Johns Hopkins surgeon and Professor of Health Policy Dr. Marty Makary helps us cut through the haze of talking heads to get to an effective, evolving, and compassionate pandemic strategy.

Check out his recent NY Times Op/Ed here.

Check out our other interviews featuring Dr. Makary here.
Read his outstanding book The Price We Pay here. 

– What’s up, ZPac? It’s Dr. Z. This is the “ZDoggMD Show.” All right, returning today, he is a regular on the show, and a regular on pretty much every frickin’ show on TV right now. This guy is all over the news, and deservedly so because he is a professor of public health at Johns Hopkins. He’s a surgeon at Johns Hopkins, the author of multiple books, including “The Price We Pay,” which we’ve talked about on this show, about the money games in medicine. He is a personal friend and hero of mine, Dr. Marty Makary. Welcome back to the show.

– Great to be with you Zubin.

– Look at you. You got the full Dr. Oz. You’ve got the scrubs. You’ve got the–

– Can I just say thank you for not using Microsoft Teams for this?

– Oh, you know, I haven’t heard nothing but good things about Microsoft Teams, Marty. Why would you say that?

– Like, it’s more cyber-secure.

– Look, I’m just waiting for you and me are talking, right? And we’re having this conversation, and then suddenly a Chinese hacker just appears in the corner and starts debunking everything we’re saying about COVID. He’s like, “No, actually it was made in a lab.”

– I don’t think Chinese hackers could do that because it’s too confusing to log on. I think that’s why it’s cyber-secure.

– That’s true. Even people who are supposed to be here have trouble logging on to Zoom. Imagine if you’re trying to actually hack into it.

– It’s so ironic because remember when Apple came out with the iPod, and then Microsoft struggled to try to come up with something similar, and they came out with that device that was–

– Zune.

– It was called the Zune, with an N, and it was horrible, and it was like discontinued after a few months, and everyone hated it, gadgets, and knobs, and features, and it’s just like, gosh, it’s ironic now that the better version of Microsoft Teams is called Zoom, with an M.

– It’s ironic on several levels. It’s also ironic that you bring in Bill Gates into this since he is the mastermind of every COVID conspiracy–

– Oh yeah.

– because, and you understand why, Marty, because at one point he went up on a TED stage years prior to the pandemic and said, “Hey guys, guess what? “A pandemic is coming.” Therefore, ergo, three dots, he caused the pandemic, right?

– All of a sudden it’s like he’s Jeremiah and he has his prophet license, it’s we all know that there’s going to be a giant pandemic that we are slowly walking into of antimicrobial resistance, which is really what he was talking about, in part, and the other part was he was talking about viruses, which we know that happens every several years or every few decades, so look, I think he’s done some good work, but the idea that all of a sudden now he’s the medical authority on this thing, it’s just ironic because there’s an active pandemic that is brewing fueled by overuse of antibiotics and antibiotic use in agriculture that we are actively engaged in, and it’s not rapid, right? It’s not like the last month of April. It’s slow, and we’re losing, and people die from it, and we’re already seeing C. diff multiresistance, and MRSA, where we have to watch kids suffer, and get better with their own immune system because we have no drugs, and this is another pandemic that’s slow-moving that we can influence, and I think, ultimately, I think we need to look at these pandemics and say, “This is not our fate. “This is something “that we can make good decisions and mitigate.”

– Why are you such a downer, man? Like, I was just getting in a mood to talk about, like, how Bill Gates’s conspiracy is gonna destroy the world, and you’re like you bring C. diff into this. See, this is the problem with you, Marty. Okay, first of all, because you’re a quality guy, you actually care about not screwing up in hospitals, right? So C. diff, MRSA, these are all preventable. We know how to stop them, yet we don’t. We overuse antibiotics, like you said. This is, I like the term you used: a slow-moving pandemic because one day we’ll just blink, and it’ll have been years in the making, and we’ll be unable to treat any of these diseases at all, and we’ll be no better in the hospital at not causing them because we’re idiots. We don’t wash our hands. We don’t do the simple things that we know already work, right?

– I was told I had to be serious on this interview by your producer for the entire show. Is that not true?

– Well, if that producer you’re referring to is Logan, then he’s probably playing a prank on both of us.

– He said here, “Be serious “and no foul language or swearing.” That’s what I’m reading here.

– You know what? Now I understand why all my guests are so boring. I didn’t realize he’s been preemptively sabotaging every interview by going, “Never laugh, never curse.” You know, it is what it is. Hey, speaking of never cursing, so you’re all over the news, right? You’re doing this. Are you doing this all from your home studio? How are you socially distancing and showing up on like Fox or CNN?

– Wherever I am I have this app on the phone called Live View, which allows you to broadcast from wherever, so if I’m in here in my office, or at home, or wherever, they can do it, and sometimes early on I went into the studio because then there’s less of a delay. You know those delays on TV?

– So you’re talking about like an ISDN studio? Like one of those pro studios where you stand there and they green-screen you into like the White House, and you’re like, “Well, Bob, the thing about COVID is,” and but there’s no ’cause that delay is the worst ’cause you hear them talking. They you have to wait, and it’s a disaster.

– Yeah, it’s sort of like being on a video conference call with eight people that never used video conferencing before, and everyone talks at the same time, and four people are on mute and talking, and it’s–

– How were you actually, did you hack in as the Chinese hacker into the call I had with my family recently? My Indian parents, “We are trying to use Zoom, “and I got your uncle, and he’s coming, “and your auntie in India,” and everybody’s like all at once, and I’m like, “Bros, bros, you know what? “I like the old–

– Feedback.

– I like the old-fashioned phone with the landline where you call long distance and it’s like $10 a minute, and you hear the hiss in the background ’cause of the transatlantic cable. I miss those days, man. That was cleaner. It was more personal.

– Yeah, I love the birds chirping and the dogs, and the feedback, and people staring at the bottom of their screen. How about we do this conversation with me like this the whole time? You can check out my haircut my brother gave me.

– Your brother gave you that haircut as a–

– He gave me a haircut. He very gladly gave me a haircut at gunpoint where I instructed him where to cut and how much to cut, and at the end I just said, “Screw it, just take it all.” I mean, I was at risk– I was at risk of a ponytail beforehand.

– You know, it’s funny. This was one of those weird communal sufferings that I’m no longer a part of being in this particular hair club for men, and so my wife’s like, “I’m trying to figure out how to get my hairdresser “to come and do a six-foot haircut in our front yard,” and you know, actually, that’s a good segue, so you put out a opinion piece this morning in the it showed up this morning in my feed in “New York Times” talking about how we need to start to thoughtfully open up, and what I thought was interesting is you acknowledged something that I’ve had to acknowledge on the show, which is, “Hey, guess what, guys? “My thinking evolves as the pandemic evolves “because nobody has all the information,” and so walk me through a little bit about what you were saying, and let’s discuss it because there was a few things I think we could hash out for the audience.

– Well, I think we always have to listen to people, and I’ve been trying to select out those who have been relegated as crazies and try to find out if there’s anything that they’re saying that’s actually legitimate or substantial, and it’s been hit-or-miss. The “Plandemic” video, maybe, maybe 5% was correct. I don’t know, do you think that’s high, or low, or–

– Was that the percent where he misspelled filmmaker in the opening credits? Yeah, exactly. It’s sort of like the first company that got FDA approval for a coronavirus test had innovation spelled incorrectly on their website, and it looked like a foreign national wrote created this website–

– Oh my gosh.

– and sure enough it’s a Chinese company with a storefront in North Carolina.

– That is classic. You know, when you start detecting those, then you realize, yeah, there’s something fishy going on, so you’re saying you’re talking to the more fringe-y folks and trying to find what wisdom you can learn from listening to even them?

– Well, I heard a nurse rant on Facebook. I think I shared it with you, and some of the stuff sounds a little extreme, but some of it may have been interesting, right? Like, maybe we don’t manage these patients with COVID-19 with the same ventilator strategy and the same indications that looks like it may be more of an issue of oxygen exchange than it is a high degree of inflammation creating a barrier at the level of the lung tissue, so maybe patients can do better with other forms of hyperoxygenation short of being intubated relative to other classic patients that go down that road of SIRS and ARDS, so that’s interesting. You know, that’s what some of these doctors are saying, and luckily I don’t have to make those decisions, but it’s really interesting. I mean, this is the educational process, right? We can learn from individuals and their experiences. When doctors say that they have an experience, and a group of doctors are saying the same thing, let’s listen to them.

– So this is something worth exploring because what it involves to go ahead and take a, okay, first of all, all of us need to be able to have a voice, right? And social media has given us a voice, and I’ve been advocating for physicians and nurses, and others to use their voice. Now, where we have to train people better is to use critical thinking, like look, Marty, you’re a world-class intellect. Don’t ever repeat that I said that because I’ll deny it–

– Is this recording? I might save that.

– You may wanna, yeah, you may wanna put it, make it your ringtone: “Uh, Marty, you’re a world-class,” but the point being you are able to critically dissect what people are saying in a way that I think the average American has not been trained to do, so when I see that same nurse video, I watch it, and I see it, I try to think critically, and okay, what could she be saying that’s true? How can we investigate it? What’s the bias of the speaker? Is there a failure of imagination? In other words, there’s so many different logical flaws we can fall into, like she says, “The only reason that this patient died was this.” I think that’s a failure of imagination. You didn’t actually think it could have been this, it could have been this, it could have been this, so that’s how you think critically, and you can go through a process, so when I saw, say, Cameron Kyle-Sidell’s video where he first talked about this idea of happy hypoxemics, and the idea that we’re early intubation may be killing these patients in certain cases. Initially I was skeptical because I said, “Well, now here’s another guy on the Internet,” and then I listened carefully, and then I looked at his credentials, and then I explored, and then I reached out to experts that I know that know the guy, and they’re like, “No, he’s onto something.” Then you get Scott Weingart on the show, and he says, “Yeah, this is what he’s onto,” so this is the process we use to listen. That’s exactly right. It doesn’t mean that you then pop up “Plandemic” and go, “See? “More experts. “They’re saying stuff. “I believe it.” That’s not how you watch “Plandemic.” Like you said, there’s 5% there that may be true, and the rest is horseshit.

– And the opposite of that, which I think is sort of the wrong approach, and it’s a reflex we’ve all been taught, is this argument: there’s no evidence, therefore I don’t believe it–

– Ah!

– And we hear that all the time, right? We’re hearing that all the time, and if there’s no evidence it just means it’s an unknown. Doesn’t mean that it’s not true, but you hear that. You hear it on rounds. You hear it frequently in the media. Every now and then you’ll hear it from a policymaker, where if they dismiss, wanna dismiss something they use the argument there’s no evidence. You know, when they, there’s no randomized control trial to prove that parachutes work, nor should there be, right? And when they discovered penicillin it was because the penicillin fungus was growing across the agar and was killing all the bacteria, and then the daughter of the scientist got a terrible infection. He had her try the fungus, and she was cured. Now, I’m not recommending that’s how we do research, but I’m certainly interested in learning from what happened, and it turned out that as soldiers were dying in World War I left and right from infections, which was a leading killer, right? When people got shot or injured they died from the infection. Guess what? They said, “You know what? “We think this might work, and we’re gonna give it,” and many, many people were saved on the battlefield because of that discovery of penicillin.

– So I think, summarizing that, it’s the absence of evidence is not the evidence of absence. In other words, sometimes anecdote can be the start of science that then you can explore. Now, I think the most I think the most clear example of that is masking, so you and I have had a similar journey on masking, which is initially it’s kind of like wait. There really isn’t a lot of evidence for the general public to go around masking. There’s anecdote. There’s correlation, so in Asian countries, the ones that mask aggressively seem to have better outcomes, but that could be correlation. They have a more maybe there’s a more obedient population. Maybe they’re more collective-minded. Maybe there’s other social distancing stuff that they’re more compliant with, so there’s other confounders, but then your thinking has evolved on this, even in the absence of a lot of data. Let me know what you’re thinking.

– Well, it’s kind of entertaining. I gotta admit I’m amused. I’ve been wearing a mask most of my adult life as a surgeon.

– It’s really good on the dating apps, too, because when you wear a mask they just don’t know, and they have to, it’s like rolling the dice, like should I swipe left? The mask is hot.

– It’s multifunctional– so the masks, of course, don’t have the official seal that’s required, and they don’t have the official filtration rate that would tell you that this is perfectly effective to prevent viruses, right? But we could dwell on that, or we could look at the real-world experience, and let’s listen to the doctors in China. Look, I don’t trust a single thing I’m hearing from the Chinese Communist Party, but I do trust what I hear from Chinese people, who are wonderful, and Chinese doctors, who have been very honest, and they have phones. You know, we’ve got all these political pundits out there giving their opinion as a Republican strategist, and Democrat strategist. Here we have them giving their opinions on the pandemic. What or why would you listen to them? I mean, could we have put any doctors on television from January 15th until March 15th?

– You mean you don’t think you don’t think Carrot Top’s opinion on the pandemic is equal to, say, Peter Hotez?

– You know, if we woulda just put on Hotez, right? And–

– Offit and–

– Yeah, all those guys. Put them on instead of putting all our faith and trust in one guy, who’s Anthony Fauci, who’s a good man, but let’s be honest. He did not blow the bugle for two months leading into this thing. I think what he says is good, sound clinical judgment. It’s good advice. It’s good recommendations, but the guy has served six presidents for a reason, right? He knows how to say things in a general way, be noncommittal. I don’t wanna, I don’t wanna knock the guy. He’s a great laboratory virologist, but what people may know from public health is there’s not always agreement between epidemiologists and virologists, right? They’re different disciplines, and both probably have their biases, right? We saw the models not account for seasonal variation with climate, and association they really did not account for, which is why we saw much lower rates of the infection in southern states, and they didn’t account for mitigation. Similarly, the virologists think in terms of the hammer of the vaccine, right? And Fauci, if we remember history, said over and over again that HIV was going to be ultimately managed with a vaccine, and he kept talking about strategies until there’s a vaccine. Well, guess what? We never got a vaccine for HIV. It was manageable through antivirals, not a vaccine. He spent over $5 million on vaccine awareness campaigns for HIV, so he’s not a bad person. He’s actually a terrific person, and he’s a real gentleman, but I think when we put our entire faith and stock in one person, there’s a chance that we’re not listening to the real infectious disease experts on the ground and the epidemiologists, so that was not until March that we started really hearing from them, and that’s when I kinda got frustrated, wrote that piece in “MedPage Today,” and called people in media, and said, “Hey, I have a different point of view “I’d like to express.” What we’re not hearing that we need to hear is get prepared for something really difficult. Get prepared to expand hospitals. Get prepared to need more PPE and ventilators, and stop non-essential travel, and limit mass gatherings and public gatherings, and a bunch of us went around the country saying, “You know, we’re not seeing this “from Fauci or the government. “He’s a good man, but he’s just not sounding the bugle. “Let’s do it ourselves,” so I went to Mayor Adler of Austin, Texas, and said, “Please stop South by Southwest. “You’ve gotta cancel it or postpone it.” We did the same with Mardi Gras, the NCAA, and we’re thinking, in early March, “Why are we doing this?” Like, why are we not hearing real infectious diseases experts in the media talking about this stuff? And so that’s how I ended up being so deep into this coronavirus thing unintentionally.

– First of all, okay, you’ve ruined Christmas. You just admitted that you stopped Mardi Gras, and South by Southwest–

– Well, that went on. That went on. They didn’t heed our warnings.

– Yeah, but still, okay, how dare you? Okay, A. B, no, you’re absolutely right. I think what’s interesting is we, my feeling on this, and I’ve said this from the beginning is we dropped the ball in actually understanding the extent of the outbreak early on ’cause we didn’t have the testing, and then we’re always trying to play catch-up, so at that point you have to shut everything down, stop the large gatherings, and then, when it works, people are like, “See, you overreacted because it worked,” but at the same time, and you mentioned this in the “New York Times” piece today, and this is something I’ve been saying from the beginning, the economic costs are actually costs in blood, too, because for every 1% in unemployment you have a 1% increase in suicide rates, mental illness, domestic abuse. Paul Offit actually came on my show early on and got a shit-ton of shit for saying what he said, which he said, “Hey, I’m a pediatrician. “I’m a virologist. “I’ve made vaccines. “Here’s what I think. “We’re not gonna have a vaccine in 18 months. “That’s crazy talk. “Here’s why, because this and this and this, “with immune enhancement, the way you test it, “so on and so forth. “People are smoking crack,” so here’s a question. Did it make sense to shut down all the schools and all that when you’re gonna cause harm to children who are now gonna be in abusive situations? And the harm in that crowd is less given what we know about the mortality, so he actually was asking very tough questions about how to surgically shut down at that time, knowing you have to protect, what you said in your “New York Times” piece: protect the elderly, protect the fragile, protect the people with chronic disease, whereas people who are younger, et cetera, it may be more of a seasonal flu mortality rate for that segment, but devastating for the other segment. I mean, what are your thoughts?

– Yeah, I wish we could just listen to each other. You know, before the days of social media there was more civility where we could actually listen to different ideas, even if they were extreme, or we didn’t like them, or we thought they were offensive, and we would, the purpose of science is to challenge notions that are previously held that are not based on a solid foundation that we have inherited as dogma, and so that means try to learn from something, and even the “Plandemic” thing, as offensive as it was, I was trying to hear is there anything in there that I can learn from? That’s the approach that we, as scientists, should take when we analyze something, and I think with the lockdown we didn’t know what we were dealing with, right? It was an unknown, and it was a very scary unknown. We were on the brink of rationing medical care at every hospital in the United States. Luckily it did not quite hit that threshold, and the case fatality rate came in lower than we previously knew from the data overseas, but New York was on the brink of rationing, so look, we had to throw the kitchen sink at this at the time, and so can we learn as we progress? Can we take the data from the steep incline of this progression and the plateau? And can we now learn from that data about this virus and evolve our strategy accordingly rather than dig into lockdown or total reopening? Because that is not the real choice put in front of us. That is what politicians try to do is polarize us into different camps like that, and social media promotes it, right? ‘Cause everyone’s got an opinion, and it’s shouting, right? It’s all shouting. It’s not listening.

– I have never seen a medical issue politicized as much as this one, and I think it’s because we’ve reached this point where civil discourse is gone because of the camps on social media, because of what Jonathan Haidt and others have written about in books like “The Coddling of the American Mind,” where what we’ve done is we’ve progressively gotten to the point where we’ve demonized anyone with beliefs that challenge our own. It feels like a physical attack when people use words on us, like for example, “Plandemic.” I did a rant saying, “Hey, this is the thing about ‘Plandemic.’ “What we should learn “is people have these conspiracy theories for a reason “because they are either feeling marginalized, “they don’t trust entities “that have shown themselves untrustworthy, “like government, and big corporations, “and those kind of things, “but you need to apply critical thinking to it, “and realize that most of the science here is bullshit,” so the amount of polarized hate, so suddenly I was accused of being some kind of Obamacrat, and I’m like, “Do you guys watch my show?” I’m like either in the center or a little bit kind of radically libertarian, but it’s so politicized that they filter it through that, and then attack with words. An argument is felt to be a physical attack, so now you have the trigger warnings, and the safe spaces on the left. On the right you’re just, you’re a communist if you say anything having to do with masks, like, “You know what? “Maybe we should wear masks in very tight spaces “if people are educated on how to use them.” Well, that’s not liberty, man, but at the same time I’ll say, “Well, cloth masks “sound like a totally idiotic American hack “for something that Asian countries already figured out. “They’re just wearing surgical masks that we don’t have “’cause they make them,” so it’s kind of interesting. I mean, I don’t know, what do you think?

– Yeah, and it’s interesting the mask argument is tied into, you know, there is sort of has been a bit of cultural arrogance. Let’s be honest, right? We’re tough people; We don’t wear masks. Chances are, if you saw somebody wearing a mask in a grocery store two years ago, guarantee you that person was Asian. Why? Because it’s part of their culture, right?

– Right.

– And they’ve accepted that if you have a cough, or sniffles, or a sneeze, or even you might be exposed to someone who does, wear a mask. It’s just best practices. Here it’s like a dunce cap or something, like we– Why is that? So one of the great lessons, or one of the great silver linings is that we finally have reeducated folks on best practices and distancing, and that’s gonna save thousands of lives every flu season from here on out for the generation, but masks, I’ve evolved my own thinking on masks. I mean, they do a lot of things. One is they prevent, of course, the obvious airborne droplet transmission directly to another person. They also prevent that airborne droplet transmission that can contaminate surfaces that others can touch. They can be a barrier for that airborne droplet transmission on you. Remember, some people speak clearly. Some people spit when they speak–

– Guilty.

– Some people naturally have micro-spit and they don’t realize it. It also removes the stigma. When everyone wears a mask at a critical time, like now, those who really need to wear a mask, those with symptoms or early symptoms, or have been close to someone and been exposed, they really need to wear a mask. They’re far more likely to be wearing a mask when we remove that stigma by everyone wearing a mask, and finally, they prevent you from touching your eyes and your, or your, sorry, your nose and your mouth, your eyes, it depends how you wear it, but we touch our nose or our mouth on average nine times a day, and it does remind you not to do that, so masks, it turns out, are a really interesting innovation, simple, and in Asian culture, or in China, when I’ve called the doctors there and asked them, “Why have you been able to manage this pandemic “after an outbreak in Wuhan?” Only 10 million people live in Wuhan, and Harbin, the other province, is similar. It’s in the north. Those where the bad outbreaks have occurred. How have they managed to manage the pandemic in a country of over 1.1 billion people, when those provinces hit hard are about 10 million? And they said, “Because of masks. “Everyone is taking precautions, hygiene, “and everyone’s wearing masks,” and I thought that was powerful–

– Well, so okay, let’s talk about this ’cause I think it’s important. Good mask use, done properly, does keep you from touching your face and all of that, although they’ve done some studies on medical students that show those dummies touch their face even with the mask ’cause they’re idiots. They’re just like rubbing their eyes. ICU nurses kind of tend to do that as well in the few series that they’ve looked at, but the bottom line is if you wear an appropriate mask correctly in the right circumstances, all those things that you said come true. If you, however, tell Billy that, “Hey, take a piece of cloth, wrap it around your face, “and walk into the store,” okay, number one, there’s the possibility that Billy is gonna get in your face ’cause he thinks he’s safe. He’s using the flimsiest like wife-beater material to, I don’t know why I picked on that, but to cover his mouth, and he is gonna continue to touch his face, and so what I’ve seen is people wearing these really ratchet cloth masks, holding a phone like this, wearing one glove like an idiot, and walking around, so to a degree it’s an education thing. It’s like you said. It’s destigmatizing. It’s a cultural thing because when done correctly it can, I agree with everything you’re saying, and that’s how my thinking has evolved. Initially, I was like, “Cloth masks, this is a dumbass idea,” and then what you start to see is people are starting to evolve. They’re learning to use them correctly, and now you go in the grocery store, and you’re not thinking so much about you. You’re thinking about that poor clerk who has to sit there, who’s behind plexiglass now, which is a great innovation, who’s wearing, you’re wearing a mask so that if you were asymptomatic but still infected you’re not gonna infect them. They have a high area under the curve of exposure. You don’t. You’re going in and out, but they do. It can be a huge innovation.

– Would Bill Gates agree with us, you think?

– Bill Gates, from his underwater fortress in the Microsoft Dome, where he’s on a Microsoft Teams meeting as we speak with alien overlords who are trying to control us? I’m not sure, Marty. Oh, one thing I wanted to mention, though, so this is where I think, and you mentioned this in your piece, get the heck out of the house, so there’s a ton of virtue-signaling, people on Twitter and other places, you know, “My name is Billy Stay-Home Smith,” like him changing his effin’ name on Twitter is gonna get you to comply with stay-at-home orders, right? This is just pure idiotic virtue-signaling, but it’s all over social media, but the whole idea of stay home is you wanna social distance and all that, but the stay in your house is a problem. Getting outside, the transmission, and you link to a piece on that, a preprint on that, the transmission is really low in outdoor spaces, including parks, and initially we had shut all those down. Now they’re starting to open up, but the idea that, and I keep harping on this here in San Mateo County, they’re asking us to wear, no, they’re not asking us, they’re requiring us to wear masks on outdoor hiking trail systems, whether we’re on a bike, or whether we’re on feet and all that, and that seems to me, first of all, the opposite stigma. Now you’re medicalizing something that is actually low-risk, that actually you ought to be exercising without a mask anyways, and out in the world doing your thing. Your risk of transmission is minuscule. If you are concerned you could wear a mask, but it seems crazy to me. I mean, what do you think about this?

– Yeah, I think not all reopenings are created equal, and the reality is that when you have a running path that is massively overrun, or you’re in Central Park, one of the most dense places in the world–

– Very different.

– Sure, that may make sense, but telling a sparsely populated area that they can’t go on the beach. I mean, I don’t fault people who made that recommendation initially. Remember, we didn’t have data. We wanted to do everything humanly possible to protect hospitals, save lives, and we’ve done a good job flattening that curve, but now we can learn from the data, and the data are telling us that the virus doesn’t like the outdoors. It doesn’t like the UV light. It doesn’t like increased humidity. It doesn’t like massive fluctuations in wind. It does not like the outdoors, so it’s not like a hood. I mean, it’s not perfectly safe, but it is a safer place to do things, so if businesses wanna conduct business in the front of the store, if that’s possible, if that’s an option. Look, a lot of businesses, it’s not an option. It’s unfortunate. It’s unfortunate that some people, especially lower-income individuals, live in more congested and tighter spaces. There are some things we just can’t fix right now, but one thing is we can learn from this data and tell people, “Let’s get outside. “Let’s wear masks. “Let’s get outside. “Let’s redesign our businesses. “Let’s protect those who are high-risk.” They may have a different set of standards, and let’s do everything humanly possible to create massive protocols and protect nursing homes. That’s where half of the deaths have occurred in New Jersey, and a third of the deaths nationwide.

– Yeah, now here’s a question because this is true in Sweden as well. In the Swedish experience, the nursing homes have just been destroyed. You mention it in your piece. You said, “You shouldn’t send COVID patients “to nursing homes if they don’t have isolation rooms.” Man, where the hell is my dispo, Marty? How do we unload ICUs if we can’t go to nursing homes? The nursing homes are deathtraps, then, because they have, by definition, lower resources, lower ability to get PPE, lower staffing. I’ve had so many nursing-home nurses reach out to me terrified for their lives, especially in the early phases of this, because they felt like they were being put at risk, and they’re seeing their residents dying of COVID or dying mysteriously of undiagnosed COVID, so I’m curious what’s the solution to this?

– You know, I love your work on moral injury. I’d love to get your take because usually when I see something in medicine that is happening that should not happen, it turns out that there’s a fair degree of burnout among those individuals involved, and I wonder if we’ve taken on this notion of, “Okay, now it’s time to release them from the hospital. “Okay, that’s gonna be one less patient to manage here. “It’s gonna allow me to focus more time and energy “on the other patients.” It’s generally good when somebody leaves, but we have sort of developed this numbness to, “Okay, they’re not going to a great circumstance. “They need more attention. “They need more medical care. “They’re going to a violent neighborhood “after they’ve been shot,” but you know what? Those are problems too big for me to address in my capacity, and we almost sort of distance ourselves from those problems, and I wonder if now, when patients had COVID-19, and were ready to leave the hospital because they still had the infection, but they didn’t have the severe symptoms that required an in-hospital stay, if we’ve almost allowed that distance with the issue to allow us to do a routine that really should not have been done in this situation given how contagious it is, how horrible–

– Yeah, that’s a, that’s a really interesting way to look at it because that is our routine, right? It’s someone else’s problem, dispo, especially if you’re a resident. It’s always like what height can I raise the bed to to get the transfer that I want? Is it ortho height? Is it neuro height? And this is the origins of moral injury in us because you build a wall that you don’t feel what that actually means, right? You said something early. You said, “This virus doesn’t like X, Y, and Z.” You know what else it doesn’t seem to like? Rich white people, and I say that not because the virus is discriminating. I’m saying that because, and you said this, it’s the poor, it’s our immigrants, it’s those with chronic disease, with the poor social determinants of health who are trapped in crowded urban locations, who have to use public transportation, who are dying at a much higher rate, and this even applies to our hospital staff, so there was a great piece. It was really horrible to read, actually, about the experience in New York of patient transporters, clerks, lower-paid, non-clinical positions. These workers were getting sick at a very high rate, and were dying at a very high rate because they tended to be a little older, have some comorbidities, and tended, almost exclusively, to be minorities, so I’m curious what your thinking is on this.

– Yeah, it’s, we tend to see the solutions from the perspective of our vantage points, and so we think of, “Well, businesses can adapt by holding yoga outdoors.” Okay, that’s great, but you know what? Try running a gas station in downtown East Baltimore, right? It’s not that simple, right? And I think we have seen almost an elitism to, “What’s the big deal? “I’m staying on my mansion estate “out in the Hamptons. “I’ve got a lot of cash reserves. “I can work on Zoom, or Microsoft Teams, if that’s– “how you’re so programmed, “and what’s the big deal? “Stay at home longer. “How dare you get out there?” And I think we’ve forgotten that most of America lives paycheck-to-paycheck, that a lot of people take public transportation, that the big drivers of this pandemic, we’re learning from the data, are public transit, mass gatherings, and we’re learning there’s a seasonal variation that we didn’t appreciate earlier, and that’s why some of these southern states, I don’t wanna say got lucky, but came in way below the projections, right? Florida three weeks ago still had projections of 7,000 deaths, and they were at 1,600 deaths, so look, it was seasonal, okay? It’s not that they’re geniuses there and they predicted this. It’s that it’s seasonal.

– Florida is God’s waiting room. It’s an elderly population. You would expect it to just be torn apart by this thing, but I think you’re right. I think there is absolutely, like other coronaviruses, it’s probably got a seasonal component, and we’re learning as we go. I think one thing we have to understand if we have to come from a position of love and understanding with each other, so you have these rich elites. I consider myself one of these. This pandemic, Marty, let’s be honest, it’s been the greatest thing that’s ever happened to me. I hate people. I hate traveling. I hate having to be face to face. This has transformed my life for the better in that I spend more time with my family. I spend time like this at a safe distance where my innate misanthropic tendencies can be put in check. I get to wax philosophical. It’s been wonderful. Sure, yes, revenue and income goes down, but I save money because I’ve been conditioned to do that by my Indian parents, so I’m positioned to weather this, but then you look at my, the guy who does my landscaping, and this sounds like such an elite thing to say, but this guy, he came to me in the early days of this and said, “I am barely surviving. “So many of my customers have canceled me “because they’re afraid somehow “that me leaf-blowing in their front yard “is gonna give them COVID, “and they’re following the letter of the law here, “which says everything shuts down, “and you’re not considered essential, “and I can’t feed my family,” and I said, “Well, I’ll pay you whether you come or not,” because I can do that, but maybe what we need is a little bit more connection, compassion, understanding of people whose situations aren’t our own, and these guys are sitting there, “Stay home,” and they’re putting it on Twitter. They are, to some extent, the elite, and I think they need to understand that for some people the economy is their lifeblood. Without an ability to actually make a living, and I’m not talking about throwing printing money and throwing money at these folks. It’s about having them be able to do something meaningful in the world that gives purpose and income. We don’t think about those things if you’re just listening to a scientist, or you’re just listening to a politician or an economist. You have to look broadly at it.

– You know, I appreciate your message of love, and that’s really what ZDogg Industries is all about. Somebody asked me, somebody asked me, “What is this guy ZDogg all about?” This was a physician, and I said, “Are you familiar “with the ‘New England Journal of Medicine’? “ZDogg is taking their message of love “to a younger audience, people in their 70s– “people in their 60s, “all the way down to young folks, people, premeds,” so I appreciate the incredible message of love. No, look, I think we gotta take care of each other, right? We’re Americans. We’re health professionals. We take care of each other, right? And I love the fact that folks are keeping staff on payroll, that they’re being charitable, that they’re going to their food banks, which I asked somebody who’s big in the charity world, “What can I do right now to give back? “God’s been good to me, actually too good to me, “and I just feel an obligation to give back,” and they said, “Go through a local food bank,” and that is a great place to give, so I love hearing that folks are doing that kinda stuff, and it’s, I think it’s part of the obligation that we have, given how much we’ve been blessed with what we have.

– Thousand points of light, not gon’ do it. Man, I miss George H.W. ‘Member that guy? I don’t, but barely. I mean, in fact it took me years to realize that’s what he was talking about is like charity, like the idea that you give. Now, he was saying replace government with that, which, again, that’s controversial, but I’m saying, “Listen, “this is if you have the means to help others, “you should try your best.” You see medical students stepping up, offering to babysit for front-line clinicians, and nurses, and stuff. They have started these organizations where it’s like med school student babysitters because they can’t do anything. These poor guys, man. They’re graduations were canceled. The nursing students have had to defer. Their boards got all screwed up. We’re just lucky we graduated in time, Marty, during non-pandemic era.

– They graduated a class in Ireland early, really early in this pandemic. They actually graduated in 2019, so they called them the Class of COVID-19– when they graduated, but on your earlier point, if somebody would have told me with that sort of incredible emphasis that you just described about we’re gonna, people need to stay home, and stay shut down, and stay locked down, if they would have said that six weeks ago, I would have said, “Oh my gosh, yes, finally, “here’s somebody who gets it. “We’ve been trying to blow the bugle. “Here’s somebody who’s on board with this,” but today we need to evolve our strategy, right? We’ve seen the massive toll that this has taken on routine medical care, on chemotherapy, on elective surgery that’s necessary, it’s not cosmetic, it’s this medically necessary stuff, but yet it’s elective. We’ve seen the toll through poverty. We’ve seen so many different aspects of this thing. We’ve gotta factor all that together and ask ourselves, “Can we reopen safely?” where we can balance those two things, including all the other things you mentioned.

– It’s, as you say, the I think when we look at this, so look, you’re a quality guy. You understand the value of measurement when done correctly. If we measure outcomes over this covish, I call it the covish period, when we’re all feeling a little covish, when we see, okay, how many deaths due to COVID directly? How many deaths indirectly due to COVID-related tragedies? How many deaths due to the shutdown itself and its effects in terms of people avoiding medical care, like you said, for things that, like chest pain, stroke, et cetera, because they’re afraid they’re gonna get COVID going into the hospital, how much damage do we do to our health care system economically that, by the way, I think is a huge opportunity, and you may agree, to actually start to unwind some of this money games and garbage that we play, and I’ve been talking to people in leadership in various hospital systems who agree. They’re just terrified about they’re burning through cash that they’ve been accruing like Smaug the dragon from “The Hobbit.” He’s just like, “I’ve been piling up this cash. “We were gonna build a new wing “and call it the Jethro Tull Wing, “and now we’re spending it on keeping our staff employed.” Oh, that’s actually a good use ’cause we’re gonna need them when the second wave comes. What’s your thinking, brother? You know, Banner, Banner Health, I love these hospital bailouts, like a lot of hospitals really need it. Some were on the brink of closure, especially in rural areas beforehand, but not all hospitals are created equal, right? Some have been price-gouging, and involved in predatory billing, sitting on piles of cash, and have billion-plus-dollar endowments, and those hospitals sometimes are getting money just as the small struggling hospital that took a big hit and is at the brink of no longer being there for their community, and I wanna make sure that money goes to the hospitals that need it most, and if you’ve seen a lot of the bailout money now, there’s been discussions on Capitol Hill, and I’ll tell you very openly I’ve been actively involved in these discussions because the money is that money is not free. That comes on the backs of everyday American workers who pay taxes, 14% of whom are now unemployed, and will still file taxes, okay? That is on, that money is on the backs of everyday Americans. When that goes to hospitals, to bail out hospitals for our communities for the sake of us continuing our art and craft, it should come with some conditions, and one of those conditions is you don’t sue patients in court that can’t afford to pay those bills–

– Hell yeah.

– You don’t price gouge, okay? You take care of people, and you serve them, and you live up to your nonprofit mission, so you may see that there have been some proposals now. This was introduced on Tuesday. They’re probably gonna vote on it next week. Whether or not that bailout money comes on the condition that you cannot sue patients in court who can’t afford to pay, and garnish their wages or put a lien on their home, and you cannot surprise-bill. There’s already a condition that if Medicare’s gonna cover all COVID-related care, you can’t surprise-bill the patients, and so look, surprise-bill does not mean you’re an out-of-network doctor, and you send them a bill. Surprise-bill means there’s no conversation of that bill before an elective, non-emergent service is offered. That’s something that we can do. Many hospitals have done it. My hospital does not ever send a surprise bill, but hospitals with an open-staff model and private groups do have honest conversations with patients before that bill is rendered for non-emergent services. That’s a civil health care system, and I think that could be one of the silver linings, along with telehealth and a lot of the other cool stuff that’s happening.

– I agree, I agree, thousand percent. Never let a good crisis go to waste, and this is a chance to actually–

– That’s Rahm Emanuel.

– Did Rahm Emanuel say that?

– He said it a lot. I don’t know if he created it or not, but he’s proud of it.

– He stole it. I’m pretty sure Lincoln said that about the Civil War. I made that up, by I’ma stickin’ by it ’cause facts are in the eye of the beholder. No, you’re absolutely right, and I think the other things that I think we’ll start to see is you look at an Epic or one of these EHR people that silo off all their information. How’s that helped us during this pandemic, Marty, to have these walled gardens where there’s no information flow, where you’re repeating stuff, where you don’t know the prevalence of COVID? This is a chance to go to Judy Faulkner and be like, “Judy, yeah, remember that time “you tried to make a lot of money “by having systems control all their data? “Yeah, remember that time “it killed a bunch of people in COVID? “Yeah, I think you should stop doing that, probably by law. “I mean, what do you think?”

– Dude, I just love that piece you did on Epic where you watched the Sunday morning piece.

– A real doctor watches an Epic fluff piece. Yeah, that was the piece–

– Yes, oh my gosh. That was hilarious. One of the best one of the best things you’ve ever done, along with everything else you’ve done, so it was just, yeah, I mean, why are we, I mean, somebody needs to, at some point, just stop and say, “What are we doing,” right? How much of the money in health care is directly going to that clinician-patient interaction, right? Why are we seeing nursing pay get frozen during this thing? I mean, what?

– Yeah, furloughing nurses, dropping, yeah.

– Yeah, I mean, look, I understand if you’re in a same-day surgery center that’s closed for three months, but I mean, we got nurses on the front lines in U.S. health care who have had their pay frozen, and that is a great American tragedy. It’s a disgrace.

– And these are nurses who are putting themselves at the most risk. They get the most patient contact, and one of the most heartbreaking things that I was reading and confirming talking to people, it’s our Filipino and Filipina nurses who are suffering the most morbidity and mortality here because, first of all, they’re 4% of nurses, especially on the West Coast. It’s very high percentage, but second of all because I don’t know if you’ve treated a lot of Filipino patients, but when they come to the U.S., hypertension, diabetes. They develop and, you know, skinny with diabetes, and so they’re at risk, and yet there was this horrible story, Hollywood Presbyterian, how this nurse ran into a code, didn’t have just had a surgical mask, no face shield, did CPR on a COVID patient, went home, told her, texted her daughter saying, “I’m really worried about having been exposed.” 14 days later she was dead, and that should never have happened. We have to do better. It’s crazy. It’s nuts, and that’s why I rant and rave about what kinda leadership do we have that put us in this position from hospitals, from everywhere, every level of it, and I’m not talking about Republicans, Democrats. I’m talking about everybody. What are we doing? It’s like what you said: What are we doing? You and I have been screaming about this for a long time.

– Well, that whole Republican-Democrat, are you pro or anti this piece or that piece of reform has been one of the great decoys that has allowed these money games to go on for so long. The reality is if you honestly explain how some of these things work, 99% of rational, reasonable people are going to agree that that makes no sense and it’s a problem, right? Look at the Post Office right now. The Post Office is hemorrhaging cash. Why? Because in the early 2000s, Congress passed an act that they had to, the Post Office had to prepay Social Security and health benefits for their employees for 10 years. Well, guess what? You can’t run a business like that, and they’ve been in the hole. They’ve been taken advantage of by Amazon, which delivers packages to its point, then the U.S. Postal Service does the rest of the expensive leg of that journey, so I mean, the good news is there’s an opportunity right now to restructure some of the broken payment models in health care because there’s a massive amount of money that’s going out there, and it should be conditional. It’s not free money, and I just wanna make sure that money goes to ways that we can change and improve the system. That’s my own personal opinion. You look at Banner Health, okay? Great health system. Great doctors there. The ones that I’ve met have been, are terrific. Great reputation. They got $200 million of bailout funding. The CEO makes $21 million. Sorry, they got 200 million of bailout funding. The CEO makes 21 million, okay? Do you think maybe we could increase nursing pay, and the respiratory therapists that are in there risking their lives? And maybe that CEO, I don’t know, can he get by with 10 million this year?

– He’s the one on Twitter going, “Hi, my name is Bob Stay-At-Home Jones, “and you need to stay at home ’cause I stay at home. “My home is a yacht, but I stay at home.” Oh man, I hear you, brother, I hear you. The struggle has been, now, quite real, and it’s interesting. It’s always fun to see you out there fighting the good fight, man, because we need more scientific voices, people with public health backgrounds and medical backgrounds who are able to see all sides of it, and aren’t scared to say something like, “Hey, man, maybe we ought to do this. “It’s not a popular thing to say, but we have to do it.” We need that. Doctors, in particular, are quite risk-averse, but then you have these, there are a few doctors that are going out there on social media and are just like, “Yeah, I think we should just go back to work,” like those Bakersfield guys and some other guys like that. They have a particular political agenda. They wanna get back to work, so they’re kinda massaging their data and that sort of thing, so I think, like you said, you listen, you pull out the wisdom, and you criticize where the critical thinking needs to be employed, but what we need is more medical voices kind of speaking up.

– You see this Dr. Rick Bright is testifying in front of Congress today about his firing, or reassignment–

– Reassignment, yeah.

– Yeah.

– So what do you think about that? Because I’ve heard so many conflicting things about that guy that I don’t know what to believe, and what, you’re an inside-the-beltway kinda guy. Tell me what’s up.

– I don’t know. I’ve also heard different things. I do really respect Scott Gottlieb because I know him to be very honest and a great, I think, medical mind, and I think he’s like-minded in the sense that he’s a great listener and he likes to learn, and he actually worked with him directly and said that he was a straight arrow and had only good experiences with him, that he was a hard-working individual. You never know. Any time somebody is let go, or reassigned, or there’s a job issue, there’s almost always a side you’re not hearing, sorta like when a couple splits up. There’s almost always a side that you don’t hear that is another side.

– Yeah, like, well, she discovered his PornHub account, and he was into really interesting things, like, “Oh, that’s an interesting twist.” There’s always, I don’t know why I went right to PornHub, but it’s a thing in the pandemic. Everybody talks about PornHub. “Rick and Morty” just did it, but I think, actually that’s one other thing I just wanted to ask you, so it’s interesting to me. I had a ton of people sent me the nurse who’s crying in New York who’s, it’s like a “Blair Witch Project” type of video where she’s like, “They just murdered this guy. “They murdered this guy, “and then this other resident intubated the right main stem “and just murdered this patient, “and then they keep reassigning me,” and I’m watching that, and it’s funny. I am of two minds. One is, “Yeah, I’ve seen that happen. “Yeah, I’ve seen that happen. “Good on you for telling the world,” and then the second mind was, “This is the wrong way to do this.” You’re gonna, first of all, you don’t have the whole story, so you don’t know. You only have one piece of that story. You weren’t the clinician. You probably didn’t talk to the doctor. You didn’t do a root-cause analysis. You didn’t go through the process. You’re a traveling nurse, and now you’re terrifying the public. They’re afraid to come into the hospital ’cause they’re afraid they’re gonna get murdered, which was the word you used about colleagues that you’re working with in the hospital, instead of going through the process, so I’m curious what you think, Marty, as a quality guy. What are your thoughts on this?

– I think we could benefit a lot from listening in every aspect of society, and honestly, I know when I send you stuff, you really wanna get all the facts before you speak about it, and I really admire that about you. There may be other times where you’re speaking freely, but I know when it comes to stuff that’s really, when it’s really important, right? When it’s you’re talking about somebody’s job. You’re talking about saying something that could influence policy or shape public opinion as a thought leader, you are very careful, and I don’t think people appreciate how much research you do on several of these topics before you speak on them, and that is the sort of attitude we need, right? When I heard about this case of a person with stage IV glioblastoma who has survived over 15 years. A lot of neurosurgeons said, “Why? “Why is he surviving in a way that nobody survives?” And it turns out they did a deep dive, and it turns out that he had an abscess after his initial resection of the tumor, and that abscess bed in the surgical field was re-operated upon, and the abscess was relieved, and they put the bone plate back on in a staged procedure. Well, something happened, right? Maybe that infection stimulated the immune system, or the bacteria did something to change the sort of immunogenicity of the underlying tumor cells that may have been in the bed. Who knows? I don’t know, but you know what? If we listen to the doctors who took care of that patient, and we find other cases so we can piece that together, then you’ve got pretest probability for a hypothesis, and you can start evaluating that, but the idea that we can only learn from groups, when we can actually listen to people and hear about their experiences, and parse them together, and say, “Let’s come up with a new idea “based on something that we’re learning about or seeing,” that is really how we identify a lot of these pandemics early. That’s how, mean, look at that doctor in China. What a hero. I know you gave him a tribute in the coronavirus music video. The guy who died in China. I mean, what an incredible story, right? Summoned by the local police in Wuhan. Something happened during that time when he was summoned into the police station, and then he died of coronavirus at the age of, what 33, 33?

– 33, yeah.

– What’s the case fatality rate for coronavirus of a 33-year-old?

– [Zubin] Very low.

– It’s like the same as in seasonal flu, or it’s like the odds of dying from viral meningitis at random, right? It’s very low, so that is an incredible story, and if I had to guess what happened, I mean, this is not recorded, right?

– No.

– I mean, look, let’s face it, probably what happened, if we put the pieces of the puzzle together, is somebody in that lab at the Wuhan Virology Institute acquired the virus from something in the lab that may have went awry, went to that hospital where that doctor who died was practicing. By the way, it’s five miles away. It’s about eight miles by driving route and five miles by a direct walk, okay? Probably they went right there. That’s, by the way, the only high-level virology lab in the entire country, five miles away from this hospital. Probably they got it in the lab, went there, the doctor, being a smart doctor, said, “Hey, wait a minute. “You and the person living under your same roof at home “both have the infection,” which is what happened. This is clearly, there’s clearly a person-to-person transmission, and he sounded the alarm, right? And if you remember, quickly they published the sequence, the virus. Him and his number two, Dr. Fen, who, by the way, has not been seen since April 1st, right? She’s been missing. She was also tweeting about this after that the initial guy died, and so it’s pretty clear what happened, right? Then the message came out, “No, there’s no human-to-human transmission.” People believed that. For all of December people were believing that nonsense, and blaming the marketplace. It was pretty clear what was happening was doctors were saying something, and people were not listening to those doctors, and they probably silenced–

– And that’s the moral of whatever actually happened. You need to listen to people, and try to apply critical thinking, so if I’m listening to that same story, I could apply a critical counter and say, “Well, he was an ophthalmologist.” It’s been shown that you get a very high dose from being close in the face in terms of inoculum ’cause our ENT docs here at Stanford and other places have, there’s been a high rate of infection, and morbidity and mortality ’cause of potentially inoculum, so you can come up. This is one thing that I think Scott Adams is actually a great, wrote a book called “Loserthink” that is about, and again, I don’t read, Marty, because reading’s for losers, speaking of “Loserthink,” but I skimmed it or listened to a podcast on it, and what he says is that sometimes when you’re looking, when you’re trying to critically think through a situation, you don’t wanna fall into a trap called failure of imagination, like I just couldn’t think of alternative explanations, and so it’s important to go through that exercise. Then go what’s most probable? Then start seeking evidence, but the bottom line is if we didn’t listen to that guy, or if we would have listened, if they would have not silenced him, what different position would we have been in? Even in the very early days, I made a big mistake. My biggest mistake in this whole process, Marty, was in early like December, late December, I basically said, “You know what? “The CDC is saying this. “The WHO is saying this. “The Chinese government sequenced this quickly. “They looked at the sequence. “There’s not a lot of mutation, meaning it’s early. “They caught this early. “I bet it’s gonna be extinguished “if we’re listening to these guys. “Let’s not panic about this.” Whoops! My biggest mistake? Listening to people that are not necessarily the sole source of information, whereas on Twitter there was all this underground sort of information coming out that I typically, as a bias, don’t trust because people do crazy shit on social media, particularly anti-vaxxers, so that was my error that I’ve learned from, that now I’m like, “No, I’m gonna listen much more carefully across the board.”

– Why do people in society want somebody who is all good or all bad? I mean, that, I mean, look at, for example, Anthony Fauci. You know what? I was critical of the fact that he didn’t say any, he didn’t sound the alarm from January 15th to March 15th, but that was a mistake, okay? Maybe there was reasons for it we’re not aware of. He’s still a very smart man. He’s still giving sound medical advice. Why do we have to like trash people?

– Mm.

– And we see this all the time with any, really, any public figure nowadays–

– It’s a–

– Now, we make mistakes.

– It’s a point-scoring game because the game has changed, Marty. It used to be the game was find truth, find civility, find compromise. Now the game is score social media points by demonizing the opposition and scoring points against them, so ever since that game changed, our whole civil discourse has changed, and that’s what we have to work on. Even if we disagree, let’s talk about it. Like, assume good intent. That’s the other thing. Like, why do we assume, let’s say we, let’s say you and I disagree about Fauci. I think he’s a god and perfect, and you criticize him for not sounding an alarm. All right, let’s take that stance. Both of us should assume the good intent of the other, and actually, Fauci’s good intent, that his actual intent is to try to do the right thing, whether he’s error-prone or not, but we don’t do that. I mean, not you and I, but in general, as a people we don’t do that, and that’s to our detriment, and I think that’s been a huge problem. Now, I get rightfully criticized by anti-vaccine people and others for not listening, and the reason is I have listened. In fact, when all this thing first became a thing, I was like, “Wait, this could be real,” like my own biases, “Yeah, don’t trust pharma. “Don’t trust government. “Don’t trust corporations, yeah,” but then you actually go through the science, and you go through the critical thinking, and you realize, “No, actually,” but I still have this feeling, Marty, and I don’t know what you feel about this. Maybe you don’t even take a stance on it, but there is a way to figure out who’s gonna have complications from vaccines, that rare, one-in-a-million complication. We just don’t know it yet, but we ought to be spending some effort, when you’re talking about vaccinating everybody, to try to see if we can understand better. I think this crisis will help us, too, to get vaccine science a little bit advanced.

– Yeah, you know, the reason why we have anti-vaxxers is because the public trust in the medical profession has been eroded to them, right? It’s from their experience. I mean, if you really sit down with one of these individuals, and really, and you know, it’s like you can discover them anywhere, right? You can find somebody who’s very pleasant, who’s a friend, a friend of the family, and they start talking about this topic, and you realize, “Oh my gosh, “they are not on board with vaccines at all. “They are one of these people that we label anti-vaxxers,” and you really dig in, and it turns out there is some deeply held mistrust, and that mistrust may have been based on something legitimate, and is taken out on this issue of, “Oh, I’m not gonna let them stick anything else in my body “after they killed Grandma unnecessarily “from this other thing,” and that is our opportunity right now. That is the exciting thing about medicine is we can rebuild the public trust, and we’re seeing young people do it. We’re seeing doctors who have been in practice forever who are saying, “I don’t care what your insurance status is. “You come in and you see me. “I’m gonna take care of you.” I mean, that is the great heritage right now in medicine that we have this privilege of upholding. It’s a incredible privilege that we saw demonstrated in Jonas Salk. When he invented the polio vaccine, he refused to get a patent on it, and he said, “This is the property of mankind.” He was urged to get a patent on it, and he said, “No, this will be a gift to humanity. “This is the property of mankind “so that as many kids in the world can get it as possible “and prevent this horrible disease.” I mean, you talk about a hero, or you talk about our great medical heritage that every nurse, every physician, every physical therapist, we all carry the torch of that great legacy from our ancestors, and it’s really an incredible public trust, so when I see the anti-vaxxer movement, when I see those who are like, “Screw this taking precautions. “I’m not wearing a mask,” what I see in there is somebody where that public trust has been eroded in their background for some reason.

– Yeah, that was beautiful, by the way. That was very well put. I think that’s inspiring, and it’s a good way to kinda close this out because it is this tradition, this torch that we carry, and I think that’s why a lot of us get triggered by anti-vaxxers because they question the very integrity of our tribe, right? They’re saying, “No, you’re in it for money,” or, “You’re in it to, as part of a big conspiracy,” but then you look at them, and you say, “Well, what happened to you?” It’s not about what’s wrong with you, it’s a, “What happened to you? “What happened?” I can tell. I can list all the things that go wrong in health care, and I’ve said that before, and I’ve had people on the show, like Britt Hermes, who used to be a naturopath, and the reason she became a naturopath is that she was tortured, and abused, and belittled by the Western medical establishment for her eczema that she had. The dermatologist was an asshole to her– and you know, and most dermatologists are. I mean, I didn’t say that out loud. I meant to just think that, and so, as a result, she was pushed into a field that, as a innate scientist, she started becoming increasingly uncomfortable with, and had to break with, and then kind of tell-all, like we need to do better in Western medicine if we’re gonna connect with people because these guys are gonna eat your lunch, and they’re not right, scientifically, so it’s interesting, so thanks for inspiring me, Marty, and for taking the time out of your day ’cause I know you’re busy as hell during this time.

– Well, I hope Bill Gates is watching, or will watch this, and I’m not sure what message to send him, but I would like to know where to click on Microsoft Teams in order to see the multiple views at the same time, so maybe he could e-mail me that information.

– You know what? Can he CC me? Or better yet BCC me, but we know Bill can read all the BCCs because Bill Gates. Do you ever wonder about that, just as a parting thought? Do you ever wonder? ‘Cause sometimes I’ll be interacting with people at YouTube, or Facebook, or Google, and I’ll BCC someone on my team, and I’m like, “Why am I bothering? “They own Gmail.”

– Right.

– It’s like this thing–

– Right.

– is really gonna be secret, like, so yeah–

– Oh yeah,

– Curious.

– they’re reading everything. Google’s reading it, Microsoft, the NSA, they’re, I mean, if I lose an e-mail, I had an appointment the other day, and I lost the e-mail with the details. I just contacted the NSA and asked them for their copy. Ow! Marty Makary, you’ve put a smile on my face, sir. It’s really good to see you, hear your voice. One day we’ll meet in person. I really like the dramatic backdrop you’ve got going. That is the number of views I got on this interview already, and it hasn’t even been released. That’s that–

– People were–

– 300,798.

– People were watching us now?

– Oh, I didn’t tell you I was recording this thing for the thing?

– Oh, well, you know what? What the heck. That’s fine. Yeah, it’s great. Great.

– Awkward, yeah, the world is like, “Wait, this is how you guys just talk?” Like, you call up Marty and just pontificate about, like, masks? I’m like, “Yeah, actually that’s kinda what we do.” ZPac–

– Well, great to see you, brother.

– Oh, it’s a pleasure, man. ZPac, I hope you enjoyed this little episode. I will link to all of other, all the other stuff we’ve done with Marty where we’ve co-interviewed guests. We’ve done a ton of stuff. Marty is a brother from another mother, and a real personal hero of mine doing great work in the world. If you haven’t checked out his book, “The Price We Pay,” you better go check it out. I’ll link to that as well, and please share this. Please do your part to give back if you have the means. I think that’s one theme that Marty and I have teased out of this. If you’re lucky enough to be able to survive this lockdown, see what you can do for others who are having a more difficult time. If you’re in health care, you’re already doing your part just by showing up, so thank you for everything you do, and I love you. We are out, peace.