Hey everyone, welcome to the drive podcast. I'm your host Peter Atia, this podcast, my website and My Weekly Newsletter, all focus on the goal of translating, the science of longevity into something, accessible for everyone. Our goal is to provide the best content in health and wellness. And we've assembled a great team of analysts to make this happen. If you enjoyed
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And dr. Zubin. Damania AKA zdoggmd. Both of these are close friends of mine who have also both been previous guest and I wanted to have Marty and Z dog back on to talk about covid, which is not something I've done a podcast on in some time. In fact, when I did my last podcast on covid, I really thought that was kind of the end of it and I was sort of done talking about covid publicly. I would obviously continue to stay as up to speed as necessary on all things relevant to my patients, but I really was kind of done with talking about covid policy and things like that.
That. But, you know, truthfully in the past, I would say month. I've become a little bit frustrated with what I've seen around, kind of shoddy science, and even worse messaging around covid. So I thought it was time to revisit the. So this episode, we talk about a bunch of things. We talk obviously about Omicron and what's known and understand that these podcasts are always dated, right? So the date of the recording of This podcast was Monday, December 27th. And by the time this podcast is out, that's already been a week, three months from now, we'll know things. We don't know today. That's just the nature of things but never the less we talk about what is known today about Omicron talked about
We understand about vaccine both benefits and risk focusing on the MRNA, vaccines here and specifically looking at the differences between Pfizer and moderna, especially in the subset of young people and further stratifying that by gender. We also talked about natural immunity something, that seems to be a very taboo subject matter, but it's a very important thing to discuss. If we spent a lot of time trying to explore the what is the endgame here. What is it that we're hoping to achieve?
From a policy perspective to get to living in a world. That looks more like it did in 2019. Is that even going to be possible? What is the difference between a pandemic and an endemic? So this is a very conversational interaction. It's partly an interview, but really in the end, it kind of just a discussion between the three of us just by briefly background. Marty is a Johns, Hopkins, professor and public health researcher. He's served on the faculty of Hopkins at the school of Public Health. For the past 16 years and served in leadership at the who he's a member of the National Academy of Medicine.
And serves as the editor-in-chief of the second largest trade publication in medicine called medpage today. He also writes for the Washington Post, the New York Times And The Wall Street Journal. Z dog, is a UCSF Stanford trained internist and the founder of turntable Health. He's also the host of a very popular podcast, zdoggmd podcast as well as the co-host of an excellent podcast called the VP z d show and that's with vinaya Prasad. Who by the way has also been a guest on this podcast and we reference been out here. In fact, I would have loved to have had benign.
A on this podcast as well, other than the fact that it would have been pretty cumbersome to have four people on a podcast. Final thing to note here. Is that because we recorded this on December 27th with the aspiration of getting this out, as quickly as possible. Our video team was not in town. So we did not do this on video and we don't really have the staff this week to put out show notes. So we're doing this, to be as quick as possible and responsive as possible to some of the questions that many of you, I suspect are asking, so I hope you'll accept our apology that this will be
Audio Only podcast and there won't be a show notes Beyond just a number of references. So without further delay. I hope you enjoy my conversation with Marty macarons have been dog. Marty. So awesome to be sitting here with both of you. As, you know, not a topic. I have been spending much time on certainly publicly. Obviously, anyone who's taking care of patients, has to be paying attention to what's relevant to them. So that's
Mitad me, the luxury I think of being able to offer my opinions to patients my interpretations, but I did feel a need to go a little bit deeper in the past few weeks and thought I'd reach out to you guys and we could do this as a discussion because you guys have been spending a heck of a lot more time on this than I have in the last five days. I've been drowning in this substance. Luckily. I have wonderful analysts who have been able to organize information for me. But anyway, let's let's just start with helping me understand.
And the listeners understand kind of what we know and don't know. And one of the ideas that we had talked about at the outset, which I think you guys agreed was a was a good thing that we can try is for the listeners. Helping people differentiate between, what we believe is fact, or when know what is knowable. And then what is opinion, because I think we're going to very easily go back and forth between those two. And I think people expect that right on some level people want to hear our opinions, but I think they also want to know when that separated from fact, so, hopefully between the three of us, we can always, kind of remember,
Which of those pillars were playing in. But what I'd like to do is kind of start with some basic questions for you guys. So we're recording this on. What is it? The 27th, right? And obviously a lot of what we're talking about is in flux part of what's prompting. This is Omicron being a new surge. What do we know about this virus? This particular mutation and how it differs from Delta and do we want to call the original one alpha or OG or what do you get when you guys called?
First of all, great to be with you, Peter, and great to see you again here Zubin. So I think we can compare Omicron to Delta because Delta represents sort of the worst of the previous strains and now we've got some pretty good laboratory data. That tells us that Omicron is not, infecting lung cells, neither lung individual cells, or what we call organoids in a lab, which is a cluster of similar tissue types at the same efficiency. It's about 90%, less efficient.
Replicating in those lung cells. So we've got laboratory data now confirmed by three independent Labs, that is not infecting those cells as well. That's why we're not seeing the cough in the severe disease and the systemic illness like fever as frequently with Omicron. We're seeing more of the upper respiratory stuff than nerys the bronchus symptoms and by virtue of that you're going to blow it off more and maybe that's one of the drivers of it being more contagious, but we've got the laboratory data. We've got epidemiological data.
Looking at South Africa. Looking at the numbers down now, over 35% off their peaks. I've got a shorter length of stay there. Observed about two and a half days. Versus eight days. Hospitals were not overrun in a country. With you could argue some, I limited resources and we've got bedside observation. So we've got epidemiological data laboratory data and bedside data that all fits that it is. In fact, no longer an open question. This is a more mild virus.
And I guess one of the questions that I have around the mildness of
Because there is also the, I think it's that Hong Kong data that you're pointing out that you have a lot of upper Airway. Replication, you know, some multi fold over the OG, strain and Delta, but this idea that it's a milder clinical syndrome is a little complicated by the fact that in South Africa you have a lot of high seroprevalence of previous infection. And so the question is, how much of this is we have now a degree of natural immunity and some vaccine immunity in South Africa. And what you're seeing is
A virus, that's more replicatable. Maybe a little less pathogenic, maybe a little less disease but in the setting of a much more immune population because if you're looking at the kind of the three precepts of a pandemic, it's a very transmissible virus that causes a lot of disease that we don't have great immunity for. So those three things and it looks like with Omicron. We have a very transmissible virus that may cause milder disease that we have quite a bit of immunity to already. And so all those things make allude to make this less of a problem.
Then Delta, in terms of what we care about, which are actual
outcomes, the risk of asking, maybe a naive question. Is it still reasonable to say that this is absolutely a covid variant or at some point will mutations of the OG strain, allow the Delta lineage get so far away from those strains, presumably in terms of virulence as one metric that we really ought to be thinking of them more as coronavirus has, and not necessarily covid-19.
I mean, where would that line be? Like, I think that is the ultimate question. Is covid going to be the fifth seasonal coronavirus? As I know you and Misha dalja had postulated early in this pandemic there, you know as a reminder to those listening for Coronavirus has that circulate year to year that account for about 25% of the cases, the common cold, this may be the fifth and it may be in this version. Now the Russian flu, which was 1889 to 1891 many are now.
Postulating that that was a horrible, pandemic of a flu season, preceding the Spanish flu and that may have very well been a coronavirus that turned into one of those four seasonal coronavirus has that we live with today. So we may have essentially a fossil of a previous pandemic that mutated to a seasonal mild coronavirus and it may be in fact, one of those for existing viruses.
Yeah. I think this dividing line is interesting, right. Because it really is at what point do we
That's the case because you know a seasonal cold can actually kill somebody who's medically Fragile with comorbidities. We see it every winter as hospitalist. We admit it's an impending sense of Doom. It's like winter is coming every time in October. We know that just standard flu standard, seasonal cold, the coronavirus stuff that we already have, the Adeno viruses, even RSV and adults can cause a very nasty syndrome if you have a lot of comorbidities and it fills up our hospital because the hospital
suppose operated capacity. So at what point is where we are now considered very different from that and that's a really operative question,
another interesting question. And again, we're clearly now in the editorial phase. But well again, we'll come back to some data later. But if you were thinking about this, through the lens of evolution Omicron would be by far the best of the three so far, like, if you're putting your virus hat on and you're saying, what's in the viruses best interest you
The perfect virus, it is highly communicative and not lethal. And in fact, like the worst viruses are the ones that are a little harder to spread and kill their hosts. So, is there any evolutionary argument to suggest that it's, we would expect this to be the evolution of the virus that it's as it gets more evolutionarily fit. It should be killing people less and it should be spreading more.
It seems that that makes evolutionary Sense on many levels. And actually, if you
Compare it to tsar's the OG. The tsar's one SARS. One seemed to have a little higher case, fatality rate affected a different Swatch of people, but it the way that it spread you could detect it symptomatically when it was contagious. And when you were asymptomatic, you weren't contagious. So we were able actually to stop that virus through Behavior, restrictions testing of for people with what we consider now to be hygiene theater pointing a, and this is editorializing pointing a temperature gun in somebody's head back. Then may actually have worked with that. But if you look,
Then the success of the virus that wasn't a very successful evolutionary virus, whereas this one? Oh boy, spreads when it's asymptomatic causes severe disease, just in typically more vulnerable people, but there's so many people that are vulnerable that you end up causing a pandemic level of drama. But as you start to evolve it to Omicron where man it spreads so fast that everybody pretty much has a date with, you know, Omicron at some point, but it causes less severe disease. We think based on the data that Marty sighting and
Emerging information. Well, that's a very successful day virus. And that virus gets rewarded by being part of the pantheon of our seasonal biome, that affects us every year. And I think it would be very unsurprising if that's the mo of evolution. In this case. I like the temperature
gun reference for some reason. Those temperature gun. Scare me as much as they. But, you know, it may be that I macron is Nature's vaccine. It is far more.
Out. And for the 93% of the population living in poor countries in the world, they don't have access to a vaccine right now and it's going to be very difficult. So a lot of people out there are going to get vaccinated and essentially by getting Omicron and it's ideal to get the vaccine over getting the infection. But it may be sort of a silver lining of this variant in it. Maybe how a pandemic ends. We do know from a Johns Hopkins study. That's now in the preprint server that you're T Cell immunity.
Which is the most under recognized part of the immune system in the entire covid, discussion that is still solid against Omicron just as it was against Delta that the crossover is very high and that if you get Omicron, you've got T Cell immunity to Delta and vice versa. That's now pretty can I jump in here on something because I'm glad you brought this up Marty and I was suspect both of you will have a lot to say on this, everybody's heard the expression. What gets measured gets managed.
What we can measure, we tend to fixate on and unfortunately when it comes to measuring immune strength, we really have one tool in the toolkit, which is to measure circulating antibodies which are not the same as neutralizing antibodies, which are part of the, you know, B cell immunity. And then you have this other thing that you've alluded to Marty called T Cell immunity. I don't think we need to go into it in great detail. I did a podcast with Steve Rosenberg that was cancer focused but we had totally in-depth discussion on be
Versus T Cell immunity. So we'll we'll send people there if they want the primer on it, but the upshot is we don't have a laboratory tests to measure T Cell immunity. We don't even have a commonly available tests to measure neutralizing antibodies. We just measure circulating antibodies. So we can't really even measure what memory B cells are doing. Do you think that's a little part of the problem here in that? We're kind of Flying Blind and making a lot of assertions about immunity based on.
Arguably. The least important thing that you could measure. And again, I'm editorializing in my question a little bit. But but what do you guys think about a pushback on that? If you think that we're undervaluing circulating antibodies, I definitely think that we are undervaluing circulating antibodies and cellular immunity as a broad group. That is the memory B cells, memory T cells, listen to our Public Health officials from day one. They talk about the antibody levels, jump up and then we see them go down and then initially
There was a fear of reinfection. Well, we didn't see it clinically at the bedside. Then when the vaccines came early on, they said, you know, you really have to get that second dose because look at the antibody levels, just go up tenfold of what they go up after the first dose. Well, that's good. But it's good for activating your memory B cells and memory. T-cells. It's good for the cellular immunity antibodies, come and go that's in the textbooks, right? They linger for months in the system and then they Wayne. And by having this intense.
Ation on only one aspect of the immune system and that is antibody titers. What we have done. Is we've created a scenario where we're chasing our tail to keep those levels High because when they're higher you're less likely to test positive. So what we have created that, we've created this expectation that the vaccine is somehow failing. Now when you test positive, even though that cellular immunity is still strong and preventing severe illness and
it creates an almost a Cascade of surrogate markers. That don't really measure what we're directly interested in.
Right? Because if you have the surrogate marker, fok, neutralizing antibodies, and then that's trying to treat a surrogate marker of cases, PCR positive cases. But what do we really care about? We care about people in the hospital, filling up the hospital sick dying. Maybe we can say long covid. Is in that question, mark of things, we care about. And so, how do we really look at that? I think what Peters question really points out his? Do we have good measurement criteria to look at? Are we actually immune against severe disease, which is
That sort of an eight memory response that as anybody's Wayne, you still are able to mount this, which means, hey, you're still going to get cold and flu symptoms. You're still going to potentially be infectious during that period, but it's not going to settle into cytokine storm AR DS and being proned in a, I see you ready to die. And that's what we care about. And I agree. I don't, you know, we talk about things like T-cell detect which I'd actually don't know much about. It's one of these communal commercially available tests. I don't know if Marty knows more about it, but I really don't think we
Good outpatient commercially available tests outside of research that measure these things.
I mean in the study that we're and I'm not really that involved. I mean I was involved in some of the planning of it but there's a study that's going on at the University of Indiana right now and it's specifically looking at long-term b-cell and T-cell immunity. And in speaking with the investigators there. I mean the assays to measure that degree of function are quite complicated. I mean, these are not things that are amenable to commercial testing with any
You're so I do feel pretty confident in saying that we don't really have the tools to measure those things and and I forgot who I heard say this but I'm paraphrasing somebody they said measuring circulating antibodies and saying, you know, everything about a person's immunity is sort of like looking in a person's bank account and saying, you know, everything about their net worth. It's probably correlated, right? But, you know, especially with a wealthy person like the, their checking account is really not.
It above their net worth, you know, they're checking account, probably doesn't have zero dollars in it. They're probably not overdrafted, but it's unlikely that a billionaire is going to have hundreds of millions of dollars sitting in a checking account. So I think that's sort of to your point. Both of you. I think created a series of metrics that are problematic. Especially when I haven't heard a clear articulation of what the end game is, right? So this is now a macro question, right? Which is
I had to go out somewhere today, and it's actually pretty unusual for Austin, because Austin really doesn't care about masks or anything like that, but I was surprised I went in and the woman said, she took my temperature and so I got the temperature gun in the face and then she said, you know, we're wearing masks, so she handed me a mask. And, you know, I don't, I don't argue with people over that kind of stuff because I feel like it's, this is just that's her pay grade. Right? Like, that's her job to tell me that, fine. I'll wear I'm asking, whatever. But I keep thinking, like, well, what's the endgame? Here is the implication? Because if you're making me wear a mask now.
Shouldn't it be implied that you're going to make me wear a mask forever? Because how do you extract yourself or walk back from this position of temperature gun mask, you know, etcetera. So when it comes to, what is the endgame? What can we all agree as a reasonable Line in the Sand Beyond which the world goes back to 2019?
I'm having a hard time understanding that so what are you guys understand with respect to
that? You know, if from my end so much of it Peter it is an emergent property if how we're measuring stuff. It's actually the question that you asked in the beginning. It's like if we care about cases and neutralizing antibody levels and it's going to be an infinite number of boosters and masking into perpetuity. And even though the data is very questionable and all this stuff. We keep doing it. This is a policy question. How do we want to be in the world? How do we want to live our lives? What's the
Prince, quantitatively and qualitatively between 2019, before we had this pandemic, but we would have severe flus. That would overwhelm hospitals in the fall and certain places would go on divert. And we've all worked. You know, I've worked in those facilities, when that happens. It's sucks. Every medical person grinds her teeth and Nash has everything but we get through it and we don't disrupt Society. We certainly don't close schools. We don't inflict masking on the public because we would never think to do that as a policy. So,
so this is really a policy question. How do we want to be in the world? And I think that's where all the division that's been sewn on social media through mainstream media, alternative media, you know, all this disinformation misinformation. I don't even know what that even means anymore has created an environment where we're so atomized by tribe. That even the policy questions become tribal identifiers. So we need to kind of really see that clearly from a perspective of a more holistic, you know, integral perspective where we go. Okay, this is what's
Opening. All right. Well, what do we really care about? We care about people, not dying, not filling up hospitals and we care about our economy working because Health actually is correlated to wealth which is correlated to longevity. I mean, these are things that are clear, socioeconomic status, education, matters for that. So these this is how we have to look at policy, not a reductionist. How many cases can we prevent? And I think there's political stuff here that happens and it's just becomes a complicated mess.
Can you imagine guys if we tested for it?
Influenza every flu season. When say four years ago. We had 41 million, flu cases in a matter of a couple months. Can you imagine if we graphed on a daily basis? The number of newly diagnosed flu cases and we create Mass hysteria. Now, it doesn't mean we blow off flu or we don't take it seriously or we don't tell people some reasonable strategies. Like if you're around someone vulnerable, be careful. If you think you've been exposed wear a mask if you have symptoms, stay home. I mean, that's kind of how we live.
Respiratory pathogen, 10 to 25% of the population will get infected with a respiratory pathogen every year in perpetuity because there's a whole bunch of them. There's rhinovirus and Econo virus, and influenza, and parainfluenza. And the for Coronavirus has we talked about if a parent brought their kid in say, for their newborn evaluation, the First Pediatrics visit and the pediatrician said your child will develop
6:55 pediatric, respiratory infections during their childhood. I mean you could you could blow that up into you know, a headline, but the reality is this is we're not going to eradicate pathogens from planet Earth real quick. Peter. You mentioned something about. We're talking about the antibody titers and sort of chasing our tail. This just came out of day before Christmas from Britain from the UK. Now, this is from the UK.
Security agency, they're pulling the data that they've got great data. So the vaccines as they have had them with the primary series are 70% effective against symptomatic, covid, 10 weeks after a booster. It goes down to 35% for Pfizer and 45% from Alterna. So, within 10 weeks, you're seeing even the booster wear off against your ability to test positive or have a
Symptomatic case, but those memory B cells and T cells are still working. The cellular immunity is still protecting against severe illness. So, if we keep chasing antibody titers, you might be getting a booster, every first Monday of every month, when you show up at work and it still won't work. I was thinking about something this morning guys, that I thought could help us kind of anchor a little bit into
The evolution that we have undoubtedly all experienced. So if I think back to March of 2020, I actually pulled my kids out of school about two weeks before the lockdown. So before to people, you know, two weeks before this guy kind of insane. I was like, you know what? I don't know anything about this virus. I don't like what I'm seeing outside of the United States. We're going to keep our kids home. Oh, my daughter was Furious. How could you do this to me? Bubble will. So, I look back at that and I think,
That was the wrong thing to do, because it didn't matter, but I didn't know better and I think it was a reasonable precaution in the absence of any information. Right? Like if this turned out to be as bad as SARS one, meaning it was as lethal as far as one, but as infectious as SARS to would have been a good thing to do, turned out, it was Overkill. So I was thinking about like, how many times has my view of this problem changed? And the answer is many and I think part of it comes down to
You a framework around what tools do we have at our exposure at our disposal and what knowledge do we have about how to reduce morbidity and mortality for covid? And I was thinking about this because the first time I delineate it, this was in the spring of 2020, and now when I do it today, so tell me if you guys would add to or subtract from this. So I break it into three broad categories. The first is preventing infections. The second is treating infections, and the third is providing supportive care for people who end up in hospitals.
In the preventing infections, you have two things basically, vaccines and behaviors. In the treating infections. You would have existing drugs versus new drugs and then supportive care. So, back in the spring of 2020. We had no vaccines. We had behaviors, but we didn't know which ones were right versus wrong. Being indoors being outdoors, wearing this type of mask, that type of mask. We didn't know anything stands 6 feet of hearts and 16 feet apart. I mean, it was just a whole bunch of made-up stuff on the treating infection side. We obviously had no new drugs, but we had a whole bunch of
Think drugs, him drugs in there was a whole slew of ideas around, well, with this drug work, what about remembering disappear? We talked about that so much. And then, of course you had half these drugs became totally, politicized Etc. And then in the supportive care, side of things. We didn't know anything, right? It was like, is this AR DS, should you be oxygenating the bejesus out of people? Steroids must be horrible. I mean, we really knew nothing. You have a whole bunch of empirical insights and when you consider where we are today on that front, I mean, I just kind of jot it.
It out a bunch of ideas. It's kind of amazing that in less than two years. We have multiple vaccines with pretty clear ideas about which behaviors reduce the spread of infection in which don't on the treatment side. We've pretty good sense of at least one existing drug, that works, which is fluvoxamine. We can discuss if there are others and we've got at least two new drugs, that seem quite promising. I'm more familiar with the Pfizer data than the mark data.
And you know, you guys can probably speak much more to the therapy side, right? The supportive care aside, but it seems to me that ICU doctors and nurses have a way better sense of what to do today than they did a year ago. Let alone, 18 months ago, anything you guys would add to that framework because I think it's important to differentiate between what the world looked like in the spring of 2020, with respect to those data points or those, you know, those parameters versus what it looks like today, so,
Expand or subtract on
that.
I can say a couple things here. That's a really good framework. It's interesting because in the prevention framework, you could also throw in. Hey, you know, what about things like vitamin D, treating metabolic syndrome diet, exercise, those kind of things which are a little soft for whole
lifestyle. But no, I like I like it.
Yeah, like lifestyle modification, which I remember in the early days. You were talking about things that you did things. I did to were were because I said, huh. This is more like OG SARS then what? Because we didn't know what the ifv infection fatality rate was. I was sitting there.
Acting like a lunatic and I stopped drinking alcohol and I did all these personal things to try to improve my metabolic condition. So that's a piece of it. And then there's a question of chemo. Prophylaxis, you know, some have been these politicize drugs. They've been advocating that they're more prophylactic as well. You can take it, you know Ivermectin once a week and prevent this what I mean, it's worth exploring. I don't think there's data that we have but your comment that this has evolved. So quickly is absolutely a beautiful Vindication of the scientific process when it's allowed to
unfold people. I think people who've politicize this a lot on both sides. Say, oh, nothing's, you know, doctors aren't really trying to do anything to treat this. We haven't really learned anything. No, the opposite is true. Multiple good vaccines things like dexamethasone in the hospital that have really improved mortality. And we've actually thrown out things that don't work, which is actually just as important because those things can actually cause harm. So the question of hydroxychloroquine, for example, you know, Ian you need us' meta-analysis showing and maybe we actually cost lives by giving that much.
Roxy chloroquine. These are things we need to actually really dive into and it comes down to this Peter. Like let's say the IFR. This is how I think about it. If the infection fatality rate let's say it's you know, .2 .3, somewhere in that range, which seems reasonable. Although we don't have the exact data. How many people in the US are roughly at risk, then of dying based on the population of the u.s. and the IFR of the disease. And I did it back of the napkin calculation of few months ago that was roughly about 1.4 million Americans.
Ins. If that thing was the actual IFR of the disease if we didn't do anything, that's at the current state of the IFR. That's how many people would die. We're at what 800,000. So the the question is, will we get to 1.4 or will it not reach 1.4 and if it doesn't what of those three buckets? What I mean, what did we do to actually improve that? And I suspect, it's a mix of vaccines Therapeutics in hospital. Lowering IFR by improving hospital care.
And some behavioral stuff like maybe avoiding big crowds when something surging, something like that, but I but that's kind of my current thinking on it. As you know, the goal is get that down from 1.4 million as much as we can without destroying the fabric of society, which will actually push it back up towards 1.4 through ancillary damage in terms of substance abuse. Overdoses mental, health problems, suicide. That kind of thing.
Yes. It's amazing. What we have in our toolbox, How Far We've Come scientific innovation to
Me what's almost equally amazing is how we've not Incorporated, many of these new Therapeutics into common practice and that is probably a glimpse as to what's broken with our broader Healthcare System. The average 17 year lag for new evidence to get, broadly adopted into practice. And we're seeing that play out now. Now, maybe it's truncated. Maybe it's a three-year lag, but it's too slow for a health emergency. Yes. It's amazing how much we've learned.
But it's also amazing how we still have doctors telling folks. All you have covid, tough it out, stay at home. You know what we should be telling them in order based on evidence a list of things and in no specific order fluvoxamine, reduces mortality by 91% budesonide a steroid inhaler. Markedly reduces hospitalization, vitamin D has been found to be correlated with severity of illness and a German study in hospitalized patients.
Hypertonic saline is an age-old treatment that's been used to sort of rinse out the naval nasal cavity. And it's been used by doctors for a long time with many viruses and you've got all of these things that are not being adopted, broadly. And to me, we are still suffering from significant group. Think we've been burned badly with groupthink in medicine throughout this pandemic in the failure to warn about it in the surface transmission idea.
In the Draconian and barbaric, practice that, doctors and hospitals were complicit in to ban people from visiting, their loved ones to say. Goodbye closing Public Schools, ironically with a less contagious, strain out there, ignoring natural immunity not talking about fluvoxamine. I just saw another White House briefing. We have never once heard our Public Health officials talk about it, the group think, and not spacing out the doses. Maybe we wouldn't be talking about boosters as vigorously. If
Have spaced out the first two doses as we should have. By the way, I want to make a comment on that when the vaccine started rolling out. I spoke with three immunologists virologist. So, these are won't name who they are, just for the sake of protecting their identity. But I mean, I explicitly talked to them about this and I said, why the four weeks between first and second shot. That seems at odds with the little bit that I know about the immune system. They said there's not a single
No reason to do that other than they probably did the trial that way for the sake of speed, but they said if you can drag your feet as much as possible between those doses do so, and I was like, well, do you think it's worth saying that? And they're like, no don't want to like not going to say that just just you know, drag your feet as much as you can show up. Three months later saying you forgot to get your second shot kind of thing. So yeah, there's a little bit of this going on. By the way. I want to
Go back to one thing. You said, Marty that I have generally found the evidence to not be favorable, which is vitamin D. At least supplemental vitamin D. So because my patients ask me about this all the time. I've said, look, don't confuse your vitamin D level, that you acquired being in the sun playing sports outside with the vitamin D level, that you can get by taking 4000 5000, IU of vitamin D. I don't think those are the same. I think vitamin D might be a surrogate for health through other means.
Means did this study that you're citing specifically look at outcomes being improved with supplemental, vitamin D or did it simply associate or note the association of higher levels of vitamin D and better outcomes, the latter. So out of all the things I mentioned that has the weakest evidence that was sort of a retrospective review of hospitalized patients. Just looking at their levels and they found some correlation, but it doesn't imply. Causation necessarily all the other stuff has randomized, controlled trial data behind it. The vitamin
The thing was a retrospective review. Yeah. So my take on that has been in my practice has been not to prescribe vitamin D and instead to get outside and exercise in the Sun and get it that way Zubin. Do you have a take on any of those including the vitamin D
thing? Yeah, that was my take on the vitamin D piece too is there's a correlation causation situation there. There is definitely something going on with naturally acquired vitamin D. That seems at least in a correlative way. Protective. One thing that I think is interesting, so fluvoxamine again.
I think when you've been through the hydroxychloroquine Ivermectin Mill there the group think, starts to shift and go Therapeutics, just simply don't work, especially if they're repurpose drugs. There is a lot of groupthink in medicine and people are, then on inclined to look at these pieces. The other interesting thing about this particular pandemic that makes it tough. Marty is that, you know, 99.6% or whatever of people are going to get better, no matter what. In other words, staying home and doing nothing. They're probably going to be just fine. And so it becomes as question of
How do we do, we tell the whole world to take, you know, budesonide and fluvoxamine, and all of that, the minute they get sick, like, Omicron. It's going to affect everyone and I'm getting tons of emails. Hey, I have cold symptoms. I'm at home. Should I go get? Monoclonal antibodies? Should I, you know, because Peter has his defined patients. I have like millions of patients who email me. And I keep telling them. I'm not your doctor, but what I always say is, you know, look, you have to look at your risk factors. You have to look at your age. You have to look at where you infected previously. How'd you do with that? There's so many
Intricacies, whereas it would be nice to say, you know, what? If you're if you have these symptoms here are low-risk high-yield things we can do and I don't know. Marty. Do you think some of those things on your list are applicable to say? Anyone who gets covid? Or would you risk stratify?
Well, we've got to risk stratify because one it's just Overkill somebody who's young and healthy, the German data just came out that between the ages of 5 and 17, not a single healthy person died pre-vaccine. So when
Had someone vaccinated it's probably a indicator of overuse if we're using some big guns in that population. And, you know, I made a comment about doctors being slow to adopt some of this stuff. And I just want to be clear. We have put doctors in a terrible situation in the United States. We've put them in a very bad situation by putting them on the front lines of this pandemic without any good data for a long time when this pandemic happened.
It hit this country in every single person all of our friends and everybody and everybody who emailed you soobin and by the way, sorry for telling people who email me just to email you. Maybe I'll thank selling them to,
yeah, you know, if it just pay me a nickel, every time that happens. And then, as Peter says, if you do, if you do a wallet biopsy, if my bank account, I'll have like at least a diamond, there will be
great. But we were all getting the questions. How does it spread do masks work? How long are you contagious for?
Can you spread it pre-symptomatic all the basic questions of covid. We did not have answers because our gigantic four point two trillion dollar Health Care system could not do the basic bedside clinical research. I remember Peter was even doing a quick video about somebody please do this study. We were all saying the same thing Labs were mostly closed because there was no PPE the NIH was unable to Pivot there, 42 billion dollars to answer these questions quickly. So what we did is we had a vaccine
Vacuum of scientific research and all the doctors were on the front lines without any data to really answer these questions. And that's when the group think began and guess what ended up filling that vacuum political opinions. So we just did this study of NIH research funding last year. Less than 5% went to covid research, three months into the pandemic. 0.05 percent of the nih's budget, went to covid research, the average time for them to give a grant was five months to
And a research team to then start the research, 257 grants on social disparities with covid an important topic but only for on how it spreads and one on masks which hasn't even read out yet. So the most basic questions doctors needed evidence for that was not being conducted. I want to go back to something that you guys have both a now alluded to. And I talked about this a little bit on the podcast with Rogan and I think it's worth mentioning again.
N because it's a fundamental issue that I think we're going to talk about many times this afternoon, David Allison and I had a discussion a couple months ago and he put this very eloquently and I it's something we all understand, but I think I like the way he phrased it. Right. Which was always know the difference between science and advocacy and as we explain these differences, now, I think people will inherently understand it. But again, we're now talking in the realm of opinion. My opinion is perhaps.
Greatest disservice that has come out of this has been that that line has been so blurred to be non-existent. So science is messy, science is uncertain, science speaks in probabilities, and science, constantly changes in the face of new information, right? So science is a process, not a thing, right? Science says,
This is what we know today with this degree of certainty, as new information becomes available. The new truth will be this. So truth is not a constant within science, right, truth. We hopefully converges on greater certainty. And so when scientists speak it doesn't really sound that reassuring. I mean, you know, we know this because we interact with Scientists a lot. They never give you a straight answer because if they're doing their jobs, honestly, they rare, you know, outside of really well.
Known phenomenon, we have to speak in uncertainty.
I think for understandable, reasons, Advocates can't do that. They don't have that luxury. Right? If you're if you're a public health Advocate, your job is to communicate something with complete certainty. But if you are observing this as a member of the public and you don't know the difference, how do you know what to make of this? So is it safe to say that Anthony fauci is an advocate in covid and not a
scientist. This is
The central thing that's going on here. I think Peter, I think you're absolutely right because what it is is if you look at fauci say where you look at Francis Collins, so recently leaked email, Francis Collins talking about the Great Barrington declaration, which was a bunch of scientists including someone who's been on my show. Jay bhattacharya saying, hey, as a matter of policy, we think the following things should happen that would improve outcomes in this pandemic based on our interpretation of what the best sign says right now, there is no
No the science. This is our policy interpretation. Right? And what Francis Collins roughly wrote in this email was hey, did you see these Fringe epidemiologists coming up with this Great? Barrington declaration. Oh, by the way, one of the French guys was a is a Nobel Prize winner at Stanford Mike Leavitt. And if you haven't seen it, we need to do a devastating and you know, decisive takedown of this. And I don't see it out there yet. And so basically saying ultimately what I would tear apart this as is hey, I disagree with this as a
Policy. We need to put out something that takes it down as a policy and there's not a discussion of oh, let's have let's discuss the underlying science. Let's actually have a discussion about policy. Like, does it make sense to treat, healthy people that are young, the same as elderly people at high risk. These are the conversations we ought to have instead. They acted as advocates. Well, our position is, do the lockdowns, make people mask, promote, whatever it is, we're promoting and that's our policy. So we need to advocate for it in. No uncertain terms.
So which means a devastating and immediate takedown of these quote-unquote Fringe. Epidemiologists. And that that's that is as clear and aspect of the difference between policy politics and science. But this is a scientist who represents our one of our largest scientific public agencies. So that was really concerning to me. I'm curious, Marty what you think of that,
that was chilling when I saw that email from Francis Collins to fauci and it called for a devastating takedown of
Another opinion. Basically, I mean they control the currency of academic medicine, which is NIH funding. When you've got the head of that, talking about taking down ideas and taking down people. This is probably the greatest lesson. We should learn from the pandemic in addressing. How do we avoid groupthink in the way that it's burned us time and time again, we've got to openly
Talk about the corruption of science itself. How there has been a shutdown of scientific discussion. How you cannot talk about certain things. It started with Google suppressing, any search of Wuhan lab leak. And they admitted this openly, they said, you know, we suppress any searches because we weren't sure and we didn't want people to get the ideas. If they weren't sure. Well, that's not their role. They did the same with the Great Barrington declaration took down. Dr. Bhattacharya. I was skeptical of the Declaration early on but look at what's happening in
Now and tell me if there wasn't some truth in what they were talking about. Martin kaldorf, very well-known vaccinologist from Harvard on the CDC, a subcommittee, basically dismissed. Openly. He told me this and he said, I could say this publicly, I've written about in the Wall Street Journal dismissed from the committee for having a different idea. He was upset about the J&J pause being to prolonged and creating vaccine hesitancy asked to leave the Committee FDA bypassed.
Their own expert advisors called ver pack on the boosters for young people vote CDC with their expert advisors on boosters for young. People told that committee specifically you're voting on older, folks. We're not holding a vote on boosters and young people. And then they go ahead and author and recommend it for young people to senior FDA officials. Quit, including the head of the vaccine Center at the FDA academic bullying. How many people have reached out?
To us and said, thank you for talking about natural immunity. I see it in my patients. I can't talk about it. I'm told we have to keep one message and that is to get everyone vaccinated and, you know, thank you for speaking up. I can't do. So, why is the NIH? Not done a study on natural immunity? They keep saying, we don't know, they're ignoring the 141 studies that have been documented by The Brownstone Institute.
It's not that hard.
Go to New York, where people had the infection.
You them test their blood. I mean, why is my research team doing this without NIH funding? Because the NIH is not only not funny, if they're not doing it and they're relying on to really flawed studies that the CDC put out. This is the Distortion of science itself, shutting down scientific discussion, and that should be our greatest lesson Corner. Come back to something you said about natural immunity because now I want to kind of get into, let's talk about what we know. So let's start with that. What do we know about?
Acquired immunity,
you know, it's interesting because there are multiple studies showing that natural immunity is actually a real thing. It's a real phenomenon. It generates really good protection against either reinfection at a lower rate or severe disease at a much higher rate. And then there are a couple of studies that are CDC sponsored studies that Marty's reviewed in depth that say the opposite. And what's interesting is as a matter again as a matter of policy, then the policy makers in the US have chosen to go with that.
Roach saying listen, it doesn't matter if you had a natural immunity, you still need to vaccines and a booster. And by the way, you cannot space them out Beyond a certain point or they will not even count for the mandates that were talking about. So we're policy actually contradicts evidence that we have. It becomes that this point is pure advocacy, pure policy and that distinction between public health and science. Or public health says we have to speak with a monolithic voice that simplifies complexity into binaries. Otherwise, no one's going to listen because Americans are
Too stupid. That's the subtext versus actual scientists. Who are like? Wait, no, wait, wait, wait, wait, wait, and those are the emails we get, right? Marty, the people who can't even talk about this Nuance because they'll get censored in their own academic institution. So, back to you.
Well, I do want to technical question. Is there a precedent for a respiratory virus to not generate natural immunity, in other words, like what would be your prior on this if you knew nothing like wouldn't? And I think this is so outside of my wheelhouse guys.
Guys, I'm not an immunologist. I'm not a virus more importantly. I'm not a virologist, right? I think that's the real question and none of us are so, do we know if it's actually the norm that once you have a virus, you tend to develop natural immunity to. I mean, that was sort of my understanding from medical school, but have things changed significantly. And what would be our
expectation here. Yeah. So just real quick strep throat, which is a bacteria that can reinfect you and reinfect you. So you cannot have a viable vaccine.
Respiratory, pathogens in general, you can get reinfected but your immunity against severe disease, tends to be quite strong.
Alternatively. When they're just changing, right? So, so of course, like the flu, you could get theoretically every year. But that's because you're getting a novel pathogen effectively,
correct? That's right. And even then, even the novel nests of the pathogen is actually not as novel. As a real phase shift in the antigens you're presented with like maybe would happen in H1N1. Swine. Flu or a new bird flu.
So yes, it's a spectrum, all the way up to measles, where it doesn't change that much, even though it's an RNA virus and you can get true permanent sterilizing immunity from natural infection, for the rest of your life. And that's why we don't even vaccinate people who were born before say 1960, because we assume they all got measles, and they have immunity. So, Marty, I'm curious your thoughts.
Yeah. I know. I look, I think one of the little known Secrets is we all have our group of go to people? We've got our immunologists are vaccinologist. Sorry.
Infectious diseases experts and we go to them frequently and we learn to trust the Judgment of many of these. And I even heard Paul offit on your podcast, Zubin talk about how there's that Spectrum. So let's look at the hot coronavirus, has what I call. The hot coronavirus has the cold ones caught cause the common cold and there are seasonal, the ones that cause severe illness or the hot coronavirus has. There's only been three in history, and that's ours MERS and covid-19.
Now, SARS was studied 17 years out, and the natural immunity was solid Murs was studied three years out? And the natural immunity was saw probably longer, but that's just the time points at which they study the virus. Is it? No longer circulate. Why would you study it much longer if it's no longer in circulation, so the starting hypothesis in my opinion should have been natural immunity appears reliable. We don't see people getting reinfected with severe illness on the ventilator in the ICU. And once we
Art scene that we can change the starting hypothesis. But let's use the starting hypothesis that natural immunity works at least in the time that it's been around and what you had was a series of studies come out from early on two months into the pandemic. Rhesus monkeys were re challenged with the virus and they did not get reinfected the Cleveland Clinic then came out with their big study of Hospital workers who are around covid all the time and found. No re-infections. And the
Did not add anything to their immune protection. Then you had the Washington University study, which actually did bone marrow biopsies and looked at the T-cell activated T-cells in the system. The very difficult experiment that we talked about is not as simple as a blood draw and they concluded that immunity from covid is likely lifelong. It's lasting and study after study kept coming out. Then we got the biggest study ever done out of Israel. A population study showing that natural immunity was 20.
Seven times more protective adjusted for age. Then vaccinated immunity. Tell me a little bit more about that one. Marty that's seems difficult to quantify. Can you can you tell me a little bit more about what that actually means? Sure. So what they did is just, they have all the positive testing data as the CDC does but they won't release it of people who test positive and then subsequently testing positive again, they also have all the vaccine records. So if you tested positive and did not get a vaccine, they looked at the rate of testing.
Positive again and it was there is something like a 13-fold difference but adjusted for age because we know every age group is different. It ended up being an age, adjusted, 27, fold difference. Now, when that came out, it was a few weeks before. The data came out on boosters. Reducing hospitalizations by tenfold and people over 65. The ten fold reduction in hospitalizations with a booster and older people. Dr. Fauci immediately described it as quote, unquote dramatic data and wrote up a
A policy around that immediately the data on natural immunity being 27 times more protective not mentioned once ever by public health officials. There's a general fear. I hear in my private conversations with public health leaders that if they talk about natural immunity people might just go out there and try to get the infection and we don't want them to do that and I agree. We don't want them to do that, but we can be honest about the data and encourage vaccinations at the same time. Look how many careers we've ruined teachers.
Nurses soldiers, getting dishonorably discharged, they have antibodies that neutralize the virus but they are antibodies. That the government does not recognize that has been a tragic misstep. And I think it's one of the reasons why the government has lost credibility. There's a lot. I want to talk about there. But can you talk about the two Studies by the CDC that suggests that natural immunity is not lasting? These studies would not qualify.
Five for a seventh grade science fair. The methodology was so poor. Is that factor opinion? Marty? That is my just Chad. I think any honey honest scientist will tell you that the conclusions cannot be derived from the data. The first study was a study looking at a narrow two-month period in the state of Kentucky and they looked at reinfection rates and they didn't say anything about whether or not they had symptoms or hospitalized or anything and the rates in both the vaccinated and
And naturally immune group were exceedingly, low. They were 0.01 percent over that two month interview interval, but because they were both so low, and they weren't equal. One happened to be two point three times higher than the other in the, in the natural immune group. So they concluded those with natural immunity. We're 2.3 times more likely to get the infection again. It's too small a sample. It's so what happened was, the CDC has data on all 50 states for 15 months, the pandemic, at the time, they did.
Called fishing in anyone in research, knows this technique. You find some small sliver of data, in some Locale, in some narrow time window that supports a foregone conclusion that you've made before reviewing the day. So they found one state over a two-month period that supported their hypothesis. Why don't they release all of the nation's data on re-infections? They've never done that. And the other study, they surveyed people in the hospital and ask them if they've had the infection in the past and they make conclusions about
Ian level Risk by surveying people in the hospital. You simply can't do that. How can you drive a population level risk without knowing the denominator? So both were highly flawed. No one really defended them except for a lot of politically appointed Physicians, were just kind of mom about it and yet these numbers get quoted all the time. Like the Maricopa, Mass study, highly flawed wouldn't make its way into any hasn't been published in any Journal. It has a review process, just the little mmwr rag.
That the CDC points out now has there been a meta-analysis Marty because one way to address a body of literature this vast because as you say there's always going to be I mean, you're you're always going to find a signal and you're always going to find noise. A good process meta-analysis could sift through that? Has someone done that definitive meta-analysis on this question. Yeah. So Martin cuddler who was the Harvard Professor? Now, he's at Brown Brownstone Institute has summarized the
One studies on natural immunity. And so in fact she gets on the TV and says we just don't know about natural immunity. Well, do the study how hard is it? This is not the riddle of the Sphinx. You can figure out how many people have been reinfected from the original days of New York and had severe illness. And as when this issue is coming up. I reached out to zoom in and I said, hey, are you hearing about re-infections after somebody? Truly was sick. Not just an asymptomatic test.
But they were truly sick from covid. Have you heard of anyone coming back to the hospital on a ventilator or dying? And look, I'm sure there's some rare case out there, but he said no look, I haven't heard about it. It's becoming like Bigfoot everyone thinks they've heard about it, but there's no good documentation. And anecdotally, I think we see the opposite, right? I mean, I know many people who have been reinfected with covid, and I can say, without exception, every one of them had a much, much milder course the
Can time now, some of that's confounded because some of those people also got vaccinated, right? So they got the first way they got their first illness. Pre-vaccine, that was pretty bad. You know? That was again in in a healthy young person that could still be like a bad case of influenza. Some of them just went on to get another covid, a few months later, pre-vaccine. Some got vaccinated and got another covid, but I think the point here is this is knowable. There are some things that are not knowable. There are some things that are knowable this Falls.
In the bucket of knowable and therefore, it's frustrating. When we don't have information on things that are knowable or when we claim. We don't have information about things that are
knowable and I think this points again at Marty's asportation set our as a policy. We haven't chosen to devote resources to this and it is a central question and I think our anecdotal experience again, speaks to the difficulty of preventing reinfection with a mucosal pathogen like a coronavirus. And that's why, you know, you can get a cold year after year, but you don't die.
That long-term immunity, you know, prevent severe disease and we see that anecdotally. Now, speak of anecdotes. One thing I want to say about that. Everybody has an anecdote off somebody who broke through vaccine or did this or that and ended up getting sick and died and Hospital. People are really good at this because they see an enriched sample. So they'll be like, well, there was a pregnant mother. Who was 20 you had no problems died of covid and this and this and all that that can happen. But when we now have an internet where these anecdotes can be Amplified into larger level,
Sorting sort of data sets. I think it influences a level of fear and policy decisions. Then that spring from that and that's something we have to kind of tease out by actually doing science. I actually studying the stuff directly and saying, okay now this is actually a well-designed study that says actually know it can happen but it's a point zero zero, one percent risk. And so do we make policy to prevent that risk? And the answer is probably not because it has costs,
you know, this gets back to I'll just keep harping on this idea of science versus
Science for Saturday. I mean, again, on the other side of the spectrum, you have, you have a whole group of people who are saying, hey, vaccines are horrible. They should never be used. Nobody should be vaccinated. Natural immunity is the only way to go vaccines, don't even prevent illness because look at all these breakthrough cases. And again, I think a very arrogant approach is to say, shut up vaccines cure. Everybody, put your head in the sand. You knuckle dragger, but that would be an advocacy position right, a scientific position.
Would be like, no, you're absolutely right vaccines. It's a probabilistic game, vaccines, reduce the probability of infection, the severity of infection, but that's all probabilistic. So, if you take 100 vaccinated, people versus 100 unvaccinated people on an individual basis, you can't make any assertion. That's what science is. And again, I go back to this thing, which is you look at all of the amazing things that have happened in the last two years. That really
The scientific method. So imagine this pandemic took place in the 16th century, like before we even had the scientific method. So let alone the capacity to generate drugs and all these other things totally different game,
right? And yet, I mean, to think we have
monoclonal antibodies. We have novel. Antivirals. We have vaccines. We've got all of this stuff done in less than 24 months.
What bums me out on. I've said it before opinion. Not fact. I think that this is a pirate victory for science. I think it has. What's the expression like we've, we've won the battle and lost the war from a scientific perspective, right? Which is, yeah, you know what 800,000 people died instead of 2 million. That's an awesome Victory, but it came at such an erosion of trust that the next time. One of these things comes.
And when you actually do need to take really Draconian measures good luck with
that. This idea of the pyrrhic victory of science. I think is is really Central here. Because one thing you said about advocacy this advocacy position. Maybe it's a good advocacy position to say. No vaccines your your dumb. If you don't take them there, they're absolutely essential to ending the pandemic. The only way through is with vaccines, but even that is an advocacy position is ineffective because how is that worked? It generates?
Logical reactants among people who are have ideological and moral reasons to be skeptical of these vaccines, whether they're politically aligned with someone who's skeptical. Whether they don't like Authority telling them what to do, whether they distrust science, whatever it is that approach to advocacy only serves to shore up people who are already agree with you and they creates reactants and others, which is the problem with mandates, which is the problem with the inflexibility of recognizing natural immunity. So even as a policy standpoint,
All we've done is serve to do exactly what you said, Peter, which is a road, our trust and ability to understand science. And then, the next thing that happens is potentially a huge disaster if we had a supercomputer to calculate all the downstream effects of what we've done during this pandemic. So, let's say we saved, you know, A Million Lives, let's say, but how many did we cost in terms of future distrust in terms of childhood? Vaccines that? Now, people are reluctant to get because they're so burned by this whole thing with the
Covid, in terms of all the, whatever screening for cancer. We didn't do. During the time that covid-19 on substance abuse the mental illness that further fragile ization of her children, through this culture of safety as mm and overprotectiveness and, and teaching them that, you know, words and people who disagree with you are evil and violent and so on. So that's something that I think, we really, if we don't wake up to that, then it doesn't matter how good our Sciences, it's not going to actually affect anything in a positive way.
You may have seen the Brown University study that just came out. I'm going to read the conclusion. We examined General cognitive childhood scores 2022 2021 versus the preceding decade. We find that children born during the pandemic. Have significantly reduced verbal motor and overall cognitive performance compared to children. Born pre-pandemic. We are in Uncharted Territory. We are playing with fire. We're now going to have a generation.
Now, living with this, we've got a mental health crisis, declared by the Surgeon General in children. We've got a fifty one percent increase in self-harm admissions to a hospital among young women. We have yet to comprehend, how significant many of these restrictions have been on the most vulnerable members of our society. And that is children who don't vote who have been subject to so many of these policies.
One of the things about this that is odd to me is again, when you contrast, 18 months ago with today is based on what we know these proposed policies and mandates. Don't even make sense. So let's talk a little bit more. Let me get a little more data so I can create a thought experiment which, you know, I love. What is the best available evidence we have? For how much a vaccinated?
Versus unvaccinated individual reduces the ability to spread an infection to some other person. In other words how much do vaccines reduce the ability to spread the infection. I think, one of the great mistakes we made as a medical community was to suggest that somehow being vaccinated was going to eliminate that risk of transmission and we've set that expectation. And now people run around saying they don't work. When in fact the
Scenes are very effective in downgrading, this Verity of illness, but the transmission piece. Now. It's pretty clear is not significantly affected by the vaccines because the virus Lanza's lands in the mucosal area of the nose and upper Airways replicates and you blow it off faster than the systemic Community can kick in. Now, the natural immunity is more based in the local area of the mucosa. And so therefore that's why some think it's more.
Effective. But when you look at this Lance's study that just came out about a month ago, the peak viral shedding was equal in those vaccinated and unvaccinated. The difference is the window of contagiousness was more narrow among those facts and mated. So we're talking one day versus about three days on average. So we could again this is a very crude assessment but we could say there's a 66 percent reduction in transmission if you believe.
Things are that are otherwise equal, you could. But if you show up to the same day care center or same workplace every day. You're still going to get on one of those days, be shedding virus at a high level. Okay? Zoom. And anything to sharpen that analysis because that's again to me. That's a very jugular question when I think about a policy decision,
right? Yeah. I think it's interesting because there's two ways that I think we can see a reduction in transmission. One is the narrowing of
of the window, which Marty talked about the other is that there is including in current data and I can't cite the specific studies that have to dig them up. But there is a reduction in symptomatic infection overall, which means the operative question becomes when a vaccinated individual is asymptomatic. And I'm not talking about pre-symptomatic like they're eventually going to develop symptoms and often we found pre-symptomatic. People are quite contagious, but they're asymptomatic, but they would test positive.
At a by PCR. Say are they infectious? And this is in the realm of speculative, now, right? But the answer is probably not and the more people that are vaccinated around them. Probably even the less infectious they'll be because those people have an innate resistance even to infection, unless the inoculum is quite High, which is why Delta was kind of a real drag. If you look at vaccine numbers with Alpha vaccine very effective, but then the combination of waning neutralizing antibodies plus a very high are
Not virus in the form of delta, made it more likely to break through in terms of infection mucosal replication. So again, I think there's those two main mechanisms by which but then you have the emergent phenomenon of a community effect, and I'm not using even the term her to meet it anymore because it's just it's gone by the wayside. It's more that there's this community cocooning effect and you see it in a place like say the bay area where the vaccination rates are 90 plus percent. They're
Aren't that many cases? And if I talk to my friends here, they're like yeah, you know, there's a few really morbidly obese, elderly people that are in ICU, but in general, it's not happening. In kids are doing just fine, even prior to being vaccinated and schools, are you know, opened up and stuff is happening. There is this kind of effect. So, I think it's more complicated than has currently been measured easily, but that doesn't mean we can't measure
it if you say it. Look at. Let's just take the most extreme. Like let's say it's reducing transmission by 2/3, and it's clearly reducing severity.
A of infection by at least 90%. And I think that would be a fair assessment and some demographics, probably more than that, but it's a good log reduction in severity. So and then you take on top of that, do we have effective agents to treat it? Think the answer is we have lots.
So now, Imagine A Different World. Imagine a world in where you had a vaccine that didn't reduce severity of illness by more than 50% but it reduced transmission by 99%.
Would we want to at least discuss whether there would be a different policy view?
Yeah, that makes perfect sense because if you if the main goal is dropping transmission, but it's not, but for the people who do get sick. They still get very sick, then your policy changes to, hey, you know, as many people as we can get vaccinated, the better it is that's a true herd immunity kind of goal there. We can do that measles Etc. But if it's the opposite, then your calculation of policy changes dramatically. And here's why I think it is.
Does at this point, like you said, we have treatments, we have prophylactics in the form of vaccine. We have prophylactics in the form of an n95 or can 95 masks. We have prophylactic in the form of, you don't go to that concert or go out to eat if you really are that paranoid, right? So at this point, we've shifted from a community level decision risk to an individual level decision. I can get vaccinated. If I want to prevent severe disease in myself. I might have a little cocooning effect on my family. That's fine. So we don't want to minimize.
Is it? But it's we do want to maximize it either because it may not be true in a maximal sense. It's true. It's on some Continuum. And then if I don't want to get sick and I'm high risk, I don't have to go to that thing, or I could wear a can 95 or an end of 95. And then, if I do get sick, I'm going to demand, you know, the right. Monoclonal that is Omicron, you know, sensitive and fluvoxamine and all the other stuff, right? So at this point, we've turned something from out of your control entirely to something that becomes a much more individual.
Which is why policies that use the mechanism of the state to actually influence your behavior. May be less effective, less relevant and backfire in a bigger sense. And it goes with colleges to wenyard. Mandating kids be double vaccinated and boosted quarantine for 10 days in their room, getting doordash. If they test positive. Well, why who exactly are they harming? Their own risk is low, their professors are vaccinated and can wear masks. So it's kind of like, at this point.
Point. What are we really doing? So if the underlying situation matters to what policy you want to actually in still,
you know, I think what what I'm struggling with is you could paint two extreme cases. So you can you imagine a scenario where the vaccine does not really reduce transmission, but really reduces severity of illness, versus a vaccine that really reduces transmission, but not so much on severity of illness. Well, again, any person with common sense could say you have a totally different
Friend set of recommendations. And if you're going to wave a policy Hammer, you're going to do it totally different in those situations.
It seems to me that we're using the wrong policy tool again opinion. Not fact, we're using the wrong policy tool for the tools on the
ground. Even when you talk about kids, which will I'm sure you'll talk about the policy tools. We have are not concurrent with the situation on the ground in terms of these parameters, that Peter discuss.
What Peter? I think that's a very reasonable opinion. But here's a fact that is the Therapeutics we have today. Have cut covid, deaths, 20 in the clinical.
And once they get distributed member, they were just FDA approved. Once they get distributed in out there. No one should be dying of covid. Right now, with rare exceptions, with all the, you know, state-of-the-art care with the randomized, control trial data behind it and packs. Love it and want a beer. No one has died from covid in those clinical trials period. Now In fairness, Marty still relatively small, right? The Pfizer study only had about a thousand in each arm. Is that correct? Yeah, little over 600 in each arm, okay.
Okay, so we used to have a joke. When I was at the NIH at the NCI, whenever a small trial would come out in a phase two, that showed an amazing result. The, the patients would say can I get that drug before the results change, you know, once the larger trial comes out. But so so just to set expectations, right? Mean people are going to die even still through these drugs, but I think the point is when you look at this protease inhibitor, which is the new Pfizer drug and this RNA replicating blockade. That's the
Drug, they're kind of remarkable. And presumably we will come out with another set of monoclonal antibodies that will be reactive to whatever strain is relevant. Just as regeneron was very effective against the OG reasonably effective against Delta. I think we can talk about how effective it is against Omicron. But yes, I think your point is kind of what we've been saying. Like, oh my God, we have tools today. We couldn't fathom 12 months ago.
So good point now, 23 people died in the placebo arms, collectively of the manipulator and Paxil vid trials, 0. Of Cove, it in the treatment arms. Now, it may not end up being, you know, that dramatic and integral population. But whatever it is, it's very impressive. It's very impressive than you. Add to that. The GSK Veer, monoclonal problem is, we've got the monoclonal is out for the Delta variant. We just can't sequence quick enough to know what to give people. That's the
My butt well, especially by the way. Marty Jory interrupt. When you start stacking these things, right? This is where it starts to get. Very Bayesian. You're vaccinated, you have access to monoclonal antibodies, you have access to a new therapeutic. You have access to existing Therapeutics is in fluvoxamine. And you have, I see use that are ninjas compared to what they were two years ago. That's right. That's five pieces of Swiss cheese. You can put on top of each other.
Oh, and you still have to try to get a piece of, you know, a pencil through. There's pretty tough. That's right. And you add fluvoxamine, budesonide. I mean, it's a so, we're all in agreement, the Therapeutics now our have matured once they're actively available everywhere. It changes the calculus. So if people were jumping out of an airplane and some people chose to use a parachute in other people chose not to, you would say, you know, people not using a parachute are making a very
He poured decision, and you might even mandate parachutes of anyone jumping out of the plane. But if the plane is flying at a very low speed, only 15 feet above an inflatable mat, that changes the calculus on the entire necessity of instituting Martial law to require parachutes or whatever. The mitigation is.
And right now, it's as if there's this mild illness that people with immunity, can develop, and we're bringing all of Heaven and
Earth down to
lock up, these college students in solitary confinement for 10 days, requiring them, to get a booster just so they can go to class despite. No evidence that boosters right now. Help young people and maybe some evidence that there's harm now that could change. But that's the evidence to date and look at what we're doing to ourselves.
We've moved to a second pandemic after covid-19, which is a pandemic of lunacy, which is this over reaction to mild illness. What
becomes so frustrating? Marty is? When we talk about this stuff and you and I are pretty aligned on this in this, isn't it? This is opinion based on the best evidence we have. So it's a mix of sort of editorializing and I will get emails from say an ICU Doctor Who will say, but I'm still seeing sick people in the eye.
I see you and to which I will reply. Okay. So what in our societal policies would actually prevent that short of locking everybody up in their house and forcing vaccinations on them. And then telling them, they can't do anything that they normally do and what's the cost of that, and the same ICU, doctor will tell me when my son is actually having a lot of anxiety in high school right now, has to see the counselor because he was kept home and it away from his social network and then the pressure of using zoom and he's an introvert and it didn't really work out. And so I, uh,
Sympathetic to that is like well now multiply that by how many millions of kids we've done this to for something that eventually it seems to me and I'm editorializing is going to be fully endemic in the sense that you have a respiratory pathogen to which initially we had no immunity or limited immunity. We now have much better immunity against severe disease. We get reinfected every year like the common cold, but people who get very sick, have a series of Therapeutics at their disposal to prevent them from dying, some old, and frail and comorbid.
People will die like they do from a common cold, but we don't have to really change society over it because it's another common pathogen that we have next. Do we really need to vaccinate every single child for this when every single child every single season after they're born is going to be infected. Naturally. They're not going to get severe disease because their parents pass along some degree of immunity and even in breast milk and as it is we're blessed that the kids don't get very sick typically from this unless they're very sick otherwise and so they're going to develop
Immunity and so it in something and lesson, a few years we won't even need to vaccinate anybody, because all adults will be exposed or vaccinated. All children will be exposed and we'll have another common circulating, endemic coronavirus. So that's what I think is where we're headed and yet, so why are we destroying our society in the process and generating so much division where squandering our community to for this thing? That just doesn't make sense to me. Now, that's editorializing. Well,
I'm going to keep editorializing for a minute and then
Want to come back to something, you said Marty, which is let's now look at the data around the risks of vaccine because again, I think one of the challenges of the scientists being conflated with The Advocates, is that no one's allowed to ask that question, right? As though somehow, you know, statins. Like let's take a drug that I mean just demonstrable e. Reduce the risk of cardiovascular disease like you just, you know,
You've got to look far and wide to figure out over the right time Horizon. If you give statins for a year, you might not see a benefit, but the monster bleah, the biggest sea change. We've had in the reduction of risk for the most prevalent, chronic condition in the developed world. Would anybody with a straight face say that there aren't risks of statins. Nobody with a straight face. Could tell you that statins, don't harm some people and there's nothing bizarre about that, right? There's nothing odd to say that. I mean
like,
Don't we talk about
this? Every time we give patients a drug. You give somebody a prescription for something. Hey, let us know if you develop a rash. If you do it could be really severe. You know you please call us right away and let's stop it. You might be one of the four point, nine percent of people that is susceptible to this side effect, right? So,
Somehow it's become impossible to have the discussion. If you're coming at it from the, the sort of the advocacy point of view, that there might be a risk associated with a vaccine until, you know, something like the J&J thing came along and then the response seemed the exact opposite. Which so this is the thing I'm struggling with. Okay. So this is a long rambling question because I don't understand something. I don't understand how
when the first J&J data came out and said, I believe it was six cases of VTE in seven million doses. So about a one-in-a-million incidence. The drug was pulled, the vaccine was pulled and in a moment. We're going to talk about myocarditis with moderna.
Nobody wants to talk about that.
Why the difference? I'm asking for opinion because I mean we can talk about what the facts are which will get through. But the broader question is help me understand the difference because I'm getting questions from patients of mine saying, I don't want my 18 year, old son, getting a third mRNA booster, which is being mandated by his university. Do you think I'm crazy to? Which I say? No, you're not. Here's the data. That set tells me. You're not crazy
and I'll let Marty answer this but I just want to say this, I think.
It comes down to the difference between peacetime and wartime vaccine communication. And again, this is advocacy versus science. So, in peacetime vaccine communication, you have children who need to get these series of vaccinations in order to prevent common. What would re become common diseases, like measles mumps, Etc. If we didn't get a certain degree of herd immunity that happens, which is above 90-odd percent. And so, the, the messaging is always been. Hey, listen, there are very rare side.
Acts of these things, and by the way, they can be quite serious, but they're very rare. But as a community benefit, pretty much that risk. Your child is so small and the risk of the communicable communicable diseases, small, right in an absolute sense. Absolutely small, but if we don't do this as a community, we're going to have a problem and you see it when vaccine rates, drop below 90% you see measles outbreaks and that sort of thing. So the public health messaging is always been a zero tolerance for anti-vaccine discussions. We don't talk much about the risks of them because we just
To do this in their mandated, for schools. And so on. Now Brisson, there's their merits and demerits to that approach. But that is the peacetime approach to vaccines. The wartime approach where you have uncertainty, you have changing data. And you have risks and benefits that are stratified by age and comorbidities. We're applying the same peacetime approach which is vaccine absolutism with no quarter and anything you say against the vaccine is taboo.
So it becomes almost unspeakable curse like in Harry Potter. You can't use them or your excommunicated from the tribe of medicine and it is become a tribal thing. Well, now, I think it's become this kind of absolutist thing that they've applied, in Wartime to something that it just doesn't apply to which is this vaccine. Which as you mentioned, has risks, that actually are worse for younger people and benefits that are much less for younger people. So we ought to be looking at it clear-eyed. So I'm
Marty over to you. That's just my rent.
Now. I like your spot on here because what, we now, see, in this tribalism of medicine, and we've seen it in the group, think of so many aspects of covid that the establishment got wrong, and the reality is, we've got a few people making all the decisions on covid, a very small group of non age. Diverse non, ethnically diverse, political appointees with political Elite.
Chances making all the decisions on covid for the country. And quite frankly. I think they're detached from the life of a young person. In Baltimore City, who was barely hanging into in school, pre covid. Okay, it's not as easy to hand that person and iPad and say we're you know, we're going to do remote learning as it is in the Hamptons are in Santa Barbara County. So what we developed was this sort of tribalism, whereby if you would question.
Thing that might result in an answer even albeit scientific, that could threaten the vaccinate, every human, being with two feet message. Then that needed to be suppressed or squashed, or ridiculed or labeled an anti-vaxxer. It could, it could be natural immunity. You know, I think that's maybe how I initially got sort of seen as hey, is he, one of us with the vaccine Community, you know? Last year. I was calling for lockdowns beforehand warning this thing.
King wrote the first piece calling, for Universal masking to keep society semi-open. And then the vaccine rollout came along and I said, hey wait a minute. It needs to be simply age-based and those who have natural immunity need to step aside in the vaccine line, so we can save more lives and let's just focus on the first doses because the immunity is pretty good. For three months. We can save more lives. Tens of thousands of people could have been saved if we adopted those policies and some people would suggest a, wait a minute. If you're saying,
Boston the second dose, your kind of anti the vaccine and if you're telling people with natural immunity, they can wait a little bit based on the data. That's kind of anti-vaccine. And if you're asking about the myocarditis complications trying to understand the rate of them, that could scare some people off. And therefore you might be putting an anti vaccine message out there the tver data system, which is the self-reported system. The FDA setup is such a shoddy poor way to track complications.
Is that with, it's basically unreliable. It's overloaded. And yet at the same time. It's very cumbersome to report into that most doctors that tell me about a complication of say they haven't reported it to tver. You really get almost no follow-up. There's been deaths in children in the United States immediately after the second dose from myocarditis. And the CDC says, they are going to investigate one of them that was several months ago. We never heard anything. So if you ask questions, it's almost as if
If you know, how dare you now look, the vaccine still makes sense in a certain context in a certain way and young people it's often to present a my SC and hospitalization more than it is to prevent death in children, but it's nuanced. It's not a one size fits all strategy, especially with those who have natural immunity. So let's talk a little bit about that Z dog Vani, did a great video on this just the other day, but let's talk a little bit about what we know and now let's just talk. In fact, for a moment, right? Let's not
A Torii lies anything, what do the data suggests with respect to the Pfizer vaccine and the Moderne vaccine with respect to the incidence of myocarditis in males and females below the age of 40 and stratify that as much as you see fit.
So I'll give the high level in. Marty can dive into the details because he's vastly bigger nerd than I'm capable of being. But I'll say this the party line has been that and you'll hear
Pediatricians around the country telling their patients. This. When asked about vaccine, they're kind of reiterating what CDC says which is the risk of myocarditis in young. People is exceeded from a vaccine is exceeded by the risk of natural covid infection causing myocarditis. In other words, if they were to go out and get natural infection their ex fold more likely to get myocarditis then any risk of myocarditis from either of
The vaccines Pfizer or moderna. Now, this isn't a setting off not knowing the denominator of how many people are actually infected with covid out in the community. They're just looking at kind of hospitalized patients and so on. And of course, those patients are sicker, of course, they have more cardiac side effects and so on, when they're infected with covid,
there's two counting issues there just to clarify right Zubin. The first is you have a negative selection for patients and then you have a underestimation of the
Later, that's right. So, in other words, we don't know how many people got infected with covid out in the community that did just fine. We're guessing at that. Oh, using incomplete tools. And so that's part of the problem in the calculations. Whereas with vaccines, we can say. Oh, these guys got vaccinated. And there were this many cases of myocarditis and they were hospitalized for this many days and they had this kind of cardiac function at discharge and these were the complications and so on so you can you can actually look at that data. Now looking at all that same data that was available, the European authorities said, you know what, actually we see a bigger risk with moderna.
For myocarditis that especially when we have Pfizer which seems to have less myocarditis, so we're just not going to recommend moderna for men, or people under 30. Now, that's a huge difference between us and European policy Based on data sets. Now, this is where the newer data comes out that Marty can talk about saying, hey, you know, this may not be true that actually natural infection is more myocardial genic than the vaccines.
Yeah. So we generally recognize this rate early.
To be somewhere in the range of 1 in 7,000 and that is young, boys and young men. So, in the age, group 15 to 25, the rate was about one in 7600. According to a New England, Journal study. After the second dose. The complications, 90% of them were clustered around the second dose and the myocarditis cases the vast majority of which were mild but to persevere in the New England Journal analysis, out of Israel.
And one person died. That is a 22 year-old died. I know it, you know, you can barely say that because you know of the sort of trigger that it creates but look by and large. This is a safe vaccine, but for parents asking these questions about vaccinating their kids to give against an illness that has an ultra rare rate of death in healthy children. This is a reasonable conversation to have maybe the rate of death from the vaccine.
The rate of death from covid in a healthy child. Now, the CDC reports. There are six hundred and sixty eight deaths over two years. So let's say roughly, 300 some deaths, a year from covid, in everyone, under age, 18, all children, who are those kids? We believe, many of us believe that they are nearly all in children with a comorbid medical condition. Now, they're still important members of our society. We needed
Do everything we can to protect them but it does change the calculus now for healthy kids, when we recognize that the vaccine is not halting transmission. So to subject all healthy children to a vaccine when the risk of myocarditis could be as high as 1 in 7,000, young males and boys.
Then all of a sudden you're talking about a very nuanced decision where some pediatricians might say, you know, what, how about we do? One dose. There is a study of kids five through 17 in Germany, that just went on the preprint server of all the deaths in Germany, over the 15 months, the pandemic right up until around March, March, April. There were zero deaths in healthy children. No healthy child has died. A hundred percent of the deaths were
Mustard in kids with a comorbid condition 100%. So that changes the calculus. Now to a parent that says, hey my kids healthy. I'm a little concerned, about the rare side effects. I'd like to talk about the data. This is a conversation. It is not a one size, fits all strategy as we are being told and especially when you get to boosters, I mean, the here's here's a new ain't here. Said New England Journal paper from December 8, looking at
Boosters and no boosters in kids. Well, I call them kids because I'm on a college campus in people under age 30, okay, in people under age 30, who are vaccinated with the primary series. There were zero deaths. This is population data from Israel, zero deaths, after the regular primary vaccine series. You cannot lower that. Any further. You cannot lower the number zero further with a booster. Well, they looked at those with boosters and as you would expect zero deaths in that group.
And then in Germany, they look to people really essentially of our period when there were there was no vaccines. And the rate was also zero for healthy kids. That tells me the kid has a comorbid condition, get the vaccine. Otherwise for healthy kids. It's a nuanced discussion. If you look at the circulation paper that came out in July of this year, the knock on this is it doesn't distinguish between Pfizer and moderna. So we'll talk about that in a second, but I think to me the most interesting table in
There is the one that stratifies by age and then it does risk and benefit male for female which again seems to me a very reasonable way to think about this, right? So when you looked at 12 to 17 year old males and females, and again, this is all mRNA vaccines. We know now, I think can we say that unequivocally the moderna vaccine is three to four times more likely to be associated with myocarditis or myo pericarditis.
Has at
least at least. Yeah, okay,
the supplemental data that came out. Literally two days ago. Looks like it's five times worse. But let's be conservative say three to four times worse. So keeping in mind I'm giving you Blended data 12 to 17 year old females eight to ten cases of myocarditis per million doses. Males 56 269 cases, lended benefits saves 38 ICU. Admissions saves one death.
So here's where I'm struggling right now. If you look at this and you say, look, you're going to give 70 cases of myocarditis to save a death. What's the natural history of those 70 cases of myocarditis? So Zubin, how many of those kids make an unremarkable recovery? How many of those kids are going to have a chronic issue with their heart? They're going to have a reduced EF for some point of their life. And will any of those kids
died.
This is the thing. We don't have enough data to be able to actually answer some of that. I think there's a degree of uncertainty. And when you're talking about the quality life year, saved in a kid, if you, if you're going to in any way, impinge on their ejection fraction of their heart in the future, or cause any scarring, or cause what we may even be under diagnosing, whether there's a riff Mia happening. It becomes a really open question that this ought to be looked at very carefully. Now, Marty may have his hands on some of the more specific data on the outcomes. You
And the 22 year-old that died. It's also it's also a little difficult to Peg causation sometimes because some of these kids had also pre-existing cardiac abnormalities. We always think about sudden, cardiac death in athletes and children and and whether to screen or not, and those kind of things are outstanding questions, but even if this were to provoke that to happen, say if they were to get myocarditis, you're impacting a child and tons of live life years that are affected as opposed to
90 year old, who may be the vaccine, gave them a fever that pushed them into cardiac arrest, but I mean, just speculating, right? It's a very different quality of life. Yours saved kind of calculation. So I don't have the specific data flow. How many of these kids go on to have chronic problems or even the hospitalization risk, right? So a certain percentage of these 86 percent, in one study that I saw get hospitalized for an average of about three days. When you hospitalized, anybody you put their life at risk.
Ask because they're in a the most dangerous place on the planet because medical errors happen infections in the hospital happen complications happen. That's why staying out of the hospital's, a good idea if you can do it. So, you have to look at that as well. And I just don't, I haven't seen the data that compellingly says, oh, this is the answer to that
the argument, I hear, by the way, because I, you know, few days ago. I saw something that was ranking colleges or something like that, and I made some snarky comment on Twitter. Like, can we start?
Think that dumbest colleges, you know, and I was going to put my alma mater, you know, going to put Stanford and Hopkins there which are two of the idiotic colleges in my view. And by the way, this is opinion. Not fact who are mandating, you know, boosters for kids and not letting them back to campus without them.
And I couldn't
believe the people that were just furious with me. How could you possibly suggest this? Of course, those kids need to have their
Third shot.
And the argument was, they're putting so many other people's lives at risk by not having booster shots. I'm thinking, explain that to me, like, again. This is every six months. I do something stupid, which is I engage on
Twitter. I need to, I need to
create sort of like a testicular tasing device. That is hooked up to the Twitter app. Where any time I look at Twitter. I get like 120 volt AC to my testes.
Just says like, don't ever do that again. Like, don't ever don't ever go on Twitter. Like nothing good comes of
it. It's a DEC device guys. Direct epididymal current. And when you apply at least seventy three jewels to your Jewels, it will dissuade you from ever clicking on that stupid app. No, I actually just real quick on this because this is is the thing. This is the tribal ization. So what you did is you behaved as an out-group to the in group of whatever public
Doctore types that are on there. And this idea that that these vaccinating triple vaccinating these kids at Stanford. And by the way, closing campus for two weeks because of Omicron, which is what they've done.
How have we got this far in the podcast without Marty, you referring it to Oma cold because this is your turn, right? So so so for we're going to close the campus for two weeks because of ohmic old continue
Zubin. Ohmic old rips through Marty is, you know, cashing in his royalty money from every time someone says
Called. And at this point, the argument is all well, they're protecting professors to protecting other people in the community. And this is my taken. I'm editorializing we have no data that that's actually at scale, true. We talked earlier in this podcast about the transmission effects with younger people to first of all, who are they exposing Waltz? Professors and family and Community? Okay, those professors and family and Community can make the decision to Triple vaccinate to wear a mask to stay away from Big crowds. In fact, a lot of the professors are teaching.
Mostly as it is. So who are they really exposing other kids their age, who are low-risk, who also have been vaccinated. And if they don't get a booster or they get a booster, what's the marginal benefit? How many cases of myocarditis will you cause we're that kid is out of school for three to six days in the hospital. We don't know the long-term effects of it. Although I suspect they are generally mild, but that's a more editorializing. These are the questions you have to ask. So when people behave in that rubber stamp way, now I'm guilty of it too because I added to realize in this way, I think.
Is crazy. I think the schools are out of their mind. I think we're promoting a culture of safety ISM and fragility and children and we're teaching them that this is okay to do and who's doing it people with power, the elderly, Uber class that can sit at home on Zoom. They're doing it to young people who this is their chance to be in college and engage with other young people in person. That's what college is. It's not about learning, that's a side effect. It's about that other stuff. So that's my take on it.
The who has put out an
Vishal statement very recently two weeks ago, saying, that Universal booster programs threatened to prolong the pandemic, they recommend against these booster programs. And they warned that they will increase Global inequities because ninety three percent of the population of poor countries has no vaccine. And one dose is better than no dose. So they're taking a Global Perspective now. Look people ask me. I'm over 65. Should I get a booster? The answer?
If you haven't had the infection, yes, it's going to reduce your risk of hospitalization. But if you just bring up what the, who is already concluded, somehow that's considered an outlier idea that you can. We cannot discuss in the United States. Who tells people under age 6. They should not be wearing a mask. The European CDC says that kids in primary school should not be wearing a mask. Many European countries have restricted or banned moderna vaccine.
From anyone under age 30 because of the risk of myocarditis. So, all of that suggests that in many ways, the United States is lagging behind in terms of implementing scientifically wise policies. Suggesting that we're making errors, in our policy that are ill informed by science. Certainly, the FDA bypassed their technical experts. What we call the verb pack, which is their external advisors.
So the verb hack had to vote on boosters for everybody. They voted against it. They voted 1:44 against it in part from because the stuff we're talking about myocarditis and other concerns and a lack of benefit demonstrated that was in what age group. Marty. That was for everyone over age 18. So it was boosters across the board. Oh, yeah. Yeah, I see. I see ya. The second wave of boosters. Yep. Yep. So they voted it down. The experts said no. These are smart people, then the FDA made a second.
It'll push in the agency weeks later and they chose this time during this process. Not to convene their experts to circumvent their own experts because they didn't want the input of people who were opposed to it and they unilaterally authorized boosters for young people. CDC did the same. And so what we are now have is this dramatic Vigor of enthusiasm around boosting every 16 and 17 year old in this country.
With really a lot of experts saying, hey, we are not on board with this, in the world, out of the world is not on board with it. And so, that's where we ended up where we are today. It's groupthink. If you think about it, when Omicron came up, it was almost like, here's an opportunity to push boosters in young people. Pfizer makes a puts out a press release saying that. Hey, if you get a booster it will help with Omicron. Okay. Nobody knew anything about Omicron at that point. There was speculation. It was mild. Now we have a lot more.
Information the next day, the next day after Pfizer's, press release about an experiment. They did in the lab without releasing the underlying scientific data. The next state, the CDC rigorously puts out a strong recommendation to boost every 16 and 17 year old. Is that what we've come to now Pharma puts out a press release. In the next day. We bypassed all of our internal experts and we have this bandwagon effect of colleges and universities which are supposed to have
Smart people, requiring boosters in a population that Germany found doesn't have any deaths in five to 17 year olds without any vaccine. I'm not recommending that. But what are we protecting them from?
And again, this is not measles. This is not sterilizing immunity. This is not high level herd immunity that we're giving them by vaccinating
them. Again. I just I'm so troubled by this, because of what I think about is the long game, right? The long game.
Is I mean how many times has Anthony fauci said, an attack on me is an attack on science.
I mean, I
actually had to go and look some of those things up because I'm like, no, he didn't really say that that's just a mean.
You know, like nobody would actually say that he's had a rough year and he didn't say it once
and he didn't say it twice, right? I lost count of how many
times he has said that. So,
you know, there's a part of me. That's very empathetic to
Anthony fauci. Right? I think that's a horrible position to be in, right? He was sort of thrust into this position as the world's, or at least the nation's expert on infectious disease matters in a moment when nobody knew anything, right? So he's having to sort
of wear a mask, don't wear a mask, and but I
think the lack of humility in
expressing uncertainty and the doubling down and then the statements around. I mean, I have to tell you, I didn't want to get too political today, but I was very disheartened to see how vociferously he denied NIH funding gain-of-function research in the Wuhan lab. I mean, I really understand how you can deny that.
Francis Collins still thinks it's unlikely. It came from the Wuhan lab. I mean, the head of the NIH. He just said that last last week, how do they not just deny it? I mean you look at his exchange with Senator Rand. Paul like this is beyond denial, right? This is attacking anybody showing you the evidence that your Institute has funded gain-of-function research in a particular lab through an intermediary. Like, where's the ambiguity here? Well, where's the humility?
The people are hungry for honesty right now. And if I were Anthony fauci or Francis Collins, I would say look we were out there, parading around gain-of-function research, giving Grand rounds and lectures around the country writing op-eds about the importance of doing gain-of-function research. We came. We came at it from a perspective that was a little old-fashioned back in the days when it took months to sequence a piece of the gene. Now, we can do it in 20 minutes. There's no need to
Frankenstein of viruses just to study them. We feel terrible. We don't believe the dollars from our research funding went directly to do this type of research, but they went to the lab and for that, we're sorry. Let's agree. Now, to ban all gain-of-function research in the future in perpetuity forever, of all kinds and let's make that an international treaty. They could show leadership on that but instead that it's almost like they're defending it. Yeah, and what I struggle with that, I think you'll both appreciate this. I know.
Do I know you will? Because I've heard you both speak on. This is when bad outcomes happen in medicine, the doctors who gets sued versus the doctors, who don't get sued. It doesn't come down to the grievousness of the error. It comes down to the arrogance and the humility with, which The Physician interacted with the patient. Every one of us. I know I have made mistakes with patients.
And when you say to that patient, I really screwed up. I mean, like, I sent you to get a CT scan, and it wasn't even supposed to be your scan. That was a clerical error on my part and you got exposed to radiation unnecessarily or even the most extreme examples of errors that have happened. You go to that patient and you say what you did, and you fess up, and if you want bonus points, maybe even explain what could be done different than next time. So that it doesn't happen to somebody else.
I don't
think there's a scenario under which a physician under that situation has been sued. You start lying and you start posturing and you start denying and you start in the face of overwhelming evidence and you sort of make the person feel like they're crazy. I mean, guess what? Like there's going to be a little packet. Coming your way from a lawyer. This is like the highest order example of this, right?
That's a really good analogy actually, because we've all been in those positions. And I tell you, I've thrown I've thrown myself at the feet of
Family saying this was a mistake. I made here are the things we're going to do to make it better. I'm sorry, you know and again I have not been sued knock on wood, but with fauci, it's interesting because let's say I'm going to play fauci advocate for a second. Here's a guy cuz I was part of a documentary that hasn't been released prior to covid. They had interviewed fauci and you know, hotels and some other people about vaccine advocacy and the anti-vaccine movement, things like that, prior to covid. And you know, he has just been kind of full laid by a lot of the sort of
More activist conspiracy angles on things and really did feel like science itself was under attack to some degree. Now you throw in okay. He's under a lot of political attack. You gets all this hate mail and all of this. He's probably doing what humans do which is entrenching solidifying, his position and becoming an absolutist, which is not what we need. It's not what we need. If he had inside or a good therapist. They can probably tell him, dude. Bro. This is not good. You need to be honest. Like if you think masks shouldn't be used because
Because we're really trying to save them for healthcare professionals. Just tell the public that and I think that that's it is, you know, these are human beings. He's 82 and we forget that anyone now 81. Wow. I mean that's just had a birthday. Nice. Happy birthday Anthony, you know, and I was on I was on a call with Anthony fauci during Ebola that I was invited to where he was trying to talk to Public Health people about. Hey, here's how we can think about ebola. He was rational. He was calm, he was logical. He was science-based. He diffused a lot of fear. I
It was brilliant, right? And so to kind of see this transition is difficult
and to be clear and I'm glad you said that by the way, I'm not saying I would be one bit better. Like it just put a big deal. Everything I'm saying to be to be critical of advocacy versus science here. I'm sure I would be doing the same thing. I'd probably be worse. He seems to have a much nicer disposition than I do. I agree. Yeah, but it doesn't change the fact, right? What's the aspiration here? And maybe this shouldn't be all on one guy's shoulders. Because
is here .0. How exhausting is this? Like I'm sick of this. And it's not my
job, me too. Like I am sick and tired of this and I
have the luxury of getting to focus on stuff that I actually find interesting.
So yeah, maybe this shouldn't be one guy. It shouldn't be one Gaiden. We should not be putting our entire faith and trust in one individual. We should be hearing about multiple different medical opinions and we should from the should have from the start. You know, I called in, as you know, I was very nervous about the pandemic and what it could do beforehand following what was happening in Wuhan and calling doctors there. And as editor-in-chief of medpage today, I wrote some
Pieces and was reading articles coming in. It was pretty clear to me that our country needed to wake up. So I had some relationships with the White House for my work on price transparency, made a phone call into the White House. And said this was in February, before the pandemic. I said, look, this is going to be really bad. We need to drop all kinds of contingency plans as a country. Stop non-essential, travel get testing up in all this stuff went through the whole gamut and they were shocked. And they said, you know what you're saying here is wood.
Be a major shift in how we're approaching this and I said, yes, I look, I've talked to the experts and I believe firmly in this, this is stuff we need to do about a week later. I got a call back from them and they said, well, good news. We got a chance to talk to. Dr. Anthony fauci. And he says we're going to be okay. Now, look, we all make mistakes and that's okay, but you've got to evolve when the data come in and he had hedged his bed watching, tsar's one. That is SARS in 2003. It just
Petered out in Asia and he kind of hedged that. That's the way it was going to go. And yet every media Outlet going to him saying hey do I need to worry do I need to worry? And as you know as a physician, it's much easier to give reassurance than it is to say. Yes. I'm very concerned. So, that's how I don't know whether or not to blame him or Meet the Press, and Face the Nation and all these, that just incessantly ran one opinion, and not that of Amisha dalja and so many other infectious.
Csis doctors with the chops to say, Hey, you know, they've got a different perspective.
Can I ask something heretical at this point, though? At this point in the pandemic where we have Omicron and we have a vaccine, we have Therapeutics. Does it even make sense to push such widespread testing whether it's antigen testing or PCR. I want to throw this at you guys and see what you think, because I'm curious the answer
to this.
I'll share with you my opinion. I don't think so because someone's art, one of you is already made this point, which is there really isn't a precedent for tracking rates of infection for Respiratory illnesses. What we pay attention to and as has been noted by many people, what we pay attention to is hospitalizations severity of illness death. So morbidity mortality, effectively is the statistic that matters and somehow infection rate has now become a metric.
Matters, so you can measure it. What get measured matters. We don't measure influenza infection rates. I've never taken a test for it. I remember when I had H1N1 in 2000. What year would that have been 99? And I had it, I never got tested for it. But we finally put two and two together because my lfts hit 1000. I mean, I was sick as a dog. I was literally on the verge of getting a liver biopsy before my doc went wait.
I think that illness you had a month ago or two months ago is H1N1. Let's wait another month before we stick a needle in your liver and sure enough my lfts return to normal. So I mean, I'd fully support I think or at least noodle the idea a lot more that what if we never tract infection rates and we used it as epidemiologic data, right? So we did some sampling, perhaps so that we could understand movement, new strains, and things like that, maybe, even use it to develop predictive models that
I tell us when there might be an uptick in hospitalizations, but it no longer became a metric like you didn't didn't see it on the news every day and people didn't talk about it as the thing that needed to go to
0 on top of that. I think there's the personal downside and upside of testing. So I'm a young person. I have a few symptoms or I'm screened. Let's say I'm screened asymptomatic, you know to do whatever I need to do at school or whatever. They screen me with an antigen test and I'm positive. Well now I'm stressed. I have to quarantine for 10 days or
R5, If you're listening to cdc's advice on Hospital workers, which apparently is different and has been deep downgraded in terms of time because of need, I'm sitting there freaking out will let me see. Do I get? Monoclonal antibodies, should I take this? Should I do that? Whereas my pretest probability of anything happening to me is so low. And in fact, the pretest probability of this being a false positive is quite high in an antigen test is that isn't that causing a degree of harm and cost and it might be. Now, the upside is, of course, that person,
If it was a true positive can stay home and doesn't infect other people, but if it's already so widespread does it. Really make a dent in something like Omicron? That's so transmissible. Now, with an old person who symptomatic, you're going to test them anyways, because at that point, they do need Therapies in the forms of monoclonal, fluvoxamine, Etc. So it's again, it's a stratified by risk, it seems, but a mass population testing,
another way to think about. This is don't order a test unless the outcome would change how you're going to manage the patient and
In the case of Therapeutics for someone who's symptomatic, the answer is yeah, might be worth testing. I think the idea of a symptomatically testing athletes is one of the most ridiculous things I've ever seen. Like, we're going to just test everybody in the NFL and NBA and NHL, and nc2 Ma. It's like series like that. What is the logic of this? If you test, if you test athletes or anyone in the population for meningococcal is bacteria in their nose.
And of the population will come back positive because that bacteria lives in a colonized, you know, non variant form everywhere to put these people in a neuro ICU. Marty. Do you understand how deadly that bacteria could be? I mean, this, we can. You imagine what the neuro ICU rate is going to do at this point. This is by the way, what if we just checked everybody for staff on their skin? Like how many people are walking around with Mersa on their skin,
quite frankly, guys?
You're not invasive enough. I would do urethral swabs on everyone, to screen for gonorrhea and chlamydia because God knows if you have an asymptomatic cases of chlamydia, I mean you're nuts could fall off. So, you know, it's all kinds of. Again. I like Peters basic medicine, Internal Medicine idea here. Don't don't do a test unless going to change your management and in some positive way.
Look at what we've done to Physicians and this is what I've sort of the complaint that I hear from.
The infectious diseases, doctors are respect. We've done a terrible thing to physicians in the United States. We put them on this singular mission to block viral, replication, hunt it out, find it, block it at all cost. And what we've lost track of is treating the entire person and we've lost track of the sustainability of any system to do this. If we start Mass testing everybody in the population, on it, you could test every child, every day when they show up to school.
Cool. In perpetuity. It is going to create a burden that's unsustainable. It's going to bankrupt our system. Look at what we're doing right now with the mixed message coming from public health, officials / the White House. And then look, I don't have a political bone in me. But this is, this has been an endemic problem with government, regardless of any political party, red party, green party that then matter, no party. You've got the government right now. Saying if you want to gather for New Year's,
Whatever you need to do this, massive testing of people coming in, and at the same time, they have a very limited supply of about 500 million tests that will be rolling out over three months, which is about 160 million. Tests a month. You would need one to two billion a month to do what they're saying. So they're telling you to do something and then you don't have the tools to do it. It's putting people in a very difficult decision paralysis and then we've got, we put doctors on this crazy.
Mission of hunt out all in viruses block replication at all costs. We've done a terrible thing to the entire medical community right now.
Yeah with no end point
has anybody in the driver's seat signaled what the endpoint is because I do think that is an important question is let's use a totally unrelated example, right? So
Person who's working their tail off to make more money because they believe that at a certain dollar amount. All their problems are going to be solved, right? Once I had this amount of money. I don't have to work this hard. I don't have to act this way. I don't have to ignore my family. Like I'm sort of making something up, right? You have to ask, well, tell me what's going to change. So, tell me when you have that many dollars and you retire, what's going to change. So how many dollars do you need?
How will it change things? So when you bring that sort of silly analogy back to this? I really haven't heard a clear articulation about, which is not to say, one hasn't been made in defense of those who would make it but I haven't heard it. Have you either of
you? I haven't heard it recently. It's been an evolving thing in the beginning. It was a bend, the curve until we get better Therapeutics and possibly a vaccine, which we don't know if it's gonna is going to work or not. Then once we had a vaccine, okay, just try to get to the point where we have enough herd immunity from vaccine and natural immunity that we'll get to that.
A point. Well, then it turns out that shifts with new variants. So now the question is, oh well now with Omicron the variance so contagious will we don't know? We did this point we have to go back to the same things. We are doing before, which is masking and forcing people to vaccinate, including children and so on to get to, I don't know what so that our hospitals don't get overwhelmed. But no one, I have not heard a public official say, oh, this is how we transition to an endemic virus or this is the goal where we're going to have a virus that lives with us forever and it's going to be okay, but we just have to get to that point.
Which means let's not overwhelm our hospital. So maybe we should shore up our staffing. Maybe we should pay nurses, and doctors, a little bit of overtime bonus, whatever it is, to get them through this. That's the thing and we haven't even calculated in like, well, how many lives were saved. Say from the, this is kind of irrelevant but looking at the area under the curve. How many lives were saved from preventing influenza for two years basically, which we've done. And then how many lives were cost by substance abuse overdosed economic.
ER, and in the third world starvation from economic problems and so on. So we don't look at things holistically and then we don't have an endpoint. So what? Even if we looked at them, Alissa tickly, we'd have nothing to shoot for. So it's been quite frustrating. It's so hard because
people are conflating two different problems that are happening. Simultaneously in the United States right now. One is the sort of residual covid-19 Public Health threat, which is
Mostly Delta, but it's the virus. Infecting the 10 to 20 million American Americans who are still at significant risk. These are adults who have no natural immunity and no vaccinated immunity and they continue to show up in the hospital and go on ventilators. And that is a problem, that is a real problem. And it's very precise. It's about 10 to 20 million adults with no immunity whatsoever. And they're going to keep showing up in the hospital and it's going to be during the viral seasons and we can't downplay.
That that is still a problem. We still got to encourage them to get vaccinated. But the separate thing going on is that 250 million Americans have some form of immunity and they're at risk of mild illness and were waging world war three to transiently, beat back, a mild infection or one that doesn't result in hospitalizations, and we're not putting that in contacts. And if you say anything to say, hey, we've got to learn to live with this. It's like hey, there are still people dying. But yeah.
Those that's a very precise group of adults with no immunity and some very older people with Hua run boosted, who are coming to the hospital about 7,000 Americans. Today are coming to the hospital. Being hospitalized with covid about 7,000 of them. Have no immunity. These are adults often with a risk factor like obesity, which we don't talk about and about 700 or so our unbelief. Stood older people. So that is a very precise problem that's address.
Isabel. But look, what we're doing to the 250 million American or everyone else out. There were holding them hostage right now. Saying you've got to take this seriously and go into, you know, make significant sacrifices. Here's what I think. The end point is people are fed up. They're pushing back. And here's what the Australian prime minister just said. Now, if you remember Australia, had the toughest lockdowns, maybe in the world Draconian, this is where sort of zero covid-19.
Goal,
that's right.
Yeah, that's right. So they did a total 180. I mean, they saw people just, you know, protest this and say, look, we're not, we're not, we don't want to live like this. They did a total 180 on their lockdowns and the Australian prime minister just made this statement very publicly. He said we've got to get past the heavy hand of government. We've got to treat people like adults. We have to move from a culture of mandates to
a culture of responsibility. That's how we're going to live with this virus in the future and that could not summarize. It better in my
opinion, all of this relates down to the form and function of covid. So our response, right? So the form takes all kinds of different forms as masks and mandates and lockdowns, and schools and so on and so forth, but what's the function of it? The function of it is to obtain some outcome that we all agree is reasonable.
Well, I think it's reasonable to say, we don't want our hospitals to have bodies piling up in the ER, parking lot. Well, so when and how did this happen? Well, occasionally, it did happen in certain areas. But on mass it has not, is it happening now will so far. We're not seeing it with Omicron. How do we prevent it? Well, targeted focused protection of the groups that Marty mentioned that are still at risk, is the highest yield way to do it. Boosting and triple vaccinating a 16.
You know, an 18 year old college student is not a high-yield way to do it, especially when the rest of the world is still begging for vaccine. So there are policy solutions to get the function that we want using forms that are less disruptive. And I think, I don't know, Peter, you shared with me. Like what Ontario's Hospital numbers look like in there. I see you utilization and yet they're going on, lockdown. And I looked at those numbers and I was like, man, Peter, like I've taken calls with more ICU beds full than that, like what?
I would they shut down an entire Province for this. I mean, I'm curious what your thoughts are.
Well, again, it comes back to the price that will be paid for this. Do we have data on what the last year has done to the vaccination rates for children? Vaccines like, MMR and things like that. Have we seen a noticeable shift? So? So the kids who should be getting those vaccines? Now, what's happening? Are we seeing a go up down,
so I don't know.
Marty has the specific data, but I've seen articles, written about this and the, at least on an anecdotal level kids going in for routine, vaccinations have dropped dramatically into the more like the 80% ish range. Because again parents are frightened and there's also a backlash against vaccines in general. It's a complex scenario. But what will the outcome of that? Be right? That that's a huge open question.
I've said this now at least twice but I just can't say it enough, which is
What is the what is the long-term consequence of this for a generation? All the people who have been marginalized. All the people who have been dismissed in their concerns. All the people who have been told you are a horrible human being for questioning a vaccine. You are a horrible human being for not getting a booster shot. You are I mean, I just wonder what the so let's assume. Let's come at this from the lens of the people in power. Want to stay in power.
That's a natural human reaction. I'm sure if I was in power. I'd want to stay in power. So if you're in power, you want to stay in power.
And presumably staying in power, has something to do with the people who put you in power. Keep you in power. Don't you think there would be some logic that would say, I want to make sure that if I want to stay in power as long as possible, I should take the most long-term view of doing what is best.
And yet you just see this doubling down on things that seem less and less logical. So, in other words with a very myopic view of power again, totally not the right way, one should be thinking about this but just as you know, we're trying to think about Omicron through the lens of evolution. I'm just trying to think of the natural history of power and wanting to consolidate it and preserve it as long as possible. This is not even in the best interest of those in power.
Peter's, just so logical, right? It's just one of these things where it's please don't be. So logical because what you're saying is making so much sense. I think people at very high levels, got a taste of what it's like to be king and they've got the keys and they don't they don't want to end up back over. It's just a theory but I don't think our policy makers are getting good medical advice. Look what happened? As soon as Omicron cropped up in South Africa and
immediately our Public Health officials retreated to the one blunt tool that they know which is we got now, give everyone a third dose across the board including young people. Now, older people, there's data and young people, there is not dated supported masks, half a New York City closed down. What about Therapeutics? What about learning to live with it? What about all these other things? And what you saw is this Retreat to the same blunt tools that we've had and not start talking.
Packs, love it, and fluvoxamine, and treatment, and learning to live with it.
You know, Peter, I think I think you again your rational thinking is not exactly how politicians actually tribal eyes in our world now worth its tribal identity and it's a badge of identity to say. Oh, no, I believe in this. And this and this and this, regardless of what the long-term outcome is. I know it will rally my base. I know it will, you know, it's covariance versus Covidien. It's right. It's the people who on the
Left feel this way about all these responses because it's been politicized that way and the right feel this way. And so in a way, they're playing broadly to their base like what do they do? When Omicron happened? They stay stopped travel to South Africa because that's easy. That's a politically expedient thing. Except for the South Africans, who suffer and the Americans who have family there and others. And of course, all macrons already everywhere, which we were saying from the beginning so that blunt tool did absolutely nothing but it's politically expedient. If you look at what say the administration's doing now, well, the key thing is
Keep case numbers down because if case numbers are high, then it's going to be much trickier to get reelected say, well then. So what do you do? You want to make sure you get as many people vaccinated and do the kind of blunt instruments that you could try to reduce cases, which is surprising that they're actually encouraging testing because that's going to actually increase. The number of cases Trump was very explicit. He's like Donald Tusk, your won't say any cases, you know, don't let the Diamond Princess dock because it will triple our cases. He was at least quite explicit about it. What he was doing so
So I think it's quite complicated and there's this weird political tribal ization that makes it irrational to people who are looking at it from an objective standpoint.
You said it. You said earlier something that I think is also interesting which is like, sort of it. What did you call them? The covariates and the covariance covariance, right? So I can't describe myself as either. I know the character of what both of those represent because I've interacted stupidly against my better judgement with both of them. And I feel like
I'm trying to understand. What's your guess on how many people are in the middle? So on the one hand, it's this is a conspiracy. The whole purpose of this thing is so far my can make more money bump up a block. The only thing that works is Ivermectin. Like you've got that whole sort of group and then you've got the people, we've largely been talking about here. Sort of everyone needs to have a booster every Monday and we never ever want to see the world.
It was in 2019 again until this virus goes the way of smallpox. Yes. This virus will one day be in a museum and until that time. It is a zero covid policy world. So you got. So how many people are not at one of those
poles. That's the operative question, and I'll tell you my experience with my platform is we have created what we call this, alt middle and it's not a politically Central position. It is the synthesis position. So
If you consider Covidien, 's to be the thesis position, Peter Lindbergh of the stoa talks about this, the thesis position that locked down, zero covid, vaccines for everyone, mandates close schools. That position is thesis antithesis position is the other position. You describe the Ivermectin Therapeutics. This is all about control. The thing is not as serious as we think, etcetera. What is the synthesis of those positions? Where do you find truth? There's everything is a little bit partial. So this alt middle perspective.
You can call it the center but it's really a synthesis position. Integral holistic position. I would say and every single political group says this that there's a silent majority of people who actually, if you really ask them and you tell them. Well, let's think about it this way. Forget about all the sound bites, forget about Twitter. Let's just talk. They will espouse and ALT middle synthesis position or will resonate with it in a way that is really quite profound, which means common sense is
There, I think critical thinking is there if you walk people through it a little bit and to a what I've never talked to a thesis or antithesis person in person that hasn't ultimately settled on a more synthesis position. So it makes me think there's hope but the way we're doing it publicly is where rewarded for polarizing into one of the extremes Covidien Covidien a thesis antithesis. And what we need to do is change our basic structure so that we reward them or alt middle kind of perspective. I don't know how to do that on.
It's very similar, by the way with kind of woke ideology. On the one hand. You have the people that in theory the woke ideologues are there to Rally against, right? The true racists. The true sexist, the true people who are you know think trans people should be killed or something like that. So you have those people and then you have kind of the woke ideologues and I think you have most people in the middle that think this is crazy. Why can't why can't there be Shades of Gray?
Here, why is this? Why is this such a bipolar issue with know as you say? No dialectical
synthesis. So this is why a podcast like Rogan's is so popular because he actually very often espouses, a synthesis rationalist position, even when he entertains kind of people on the show that are really more antithesis or more synthesis, you know, like a Peter McCullough vaccine guy. He is in when you were on the show, too. I was
King Kong out. This is the synthesis position. You're poking fun at all. The extremes of this, and there's not very many rational people in the United States, who would really want to hurt a trans person or really want to exclude somebody based on their sexual orientation or their race, right consciously, they would not want to do that. And I think we could because we've had progress, we've had Decades of progress on this. And so, what we see though is that in order to belong in an atomized World in a tribe that you can identify with.
You take a much more extreme us-versus-them position. And I think the woke ideologues are in that. And what it does. Is it diminishes real racism, real? Inequity, the fact that, you know, we talked about covid, 'it's well, are you going to call a African-American? I like a black person in Baltimore, who's afraid because of Tuskegee and a long history of medical abuse of getting a vaccine. You're going to call them a CO Vidya. What is, how are you going to reconcile that with your apparent woken s, right. So there, it just generates a ton of
Going to dissonance until you can see this from a integral perspective that all the stuff has a bit of Truth and partiality to it and you're always trying to synthesize something that's evolving, like an organism towards something. That's more true. Which means you also have to assume in most people good intent, which we have trouble doing because we are tribal creatures that like to villainize, out-group. And so, getting over that assuming good intent. I think you might have said this on Rogan, man, if we were able to actually get in people's head. Maybe Rogan said that and assume all we know they're actually well-intentioned.
And that already levels the playing Ground that now you can have a
conversation. I remember that, that was a really great Insight from Joe, which was, you could totally eliminate racism, or at least distill it down to the true races. If you had mind reading software, once you had mind reading software this issue of intent, mattering, you know, because we were debating whether or not intent mattered which of course it does. Right. But yeah, that's that's a fair point. I want to say something else. This is kind of a Mia culpa.
I feel my tribalism more than I've ever felt it around this. You know, I remember a few months ago. Somebody sent me an image of a woman on Twitter. I think she was a pediatrician and she's clearly. We're going to zero covid philosophy or at least that's, I shouldn't even say. She's sure. You know, that was my inference based on what she had just posted, which was a picture of her and her three kids at a grocery store. They were in masks face Shields.
PPE. And this was, this was not in 2020. This was like, literally this summer. And, you know, her comment, like, she was posting this picture very proudly with her, and her three kids, and making a comment, like, this is how we roll and 95 face shield. This this, this, I mean, you couldn't see her kids. You literally would have seen more of them. If they were girls in
Riyadh,
That's how little you could see these poor little.
Kids that looked like they were none of them over 10 and I can't tell you why, but I got really
pissed. I
got so pissed at her. I don't know her. I don't know anything about her. I don't know her story. I mean, I replied on Twitter and some snarky response to the effect of. Please tell me your kids are immunocompromised. Like why on Earth would you do this to them? Otherwise?
But it's that particular interaction has stayed with me so far because of how much it worries me about what I've become in this. How have I become so angry at both extremes here.
First of all, I'm really impressed that you have enough self awareness to recognize that because most people don't I'm with you on this. I think what you're expressing is the righteous indignation of the alt middle. It is this like, wait, this is insane. Just like when you see somebody talking about this whole thing's a hoax and you need to take Ivermectin be
The for the rest of your life, that's insane. And it generates a kind of a moral outrage right based on our own moral palette of what we find valuable. Now, what I'll add one other piece of this is that this has been potentiated by a collective anxiety of contagion of Marty calls it, the pandemic of lunacy. That is we are social creatures to. So as much as we try to hide from it, we're connected to others. And this General level of anxiety and panic and
Disruption and social fabric tearing has, then it feeds back on us as individuals, because we're also part of a whole. And that generates that and that's why things like Twitter, really weaponize, this like I try to stay away from Twitter now because it I know I feel it. And you know, who's my who's my you know, if you think of this as a nuclear reactor and I'm about to blow, I'm going to go to go Chernobyl and the tops gonna blow out, you know, it's going to be fall out all over the country. The person who is my graphite control rod is my wife because what'll happen is, I'll see something on Twitter and we'll be like you
Peter, it would be like a family of people like stay hashtag stay home. And it'll they got 13 pronouns in their description and they've got 14 masks on their Avatar and they put somehow like, bend the curve in their name, and I'm so triggered because I'm just outraged by they don't see the other Downstream side effects of their approach and I'll start ranting and raving to my wife. And if these people are idiots, I bet they're all over Stanford, where you work and this and that and the other thing and she's like, could it be possible that and you watch? You'll do so, could it be that that person is going through this and this and this and they're seeing it this
Sway. And they've been also Paralyzed by fear from this and you're demonizing them as a bad person, but they're actually a good person and you can just see like she's lowered the control rod and suddenly I have empathy for this person and suddenly I'm like, okay. All right. Okay. All right, but we're humans. That's just how we react. The thing is, we've potentiated it on mass now with technology that hacks, our dopamine drive to go, in-group out-group. So, I don't know. I don't know. Marty. What do you
think? It's a really good point that you're both raising here.
And I think we need to do everything we can to stand against tribalism. I think we all of us can do that. We can be role models to others. We can listen to others. We can admit when we're wrong. I mean, these are characteristics that are being completely Lost in the Echo, chambers of cable, news and hearing what you want to hear. So, you're living in an alternate reality because big Tech is feeding you news, that actually makes the other side look, like they're crazy, right?
Because that's how the news has framed their position and you don't can't see it any other way. So I'd love the Rogan interview with Peter and I think that's part of what we're not talking about society that we need to talk about and we got to fix this because the next pandemic is probably going to be more severe. You know, we had we've had a number in our lifetime. I mean, beginning with polio older patients, tell me what it was like going through the polio epidemic.
One n one SARS MERS Ebola, zika, I mean, we've gotten lucky, we've skim the trees on a couple of these, but the next pandemic that's going to be a major serious pandemic. Maybe antimicrobial resistance, which is increasing each year. Maybe an influenza virus. This covid-19 virus had an overall Global case fatality rate for infection fatality rate somewhere around two tenths of one percent somewhere in that ballpark, right? Well, what if it's two percent
Sent with a strain of influenza and we've got this polarized Echo chamber of hearing news and the politicalization of the human immune system, where the B and T cells have joined, the Republican party and the bodies, you know, neutralizing antibodies have join the Democrat Party. We can't do this. If you chose, we're going to need diverse opinions, an open Forum of discussion, honesty, humility, and I'm concerned where we are leaving in terms of our
situation at the end of this pandemic.
Here. Yeah, I
gotta be honest with you. I'm not optimistic. I mean, I'm going to probably Focus most of my energy on controlling myself, which they, the easiest step on that is literally not looking at Twitter. That's that's
and like, I don't, I
spend very little time on Twitter. Like, I mean less than I mean I really don't spend much time on it. The problem is like any amount of time on it seems to be annoying. It's like you could spend 30 minutes a week on Twitter and that's
I have to think it's an anti longevity agent right there. That's got there's got to be a study that will demonstrate that, you know, an hour a week on Twitter will shorten your life expectancy by a year and more importantly will reduce your happiness, all along the way because it just I mean, I think there are people who are really good at Twitter who just love to be incendiary and it doesn't bug them and nothing bugs them. They just love to carpet bomb for fun. But like if you actually think you're trying,
Make a point and engage which sometimes I do. I think there's no
upside. Yeah, I agree. It's a bad format in general for that. He said something, I think is key that I wish more people would say, which is, I'm going to focus on me, right? Like so much, especially with guys, you know, we're so bad at dealing with our own internal States, whether it's emotional states, whether it's cognitive states that we repressed, and I and then project everything out into the world, and we create the world that
We hate because it's a reflection of our internal State. And, you know, there was an Indian Sage nisargadatta, who said, you know, some dude asked him there was a the book was like, a bunch of like, Americans come to him and ask him a bunch of questions of this Guru in India. And and there's one kid asked him. It's in the 70s or whatever and he's like, man, there's so much war and stuff. We need to like reform the world, man, the world so broken. You're sitting here in this cave, meditating, what's wrong with you? And he's like, listen buddy. He's like don't be talking about
I don't know why I'm suddenly doing my dad. Don't be talking about the reforms. Okay, mind the reformer itself. Look inside, you're creating your own situation until that internal conflict. That's generating. This unhappiness is pacified. You're never going to see the world that you want to see. Well, I think there's a lot there, which means we have to be self-aware. Okay, if Twitter is bad for us, if it really hacks are neural, circuitry that causes us on discomfort and lack of longevity, which I agree with you. Peter for me. It does. That's why I just I what I do is I do.
And run, I do the Rogan. I like dump a video. They're like, okay, guys have fun with this, and I'm out. And then every now and again, I'll be sitting on the pot, and I'll open up Twitter because I'm like, hey, what's going on on Twitter? And I'm like, oh shit. This went nuts. This is not good.
Another thing. I want to maybe this is maybe a better question for you Marty, but what what can parents do because that's the demographic. I find myself most concerned with right now, is this this group of, you know, what are we going to call? Alt middle, folks? Who?
Absolutely believe in science, certainly understand the benefits of vaccines understand why we needed to do what we needed to do 18 months ago. But today, I mean, these are the calls. I get a lot of is, hey, you know, my kids still are wearing masks every day in schools. They're not being permitted to play sports if they're not vaccinated. These are healthy 12 year old kids that are not permitted to play sports unless they get vaccinated.
I feel very fortunate, right? I live in a state that doesn't exactly believe in the government, controlling you. And therefore from the minute. We've, you know, we've been here for fifteen months schools. Never been shut down for a day. Our kids are not in masks or it's, you know, it's masks optional. So my kids are not in masks, no, restriction on Sports, you know, that kind of stuff. I feel very fortunate, one of the parents do who don't live in these states. I mean, what you said earlier Marty, this is only going to change when enough people get pissed.
About it and the policymakers, basically realize. Oh my God, I'm gonna get voted out of office as a result of this. And by the way, how do you do that with health Advocates? Because they're not really on the hook for votes so that you have sort of two layers of this here, which makes it a little more complicated, right? Yeah. Well, I think a lot of people are getting fed up right now and this country has democracy and the Democracy does work. It can take time but elections are already.
Showing polling right now that people want a reasonable approach. And for parents. They should demand an endpoint to restrictions in the school's. If there is a policy that they have no control over, they should demand an end point when we put in so many restrictions in schools. Be it the plexiglass, which ironically could reduce ventilation and air flow in a classroom and kids have to cover their faces with a cloth mask, which the study run out of Stanford and Bangladesh showed head.
Really no impact at all on transmission. Just it's such a poor quality mask or vaccine mandates or a booster mandate, which is what you know, the bandwagon of the lunacy of what colleges are jumping into right now. They should demand and points to these things, you know, at what point but what watch the Pharma industry changed the language. And I predict this will happen from a booster to annual boost. Have you gotten your annual booster, it may
Maybe then, you know, we get a new variant. They pop up a new booster and a six-month interval. The language will change to are you up to date like it's software and people that are chasing. This may be getting boosters. You know, they may look back and 20 years and realize, hey, I just got 15 boosters for what people should demand an end point. They should demand criteria to remove the masks. They were put in place with no criteria to remove them.
They should ask their pediatrician about a single dose of the Pfizer vaccine for their child. That's a reasonable option. It can depend on a lot of factors and maybe they have concerns. Maybe their pediatrician sees a risk factor in the child and thinks one dose would be safer, spacing out. The doses asked about natural immunity. There's people with natural immunity, should feel good about their immune protection. So I think these are the things people need to talk about and ask about and vote on.
And come election time. I want to ask both you guys. This question, who are the people that you find to be voices of Reason in this? Who do you? Who do you like to read? Who do you like to listen to Zubin? You? You work pretty closely with vinaya Prasad. I find him to be just another amazing example of a thoughtful person in the middle. Who's rational, any other folks? We can point people in the direction of besides, the two of you
guys. I'm personally a fan of dr. Monica Gandhi, UCSF infectious.
These doctor she's been a voice of reason calm. She also has a really beautiful maternal kind of wisdom about her that she gives off. That's a good contrast to a lot of the talking has it or guys and she's very smart about it. And actually, if you talk to her offline, she is very much obsessed with getting us back to living instead of living in fear all the time. And part, you know, part of the reason she was such a big advocate of even cloth masks in the early days of the pandemic is she felt that look if it lowers inoculum.
It'll prevent some severe disease. But the main thing is, it'll get people out there, stop these lockdowns, open up our schools, these kind of things. And, and so, she's a pragmatist, very, very smart and data-driven gal. Marty. Who's, who's on your short list.
There's really just one person and that's dr. Anthony fauci. Just do now, now, in all fairness. He is a true gentleman. If you've ever interacted with them, and he's a very nice guy, just have had different opinions on how to manage the covid strategy on.
Almost every single aspect of the pandemic. But to answer your question Monica. Gandhi is terrific. She's got a great sort of feed that she puts out. She's got a site and a Twitter feed, that's got great information. I'm Micha. Dalja from Johns Hopkins, Peter. You've had him on, I think early in the in the pandemic. He's as correct as I think. Anyway, everyone's been wrong. Every experts been wrong. Every expert, missed India, and Delta, and so many other things but he's
As correct. I think Martin kaldorf. He's the gentleman from Harvard who's now, with Brownstone Institute puts out great information. And I would say, more importantly, I do not listen to anyone who's a politically appointed physician. Anyway, current past or future. If someone trying to become a politically appointed physician, or was I just block them right out and I go to these, go to people who I trust.
Can I add a couple here? Like so it's interesting because I agree, Marty like I actually will even take it a step further, and go. Someone who's very politically angled on, on social media who's taking very strong political stances. I don't trust them either, just because they aren't able to disambiguate that tribalism from their recommendations. I actually am a big fan of John mandro, le he's a EP doc. Cardiac cardiologist on Twitter. He's done good work in the space and has been very rational the other person. And I don't know Peter, if you know
This guy or if you guys have had conflict in the past because he's more of a vegan dude. Who I used to have a little bit of beef with but now I'm convinced, he's been very rational on this pandemic is David Katz actually out of Yale and he's really written extensively. Very heterodox, like stuff that would get you booted out of the try. Basically saying hey, we should look at the big picture here. We need to look at the harms and benefits to society and and he's been very rational is written very eloquently and ALT middle synthesis of this pandemic.
The only
thing I would add to that guy's is, but I don't even know everybody on the list that you guys have mentioned. That's how little I'm personally paying attention to this, but I'll now start paying attention to some of those folks. Sporadically. I don't want to I've no desire to spend too much time on. This is a general principle. I have no trust in people who can't change their opinion. So when I encounter a person who says the exact same thing over and over, and over, and over, and over again, and when you ask them,
Do you feel differently about this now versus you know, six months ago or a year ago? Or 18 months ago? The answer is nope. Nope, Double Down. Double Down, double down. No matter what they're talking about. It doesn't guarantee that they're full of shit. But it is it increases the pretest probability significantly. Yeah. Yeah, like school closures last year and if anyone who called for school closures has not come out and said, you know, we got this terribly wrong and it disproportionately affects.
Affected poor and minority communities. I feel terrible. Then, you know, I've written them
off. Yeah, it's hard to trust them. Actually, what Peter's pointing at I think is something that I talk about when I talk about alt middle, which is, you should be able to question every single one of your beliefs. Because there's really, you know, if you're sticking to one single view, either you're probably missing something. The only belief that I think is a little bit beyond question is that, you should always question your beliefs. So, it's like a meta belief about belief.
I think people who hold that where they hold their beliefs Loosely based on new evidence and persuasion and so on but they're not wishy-washy. They're not just going. Where the wind goes. I think those are the people that are the most trustworthy and who are able to call out their own biases and say when they're wrong. And also celebrate, when they're correct and go. Listen. This is, this gives me some credibility. I was right about this in this in this, I was wrong about this for these reasons and this is how it's changed my thinking.
Yeah, but best investors will tell you. They have very strong convictions loosely held. Ah, and so
I've always loved that Mantra right. Strong convictions loosely held and what's interesting is I assumed we'd be 50%, sort of fact 50% opinion. I think a little more on the opinion side, but what's really interesting is there's nobody who's successfully running a hedge fund on the Mantra of. I'm always right? Because in the hedge fund space it kind of doesn't matter what you think, it matters, how much money you make.
And the dollars always decide. So if you just say I'm always right. I'm always right. I'm never willing to change my point of view, in the presence of new information. You're going to end up losing money eventually. If you can be malleable and say this is my point of view based on the available data. Hey, there's new data. I'm going to change my point of view. There's just no comparison in the long-term success of those two investment strategies. And so it all kind of shakes itself out. It's very interesting.
That in policy in medicine, even the system of reward is so uncoupled from the outcome that there's Mass confusion around this. And that's why it's very difficult to suss out the really good critical thinkers versus the not-so-good critical
thinkers. That's a good. That's a great Point, great analogy. Actually, I think more people would benefit from having some of those endpoints sink with that kind of.
Thinking in medicine because you're right there disambiguated. They're completely disengaged. In fact, it's even hard to know. What outcomes like if you're talking about improving a healthcare system. Okay. So what are the what are your endpoints? Well, what are you trying to do? Exactly while we want a lower? Hemoglobin A1c? Okay, but is that really what you want or do you want this 62 year old Hispanic grandfather to be able to see the graduation of their kid with decent faculties decent Vision. Okay, that's a different end. Point than a hemoglobin A1c. So how are you going to do that?
And how are you going to measure that? So because it's a complex human system, that's where it becomes. So so interesting and difficult, but how is it that different than the financial system Financial systems exceedingly complex. It's just the measurement. Outcome is dollars. It's much simpler in that sense.
But measurement outcome is unambiguous. Yeah. Yeah, it's very binary and it's very unambiguous and you see it in the style of patient management among physicians in the hospital. I mean, think about being on rounds in the ICU Peter heroin, you know, when we were doing
That together the doctors who say, you know, I thought this patient was not going to benefit from steroids. But now it looks like they have a nice response. Let's go ahead and continue this therapy. The people who constantly pivoted re-evaluated evolve their position based on information. They were the best doctors them. The ones who shut down Suggestions by a student on the team. Who says, you know, I read this and they said that's a dumb idea. That's not going to work. Those were early predictors of not just,
And who is going to be a great physician, but who's going to be a great person down the road? And the one criticism that irks me, that gets thrown at the government. And I've got plenty of criticisms for the government. But the one criticism that I hear that I'm not on board with his when they say, oh, they're flip-flopping. Well, they should this is, you know, this is yeah. Some political philosophy. You got to dig in on they should they should constantly be changing. I'm glad you said that Marty because I completely
I agree with that and I think it's a very important distinction to make to me. It is not a problem. When an advocate or policy maker says this is the way we're going to do things. Actually. This is not the way we're going to do things. We're going to change situations change, right? No, new taxes. Guess what? When George h.w., Bush said, no new taxes, wasn't one. There wasn't a recession going on. There was a recession going on. It wasn't a popular thing to do. It got them out voted. But politicians get
Hammered when they change their mind, which is why I would never wish being a politician on my worst enemy, but it is a bit of an unfair criticism. When we say in defense of the criticism. Now, I will say this. It's because it's typically done with a lack of
transparency. Yeah, you know relating to that is an interesting piece of this is this idea of persuasion. So, how are you going to persuade somebody of something? You think is important based on the data that you have? If you do not show them that you're flexible in your thinking.
King. But firm in your convictions, loosely held in that new data would change your mind and I get a lot of emails saying you're the only person who convinced me to vaccinate, I was so angry with Biden or whoever for mandating this and they talk to me like I'm stupid and it seems like they don't recognize myocarditis and all these other things but you guys talked about it and yet you still say, okay. I think this is important for people like yourself and so on and so I can email after email saying you have convinced me but then in the same breath I get the dogmatists saying, hey, you're like, uh, some kind of
Waxer, you know, you're holding back the cause and it's like, well, I wish you could look at my inbox then, right? You do need that flexibility. Now, I'm not saying I'm perfect at that. I'm very odd. There's things. I need a lot of work on, but at least it's on the radar, right? And I think Peter thinks this way, that's why we all kind of gravitate to each other, right? Peter, and Marty and me, we were like, oh, no, there's something about you get the vibe. This is someone who thinks independently and is able to change their mind, and is it curious and so on. And I think that's an example for other people that you're mentoring or
Ching or whatever and we see in the hospital all the time. You know, those attendings
right gentlemen, I feel like we could keep talking but I feel like we've also sort of provided I think hopefully some a some information for folks with respect to Omicron a little bit of clarity around what we do and don't know about the utility of vaccines, the potential risks of vaccines. I think we've also shared our biases, right? I think, I guess we have an explicitly stated it, but I think we're all pretty anti mandate.
At least given the current facts. I love, I don't one of you made this thing was you Marty. It might be a reasonable idea to mandate parachutes. If people are jumping at 10,000 feet. It might be entirely. Another thing to not mandate parachutes when people are jumping from 15 feet into the water. So you have to know the situation. You can't just say, we must do this. We must never do that. So I love that analogy and I think given where we are now,
I realize the amount of criticism I face for being against mandates, but I think you got to let your, you got it. Your conscience has to speak on this and I think it's wrong. Yeah, we got to treat people like adults
strong convictions, loosely held? Yeah,
that's right. Maybe. Maybe in the maybe in the presence of new information. I'll change that conviction. But given the evidence I have today. It's a pretty strong conviction. Yeah. Gents. Thank you so much. And I really hope we don't have to do this again.
I hope so too. I hope we can just talk about what it was like in the hospital.
In the 90s and 2000's because that's funny. And again, concerning on many, many levels.
And if you do figure out how to get that epididymal taser thing working, you let me know because I really could use that
device. Listen guys. I am the patent holder for the PKG. The prostatic cardiogram. I put a couple leads one on the, on the perineum, couple on each testicle and I get a PKG. Sometimes you go into P FIB where your prostate is just FIB relating at which point you get a high-output failure, you know, I haven't fully thought it out, but I'm hoping to get Peter to your connections. I can get
An investment in Marty through your political connections, I can get some buy-in from policy, but the peak age of prosthetic defibrillator, in every closet, I think, is what I'm hoping for
policy-wise your mandated of course,
right? Of course, I will that good with operative the word man in there because it's mostly for men. But again, I want to be gender-neutral about this.
All right. Gentlemen, thank you. Enjoy the remainder of your holiday season. Okay. You too. Good to see you Peter.
Good to see you soon. You to happy New Year,
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