COVID-19 has a really high rate of asymptomatic infection. Here’s what that may mean for our pandemic strategy.
Here’s that Washington Post article I referenced (reprinted without paywall via Seattle Times).
What’s up everybody. It’s Dr. Z. Welcome to the show. It’s our “Sunday Sermon” live for people catching it on the replay on YouTube. Thanks for supporting the show. Today we’re gonna talk about something that’s really important that we’ve talked about before, but I really wanna dig into it with you guys today and that is asymptomatic cases of COVID-19.
What’s the deal with that? Does it have to do with some preexisting immunity? Does it have to do with genetics and receptors and ACE2? Does it have to do with masks? What is it that causes some people, in fact, 40% and upwards in the current pandemic stats that we have, to be without symptoms, but will test positive for the SARS CoV-2 virus. So this is very important. It has a lot of ramifications for what we do in terms of managing the pandemic, reducing number of deaths, improving overall immunity, and our strategy for this pandemic that gets the economy open, us back to business, and through this current event.
The other thing I wanna touch on is Michael Mina from Harvard, epidemiologist, his proposal of a quick, cheap saliva test that people could do every single day for like a dollar a day that might change the face of how we manage this pandemic as well. Those two items, the asymptomatic carriers and the testing issue, are deeply intertwined.
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All right, let’s get into this. So recently we’re getting more and more information about asymptomatic carriers. Now, remember in the early days, there was not even a feeling that there’s a lot of asymptomatic transmission. In other words, it felt like, oh, could this be like the original SARS where you you can only experience a symptomatic case and only be transmissible, in other words, only share the virus when you have symptoms yourself, which made SARS the OG, the original SARS really much easier to catch and treat because you could screen for fevers and symptoms and you were most contagious when you were having those fevers and symptoms, but what we’re seeing now is either asymptomatic or presymptomatic people, people who are eventually gonna develop symptoms, but don’t have them yet, can spread the virus and the interesting dynamics of this.
Why, why, why would people, and again, there’s been conspiracy theorists who say, well, if this thing is so deadly, how come so many people are asymptomatic? And the idea is exactly that. It is so deadly for susceptible people. We still don’t fully understand what that means. We know that it has to do with advanced age. We know it has to do with other diseases that people have like diabetes, hypertension, heart disease, lung disease, immune compromised, those kinds of things puts you at risk and if you have two or more of those things, no matter what your age, you’re at considerable risk.
So what we see even in the Bay Area, it’s a Pacific Islander population that seems to be taking the brunt of the hospitalizations. So these are not asymptomatic cases. Why is that? And it doesn’t even seem to be so age related. Well, close knit families, a high prevalence of chronic disease because of the Western diet and we see that in our Tongan and Samoan populations here in the Bay Area.
Now, why am I talking about this? Because this gets into the question of why are people asymptomatic? So it could be roughly three things that might be contributing to that, okay? The first is your genetics. So some people just seem to have a genetic susceptibility to being infected and getting symptoms from this and could that have to do with the ACE2 receptor that the virus binds to on the surface of cells in the lung and the blood vessels in the kidney, in the heart, it’s in multiple locations and could it be that different expression of that receptor on the surface of the cells, think of a receptor as a little catcher’s mitt and the virus is a little baseball coming. If there’s tons of catcher’s mitts on the surface of your cells and those catcher’s mitts are really kind of big and sensitive to the exact size of the baseball that’s represented by the SARS virus, the CoV-2 virus, it’s gonna be very likely that they’re gonna bind, and then it’s gonna pull it into the cell and then the virus is gonna start replicating.
So you don’t want a lotta catcher’s mitts that fit that baseball on yourselves. Now, some people may just have fewer of these innately. Some people may develop fewer of them, so there’s some feeling that people with a lot of allergies, a lot of allergic diseases, their ACE2 catcher’s mitts are downregulated, meaning there are less of them on their cell surfaces for a variety of reasons, which means maybe they have some innate resistance to the virus. Now that doesn’t mean you don’t get infected. It may mean that you get infected, but at a amount of virus replication that the body’s able to over come through its immune system. So you never get so much viral replication that it’s just bursting out of the cells everywhere and the immune system can’t keep up in which case you go to phase two, which is the massive immune response that can cause all the harm to the body that leads to people being in the ICU, massive inflammation of the lungs and organs, blood clots, heart failure, and all the other consequences that you can see downstream of COVID-19 disease.
So could it be that having fewer of those receptors actually then leads you to have milder disease that may actually have no symptoms or never be infected at all, never actually even develop enough of a response that you could measure it in terms of the antibodies that you can measure in the blood that show that you’ve been exposed before. So entirely possible.
So what’s going on with our Pacific Islander population that seems to be and Latino and Latinas are admitted at a higher rate as well. African Americans were admitted at a higher rate and what’s going on? Well, the other genetic issue may not be a genetic issue. It may be a cultural issue or a socioeconomic issue. So when you have a family structure where multiple generations live under the same roof and you have generations at risk, the older generations, people with chronic disease, which we talked about, diabetes, hypertension, et cetera, living in a small space, indoors, not ventilated, the dose of virus that you’re gonna share when you get infected is theoretically gonna be higher, which means you’re already at a disadvantage, multiple cells get infected, immune systems already behind trying to respond, so no matter what your genetic advantage or disadvantages, this is gonna be a worse situation.
This is called a viral inoculum. And that’s just a fancy way of saying how much virus you get at once. There’s a concept in infectious diseases called the ID50, the infectious dose where 50% of the population will develop symptoms. And you can measure that for different viruses. It’s unethical to do it for SARS CoV-2 because the chance of someone dying when you actively infect them with the virus to test what the ID50 is high enough that it’s not ethical to do that trial, but we’ve done it for other viruses, coughs and colds and influenza, even.
So we have a kind of sense that the higher the dose, when you reach that ID50, you’re gonna start having symptoms. And when you go beyond that ID50, the symptoms get worse in studies that we’ve seen. Now Monica Gandhi at UCSF has been in the news lately talking about these studies and I’m gonna link to a Washington Post article that actually has some of these links where you can look at further references on this. And the sense that we get is higher dose, worst symptoms, lower dose may be no symptoms, but you still get infected, but you don’t have symptoms and you might actually still be able to transmit virus, but you don’t have symptoms.
Now, what could lower your dose? Well, we were talking about our Pacific Islander population, and again, I’m picking on that population in specific because we have a fair number of inpatients in the Bay area that, and this has been written about in the news, that seems like it’s hitting that population very hard. And again, is there a cultural component because they’re very close knit family and so you’re sharing virus at a high inoculum. Remember when Paul Offit, who was talking about vaccines was on our show, he talked about chickenpox in the old days, the varicella virus. The first kid who got sick kinda got sick. That was me in my family of three. The subsequent illnesses of the siblings were often much, much worse, including varicella, pneumonia, meningitis, the complications of chickenpox that we’ve forgotten about because we now have a chickenpox vaccine. Could it be that the first kid got it at school through a transient exposure to somebody, low inoculum, low dose, and then subsequently got really infected, is in a tight space with the siblings, siblings get a much higher dose, and now you’re already behind the ball? And that same thing could be happening with SARS CoV-2, the virus that causes COVID-19 disease.
And so this matters what the dose is. Now, we’ve been telling people huddle inside, don’t go out this, that, and the other thing. Well, what if somebody’s sick in that house? Now, what you’ve done is you’ve done them a disservice. Now that doesn’t mean that that’s the wrong advice in general to give in the early pandemic, but you do need to clarify, hey, what the dose matters.
Now, if that’s true, we talked about the genetics now, by the way, why are kids is another big mystery? Why don’t kids get this disease as much? We’re gonna come back to all three reasons. We’re gonna talk about why you may have asymptomatic disease may apply to children as well. So let’s think about receptors and just the genetic structure of children. Well, they’re younger, maybe they have fewer ACE receptors. Maybe there’s a different structure. We don’t know, but maybe there’s something to do with their innate receptor sensitivity, okay. Now what’s the other way that you could potentially have an asymptomatic case? Well, we talked about inoculum already. So how much exposure to virus you get matters.
In the early pandemic, the data seemed to suggest people, there was only like a 15% rate of asymptomatic cases. Now this could be because we just weren’t testing, honestly. So it could be skewed a little bit, but let’s say it’s not. In the early days, 15% asymptomatic, lot of high mortality, sick patients. Now it could be ’cause we didn’t know how to treat, it could be multiple things, but bear with me for a second. What if it’s because nobody was wearing a mask, we weren’t social distancing, we weren’t washing hands, people were getting high doses from people. They didn’t know what this was. They thought people were just having a cold or something and the next thing you know, you’re getting a huge dose in the face. Like the ophthalmologist who had originally blew the whistle on this in China, he died of this disease. He was only 30 something with not preexisting conditions. Early healthcare professionals were getting very sick and I talk with Peter Hotez about this. Could this be because they got a high inoculum? There wasn’t universal mask wearing all of this. Well, yeah, that’s totally possible. It’s entirely possible.
So the question and this has been speculated with children. Children are much lower to the ground. So if they’re sneezing or coughing, they’re gonna transmit to adults, a lesser dose and adults actually aren’t really at their level most of the time. So they’re not getting as big a dose. This is a theory. Now again, you have to study it. It’s hard to say this is speculation, but it is interesting.
Now related to inoculum comes masks. If you look at countries that at baseline had high universal masking scores, the Czech Republic, Singapore, they have a much lower death rate per capita than others. They were still affected, but perhaps more were asymptomatic, less had severe disease because inoculums were lower. It could be that the Japanese may have a component of this as well. And this becomes really interesting because then it has ramifications for what we’re doing now. People are like, oh, wear a mass to protect other people from you. What about if you’re actually protecting yourself with a mask and we’ve talked about this. By lowering your inoculum, you could actually get away with no symptoms or mild symptoms instead of ICU, right? So inoculum is a huge bucket that you have to think about. How much virus you’re getting is a huge bucket that you have to think about when you talk about why do some people have no symptoms at all? Now, we talked about genetics. We talked about inoculum. Right?
Now what’s the third thing that could be leading to people having no symptoms, but yet getting exposed and infected with this virus? Preexisting immunity. What does this mean? I thought this was a new virus. I thought SARS CoV-2 was the novel coronavirus. It’s not a coronavirus humans have seen before. So why on earth would we have any preexisting immunity? In fact, in the early days of the pandemic, a lot of the fear that was induced was based on this idea that, oh my gosh, this is a plague that humans have never experienced. And it has a 10, 15% mortality in the early numbers you were seeing and hardly any asymptomatic cases, but just enough to terrify you into thinking that you could get it from someone who’s not coughing or they’re pre-symptomatic and we didn’t understand mortality. Well, that’s terrifying, right? So what do you do in response to that? You do a very aggressive public health response to keep the hospitals from being overwhelmed. You shut down everything and it feels, we’re talking about the difference between what seems right. If you look at slighty funnier than placebo, you can look at it a hundred times and never noticed that it’s missing an L. Well, that’s how our intuition often fails when it comes to science.
And so early on, a lot of us felt like, oh, this is really overreacting and this doesn’t feel, nobody’s getting sick, right? But what you saw was actually, and I was in that group too, the numbers really, really drop off because that’s just simply the math of how pandemics behave. But the question then is, was that the right thing to do longterm, in other words, what’s ultimately gonna happen and that again brings us right back. This is where we need to have open discussions across, forget about politics, you can’t, it’s hard to, but let’s just pretend for a second that we don’t have a political unconscious elephant that’s stomping around wanting to tear the other side apart and let’s just look at these things objectively, so that means that you listen to all viewpoints, you listened to the hydroxychloroquiners even though there’s lots of data saying it’s not really happening, but you listen to them anyways and you go, okay, let’s keep studying.
You listen to people who say lockdowns actually weren’t necessarily the right answer. Now, why would you listen to that? It sounds crazy, right ’cause in retrospect, wow, we bent the curve quite a bit, et cetera, now everybody’s scared because of this preexisting immunity. What does that mean? We said this was a new coronavirus. This is what that means. It seems the more we look, the more we find about this virus and that takes time. Studying antibodies, in other words, these little proteins that are B cells, our immune system B cells produce that bind to proteins on the surface of that baseball that’s coming for our catcher’s mitt, our ACE2 receptor SARS baseball coming. Well it turns out the body can, if it’s been exposed to that exact virus, you can make neutralizing antibodies that bind to certain aspects of that baseball that then prevent it from binding to the catcher’s mitt and allows our immune system to then take it away. We don’t have a lot of that ’cause this is a virus that’s recombined in a way that humans haven’t seen it, but humans have other aspects of immunity that do not have to do with directly with antibodies right away and that’s the T cell, the cellular mediated immunity that we’ve been talking about on recent shows.
It turns out that that immunity is triggered by previous exposure to viruses and vaccines that do not directly, necessarily, resemble the current virus. They could have aspects that resemble it, like other coronaviruses. What are other coronaviruses? The common cold. There’s like four odd or more coronaviruses that cause a common cold and exposure to those viruses historically can then lead you to ramp up a cellular mediated immune response. It takes a couple of days to spin up when it sees a new virus that kind of resembles a little bit some of the aspects of the old viruses, but once it spins up, it can handle that virus, assuming the inoculum is not too high, you don’t get too big a dose and assuming your other aspects of your immune system are healthy and you’re otherwise healthy or in decent shape and maximizing your immune response. Well, that could be a game changer because as we start to see now, 40% asymptomatic cases, well that tells you there may be some innate immunity or we’re lowering the inoculum or both, but if you look at Singapore, so what they started doing is measuring T-cell immunity and Monica Gandhi in this Washington Post article, they cite some of this, so I will link to that after the show, in Singapore, up to 50% of people had preexisting T-cell mediated immunity to the SARS coronavirus-2. How?
It’s not been circulating. It’s cross immunity from probably previous coronavirus exposure and this may explain why different populations suffer differentially. It may explain why we are seeing, despite a relative opening in Sweden, right, they didn’t do very aggressive lockdowns. They did voluntary stuff. There’s a lot of trust in the government there. The population voluntarily complies with social distancing, even though they didn’t have universal masking, they had a higher per capita death rate than some other European countries, but lower than the UK. And now we’re seeing the death rate drop. Now why is that? There may be, and I did a video on this, a pool of people who are already partially immune to this virus. That means that if they get exposed and the inoculum is not too high, they could blow it off, get a booster if you will of immunity and then be a part of that pool that the virus no longer gets to play ball in. And what that means is a kind of community immunity, a kind of a shield where the virus is trying to throw itself as a baseball, but all the catcher’s mitts are already filled with other baseball, like it’s seen this already. It’s like, I’m not playing this game.
That leads to immunity where what you see is the reproductive number, in other words, how many people for every person infected, how many people does that person infect starts to drop and when it drops below one, so each person infects less than one other person, pretty soon, you don’t have a pandemic anymore. And that is the way out of this mess. So preexisting T-cell mediated immunity, whether it’s from colds, whether it’s from previous vaccination. So there’s some evidence that it’s observational evidence, it’s correlation, it doesn’t say that it implies causation, but people who’ve recently been vaccinated for say pneumonia or polio had like a 30% less, I forget the exact number, rate of SARS-2 coronavirus infection. Now there’s a lot of confounders there. It could just be the people that tend to get vaccines are more woke about their health, tend to be more healthy, more proactive, more careful, and therefore less likely to get COVID-19 disease, but it’s also possible that MMR vaccination, et cetera, childhood vaccinations that kids are more close to actually rev up that T-cell mediated interferon based immunity that Paul Offit talked about on our show and give us immunity and maybe that’s why children who are exposed to tons of colds, get a booster shot every year, they get three colds or they’ve recently had MMR vaccination, measles, mumps, rubella vaccination and there’s some homology between those viruses and SARS coronavirus-2, SARS-CoV-2.
Could it be that that’s another reason that children seem to have milder disease? Well, that’s possible, which means make sure to be up to date on your vaccinations. It means vaccinations do work, not just for the virus that you’re talking about, You’re protecting against with that vaccine, but for other viruses and this has been felt for some time, actually, that there’s this cross protection. BCG vaccination, which we’ve talked about that used to be given for tuberculosis, and is it still in some places, seems to confer protective effects against unrelated viruses, presumably due to T-cell mediated immunity. That could be a game changer for how we think about vaccination.
And so the idea here is then, well, okay, do we need to shut down the economy again if we get surges in cases? Are those surges in cases largely minimal symptoms or asymptomatic in young people. If that’s the case, Monica Gandhi even argued in this article that asymptomatic infections are great. They’re not great because you can spread them, but they’re great because they generate immunity in a pool of people that then get us closer to herd immunity. It means that the overall infection, fatality rate drops for the disease and we get through this.
And I actually speculate, and this may be crazy, that the common colds, these standard coronaviruses, when they were new to a population probably behaved a lot like COVID-19. So imagine Native Americans have never had a common cold. They get a common cold from a European settler and they go into ARDS and die or cytokine storm and die. And one day, this is my prediction, the SARS coronavirus-2 SARS CoV-2 COVID-19 disease is gonna be just circulating in the population and will generate cold like symptoms for most people. Now remember, the common cold can kill you if you have multiple comorbidities and you’re susceptible or immune compromised. And I think that’s what’s ultimately the destiny for SARS-CoV-2.
So the question then is what do we do now? Well, here’s the take home point from this. People who are at the highest risk of dying, two or more comorbidities or over 65, oughta be doing everything they can to avoid contact with people who are sick or asymptomatic with the disease. Masking, washing hands, social distancing, staying home when they can. Everybody else should do the following, and again, this is my proposal, wear a dang mask. I don’t care what your politics are. I hate masks. My politics say take them off. You never tell me what to do and you never force an American to do something that isn’t shown by a lot of evidence to be absolutely necessary and is gonna harm other people if you don’t do, but I think that we oughta have, like the Swedes, a high level of voluntary compliance with basic masking. I don’t care what you put on your face, but I do think we should spin up surgical masks because they are really good compared to cloth and all that.
And what that does is it lowers the inoculum that we talked about, which means that when you start generating spread, which you will, because mass aren’t perfect at preventing infection. They’re not at all. In the absence of social distancing and et cetera, you’re gonna get infections. Those infections are more likely to be asymptomatic as was seen on an Argentine cruise ship cited in the article that I’m gonna share. 81% of people on that ship were asymptomatic as opposed to 40 or less normally. Why? Because when the outbreak happened, everybody got surgical masks and the crew got N-95s. Inoculum dropped. Did it prevent them from being exposed? No, but when they were exposed, they had enough immune capacity relative to the amount of virus to actually fight the virus off and develop antibodies. That’s huge. You’ve effectively immunized them and reduced the pool of infectable people. Why? A mask. Even when they couldn’t properly socially distance.
So the masks help and this is new for me, guys. I would not have been able to tell you this a few months ago, when I was saying universal masking for the public sounds dumb. And I had to change my opinion based on new data, including this and I think that could be potentially a game changer. That’s the other thing, guys, people are very skeptical of the scientific community because they seem to have changing recommendations. You know why? It’s because the knowledge base changes on this virus. In really a hugely short amount of time, a bunch of information has come out and the panic and fear subsides, and people start to go, wait, now, hold on. Based on this data, we need to actually recommend this. Well, that’s different. Now remember WHO and CDC, they have to make guidelines that are super risk averse for the most possible people weighing all these things and thinking about what’s the political ramifications. It’s very hard to do science quickly that way, right? So you have to listen to data on the ground. You have to listen to dissenting opinions.
People have accused me of shutting down like these America’s frontline doctors and these other people like, no, no, I did not do that. I said, let them speak. Don’t censor them. But here’s the counter to what they’re saying, right? When those Bakersfield docs talked about, we need to open the economy, this has the mortality rate of flu, I said, no, that’s not right because the data they’re giving you is wrong. It’s misinterpreted, but their proposal that economic damage and social damage and mental health damage from our shutdowns is a bottom of an iceberg and deaths from COVID are the top is important.
So when you’re actually making decisions now, you better look at the harm that this whole pandemic, the fear and the constant media, the constant we could get rid of all that. It’s so hard to our mental health, to our children’s mental health. We need to safely open up schools. This is a regressive tax on the poor closing schools, which means we need to provide our teachers with safe masks. We need to try to get kids to where masks where they can. Lower inoculum as much as we can, but I’ll tell you, we keep schools closed, we are gonna harm a generation of children, irreparably.
So these are the things we better be debating openly and civilly and using as much data as we can. Now that gets me to this. So what’s my recommendation? Wear a damn mask, open up the economy, right? Except for the highest risk things. Use your damn common sense. And what we’ll start to see is a threshold community immunity that’s lower than we think it is. And by the time we get to a vaccine, which will probably be next year, then we can help everybody and the most vulnerable with a vaccine that presumably will be safe and effective because we’re gonna test it in phase three. Do not rush the phase three trials as Paul Offit said on my show, check that link out. And at that point, this thing will start to modulate into something that’s with us for good, but doesn’t really do so much harm, right? Kind of like H1N1 flu. It can still hurt people. We have a vaccine for it. You can take the vaccine.
We develop community immunity and we move on and talk something else, like the second season of “Umbrella Academy” on Netflix. You see what I’m saying?
Alright. I promised you I would talk about one other thing, which is testing. Testing right now is a complete and utter disaster. We’re talking like seven to 10 day turnarounds, two week turnarounds for testing. That’s a useless test at that point because there’s bottleneck and supplies. Hopefully this week we’re gonna have one of the big companies that does PCR testing on the show and we’re gonna talk to them about this stuff. It’s gonna be really cool, so stay tuned. That may happen later in the week. But Michael Mina at Harvard has gone on multiple platforms now and talked about this idea of doing a different type of test in a different conception. And it’s this. It’s a simple saliva swab that you can do at home that costs maybe a dollar a day that could be developed by multiple different small companies and spun up relatively quickly. And what it does, it doesn’t test for genes, it doesn’t test for RNA. It tests for an antigen, a protein that then, kind of like a pregnancy test or a rapid flu test, right, flu antigen, you quickly test it turns blue, you’re positive, doesn’t change color, no big deal. The problem with that test, right? So anyone can do it at home. The problem with that test is that it’s not very sensitive, which means it’s gonna miss people that are infected a fair amount of the time as opposed to the PCR test, which is still not perfect, but it’s much more sensitive, right? And we don’t really know the specificity of it. In other words, how often are you falsely positive, which is another problem. If you get a positive, you’re like, damn, okay. But here’s the thing. If you’re at home and the test is not very sensitive, right, there is a correlation between how infected you are, how much viral load you have. In other words, what’s the inoculum you could spread to others and whether that test is positive.
So at a high viral load, the test is much more likely to be positive and the sensitivity’s gonna be higher. Well, when do you care when you’re positive? When you’re gonna share this disease, that’s when you care. So here’s his proposal. Spin this testing up, test people every single day, let them self test at home. If they’re positive, stay home or get a PCR confirmatory test. That’s when you’re infectious. Keep testing until you’re not or the 10 days quarantine period expires. And if everybody did that as much as you could, you could open up schools. You could open up restaurants because everybody’s presumably testing and if you are actually asymptomatic and positive, you stay home. That’s a game changer and the sensitivity of the test goes up when you repeat it every single day, you’re more likely to catch it and if it’s a false positive, well, you could always get the gold standard testing at that point, which would lower the amount of other testing you’d have to do.
Now, why hasn’t it happened? Because the way the FDA regulates these home tests is as a diagnostic test, which means it’s almost impossible to get it to happen and get it approved because there’s all these requirements that would sink it. So you need to change our regulatory structure and have some exemption for that, which means we have to lobby our political people. So Google, or I’ll put some links into Michael Mina, he talked on “Med Cram,” which is a great in-depth show on YouTube about exactly this and they went deep on it. So I might try to link to that too when I put this up on YouTube, on my zdoggmd.com website where I host all these videos and have all the links.
So this is exactly the kind of out of the box thinking that could get us the heck out of this mess. So now you test everybody, you lower the amount of overall transmission, you get to a vaccine, you keep the vulnerable safe, you lower the death rate because you’re keeping vulnerable people from dying, and you allow some degree of asymptomatic transmission that’s gonna happen from opening up the economy, but if everybody’s masking the inoculum’s lower, so they’re less likely to get severe disease and overwhelm the system and die, and we’re done. Then this thing becomes part of our background infections that happen every year and people don’t generally die from it. This is not rocket science. I’m thinking this may be an answer.
Now again, I don’t know for sure. This is an evolving science, but if that’s true, listen, the downside of trying that is actually not that high because universal masking would, in general, lower inoculum. We’re already going for a vaccine. We know the downside of aggressive lockdowns now and fear and constant media coverage of this crap, so let’s just have a rational discussion about it and I hope to see in the comments what you guys think, all right?
So that’s today’s “Sunday Sermon.” I wanted to talk about meditation and all that. I had this amazing meditative experience this morning. I don’t wanna mix those things ’cause people start tuning out, but I wanna thank everybody. Let’s see if we have stars. So I started the show by mentioning this, this exact pen that I am holding in my hand, right? Right now, ZDogg MD slighty funnier than placebo that has a typo in it can be yours if you are the number one stars donor today. I get a penny per star. It supports the show. We’re shooting a music video next week called “Waiting for the World to Change.” You can find that on my website, under the podcast tab, you can hear the track, and your support helps us make that video dope and all the other things that we do because I know it’s difficult economic times, but if you can support what we do, we try to be a moderate voice that isn’t political, that talks science and if you enjoy that and you want this pen, be the number one stars donor.
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