back to indexMichael Mina: Rapid Testing, Viruses, and the Engineering Mindset | Lex Fridman Podcast #146
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The following is a conversation with Michael Mina.
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He's a professor at Harvard doing research
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on infectious disease and immunology.
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The most defining characteristic of his approach
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to science and biology is that of a first principles thinker
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and engineer focused not just on defining the problem,
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but finding the solution.
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In that spirit, we talk about cheap rapid at home testing,
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which is a solution to COVID 19 that to me has become
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one of the most obvious, powerful, and doable solutions
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that frankly should have been done months ago
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and still should be done now.
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As we talk about its accuracy,
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it's high for detecting actual contagiousness
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and hundreds of millions can be manufactured quickly
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and relatively cheaply.
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In general, I love engineering solutions like these
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even if government bureaucracies often don't.
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It respects science and data, it respects our freedom,
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it respects our intelligence and basic common sense.
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Quick mention of each sponsor
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followed by some thoughts related to the episode.
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Thank you to Brave, a fast browser that feels like Chrome
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but has more privacy preserving features,
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Athletic Greens, the all in one drink
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that I start every day with
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to cover all my nutritional bases,
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ExpressVPN, the VPN I've used for many years
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to protect my privacy on the internet,
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and Cash App, the app I use to send money to friends.
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Please check out these sponsors in the description
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to get a discount and to support this podcast.
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As a side note, let me say that
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I've always been solution oriented, not problem oriented.
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It saddens me to see that public discourse
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disproportionately focuses on the mistakes
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of those who dare to build solutions
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rather than applaud their attempt to do so.
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Teddy Roosevelt said it well
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in his The Man in the Arena speech over 100 years ago.
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I should say that both the critic
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and the creator are important,
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but in my humble estimation,
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there are too many now of the former
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and not enough of the latter.
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So while we spread the derisive words
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of the critic on social media, making it viral,
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let's not forget that this world is built
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on the blood, sweat, and tears of those who dare to create.
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If you enjoy this thing, subscribe on YouTube,
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review it with five stars on Apple Podcast,
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follow on Spotify, support on Patreon,
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or connect with me on Twitter at Lex Friedman.
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And now, here's my conversation with Michael Minna.
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What is the most beautiful, mysterious,
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or surprising idea in the biology of humans or viruses
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that you've ever come across in your work?
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Sorry for the overly philosophical question.
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Wow, well that's a great question.
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You know, I love the pathogenesis of viruses,
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and one of the things that I've worked on a lot
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is trying to understand how viruses interact with each other.
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And so pre all this COVID stuff,
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I was really, really dedicated to understanding
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how viruses impact other pathogens,
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so how if somebody gets an infection with one thing
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or a vaccine, does it either benefit or harm you
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from other things that appear to be unrelated to most people.
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And so one system which is highly detrimental to humans,
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but what I think is just immensely fascinating, is measles.
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And measles gets into a kid's body.
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The immune system picks it up,
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and essentially grabs the virus,
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and does exactly what it's supposed to do,
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which is to take this virus
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and bring it into the immune system
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so that the immune system can learn from it,
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can develop an immune response to it.
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But instead, measles plays a trick.
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It gets into the immune system,
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serves almost as a Trojan horse,
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and instead of getting eaten by these cells,
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it just takes them over,
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and it ends up proliferating in the very cells
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that were supposed to kill it.
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And it just distributes throughout the entire body,
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gets into the bone marrow,
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kills off children's immune memories.
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And so it essentially, what I've found
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and what my research has found is that this one virus
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was responsible for as much as half
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of all of the infectious disease deaths in kids
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before we started vaccinating against it,
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because it was just wiping out children's immune memories
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to all different pathogens,
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which is, I think, just astounding.
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It's just amazing to watch it spread throughout bodies.
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We've done the studies in monkeys,
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and you can watch it just destroy
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and obliterate people's immune memories
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in the same way that some parasite
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might destroy somebody's brain.
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Is that evolutionary just coincidence,
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or is there some kind of advantage
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to this kind of interactivity between pathogens?
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Oh, I think in that sense, it's just coincidence.
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It probably is a, it's a good way for measles to,
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it's a good way for measles to essentially
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be able to survive long enough to replicate in the body.
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It just replicates in the cells
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that are meant to destroy it.
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So it's utilizing our immune cells for its own replication,
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but in so doing, it's destroying the memories
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of all the other immunological memories.
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But there are other viruses,
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so a different system is influenza,
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and flu predisposes to severe bacterial infections.
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And that, I think, is another coincidence,
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but I also think that there are some evolutionary benefits
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that bacteria may hijack
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and sort of piggyback on viral infections.
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Viruses can, they just grow so much quicker than bacteria.
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They replicate faster,
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and so there's this system with viruses,
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with flu and bacteria,
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where the influenza has these proteins
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that cleave certain receptors,
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and the bacteria want to cleave those same receptors.
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They want to cleave the same molecules
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that gave entrance to those receptors.
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So instead, the bacteria found out, like,
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hey, we could just piggyback on these viruses.
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They'll do it 100 or 1,000 times faster than we can.
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And so then they just piggyback on,
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and they let flu cleave all these sialic acids,
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and then the bacteria just glom on in the wake of it.
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So there's all different interactions between pathogens
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that are just remarkable.
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So does this whole system of viruses
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that interact with each other
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and so damn good at getting inside our bodies,
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does that fascinate you or terrify you?
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I'm very much a scientist,
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and so it fascinates me much more than it terrifies me.
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But knowing enough, I know just how well,
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you know, we get the wrong virus in our population,
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whether it's through some random mutation
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or whether it's this same COVID 19 virus,
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and it, you know, these things are tricky.
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They're able to mutate quickly.
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They're able to find new hosts
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and rearrange in the case of influenza.
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So what terrifies me is just how easily
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this particular pandemic could have been so much worse.
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This could have been a virus
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that is much worse than it is.
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You know, same thing with H1N1 back in 2009.
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That terrifies me.
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If a virus like that was much more detrimental,
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you know, that would be,
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it could be much more devastating.
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Although it's hard to say, you know,
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the human species were, well,
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I hesitate to say that we're good at responding to things
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because there are some aspects that were,
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this particular virus, SARS COVID 2 and COVID 19
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has found a sweet spot where it's not quite serious enough
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on an individual level that humans just don't,
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we haven't seen much of a useful response by many humans.
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A lot of people even think it's a hoax.
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And so it's led us down this path of,
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it's not quite serious enough
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to get everyone to respond immediately
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and with the most urgency, but it's enough,
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it's bad enough that, you know,
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it's caused our economies to shut down and collapse.
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And so I think I know enough about virus biology
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to be terrified for humans that, you know,
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it can, it just takes one virus,
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just takes the wrong one to just obliterate us
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or not obliterate us,
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but really do much more damage than we've seen.
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It's fascinating to think that COVID 19
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is a result of a virus evolving together with like Twitter,
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like figuring out how we can sneak past the defenses
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So it's not bad enough.
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And then the misinformation,
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all that kind of stuff together is operating
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in such a way that the virus can spread effectively.
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I wonder, I mean, obviously a virus is not intelligent,
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but there's a rhyme and a rhythm
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to the way this whole evolutionary process works
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and creates these fascinating things
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that spread throughout the entire civilization.
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Absolutely, it's, yeah,
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I'm completely fascinated by this idea
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of social media in particular,
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how it replicates, how it grows.
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You know, I've been, how it actually starts interacting
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with the biology of the virus, masks,
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who's gonna get vaccinated, politics,
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like these seem so external to virus biology,
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but it's become so intertwined.
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And it's interesting.
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And I actually think we could find out
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that the virus actually becomes,
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obviously not intentionally,
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but we could find that people choosing not to wear masks,
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choosing not to counter this virus
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in a regimented and sort of organized way,
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effectively gives the virus more opportunity to escape.
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We can look at vaccines.
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We're about to have
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one of the most aggressive vaccination programs
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the world has ever seen.
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But we are unfortunately doing it
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right at the peak of viral transmission
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when millions and millions of people
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are still getting infected.
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And when we do that,
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that just gives this virus so many more opportunities.
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I mean, orders of magnitude more opportunity
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to mutate around our immune system.
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Now, if we were to vaccinate everyone
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when there's not a lot of virus,
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then there's just not a lot of virus.
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And so there's not going to be as many,
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I don't even know how many zeros are at the end
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of however many viral particles
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there are in the world right now,
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more than quadrillions.
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And so if you assume that at any given time,
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somebody might have trillions of virus in them
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and any given individual,
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so then multiply trillions by millions
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and you get a lot of viruses out there.
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And if you start applying pressure, ecological pressure,
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to this virus, that when it's not abundant,
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God, the opportunity for a virus to sneak around immunity,
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especially when all the vaccines are identical,
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essentially, it's...
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All it takes is one to mutate and then jumps.
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Takes one in the whole world.
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And we have to not forget
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that this particular virus was one.
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It was one opportunity and it has spread across the globe
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and there's no reason that can't happen tomorrow anew.
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I have a million other questions in this direction,
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but I'd love to talk about one of the most exciting aspects
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of your work, which is testing or rapid testing.
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You wrote a great article in Time on November 17th.
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This is like a month ago about rapid testing titled,
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How We Can Stop the Spread of COVID 19 by Christmas.
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Let's jot down the fact that this is a month ago.
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So maybe your timeline would be different,
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but let's say in a month.
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So you've talked about this powerful idea
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for quite a while throughout the COVID 19 pandemic.
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How do we stop the spread of COVID 19 in a month?
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Well, we use tests like these.
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So the only reason the virus continues spreading
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is because people spread it to each other.
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And so there's a few ways to stop the virus
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from spreading to each other.
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And that is you either can vaccinate everyone
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and vaccinating everyone is a way to immunologically
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prevent the virus from growing inside of somebody
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and therefore spreading.
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We don't know yet actually if this vaccine,
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if any of these vaccines are going to
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prevent onward transmission.
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So that may or may not serve to be one opportunity.
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Certainly I think it will decrease transmission.
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But the other idea that we have at our disposal now,
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we had it in May, we had it in June,
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July, August, September, October, November,
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and now it's December.
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We still choose not to use it in this country
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and in much of the world.
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And that's rapid testing.
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That is giving, it's empowering people to know
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that they are infected and giving them the opportunity
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to not spread it to their loved ones
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and their friends and neighbors and whoever else.
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We could have done this.
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Today we could start.
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We have millions of these tests.
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These tests are simple paper strip tests.
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They are, inside of this thing
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is just a little piece of paper.
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Now I can actually open it up here.
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So this, this is how we do it right here.
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We have this little paper strip test.
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This is enough to let you know if you're infectious.
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With somewhere around the order of 99% sensitivity,
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99% specificity, you can know
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if you have infectious virus in you.
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If we can get these out to everyone's homes,
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build these, make 10 million, 20 million,
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30 million of them a day.
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You know, we make more bottles of Dasani water every day.
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We can make these little paper strip tests.
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And if we do that and we get these into people's homes
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so that they can use them twice a week,
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then we can know if we're infectious.
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You know, is it perfect?
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But is it near perfect?
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You know, and so if we can say,
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hey, the transmission of this is, you know,
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for every hundred people that get infected right now,
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they go on to infect maybe 130 additional people.
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And that's exponential growth.
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So a hundred becomes 130.
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A couple of days later that 130 becomes
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another 165 people have now been infected.
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And you know, go over three weeks
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and a hundred people become 500 people infected.
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Now it doesn't take much to have those hundred people
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not infect 130, but infect 90.
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All we have to do is remove say 30, 40% of new infections
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from continuing their spread.
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And then instead of exponential growth,
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you have exponential decay.
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So this doesn't need to be perfect.
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We don't have to go from a hundred to zero.
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We just have to go and have those hundred people infect 90
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and those 90 people infect, you know, 82,
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whatever it might be.
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And you do that for a few weeks and boom,
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you have now gone instead of a hundred to 500,
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you've gone from a hundred to 20.
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It's not very hard.
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And so the way to do that is to let people know
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that they're infectious.
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I mean, we're a perfect example right now.
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This morning I used these tests to make sure
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that I wasn't infectious.
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No, but it reduced my odds 99%.
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I already was at extremely low odds
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because I spend my life quarantining these days.
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Well, the interesting thing with this test,
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with the testing in general,
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which is why I love what you've been espousing,
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is it's really confusing to me that this has not been
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taken on as it's one actual solution
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that was available for a long time.
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There doesn't seem to have been solutions proposed
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at a large scale and a solution that it seems
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like a lot of people would be able to get behind.
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There's some politicization or fear of other solutions
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that people have proposed, which is like lockdown.
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And there's a worry, you know,
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especially in the American spirit of freedom,
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like you can't tell me what to do.
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The thing about tests is it like empowers you
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with information essentially.
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So like it gives you more information about your,
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like your role in this pandemic,
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and then you can do whatever the hell you want.
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Like it's all up to your ethics and so on.
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So like, and it's obvious that with that information,
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people would be able to protect their loved ones
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and also do their sort of quote unquote duty
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for their country, right?
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Is protect the rest of the country.
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That's exactly right.
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I mean, it's just, it's empowerment,
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but you know, this is a problem.
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We have not put these into action in large part
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because we have a medical industry
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that doesn't want to see them be used.
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We have a political and a regulatory industry
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that doesn't want to see them be used.
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That sounds crazy.
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Why wouldn't they want them to be used?
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We have a very paternalistic approach
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to everything in this country.
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You know, despite this country kind of being founded
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on this individualistic ideal,
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pull yourself up from your bootstraps, all that stuff.
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When it comes to public health,
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we have a bunch of ivory tower academics who want data.
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They, you know, they want to see perfection.
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And we have this issue of letting perfection
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get in the way of actually doing something at all,
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you know, doing something effective.
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And so we keep comparing these tests, for example,
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to the laboratory based PCR test.
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And sure, this isn't a PCR test,
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but this doesn't cost a hundred dollars
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and it doesn't take five days to get back,
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which means in every single scenario,
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this is the more effective test.
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And we have, unfortunately, a system
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that's not about public health.
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We have entirely eroded any ideals of public health
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in our country for the biomedical complex,
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you know, this medical industrial complex,
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which overrides everything.
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And that's why, you know, I'm just,
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can I swear on this pot?
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I'm just so fucking pissed that these tests don't exist.
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Meanwhile, and everyone says, you know,
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oh, we couldn't make these, you know,
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that we could never do it.
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That would be such a hard, a difficult problem.
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Meanwhile, the vaccine gets,
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we have at the same time that we could have gotten
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these stupid little paper strip tests out to every household,
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we have developed a brand new vaccine.
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We've gone through phase one, phase two, phase three trials.
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We've scaled up its production.
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And now we have UPS and FedEx
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and all the logistics in the world,
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getting freezers out to where they need to be.
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We have this immense, we see when it comes to sort of
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medicine, you know, something you're injecting into somebody,
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then all of a sudden people say, oh, yes we can.
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But you say, oh no, that's too simple a solution,
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too cheap a solution.
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No way could we possibly do that.
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It's this faulty thinking in our country,
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which, you know, frankly is driven by big money, big,
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you know, the only time when we actually think
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that we can do something that's maybe aggressive
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and complicated is when there's billions and billions
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of billions of dollars in it, you know.
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I mean, on a difficult note, because this is part
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of your work from before the COVID,
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it does seem that I saw a statistic currently
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is that 40% would not be taken,
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of Americans would not be taking the vaccine,
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some number like this.
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So you also have to acknowledge that all the money
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that's been invested, like there doesn't appear
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to be a solution to deal with like the fear,
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distrust that people have.
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I bet, I don't know if you know this number,
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but for taking a strip, like a rapid test like this,
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I bet you people would say,
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like the percentage of people that wouldn't take it
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is in the single digits, probably.
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I completely think so.
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And you know, there's a lot of people
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who don't want to get a test today.
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And that's because it gets sent to a lab,
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it gets reported, it has all this stuff.
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And we're a country which teaches people
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from the time they're babies, you know,
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to keep their medical data close to them.
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We have HIPAA, we have all these,
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we have immense rules and regulations
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to ensure the privacy of people's medical data.
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And then a pandemic comes around
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and we just assume that the average person
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is gonna wipe all that away and say,
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oh no, I'm happy giving out not just my own medical data,
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but also to tell the authorities,
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everyone who I've spent my time with,
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so that they all get a call and are pissed at me
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for giving up their names.
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You know, so people aren't getting tested
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and they're definitely not giving up their contacts
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when it comes to contact tracing.
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And so for so many reasons, that approach is failing.
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Not to even mention the delays in testing
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and things like that.
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And so this is a whole different approach,
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but it's an approach that empowers people
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and takes the power a bit away from the people in charge.
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You know, and that's what's really grating on,
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I think, public health officials who say,
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no, we need the data.
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So they're effectively saying, if I can't have the data,
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I don't want the individuals,
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I don't want the public to have their own data either.
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Which is a terrible approach to a pandemic
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where we can't solve a public health crisis
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without actively engaging the public.
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It just doesn't work.
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And you know, and that's what we're trying to do right now,
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which is a terrible approach.
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So first of all, there's a,
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you have a really nice informative website,
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rapidtest.org, with information on this.
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I still can't believe this is not more popular.
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Okay, but our, one of the FAQs you have
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is a rapid test too expensive.
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So can cost be brought down?
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Like I pay, I take a weekly PCR test
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and I think I pay 160, 170 bucks a week.
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No, I mean, it's criminal.
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Absolutely we can get costs.
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This thing right here costs less than a dollar to make.
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With everything combined, plus the swabs,
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you know, maybe it costs a dollar 50.
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Could be sold for, frankly, it could be sold for $3
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and still make a profit if they wanna sell it for five.
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This one here, this is a slightly more complicated one,
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but you can see it's just got
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the exact same paper strip inside.
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And this is really, it doesn't look like much,
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but it's kind of the cream of the crop
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in terms of these rapid tests.
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This is the one that the US government bought
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and it is doing an amazing job.
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It has a 99.9% sensitivity and specificity.
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So it's really, it's really good.
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And so essentially the way it works is you just,
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you use a swab, you put the,
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once you kind of use a swab on yourself,
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you put the swab into these little holes here.
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You put some buffer on it and you close it
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and a line will show up if it's positive
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and a line won't show up if it's negative.
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It takes five, 10 minutes.
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This whole thing, this can be made so cheap
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that the US government was able to buy them,
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buy 150 million of them from Abbott for $5 a piece.
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So anyone who says that these are expensive,
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we have the proof is right here.
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This one at its, Abbott did not lose money on this deal.
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They got $750 million for selling 150 million of these
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at five bucks a piece.
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All of these tests can do the same.
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So anyone who says that these should be,
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unfortunately what's happening though
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is the FDA is only authorizing
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all of these tests as medical devices.
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So what happens when you, if I'm a medical company,
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if I'm a test production company
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and I wanna make this test and I go through
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and the FDA at the end of my authorization,
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the FDA says, okay, you now have a medical device,
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not a public health tool, but a medical device.
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And that affords you the ability to charge
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insurance companies for it.
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Why would I ever as a, you know,
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in our capitalistic economy and sort of infrastructure,
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why would I ever not sell this for $30
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when insurance will pay for it or $100?
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You know, it might only cost me 50 cents to make,
link |
but by pushing all of these tests through a medical pathway
link |
at the FDA, what extrudes out the other side
link |
is an expensive medical device that's erroneously expensive.
link |
It doesn't need to be inflated in cost,
link |
but the companies say, well, I'd rather make fewer of them
link |
and just sell them all for $30 a piece
link |
than make tens of millions of them, which I could do,
link |
and sell them at a dollar marginal profit.
link |
And so it's a problem with our whole medical industry
link |
that we see tests only as medical devices
link |
and what I would like to see is for the government
link |
in the same way that they bought 150 million of these
link |
from Abbott, they should be buying, you know,
link |
all of these tests, they should be buying 20 million a day
link |
and getting them out to people's homes.
link |
This virus has cost trillions of dollars
link |
to the American people.
link |
It's closed down restaurants and stores
link |
and obviously the main streets across America
link |
It's killing people, it's killing our economy,
link |
it's killing lifestyles and lives.
link |
This is an obvious solution.
link |
To me, this is exciting.
link |
This is like, this is a solution.
link |
I wish like in April or something like that
link |
to launch like the larger scale manufacturing deployment
link |
Doesn't matter what test they are.
link |
It's obviously the capitalist system
link |
would create cheaper and cheaper tests
link |
that would be hopefully driving down to $1.
link |
So what are we talking about?
link |
In America, there's, I don't know,
link |
300 plus million people.
link |
So that means you wanna be testing regularly, right?
link |
So how many do you think is possible to manufacture?
link |
What would be the ultimate goal to manufacture per month?
link |
Yep, so if we wanna slow this virus
link |
and actually stop it from transmitting,
link |
achieve what I call herd effects.
link |
Like vaccine herd immunity,
link |
herd effects are when you get that R value below one
link |
through preventing onward transmission.
link |
If we wanna do that with these tests,
link |
we need about 20 million to 40 million of them every day,
link |
which is not a lot.
link |
In the United States.
link |
In the United States.
link |
So we could do it.
link |
There's other ways.
link |
You can have two people in a household swab each other,
link |
swab themselves rather,
link |
and then mix, put the swabs into the same tube
link |
and onto one test so you can pool.
link |
So you can get a two or three X gain in efficiency
link |
through pooling in the household.
link |
You could do that in schools or offices too,
link |
wherever and just use a swab.
link |
You have a, there's two people.
link |
I mean, even if it's just standing in line
link |
at a public testing site or something,
link |
you could just say, okay,
link |
these two are the last people to test or swab themselves.
link |
They go into one thing.
link |
And if it comes back positive,
link |
then you just do each person and it's rapid.
link |
So you can just say to the people, one of you is positive.
link |
Let's test you again.
link |
So there's ways to get the efficiency gains much better.
link |
But let's say, I think that the optimal number right now
link |
that matches sort of what we can produce more or less today,
link |
if we want it, is 20 million a day.
link |
Right now, one company that,
link |
I don't have their test here,
link |
but one company is already producing 5 million tests
link |
themselves and shipping them overseas.
link |
It's an American company based in California called Inova,
link |
and they are giving 5 million tests to the UK every day.
link |
Not to the, you know, and this is just because there's no,
link |
the federal government hasn't authorized these tests.
link |
So without the support of the government.
link |
So yeah, so essentially,
link |
if the government just puts some support behind it,
link |
then yeah, you can get 20 million, probably easy.
link |
Oh yeah, this, I mean, just here,
link |
I have three different companies.
link |
These, they all look similar.
link |
Well, this one's closed,
link |
but these are three different companies right here.
link |
This is a fourth, Abbott.
link |
Now, this is a fifth.
link |
These two are a little bit different.
link |
Do you mind if in a little bit,
link |
would you take some of these or?
link |
Yeah, let's do it.
link |
We can absolutely do them.
link |
So you have a lot of tests in front of you.
link |
Could you maybe explain some of them?
link |
So there's a few different classes of tests
link |
that I just have here, and there's more tests.
link |
There's many more different tests out in the world too.
link |
These are one class of tests.
link |
These are rapid antigen tests
link |
that are just the most bare bones paper strip tests.
link |
These are, this is the type that I wanna see produced
link |
in the tens of millions every day.
link |
You don't even need the plastic cartridge.
link |
You can just make the paper strip,
link |
and you could have a little tube like this
link |
that you just dunk the paper strip into.
link |
You don't actually need the plastic,
link |
which I'd actually prefer,
link |
because if we start making tens of millions of these,
link |
this becomes a lot of waste.
link |
So I'd rather not see this kind of waste be out there.
link |
And there's a few companies,
link |
Quidel is making a test called the Quick View,
link |
which is just this.
link |
It's a, they've gotten rid of all the plastic.
link |
And for people who are just listening to this,
link |
we're looking at some very small tests
link |
that fit in the palm of your hand,
link |
and they're basically paper strips
link |
fit into different containers.
link |
And that's hence the comment about the plastic containers.
link |
These are just injection molded, I think.
link |
And they're, you know,
link |
they can build them at high numbers,
link |
but then they have to like place them in there appropriately
link |
and all this stuff.
link |
So it is a bottleneck,
link |
or somewhat of a bottleneck in manufacturing.
link |
The actual bottleneck, which the government, I think,
link |
should use the Defense Productions Act to build up,
link |
is there's a nitrocellulose membrane,
link |
a laminated membrane on this,
link |
that allows the material,
link |
the buffer with the swab mixture to flow across it.
link |
So the way these work,
link |
they're called lateral flow tests.
link |
And you take a swab,
link |
you swab the front of your nose,
link |
you dunk that swab into some buffer,
link |
and then you put a couple of drops of that buffer
link |
onto the lateral flow.
link |
And just like paper,
link |
if you dip a piece of paper into a cup of water,
link |
the paper will pull the water up through capillary action.
link |
This actually works very similarly.
link |
It flows through somewhat a capillary action
link |
through this nitrocellulose membrane.
link |
And there's little antibodies on there,
link |
these little proteins that are very specific,
link |
in this case, for antigens or proteins of the virus.
link |
So these are antibodies similar to the antibodies
link |
that our body makes from our immune system,
link |
but they're just printed on these lateral flow tests,
link |
and they're printed just like a little, a line.
link |
So then you slice these all up into individual ones.
link |
And if there's any virus on that buffer,
link |
as it flows across, the antibodies grab that virus,
link |
and it creates a little reaction with some colloids in here
link |
that cause it to turn dark.
link |
Just like a pregnancy test,
link |
one line means negative, it means a control strip worked,
link |
and two lines mean positive.
link |
It means, you know, if you get two lines,
link |
it just means you have virus there.
link |
You're very, very likely to have virus there.
link |
And so they're super simple.
link |
It is the exact same technology as pregnancy tests.
link |
It's the technology, this particular one from Abbott,
link |
this has been used for other infectious diseases
link |
like malaria, and actually a number of these companies
link |
have made malaria tests that do the exact same thing.
link |
So they just coopted the same form factor
link |
and just changed the antibodies
link |
so it picks up SARS CoV2 instead of other infections.
link |
Is it also, the Abbott one, is it also a strip?
link |
Yep, yeah, this Abbott one here is,
link |
there's the, in this case,
link |
instead of being put in a plastic sheath,
link |
it's just put in a cardboard thing and literally glued on.
link |
I mean, it looks like nothing, you know, it's just,
link |
it looks like a, like,
link |
I mean, it's just the simplest thing you could imagine.
link |
The exterior packaging looks very Apple like, it's nice.
link |
It does, yeah, yeah.
link |
Yeah, so it's nice when it comes in a,
link |
this is how they're packaged, you know,
link |
so, and they don't have to, you know,
link |
these are coming in individual packages against,
link |
again, because they're really considered
link |
individual medical devices,
link |
but you could package them in bigger packets and stuff.
link |
You wanna be careful with humidity
link |
so they all have a little,
link |
one of those humidity removing things
link |
and oxygen removing things.
link |
So that's, this is one class, these antigen tests.
link |
If we could just pause for a second, if it's okay,
link |
and could you just briefly say what is an antigen test
link |
and what other tests there are out there,
link |
like categories of tests?
link |
Just really quick.
link |
So the testing landscape is a little bit complicated,
link |
but it's, but I'll break it down.
link |
There's really just three major classes of tests.
link |
We'll start with the first two.
link |
The first two tests are just looking for the virus
link |
or looking for antibodies against the virus.
link |
So we've heard about serology tests,
link |
or maybe some people have heard about it.
link |
Those are a different kind of test.
link |
They're looking to see has somebody in the past,
link |
does somebody have an immune response against the virus,
link |
which would indicate that they were infected
link |
So we're not talking about the antibody tests.
link |
I'll just leave it at that.
link |
Those, they actually can look very similar to this,
link |
or they can be done in a laboratory.
link |
Those are usually done from blood
link |
and they're looking for an immune response to the virus.
link |
Everything I'm talking about here
link |
is looking for the virus itself,
link |
not the immune response to the virus.
link |
And so there's two ways to look for the virus.
link |
You can either look for the genetic code of the virus,
link |
like the RNA, just like the DNA of somebody's human cells,
link |
or you can look for the proteins themselves,
link |
the antigens of the virus.
link |
So I like to differentiate them.
link |
If you were a PCR test that looks for RNA in,
link |
let's say if we made it against humans,
link |
it would be looking for the DNA inside of our cells.
link |
That would be actually looking for our genetic code.
link |
The equivalent to an antigen test
link |
is sort of a test that like actually is looking
link |
for our eyes or our nose or physical features of our body
link |
that would delineate, okay, this is Michael, for example.
link |
And so you're either looking for a sequence
link |
or you're looking for a structure.
link |
The PCR tests that a lot of people have gotten now
link |
and they're done in labs usually
link |
are looking for the sequence of the virus, which is RNA.
link |
This test here by a company called Detect,
link |
this is one of Jonathan Rothberg's companies.
link |
He's the guy who helped create modern day sequencing
link |
and all kinds of other things.
link |
So this Detect device, that's the name of the company,
link |
this is actually a rapid RNA detection device.
link |
So it's almost, it's like a PCR like test
link |
and we could even do it here.
link |
It's really, it's a beautiful test in my opinion,
link |
works exceedingly well.
link |
It's gonna be a little bit more expensive.
link |
So I think it could confirm,
link |
could be used as a confirmatory test for these.
link |
Is there a greater accuracy to it?
link |
Yes, I would say that there is a greater accuracy.
link |
There's also a downfall though of PCR
link |
and tests that look for RNA.
link |
They can sometimes detect somebody
link |
who is no longer infectious.
link |
So you have the RNA test
link |
and then you have these antigen tests.
link |
The antigen tests look for structures,
link |
but they're generally only going to turn positive
link |
if people have actively replicating virus in them.
link |
And so what happens after an infection dissipates,
link |
you've just gone from having sort of a spike.
link |
So if you get infected, maybe three days later,
link |
the virus gets into exponential growth
link |
and it can replicate to trillions of viruses
link |
Your immune system then kind of tackles it
link |
and beats it down to nothing.
link |
But what ends up in the wake of that,
link |
you just had a battle.
link |
You had this massive battle that just took place
link |
inside your upper respiratory tract.
link |
And because of that, you've had trillions and trillions
link |
of viruses go to zero, essentially.
link |
But the RNA is still there.
link |
It's just these remnants.
link |
In the same way that if you go to a crime scene
link |
and blood was sort of spread all over the crime scene,
link |
you're going to find a lot of DNA.
link |
There's tons of DNA.
link |
There's no people anymore, but there's a lot of DNA there.
link |
Same thing happens here.
link |
And so what's happening with PCR testing
link |
is when people go and use these exceedingly high sensitivity
link |
PCR tests, people will stay positive for weeks or months
link |
after their infection has subsided,
link |
which has caused a lot of problems, in my opinion.
link |
It's problems that the CDC and the FDA and doctors
link |
don't want to deal with.
link |
But I've tried to publish on it.
link |
I've tried to suggest that this is an issue,
link |
both to New York Times and others.
link |
And now it's unfortunately kind of taken
link |
on a life of its own of conspiracy theorists
link |
thinking that they call it a case demic.
link |
They say, oh, you know, PCR is detecting people
link |
who are no longer, who are false positive.
link |
They're not false positives.
link |
They're late positives, no longer transmissible.
link |
I think the way you, like what I saw in rapidtest.org,
link |
I really liked the distinction between diagnostic
link |
sensitivity and contagiousness sensitivity.
link |
That's, it's so, that website is so obvious
link |
that it's painful because it's like, yeah,
link |
that's what we should be talking about is
link |
how accurately is a test able to detect your contagiousness?
link |
And you have different plots that show that actually
link |
there's, you know, that antigen tests,
link |
the tests we're looking at today, like rapid tests,
link |
are actually really good at detecting contagiousness.
link |
It all mixes back with this whole idea that,
link |
of the medical industrial complex.
link |
You know, in this country, and in most countries,
link |
we have almost entirely defunded
link |
and devalued public health, period.
link |
You know, we just have.
link |
And what that means is that we don't even,
link |
we don't have a language for it.
link |
We don't have a lexicon for it.
link |
We don't have a regulatory landscape for it.
link |
And so the only window we have to look at a test today
link |
is as a medical diagnostic test.
link |
And that becomes very problematic when we're trying
link |
to tackle a public health threat
link |
and a public health emergency.
link |
By definition, this is a public health emergency
link |
And yet we keep evaluating tests
link |
as though the diagnostic benchmark is the gold standard.
link |
Where if I'm a physician, I am a physician,
link |
so I'll put on that physician hat for a moment.
link |
And if I have a patient who comes to me
link |
and wants to know if their symptoms are a result of them
link |
having COVID, then I want every shred of evidence
link |
that I can get to see, does this person currently
link |
or did they recently have this infection inside of them?
link |
And so in that sense, the PCR test is the perfect test.
link |
It's really sensitive.
link |
It will find the RNA if it's there at all
link |
so that I could say, you know, yeah,
link |
you have a low amount of RNA left.
link |
You might've been, you said your symptoms
link |
started two weeks ago.
link |
You probably were infectious two weeks ago
link |
and you have lingering symptoms from it.
link |
But that's a medical diagnosis.
link |
It's kind of like a detective recreating a crime scene.
link |
They wanna go back there and recreate the pieces
link |
so that they can assign blame or whatever it might be.
link |
But that's not public health.
link |
In public health, we need to only look forward.
link |
We don't wanna go back and say,
link |
well, was this person, are there symptoms
link |
because they had an infection two weeks ago?
link |
In public health, we just wanna stop the virus
link |
from spreading to the next person.
link |
And so that's where we don't care
link |
if somebody was infected two weeks ago.
link |
We only care about finding the people
link |
who are infectious today.
link |
And unfortunately, our regulatory landscape
link |
fails to apply that knowledge
link |
to evaluate these tests as public health tools.
link |
They're only evaluating the tests as medical tools.
link |
And therefore, we get all kinds of complaints
link |
that say this test, which detects 99 plus,
link |
99.8% of current infectious people,
link |
by the FDA's rubric, they'll say,
link |
no, no, it's only 50% sensitive.
link |
And that's because when you go out into the world
link |
and you just compare this against PCR positivity,
link |
most people who are PCR positive in the world right now
link |
at any given time are post infectious.
link |
They're no longer infectious
link |
because you might only be infectious for five days,
link |
but then you'll remain PCR positive
link |
for three or four or five weeks.
link |
And so when you go and just evaluate these tests
link |
and you say, okay, this person's PCR positive,
link |
does the rapid antigen test detect that?
link |
More often than not, it's no.
link |
But that's because those people don't need isolation.
link |
They're post infectious.
link |
And it's become much more of a problem
link |
than I think even the FDA themself is recognizing
link |
because they are unwilling at this point
link |
to look at this as a public health problem
link |
requiring public health tools.
link |
We'll definitely talk about this a little bit more
link |
because the concern I have is that
link |
a bigger pandemic comes along.
link |
What are the lessons we draw from this
link |
and how we move forward?
link |
Let's talk about that in a bit.
link |
But sort of, can we discuss further the lay of the land here
link |
of the different tests before us?
link |
So I talked about PCR tests and those are done in the lab
link |
or they're done essentially with a rapid test like this,
link |
the detect, and we can even try this in a moment.
link |
It goes into a little heater.
link |
So you might have one of these in a household
link |
or one of these in a nursing home or something like that
link |
Or you could have one that has 100 different outlets.
link |
This is just to heat the tube up.
link |
These are the rapid tests.
link |
They're super simple, no frills.
link |
You just swab your nose and you put the swab into a buffer
link |
and you put the buffer on the test.
link |
So we can use these right now if you want.
link |
We can try it out.
link |
And all the tests we're talking about,
link |
they're usually swabbing the nose.
link |
Like that's the...
link |
That's still the main, yeah.
link |
There are some saliva tests coming about
link |
and these can all work potentially with saliva.
link |
They just have to be recalibrated.
link |
But these swabs are really not bad.
link |
This isn't the deep swab that goes like way back
link |
into your nose or anything.
link |
This is just a swab that you do yourself
link |
like right in the front of your nose.
link |
So if you wanna do it.
link |
Yeah, do you mind if I?
link |
Yeah, why don't we start with this one?
link |
Because this is Abbott's Buy Next Now test
link |
and it's really, it's pretty simple.
link |
This is the swab from the Abbott test.
link |
That's the swab from the Abbott test.
link |
So what I'm gonna do to start
link |
is I'm going to take this buffer here,
link |
which is, this is just the buffer
link |
that goes onto this test.
link |
So this is a brand new one.
link |
I just opened this test out.
link |
I'm gonna just take six drops of this buffer
link |
and put it right onto this test here.
link |
Two, three, four, five, six.
link |
And now you're gonna take that swab, open it up.
link |
Yep, and now just wipe it around inside the,
link |
into the front of your nose.
link |
Do a few circles on each nostril.
link |
This always makes me wanna sneeze.
link |
Okay, now I'm gonna have you do it yourself.
link |
I'm getting emotional.
link |
Hold it parallel to the test.
link |
So put the test down on the table.
link |
Yep, and then go into that bottom hole.
link |
Yep, and push forward
link |
so that you can start to see it in the other hole.
link |
Now turn, if it's, once it hits up against the top,
link |
just turn it three times.
link |
One, two, three, and sort of, yep.
link |
And now you just close,
link |
so pull off that adhesive sticker there.
link |
And now you just close the whole thing.
link |
Now what we will see
link |
is we will see a line form.
link |
What's happening now is the buffer that you put in there
link |
is now moving up onto the paper strip test,
link |
and it has the material from the swab in there.
link |
And so what we'll see is a line will form,
link |
and that's gonna be the control line.
link |
And then we'll also see the,
link |
ideally we'll see no line for the actual line.
link |
We'll see no line for the actual test line.
link |
And that's because you should be negative.
link |
So one line will be positive and two lines will be negative.
link |
There's this purple thing creeping up
link |
onto the control line.
link |
That's what you wanna be seeing.
link |
So you want to see that,
link |
so right now you essentially want to see
link |
that that blue line turns pink or purply color.
link |
There's a blue line that's already there printed.
link |
It should turn sort of a purple pink color.
link |
And ideally there will be no additional line for the sample.
link |
that's the 99 point whatever percent accuracy on,
link |
that means I have, I'm contagious.
link |
That would mean that you're likely contagious
link |
or you likely have infectious virus in you.
link |
because one of the things that my plan calls for
link |
is because sometimes these tests
link |
can get false positive results, it's rare.
link |
Maybe 1% or in the case of this Binex now,
link |
this Abbott test 0.1%.
link |
So one in a thousand, one in 500,
link |
something like that can be falsely positive.
link |
What I recommend is that when somebody is positive
link |
you turn around and you immediately test
link |
on a different test.
link |
You could either do it on the same,
link |
but for good measure,
link |
you want to use a separate test
link |
that is somewhat orthogonal,
link |
meaning that it shouldn't turn falsely positive
link |
for the same reason.
link |
This particular test here,
link |
this detect test because it is looking for the RNA
link |
and not the antigen,
link |
this is an amazingly accurate test
link |
and it's sort of a perfect gold standard
link |
or confirmatory test for any of these antigen tests.
link |
So one of the recommendations that I've had,
link |
especially if people start using antigen tests
link |
before you get onto a plane
link |
or as what I call entrance screening,
link |
if somebody is positive,
link |
you don't immediately tell them,
link |
you're positive, go isolate for 10 days.
link |
You tell them, let's confirm on one of these,
link |
That is because it's completely orthogonal,
link |
it's looking for the RNA instead of the antigen.
link |
There's no reason, no biological reason
link |
that both of these should be falsely positive.
link |
So if one's falsely positive and the other one is negative,
link |
especially because this one's more sensitive,
link |
then I would trust this as a confirmatory test.
link |
If this one's negative, then the antigen test
link |
would be considered falsely positive.
link |
It does look like there's only a single line,
link |
so this is very exciting news.
link |
That's right, yep.
link |
It says wait 15 minutes to see both lines,
link |
but in general, if somebody's really gonna be positive,
link |
that line starts showing up within a minute or two.
link |
So you wanna keep the whole,
link |
we'll keep watching it for the whole 15 minutes
link |
as it's sitting there, but I would say
link |
you're knowing that you've had PCR tests recently
link |
The odds are pretty good.
link |
The odds are very good.
link |
The packaging, very iPhone like.
link |
I'm digging the sexy packaging.
link |
I'm a sucker for good packaging, okay.
link |
So then there's this test here,
link |
which is, this is another, it's funny.
link |
Let me open this up and show you.
link |
This is a really nice test.
link |
It's another antigen test.
link |
Works the exact same way as this, essentially,
link |
but what you can see is it's got lights in it
link |
and a power button and stuff.
link |
This is called an allume test, which is fine,
link |
and it's a really nice test, to be honest,
link |
but it has to pair with an iPhone.
link |
And so it's good as a,
link |
I think that this is gonna become,
link |
there's a lot of use for this from a medical perspective,
link |
where you want good reporting.
link |
This can, because it pairs with an iPhone,
link |
it can immediately send the report
link |
to a department of health,
link |
whereas these paper strip tests, they're just paper.
link |
They don't report anything unless you wanna report it.
link |
Okay, so I'm gonna just pick it apart.
link |
And so you can see is there's fluorescent readers
link |
and little lasers and LEDs and stuff in there.
link |
You can actually see the lights going off.
link |
And there's a paper strip test right inside there,
link |
but you can see that there's a whole circuit board
link |
and all this stuff, right?
link |
And so this is the kind of thing
link |
that the FDA is looking for,
link |
for home use and things like that,
link |
because it's kind of foolproof.
link |
You can't go wrong with it.
link |
It pairs with an iPhone, so you need Bluetooth.
link |
So it's gonna be more limited.
link |
It's a great test, don't get me wrong.
link |
It's as good as any of these.
link |
But when you compare this thing with a battery
link |
and a circuit board and all this stuff,
link |
it's got its purpose, but it's not a public health tool.
link |
I don't wanna see this made in the tens of millions a day
link |
But FDA likes that kind of stuff.
link |
FDA loves this stuff,
link |
because they can't get it out of their mind
link |
that this is a public health crisis.
link |
We need, I mean, just look at the difference here.
link |
Something with flashing lights is essential.
link |
It's got batteries, it's got a Bluetooth thing.
link |
It's a great test, but to be honest,
link |
it's not any better than this one.
link |
And so I want this one.
link |
It's nice and all.
link |
The form factor is nice,
link |
and it's really nice that it goes to Bluetooth.
link |
But it goes against the principle of just 20 million a day.
link |
The easy solution, everybody has it.
link |
You can manufacture and probably,
link |
you could've probably scaled this up in a couple of weeks.
link |
These companies, I mean, the rest of the world has these.
link |
They can be scaled up.
link |
They already exist.
link |
You know, SD biosensors,
link |
one company's making tens of millions a day,
link |
not coming to the United States,
link |
but going all over Europe,
link |
going all over Southeast Asia and East Asia.
link |
The US is just, you know, we can't get out of our own way.
link |
I wonder why somebody,
link |
I don't know if you were paying attention,
link |
but somebody like an Elon Musk type character.
link |
So he was really into doing
link |
some like obvious engineering solution,
link |
like this at home rapid test
link |
seems like a very Elon Musk thing to do.
link |
I don't know if you saw,
link |
but I had a little Twitter conversation with Elon Musk.
link |
Does he not like, what is he,
link |
do you know what his thoughts are on rapid testing?
link |
Well, he was using a slightly different one,
link |
one of these, but that requires an instrument
link |
called the BD Veritor.
link |
And he got a false positive,
link |
or no, I shouldn't say,
link |
he didn't necessarily get a false positive.
link |
He got discrepant results.
link |
He did this test four times.
link |
He got two positives, two negatives,
link |
but then he got a PCR test
link |
and it was a very low positive result.
link |
So I think what happened is he just tested himself
link |
at the tail end of an,
link |
this was actually right before he was about to send those.
link |
It was the day of essentially that he was sending
link |
the astronauts up to the space station the other day.
link |
So he was using these rapid tests
link |
cause he wanted to make sure that he was good to go in
link |
and he got discrepant results.
link |
Ultimately they were correct,
link |
but two were negative, two were positive.
link |
But what really happened once he shared his PCR results
link |
and they were very low positive.
link |
So really what was happening is,
link |
my guess is he found himself right at the edge
link |
of his positivity, of his infectiousness.
link |
And so the test worked how it was supposed to work.
link |
It probably had he used it two days earlier,
link |
it would have been screaming positive.
link |
He wouldn't have gotten discrepant results,
link |
but he found himself right at the edge
link |
by the time he used the test.
link |
So the PCR would always pick it up
link |
cause it's still, cause that will still stay positive
link |
then for weeks potentially.
link |
But the rapid antigen test was starting to falter,
link |
but just he probably was really no longer
link |
particularly infectious.
link |
And so it was kind of when it gets to be a very low viral
link |
load, it becomes stochastic.
link |
It's fascinating this duality.
link |
So one you can think from an individual perspective,
link |
it's unclear when you take four and half are positive,
link |
half are negative, like what are you supposed to do?
link |
But from a societal perspective,
link |
it seems like if just one of them is positive,
link |
just stay home for a couple of days, for a while.
link |
So when you're a CEO of a company,
link |
you're launching astronauts to space,
link |
you may not want to rely absolutely on the antigen test
link |
as a thing by which you steer your decisions
link |
of like 10,000 plus people companies.
link |
But us individuals just living in the world,
link |
if you can, if it comes up positive,
link |
then you make decisions based on that.
link |
And then that scales really nicely to an entire society
link |
of hundreds of millions of people.
link |
And that's how you get that virus to stop spreading.
link |
That's exactly right.
link |
You don't have to catch every single one.
link |
And the nice thing is that these will,
link |
these will catch the people who are most infectious.
link |
So with Elon Musk, it generally that test,
link |
we don't have the counterfactual.
link |
We don't have his results from three days earlier
link |
when he was probably most infectious.
link |
But my guess is the fact that it was catching two
link |
out of the four, even when he was down at a CT value
link |
of really, really very, very low viral load on the PCR test
link |
suggests that it was doing its job.
link |
And you just wanna, and the nice thing is
link |
because these can be produced at such scale,
link |
getting one positive doesn't immediately have to mean
link |
10 days of isolation.
link |
That's the CDC is more conservative stance to say,
link |
if you're positive on any tests,
link |
stay home for 10 days and isolate.
link |
But here, people would just have more tests.
link |
So the recommendation should be test daily.
link |
If you turn positive, test daily
link |
until you've been negative for 24, 48 hours
link |
and then go back to work.
link |
And the nice thing there is right now,
link |
people just aren't testing
link |
because they don't wanna take 10 days off.
link |
They're not getting paid for it.
link |
So they can't take 10 days off.
link |
Do you know what Elon thinks about this idea
link |
of rapid testing for everybody?
link |
So I understood I need to look at that whole Twitter thread.
link |
So I understand his perhaps criticism of,
link |
he had like a conspiratorial tone from my vague look at it
link |
of like, what's going on here with these tests?
link |
But what does he actually think about
link |
this very practical to me engineering solution
link |
of just deploying rapid tests to everybody?
link |
It seems like that's a way to open up the economy in April.
link |
Well, to be honest,
link |
I've been trying to get in touch with him again.
link |
I think, take somebody like Elon Musk
link |
with the engineering prowess within his ranks,
link |
to easily, easily build these at the tens of millions a day.
link |
He could build the machines from scratch.
link |
A lot of the companies,
link |
they buy the machines from South Korea or Taiwan, I believe.
link |
We don't have to, we can build these machines.
link |
They're simple to build.
link |
Put somebody like Elon Musk on it,
link |
take some of his best engineers and say,
link |
look, the US needs a solution in two weeks.
link |
Build these machines, figure it out.
link |
He'll do it, he could do it.
link |
This is a guy who is literally,
link |
he has started multiple entirely new industries.
link |
He has the capital to do it without the US government
link |
And you know what, it would,
link |
the return on investment for him would be huge.
link |
But frankly, the return on investment in the country
link |
would be hundreds of billions of dollars,
link |
because it means we could get society open.
link |
So I know that his first experience
link |
with these rapid tests was confusing,
link |
which is how I ended up having this Twitter
link |
kind of conversation with him very briefly.
link |
But I think that if he understood
link |
sort of a little bit more, and I think he does,
link |
I really love to talk to him about it,
link |
because I think he could totally change
link |
the course of this pandemic in the United States,
link |
He loves grand things.
link |
Yeah, I think out of all the solutions I've seen,
link |
this is the obvious engineering solution
link |
to at least a pandemic of this scale.
link |
I love that you say the engineering solution.
link |
So this is something I've been really trying to,
link |
I'm an engineer, my previous history was all engineering,
link |
and that's really how I think.
link |
I then went into medicine and PhD world,
link |
but I think that the world,
link |
like one of the major catastrophes,
link |
or one of the major problems,
link |
is that we have physicians making the decisions
link |
about public health and a pandemic,
link |
when really we need engineers.
link |
This is an engineering problem.
link |
And so what I've been trying to do,
link |
I actually really want to start a whole new field
link |
called public health engineering.
link |
And so I've been, eventually I want to try
link |
to bring it to MIT and get MIT
link |
to want to start a new department or something.
link |
That's a doubly awesome idea.
link |
That, this is really, okay.
link |
I love this, I love every aspect.
link |
I love everything you're talking about.
link |
A lot of people believe,
link |
because vaccines started being deployed currently,
link |
that we are no longer in need of a solution.
link |
We're no longer in need of slowing the spread of the virus.
link |
To me, as I understand,
link |
it seems like this is the most important time
link |
to have something like a rapid testing solution.
link |
Can you kind of break that apart?
link |
What's the role of rapid testing currently
link |
in the next, what is it, three, four months maybe?
link |
The vaccine rollout isn't gonna be as peachy
link |
as everyone is hoping.
link |
And I hate to be the Debbie Downer here,
link |
but there's a lot of unknowns with this vaccine.
link |
You've already mentioned one,
link |
which is there's a lot of people
link |
who just don't want to get the vaccine.
link |
I hope that that might change as things move forward
link |
and people see their neighbors getting it
link |
and their family getting it and it's safe and all.
link |
We don't know how effective the vaccine is gonna be
link |
after two or three months.
link |
We've only measured it in the first two or three months,
link |
which is a massive problem,
link |
which we can go into biologically,
link |
because there's very good reasons to believe
link |
that the efficacy could fall way down
link |
after two or three months.
link |
We don't know if it's gonna stop transmission.
link |
And if it doesn't stop transmission,
link |
then there's, you know,
link |
herd immunity is much, much more difficult to get
link |
because that's all based on transmission blockade.
link |
And frankly, we don't know how easily
link |
we're going to be able to roll it out.
link |
Some of the vaccines need really significant cold chains,
link |
have very short half lives outside of that cold chain.
link |
We need to organize massive numbers of people
link |
to be able to distribute these.
link |
Most hospitals today are saying that they're not equipped
link |
to hire the right people
link |
to be even administering enough of these vaccines.
link |
And then a lot of the hospitals
link |
are frustrated because they're getting much lower,
link |
smaller allocations than they were expecting.
link |
So I think right now, like you say,
link |
right now is the best time,
link |
you know, besides three or four or five or six months ago,
link |
right now is the best time to get these rapid tests out.
link |
And we need to, I mean,
link |
the country has the capacity to build them.
link |
We have, we're shipping them overseas right now.
link |
We just need to flip a switch,
link |
get the FDA to recognize
link |
that there's more important things than diagnostic medicine,
link |
which is the effectiveness of the public health program
link |
when we're dealing with a pandemic.
link |
They need to authorize these as public health tools,
link |
or, you know, frankly, the president could,
link |
you know, there's a lot of other ways to get these tests
link |
to not have to go through
link |
the normal FDA authorization program,
link |
but maybe have the NIH and the CDC give a stamp of approval.
link |
And if we could, we could get these out tomorrow.
link |
And that's where that article came from,
link |
you know, how we can stop the spread of this virus
link |
by Christmas, we could, you know, now it's getting late.
link |
And so we have to keep updating that timeframe,
link |
maybe putting Christmas in the title wasn't,
link |
I should have said how we can stop
link |
the spread of this virus in a month.
link |
It would be a little bit more timeless,
link |
but we could do it, you know, we really could do it.
link |
And that's the most frustrating part here is that
link |
we're just choosing not to as a country.
link |
We're choosing to bankrupt our society
link |
because some people at the FDA and other places
link |
just can't seem to get their head around the fact
link |
that this is a public health problem,
link |
not a bunch of medical problems.
link |
Is there a way to change that policy wise?
link |
So this is a much bigger thing that you're speaking to,
link |
which I love in terms of the MIT engineering approach
link |
Is there a way to push this?
link |
Is this a political thing?
link |
Like where some Andrew Yang type characters
link |
need to like start screaming about it?
link |
Is it more of an Elon Musk thing
link |
where people just need to build it
link |
and then on Twitter start talking crap
link |
to politicians for not doing it?
link |
What are the ideas here?
link |
I think it's a little of both.
link |
I think it's political on the one hand,
link |
and I've certainly been talking to Congress a lot,
link |
talking to senators.
link |
Are they receptive?
link |
I mean, that's the crazy thing.
link |
Everyone but the FDA is receptive.
link |
I mean, it's astounding.
link |
I mean, I advise, informally I advise the president
link |
and the president elects teams.
link |
I talk to Congress, I talk to senators, governors,
link |
and then all the way down to mayors of towns and things.
link |
And I mean, months ago I held a round table discussion
link |
with Mayor Garcetti, who's the mayor of LA,
link |
and I brought all the companies who make these things.
link |
This was in like July or August or something.
link |
I brought all the companies to the table
link |
and said, okay, how can we get these out?
link |
And unfortunately, it went nowhere
link |
because the FDA won't authorize them
link |
as public health tools.
link |
The nice thing is that this is one of the nice
link |
and frustrating things.
link |
This is one of the few bipartisan things that I know of.
link |
And like you said, it's a real solution.
link |
Lockdowns aren't a solution.
link |
They're an emergency bandaid to a catastrophe
link |
that's currently happening.
link |
They're not a solution.
link |
And they're definitely not a public health solution
link |
if we're taking a more holistic view of public health,
link |
which includes people's wellbeing,
link |
includes their psychological wellbeing,
link |
their financial wellbeing.
link |
Just stopping a virus if it means
link |
that all those other things get thrown under the bus
link |
is not a public health solution.
link |
It's a myopic or very tunnel visioned approach
link |
to a virus that's spreading.
link |
This is a simple solution with essentially no downfall.
link |
There is nothing bad about this.
link |
It's just giving people a result.
link |
And it's bipartisan.
link |
The most conservative and the most liberal people,
link |
everyone just wants to know their status.
link |
Nobody wants to have to wait in line for four hours
link |
to find out their status on Monday,
link |
a week later, on Saturday.
link |
It just doesn't make any sense.
link |
It's a useless test at that point.
link |
And everyone recognizes that.
link |
So why do you think, like the mayor of LA,
link |
why do you think politicians are going for these,
link |
from my perspective, like kind of half ass lockdowns,
link |
which is not, so I have seen good evidence
link |
that like a complete lockdown can work,
link |
but that's in theory, it's just like communism in theory
link |
Like theoretically speaking, but it just doesn't,
link |
at least in this country, we don't,
link |
I think it's just impossible to have complete lockdown.
link |
And still politicians are going for these kind of lockdowns
link |
that everybody hates,
link |
that's really hurting small businesses.
link |
Like why are they going for that?
link |
And big businesses, and yeah, all businesses,
link |
but like basically not just hurting,
link |
they're destroying small businesses, right?
link |
Which is going to have potentially, I mean,
link |
yeah, I've been reading as I don't shut up
link |
about the rise and fall of the Third Reich,
link |
and there's economic effects that take a decade to,
link |
there's going to be long lasting effects
link |
that may be destructive to the very fabric of this nation.
link |
So why are they doing it,
link |
and why are they not using the solution?
link |
Is there any intuition?
link |
I mean, you've said that FDA has a stranglehold, I guess,
link |
on this whole public health problem.
link |
Is that all it is?
link |
That's honestly, it's pretty much all it is.
link |
The companies, so somebody like Mayor Garcetti
link |
or Governor Baker, Cuomo, Newsom,
link |
any of these, DeWine, I've talked to a lot of governors
link |
in this country at this point,
link |
and of course the federal government,
link |
including the president's own teams,
link |
and the heads of the NIH, the heads of the CDC about this.
link |
The problem is the tests don't exist in this country
link |
at the level that we need them to right now
link |
to make that kind of policy, to make that kind of program.
link |
They could, but they don't.
link |
And so what that means is that when Mayor Garcetti says,
link |
okay, what are my actual options today,
link |
despite these sounding like a great idea,
link |
he looks around and he says, well, they're not authorized.
link |
They don't exist right now for at home use.
link |
And from his perspective,
link |
he's not about to pick that fight with the FDA,
link |
and it turns out nobody is.
link |
Why are people afraid of,
link |
it seems like an easy struggle to fight.
link |
So they don't see it as a fight.
link |
They think that the FDA is the end all be all.
link |
Everyone thinks the FDA is the end all be all.
link |
And so they just defer, everyone is deferential,
link |
including the heads of all the other government agencies
link |
because that is their role.
link |
But what everyone is failing to see
link |
is that the FDA doesn't even have a mandate or a remit
link |
to evaluate these tests as public health tools.
link |
So they're just falling in this weird gray zone
link |
where the FDA is saying, look,
link |
we evaluate medical products.
link |
That's the only thing that I meant,
link |
like Tim Stenzel, head of in vitro diagnostics at the FDA,
link |
he's doing what his job is,
link |
which is to evaluate medical tools.
link |
Unfortunately, this is where I think the CDC
link |
has really blundered.
link |
They haven't made the right distinction to say, look,
link |
okay, the FDA is evaluating these for doctors to use
link |
and all that, but we're the CDC
link |
and we're the public health agency of this country
link |
and we recognize that these tools
link |
require a different authorization pathway
link |
and a different use, not prescription.
link |
There's a difference between medical devices
link |
and public health.
link |
And I guess FDA is not designed for this public health,
link |
especially in emergency situations.
link |
And they actually explicitly say that.
link |
I mean, when I go and talk to Tim,
link |
and he's a very reasonable guy,
link |
but when I talk to him, he says,
link |
look, we don't, we just do not evaluate
link |
a public health tool.
link |
If you're telling me this is a public health tool,
link |
great, go and use it.
link |
And so I say, okay, great, we'll go and use it.
link |
And then the comment is,
link |
but does it give a result back to somebody?
link |
I say, well, yes, of course it gives a result
link |
back to somebody, it's being done in their home.
link |
So then it's defined as a medical tool, can't use it.
link |
So it's stuck in this gray zone where unfortunately,
link |
there's this weird definition that any tool,
link |
any test that gives a result back to an individual
link |
is defined by CMS, Centers for Medicaid Services,
link |
as a medical device requiring medical authorization.
link |
But then you go and ask, it gets crazier,
link |
because then you go and ask Seema Verma,
link |
the head of CMS, you know, okay,
link |
can these be authorized as public health tools
link |
and not fall under your definition of a medical device?
link |
So then the FDA doesn't have to be the ones
link |
authorizing it as a public health tool.
link |
And Seema Verma says, oh, we don't have any jurisdiction
link |
over point of care and sort of rapid devices like this.
link |
We only have jurisdiction over lab devices.
link |
So it's like nobody has ownership over it,
link |
which means that they just keep,
link |
they stay in this purgatory of not being approved.
link |
And so this is where I think, frankly, it needs a president.
link |
It needs a presidential order to just unlock them,
link |
to say this is more important than having a prescription.
link |
And in fact, I mean, really what's happening now,
link |
because there is this sense that tests
link |
are public health tools,
link |
even if they're not being defined as such,
link |
the FDA now is pretty much,
link |
not only are they not authorizing these
link |
as public health tools,
link |
what they're doing by authorizing
link |
what are effectively public health tools as medical devices,
link |
they're just diluting down the practice of medicine.
link |
I mean, his answer right now, unfortunately is,
link |
well, I don't know why you want these to be
link |
sort of available to everyone without a prescription.
link |
We've already said that a doctor can write
link |
a whole prescription for a whole college campus.
link |
It's like, well, if you're going in that direction then,
link |
and that's no longer medicine,
link |
having a doctor write a prescription for a college campus,
link |
for everyone on the campus to have repeat testing,
link |
now we're just in the territory of eroding medicine
link |
and eroding all of the legal rules
link |
and reasons that we have prescriptions in the first place.
link |
So it's just everything about it is just destructive
link |
instead of just making a simple solution,
link |
which is these are okay as public health tools
link |
as long as they meet X and Y metrics,
link |
go and CDC can put their stamp of approval on them.
link |
What do you think, sorry if I'm stuck on this,
link |
your mention of MIT and public health engineering, right?
link |
I mean, it has a sense of,
link |
I talked to computational biology folks.
link |
It's always exciting to see computer scientists
link |
start entering the space of biology.
link |
And there's actually a lot of exciting things
link |
that happen because of that,
link |
trying to understand the fundamentals of biology.
link |
So from the engineering approach to public health,
link |
what kind of problems do you think can be tackled?
link |
What kind of disciplines are involved?
link |
Like, do you have ideas in this space?
link |
I mean, I can speak to one of the major activities
link |
So what I normally do in my research lab
link |
is develop technologies that can take a drop
link |
of somebody's blood or some saliva
link |
and profile for hundreds of thousands
link |
of different antibodies against every single pathogen
link |
that somebody could be possibly exposed to.
link |
So this is all new technology
link |
that we've been developing more
link |
from a bioengineering perspective.
link |
But then I use a lot of the mathematics tools
link |
to A, interpret that.
link |
But what I really wanna do, for example,
link |
to kind of kick off this new field
link |
of what I consider public health engineering
link |
is to create, maybe it's a little ambitious,
link |
but create a weather system for viruses.
link |
I want us to be able to open up our iPhones,
link |
plug in our zip code and get a better sense,
link |
get a probability of why my kid has a runny nose today.
link |
Is it a rhinovirus, an adenovirus, or is it flu?
link |
And we can do that.
link |
We can start building the rules of virus spread
link |
across the globe, both for pandemic preparedness,
link |
but also for just everyday use in the same way
link |
that people used to think that predicting the weather
link |
was gonna be impossible.
link |
Of course, we know that's not impossible now.
link |
Is it always perfect?
link |
No, but does it offer, does it completely change the way
link |
that we go about our days?
link |
I envision, for example, right now,
link |
we open up our iPhone, we plug in a zip code,
link |
and if it tells us it's gonna rain today,
link |
we bring an umbrella.
link |
So in the future, it tells us,
link |
hey, there's a lot of SARS CoV2 in your community.
link |
Instead of grabbing your umbrella, you grab your mask.
link |
We don't have to have masks all the time.
link |
But if we know the rules of the game
link |
that these viruses play by,
link |
we can start preparing for those.
link |
And every year, we go into every flu season blindfolded
link |
with our hands tied behind our back, just saying,
link |
I hope this isn't a bad flu season this year.
link |
I don't, I mean, this is, we're in the 21st century.
link |
We have the tools at our disposal now
link |
to not have that attitude.
link |
This isn't like 1920s.
link |
You know, we can just say,
link |
hey, this is gonna be a bad flu season this year.
link |
Let's act accordingly and with a targeted approach.
link |
You know, we don't, for example,
link |
we don't just use our umbrellas all day long,
link |
every single day, in case it might rain.
link |
We don't board up our homes every single day
link |
in case there's a hurricane.
link |
We wait, and if we know that there's one coming,
link |
then we act for a small period of time accordingly.
link |
And then we go back, and we've prepared ourselves
link |
in like these little bursts to not have it ruin our days.
link |
I can't tell you how exciting
link |
that vision of the future is.
link |
I think that's incredible.
link |
And it seems like it should be within our reach,
link |
the, just these like weather maps of viruses
link |
floating about the Earth, and it seems obvious.
link |
It's one of those things where right now,
link |
it seems like maybe impossible.
link |
And then looking back like 20 years from now,
link |
we'll wonder like why the hell
link |
this hasn't been done way earlier.
link |
Though one difference between weather,
link |
I don't know if you have interesting ideas in this space.
link |
The difference between weather and viruses
link |
is it includes, the collection of the data
link |
includes the human body, potentially.
link |
And that means that there is some, as with the contact
link |
tracing question, there's some concern about privacy.
link |
There seems to be this dance that's really complicated.
link |
With Facebook getting a lot of flack
link |
for basically misusing people's data,
link |
or just whether it's perception or reality,
link |
there's certainly a lot of reality to it too,
link |
where they're not good stewards of our private data.
link |
So there's this weird place where it's like obvious
link |
that if we do, if we collect a lot of data
link |
about human beings and maintain privacy
link |
and maintain all like basic respect for that data,
link |
just like honestly common sense respect for the data,
link |
that we can do a lot of amazing things for the world,
link |
like a weather map for viruses.
link |
Is there a way forward to gain trust of people
link |
or to do this well, do you have ideas here?
link |
How big is this problem?
link |
I think it's a central problem.
link |
There's a couple central problems that need to be solved.
link |
One, how do you get all the samples?
link |
That's not actually too difficult.
link |
I'm actually, I have a pilot project going right now
link |
with getting samples from across all the United States.
link |
Tens of thousands of samples every week
link |
are flowing into my lab and we process them.
link |
So it's taking the, it's taking like one of the,
link |
basically there's biology here and chemistry
link |
and converting that into numbers.
link |
That's exactly right.
link |
So what we're doing, for example,
link |
there's a lot of people who go to the hospital every day,
link |
a lot of people who donate blood, people who donate plasma.
link |
So one of the projects that I have,
link |
I'll get to the privacy question in a moment,
link |
but this, so what I wanna do is the name that I've given
link |
this as a global immunological observatory.
link |
There's no reason not to have that.
link |
I've said, instead of saying, well,
link |
how do we possibly get enough people on board
link |
to send in samples all the time?
link |
Well, just go to the source.
link |
So there's a company in Massachusetts
link |
that makes 80% of all the instruments
link |
that are used globally to collect plasma from plasma donors.
link |
So I went to this company, Hemenetics, and said,
link |
is there a way you have 80% of the global market
link |
on plasma donations?
link |
Can we start getting plasma samples
link |
from healthy people that use your machines?
link |
So that hooked me up with this company called Octopharma.
link |
And Octopharma has a huge reach
link |
and offices all over the country
link |
where they're just collecting people's plasma.
link |
They actually pay people for their plasma
link |
and then that gets distributed to hospitals
link |
and all this stuff is anonymous plasma.
link |
So I've just been collecting anonymous samples.
link |
And we're processing them, in this case,
link |
for COVID antibodies to watch from January
link |
up through December, we're able to watch
link |
how the virus entered into the United States
link |
and how it's transmitting every day across the US.
link |
So we're getting those results organized now
link |
and we're gonna start putting them publicly online soon
link |
to start making at least a very rough map of COVID.
link |
But that's the type of thinking that I have
link |
in terms of like, how do you actually capture
link |
huge numbers of specimens?
link |
You can't ask everyone to participate on sort of a,
link |
I mean, you maybe could if you have the right tools
link |
and you can offer individuals something in return
link |
like 23andMe does.
link |
That's a great way to get people to give specimens
link |
and they get results back.
link |
So with these technologies that I've been building
link |
along with some collaborators at Harvard,
link |
we can come up with tools that people might actually want.
link |
So I can offer you your immunological history.
link |
I can say, give me a drop of your blood on a filter paper,
link |
mail it in and I will be able to tell you
link |
every infectious disease you've ever encountered
link |
and maybe even when you encountered it roughly.
link |
I could tell you, do you have COVID antibodies right now?
link |
Do you have Lyme disease antibodies right now?
link |
Flu, triple E and all these different viruses.
link |
Also peanut allergies, milk allergies, anything.
link |
If your immune system makes a response to it,
link |
we can detect that response.
link |
So all of a sudden we have this very valuable technology
link |
that on the one hand gives people maybe information
link |
they might want to know about themselves,
link |
but on the other hand becomes this amazingly rich
link |
source of big data to enter into
link |
this global immunological observatory
link |
sort of mathematical framework to start building
link |
these maps, these epidemiological tools.
link |
But you asked about privacy
link |
and absolutely that's essential to keep in mind
link |
first and foremost.
link |
So privacy can be,
link |
you can keep these samples 100% anonymous.
link |
They are just, when I get them, they show up with nothing.
link |
They're literally just tubes.
link |
I know a date that they were collected
link |
and a zip code that they're collected from
link |
or even just sort of a county level ID.
link |
So with an IRB and with ethical approval
link |
and with the people's consent,
link |
we can maybe collect more data,
link |
but that would require consent.
link |
But then there's this other approach
link |
which I'm really excited about,
link |
which is certainly going to gain some scrutiny I think,
link |
but we'll have to figure out where it comes into play.
link |
But I've been recognizing that we can take somebody's
link |
immunological profile and we can make a biological
link |
fingerprint out of it.
link |
And it's actually stable enough
link |
so that I could take your blood.
link |
Let's say I don't know who you are,
link |
but you sent me a drop of blood a year ago
link |
and then you sent me a drop of blood today.
link |
I don't know that those two blood spots
link |
are coming from the same person.
link |
They're just showing up in my lab.
link |
But I can run our technology over
link |
and it just gives me your immunological history.
link |
But your immunological history is so unique to you
link |
and the way that your body responds to these pathogens
link |
is so unique to you
link |
that I can use that to tether your two samples.
link |
I don't know who you are, I know nothing about you.
link |
I only know when those samples came out of a person.
link |
But I can say, oh, these two samples a year apart
link |
actually belong to the same person.
link |
Yeah, so there's sufficient information
link |
in that immunological history to match the samples.
link |
Or from a privacy perspective, that's really exciting.
link |
Does that generally hold for humans?
link |
So you're saying there's enough uniqueness to match?
link |
Yeah, because it's very stochastic, even twins.
link |
So this, I believe, we haven't published this yet.
link |
You have a twin too, right?
link |
I do have a twin, I have an identical twin brother,
link |
which makes me interested in this.
link |
He looks very much like me.
link |
Oh, is that how that works?
link |
And DNA can't really tell us apart.
link |
But this tool is one of the only tools in the world
link |
that could tell twins apart from each other.
link |
Could still be accurate enough to say this blood,
link |
it's like 99.999% accurate to say
link |
that these two blood samples came from the same individual.
link |
And it's because it's a combination,
link |
both of your immunological history,
link |
but also how your unique body responds to a pathogen,
link |
The way that we make antibodies is, by and large,
link |
it's got an element of randomness to it.
link |
How the cells, when they make an antibody,
link |
they chop up the genetic code to say,
link |
okay, this is the antibody that I'm gonna form
link |
for this pathogen.
link |
And you might form, if you get a coronavirus, for example,
link |
you might form hundreds of different antibodies,
link |
not just one antibody against the spike protein,
link |
but hundreds of different antibodies
link |
against all different parts of the virus.
link |
So that gives this really rich resolution of information
link |
that when I then do the same thing
link |
across hundreds of different pathogens,
link |
some of which you've seen, some of which you haven't,
link |
it gives you an exceedingly unique fingerprint
link |
that is sufficiently stable over years and years and years
link |
to essentially give you a barcode.
link |
And I don't have to know who you are,
link |
but I can know that these two specimens
link |
came from the same person somewhere out in the world.
link |
So fascinating that there's this trace,
link |
your life story in the space of viruses,
link |
in the space of pathogen, like these,
link |
you know, because there's this entire universe
link |
of these organisms that are trying to destroy each other.
link |
And then your little trajectory through that space
link |
leaves a trace, and then you can look at that trace.
link |
That's fascinating.
link |
And that, I mean, there's, okay,
link |
that data period is just fascinating.
link |
And the vision of making that data universally connected
link |
to where you can make, like infer things,
link |
and just like with the weather, is really fascinating.
link |
And there's probably artificial intelligence
link |
applications there, start making predictions,
link |
start finding patterns.
link |
Exactly, we're doing a lot of that already.
link |
And that's how, how do we have this going?
link |
You know, I've been trying to get this funded for years now.
link |
And I've spoken to governments, you know,
link |
everyone says, cool idea, not gonna do it.
link |
You know, why do we need it?
link |
The why do you need it?
link |
Yeah, the why do you need it.
link |
And of course now, you know, I mean,
link |
I wrote in 2015 about this,
link |
why we would, why this would be useful.
link |
And of course, now we're seeing why it would be useful.
link |
Had we had this up and running in 2019,
link |
had we had it going, we were drawing blood from,
link |
you know, we're getting blood samples from hospitals
link |
and clinics and blood donors from New York City,
link |
let's just say, you know, that could have,
link |
we didn't run the first PCR test for coronavirus
link |
until probably a month and a half or two months
link |
after the virus started transmitting in New York City.
link |
So it's like with the rain,
link |
we didn't start wearing umbrella or taking out umbrellas.
link |
Exactly, for two months, but different than the rain,
link |
we couldn't actually see that it was spreading right now.
link |
And so Andrew Cuomo had no choice
link |
but to leave the city open.
link |
You know, there were hints that maybe the virus
link |
was spreading in New York City,
link |
but you know, he didn't have any data to back it up.
link |
And so it was just week on week and week.
link |
And he didn't have any information to really go by
link |
to allow him to have the firepower
link |
to say we're closing down the city.
link |
This is an emergency.
link |
We have to stop spread before it starts.
link |
And so they waited until the first PCR tests
link |
were coming about.
link |
And then the moment they started running PCR tests,
link |
they find out it's everywhere.
link |
You know, and so that was a disaster
link |
because of course New York City, you know,
link |
was just hit so bad because nobody was,
link |
you know, we were blind to it.
link |
We didn't have to be blind to it.
link |
And the nice thing about this technology is
link |
we wouldn't have, with the exact same technology
link |
we had in 2017, we could have detected
link |
this novel coronavirus spreading in New York City in 2020.
link |
Not because we changed, not because we are actually
link |
actively looking for this novel coronavirus,
link |
but because we would see, we would have seen patterns
link |
in people's immune responses using AI,
link |
or just frankly using our, just the raw data itself.
link |
We could have said, hey, it looks like there's
link |
something that looks like known coronavirus
link |
is spreading in New York, but there's gaps.
link |
You know, there's, for some reason,
link |
people aren't developing an immune response
link |
to this coronavirus that seems to be spreading
link |
to these normal things that, you know,
link |
and it just looks, the profile looks different.
link |
And we could have seen that and immediately,
link |
especially since we had an idea that
link |
there was a novel coronavirus circulating in the world,
link |
we could have very quickly and easily seen,
link |
hey, clearly we're seeing a spike of something
link |
that looks like a known coronavirus,
link |
but people are responding weirdly to it.
link |
Our AI algorithms would have picked it up,
link |
and just our basic, heck, you could have put it
link |
in an Excel spreadsheet, we would have seen it.
link |
Some basic visualization would have shown it.
link |
Exactly, we would have seen spikes,
link |
and they would have been kind of like off, you know,
link |
immune responses that the shape of them
link |
just looked a little bit different,
link |
but they would have been growing,
link |
and we would have seen it, and it could have
link |
saved tens of thousands of lives in New York City.
link |
So to me, the fascinating question,
link |
everything we've talked about,
link |
so both the huge collection of data at scale,
link |
just super exciting, and then the kind of obvious
link |
at scale solution to the current virus
link |
and future ones is the rapid testing.
link |
Can we talk about the future of viruses
link |
that might be threatening our very existence?
link |
So do you think like a future natural virus
link |
can have an order of magnitude greater effect
link |
on human civilization than anything we've ever seen?
link |
So something that either kills all humans,
link |
or kills, I don't know, 60, 70% of humans.
link |
So something like something we can't even imagine.
link |
Is that something that you think is possible?
link |
Because it seems to not have happened yet.
link |
So maybe like the entirety, whoever the programmer is
link |
of the simulation that sort of launched the evolution
link |
from the Big Bang seems to not want to destroy us humans.
link |
Or maybe that's the natural side effect
link |
of the evolutionary process that humans are useful.
link |
But do you think it's possible
link |
that the evolutionary process will produce a virus
link |
that will kill all humans?
link |
I don't think it's likely.
link |
And the reason I don't think it's likely
link |
is on the one hand, it hasn't happened yet,
link |
in part because mobility is a recent phenomena.
link |
People weren't particularly mobile
link |
until fairly recently.
link |
Now, of course, now that we have people flying back
link |
and forth across the globe all the time,
link |
the chances of global pandemics
link |
has escalated exponentially, of course.
link |
And so on the one hand,
link |
that's part of why it hasn't happened yet.
link |
We can look at things like Ebola.
link |
Now, Ebola, we haven't generally had major Ebola epidemics
link |
in the past, not because Ebola wasn't transmitting
link |
and infecting humans, but because it was largely affecting
link |
and infecting humans in disconnected communities.
link |
So you see out in rural parts of Africa, for example,
link |
in Western Africa, you might end up having
link |
isolated Ebola outbreaks,
link |
but there weren't connections that were fast enough
link |
that would allow people to then spread it into the cities.
link |
Of course, we saw back in 2014, 15 massive Ebola outbreak
link |
that wasn't because it was a new strain of Ebola,
link |
but it was because there's new inroads and connections
link |
between the communities and people got it to the city.
link |
And so we saw it start to spread.
link |
So that should be a little bit foreshadowing
link |
of what's to come.
link |
And now we have this pandemic.
link |
We had 2009, we have this.
link |
There is a benefit or there is sort of a natural check.
link |
And this is like kind of like a Voltaire
link |
predator prey dynamic kind of systems,
link |
ecological systems and mathematics that
link |
if you have something that's so deadly,
link |
people will respond more maybe with a greater panic,
link |
a greater sense of panic, which alone could, you know,
link |
But at the same time, we now know that we can lock down.
link |
We know that that's possible.
link |
And so if this was a worse virus
link |
that was actually killing 60% of people as infecting,
link |
we would lock down very quickly.
link |
My biggest fear though, is let's say that was happening.
link |
You need serious lockdowns if you're gonna keep things going.
link |
So the only reason we were able to keep things going
link |
during our lockdowns is because it wasn't so bad
link |
that we were still able to have people work
link |
in the grocery stores.
link |
Still have people work in the shipping
link |
to get the food onto the shelves.
link |
So on the one hand, we could probably figure out
link |
how to stop the virus,
link |
but can we stop the virus without starving?
link |
You know, and I'm not sure that that,
link |
if this was another acute respiratory virus
link |
that say had a slightly, say it transmitted the same way,
link |
but say it actually did worse damage to your heart,
link |
but it was like a month later
link |
that people started having heart attacks in mass.
link |
You know, it's like not just one offs, but really severe.
link |
Well, that could be a serious problem for humanity.
link |
So in some ways I think that there are lots of ways
link |
that we could end up dying at the hand of a virus.
link |
I mean, we're already seeing it.
link |
Just, I mean, my fear is still,
link |
I think coronaviruses have demonstrated
link |
a keen ability to destroy or to create outbreaks
link |
that can potentially be deadly to large numbers of people.
link |
Flu strains, though, are still by and large my concern.
link |
So you think the bad one might come from the flu,
link |
Yeah, their replication cycle,
link |
they're able to genetically recombine
link |
in a way that coronaviruses aren't.
link |
They have segmented genomes,
link |
which means that they can just swap out
link |
whole parts of their genomes, no problem,
link |
repackage them, and then boom,
link |
you have a whole antigenic shift, not a drift.
link |
What that means is that on any occasion,
link |
any day of the year, you can have, boom,
link |
a whole new virus that didn't exist yesterday.
link |
And now with farming and industrial livestock,
link |
we're seeing animals and humans come into contact much more.
link |
Just the opportunities for an influenza strain
link |
that is unique and deadly to humans increases.
link |
All the while, transmission and mobility has increased.
link |
It's just a matter of time, in my opinion.
link |
What about from immunology perspective
link |
of the idea of engineering a virus?
link |
So not just the virus leaking from a lab or something,
link |
but actually being able to understand the protein,
link |
like everything about what makes a virus enough
link |
to be able to figure out ways to maybe target it
link |
or untarget it, attack biologics.
link |
Subverse immunity.
link |
Is that something, obviously that's somewhere
link |
on the list of concerns, but is that anywhere close
link |
of the top 10 highlights along with nuclear weapons
link |
and so on that we should be worried about?
link |
Or is the natural pandemic really the one
link |
that's much greater concern?
link |
I would say that the former, that manmade viruses
link |
and genetically engineered viruses should be right up there
link |
with the greatest concerns for humanity right now.
link |
We know that the tools, for better or worse,
link |
the tools for creating a virus are there.
link |
And I mean, heck, the human species
link |
is no longer vaccinated against smallpox.
link |
I didn't get a smallpox vaccine.
link |
You didn't get a smallpox vaccine, at least I don't think.
link |
And so if somebody wanted to make smallpox
link |
and distribute it to the world in some way,
link |
it could be exceedingly deadly and detrimental to humans.
link |
And that's not even sort of using your imagination
link |
to create a new virus.
link |
That's one that we already have.
link |
Unlike the past when smallpox would circulate,
link |
you had large fractions of the community
link |
that was already immune to it.
link |
And so it wouldn't spread
link |
or it would spread a little bit slower.
link |
But now we have essentially in a few years,
link |
we'll have a whole global population that is susceptible.
link |
Let's look at measles.
link |
We have an entire, I mean, measles, I have,
link |
there are some researchers in the world right now,
link |
which for various reasons are working on creating
link |
a measles strain that evades immunity.
link |
It's not for bioterrorism,
link |
at least that's not the expectation.
link |
It's for using measles as an oncolytic virus to kill cancer.
link |
And the only way you can really do that
link |
is if your immune system doesn't,
link |
if you take a measles virus and there's,
link |
we don't have to go into the details of why it would work,
link |
but it could work.
link |
Measles likes to target potentially cancer cells.
link |
But to get your immune system not to kill off the virus
link |
if you're trying to use the virus to target it,
link |
you maybe want to make it blind to the immune system.
link |
But now imagine we took some virus like measles,
link |
which has an R naught of 18, transmits extremely quickly.
link |
And now we have essentially,
link |
let's say we had a whole human race
link |
that is susceptible to measles.
link |
And this is a virus that spreads
link |
orders of magnitude easier than this current virus.
link |
Imagine if you were to plug something toxic
link |
or detrimental into that virus and release it to the world.
link |
So it's possible to be both accidental and intentional.
link |
Yeah, so Mark Lipsitch is a good colleague of mine
link |
at Harvard, we're both in the,
link |
he's the director of the Center
link |
for Communicable Disease Dynamics from a faculty member.
link |
He's spoken very, very forcefully
link |
and he's very outspoken about the dangers
link |
of gain of function testing,
link |
where in the lab we are intentionally creating viruses
link |
that are exceedingly deadly
link |
under the auspices of trying to learn about them.
link |
So that if the idea is that if we kind of accelerate
link |
evolution and make these really deadly viruses in the lab,
link |
we can be prepared for if that virus ever comes about
link |
naturally or through unnatural means.
link |
The concern though is, okay, that's one thing,
link |
but what if that virus got out on somebody's shoe?
link |
If the effects of an accident are potentially catastrophic,
link |
is it worth taking the chances just to be prepared
link |
a little bit for something that may
link |
or may not ever actually develop?
link |
And so it's a serious ethical quandary we're in,
link |
how to both be prepared,
link |
but also not cause a catastrophic mistake.
link |
As a small tangent,
link |
there's a recent really exciting breakthrough of alpha two,
link |
of alpha fold two solving protein folding
link |
or achieving state of the art performance
link |
on protein folding.
link |
And then I thought proteins have a lot to do with viruses.
link |
It seems like being able to use machine learning
link |
to design proteins that achieve certain kinds of functions
link |
will naturally allow you to use maybe down the line,
link |
not yet, but allow you to use machine learning
link |
to design basically viruses,
link |
maybe like measles, like for good,
link |
which is like to attack cancer cells, but also for bad.
link |
Is that a crazy thought
link |
or is this a natural place where this technology may go?
link |
I suppose as all technologies can,
link |
which is for good and for bad.
link |
Do you think about the role of machine learning in this?
link |
Oh yeah, absolutely, I mean, alpha fold is amazing.
link |
It's an amazing algorithm, a series of algorithms.
link |
And it does demonstrate, to me,
link |
it demonstrates just how powerful,
link |
everything in the world has rules.
link |
We just don't know the rules.
link |
We often don't know them,
link |
but our brain has rules, how it works.
link |
Everything is plus and minus.
link |
There's nothing in the world that's really not
link |
at its most basic level, positive, negative.
link |
It's all, obviously, it's all just charge.
link |
And that means everything.
link |
You can figure it out with enough computational power
link |
and enough, in this case, I mean,
link |
machine learning and AI is just one way to learn rules.
link |
It's an empirical way to learn rules,
link |
but it's a profoundly powerful way.
link |
And certainly, now that we are getting to a point
link |
where we can take a protein and know how it folds,
link |
given its sequence, we can reverse engineer that
link |
and we can say, okay, we want a protein to fold this way.
link |
What does the sequence need to be?
link |
We haven't done that yet so much,
link |
but it's just the next iteration of all of this.
link |
And so let's say somebody wants to develop a virus
link |
it's gonna start with somebody wanting to develop a virus
link |
to defeat cancer, something good.
link |
And so it would start with a lot of money
link |
from the federal government for all the positives
link |
that will come out of it.
link |
But we have to be really careful
link |
because that will come about.
link |
There's no doubt in my mind that we will develop,
link |
we're already doing it.
link |
We engineer molecules all the time for specific uses.
link |
Oftentimes, we take them from a lab
link |
and then we take them from a lab and then we make them.
link |
Oftentimes, we take them from nature and then tweak them.
link |
But now we can supercharge it.
link |
We can accelerate the pace of discovery.
link |
To not have it just be discovery,
link |
we have it be true ground up engineering.
link |
Let's say you're trying to make a new molecule
link |
to stabilize somebody with some retinal disease.
link |
So we come up with some molecule
link |
to stability of somebody with retinal degeneration.
link |
Just a small tweak to that,
link |
to say make a virus that causes the human race
link |
I mean, it sounds really conspiracy theoryish,
link |
We're learning so much about biology
link |
and there's always nefarious reasons.
link |
I mean, heck, look at how AI and just Google searches,
link |
those can be, they are every single day
link |
being leveraged by nefarious actors
link |
to take advantage of people, to steal money,
link |
to do whatever it might be.
link |
Eventually, probably to create wars
link |
or already to create wars.
link |
And I mean, I don't think there's any question at this point
link |
behind disinformation campaigns.
link |
And so it's being leveraged.
link |
This thing that could be wholly good
link |
is always going to be leveraged for bad.
link |
And so how do you balance that as a species?
link |
I'm not quite sure.
link |
The hope is, as you mentioned previously,
link |
that there's some, that we were able
link |
to also develop defense mechanisms.
link |
And there's something about the human species
link |
that seems to keep coming up with ways to,
link |
just like on the deadline,
link |
just at the last moment,
link |
figuring out how to avoid destruction.
link |
I think I'm eternally optimistic about the human race
link |
not destroying ourselves,
link |
but you could do a lot of things
link |
that would be very painful.
link |
Well, we're doing it already, just,
link |
I mean, we are seeing how our regulation today,
link |
we did this thing, it started as a good thing,
link |
regulation of medical products,
link |
but now it is unwillingly and unintentionally harming us.
link |
Our regulatory landscape,
link |
which was developed totally for good in our country
link |
is getting in the way of us deploying a tool
link |
that could stop our economies
link |
from having to be sort of sputteringly closed,
link |
that could stop deaths from happening
link |
at the rate that they are.
link |
And it's, I think we will come to a solution.
link |
Of course, now we're gonna get the vaccine
link |
and it's gonna make people lose track
link |
of like why we even bother testing, which is a bad idea.
link |
But we're already seeing that.
link |
We have this amazing capacity to both do damage
link |
when we don't intend to do damage
link |
and then also to pull up when we need to pull up
link |
and stop complete catastrophe.
link |
And so we are an interesting species in that way,
link |
So there's a lot of young folks, undergrads,
link |
grads, they're also young, listen to this.
link |
So is there, you've talked about a lot of fascinating stuff
link |
that's like, there's ways that things are done
link |
and there's actual solutions
link |
and they're not always like intersecting.
link |
Do you have advice for undergraduate students
link |
or graduate students or even people in high school now
link |
about a life, about a career of how they might be able
link |
to solve real big problems in the world,
link |
how they should live their life
link |
in order to have a chance to solve big problems
link |
I struggle a little bit sometimes to give advice
link |
because the advice that I give
link |
from my own personal experience is necessarily distinct
link |
from the advice that would make other people successful.
link |
I have unending ambitions to make things better, I suppose.
link |
And I don't see barricades
link |
where other people sometimes see barricades.
link |
Now, even just little things like when this virus started,
link |
I'm a medical director at Brigham and Women's Hospital
link |
and so I oversee or helped oversee
link |
molecular virology diagnostics.
link |
So when this virus started, wearing my epidemiology hat
link |
and wearing my sort of viral outbreak hat,
link |
I recognized that this is gonna be a big virus
link |
that was important on a global level.
link |
Even if the CDC and WHO weren't ready to admit
link |
that it was a pandemic,
link |
it was obvious in January that it was a pandemic.
link |
So I started trying to get a test built at the Brigham,
link |
which is one of Harvard's teaching hospitals.
link |
The first encounters I had with the upper administration
link |
of the hospital were pretty much, no, why would we do that?
link |
That's silly, who are you?
link |
And I said, well, okay, don't believe me, sure.
link |
But I kept pushing on it.
link |
And then eventually I got them to agree.
link |
It was really only a couple of weeks
link |
before the Biogen conference happened.
link |
We started building the test.
link |
I think they started looking abroad and saying,
link |
okay, this is happening, sure, like, maybe he was right.
link |
But then I went a step further and I said,
link |
we're not gonna have enough tests at the hospital.
link |
And so my ambition was to get a better testing program
link |
started and so I figured what better place
link |
to scale up testing than the Broad Institute.
link |
Broad Institute is amazing, very high throughput,
link |
high efficiency research institute
link |
that does a lot of genomic sequencing, things like that.
link |
So I went to the Broad and I said,
link |
hey, there's this coronavirus
link |
that's obviously gonna impact our society greatly.
link |
Can we start modifying your high efficiency instruments
link |
and robots for coronavirus testing?
link |
Everyone in my orbit, in the hospital world,
link |
just said, that's ridiculous.
link |
How could you possibly plan to do that?
link |
And to me, it was like the most dead simple thing to do.
link |
It didn't, but the higher ups and the people
link |
who think about, I think one of the things
link |
is to recognize that most people in the world
link |
don't see solutions, they just see problems.
link |
And it's because it's an easy thing to do.
link |
Thinking of problems and how things will go wrong
link |
is really easy because you're not coming up
link |
with a brand new solution.
link |
And this to me was just a super simple solution.
link |
Hey, let's get the Broad to help build tests.
link |
Every single hospital director told me no,
link |
like it's impossible.
link |
My own superiors, the ones I report to in the hospital,
link |
said, you know, Mike, you're a new faculty member.
link |
Your ideas probably would be right,
link |
but you're too naive and young to know that it's impossible.
link |
Obviously now the Broad is the highest
link |
throughput laboratory in the country.
link |
And so I think my recommendation to people
link |
is as much as possible, get out of the mode
link |
of thinking about things as problems.
link |
Sometimes you piss people off,
link |
I could probably use a better filter sometimes
link |
to try to like be not so upfront with certain things.
link |
But it's just so crucial to always just see,
link |
to just bring it, like think about things in new ways
link |
that other people haven't.
link |
Cause usually there's something else out there.
link |
And one of the things that has been most beneficial to me,
link |
which is that my education was really broad.
link |
It was engineering and physics.
link |
And well, and then I became a Buddhist monk.
link |
Well, and then I became a Buddhist monk for a while.
link |
And so that gave me a different perspective,
link |
but then it was medicine and immunology.
link |
And now I've brought all of it together
link |
from a mathematics and biology and medicine perspective
link |
and policy and public health.
link |
And I think that, you know,
link |
I'm not the best in any one of these things.
link |
I recognize that there are gonna be geniuses out there
link |
who are just worlds better than me
link |
at any one of these things that I try to work on.
link |
But my superpower is bringing them all together,
link |
you know, and just thinking,
link |
and that's, I think how you can really change the world.
link |
You know, I don't know that I'll ever change the world
link |
in the way that I hope.
link |
But that's how you can have a chance.
link |
Yeah, that's how you can have a chance, exactly.
link |
And I think it's also what, you know, this to me,
link |
this rapid testing program,
link |
like this is the most dead simple solution in the world.
link |
And this literally could change the world.
link |
It could change the world.
link |
It could change, and it is, you know,
link |
there's countries that are doing it now.
link |
The US isn't, but I've been advising many countries on it.
link |
And I would say that, you know,
link |
some of the early papers that we put out earlier on,
link |
a lot of the things actually are changing.
link |
You don't always, unless you really look hard,
link |
you don't know where you're actually having an effect.
link |
Sometimes it's more overt than other times.
link |
In April, I published a paper that was saying,
link |
hey, with the PCR values from these tests,
link |
we need to really focus on the CT values,
link |
the actual quantitative values
link |
of these lab based PCR tests.
link |
At the time, all the physicians and laboratory directors
link |
told me that was stupid.
link |
You know, why would you do that?
link |
They're not accurate enough.
link |
And of course, now it's headline news that, you know,
link |
Florida, they just mandated reporting out the CT values
link |
of these tests, cause there's a real utility of them.
link |
You can understand public health from it.
link |
You can understand better clinical management.
link |
You know, that was a simple solution
link |
to a pretty difficult problem.
link |
And it is changing.
link |
The way that we approach all of the lab testing
link |
in this country is starting to, it's taken a few months,
link |
but it's starting to change because of that.
link |
And, you know, that was just me saying,
link |
hey, this is something we should be focusing on.
link |
Got some other people involved and other people.
link |
And now people recognize, hey, there's actual value
link |
in this number that comes out of these lab based PCR tests.
link |
So sometimes it does grow fairly quickly.
link |
But I think the real answer,
link |
if my only answer, I don't know what, you know,
link |
I recognize that everyone, some people are gonna be
link |
really focused on and have one small, but deep skillset.
link |
I go the opposite direction.
link |
I try to bring things together.
link |
And, but the biggest thing I think is just,
link |
don't see barriers, like just see,
link |
like there's always a solution to a barrier.
link |
If there's a barrier,
link |
that literally means there's a solution to it.
link |
That's why it's called a barrier.
link |
And just like you said, most people will just present to you,
link |
only be thinking about it and present to you with barriers.
link |
And so it's easy to start thinking
link |
that's all there is in this world.
link |
And just think big.
link |
I mean, God, you know, there's nothing wrong
link |
with thinking big.
link |
Elon Musk thought big and, you know,
link |
and then thinking big builds on itself.
link |
You know, you get a billion dollars from one big idea
link |
and then that allows you to make three new big ideas.
link |
And there's a hunger for it if you think big
link |
and you communicate that vision with the world.
link |
All the most brilliant and like passionate people
link |
will just like, you'll attract them
link |
and they'll come to you.
link |
And then it makes your life actually really exciting.
link |
The people I've met at like Tesla and Neuralink,
link |
I mean, there's just like this fire in their eyes.
link |
They just love life.
link |
And it's amazing, I think, to be around those people.
link |
I have to ask you about what was the philosophy,
link |
the journey that took you to becoming a Buddhist monk
link |
and what did you learn about life?
link |
What did you take away from that experience?
link |
How did you return back to Harvard
link |
and the world that's unlike that experience, I imagine?
link |
Yeah, well, I was at Dartmouth at the time.
link |
Well, I went to Sri Lanka.
link |
I was already pretty interested in developing countries
link |
and sort of under resourced areas.
link |
And I was doing a lot of engineering work
link |
and I went there, but I was also starting to think
link |
maybe health was something of interest.
link |
And so I went to Sri Lanka
link |
because I had a long interest in Buddhism as well,
link |
just kind of interested in it as a thing.
link |
Which aspect of the philosophy attracted you?
link |
I would say that the thing that interested me most
link |
was really this idea of kind of a butterfly effect
link |
of like what you do now has ripple effects
link |
that extend out beyond what you can possibly imagine,
link |
both in your own life and in other people's lives.
link |
And in some ways, Buddhism has, not in some ways,
link |
in a pretty deep way, Buddhism has that
link |
as part of its underlying philosophy
link |
in terms of rebirth and sort of your actions today
link |
propagate to others, but also propagate
link |
to sort of what might happen in your circle
link |
of what's called samsara and rebirth.
link |
And I don't know that I subscribe fully
link |
to this idea that we are reborn,
link |
which always was a little bit of a debate internally,
link |
I suppose, when I was a monk.
link |
But it has always been, it was that
link |
and then it was also meditation.
link |
At the time I was a fairly elite rower.
link |
I was rowing at the national level
link |
and rowing to me was very meditative.
link |
It was just, even if you're in a boat with other people,
link |
I mean, on the one hand, it's like the extreme
link |
of like a team sport, but it's also the extreme
link |
sort of focus and concentration that's required of it.
link |
And so I was always really into just meditative
link |
I was doing a lot of pottery too,
link |
which was also very meditative.
link |
And so Buddhism just kind of really,
link |
there are a lot of things about meditating
link |
that just appealed.
link |
And so I moved to Sri Lanka,
link |
planning to only be there for a couple of months.
link |
And then I was shadowing in this medical clinic
link |
and there was this physician who was just really,
link |
I mean, it's just kind of a horrible situation.
link |
Frankly, this guy was trained decades earlier.
link |
He was an older physician and he was still just practicing
link |
like these fairly barbaric approaches to medicine
link |
because he was a rural town
link |
and he just didn't have a lot of,
link |
he didn't have any updated training, frankly.
link |
And so, I just remember this like girl came in
link |
with like shrapnel in her hand
link |
and his solution was to like air it out.
link |
And so he was like, without even numbing her hand,
link |
he was like cutting it open more with this idea
link |
that like the more oxygen and stuff.
link |
And it just, I think there was something about all of this.
link |
And I was already talking to these monks at the time.
link |
I would be in this clinic in the morning and I'd go
link |
and my idea was to teach English
link |
to these monks in the evening.
link |
Turned out I'm a really bad English teacher.
link |
So they just taught, they allowed me just to sit with them
link |
and meditate and they were teaching me more about Buddhism
link |
than I could have possibly taught them about English
link |
or being an American or something.
link |
And so I just slowly, I just couldn't take,
link |
I like couldn't handle being in that clinic.
link |
So more and more, I just started moving to,
link |
spending more and more time at this monastery.
link |
And then after about two months,
link |
I was supposed to come back to the States
link |
and I decided I didn't want to.
link |
So I moved to this monastery in the mountains
link |
primarily because I didn't have the money
link |
to like just keep living.
link |
So living in a monastery is free.
link |
And so I moved there and just started meditating
link |
more and more and then months went by
link |
and it just really gravitated.
link |
I gravitated to the whole notion of it.
link |
I mean, it became, it sounds strange,
link |
but meditating almost just like anything
link |
that you've put your mind to became exciting.
link |
It became like there weren't enough hours
link |
in the day to meditate.
link |
And I would do it for 18 hours a day, 15 hours a day,
link |
just sit there and you, and like,
link |
I mean, I hate sleeping anyway,
link |
but I wouldn't want to go to sleep
link |
because I felt like I didn't accomplish
link |
what I needed to accomplish in meditation that day,
link |
which is so strange because there is no end,
link |
but it was always, but there are these,
link |
there are these steps that happen during meditation
link |
that are very prescribed in a way.
link |
Buddha talked about them and these are ancient writings,
link |
I mean, the writings are real.
link |
They're thousands of years old now.
link |
And so whether it was Buddha writing them or whoever,
link |
there are lots of different people
link |
who have contributed to these writings over the years.
link |
But they're very prescribed
link |
and they tell you what you're gonna go through.
link |
And I didn't really focus too much on them.
link |
I read a little bit about them,
link |
but your mind really does.
link |
When you actually start meditating at that level,
link |
like not an hour here and there,
link |
but like truly just spending your day as meditating,
link |
it becomes kind of like this other world
link |
where it becomes exciting and you're actively working,
link |
you're actively meditating,
link |
not just kind of trying to quiet things.
link |
That's sort of just the first stage
link |
of trying to get your mind to focus.
link |
Most people never get past that first stage,
link |
especially in our culture.
link |
Could you briefly summarize
link |
what's waiting beyond the stage of just quieting the mind?
link |
It's hard for me to imagine that there's something
link |
that could be described as exciting on there.
link |
Yeah, it's an interesting question.
link |
So I would say, so the first thing,
link |
the first step is truly just to like be able
link |
to close your eyes, focus on your breath
link |
and not have other thoughts enter into your mind.
link |
That alone is just so hard to do.
link |
Like I couldn't do it now if I wanted, but I could then.
link |
But once you get past that stage,
link |
you start entering into like all these other,
link |
you go through the kind of,
link |
I went through this like pretty trippy stage,
link |
which is a little bit euphoric
link |
where you just kind of start not hallucinating.
link |
I mean, it wasn't like some crazy thing
link |
that would happen in a movie,
link |
but definitely just weird.
link |
You start getting into the stage
link |
where you're able to quiet your mind for so long,
link |
for hours at a time that like for me,
link |
I started getting really excited
link |
about this idea of mindfulness,
link |
which is part of Buddhism in general,
link |
but it's part of Theravada Buddhism in particular
link |
for this in this way, which was you take,
link |
you start focusing on your daily activities,
link |
whether that's sipping a cup of tea or walking
link |
or sweeping around.
link |
I lived on this mountainside in this cottage thing,
link |
it was built into the rock.
link |
And so every morning I would wake up early
link |
and sweep around it and stuff,
link |
cause that's just what we did.
link |
And you start to, you meditate on all those activities.
link |
And one of the things that was so exciting,
link |
which sounds completely ridiculous now
link |
was just almost learning about your daily activities
link |
in ways that you never would have thought about before.
link |
So what's involved with like picking up this glass of water?
link |
If I said, okay, I'm just gonna pick,
link |
I'm gonna take a drink of water,
link |
to me right now, it's a single activity.
link |
But during meditation, it's not a single activity.
link |
It's a whole series of activities
link |
of like little engineering feats and feelings.
link |
And it's gripping the water
link |
and it's feeling that the glass is cold
link |
and it's lifting and it's moving and dragging and dragging.
link |
And you start to learn a whole new language of life.
link |
And that to me was like this really exhilarating thing
link |
that it was an exhilarating component of meditation
link |
that there was never enough time.
link |
It's kind of like learning a new computer language.
link |
Like it gets really exciting when you start coding
link |
and all these new things you can do.
link |
You learn how to experience life in a much richer way.
link |
And so you never run out of ways
link |
to go deeper and deeper and deeper
link |
in the way you experienced even just
link |
the drinking of the glass of water.
link |
That's exactly right.
link |
And what becomes kind of exhilarating
link |
is you start to be able to predict things
link |
that you never are,
link |
I don't even have predictions, right word.
link |
But I always think of the matrix,
link |
where I forget who it was,
link |
somebody was shooting at Neo
link |
and he like leans backwards and he dodges the bullets.
link |
In some ways, when you start breaking
link |
every little action that your hands do
link |
or that your feet do or that your body does
link |
down into all these little actions
link |
that make up one what we normally think of as an action,
link |
all of a sudden you can start to see things
link |
almost in slow motion.
link |
I like to think of it very much like language.
link |
The first time somebody hears a foreign language,
link |
it sounds really fast usually.
link |
You don't hear the spaces between words.
link |
And it just sounds like a stream of consciousness.
link |
And it just sounds like a stream of noises
link |
if you've never heard the language before.
link |
And as you learn the language,
link |
you hear clear breaks between words
link |
and it starts to gain context.
link |
And all of a sudden like that,
link |
what once sounded very fast slows down and it has meaning.
link |
That's our whole life.
link |
Well, there's this whole language happening
link |
that we don't speak generally.
link |
But if you start to speak it
link |
and if you start to learn it and you start to say,
link |
hey, I'm picking up this glass
link |
is actually 18 little movements.
link |
Then all of a sudden it becomes extremely exciting
link |
and exhilarating to just breathe.
link |
Breathing alone and the rise and fall of your abdomen
link |
or the way the air pushes in and out of your nose
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becomes almost interesting.
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And what's really neat is the world just starts slowing down
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and I'll never forget that feeling.
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And if there was one euphoric feeling from meditation
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I want to gain back,
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but I don't think I could without really meditating
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like that again and I don't think I will,
link |
was this like slow motion of the world.
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It was finding the spaces between all the movements
link |
in the same way that the spaces between all the words happen.
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And then it almost gives you this new appreciation
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for everything, it was really amazing.
link |
And so I think it came to an abrupt end though
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when the tsunami hit.
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I was there in the Indian Ocean tsunami hit in 2004.
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And it was like this dichotomy of being a monk
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and just meditating in this extraordinary place.
link |
And then the tsunami hits and kills 40,000 people
link |
in a few minutes on the coast
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of this really small little country in Sri Lanka.
link |
And then my whole world of being a monk
link |
came crashing down.
link |
And when I go to the coast,
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and I mean, that was just a devastating visual sight
link |
and emotional sight.
link |
But the strangest thing happened,
link |
which was that everyone just wanted me to stay as a monk.
link |
You know, people in that culture, they wanted to,
link |
the monks largely fled from the coastlines those,
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you know, and so then there I was
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and people wanted me to be a monk.
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They wanted me to stay on the coast,
link |
but be a monk and not help,
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like not help in the way that I considered helping.
link |
They wanted me just to keep meditating
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so that they could bring me offerings
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and have their sort of karmic responsibilities
link |
attended to as well.
link |
And so that was really bizarre to me.
link |
It was like, how could I possibly just sit around
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while all these people, half of everyone's family just died?
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And so in any case, I stopped being a monk
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and I moved to this refugee camp
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and lived there for another six months or so
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and just stayed there, not as a monk,
link |
but tried to raise some money from the US
link |
and tried to like, I didn't know what I was doing.
link |
Frankly, I was 22.
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And I don't think I appreciated at the time
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how much of a role I was having in that community's life.
link |
But it's taken me many years to process all of this
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since then, but I would say it's what put me
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into the public health world, living in that refugee camp.
link |
And that difference that happened,
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from being a monk to being in this devastating environment
link |
just really changed my whole view
link |
of sort of why I was existing, I suppose.
link |
Well, so there's this richness of life
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in a single drink of water that you experience,
link |
and then there's this power of nature
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that's capable to take the lives of thousands of people.
link |
So given all that, the absurdity of that,
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let me ask you, and the fact that you study things
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that could kill the entirety of human civilization,
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what do you think is the meaning of this all?
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What do you think is the meaning of life,
link |
this whole orchestra we've got going on?
link |
Does it have a meaning?
link |
And maybe from another perspective,
link |
how does one live a meaningful life, if such is possible?
link |
Well, from what I've seen,
link |
I don't think there's a single answer to that by any stretch.
link |
One of the most interesting things about Buddhism to me
link |
is that the human existence is part of suffering,
link |
which is very different from Judeo Christian existence,
link |
which is that human existence is something to be,
link |
is a very different, it's something to,
link |
there's a richness to it.
link |
In Buddhism, it's just another one of your lives,
link |
but it's your opportunity to attain nirvana
link |
and become a monk, for example, and meditate
link |
to attain nirvana,
link |
else you kind of just go back into the samsara,
link |
the cycle of suffering.
link |
And so, when I look at, I mean, in some ways,
link |
the notion of life and what the purpose of life is,
link |
they're kind of completely distinct,
link |
this sort of Western view of life,
link |
which is that this life is the most precious thing
link |
in the world versus this is just another opportunity
link |
to try to get out of life.
link |
I mean, the whole notion of nirvana, and in Buddhism,
link |
it getting out of this sort of cycle of suffering
link |
If you could attain nirvana throughout this life,
link |
the idea is that you don't get reborn.
link |
And so, when I look at these two,
link |
on the one hand, you have Christian faith
link |
and other things that want to go to heaven
link |
and live forever in heaven.
link |
Then you have this other whole half of humans
link |
who want nothing more than to get out of the cycle
link |
of rebirth and just, poof, not exist anymore.
link |
The cycle of suffering, yeah.
link |
Yeah, and so how do you reconcile those two?
link |
Do you have both of them in you?
link |
Do you basically oscillate back and forth?
link |
I don't think I, I think I just,
link |
I look at us and I think we're just a bunch of proteins.
link |
That we form and we, they work in this really amazing way
link |
and they might work in a bigger scale.
link |
There might be some connections
link |
that we're not really clear about,
link |
but they're still biological.
link |
I believe that they're biological.
link |
How did these proteins become conscious
link |
and why do they want to help civilization
link |
by having at home rapid tests at scale?
link |
Well, I think, I don't have an answer to that one,
link |
but I really do believe. I was hoping you would.
link |
It's just, you know, this is just an evolution
link |
of consciousness I don't, I don't personally think is,
link |
my feeling is that we're a bunch of pluses and minuses
link |
that have just gotten so complex
link |
that they're able to make rich feelings, rich emotions.
link |
And I do believe though, you know, on the one hand,
link |
I sometimes wake up some days,
link |
my fiance doesn't always love it,
link |
but you know, I kind of think we're all just a bunch
link |
of robots with like pretty complicated algorithms
link |
that we deal with.
link |
And, you know, in that sense, like, okay,
link |
if the world just blew up tomorrow
link |
and nothing existed the day after that,
link |
it's just another blip in the universe, you know?
link |
But at the same time, I don't know.
link |
So that's kind of probably my most core basic feeling
link |
about life is like, we're just a blip
link |
and we may as well make the most of it
link |
while we're here blipping.
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It's one hell of a fun blip though.
link |
It is, it's an amazing blink of an eye in time.
link |
Michael, this is, you're one of the most interesting people
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I've met, one of the most interesting conversations,
link |
important ones now, I'm going to publish it very soon.
link |
I really appreciate taking the time,
link |
I know how busy you are, it was really fun.
link |
Thanks for talking today.
link |
Well, thanks so much, this was a lot of fun.
link |
Thanks for listening to this conversation
link |
with Michael Mina and thank you to our sponsors.
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And now, let me leave you with some words
link |
from Teddy Roosevelt.
link |
It is not the critic who counts.
link |
Not the man who points out how the strong man stumbles
link |
or where the doer of deeds could have done them better.
link |
The credit belongs to the man who actually is in the arena,
link |
whose face is marred by dust and sweat and blood,
link |
who strives valiantly, who errs,
link |
who comes short again and again,
link |
because there is no effort without error and shortcoming,
link |
but who does actually strive to do the deeds,
link |
who knows great enthusiasms, the great devotions,
link |
who spends himself in a worthy cause,
link |
who at the best knows in the end that triumph
link |
of high achievement, and who at the worst, if he fails,
link |
at least fails while daring greatly,
link |
so that his place shall never be
link |
with those cold and timid souls
link |
who neither know victory nor defeat.
link |
Thank you for listening and hope to see you next time.