back to indexJay Bhattacharya: The Case Against Lockdowns | Lex Fridman Podcast #254
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The following is a conversation with Jay Bhattacharya,
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Professor of Medicine, Health Policy and Economics
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at Stanford University.
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Please allow me to say a few words about lockdowns
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and the blinding, destructive effects of arrogance
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on leadership, especially in the space of policy and politics.
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Jay Bhattacharya is the coauthor
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of the now famous Great Barrington Declaration,
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a one page document that in October 2020
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made a case against the effectiveness of lockdowns.
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Most of this podcast conversation
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is about the ideas related to this document.
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And so let me say a few things here about what troubles me.
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Those who advocate for lockdowns as a policy
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often ignore the quiet suffering of millions
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that it results in, which includes economic pain,
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loss of jobs that give meaning and pride
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in the face of uncertainty, the increase in suicide
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and suicidal ideation, and in general,
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the fear and anger that arises from the powerlessness
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forced onto the populace
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by the self proclaimed elites and experts.
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Many folks whose job is unaffected by the lockdowns
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talk down to the masses about which path forward
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is right and which is wrong.
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What troubles me most is this very lack of empathy
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among the policymakers for the common man
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and in general for people unlike themselves.
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The landscape of suffering is vast
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and must be fully considered
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in calculating the response to the pandemic
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with humility and with rigorous,
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open minded scientific debate.
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Jay and I talk about the email from Francis Collins
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to Anthony Fauci that called Jay and his two coauthors
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fringe epidemiologists and also called
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for a devastating published take down of their ideas.
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These words from Francis broke my heart.
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I understand them, I can even steel man them,
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but nevertheless, on balance,
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they show to me a failure of leadership.
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Leadership in a pandemic is hard,
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which is why great leaders are remembered by history.
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They are rare, they stand out and they give me hope.
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Also, this whole mess inspires me
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on my small individual level to do the right thing
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in the face of conformity, despite the long odds.
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I talked to Francis Collins,
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I talked to Albert Burla, Pfizer CEO.
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I also talked and will continue to talk
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with people like Jay and other dissenting voices
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that challenge the mainstream narratives
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and those in the seats of power.
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I hope to highlight both the strengths and weaknesses
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in their ideas with respect and empathy,
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but also with guts and skill.
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The skill part, I hope to improve on over time.
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And I do believe that conversation
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and an open mind is the way out of this.
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And finally, as I've said in the past,
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I value love and integrity far, far above money,
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Those latter three are all ephemeral.
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They slip through the fingers of anyone
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who tries to hold on and leave behind
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an empty shell of a human being.
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I prefer to die a man who lived by principles
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that nobody could shake and a man
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who added a bit of love to the world.
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This is the Lex Friedman podcast.
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To support it, please check out our sponsors
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in the description.
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And now, here's my conversation with Jay Bhattacharya.
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To our best understanding today, how deadly is COVID?
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Do we have a good measure for this very question?
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So the best evidence for COVID, the deadliness of COVID,
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comes from a whole series of seroprevalence studies.
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Seroprevalence studies are these studies
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of antibody prevalence in the population at large.
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I was part of the very first set of seroprevalence studies,
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one in Santa Clara County, one in L.A. County,
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and one with Major League Baseball around the U.S.
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If I may just pause you for a second.
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If people don't know what serology is and seroprevalence,
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it does sound like you say zero prevalence.
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It's not, it's sero and serology is antibodies.
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So it's a survey that counts the number of antibodies.
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Specific to COVID, yes.
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People that have antibodies specific to COVID,
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which perhaps shows an indication
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that they likely have had COVID,
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and therefore this is a way to study
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how many people in the population
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have been exposed to or have had COVID.
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Exactly, yeah, exactly.
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So the idea is that we don't know
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exactly the number of people with COVID
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just by counting the people
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that present themselves with symptoms of COVID.
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COVID has, it turns out, a very wide range of symptoms,
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ranging from no symptoms at all
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to this deadly viral pneumonia
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that has killed so many people.
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And the problem is, if you just count the number of cases,
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the people who have very few symptoms
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often don't show up for testing.
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They're outside of the can of public health.
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And so it's really hard to know the answer to your question
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without understanding how many people are infected,
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because you can probably tell the number of deaths,
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even though there's some controversy over that.
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But that, so the numerator is possible,
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but the denominator is much harder.
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How much controversy is there about the death?
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We're gonna go on a million tangents.
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Is that, okay, we're gonna, I have a million questions.
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So one, I love data so much,
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but I'm like almost tuned out
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paying attention to COVID data,
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because I feel like I'm walking on shaky ground.
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I don't know who to trust.
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Maybe you can comment on different sources of data,
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different kinds of data.
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The death one, that seems like a really important one.
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Can we trust the reported deaths associated with COVID,
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or is it just a giant, messy thing that mixed up?
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And then there's this kind of stories about hospitals
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being incentivized to report a death as COVID death.
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So there's some truth in some of that.
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Let me just talk about the incentives.
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So in the United States, we passed this CARES Act
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that was aimed at making sure hospital systems
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didn't go bankrupt in the early days of the pandemic.
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The couple of things they did,
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one was they provided incentives to treat COVID patients,
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tens of thousands of dollars extra per COVID patient.
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And the other thing they did is they gave a 20% bump
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to Medicare payments for elderly patients
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who are treated with COVID.
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The idea is that there's more expensive to treat them
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at the early days.
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So that did provide an incentive
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to sort of have a lot of COVID patients in the hospital,
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because your financial success of the hospital,
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or at least not lack of financial ruin
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depended on having many COVID patients.
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The other thing on the death certificates
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is that reporting of deaths is a separate issue.
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I don't know that there's a financial incentive there,
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but there is this sort of like complicated,
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you know, when you fill out a death certificate
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for a patient with a lot of conditions,
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like let's say a patient has diabetes,
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a patient that, well, that diabetes could lead
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You know, you have a heart attack, heart failure,
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your lungs fill up, then you get COVID and you die.
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So what do you write on the death certificate?
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Was it COVID that killed you?
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Was it the lungs filling up?
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Was it the heart failure?
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Was it the diabetes?
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It's really difficult to like disentangle.
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And I think a lot of times what's happened
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is that people have like erred
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on the side of signing it as COVID.
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Now, what's the evidence of this?
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There's been a couple of audits of death certificates
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in places like Santa Clara County,
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where I live, in Alameda County, California,
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where they carefully went through the death certificate
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and said, okay, is this reasonable to say
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this was actually COVID or it was COVID incidental?
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And they found that about 25%, 20, 25% of the deaths
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were more likely incidental than directly due to COVID.
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I personally don't get too excited about this.
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I mean, it's a philosophical question, right?
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Like ultimately, what kills you?
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Which is an odd thing to say if you're not in medicine,
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but like really, it's almost always multifactorial.
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It's not always just the bus hits you.
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The bus hits you, you get a brain bleed.
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Was it the brain bleed that killed you?
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Would it have burst anyway?
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I mean, you know, the bus hits you, killed you, right?
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The way you die is a philosophical question,
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but it's also a sociological and psychological question
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because it seems like every single person
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who has passed away over the past couple of years,
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kind of the first question that comes to mind.
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Not just because you're trying to be political,
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but just in your mind.
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No, I think there's a psychological reason for this, right?
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So, you know, we spent the better part
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of at least a half century in the United States
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not worried too much about infectious diseases.
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The notion was we essentially conquered them.
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It was something that happens
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in far away places to other people.
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And that's true for much of the developed world.
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Life expectancy were going up for decades and decades.
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And for the first time in living memory,
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we have a disease that can kill us.
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I mean, I think we're effectively evolved to fear that,
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like the panic centers of our brain,
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the lizard part of our brain takes over.
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And our central focus has been avoiding this one risk.
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And so it's not surprising that people,
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when they're filling out death certificates
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or thinking about what led to the death,
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this most salient thing that's in the front
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of everyone's brain would jump to the top.
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And we can't ignore this very deep psychological thing
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when we consider what people say on the internet,
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what people say to each other,
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what people write in scientific papers, everything.
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It feels like when COVID has been brought onto this world,
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everything changed in the way people feel about each other,
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just the way they communicate with each other.
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I think the level of emotion involved,
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I think in many people, it brought out the worst in them.
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For sometimes short periods of time
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and sometimes it was always therapeutic,
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like you were waiting to get out
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like the darkest parts of you,
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just to say, if you're angry at something in this world,
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I'm going to say it now.
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And I think that's probably talking
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to some deep primal thing that fear we have
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for formalities of all different kinds.
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And then when that fear is aroused
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in all the deepest emotions,
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it's like a Freudian psychotherapy session,
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but across the world.
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It's something that psychologists are going to have
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a field day with for a generation trying to understand.
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I mean, I think what you say is right,
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but piled on top of that is also this sort of,
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this impetus to empathy,
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the empathized compassion toward others,
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essentially militarized, right?
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So I'm protecting you by some actions
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and those actions, if I don't do them,
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if you don't do them,
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well, that must mean you hate me.
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It's created this like social tension
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that I've never seen before.
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And we looked at each other
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as if we were just simply sources of germs
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rather than people to get to know,
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people to enjoy, people to get to learn from.
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It colored basically almost every human interaction
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for every human on the planet.
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Yeah, the basic common humanity.
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It's like you can wear a mask,
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you can stand far away,
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but the love you have for each other
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when you're looking into each other's eyes,
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that was dissipating by region too.
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I've experienced having traveled
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quite a bit throughout this time.
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It was really sad,
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even people that are really close together,
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just the way they stood,
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the way they looked at each other.
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And it made me feel for a moment
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that the fabric that connects all of us
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is more fragile than I thought.
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I mean, if you walk down the street,
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or if you ever, if you did this during COVID,
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I'm sure you had this experience
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where you walk down the street,
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if you're not wearing a mask,
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or even if you are,
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people will jump off the sidewalk
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that you walked past them,
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as if you're poison,
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even though the data are that COVID spreads
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indifferently outdoors,
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or if at all, really, outdoors.
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But it's not simply a biological
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or infectious disease phenomenon,
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or epidemiological phenomenon.
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It is a change in the way humans treated each other,
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I do wanna say on the flip side of that,
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so I was mostly in Boston, Massachusetts
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when the pandemic broke out.
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I think that's where I was, yeah.
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And then I came here to Austin, Texas
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to visit my now good friend, Joe Rogan,
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and he was the first person without pause,
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this wasn't a political statement,
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this was anything,
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just walked toward me and gave me a big hug
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and say, it's great to see you.
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And I can't tell you how great it felt
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because I, in that moment,
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realized the absence of that connection back in Boston
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over just a couple of months.
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And it's, we'll talk about it more,
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but it's tragic to think about that distancing,
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that dissolution of common humanity at scale,
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what kind of impact it has on society.
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Just across the board, political division,
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and just in the quiet of your own mind,
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in the privacy of your own home, the depression,
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the sadness, the loneliness that leads to suicide.
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And forget suicide, just low key suffering.
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Yeah, no, I think that's the suffering,
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that isolation, we're not meant to live alone,
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we're not meant to live apart from one another.
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I mean, that's, of course, the ideology of lockdown
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is to make people live apart, alone, isolated,
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so that we don't spread diseases to each other, right?
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But we're not actually designed as a species
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And that, what you're describing, I think,
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if everyone's honest with themselves, have felt,
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especially in places where lockdowns have been
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sort of very militantly enforced,
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has felt deep into their core.
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Well, if I could just return to the question of deaths.
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You said that the data isn't perfect,
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because we need these kind of seroprevalence surveys
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to understand how many cases there were
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to determine the rate of deaths.
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And we need to have a strong footing
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in the number of deaths.
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But if we assume that the number of deaths
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is approximately correct, like what's your sense,
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what kind of statements can we say about the deadliness
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of COVID across different demographics?
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Maybe not in a political way or in the current way,
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but when history looks back at this moment of time,
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50 years from now, 100 years from now,
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the way we look at the pandemic 100 years ago,
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what will they say about the deadliness of COVID?
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I mean, I think the deadliness of COVID depends on
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not just the virus itself, but who it infects.
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So probably the most important thing about it,
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about the deadliness of COVID,
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is this steep age gradient in the mortality rate.
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So according to these seroprevalence studies
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that have been done, now hundreds of them,
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mostly from before vaccination,
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because vaccination also reduces
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the mortality risk of COVID,
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the seroprevalence studies suggest that the risk of death,
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if you're, say, over the age of 70, is very high.
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You know, 5% if you get COVID.
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If you're under the age of 70, it's lower, 0.05.
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But there's not a single sharp cutoff.
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It's more like, I have a rule of thumb that I use.
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So if you're 50, say, the infection fatality rate
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from COVID is 0.2%, according to the seroprevalence data.
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That means 99.8% survival if you're 50.
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And for every seven years of age above that, double it.
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Every seven years of age below that, halve it.
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So a 57 year old would have a 0.4%.
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Mortality, a 64 year old would have a 0.8% and so on.
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And if you have a severe chronic disease,
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like diabetes or if you're morbidly obese,
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it's like adding seven years to your life.
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And this is for unvaccinated folks?
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This is unvaccinated before Delta also.
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Are there a lot of people that would be listening to this
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with PhDs at the end of their name
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that would disagree with the 99.8, would you say?
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So I think there's some disagreement over this.
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And the disagreement is about the quality
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of the seroprevalence studies that were conducted.
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So as I said earlier, I was the senior investigator
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in three different seroprevalence studies
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very early in the epidemic.
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I view them as very high quality studies.
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In Santa Clara County, what we did is we used a test kit
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that we obtained from someone who works
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in major league baseball, actually.
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He had ordered these test kits very early in March, 2020,
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that measures, very accurately measures antibody levels,
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antibodies in the bloodstream.
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These test kits were eventually were approved by the,
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had an EUA by the emergency use authorization by the FDA,
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sort of shortly after we did this.
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And it had a very low false positive rate,
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false positive means if you don't have
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these COVID antibodies in your bloodstream,
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the kit shows up positive anyways.
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That turns out to happen about 0.5% of the time.
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And based on studies, a very large number of studies
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looking at blood from 2018, you try it against this kit,
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and 0.5% of the time, 2018,
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there shouldn't be antibodies there to COVID.
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So if it turns positive to false positives, 0.5% of the time.
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And then like a false negative rate, about 10%, 12%,
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something like that, I don't remember the exact number,
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but the false positive rate is the important thing there.
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So you have a population in March, 2020 or April, 2020,
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with very low fraction of patients
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having been exposed to COVID,
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you don't know how much, but low,
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even a small false positive rate
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could end up biasing your study quite a bit.
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But there's a formula to adjust for that.
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You can adjust for the false positive rate,
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false negative rate.
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We did that adjustment, and those studies found
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in a community population,
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so leaving aside people in nursing homes
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who have a higher death rate from COVID,
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the death rate was 0.2% in Santa Clara County
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Across all age groups in a community,
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community meaning just like regular folks.
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Yeah, so that's actually a real important question too.
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So the Santa Clara study,
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we did this Facebook sampling scheme,
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which is, I mean, not the ideal thing,
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but it was very difficult to get a random sample
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and during lockdown,
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where we put out an ad on Facebook
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soliciting people to volunteer for the study,
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randomly selected set of people.
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We were hoping to get a random selection of people
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from Santa Clara County, but it tended to,
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the people who tend to volunteer
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were from the richer parts of the county.
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Like I had Stanford professors writing,
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begging to be in the study
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because they wanted to know their antibody levels.
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So we did some adjustment for that.
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In LA County, we hired a firm
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that had a preexisting representative sample of LA County.
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But it didn't include nursing homes,
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it didn't include people in jail, things like that,
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didn't include the homeless populations.
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So it's representative of a community dwelling population,
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And there we found that both in LA County
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and Santa Clara County in April, 2020,
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something like 40 to 50 times more infections
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than cases in both places.
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So for every case that had been reported
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to the public health authorities,
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we found 40 or 50 other infections,
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people with antibodies in their blood
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that suggested that they'd had COVID and recovered.
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So people were not reporting,
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or severe, at least in those days, underreporting.
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Yeah, I mean, there was testing problem.
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I mean, there weren't so many tests available.
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People didn't know.
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A lot of them, we asked a set of questions
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about the symptoms they'd faced,
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and most of them said they'd faced no symptoms,
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or at the most, 30, 40% of them said
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they'd faced no symptoms.
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And I mean, even these days,
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how many people report that they get COVID
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when they get COVID?
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Okay, have those numbers, that 0.2%,
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has that approximately held up over time?
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That is, so Professor John Ioannidis,
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who's a colleague of mine at Stanford,
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is a world expert in meta now,
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so probably the most cited scientist on Earth, I think,
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He did a meta analysis of now 100 or more
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of these seroprevalence studies.
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And what he found was that that 0.2%
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is roughly the worldwide number.
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In fact, I think he cites this lower number, 0.15%,
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as the median infection fatality rate worldwide.
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So we did these studies,
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and it generated an enormous amount of blowback
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by people who thought that the infection fatality rate
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And there's some controversy over the quality
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of some of the other studies that are done.
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And so there are some people who look at this
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same literature and say, well,
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the lower quality studies tend to have lower IFRs.
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The higher quality studies.
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Oh, infection fatality rate, I apologize.
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I do this in lectures, too, I apologize.
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And I'm going to rudely interrupt you
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and ask for the basics sometimes, if it's okay.
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So these higher quality studies, they say,
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tend to produce higher IFR.
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But the problem is that if you want
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a global infection fatality rate,
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you need to get seroprevalence studies from everywhere,
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even in places that don't necessarily
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have the infrastructure set up
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to produce very, very high quality studies.
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And in poor places in the world,
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places like Africa,
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the infection fatality rate is incredibly low.
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And in some richer places, like New York City,
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the infection fatality rate is much higher.
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There's a range of IFRs, not a single number.
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This sometimes surprises people,
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because they think, well, it's a virus,
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it should have the same properties no matter where it goes.
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But the virus kills or infects or hurts
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in interaction with the host.
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And the properties of both the host and the virus
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combine to produce the outcome.
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But you also mentioned the environment, too?
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Well, I'm thinking mainly just about the person.
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Like if I'm gonna think about it,
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the most simplest way to think about it is age.
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Age is the single most important risk factor.
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So older places are going to have a higher IFR
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than younger places.
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Africa, 3% of Africa is over 65.
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So in some sense, it's not surprising
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that they have a low infection fatality rate.
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So that's one way you would explain
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the difference between Africa and New York City
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in terms of the fatality rate, is the age, the average age?
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Yeah, and especially in the early days of the epidemic
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in New York City, the older populations
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living in nursing homes were differentially infected
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based on, because of policies that were adopted,
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to send COVID infected patients back to nursing homes
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to keep hospitals empty.
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What do you mean by differentially infected?
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The policy that you adopt determines who is most exposed.
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So that's what I mean by different.
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The policy, it's the person that matters.
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I mean, it's not like the virus just kind of doesn't care.
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I mean, the policy determines the nature of the interaction.
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And there's also, I mean, there is some contribution
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from the environment, different regions
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have different proximity maybe of people interacting
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or the dynamics of the way they interact.
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Yeah, like if you have situations
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where there's lots of intergenerational interactions,
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then you have a very different risk profile
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than if you have societies
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that are where generations are more separate
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Okay, so let me just finish real fast about this.
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So you have in New York, you have a population
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that was infected in the early days
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that was very likely going to die,
link |
had a much higher likelihood of dying if infected.
link |
And so New York City had a higher IFR,
link |
especially in the early days than like Africa has had.
link |
The other thing is treatment, right?
link |
So the treatments that we adopted
link |
in the early days of the epidemic,
link |
I think actually may have exacerbated the risk of death.
link |
Using ventilators, like the over reliance on ventilators
link |
is what I'm primarily thinking of,
link |
but I can think of other things.
link |
But that also we've learned over time
link |
how better to manage patients with the disease.
link |
So you have all those things combined.
link |
So that's where the controversy over this number is.
link |
I mean, New York City also is a central hub
link |
for those who tweet and those who write powerful stories
link |
and narratives in article form.
link |
And I remember those quite dramatic stories
link |
about sort of doctors in the hospitals
link |
and these kinds of things.
link |
I mean, there's very serious, very dramatic,
link |
very tragic deaths going on always in hospitals.
link |
Those stories, loved ones losing each other on a deathbed,
link |
that's always tragic.
link |
And you can always write a hell of a good story about that.
link |
And you should, about the loss of loved ones.
link |
But they were doing it pretty well, I would say,
link |
over this kind of dramatic deaths.
link |
And so in response to that, it's very unpleasant to hear,
link |
even to consider the possibility
link |
that the death rate is not as high as you might feel.
link |
Yeah, I was surprised by the reaction,
link |
both by regular people and also the scientific community
link |
in response to those studies,
link |
those early studies in April of 2020.
link |
To me, they were studies.
link |
I mean, they're the kinds of,
link |
not exactly the kinds of work I've worked on all my life,
link |
but kind of like the kind of, you write a paper
link |
and you get responses from your fellow scientists
link |
and you change the paper to improve it,
link |
you hopefully learn something from it.
link |
Well, but to push back, it's just a study.
link |
But there's some studies, and this is kind of interesting,
link |
because I've received similar pushback on other topics.
link |
There's some studies that, if wrong,
link |
might have wide ranging detrimental effects on society.
link |
So that's the way they would perceive the studies.
link |
If you say the death rate is lower,
link |
and you end up, as you often do in science,
link |
realizing that, nope, that was a flaw
link |
in the way the study was conducted,
link |
or we're just not representative of a broader population,
link |
and then you realize the death rate is much higher,
link |
that might be very damaging in people's view.
link |
So that's probably where the scientific community
link |
sort of just steel man the kind of response,
link |
is that's where they felt like,
link |
there's some findings where you better be damn sure
link |
before you kind of report them.
link |
Yeah, I mean, we were pretty sure we were right,
link |
and it turns out we were right.
link |
So we released the Santa Clara study
link |
via this open science process
link |
and this server called MedArchive.
link |
It's designed for releasing studies
link |
that have not yet been peer reviewed
link |
in order to garner comment from the scientists
link |
before peer review.
link |
The LA County study,
link |
we went through this traditional peer review process
link |
and got it published in the Journal
link |
of American Medical Association sometime in like July,
link |
I think, I forget the date, of 2020.
link |
The Santa Clara study released in April of 2020
link |
in this sort of working paper archive.
link |
The reason was that we felt we had an obligation,
link |
we had a result that we thought was quite important,
link |
and we wanted to tell the scientific community about it
link |
and also tell the world about it.
link |
And we wanted to get feedback.
link |
I mean, that's part of the purpose
link |
of sending it to these kinds of places.
link |
I think a lot of the problem is that
link |
when people think about published science,
link |
they think of it as automatically true.
link |
And if it goes through peer review,
link |
it's automatically true.
link |
If it hasn't gone through peer review,
link |
it's not automatically true.
link |
And especially in medicine,
link |
when we're not used to having this access
link |
to pre peer reviewed work.
link |
I mean, in economics, actually, that's quite normal.
link |
You takes years to get something published.
link |
So there's a very active debate over
link |
or discussion about papers before they're peer reviewed
link |
in this sort of working paper way,
link |
much less normal or much newer in medicine.
link |
And so I think part of that,
link |
the perception about what process happens in open science
link |
when you release a study, that got people confused.
link |
And you're right, it was a very important result
link |
because we had just locked the world down
link |
in middle of March with, I think, catastrophic results.
link |
And if that study was right, if our study was right,
link |
that meant we'd made a mistake.
link |
And not because the death rate was low,
link |
that's actually not the key thing there.
link |
The key thing is that we had adopted these policies,
link |
these test and trace policies,
link |
these policies, these lockdown policies
link |
aimed at suppressing the virus level to close to zero.
link |
That was essentially the idea.
link |
If we can just get the virus to go away,
link |
we won't have to ever worry about it again.
link |
The main problem with our result
link |
as far as that strategy was concerned wasn't the death rate,
link |
it was the 40 to 50 times more infections than cases.
link |
It was the 2.5% or 3% or 4% prevalence rate
link |
that we identified of the antibodies in the population.
link |
If that number is right, it's too late.
link |
The virus is not going to go to zero.
link |
And no matter how much we test and trace and isolate,
link |
we're not going to get the viral level down to zero.
link |
So we're gonna have to let the virus
link |
go through the entire population in some way or some other?
link |
We can talk about that in a bit.
link |
That's the Great Barrington Declaration.
link |
You don't have to let the virus go through the population.
link |
You can shield preferentially.
link |
The policy we chose was to shield preferentially
link |
the set of people who could work from home
link |
without losing their job.
link |
And we did a very good job at protecting them.
link |
Well, let me take a small tangent.
link |
We're gonna jump around in time,
link |
which I think will be the best way to tell the story.
link |
So that was the beginning.
link |
Yeah, okay, actually, can I go back one more thing for that?
link |
Because that's really important
link |
and I should have started with this.
link |
What led me to do those studies was a paper
link |
that I had remembered seeing
link |
from the H1N1 flu epidemic in 2009.
link |
This is where I've been much less active
link |
in writing about that.
link |
I had written like a paper or two about that in 2009.
link |
There was actually the same debate over the mortality rate,
link |
except it unfolded over the course of three years,
link |
two or three years.
link |
The early studies of the mortality rate in H1N1
link |
counted the number of cases in the denominator,
link |
counted the number of deaths in the numerator,
link |
cases meaning people identified as having H1N1,
link |
showing up the doctor, tested to have it.
link |
And the earliest estimates of the H1N1 mortality
link |
were like 4%, 3%, really, really high.
link |
Over the course of a couple of more years,
link |
a whole bunch of seroprevalence studies,
link |
seroprevalence studies of H1N1 flu came out.
link |
And it turned out that there were 100 or more times
link |
people infected per case.
link |
And so the mortality rate was actually something like 0.02%
link |
for H1N1, not the three, like 100 fold difference.
link |
So this made you think, okay,
link |
it took us a couple of two or three years
link |
to discover the truth behind the actual infections
link |
for H1N1, and then what's the truth here
link |
and can we get there faster?
link |
Yeah, and it spreads in a similar way as the H1N1 flu did.
link |
I mean, it spreads via solization,
link |
via person to person breathing, kind of contact up.
link |
It may be some by fomites, but it seems less likely now.
link |
In any case, it seemed really important to me
link |
to speed up the process
link |
of having those seroprevalence studies
link |
so that we can better understand who was at risk
link |
and what the right strategy ought to be.
link |
This might be a good place to kind of compare influenza,
link |
the flu, and COVID in the context of the discussion
link |
we just had, which is how deadly is COVID?
link |
So you mentioned COVID is a very particular
link |
kind of steepness, where the X axis is age.
link |
So in that context, could you maybe compare influenza
link |
and COVID, because a lot of people outside the folks
link |
who suggest that the lizards who run the world
link |
have completely fabricated and invented COVID,
link |
outside of those folks, kind of the natural process
link |
by which you dismiss the threat of COVID is, say,
link |
well, it's just like the flu.
link |
The flu is a very serious thing, actually.
link |
So in that comparison, where does COVID stand?
link |
Yeah, the flu is a very serious thing.
link |
It kills 50, 60,000 people a year,
link |
something I found out,
link |
depending on the particular strain that goes around,
link |
that's in the United States.
link |
The primary difference to me,
link |
there's lots of differences,
link |
but one of the most salient differences
link |
is the age gradient and mortality risk for the flu.
link |
So the flu is more deadly to children than COVID is.
link |
There's no controversy about that.
link |
Children, thank God, have much less severe reactions
link |
to COVID infection than they do to flu infections.
link |
And rate of fatalities and stuff like that.
link |
Rate of fatality, all of that.
link |
I think you mentioned,
link |
I mean, it's interesting to maybe also comment on,
link |
I think in another conversation you mentioned
link |
there's a U shape to the flu curve,
link |
so meaning there's actually quite a large number of kids
link |
that die from flu.
link |
Yeah, I mean, the 1918 flu, the H1N1 flu,
link |
the Spanish flu in the US killed millions of younger people.
link |
And that is not the case with COVID.
link |
More than, I'm gonna get the number wrong,
link |
but something like 70, 80% of the deaths
link |
are people over the age of 60.
link |
Well, we've talked about the fear the whole time, really.
link |
But my interaction with folks,
link |
now I wanna have a family, I wanna have kids,
link |
but I don't have that real firsthand experience,
link |
but my interaction with folks is at the core of fear
link |
that folks had is for their children.
link |
Like that somehow I don't wanna get infected
link |
because of the kids.
link |
Because God forbid something happens to the kids.
link |
And I think that obviously that makes a lot of sense
link |
this kind of the kids come first no matter what,
link |
that's number one priority.
link |
But for this particular virus,
link |
that reasoning was not grounded in data, it seems like,
link |
or that emotion and feeling was not grounded in data.
link |
But at the same time, this is way more deadly than the flu
link |
just overall, and especially to older people.
link |
The numbers, when the story is all said and done,
link |
COVID would take many more lives.
link |
Yeah, so, I mean, 0.2 sounds like a small number,
link |
but it's not a small number worldwide.
link |
What do you think that number will be
link |
by the, you know, that's not like me,
link |
but would we cross, I think it's in the United States,
link |
it's the way the deaths are currently reported,
link |
it's like 800,000, something like that.
link |
Do you think we'll cross a million?
link |
Seems likely, yeah.
link |
Do you think it's something that might continue
link |
with different variants, what?
link |
Well, I think, so we can talk about the end state of COVID.
link |
The end state of COVID is it's here forever.
link |
I think that there is good evidence of immunity
link |
after infection, such that you're protected
link |
both against reinfection and also against
link |
severe disease upon reinfection.
link |
So the second time you get it, it's not true for everyone,
link |
but for many people, the second time you get it
link |
will be milder, much milder than the first time you get it.
link |
With the long tail, like that lasts for a long time.
link |
Yeah, so just, there are studies that follow, of course,
link |
people who are infected for a year,
link |
and the reinfection rate is something like
link |
somewhere between 0.3 and 1%.
link |
And like a pretty fantastic study out in Italy
link |
has found that, there's one in Sweden, I think,
link |
there's a few studies that have found similar things.
link |
And the reinfections tend to produce much milder disease,
link |
much less likely to end up in the hospital,
link |
much less likely to die.
link |
So what the end state of COVID is,
link |
it's circulating the population forever
link |
and you get it multiple times.
link |
Yeah, and then there's, I think, studies and discussions
link |
like the best protection would be to get it
link |
and then also to get vaccinated.
link |
And then a lot of people push back against that
link |
for the obvious reasons from both sides,
link |
because somehow the discourse has become
link |
less scientific and more political.
link |
Well, I think you wanna, the first time you meet it
link |
is gonna be the most deadly for you.
link |
And so the first time you meet it,
link |
it's just wise to be vaccinated.
link |
The vaccine reduces severe disease.
link |
Yeah, we'll talk about the vaccine,
link |
because I wanna make sure I address it carefully
link |
and properly and in full context.
link |
But yes, sort of to add to the context,
link |
a lot of the fascinating discussions we're having
link |
is in the early days of COVID
link |
and now for people who are unvaccinated.
link |
That's where the interesting story is.
link |
The policy story, the sociological story and so on.
link |
But let me go to something really fascinating
link |
just because of the people involved,
link |
the human beings involved,
link |
and because of how deeply I care about science
link |
and also kindness, respect and love and human things.
link |
Francis Collins wrote a letter in October 2020
link |
to Anthony Fauci and I think somebody else.
link |
I have the letter, oh, it's not a letter, email, I apologize.
link |
Hi, Tony and Cliff, cgbdeclaration.org.
link |
This proposal, this is the Great Barrington Declaration
link |
that you're a coauthor on.
link |
This proposal from the three fringe epidemiologists
link |
who met with the secretary
link |
seem to be getting a lot of attention
link |
and even a co signature from Nobel Prize winner,
link |
Mike Levitt at Stanford.
link |
There needs to be a quick and devastating
link |
published take down of its premises.
link |
I don't see anything like that online yet.
link |
Is it underway, question mark, Francis.
link |
Francis Collins, director of the NIH,
link |
somebody I talked to on this podcast recently.
link |
Okay, a million questions I wanna ask.
link |
But first, how did that make you feel
link |
when you first saw this email come to light,
link |
when did it come to light?
link |
This week, actually, I think, or last week.
link |
Okay, so this is because of freedom of information.
link |
Which, by the way, sort of maybe,
link |
because I do wanna add positive stuff
link |
on the side of Francis here.
link |
Boy, when I see stuff like that,
link |
I wonder if all my emails leaked, how much embarrassing stuff.
link |
Like, I think I'm a good person,
link |
but I haven't read my old emails.
link |
Maybe, I'm pretty sure sometimes I could be an asshole.
link |
Well, I mean, look, he's a Christian,
link |
and I'm a Christian, I'm supposed to forgive, right?
link |
I mean, I think he was looking at this
link |
Great Barrington Declaration as a political problem
link |
to be solved, as opposed to a serious
link |
alternative approach to the epidemic.
link |
So maybe we'll talk about it in more detail,
link |
but just in case people are not familiar,
link |
Great Barrington Declaration was a document
link |
that you coauthored that basically argues
link |
against this idea of lockdown as a solution to COVID,
link |
and you propose another solution that we'll talk about.
link |
But the point is, it's not that dramatic of a document,
link |
it is just a document that criticizes
link |
one policy solution that was proposed.
link |
But it was the policy solution that had been put forward
link |
by Dr. Collins and by Tony Fauci,
link |
and a few other science, I mean, I think a relatively
link |
small number of scientists and epidemiologists
link |
in charge of the advice given to governments worldwide.
link |
And it was a challenge to that policy
link |
that said that, look, there is an alternate path,
link |
that the path we've chosen, this path of lockdown
link |
with the aim to suppress the virus to zero effectively,
link |
I mean, that was unstated.
link |
Cannot work and is causing catastrophic harm
link |
to large numbers of poor and vulnerable people worldwide.
link |
We put this out in October 4th, I think, of 2020,
link |
and it went viral.
link |
I mean, I've never actually been involved
link |
with anything like this,
link |
where I just put the document on the web,
link |
and tens of thousands of doctors signed on,
link |
hundreds of thousands of regular people signed on.
link |
It really struck a chord of people,
link |
because I think even by October of 2020,
link |
people had this sense that there was something really wrong
link |
with the COVID policy that we've been following.
link |
And they were looking for reasonable people
link |
to give an alternative.
link |
I mean, we're not arguing that COVID isn't a serious thing.
link |
I mean, it is a very serious thing.
link |
This is why we had a policy that aimed at addressing it.
link |
But we were saying that the policy we're following
link |
is not the right one.
link |
So how does a democratic government deal with that challenge?
link |
So to me, that, you asked me how I felt.
link |
I was actually, frankly, just,
link |
I suspected there'd been some email exchanges like that,
link |
not necessarily from Francis Collins,
link |
around the government around this time.
link |
I mean, I felt the full brunt of a propaganda campaign
link |
almost immediately after we published it,
link |
where newspapers mischaracterized it
link |
in the same way over and over and over again,
link |
and sought to characterize me
link |
as sort of a marginal fringe figure or whatnot.
link |
Sunetra Gupta, Martin Kulldorff,
link |
or the tens of thousands of other people that signed it.
link |
I felt the brunt of that all year long.
link |
So to see this in black and white,
link |
in the handwriting, essentially,
link |
I mean, the metaphorical handwriting of Francis Collins
link |
was actually, frankly, a disappointment,
link |
because I've looked up to him for years.
link |
Yeah, I've looked up to him as well.
link |
I mean, I look for the best in people,
link |
and I still look up to him.
link |
What troubles me is several things.
link |
The reason I said about the asshole emails
link |
I send late at night is I can understand this email.
link |
It's fear, it's panic, not being sure.
link |
The fringe, three fringe epidemiologists.
link |
Plus Mike Leavitt, who won a Nobel Prize, I mean.
link |
But using fringe, maybe in my private thoughts,
link |
I have said things like that about others,
link |
like a little bit too unkind.
link |
Like, you don't really mean it.
link |
Now, add to that, he recently, this week,
link |
whatever, doubled down on the fringe.
link |
This is really troubling to me,
link |
that I can excuse this email,
link |
but the arrogance there, Francis, honestly,
link |
I mean, broke my heart a little bit there.
link |
This was an opportunity to, especially at this stage,
link |
to say, just like I told him,
link |
to say I was wrong to use those words in that email.
link |
I was wrong to not be open to ideas.
link |
I still believe that this is not,
link |
like, say, like, actually argue with the proposal,
link |
with the policy, the proposed solution.
link |
Also, the devastating published,
link |
devastating takedown, devastating takedown.
link |
As you say, somebody who's sitting on billions of dollars
link |
that they're giving to scientists,
link |
some of whom are often not their best human beings
link |
because they're fighting with each other over money,
link |
not being cognizant of the fact
link |
that you're challenging the integrity,
link |
you're corrupting the integrity of scientists
link |
by allocating them money,
link |
you're now playing with that
link |
by saying devastating takedown.
link |
Where do you think the published takedown will come from?
link |
It will come from those scientists
link |
to whom you're giving money.
link |
What kind of example would they give
link |
to the academic community that thrives on freedom?
link |
Like, this is, I believe Francis Collins is a great man.
link |
One of the things I was troubled by
link |
is the negative response to him
link |
from people that don't understand
link |
the positive impact that NIH has had on society,
link |
how many people it's helped.
link |
But this is exactly the, so he's not just a scientist.
link |
He's not just a bureaucrat who distributes money.
link |
He's also a scientific leader
link |
that in difficult times we live in,
link |
is supposed to inspire us with trust,
link |
with love, with the freedom of thought.
link |
He's supposed to, you know those fringe epidemiologists?
link |
Those are the heroes of science.
link |
When you look at the long arc of history,
link |
we love those people.
link |
We love ideas, even when they get proven wrong.
link |
That's what always attracted me to science.
link |
Like somebody, the lone voice saying,
link |
oh no, the moon of Jupiter does move.
link |
But the funny thing is,
link |
Galileo was saying something truly revolutionary.
link |
We were saying that what we proposed
link |
in the Great Barbarian Declaration
link |
was actually just the old pandemic plan.
link |
It wasn't anything really fundamentally novel.
link |
In fact, there were plans like this
link |
that lockdown scientists had written
link |
in late February, early March of 2020.
link |
So we were not saying anything radical.
link |
We were just calling for a debate effectively
link |
over the existing lockdown policy.
link |
And this is a disappointment,
link |
a really, truly a big disappointment
link |
because by doing this, you were absolutely right, Lex.
link |
He sent a signal to so many other scientists
link |
to just stay silent, even if you had reservations.
link |
Yeah, devastating take down that people,
link |
you know how many people wrote to me privately,
link |
like Stanford, MIT,
link |
how amazing the conversation with Francis Collins was?
link |
There's a kind of admiration because,
link |
okay, how do I put it?
link |
A lot of people get into science
link |
because they wanna help the world.
link |
They get excited by the ideas
link |
and they really are working hard to help
link |
in whatever the discipline is.
link |
And then there is sources of funding
link |
which help you do help at a larger scale.
link |
So you admire the people that are distributing the money
link |
because they're often, at least on the surface,
link |
are really also good people.
link |
Oftentimes they're great scientists.
link |
So like, it's amazing.
link |
That's why I'm sort of,
link |
like sometimes people from outside
link |
think academia is broken some kind of way.
link |
No, it's a beautiful thing.
link |
It really is a beautiful thing.
link |
And that's why it's so deeply heartbreaking
link |
where this person is,
link |
I don't think this is malevolence.
link |
I think he's just incompetence of communication twice.
link |
I think there's also arrogance at the bottom of it too.
link |
But all of us have arrogance at the bottom.
link |
There's a particular kind of arrogance.
link |
So here it's of the same kind of arrogance
link |
that you see when Tony Fauci gets on TV
link |
and says that if you criticize me,
link |
you're not simply criticizing a man,
link |
you're criticizing science itself.
link |
That is at the heart also of this email.
link |
The certainty that the policies that they were recommending,
link |
Collins and Fauci were recommending
link |
to the president of the United States were right.
link |
Not just right, but right so far right
link |
that any challenge whatsoever to it is dangerous.
link |
And I think that is really the heart of that email.
link |
It's this idea that my position is unchallengeable.
link |
Now to be completely, to be as charitable as I can be
link |
to this, I believe they thought that.
link |
I believe some of them still think that,
link |
that there was only one true policy possible
link |
in response to COVID.
link |
Every other policy was immoral.
link |
And if you come from that position,
link |
then you write an email like that.
link |
You go on TV, you say effectively la science est moi, right?
link |
I mean, that is what happens
link |
when you have this sort of unchallengeable arrogance
link |
that the policy you're following is correct.
link |
I mean, when we wrote the Great Bank Declaration,
link |
what I was hoping for was a discussion
link |
about how to protect the vulnerable.
link |
I mean, that was the key idea to me in the whole thing
link |
was better protection of the older population
link |
who were really at really serious risk
link |
if infected with COVID.
link |
And we had been doing a very poor job, I thought,
link |
to date in many places in protecting the vulnerable.
link |
And what I wanted was a discussion by local public health
link |
about better methods, better policies
link |
to protect the vulnerable.
link |
So when we were met with instead a series
link |
of essentially propagandist lies about it.
link |
So for instance, I kept hearing from reporters in those days,
link |
why do you want to let the virus rip?
link |
Let it rip, let it rip.
link |
The words let it rip does not appear
link |
in the Great Bank Declaration.
link |
The goal isn't to let the virus rip.
link |
The goal is to protect the vulnerable,
link |
to let society go open schools and do other things
link |
that function as best it can
link |
in the midst of a terrible pandemic, yes,
link |
but not let the virus rip
link |
where the most vulnerable aren't protected.
link |
The goal was to protect the vulnerable.
link |
So why let it rip?
link |
Because it was a propaganda term
link |
to hit the fear centers of people's brains.
link |
Oh, these people are immoral.
link |
They just want to let the virus go through society
link |
and hurt everybody.
link |
That was the idea.
link |
It was a way to preclude a discussion
link |
and preclude a debate about the existing policy.
link |
So this is an app called Clubhouse.
link |
I've gone back on it recently to practice Russian,
link |
unrelated for a few big Russian conversations coming up.
link |
Anyway, it's a great way
link |
to talk to regular people in Russian.
link |
But I also, I was nervous.
link |
I was preparing for a Pfizer CEO conversation
link |
and there was a vaccine room and so I joined it.
link |
And it was a pro science room.
link |
These are like scientists
link |
that were calling each other pro science.
link |
The whole thing was like theater to me.
link |
I mean, I haven't thoroughly researched,
link |
but looking at the resume,
link |
they were like pretty solid researchers and doctors.
link |
And they were mocking everybody who was at all,
link |
I mean, it doesn't matter what they stood for,
link |
but they were just mocking people
link |
and the arrogance was overwhelming.
link |
I had to shut off because I couldn't handle
link |
that human beings can be like this to each other.
link |
And then I went back just to double check,
link |
is this really happening?
link |
How many people are here?
link |
And then I asked to come on stage on Clubhouse
link |
to make a couple of comments.
link |
And then as I opened my mouth, I said, thank you so much.
link |
This is a great room, sort of the usual civil politeness,
link |
all that kind of stuff.
link |
And I said, I'm worried that the kind of arrogance
link |
with which things are being discussed here
link |
will further divide us, not unite us.
link |
And before I said even the unite us, further divide us,
link |
I was thrown off stage.
link |
Now, this isn't why I mentioned platform,
link |
but like I am like Lex Friedman, MIT,
link |
also, which is something those people seem
link |
to sometimes care about, followers and stuff like that.
link |
Like, did you just do that?
link |
And then they said, enough of that nonsense.
link |
Enough of that nonsense.
link |
They said to me, enough of that nonsense.
link |
Somebody who is obviously interviewed, Francis Collins,
link |
is the Pfizer CEO.
link |
To bring you on, French epidemiologist also, so just.
link |
But this broke my heart, the arrogance.
link |
And this is, echoes of that arrogance
link |
is something you see in this email.
link |
And I really would love to have a million things
link |
to talk about to try to figure out
link |
how can we find a path forward?
link |
I think a lot of the problems we've seen
link |
in the discussion over COVID,
link |
and especially in the scientific community,
link |
there's two ways to look at science, I think,
link |
that have been competing with each other for a while now.
link |
One way, and this is the way that I view science
link |
and why I've always found it so attractive,
link |
is an invitation to a structured discussion
link |
where the discussion is tempered by evidence,
link |
by data, by reasoning and logic, right?
link |
So it's a dialectical process where if I believe A
link |
and you believe B, well, we talk about it.
link |
We come up with an experiment
link |
that distinguishes between the two.
link |
And while B turns out to be right,
link |
I'm all frustrated, but I buy you dinner
link |
and I say, no, no, no, no, C.
link |
And then we go on from there, right?
link |
That's what science is at its best.
link |
It's this process of using data in discussion.
link |
It's a human activity, right?
link |
To learn, to have the truth unfold itself before us.
link |
On the other hand, there's another way
link |
that people have used science or thought about science
link |
as truth in and of itself, right?
link |
Like if it's science, therefore it's true automatically.
link |
And what does the science say to do?
link |
Well, the science never says to do anything.
link |
The science says, here's what's true.
link |
And then we have to apply our human values to say,
link |
okay, well, if we do this, then this is likely to happen.
link |
That's what the science says.
link |
If we do that, then that is likely to happen.
link |
Well, we'd rather have this than that, right?
link |
But science doesn't tell us
link |
that we'd rather have this than that.
link |
It's our human values that tell us
link |
that we'd rather have this than that.
link |
Science plays a role, but it's not the only thing.
link |
It's not the only role.
link |
It's like, it helps understand the constraints we face,
link |
but it doesn't tell us what to do
link |
in face of those constraints.
link |
But underneath it, at the individual level,
link |
at the institutional level,
link |
it seems like arrogance is really destructive.
link |
So the flip side of that, the productive thing is humility.
link |
So sort of always not being sure that you're right.
link |
This is actually kind of,
link |
Stuart Russell talks about this for AI research.
link |
How do you make sure that AI,
link |
super intelligent AI doesn't destroy us?
link |
You built in a sort of module within it
link |
that it always doubts its actions.
link |
Like, it's not sure.
link |
Like, I know it says I'm supposed to destroy all humans,
link |
but maybe I'm wrong.
link |
And that maybe I'm wrong is essential for progress,
link |
for actually doing in the long arc of history better,
link |
not the perfect thing,
link |
but better and better and better and better.
link |
I mean, the question I have here for you is this,
link |
this email so clearly captures some maybe echo,
link |
but maybe a core to the problem.
link |
Do you put responsibility of this email,
link |
of the shortcomings and failures
link |
on individuals or institutions?
link |
Is this Francis Collins, Anthony?
link |
No, this is an institutional failure, right?
link |
So the NIH, so I've had two decades of NIH funding.
link |
I've sat on NIH review panels.
link |
The purpose of the NIH is what you said earlier, Lex.
link |
The purpose of the NIH is to support the work of scientists.
link |
To some extent, it's also to help scientists,
link |
to direct scientists to work on things
link |
that are very important for public health
link |
or for the health of the public.
link |
So, and the way you do that is you say,
link |
okay, we're gonna put $50 million
link |
on the research in Alzheimer's disease this year
link |
or $70 million on HIV or whatever it is, right?
link |
And that pot of money then scientists compete
link |
with each other for the best ideas to use it
link |
to address that problem.
link |
So it's essentially an endeavor
link |
to support the work of scientists.
link |
It is not in and of itself a policy organ.
link |
It doesn't say what public health policy should be.
link |
For that, you have the CDC and what happened
link |
during the pandemic is that people in the NIH
link |
were called upon to contribute
link |
to public health policymaking.
link |
And that created the conflict of interest
link |
you see in that email, right?
link |
So now you have the head of the NIH in effect saying
link |
to all scientists, you must agree with me
link |
in the policy that I've recommended
link |
or else you're a fringe.
link |
That is a deep conflict of interest.
link |
It's deep because first he's conflicted.
link |
He has this dual role as the head of the NIH,
link |
supporter of scientific funding
link |
and then also inappropriately called
link |
to set or help set pandemic policy.
link |
That should never have happened.
link |
There should be a bright line between those two roles.
link |
Let me ask you about just Francis Collins.
link |
I had a chance to talk to him on a podcast.
link |
I don't know if you maybe by chance
link |
gotten a chance to hear a few words.
link |
I heard some of it, yeah.
link |
Well, I have kind of a question to that
link |
because a lot of people wrote to me quite negative things
link |
about Francis Collins and like I said,
link |
I still believe he's a great man and a great scientist.
link |
One of the things when I talked to him off mic
link |
about the vaccine,
link |
the excitement he had about when we were recollecting
link |
when they first gotten an inkling
link |
that it's actually going to be possible to get a vaccine,
link |
just he wasn't messaging,
link |
just in the private or of our own conversation,
link |
he was really excited and why was he excited?
link |
Because he gets to help a lot of people.
link |
This is a man that really wants to help people
link |
and there could be some institutional self delusion,
link |
the arrogance, all those kinds of things
link |
that lead to this kind of email.
link |
But ultimately the goal is this,
link |
I don't think people quite realize this.
link |
The reason he would call you a fringe epidemiologist,
link |
the reason there needs to be a devastating published
link |
take down, he, I believe really believes
link |
that it could be very dangerous
link |
and it's a lot of burden to carry on his shoulders
link |
because like you said, in his role
link |
where he defines some of the public policy,
link |
depending on how he thinks about the world,
link |
millions of people could die
link |
because of one decision he make.
link |
And that's a lot of burden to walk with.
link |
Yeah, no, I think that's right.
link |
I don't think that he has bad intentions.
link |
I think that he was basically put,
link |
was put or maybe put himself in a position
link |
where this kind of conflict of interest
link |
was going to create this kind of reaction, right?
link |
The kind of humility that you're calling for
link |
is almost impossible when you have that dual role
link |
that you shouldn't have as funder of science
link |
and also setter of scientific policy.
link |
I agree with everything you just said,
link |
except the last part.
link |
The humility is almost impossible.
link |
Humility is always difficult.
link |
I think there's a huge incentive
link |
for humility in that position.
link |
Now look at history.
link |
Great leaders that have humility are popular as hell.
link |
So if you like being popular,
link |
if you like having impact, legacy,
link |
these descendants of ape seem to care about legacy,
link |
especially as they get older in these high positions.
link |
I think the incentive for humility is pretty high.
link |
Well, the thing is there's a lot
link |
that he has to be proud of in his career.
link |
I mean, the Human Genome Project
link |
wouldn't have happened without him.
link |
And he is a great man and a great scientist.
link |
So it is tragic to me that his career
link |
has ended in this particular way.
link |
Can I ask you a question
link |
about my podcast conversation with him?
link |
By way of advice or maybe criticism,
link |
there's a lot of people that wrote to me
link |
kind words of support and a lot of people
link |
that wrote to me respectful, constructive criticism.
link |
How would you suggest to have conversations
link |
with folks like that?
link |
And maybe, I mean,
link |
because I have other conversations like this,
link |
including I was debating whether to talk to Anthony Fauci.
link |
He wanted to talk.
link |
And so what kind of conversation do you have?
link |
And sorry to take us on a tangent,
link |
but almost from an interview perspective
link |
of how to inspire humility and inspire trust in science
link |
or maybe give hope that we know what the heck we're doing
link |
and we're gonna figure this out?
link |
I mean, I think you're,
link |
I've had been now interviewed by many people.
link |
I think the style you have really works well, Lex.
link |
because I don't think you're gonna be ever an attack dog
link |
trying to go after somebody and force them to like,
link |
sort of admit that they were wrong or whatever about,
link |
I mean, I also actually find that form of journalism
link |
and podcasting really off putting.
link |
It's hard to watch.
link |
Also, it's a whole other tangent.
link |
Is that actually effective?
link |
Do you wanna ask Hitler,
link |
and I think about this a lot, actually interviewing Hitler.
link |
I've been studying a lot about the rise and fall
link |
of the Third Reich.
link |
I think about interviewing Stalin.
link |
Like I put myself in that mindset,
link |
like how do you have conversations with people
link |
to understand who they are so that,
link |
not so you can sit there and yell at them,
link |
but to understand who they are
link |
so that you can inspire a very large number of people
link |
to be the best version of themselves
link |
and to avoid the mistakes of the past.
link |
I believe that everyone that's involved in this debate
link |
has good intentions.
link |
They're coming at it from their points of view.
link |
They have their weaknesses.
link |
And if you can paint a picture in your questioning
link |
by sympathetic questioning of those strengths and weaknesses
link |
and their point of view, you've done a service.
link |
That's really all I personally like to see
link |
in those kinds of interviews.
link |
I don't think a gotcha moment is really the key thing there.
link |
The key thing is understanding where they're coming from,
link |
understanding their thinking,
link |
understanding the constraints they faced
link |
and how did they manage them.
link |
That's gonna provide a much,
link |
I mean, to me, that's what I look for
link |
when I listen to podcasts like yours,
link |
is an understanding of that person and the moment
link |
and how they dealt with it.
link |
I mean, I guess the hope is to discover in a sympathetic way
link |
a flaw in a person's thinking together.
link |
Like as opposed to discovering the positive thing together,
link |
you discover the thing, well,
link |
I didn't really think about that.
link |
Yeah, I mean, that's how science is, right?
link |
That's why we find it so attractive is this,
link |
I like it when a student shows me I'm thinking incorrectly.
link |
Right, I'm really grateful to that student
link |
because now I have an opportunity to change my mind about it
link |
and then start thinking even more correctly.
link |
I mean, and there are moments when,
link |
I mean, like this is probably a good time to say
link |
like what I think I got wrong during the pandemic, right?
link |
So like for instance, you said Francis Collins had a moment
link |
when he learned that there was quite possible
link |
to get a vaccine going.
link |
He must've learned that quite early.
link |
And I didn't learn that early.
link |
I mean, I didn't know, in March of 2020,
link |
in my experience with vaccine development,
link |
it would've take, I thought it would take a decade or more
link |
That was wrong, right?
link |
I didn't, and I was so happy
link |
when I started to see the preliminary numbers
link |
in the Pfizer trial that strongly suggested
link |
it was going to work.
link |
And I was, I mean, like very few times in my life
link |
I'm so happy to be wrong.
link |
And it changes kind of, I think I've heard you mention
link |
that a lockdown is still a bad idea
link |
unless the vaccine comes out in like tomorrow.
link |
There's still like suffering and economic pain,
link |
all kinds of pain can still happen
link |
in even just a scale of weeks versus months.
link |
Well, let's talk about the vaccine.
link |
What are your thoughts on the safety and efficacy
link |
of COVID vaccines at the individual and the societal level?
link |
So for the vaccine safety data,
link |
it's actually challenging to convey to the public
link |
how this is normally done.
link |
Like normally you would do this in the context of the trial,
link |
you'd have a long trial with large numbers,
link |
relatively large numbers of people,
link |
you'd follow them over a long time
link |
and the trial will give you some indication
link |
of the safety of the vaccine.
link |
And it did, I mean, but the trial,
link |
the way it was constructed, when it came out
link |
that it was protective against COVID,
link |
it was no longer ethical to have a placebo arm.
link |
And so that placebo arm was vaccinated, large part of it.
link |
And so that meant that from the trial,
link |
you were not going to be able to get data
link |
on the longterm safety profiles of the vaccine.
link |
And also the other thing about trials,
link |
although there's tens of thousands of people enrolled,
link |
that's still not enough to get
link |
when you deploy a vaccine at population scale,
link |
you're gonna see things that weren't in the trial,
link |
guaranteed, populations of people
link |
that weren't represented well in the trial
link |
are gonna be given the vaccine
link |
and then they're gonna have things that happen to them
link |
that you didn't anticipate.
link |
So I wasn't surprised when people were a little bit
link |
skeptical when the trial was done about the safety profile,
link |
just the way the nature of the thing was gonna make it
link |
so that it was gonna be hard to get a complete picture
link |
from the trials itself.
link |
And the trial showed they were pretty safe
link |
and quite effective at preventing both you
link |
from getting COVID,
link |
like I said, I think the main endpoint of the trial itself
link |
was a symptomatic COVID, right?
link |
So that was like, that was, I mean, it was really to me,
link |
like it was about as amazing achievement as anything,
link |
organizing a trial of that scale and running it so quickly.
link |
And the final results being so surprisingly high.
link |
And so, but the problem then was,
link |
normally it would take a long time,
link |
the FDA would tell Pfizer to go back
link |
and try it in this subgroup,
link |
they'd work more on dosing,
link |
they do all these kinds of things
link |
that kind of didn't, we really didn't have time for
link |
in the middle of the pandemic, right?
link |
So you have a basis for approval that it's less full
link |
than normally you would have for a population scale vaccine.
link |
But the results were good, the results looked really good.
link |
And actually, I should say for the most part,
link |
that's been born out when we've given the vaccine at scale
link |
in terms of protection against severe disease, right?
link |
So people who have got the vaccine
link |
for a very long time after they've had
link |
for the full vaccination have had great protection
link |
against being hospitalized and dying if they get COVID.
link |
Let's separate, because this seems to be,
link |
there's critics of both categories, but different.
link |
Kids and kids, not older people,
link |
like let's say five years old and above or something,
link |
or 13 years old and above.
link |
So for those, it seems like the reduction
link |
of the rate of fatalities and serious illness
link |
seems to be something like 10X.
link |
I mean, for older people, it is a godsend, this vaccine.
link |
It transforms the problem of focus protection
link |
from something that's quite challenging,
link |
possible, I believe, but quite challenging
link |
to something that's much, much more manageable.
link |
Because the vaccine in and of itself when deployed
link |
in older populations is a form of focus protection.
link |
Yes, by the way, we'll talk about the focus protection
link |
in one segment, because it's such a brilliant idea
link |
for this pandemic or for future pandemics.
link |
I thought the sociological, psychological discussion
link |
about the letter from Francis Collins is,
link |
because it was so recent, it has been so troubling to me,
link |
so I'm glad we talked about that first.
link |
But so there seems to be, the vaccines work
link |
to reduce deaths, and that has especially
link |
the most transformative effects for the older folks.
link |
I've told you one thing that I got wrong in the pandemic.
link |
Let me tell you the second thing I got wrong,
link |
for sure, in the pandemic.
link |
In January of this year, 2021,
link |
I thought that the vaccines would stop infection.
link |
Right, it would make it so that you were much less likely
link |
to be infected at all, because the antibodies
link |
that were produced by the vaccines
link |
looked like they were neutralizing antibodies
link |
that would essentially block you from being infected at all.
link |
That turned out to be wrong, right?
link |
So I think, and it became clear as data came out
link |
from Israel, which vaccinated very early,
link |
that they were seeing surges of infection,
link |
even in a very highly vaccinated population,
link |
that the vaccine does not stop infection.
link |
So you're a used car salesman,
link |
and you were selling the vaccine,
link |
and the features you thought a vaccine would have,
link |
I mean, I have a similar kind of sense
link |
when the vaccine came out.
link |
Vaccine would reduce, if you somehow were able to get it,
link |
it would reduce rate of death and all those kinds of things,
link |
but it would also reduce the chance of you getting it,
link |
and if you do get it, the chance of you transmitting it
link |
And it turns out that those latter two things
link |
are not as definitive, or in fact,
link |
I mean, I don't know to which degree they're not there at all.
link |
I think it's a little complicated,
link |
because I think the first two or three months
link |
after you're fully vaccinated, after the second dose,
link |
you have 60, 70% efficacy peak against infection.
link |
So that, which is pretty good, I mean, right?
link |
But by six, seven, eight months, that drops to 20%.
link |
Some places, some studies, like there's a study
link |
out of Sweden that suggests it might even drop to zero.
link |
But, and then you're also infectious
link |
for some period of time, if you do get it,
link |
even though you're vaccinated.
link |
It seems to be lucidated that the period of time
link |
your infectious is shorter.
link |
Is shorter, but the infectivity per day is about as high.
link |
So you still, the point is that the vaccine
link |
might reduce some risk of infecting others,
link |
but it's not a categorical difference.
link |
So, it's not safe to be in the presence
link |
of just vaccinated people.
link |
You can still get infected.
link |
Right, so, I mean, there's a million things
link |
I wanna ask here, but is there in some sense
link |
because the vaccine really helps
link |
on the worst part of this pandemic,
link |
which is killing people.
link |
Doesn't that mean, where does the vaccine hesitancy
link |
come from in terms of, it seems like,
link |
obviously a vaccine is a powerful solution
link |
to let us open this thing up.
link |
Yeah, so I wrote a Wall Street Journal op ed
link |
with Sunetra Gupta in December of last year.
link |
A very night with a very naive title,
link |
which says we can end the lockdowns in a month.
link |
And the idea is very simple.
link |
Vaccinate all vulnerable people
link |
Right, and the idea was that the lockdown harms,
link |
this is directly related to the Great Barrington Declaration.
link |
Great Barrington Declaration said the lockdown harms
link |
are devastating to the population at large.
link |
There's this considerable segment of people
link |
that are vulnerable, protect them.
link |
Well, with the vaccine, we have a perfect tool
link |
to protect the vulnerable, which is, I still believe,
link |
I mean, it's true, right?
link |
You vaccinate the vulnerable, the older population,
link |
and as you said, there's a tenfold decrease
link |
in the mortality risk from getting infected,
link |
which is, I mean, amazing.
link |
So that was the strategy we outlined.
link |
What happened is that the vaccine debate got transformed.
link |
So first there's, so you're asking about vaccine hesitancy.
link |
I think first there's the inherent limitations
link |
of how to measure vaccine safety, right?
link |
So we talked about a little bit about the trial,
link |
but also after the trial, there's a mechanism,
link |
and this is the work I've been involved with before COVID,
link |
on tracking and identifying and checking
link |
whether the vaccines actually are safe.
link |
And the central challenge is one of causality.
link |
So you no longer have the randomized trial,
link |
but you wanna know is the vaccine,
link |
when it's deployed at scale, causing adverse events.
link |
Well, you can't just look at people who are vaccinated
link |
and see what adverse events happen,
link |
because you don't know what would have happened
link |
if the person had not been vaccinated.
link |
So you have to have some control group.
link |
Now, what happened is there's several systems
link |
to check this that the CDC uses.
link |
One very commonly known one now is called VAERS,
link |
the Vaccine Adverse Event Reporting System.
link |
There, anyone who has an adverse event,
link |
either a regular person or a doctor can just go report,
link |
look, I had the vaccine and two days later I had a headache
link |
or whatever it is, the person died
link |
a day after I had the vaccine, right?
link |
Now, the vaccine was rolled out to older people first,
link |
and older people die sometimes with or without the vaccine.
link |
So sometimes you'll see someone's vaccinated
link |
and a few days later they die.
link |
Did the vaccine cause it or something else cause it?
link |
Really difficult to tell.
link |
In order to tell, you need a control group.
link |
For that, there are other systems the FDA and CDC have,
link |
like there's one called VSD, Vaccine Safety Datalink.
link |
There's another system called BEST,
link |
I forget what the acronym is,
link |
to essentially to track cohorts of people,
link |
vaccinated versus unvaccinated,
link |
with as careful of matching as you can do.
link |
It's not randomized,
link |
and then see if you have safety signals
link |
that pop up in the vaccinated
link |
relative to the control group unvaccinated.
link |
And so that's, for instance,
link |
how the myocarditis risk was picked up
link |
in especially young men.
link |
It's also how the higher risk of blood clots
link |
in middle age and older women
link |
with the J&J vaccine was picked up.
link |
There, what you have are situations
link |
where the baseline risk of these outcomes are so low
link |
that if you see them in the vaccinated arm at all,
link |
that it's not hard to understand that the vaccine did this.
link |
Young men should not be having myocarditis.
link |
Middle age women should not be having
link |
huge blood clots in the brain.
link |
So when you see that, you can say it's linked.
link |
Now, the rates are low.
link |
So young men, maybe one in 5,000,
link |
one in 10,000 of the vaccine,
link |
vaccine related myocarditis, pericarditis.
link |
Young women, middle age women, I don't know.
link |
I'm not sure what the right number might be,
link |
but like I'd say, it's like one in hundreds of thousands,
link |
something like that.
link |
So these are rare outcomes,
link |
but they are vaccine linked outcomes.
link |
How do you deal with that as a messaging thing?
link |
I think you just tell people.
link |
You tell people here are the risks.
link |
You transparently tell them.
link |
And just, you're not,
link |
so they're not getting into something that they don't know.
link |
And don't treat people like they're children
link |
and need to be told lies
link |
because they won't understand
link |
the full complexity of the truth.
link |
People, I think, are pretty good at,
link |
or actually, people with time are good at understanding data,
link |
but better than anything.
link |
They're better at,
link |
they're extremely good at detecting arrogance and bullshit.
link |
And you give them either one of those.
link |
I mean, I'll give you one
link |
that's where I think it's greatly undermined vaccine,
link |
greatly undermined the demand for the vaccine,
link |
is this weird denial that if you recover from COVID,
link |
you have extremely good immunity,
link |
both against infection and access to disease.
link |
And that denial leads to people distrusting the message
link |
given by like the CDC director, for instance,
link |
in favor of the vaccine, right?
link |
Why would you deny a thing that's such an obvious fact?
link |
Like you can look at the data and it just,
link |
I mean, it just pops out at you
link |
that people that are COVID recovered
link |
are not getting infected again at very high rates,
link |
After these kinds of conversations,
link |
I'm sure after this very conversation,
link |
I often get a number of messages from Joe, Joe Rogan,
link |
and from Sam Harris, who to me are people I admire,
link |
I think are really intelligent, thoughtful human beings.
link |
They also have a platform.
link |
And I believe, at least in my mind,
link |
about this COVID set of topics,
link |
they represent a group of people.
link |
Each group has smart, thoughtful,
link |
well intentioned human beings.
link |
And I don't know who is right,
link |
but I do know that they're kind of tribal a little bit,
link |
And so the question I wanna ask is like,
link |
what do you think about these two groups
link |
and this kind of tension over the vaccine
link |
that sometimes it just keeps finding different topics
link |
on which to focus on,
link |
like whether kids should get vaccinated or not,
link |
whether there should be vaccine mandates or not,
link |
which seem to be often very kind of specific policy
link |
kinds of questions that miss the bigger picture.
link |
I think it's a symptom of the distrust
link |
that people have in public health.
link |
I think this kind of schism over the vaccine
link |
does not happen in places
link |
where the public health authorities
link |
have been much more trustworthy, right?
link |
So you don't see this vaccine
link |
hasn't seen Sweden, for instance.
link |
What's happened in the United States
link |
is that the vaccine has become first because of politics,
link |
but then also because of the scientific arrogance,
link |
this sort of touchstone issue,
link |
and people line up on both sides of it,
link |
and the different language you're hearing
link |
is structured around that.
link |
So before the election, for instance,
link |
I did a testimony in the House
link |
on measurement of vaccine safety.
link |
And I was invited by the Republicans.
link |
There were, I think, four other experts
link |
invited by the Democrats,
link |
or three other experts invited by Democrats,
link |
each of whom had a lot of experience
link |
in measuring vaccine safety.
link |
I was really surprised to hear them each doubt
link |
whether the FDA would do a reasonable job
link |
in assessing vaccine safety,
link |
including by people who have long records
link |
of working with the FDA.
link |
I mean, these are professionals, great scientists,
link |
whose main sort of goal in life
link |
is to make sure that unsafe vaccines
link |
don't get released into the world.
link |
And if they are, they get pulled.
link |
And they're casting down on the vaccine
link |
the ability to track vaccine safety before the election.
link |
And then after the election,
link |
the rhetoric switched on a dime, right?
link |
All of a sudden, it's Republicans that are cast
link |
as if they're vaccine hesitant.
link |
That kind of political shift, the public notices.
link |
If all it takes is an election to change
link |
how people talk about the safety of the vaccine,
link |
well, we're not talking science anymore,
link |
many people think, right?
link |
I think that created its hesitancy.
link |
The other thing I think,
link |
I think the hesitancy,
link |
some politicians viewed it as a political,
link |
as sort of like a political opportunity
link |
to sort of demonize people who are hesitant.
link |
And that itself fueled hesitancy, right?
link |
Like if you're telling me I'm a rube
link |
that just doesn't want the vaccine
link |
because I want everyone to die,
link |
well, I'm gonna react really negatively.
link |
And if you're talking down to me
link |
about my legitimate sort of concerns
link |
about whether this vaccine is safe to take,
link |
I mean, I've heard from women
link |
who were thinking about getting pregnant,
link |
should I take the vaccine?
link |
I mean, there are all kinds of questions,
link |
legitimate questions that I think
link |
should have good data to answer
link |
that we don't necessarily have good data to answer.
link |
So what do you do in the face of that?
link |
Well, one reaction is to pretend
link |
like we know for a fact that it's safe
link |
when we don't have the data to know for a fact
link |
in that particular group
link |
with that particular set of clinical circumstances you know.
link |
And that I think breeds hesitancy.
link |
People can detect that bullshit.
link |
Whereas if you just tell people, you know, I don't know.
link |
Yeah, leave with humility.
link |
Yeah, you will end up with a better result.
link |
Let me ask you about,
link |
I've recently had a conversation with the Pfizer CEO.
link |
This is part therapy session, part advice,
link |
because again, I really want us to get through this together
link |
and it feels like the division is a thing
link |
that prevents us from getting through this together.
link |
And once again, just like with Francis Collins,
link |
a lot of people wrote to me words of support
link |
and a lot of people wrote to me words of criticism.
link |
I'm trying to understand the nature of the criticism.
link |
So some of the criticism had to do with against the vaccine
link |
and those kinds of things.
link |
That I have a better understanding of.
link |
But some kind of deep distrust of Pfizer.
link |
So actually looking at Big Pharma broadly,
link |
I'm trying to understand am I so naive
link |
that I just don't see it?
link |
Because yes, there's corrupt people and they're greedy,
link |
they're flawed in all walks of life.
link |
But companies do quite an incredible job
link |
of taking a good idea at the scale
link |
and making some money with that idea.
link |
But they are the ones that achieve scale on a good idea.
link |
I don't know, it's not obvious to me.
link |
I don't see where the manipulation is.
link |
So the fear that people have and I talked to Joe
link |
about this quite a bit.
link |
I think this is a legitimate fear
link |
and a fear you should often have
link |
that money has influenced,
link |
this proportional influence, especially in politics.
link |
So the fear is that the policy of the vaccine
link |
was connected to the fact that lots of money
link |
could be made by manufacturing the vaccine.
link |
And I understand that.
link |
And it's actually quite a heck of a difficult task
link |
to alleviate that concern.
link |
Like you really have to be a great man or woman or a leader
link |
to convince people that you're not full of shit,
link |
that you're not just playing a game on them.
link |
I don't know, it's a difficult task.
link |
But at the same time, I really don't like
link |
the natural distrust every billionaire,
link |
distrust everybody who's trying to make money
link |
because it feels like under a capitalistic system at least,
link |
the way to do a lot of good,
link |
like to do good at scale in the world
link |
is by being at least in part motivated by profit.
link |
I mean, I share your ambivalence, right?
link |
So on the one hand, you have a fantastic achievement.
link |
The discovery of the vaccine
link |
and then the manufacturing at scale
link |
so that billions of people can take the vaccine
link |
in a relatively short time.
link |
That is a remarkable achievement
link |
that could not have happened without companies like Pfizer.
link |
And on the other hand,
link |
there is this sort of corrupting influence of that money.
link |
Just to give you one example,
link |
there's an enormous controversy over whether
link |
relatively inexpensive repurposed drugs
link |
can be used to treat the disease.
link |
None of, no company like Pfizer
link |
has any interest whatsoever in evaluating it.
link |
Even Merck, I think it was Merck,
link |
that had the patent on ivermectin now expired,
link |
has no interest at all in checking to see if it works.
link |
Not only do they not have interest,
link |
they have a way of talking about people
link |
who might have a little bit of interest
link |
Full of arrogance.
link |
And that is what troubles me.
link |
Is there not a, it's back to the play of science.
link |
It's not, they're not a bit of curiosity.
link |
One, okay, one, the natural curiosity of a human being
link |
that should always be there and an open mind is.
link |
And second, in the case of ivermectin
link |
and other things like that,
link |
you have to acknowledge
link |
that there's a very large number of people
link |
who care about this topic.
link |
And this is a way to inspire them
link |
to also play in the space of science,
link |
to inspire them with science.
link |
You can't just like dismiss everybody
link |
that you can't just dismiss people, period.
link |
Well, I mean, I think here, take ivermectin, right?
link |
There's actually a study funded by the NIH,
link |
by Tony Fauci's NIAID and the NIH
link |
called ACTIV6 that's a randomized trial of ivermectin.
link |
It's due to be completed in March, 2023.
link |
So normally when you have private actors
link |
like these big drug companies that have no interest
link |
in conducting some kind of scientific experiment
link |
that would have some public benefit,
link |
it's the job of the government,
link |
and in this case, the NIH to fund that kind of work.
link |
The NIH has been incredibly slow
link |
in its evaluations of these repurposed drugs.
link |
And it's been left to lots of other private activities
link |
of uneven quality.
link |
And hence, that's why you have these big fights.
link |
Because the data are not solid,
link |
you're gonna have these big fights.
link |
Yeah, but also, okay, forget the process of science here,
link |
the studies, not enough effort being put into the studies,
link |
just the way it's being communicated about.
link |
Yeah, no, like to horse paste, I mean, come on.
link |
The FDA put a tweet out telling people who are like,
link |
they're taking ivermectin
link |
because they've heard good things about it
link |
and they're sick and they're desperate.
link |
And to call it horse paste, that was terrible.
link |
That was deeply irresponsible.
link |
My hope is grounded in the fact
link |
that young people see the bullshit of this,
link |
young PhD students, graduate students,
link |
young students in college,
link |
they see the less than stellar way
link |
that our scientific leaders
link |
and our political leaders are behaving,
link |
and then the new generation
link |
will not repeat the mistakes of the past.
link |
That is my hope, because that's the cool thing I see
link |
about young people is they're good at detecting bullshit
link |
and they don't want to be part of that.
link |
That's my hope in the space of science.
link |
Let me return to this idea
link |
of the Great Barrington Declaration,
link |
return to the beginning.
link |
So what are the basics?
link |
Can you describe what the Great Barrington Declaration is?
link |
What are some of the ideas in it?
link |
You mentioned focused protection.
link |
What are your concerns about lockdowns?
link |
Just paint the picture of this early proposal.
link |
Sure, so the Great Barrington Declaration,
link |
first, why is it called Great Barrington Declaration?
link |
It's such a great name.
link |
I mean, it's such an epic name,
link |
but the reason why it's called that is way less than epic.
link |
It was because the conference,
link |
which is organized by Martin Kulldorff,
link |
who was a professor at Harvard University,
link |
by a statistician, he actually designed the safety system,
link |
the statistical system that the FDA uses
link |
for tracking vaccine safety.
link |
He and I had met previously just the summer before,
link |
that summer, and he invited me
link |
to come to this small conference
link |
where he was inviting me and Sunetra Gupta,
link |
who is a professor of theoretical epidemiology at Harvard,
link |
sorry, at Oxford University.
link |
And I mean, I jumped at the chance
link |
because I knew that Martin and Sunetra
link |
were both smarter than me,
link |
and it would be fun to talk about
link |
what the right strategy would be.
link |
On the drive in, I didn't know what the name of the town was
link |
and I asked, they said it was Great Barrington,
link |
and I had it in the back of my head.
link |
Martin and I arrived a little early
link |
and we were writing an op ed about some of the ideas,
link |
I hope we'll get to talk about very soon,
link |
about focused protection and the right strategy.
link |
And when Sunetra arrived,
link |
we realized we'd actually come basically to the same place
link |
about the right way to deal with the epidemic.
link |
And I thought, well, why don't we write something
link |
like the Port Huron Statement,
link |
is what I had in the back of my head.
link |
And I'm like, well, what's the name of this town again?
link |
It was Great Barrington.
link |
Yeah, so it's not Barrington, it's Great Barrington.
link |
Which is fantastic, right?
link |
It's so over the top that it's perfect.
link |
It's literally like the Big Bang.
link |
There's something about these over the top fun titles
link |
that just really delivered the power.
link |
That's my main contribution was the title,
link |
the name Great Barrington Decorate.
link |
But yeah, so it was kind of a,
link |
so the idea is actually, well, the title is great.
link |
And I think that it was written in a very stylish way.
link |
It's less than a page, you can go look online and read it.
link |
It's written for, not for scientists,
link |
but for the general public
link |
so that people can understand the ideas really simply.
link |
But it is not actually a radical set of ideas.
link |
It actually represents the old pandemic plans
link |
that we've used for a century
link |
dealing with other similar pandemics.
link |
First, let me talk about the science it rests on,
link |
and then I'll talk about the plan.
link |
The science actually, some of it we already talked about.
link |
There's this massive age gradient
link |
in the risk of COVID infection.
link |
Older people face much higher risk than younger people.
link |
The second bit of science is all,
link |
that's not controversial, right?
link |
Even if you think the IFR is 0.7 or 0.2,
link |
no matter what, everyone thinks,
link |
everyone agrees on this age gradient.
link |
The second bit of science is also not controversial.
link |
The lockdown focused policies that we've followed
link |
have absolutely devastating consequences
link |
on the health of the population.
link |
Let me just give you some examples.
link |
And this was known in October of 2020 when we wrote it.
link |
So the UN was sounding alarms
link |
that there would be tens of millions of people
link |
who would starve as a consequence
link |
of the economic dislocation caused by the lockdowns.
link |
And that's come to pass.
link |
Hundreds of thousands of children
link |
in places like South Asia dead from starvation
link |
as a consequence of lockdowns.
link |
The priorities like the treatment of patients
link |
with tuberculosis in poor countries stopped
link |
because of lockdowns.
link |
Childhood vaccinations of measles, mumps, rubella,
link |
DPT, diphtheria, so on, pertussis, tetanus,
link |
all those standard vaccination campaigns stopped.
link |
Tens of millions of children skipping these doses
link |
for diseases that are actually deadly for them.
link |
Is there, just on a small tangent,
link |
is it well understood to you what are the mechanisms
link |
that stop all those things because of lockdowns?
link |
Is it some aspect of supply chain?
link |
Is it just literally because hospital doors are closed?
link |
Is it because there's a disincentive to go outside
link |
by people even when they deeply need help?
link |
It's all of the above.
link |
But a lot of those efforts,
link |
especially those vaccination efforts are funded
link |
and run by Western efforts.
link |
Like Gavi is a, I think it's a Gates funded thing actually
link |
that provides vaccines for millions of kids worldwide.
link |
And those efforts were scaled back.
link |
Malaria prevention efforts.
link |
So in the developing world,
link |
it was a devastating effect, these lockdowns.
link |
There was also direct effects.
link |
Like in India, the lockdowns, when they first instituted,
link |
there was an order that 10 million migrant workers
link |
who live in big cities and they live hand to mouth,
link |
they buy coconuts, they sell the coconuts with the money,
link |
they buy food for themselves and coconuts
link |
for the next day to sell,
link |
walk back to their villages
link |
or go back to their villages overnight.
link |
So 10 million people walking back to their villages
link |
or taking a train back, 1,000 died on route.
link |
Overcrowded trains dying essentially on the side of the road.
link |
I mean, it was absolutely inhumane policy.
link |
And the lockdowns there,
link |
it's kind of like what's happened in the West as well,
link |
but it was so severe.
link |
There was a seroprevalence study done in Mumbai
link |
by a friend of mine at the University of Chicago.
link |
What he found was that in the slums of Mumbai,
link |
there were 70% seroprevalence in July or August of 2020,
link |
whereas in the rest of Mumbai, it was 20%, right?
link |
So it was incredibly unequal.
link |
The lockdowns protected the relatively well off
link |
and spread the disease among the poor.
link |
So that's in the developing world.
link |
In the developed world, the health effects of lockdowns
link |
were also quite bad, right?
link |
So we've talked already about isolation and depression.
link |
There was a study done in July of 2020
link |
that found that one in four young adults
link |
seriously considered suicide.
link |
Now, suicide rates haven't spiked up so much,
link |
but the depths of despair that would lead somebody
link |
to seriously consider suicide itself
link |
should be a source of great concern in public health.
link |
Yeah, this is one of the troubling things about measuring
link |
well being is we're okay at measuring death and suicide.
link |
We're not so good at measuring suffering.
link |
It's like people talk about maybe even Holodomor
link |
under Stalin or the concentration camps with Hitler.
link |
We talk about deaths, but we don't talk about the suffering
link |
over periods of years by people living in fear,
link |
by people starving, psychological trauma
link |
that lasts a lifetime, all of those things.
link |
I mean, and just to get back to that point,
link |
we closed schools, especially in blue states,
link |
we closed schools.
link |
Now, richer parents could send their kids
link |
to private schools, many of which stayed open
link |
even in the blue states.
link |
They could get pods, they could get tutors,
link |
but that's not true for poor and middle class parents.
link |
And as a result, what we did is we took away
link |
life opportunities for kids.
link |
We tried to teach five year olds to read via Zoom
link |
in kindergarten, right?
link |
And the consequence actually, you think, okay,
link |
we can just make it up, but it's really difficult
link |
There's a literature in health economics that shows
link |
that even relatively small disruptions in schooling
link |
can have lifelong consequences, negative consequences
link |
So they end up growing up poorer, they lead shorter lives
link |
and less healthy lives as a consequence.
link |
And that's what the literature now shows is likely to happen
link |
with the interruptions of schooling that we had
link |
in the United States.
link |
Many European countries actually managed to avoid this.
link |
There were in the early days of the epidemic
link |
great indications that children first were not
link |
very severely at risk from COVID itself,
link |
nor are they super spreaders.
link |
Schools were not the source of community spread,
link |
communities spread the disease to schools,
link |
not the other way around.
link |
And we can talk about the scientific base of that
link |
if you'd like, but that was pretty well known
link |
We closed hospitals in order to keep them
link |
available to COVID patients, but as a result,
link |
women skipped breast cancer screening.
link |
As a result, they are showing up with late stage
link |
breast cancer that should have been picked up last year.
link |
Men and women skipped colon cancer screening,
link |
again, with later stage disease that should have been
link |
picked up last year with earlier stage.
link |
For patients with diabetes, it's very important
link |
to have regular screening for blood sugar levels
link |
and sort of counseling for lifestyle improvement.
link |
And we skipped that.
link |
People stayed home with heart attacks
link |
and died at home with heart attacks.
link |
So you had this like sort of wide range of medical
link |
and psychological harms that were being utterly ignored
link |
as a result of the lockdowns.
link |
Plus there's the economic pain.
link |
So like you said, whatever is a good term
link |
for the non laptop class, people would lose their jobs.
link |
Yes, there might be in the Western world support
link |
for them financially, but the big loss there
link |
that is perhaps correlated with depression and suicide
link |
is loss of meaning, loss of hope for the future,
link |
loss of kind of a sense of stability,
link |
all the pride you have in being able to make money
link |
that allows you to pave your own way in the world.
link |
And yes, just having less money than you're used to
link |
so your family, your kids are suffering,
link |
all those kinds of things.
link |
And there's, again, an economics literature on this,
link |
on deaths of despair it was called.
link |
2009, there was the great recession.
link |
It led to an enormous uptake in overdose from drugs,
link |
suicidality, depression, as a result of the job losses
link |
that happened during the great recession.
link |
Well, that's happening again,
link |
like an enormous increase in drug overdoses.
link |
That's not an accident, that's a lockdown harm, right?
link |
Same thing with the job losses.
link |
The job losses, by the way, are like, it's so interesting
link |
because the states that stayed open
link |
have had much, much lower unemployment
link |
than the states that stayed closed.
link |
The labor force participation rates declined by 3%.
link |
It's women that separated
link |
because they stayed home with their kids.
link |
We've reversed a generation of women,
link |
improving women's participation in the labor force.
link |
Do you think it has to do with the institutions
link |
that we mentioned that there was so much priority given
link |
or so much power given to maybe NIH
link |
versus other civilian leaders?
link |
Or do people just not care about the economic pain?
link |
The leaders, I mean, because to me it was obvious.
link |
I mean, probably it's just studying history.
link |
Whenever I listen to people on Twitter
link |
or on mainstream news or just anything,
link |
I realize that's the very kind of top.
link |
The people that have a voice
link |
represent a tiny selection of people.
link |
And so whenever there's hard times,
link |
I always kind of think about the quiet, the voiceless,
link |
the quiet suffering of the tens of millions,
link |
of the hundreds of millions.
link |
Do the political leaders not just give a damn?
link |
I mean, I think it was actually a very odd ethical thing
link |
at the beginning of the pandemic
link |
where if you brought up economic harms at all,
link |
you were seen as callous.
link |
So I had a reporter call me up
link |
almost at the very beginning of the epidemic
link |
asking me about a very particular phenomenon.
link |
So he was anticipating a rise in child abuse
link |
because children were gonna be staying at home.
link |
Child abuse is generally picked up at school.
link |
And that actually happened.
link |
So the reported child abuse dropped,
link |
but actual child abuse increased
link |
because normally you pick up the child abuse at school
link |
and that you have the intervention, right?
link |
So yeah, so I was talking about like,
link |
well, there's gonna be some economic harms
link |
and they're gonna have health consequences,
link |
but the economic harms matter.
link |
But he counseled me.
link |
And I think he had my best interest at heart.
link |
Like if you were to put that in the story,
link |
I would be, I'd essentially be canceled.
link |
Because what the narrative that arose in March of 2020
link |
is if you care about money at all,
link |
you're evil and crass, you must only care about lives.
link |
The problem with that narrative is that that money,
link |
which we're talking about,
link |
is actually lives of poor people, right?
link |
When you throw 100 million people around the world
link |
into poverty, you're going to see enormous harm
link |
to their health, enormous increases in their mortality.
link |
It is not immoral to think about that and worry about that
link |
in the context of this pandemic response.
link |
Our mind focused so much on COVID that it forgot
link |
that there are so many other public health priorities as well
link |
that need our attention desperately.
link |
And this is the thing I sensed about San Francisco
link |
when I visited, I was thinking of moving there for a startup.
link |
This is the thing I'm really afraid of,
link |
especially if I have any effect on the world
link |
through a startup, is losing touch in this kind of way.
link |
That you mentioned the laptop class,
link |
living in this world where you're only concerned
link |
about this particular class of people.
link |
And also, perhaps early on in the pandemic,
link |
amongst the laptop class,
link |
there was a legitimate concern for health,
link |
like you're not sure how deadly this virus is.
link |
You're not sure who to listen to, so there's a real concern.
link |
And then at a certain point when the data starts coming in,
link |
you start becoming more and more detached from the data.
link |
You don't start caring less and less,
link |
and you start just swimming in the space of narratives,
link |
like existing in the space of narratives,
link |
and you have this narrative in San Francisco
link |
in the laptop class that you just are very proud
link |
that you know the truth,
link |
you're the sole possessors of the truth,
link |
you congratulate yourself on it,
link |
and you don't care what actually gigantic detrimental effect
link |
that has on society, because you're mostly fine.
link |
I'm so terrified of that.
link |
Well, actually, I think the antidote to that
link |
is just to remember.
link |
I don't think, you know, remember where you came from
link |
and remember who you're doing this for.
link |
At the back of your head should always be,
link |
what's the purpose?
link |
Like, why am I here?
link |
What's the purpose of this?
link |
And if the purpose is simply self aggrandizement,
link |
then you should rethink,
link |
because it'll just end up being a hollow life.
link |
All of us will be forgotten in the end.
link |
Focused protection, the idea, the policy,
link |
what is focused protection?
link |
Right, so I was saying that there's two scientific bases,
link |
right, so one is this steep age gradient,
link |
and the second is the existence of locked arms.
link |
Again, I think there's very little disagreement
link |
in the scientific community on both of those facts.
link |
If you put those facts together,
link |
the obvious policy is to protect the people
link |
who are at the most severe risk from the disease itself.
link |
And that's the idea of focused protection.
link |
That's the general principle of it.
link |
The actual implementation of it
link |
depends on the living circumstances
link |
of the people that are at risk,
link |
the resources that are available in the community,
link |
the technology that's available to do this.
link |
And so it's almost always going to be,
link |
in fact, it'll always be a local thing,
link |
because it'll depend on all of those things
link |
which are all local in nature.
link |
Right, so one very, very obvious thing,
link |
in a country like ours,
link |
where so many older people live in institutionalized settings
link |
and nursing home settings,
link |
and that's where older, really vulnerable,
link |
chronically ill patients often live,
link |
and you know this disease affects that group,
link |
most commonly, it is absolutely vital
link |
to protect that group.
link |
We should have known that in February 2020,
link |
just from the Chinese data.
link |
And we should have thought about that group
link |
as the key constraint in our policymaking.
link |
Instead, we thought about, in February and March 2020,
link |
as hospital beds as the key constraint.
link |
Hospital beds and ventilator shortages,
link |
and so we ran around trying to address
link |
that constraint, like a linear programming problem,
link |
you figure out which constraint's binding
link |
and you address that one thing
link |
and then you go on to the next one, right?
link |
If that one constraint,
link |
we said, okay, the constraint is hospital beds.
link |
That led to the decision in many of the Northeast states
link |
to send COVID infected patients who were on the verge
link |
or looked like they were about to recover
link |
back to nursing homes,
link |
who then spread the disease all through there,
link |
because they wanted to preserve the hospital beds.
link |
Well, for somebody who loves numerical optimization,
link |
I love the way you frame this.
link |
But those are kind of connected, right?
link |
If you actually focus on protecting the vulnerable,
link |
you will also have the effect
link |
of not hitting the ceiling of the available hospital beds.
link |
If we protected the vulnerable,
link |
the vulnerable are the most likely to be hospitalized,
link |
and so by protecting the hospital,
link |
by protecting the vulnerable,
link |
we will also have addressed the shortage of hospital beds
link |
So that little shift in priority
link |
would have had a big impact.
link |
Okay, but specifically, the idea is to,
link |
and we could talk about different ideas
link |
of how to actually do this,
link |
but you basically do a lockdown or something like that
link |
on a very small set of people.
link |
You may have to do that
link |
if community spread is very high,
link |
but generally, I think it would depend on, again,
link |
the living circumstances and the,
link |
so for instance, if you are in a,
link |
if you have a, here's a very simple idea
link |
that doesn't require a lockdown forced on them.
link |
I don't actually generally,
link |
I'm not in favor of that kind of forced lockdown
link |
because you just won't get cooperation.
link |
But what you could do is provide resources
link |
to that group of people.
link |
So imagine you live next door to somebody, an older couple,
link |
and there's high community spread.
link |
Well, they have to go grocery shopping.
link |
We did like, some communities did these
link |
like senior only grocery hour, right?
link |
But they have to still have to go out
link |
and they might get exposed
link |
when they're shopping amongst other seniors.
link |
Well, why not organized home delivery of groceries to them?
link |
We did that for the laptop class, right?
link |
Or you can even just use a volunteer effort.
link |
The older people living next door,
link |
just call them up and say,
link |
can I help you go out and go shopping for you?
link |
And so you would have potentially federal support
link |
of that kind of thing.
link |
So these kinds of efforts.
link |
Identify where the vulnerable people live.
link |
It's really challenging in multigenerational homes.
link |
In LA County, for instance,
link |
there's a lot of older people living together
link |
with younger people in relatively crowded,
link |
there it's really quite a challenge.
link |
But there again, you can use resources.
link |
So if grandma is worried that grandson has come home,
link |
but is potentially been exposed,
link |
grandson calls grandma says, I mean,
link |
I might've been at a party where COVID was.
link |
Grandma calls public health, public health,
link |
and says, okay, you can have this hotel room
link |
for a couple of days until you check to turn negative.
link |
In case it wasn't clear,
link |
the idea of focused protection
link |
is the people that are vulnerable, protect them.
link |
And everybody else goes on with their lives,
link |
open up the economy, just do as it was before.
link |
There was still fear abroad.
link |
So there still would be some restrictions
link |
that people would pose on themselves.
link |
They probably would go to parties less.
link |
The grandsons probably wouldn't go so many parties, right?
link |
There would be less participation in big gatherings.
link |
And you may even say like big gatherings
link |
in order to restrict community spread again.
link |
I'm not against any of that,
link |
but you shouldn't be closing businesses.
link |
You shouldn't be closing churches and synagogues.
link |
You shouldn't be forcing people to not go to school.
link |
You should not be shuttering businesses.
link |
You should just allow society to go on.
link |
Some disease will spread, but as we've seen,
link |
the lockdown didn't stop the disease from spreading anyways.
link |
So what do you make of the criticism that this idea,
link |
like all good ideas cannot actually be implemented
link |
in a heterogeneous society
link |
where there's a lot of people intermixing?
link |
And once you open it up,
link |
people like the younger people will just forget
link |
that this is even existing.
link |
And they'll stop caring about the older people
link |
and mess up the whole thing.
link |
And the government will not want to fund
link |
any kind of the great efforts you're talking about
link |
about food delivery and then the food delivery services
link |
be like, why the heck am I helping out on this anyway?
link |
Because like, it's not making me much money.
link |
And so therefore like all good ideas, it will collapse.
link |
That might be true.
link |
I mean, I think it's always a risk with policy thing,
link |
but I think if you think back to the moment,
link |
but we actually felt like we were in this together
link |
Right, I think that that empathy that we had
link |
that was used to like tell people to stay in
link |
and like happily, not go in happily,
link |
but like stay in to like wear a mask
link |
or to do all these things that we thought
link |
would help other people could have been redirected
link |
to actually helping the people who most needed to be helped.
link |
Especially, I do remember March.
link |
So this is even way before Barrington,
link |
all that kind of stuff.
link |
March, April, May, there was a feeling like
link |
if we all just work together, we'll solve this.
link |
And that maybe started to, when did that start breaking down?
link |
I mean, unfortunately the election is mixed into this.
link |
That it became politicized.
link |
But I think it lasted quite a long time.
link |
I think into the summer,
link |
I think there was some of that sense.
link |
I don't know, it obviously varied among different people.
link |
But I think that it's true it would have been challenging.
link |
It's also true that it's heterogeneous,
link |
exactly the way you said.
link |
But what that means is you need a local response,
link |
a response, so like my vision of a public health officer
link |
is someone that understands their community,
link |
not necessarily the nation at large, but their community,
link |
and then works within their community
link |
to figure out how to deploy the resources
link |
that they have available
link |
to do the kind of protection policies we're talking about.
link |
That's what should have happened.
link |
Instead, they spent a huge amount of efforts
link |
closing, making sure businesses stayed closed.
link |
Businesses that, I mean,
link |
they're like hardware stores that closed.
link |
What good did closing a hardware store do
link |
for the spread of COVID?
link |
If it had an effect on COVID spread,
link |
I mean, it's gonna be March.
link |
Checking to make sure that plexiglass
link |
was put up everywhere,
link |
which now in retrospect turns out
link |
to have probably made the disease worse.
link |
Masking enforcement, so shaming around masks,
link |
I mean, a huge amount of effort on things
link |
that were only tangentially related to focus protection.
link |
What if we turned our energy,
link |
that enormous energy put into that,
link |
instead into focus protection of the vulnerable?
link |
That's essentially the conversation I was calling for.
link |
And it wasn't, I mean, I didn't think of it
link |
as we had every single idea.
link |
I mean, we gave some concrete proposals,
link |
but the criticism we got was that
link |
those concrete proposals weren't enough.
link |
And the answer to that is that's true.
link |
They weren't enough.
link |
I wasn't thinking of them as enough.
link |
I was thinking that I wanted to involve
link |
an enormous number of people in local public health
link |
to help think about how to do focus protection
link |
in their communities.
link |
The question that's interesting here is about the future too.
link |
So COVID has very specific characteristics,
link |
like you mentioned, about the curve of the death rate
link |
based on the, like it seems like with COVID,
link |
it's a little bit easier to actually identify
link |
a group of people that you need to protect.
link |
So other viruses may not be this way.
link |
So might lockdown be a good idea, like hardcore lockdown
link |
for a future virus that's 10 times deadlier,
link |
but spreads at the same rate as COVID?
link |
Or maybe another way to ask that is imagine a virus
link |
that's 10 times deadlier, what's the right response?
link |
I mean, I think it's always gonna be focus protection,
link |
but the group that needs the focus protection may change
link |
depending on the biology of the virus, right?
link |
So the polio epidemic in the 40s and 50s in the US,
link |
the great, the people at most risk were children.
link |
We didn't know really at the beginning
link |
there was this fecal oral spread.
link |
And so we did all kinds of crazy things,
link |
including like spraying DDT in communities,
link |
which somehow was supposed to get rid of polio.
link |
But the focus was on whenever there was an outbreak,
link |
they would close the school down.
link |
And that was the right thing to do
link |
because that group that needed protection was children.
link |
And the disease was spread, we thought in schools.
link |
I don't think there's a single formula that works,
link |
but there's a single principle that works, right?
link |
No matter, it's hard to imagine a disease
link |
that's uniformly deadly across every group
link |
in every single person.
link |
There's always gonna be some group
link |
that's differentially harmed.
link |
There's always gonna be some group
link |
that's differentially protected.
link |
And that may change over time, right?
link |
So like in this disease, in this epidemic,
link |
as people got infected and recovered,
link |
we now had a class of people
link |
that were pretty well protected against the disease.
link |
They should be, like instead of ostracizing them
link |
because they don't want a vaccine,
link |
we should be allowing them to work.
link |
I mean, we're having staffing shortages in hospitals now
link |
because we forgot that principle.
link |
Is quite a bit of this a technology problem?
link |
how much of it is a sociological problem?
link |
How much of it is a technology problem?
link |
Like where do you put the blame
link |
sort of on why this didn't go so great
link |
and how it can go great in the beginning?
link |
I mean, think about lockdowns.
link |
Like if we didn't have Zoom,
link |
we wouldn't have lockdowns.
link |
There's a reason in 2009 we didn't lock down.
link |
I mean, we didn't have the technology to replace work
link |
with this remote technology.
link |
So we had good lockdown technology in Zoom.
link |
We didn't have good focus protection technology.
link |
Yeah, I mean, focus protection
link |
is always gonna be complicated,
link |
especially for something like this that spreads so easily,
link |
it's gonna be complicated.
link |
And I'm the last person to say it would have been perfect.
link |
There would have been people that would have gotten sick,
link |
but they got sick anyways.
link |
The hope was that if we suppress community spread
link |
low enough, we can protect the vulnerable.
link |
That was the hope by lockdown.
link |
The reality was that only a certain class of people
link |
were able to benefit from lockdown.
link |
The rest of society, we call them essential workers,
link |
had to keep working and they got sick.
link |
And the disease kept spreading.
link |
It didn't actually have a substantial effect
link |
on community spread in non laptop class populations.
link |
And also we should probably expand the class of people
link |
we call vulnerable to those who would suffer,
link |
who have the capacity to suffer,
link |
given the policies you're weighing.
link |
It's very disingenuous to call the vulnerable
link |
just the people, obviously we had the very specific meaning,
link |
but broadly speaking, vulnerable should include anybody
link |
who can suffer based on the policies you take
link |
in response to a virus.
link |
That principle you just said is completely agree with
link |
is something I think has been lost.
link |
And unfortunately lost, right?
link |
So the policies themselves, if they have harm,
link |
those are real and we shouldn't pretend like they're not.
link |
And essentially demonize the people that suffer them.
link |
Or pretend, I mean like a lot of times like the depression
link |
that we've been talking about,
link |
that's thought of as like not so important,
link |
but it is important.
link |
And especially the harm to the people in poor countries,
link |
it's like been out of sight, out of mind
link |
in much of the rich parts of the world.
link |
Once again, I've hoped that we seeing this,
link |
learning lessons of history with the communication tools
link |
who have now will learn this.
link |
It's like going to another country
link |
and bombing targeted terrorist locations,
link |
and there's going to be some civilians who die,
link |
pretending that the child who watches their dad die
link |
is not going to grow up, first of all, traumatized,
link |
but second of all, potentially bring more hate to the world
link |
than the hate that you were allegedly fighting
link |
in the first place.
link |
That's another sort of considering only one kind of harm
link |
and not the full range of harms
link |
that are being caused by your policies.
link |
You know, like the good return to focus protection,
link |
we still should be following the policy now for COVID
link |
and we're not, right?
link |
So the vaccines, there's a great shortage of vaccines.
link |
You wouldn't know it in the United States
link |
and the rich parts of the world,
link |
but there's a great shortage of vaccines.
link |
We're not going to be able to vaccinate the most of the,
link |
like the entire set of elderly at least,
link |
and or larger groups until late 2022.
link |
Huge numbers of older people around the world
link |
in poor countries that have not COVID recovered yet,
link |
so they're still quite vulnerable, have not had the vaccine.
link |
And yet we're talking about vaccinating five year olds
link |
who benefit, if at all, from the vaccines
link |
of just a very little bit
link |
because they face such a low risk of harm from COVID.
link |
Well, something that's a little bit near and dear
link |
to our specific, the two of our hearts.
link |
So you're at Stanford.
link |
So Stanford recently announced
link |
that they're going back to virtual,
link |
at least for some period of time in response to the,
link |
maybe you can clarify, but I think it's in response
link |
to the escalated, how would they phrase it?
link |
It's related to Omicron.
link |
And a few other universities are kind of like
link |
considering back and forth.
link |
In my perspective, as somebody who loves
link |
in person lectures, who sees the value of that
link |
to students, to young minds, also looking at the data,
link |
seems the risk aversion in university policies
link |
around this, given how healthy the student population is,
link |
seems not well calibrated.
link |
Let's put it this way.
link |
Also, pathological is one way to put it.
link |
Given that, I believe, depending on the university,
link |
but I think many universities require
link |
that the student body is vaccinated at this point.
link |
So I think it's a big mistake by Stanford to do this.
link |
And I'd like to say that because I just hope MIT doesn't.
link |
But what are your thoughts about Stanford?
link |
Is there a student?
link |
I completely agree with you.
link |
I think we have failed in our mission
link |
to educate our students by this decision.
link |
And I think, frankly, just more broadly,
link |
I think we failed generally over the course
link |
of the last year and a half in living up
link |
to our educational mission.
link |
In person teaching is vital.
link |
Now, I can understand, if you have older faculty,
link |
the principle of focus protection says,
link |
provide some alternative teaching arrangements for them.
link |
That makes sense to me.
link |
From the kid's point of view,
link |
they're more harmed by not getting the education
link |
we promised them than by COVID.
link |
So applying this principle of this focus protection,
link |
let young professors teach in person.
link |
This is before the vaccine.
link |
After the vaccine, let everyone teach in person.
link |
Yeah, this is the part,
link |
I don't understand the discussion we're even having
link |
because, okay, let's leave focus protection aside here
link |
because that's a brilliant policy for,
link |
perhaps for the future when there's no vaccine.
link |
Now with the vaccine, I'm misunderstanding something here
link |
because we're now in a space that's psychological.
link |
It's no longer about biology
link |
because with the booster shots,
link |
which I believe MIT is now requiring before January,
link |
with the booster shots, the data shows,
link |
no matter how old you are, the risks are very low
link |
for ending up in a hospital
link |
relative to all the other risks you face when you're older.
link |
I don't understand.
link |
Can you explain the policy around closing a university
link |
but also just a policy about just being so scared still
link |
in the university setting?
link |
I think the great universities have done great harm
link |
by modeling this kind of behavior.
link |
Yes, to me, sorry to keep interrupting,
link |
but to me, the university should be the beacon
link |
of great behavior, not the beacon of scared, conservative,
link |
let's not mess up.
link |
Let's not make it pathological.
link |
Let's not make anybody angry.
link |
It should be a place to play in the space of ideas.
link |
Yes, so I think the central problem is,
link |
actually related to the central problem
link |
of COVID policy more generally,
link |
the goal seems to be to stop the disease from spreading
link |
rather than to reduce the harm from the disease.
link |
If the goal is to stop the disease from spreading,
link |
the sad fact is we have no technology to accomplish that.
link |
Like it's already deeply integrated into human civilization.
link |
Well, I mean, it's here forever, right?
link |
There's a zero survey of white tail deer in the US.
link |
It turns out 80% of white tail deer in the US
link |
have COVID antibodies.
link |
Dogs get it, cats get it.
link |
There's almost certainly human animal transmission of it.
link |
I mean, presumably, I mean, I've heard bats get it,
link |
apparently, so you have a situation
link |
where you have this disease that's here to stay.
link |
And the vaccines don't stop the spread of it,
link |
the lockdowns don't stop the spread of it.
link |
We have no technology to stop the spread of it.
link |
And so we're burning the earth trying to stop,
link |
do something that's impossible
link |
rather than working on what's possible.
link |
And so like letting regular college happen,
link |
that's a great good.
link |
Universities are a wonderful invention
link |
and it's contributed so much to society.
link |
Just decide to shut it down.
link |
The universities should be fighting tooth and nail
link |
to not be shut down, not the other way around.
link |
Whatever the mechanisms that results
link |
in the universities doing that,
link |
that's probably, this is me talking,
link |
it probably has to do with certain incentives
link |
for the administration, probably has to do with lawyers
link |
and legal kinds of things to avoid legal trouble.
link |
But once again, it's when the administration
link |
has too much power and too much definition
link |
of what the policy is for the university,
link |
that's when you get into trouble.
link |
The beauty, the power of the university
link |
should be about the faculty and the students.
link |
Administration just gets in the way, get out of the way.
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I mean, they can help organize things.
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They play some important role, but they certainly do.
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But they need to remember what the mission is.
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The mission is not safety.
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The mission, actually, universities should be
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dangerous places for ideas and whatnot.
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What is the role of fear in a pandemic?
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We've been dancing around it.
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Is it destructive?
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Or is there sort of a complicated story here?
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Because they're taking us back into January 2020.
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There was so much uncertainty.
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This could have been a pandemic that is Black Death,
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the bubonic plague.
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It could have killed hundreds of millions of people.
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We don't know that.
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We're very new to this.
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It's been a while.
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So there is some value to fear
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so that you don't do the stupid thing.
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You don't just go on living.
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I guess where I come from,
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I think it's almost entirely counterproductive.
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I think fear should never be used as a tactic
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to manipulate human behavior by public health.
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So the fear on the individual level,
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that feeling of fear,
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you should be very hesitant about that feeling
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because it could be easily manipulated by the powerful.
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I think that fear is natural.
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And it's not something that you have to stoke to get
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when the facts on the ground suggest it, right?
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In fact, the tendency for humans
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in the face of threats from infectious disease
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is to exaggerate the fear in their own minds
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of being contaminated by the environment and by others.
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That's just natural to humans.
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And the role of public health
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is not necessarily to eradicate the fear,
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but obviously technological advances
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can help eradicate the fear,
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but it's really to help manage that fear
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and help people put the sort of incentives
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that come out of that to useful things
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as opposed to harmful things.
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What's happened in this pandemic
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is that there's been a deliberate policy to stoke the fear,
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to help make people think that the disease
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is worse than it actually is.
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In survey after survey, you see this.
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And that's been incredibly damaging.
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So young people have readily given away
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their willingness to participate in regular life
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because A, they fear COVID more than they ought,
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and B, they fear that they're gonna harm the vulnerable
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You put those two together
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and you get this powerful demand for lockdowns.
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You see this all over the world.
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Broadly speaking, you have a powerful demand
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for irrational policies, irrational policies,
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because I would like to mention the flip side of that.
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I've been saddened to see how much money
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there is to be made by the martyrs,
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the people, the conspiracy theorists
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that tell you you should be afraid of the government.
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You should be afraid of the man.
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It feels like fear is the problem.
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I think there's some guy that once said something
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about we should fear fear itself.
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He was a president or something.
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I vaguely remember that.
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So I'm worried about both sides here, that.
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Well, I think the general principle
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is that should not be a tool of public policy, right?
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The public policy should attempt,
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and public health policy in particular,
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should attempt to address that fear.
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It's not that you should tell people lies, of course not.
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Tell people accurately what the risk is.
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Give people tools that have evidence
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that they can address their risk with
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and level with people when we don't know.
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I think that is the right adult way
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to deal with this pandemic from a public health point of view.
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And that is not the policy we have followed.
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Instead, public health is intentionally stoked the fear
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in order to gain compliance with its edicts.
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And I think the consequence of that
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is people distrust public health.
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What you're talking about, the distrust of government,
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I think is partly a consequence of that.
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That movement, which is much smaller once upon a time,
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is much larger now because of essentially
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people look at what public health has done
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and said they've lied to me a whole bunch of times
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and a whole bunch of things is the general sense.
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And there are consequences to that.
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We're gonna have to work in public health for a long time
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to try to regain the trust of the public.
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Throughout all of this, you've been inspiring to me,
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to a lot of people.
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So you've been fearless, bold,
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in these kind of challenging the policies
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and not in a martyr kind of way
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because you're walking the line gracefully
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and beautifully, I would say.
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And looking at that, I think you're an inspiration
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to a lot of young people.
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So I have to ask, what advice would you give them
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if they're thinking of going into science,
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if they're thinking of having an impact in the world,
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what advice would you give them about their career
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and maybe about their life?
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Thinking about somebody in high school,
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maybe in undergraduate college.
link |
I'd say a few things.
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One is, this is a wonderful profession.
link |
You have an opportunity to improve the lives of so many
link |
and do it by having fun,
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the kind of play we're talking about.
link |
It's an absolute privilege to be able to work
link |
in this kind of area.
link |
And to young people looking to say,
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that have some gifts or desire for this area,
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I say, please, go for it.
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So this area of science broadly.
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Yeah, I mean, it could be,
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I mean, I don't have any gifts in AI,
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but like, it could be your buddy,
link |
or in health or in medicine or whatever,
link |
whatever your gifts lie, develop them,
link |
work hard and develop them,
link |
because it's worth it.
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It's worth it, not just because you get some status,
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but because the journey is fun.
link |
And the result is improvements in the lives of so many.
link |
So I think that is the encouragement I give.
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I'd also say, if you're looking at this ugliness
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of this debate that's happened over the pandemic,
link |
I'd say to young people,
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we need you to come in and help transform it.
link |
Many of the people you see in this debate
link |
that behave poorly, I ask you forgive them.
link |
I've done my best to try,
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because many of them are acting out of their own sense
link |
that they need to do good,
link |
but the mistake they've made is in this arrogance
link |
So when you come in, remember that example
link |
as a negative example.
link |
And so that when you join the debate,
link |
you'll join it in a spirit of humility
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and a spirit of trying to learn
link |
while keeping that love that led you
link |
to enter the field in the first place.
link |
And yeah, choose forgiveness versus like derision.
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Like the people that you know have messed up,
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like give them a pass,
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because it feels like that's how improvement starts.
link |
Funny, I've been thinking this is like,
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I told you I'm Christian, right?
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So like God has given me many opportunities
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to forgive people, learned to practice how to do that.
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It's a very humbling thing, I guess.
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Is there a memory from when you were young
link |
that was very formative to you?
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So you just gave advice to some young people.
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Is there something that stands out to you
link |
that a decision you made, an event that happened
link |
that made you the man you are today?
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I actually grew up in a relatively poor environment.
link |
Like I was born in India and we moved when I was four.
link |
My dad had eight brothers and sisters
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and my mom had four brothers and sisters.
link |
She grew up in the slum in Calcutta.
link |
My dad, his dad died when he was young
link |
and he supported his family, his brothers and sisters
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with university scholarship money.
link |
Came to the US and my dad worked in a McDonald's,
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even though he's an electrical engineer,
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couldn't find a job in 1971.
link |
And so he worked at McDonald's.
link |
We lived in a, like this, basically the housing port
link |
like development in Cambridge,
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this like this middle building on the 17th floor,
link |
this like housing development.
link |
I mean, I think that was transformative for me.
link |
Like I didn't realize so much at the time
link |
how that experience of being essentially like poor,
link |
lower middle class, what effect it had on my outlook.
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You mentioned to me offline
link |
that you listened to the conversation
link |
that I had with my dad.
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What impact did your dad have on your life?
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What memories do you have about him?
link |
He was a rocket scientist actually.
link |
He helped design rocket guidance systems.
link |
He died when I was 20 and I still miss him to this day.
link |
And I think that experience of seeing him
link |
sacrifice himself for his family, brilliant man,
link |
but in many ways frustrated with like his opportunities
link |
in the world, which is probably what led him
link |
to come to the US in the first place.
link |
That's transformed, that's had a transformative effect on me
link |
and I wish I could tell him that looking back.
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Do you think about your own mortality?
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Do you think about your death?
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Your dad is no longer with us.
link |
You're the old wise sage that represents.
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I've only worried about death once in this pandemic.
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Although I've had two, my cousin was 73
link |
and my uncle who's 74 died in India during the pandemic.
link |
And I grieve them both from COVID.
link |
Like the fear of COVID really has only hit me
link |
only really once during this and it wasn't for me.
link |
And I recognize it's irrational.
link |
So on the eve of the Santa Clara County seroprevalence study,
link |
it was a really interesting thing
link |
because so many people volunteered to help.
link |
And my daughter who's 20, I guess she was 19 at the time
link |
and my wife also volunteered to help
link |
with like various aspects of the study.
link |
And so the eve of the study,
link |
they were going to go out in public
link |
and I didn't know what the death rate was
link |
because we hadn't done the study.
link |
And I suspected it was lower than people were saying
link |
but I didn't know.
link |
I knew about the age gradient
link |
because I'd seen the Chinese data and my daughter's young
link |
but my wife is my age and I didn't know the death rate.
link |
And I couldn't sleep the night before.
link |
Like what if I'm putting my family,
link |
my daughter and my wife at risk
link |
because of some activity that I'm doing.
link |
It was kind of, I don't know.
link |
So it's worried about the wellbeing of others.
link |
When you look in the mirror.
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I mean, like I just, it's not, again, I'm Christian.
link |
So I don't, death is not the end for me, I believe.
link |
And so I don't particularly worried about my own death
link |
but I do, I mean, I just, I think we can't help
link |
but we worry about the wellbeing of our loved ones.
link |
So from the perspective of God, then let me ask you,
link |
what do you think is the meaning
link |
of this whole journey we're on?
link |
What do you think is the meaning of life?
link |
You know, it's very simple.
link |
Treat your neighbor as yourself.
link |
It's love, as simple as that.
link |
Well, I'd love to see a little bit more of that
link |
It's an opportunity for the best of our nature to shine.
link |
It's, I've seen some of the worst
link |
but I think some of that is just good therapy.
link |
And I'm hoping in the end, what we have here is love.
link |
At the very least, make your dad proud
link |
with some incredible rockets that we're launching.
link |
I think you'd get along well with my dad, Lex.
link |
I definitely would.
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Thank you so much.
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This is an incredible honor to talk to you, Jay.
link |
You've been an inspiration to so many people
link |
and keep fighting the good fight.
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Thank you so much for spending your valuable time
link |
Thank you for having me here, appreciate it.
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Thanks for listening to this conversation
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with Jay Bhattacharya.
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To support this podcast,
link |
please check out our sponsors in the description.
link |
And now let me leave you some words from Alice Walker.
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The most common way people give up their power
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is by thinking they don't have any.
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Thank you for listening and hope to see you next time.