standing ovation. In Moscow, my colleague Valerie Hopkins spoke to Russians who were placing flowers in his honor. And expressing disbelief that he was gone. And I asked them if they believe in the beautiful Russia of the future, what that Navalny talked about, and they said yes, but we don't think we will survive to see it.
Starting point is 00:34:53 At least 400 people have been detained since his death, including a priest who had been scheduled to hold a memorial service in St. Petersburg. Thank you. by Diane Wong and Dan Powell and was engineered by Alyssa Moxley. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderland. That's it for The Daily. I'm Sabrina Tavernisi. See you tomorrow.

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