We’re back! In this episode we talk: dumb COVID policies, mask shaming on both sides, Kyrie Irving vaccine controversy, worshipping Lord Zero COVID (Hong Kong and elsewhere), press coverage biases, a FOURTH booster shot, ethical considerations around pharma not providing meds to Russia, dumber college COVID policies, the deal with early treatments, Ash Jha and John Ioannidis, and the James Webb telescope and STEM inspiration.
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– [Zubin] Hey, everybody, welcome to “The VPZD Show”. What are at episode 15 now, VP?
– [Vinay] 15, 14, something like that, ZD-
– Somewhere in there.
– Something like that.
– [Zubin] Somewhere in there, but I’m one of your hosts, Dr. Zubin Damania, UCSF Stanford trained hospitalist and host of the “ZDoggMD Show” and this is Dr. Vinay Prasad. He is an extraordinary, extraordinary, extraordinary, extraordinary.
– [Vinay] Extraordinary insert your favorite word, it’ll depend on who you ask. I’m an associate professor here at UCSF and I’m a hemonc doctor and we are the host of this news show, I like to call it a medical news show, but you know we don’t always get through all the news.
– [Zubin] That’s true and you know it’s good for me because it’s where I get my news now, Vinay. I no longer watch the news. I’m too frightened I’ll learn something about Putin that’ll make me wanna fly over there and slap him across the face. I’m too emotionally volatile.
– [Vinay] Well, I don’t blame you. I mean the news is, it was always depressing, it’s been really depressing lately. COVID is, you have to click on the tab to get to COVID these days, that’s saying something, you gotta click on the tab. It’s Russia, Russia and then if you click on the second tab, oh, look at this, actually live confirmation hearings are number one of the Supreme Court justice, Ukraine Russia War number two, and coronavirus pandemic last updated 20 minutes ago, I’m looking at the New York Times. It’s number three so it’s been pushed back.
– [Zubin] Well, you know, we can thank pestilence, war, I mean I guess it is pestilence, we can thank war for this and also Supreme Court stuff. I mean, it’s kind of cool, we have female African American justice being, going through the confirmation process. I mean, it’s pretty remarkable.
– [Vinay] I haven’t kept up. Are you a legal scholar? Are you like the law?
– I am. I’ll tell you what, whatever’s in the news, I’m suddenly an expert in it. So when Putin invaded Ukraine, I almost, I just decided, you know what, I’m a geopolitical expert, I know Russian history, here we go.
– Well you joke, but some of these COVID pundits, they added a biosafety expert in their handle and started tweeting some nonsense about it.
– [Zubin] Man, that’s great. You know, look, if it gives you power, glory and influence, why wouldn’t you do it? I mean that seems to be the driver for a lot of folks. People have accused us of that too, oh, they just want influence and all that. We’ve talked about this. It’s like kind like, well, no, VP’s been up to no good for a long time.
– [Vinay] And interestingly, if you look at my Twitter feed, you didn’t see the Russia pivot because I do actually stay out of things that I don’t like to think about or I don’t have any expertise in. The reason I got deep into COVID is of course I feel like I do have that expertise and people weren’t saying what I wanted them to say, they were saying crazy stuff.
– [Zubin] Yeah so you had to have an intervention on a mass scale that led to this podcast.
– Mass intervention and it’s still not done. And by the way, we have to close the loop on something. On the last episode of VPZD, you told the saga of the Cal Academy, which is sorry to bring up old news, I thought the wound was healed, I’m gonna pick at the scab, you brought up this covidian museum in Golden Gate Park that has singlehandedly decided to enforce a booster mandate at young age. Of course, when you think booster mandates, you think the place that ought to make those kind of big decisions is of course Cal Academy. It’s not supposed to be any sort of federal regulator, it should be Cal Academy. And we pointed out the absurdity of the policy, et cetera. Somebody wrote to me, a very smart person, and this person said that one of the things you didn’t mention that is further evidence of the absurd policy was that if you’re one day post booster, you don’t need the test. And so the booster, it cannot possibly work immediately and yet the policy did not have any sort of time window after the booster. And so that’s yet another example that they don’t know what they’re talking about.
– [Zubin] Yeah, you know, it’s funny man, VP, like as they updated that, I deactivated Twitter and I’d gotten up to the limit of where I could reactivate it so it was like, okay, the clock was ticking and then I’d just lose that account for good and I was okay with that and then a lot of people talked to me, including you and they were like you know, you were correct about the Cal Academy but that wasn’t the reason I deleted Twitter, it’s because it’s a cess pool, but I realized your idea of just hey, just have your team post and ghost on there so that you can reach people with the videos you care about that are nuanced and actually contextual and aren’t the little sound bites, you’re very good at Twitter, I mean you put in threads and you do all that, I’m too lazy, I’m a bad writer. So with the Cal Academy thing, I’ve been thinking about that a lot, dude, they needed to change their policy, that’s not a science based policy like you said because there’s absurdity baked into it. Like the fact that one day post booster, you don’t need a test, it doesn’t make any sense. And I understand that they’re trying to kind of push people to do this thing, which again, also doesn’t make sense.
– [Vinay] You know that’s not their fucking job. I’ll be honest, I hate to say it, that’s not their fucking job. They’re a museum. They shouldn’t be pushing 12 year olds to get boosted. They’re so far out of their fucking job. I mean, are you crazy? They have not even thought through the ramifications of aggressive boosting. We’ve had two people resign at FDA, Paul has been talking about it, Offit, your friend. You can’t have these rogue museums decide to set booster policies. I mean this is not how it should work in America. I mean, look, we can disagree when the CDC sets a policy, we can disagree when the FDA authorizes a product, you can agree, you can disagree, you can disagree with your state policy, I get that, but you just can’t have a system where rando preschool, rando museum is setting policies like this. These are products that are under emergency use authorization. they’re not meant for museums to decide we’re gonna use coercive power at our museum. We have to have some expertise involved in those decisions. Even if I disagree with the decision, I’d rather it be made at a different level.
– [Zubin] Yeah, oh no, I’m with you. And the thing is schools are doing this, public schools. So my kids in a middle school, there’s no indoor mask mandate now.
– And yet, yeah, every single child is wearing a mask she told me. She feels peer pressured and social pressured into wearing one. She doesn’t have a problem with masking, but she’s like, “Well, if it doesn’t make scientific sense, why are we doing it?” And I’m like, “Good question.” But the interesting thing is so there was a kid in her class, in one of her classes, that decided I’m gonna take my mask off and the teacher moved the child, so publicly told the class, listen, if you’re gonna not wear a mask, I’m gonna put you next to the door because I’m high risk. And of course, this person was not necessarily high risk. They were my age, masked, triple vaccinated and made an example of this child.
– [Vinay] That’s not good, man. That’s not good.
– Not good. That is an example I think of what you’re saying of these rogue scientists, rogue decision makers. Since when is that the role of a teacher? Now I understand if the teacher’s uncomfortable, then there’s probably structural things they can address, but singling out a child who’s actually obeying the state non-mandate seems crazy to me.
– [Vinay] Let’s point out that there can be problems on both sides and I can imagine there’s a kid right now in I don’t know maybe a Texas school and it’s the only child who chooses to mask and that child shouldn’t be bullied, shouldn’t be teased, shouldn’t be made to feel uncomfortable, let’s say that. At the same time, if you come to outdoor N95 capital of the world, the Bay Area, and you are a child who decides, hey listen, I’m young, I’m healthy, maybe I don’t need to wear this N95 and the rule has changed, you should not be ostracized, shamed like this teacher is doing. And by the way, I’m fully cognizant of the fact that there are some people who are actually still vulnerable, absolutely. People who are undergoing certain types of treatments, highly vulnerable. I think we also have to recognize that when people self-identify as I’m immunosuppressed or vulnerable, they may not be meaning the same thing that a physician might mean when they think about the most vulnerable people. I had someone recently tell me that they know somebody who’s 24 with mild exercise-induced asthma who is immunocompromised. And asthma of course is a subtle risk factor for COVID-19, sure, but I wouldn’t classify a 24 year old who can run 11 miles as this person could and has to use an albuterol inhaler sometimes when they’re running so hard, I wouldn’t classify that person as a highly vulnerable person from COVID-19. And so I think we need to have some clarity as to who is actually vulnerable and who isn’t vulnerable. And as you know, David Lineheart had some nice articles in the New York Times showing that liberals, particularly very liberal people, vastly overestimate the risk of this virus and they have a really distorted sense of risk, they’re sort of enumerate.
– [Zubin] Yeah, I think this is crucial, actually everything you pointed out because there’s listen, we tend to take this tech because we live in the N95 outdoor capital of the world, right, like you said. We tend to really focus on this idea of like, hey don’t shame people if they don’t wanna wear masks and let’s look at risk, and you’re right, liberals overestimate risk, but then you get to, I think what we should, I’m glad you pointed this out that like in other parts of the country it’s the opposite issue. It’s the conservatives overestimating risk of the vaccine, underestimating risk in high risk populations and then over-emphasizing the problems with masking and there is the shaming component of people who do wear masks. And now this idea of being enumerate, like not understanding risk, I think that’s a core problem here. Like if we could really teach people, like if you could teach the California Academy of Science about risk, wouldn’t that be nice? I mean, if they can’t figure it out, how is an individual getting it right? I think there’s a client, yeah.
– [Vinay] No, that’s really well put. And if I really think about the Cal Academy, the reason I think it irks me is they are not really proving themselves to be scientists, they’re proving themselves to be ideologues. Like we all know there’s this left right political dimension to this. By the way, on this topic, you’re talking about ridiculous policies, Kyrie Irving, this has happened since we last spoke, this is in the news. I think I did a video on it and boy, I really, it’s a story that really I find so intriguing. So Kyrie Irving is a basketball player in New York City and that’s his home team and he is unvaccinated and somebody has told me that he’s had and recovered from COVID-19, but he’s a 20 something year old, extremely healthy guy, had, recovered COVID-19, unvaccinated, and in New York City, they have list lifted the mandate for the stadium arena. You can now attend in the stadium arena, no mask, no vaccine passport, you can be there in the front row. Unfortunately, if you are unvaccinated and an employee in New York City, you’re not allowed to work. And so that means Kyrie Irving can literally sit courtside breathing all over the court, but he cannot stand on the court because that would be an unvaccinated player playing. And he went into the locker room and they fined his team $50,000. So here you have the dude in a picture, he’s like three feet away from the people playing, but if he stood on the court and he shot the basketball, that would be a violation of the rules. And I just think that this is why, you don’t need to know anything in America to know that that’s some bullshit, that’s some bullshit, man. That’s some stupid rule. And you know, I saw Kevin Durant he just went on a rant about how this is such a stupid rule. I mean it is a stupid rule and people who want to have trust in public health and I’m one of them, we have to condemn stupid rules like this. We have to say, look, this is not public health, this is zealotry, irrationality. This is not what evidence-based public health means. This is literally contradictory. Thoughts?
– [Zubin] Dude, this is the left brain ascendancy. So this reductionist, everything is parts and rules and bureaucracy. that’s what this is. It’s like, oh, well here here’s the rule and it makes no sense, it’s out of context, it actually has no common sense or rationale and it’s unscientific. So you combine all those things and now that’s policy, of course you should be upset. And like you said, because we actually care about public health, contrary to some what some people say about us, which I think is insane, we actually revere the idea of public health. I revere vaccination as a public health tool and yet here we’re seeing it, all that trust and belief in that system is being eroded by these morons, they’re bureaucrats and functionaries and idiots and you want to take them outside and beat them because you’re just like, what is wrong with you? You’re ruining decades of progress on this stuff by just behaving like an ideologue. I think you said it, it’s a just pure tribal ideologueness.
– [Vinay] You know and I look at like, I see on Twitter, I’ve been writing a couple Substacks, when cases go up, what happens when cases go up? I wrote one February 10th, March 10th, now finally the wastewater data, it’s looking a little, making people nervous, that wastewater, see. When they’re looking in the effluent, I think they call it effluent, that’s the technical term for what they’re looking at.
– Yes, yes, it’s the log of the logs.
– [Vinay] Let’s just say that I had to do a lot of things I didn’t wanna do to get into medical school, but I didn’t have to go through some effluent, but okay, they’re looking in the effluent and they find that it’s going up, they’re getting nervous and then I see people saying, we gotta get ahead of this, we gotta start masking those toddlers again. I’m like, no, that’s not what you do, that’s not what you do to get ahead of this. What you do is you vaccinate people who didn’t have COVID-19 over the age of 65, you boost them, but you take it easy on the young people, that’s not gonna be the driver here.
– [Zubin] Yeah but try not to generate fatigue in the population too which you’ve done already. What are your thoughts on Hong Kong? ‘Cause the Hong Kong situation to me is amazing. It’s like, wait, they did everything here incorrect in terms of risk. So the over 70 year old population was like, no, we don’t trust vaccines.
– [Vinay] They’re like, oh yeah. The over 85 year old population was like, I’m pretty worried about the long term consequences of vaccine. I’m like, how long term are you worried about? You’re 85. You need that vaccine for next week, buddy. What are you worried about? You’re worried about what, when you’re 95, 105? But yeah.
– Again risk, risk.
– [Vinay] They followed the zero COVID ideology. They built the altar to Lord Zero COVID. And the problem with Lord Zero COVID is it’s a false God. Lord Zero COVID is not tenable. Now, they could have done one thing, as you say, if they had just vaccinated older people, then if omicron swept them, it would’ve been a lot better. New Zealand, maybe they’re kind of closer to that. They did vaccinate older people, they did get swept by omicron, they did prey to Lord Zero COVID, but I think they’ve done better, but they’re also very cleverly, I don’t know if you know this, the New Zealand health policy minister, they decided to take their country and drop it in the middle of the Pacific Ocean as an island nation. That was a very smart early policy move, good move. I kept saying that we should do it here, but no one listened to me.
– [Zubin] Yeah our problem is we’re connected to Mexico and Canada and this whole land bridge I think the whole breakup of Pangaea was one of the smartest public health moves in history, you know?
– [Vinay] You’re right. Yeah, it separated the flora and fauna, you break up Pangaea. So you’re pro-tectonic plates, you’re pro-tectonic plates?
– [Zubin] You know what? People say I’m anti-geology. I’m not, I’m pro-tectonic plates.
– [Vinay] Pro-tectonic plates.
– [Zubin] I’m pro-magma. I really enjoy those collusions between the plates that generate the ring of fire around the Pacific.
– [Vinay] I like the word magma.
– [Zubin] Yes, magma, yes.
– [Vinay] Yeah. You know this is I think the 4th or 5th Dr. Evil reference you have dropped on this podcast.
– [Zubin] As a diminutive bald man.
– [Vinay] It always resonated, it always connected.
– [Zubin] It really did, you know the laser. So back to Hong Kong, I got to say speaking of Dr. Evil.
– Well I was gonna say that that’s how it was when you launched your YouTube channel. They’re like, “What do you want?” You’re like, “One million dollars, one million subscribers.”
– [Zubin] I want one million subscribers, actually back then it was like 10,000 subscribers. They’re like, “Dr. ZDogg, that’s really achievable these days, like any kid with an Instagram account can do that.”
– [Vinay] Anybody with a TikTok who dances, yeah.
– [Zubin] Anybody, right yeah, 100,000 subscribers, anyone? Oh man. But you know so Hong Kong, you’re right, if they had just vaccinated, then you can have Omicron BA.2 or BA.3 or BA.12, you’re protected against severe disease. The reason they have the highest death rate in the world right now is because they didn’t vaccinate their most vulnerable, which is you have one job, just do that.
– [Vinay] You had one job.
– [Zubin] I like this idea of the Lord COVID Zero, like he shall smite thee with open borders if ye doth choose the open borders, you shall be smoked.
– [Vinay] They’re doing a lot of things to sate God Zero COVID. Even in Europe, they started culling hamsters, they’re killing off some hamsters.
– [Zubin] No.
– [Vinay] Yeah, they’ve got some people culling animals. You know the animals can get zero COVID. I saw that COVID has been evolving in deer.
– [Zubin] Yes. And deer, I understand you could totally get to zero deer. That’s an easy thing, you just let Joe Rogan go hunting for like a week.
– [Vinay] Who knew he was both the problem and the solution?
– [Zubin] And the solution. You got to hold paradox if you’re gonna live in this world.
– [Vinay] I feel, I honestly, I listened to his episodes and there’s a lot I liked, lot I didn’t like, but after I kept watching people attack him, even I started to feel some sympathy because I’m like, he’s a guy who has a show. You don’t have to listen. The fact he’s very influential speaks poorly of you just because you’re offering a shit product, CNN. I mean your product is terrible. I mean not a day goes by where I look at the news and I think to myself, there are so many errors in this story, so many errors in the coverage of this article, so much uncritical stuff. I gotta say, lately I’ve been really pessimistic because I don’t know. I tweeted some article, I wrote something, I saw something and then somebody tells me, “Oh, here’s the thing you’re missing about this article” except everything they say from that point is like totally wrong and I’m like, oh my God. And you know, it hit me ZDogg that like that the average person watching just has no idea who is right and who is wrong and I felt like chill down my spine.
– [Zubin] Yeah that’s why when Putin invaded Ukraine, and I’m absorbing all the news and I was like, wow, a war in Europe in this day and age and this is happening, I did some rant live and I was just like, God, fuck this and fucking Putin and then I realized something, I was like wait, I have no of what I’m talking about because I’m just believing whatever I’m seeing on CNN or Fox or any of this stuff and I have no independent ability to confirm any of this, I have no idea of the deep history involved, I know nothing. And so recently I read an article in I don’t know if it was Wall Street Journal or something, it was an op-ed and it basically said, “How come the press is not talking about the fact that the Ukrainians are winning this war?” Like they’re talking about this inevitable Russian victory, but if you look at all the actual battlefield data and he went through kind of meticulously and said, “The Russians are losing this and nobody is talking about that.”” And I thought, okay, whether that’s true or not, what’s fascinating is completely diametrically opposite truths can be out there and you don’t know which is true. And as a non-expert in this, I have no clue. So imagine what it’s like in COVID for somebody trying.
– [Vinay] That’s a great analogy because obviously in any war, there’s news and there’s propaganda and they often intertwine. The fact is that the people who are running the show are often the people who are also selecting what information to make available and truth be told, I think there are things that I’ve read and listened to that I think are credible, there are things that I’m not so sure about. I don’t have a deep geopolitical expertise in this space, but as you say, it reminds me of what it would be like if I was approaching COVID not as somebody who’s a professor of epidemiology and a doctor, but as a layperson, it would be very, very difficult and I think you’d have a hard time teasing out what’s truth from fiction, absolutely right.
– [Zubin] Yeah and you know on top of that, so my kids and I went to this local Chinese restaurant here in San Carlos near our studio and we were sitting in there and they had the big screen TV on with nightly news playing and I don’t have TV, like I don’t watch, I have Netflix and those kind of things, I don’t have any cable so I don’t watch news, I read articles on news that digested and so on and I found myself riveted by these stories of Ukraine and I realized something ’cause I was getting angry, I was feeling like emotional, and my kids were like, “What are you watching?” And I’m like, “The news. Shut up, I’m watching the news about this monster Putin and his murdering these”, and then I realized what was happening is the medium, how you’re actually portraying news will determine your empathic emotional response and watching like video images of this stuff and the way they’re framing it and the way they’re appealing to this kind of very limbic hijack of our emotions, I was like, wow, I’m getting so angry and I’m feeling so much sadness for these people and so on whereas when I read an article, I’m able to kind of detach a little bit and have a more detached compassion. So we really are, the medium is the message and it really does manipulate us. So I imagine the same’s with COVID, I’ve not seen TV reporting on COVID, but I’ve had people reach out and they’re like, “You are a monster. Like why don’t you take this “seriously”? People are dying. I’ve seen these stories on the news,” and I just didn’t understand it until I watched this news approach and I was like, oh, they’re completely emotionally invested in this because of the medium that’s informing them.
– [Vinay] I mean and I think there’s obviously a role for both because I think many things in war, it’s taken that one photograph that’s really kind of brought people to see what was going on that they couldn’t see when it was just stats. At the same time, I think COVID is a great example. As you say, you can take a video camera to the emergency room and you can talk to a doctor who just finished a long shift who’s seen grim things and that doctor says, “Things are bad here. We have to do everything. We have to close schools.” And now suddenly you have a very emotional appeal to closing schools. And to some degree, this did kind of happen, but the reality is if you close the schools, the doctor will still be bombarded and it will be almost the same as if you open the schools. The only difference is those kids will be crushed. And there’s no documentary film crew following around every kid who’s getting abused by their parents, who don’t have enough to eat, who’s falling behind on grades. So it’s sort of an asymmetry of what we can photograph and what we can’t photograph and I can imagine if you had a different documentary film crew that’s following the kid who’s no longer in school who’s trapped at home with an abusive parent with literally no hope, don’t even know when they’ll be rescued, I think it will have a different emotional appeal. And so that’s problem with policy. I think at least in healthcare policy where I do have expertise in is that you have to feel both stories, yes, but you have to then objectively look at the data and say which is worse and that’s the harder part, I think that’s the part that takes practice.
– [Zubin] This is central to this whole thing because you have the general mainstream media that are making these decisions of what to cover, right? So if they’re covering the doctor who’s like head is in his or her hands and has seen this horrible thing, that’s what they’re gonna do, but they’re gonna make an election or a choice not to cover the other story like you said. And I think what you point at is this distinction that I often make when I talk about this, which is the distinction between cognitive empathy and affective empathy. So affective empathy is feeling someone else’s pain as your own and acting from that short term feeling. Cognitive empathy is a more detached understanding. Now, psychopaths can have cognitive empathy so they can manipulate people by understanding what they’re feeling, but not necessarily feeling it. So it has its downsides, but it has its upsides, which is you can understand a problem, you can understand their suffering and then you can apply a broader, less emotional solution, which in this case would be to look at the area under the curve of harm to children and go we should not close schools.
– [Vinay] Now let me ask you this, in the time since we last spoke, there’s some big news out there and I wanna know how you feel about it. Now, do you want me to give your fourth dose in your left arm or right arm, which arm are you gonna take?
– [Zubin] I want you to give it right in Buck’s fascia and the doctors out there will know exactly what I’m talking about.
– [Vinay] In Buck’s fascia.
– [Zubin] Right in the spongiform tissue.
– [Vinay] Oh boy, it’s contraindicated.
– [Zubin] It is.
– [Vinay] So well it will get you the inflammatory response, but I was shocked because I guess Pfizer’s going after 65 and up and we’ll have a debate about that data. I wish it were randomized, but I think it’s 65 and up is one situation. Moderna’s going for 18 and above.
– [Zubin] For a fourth.
– [Vinay] For a fourth and they have no randomized, I mean are you serious? Is anyone gonna seriously look me in the eye and say, “I’ve got a 19 year old guy here from college, a college kid, he’s super healthy, he goes running all the time, he’s super fit. He’s gotten three doses of mRNA vaccine and he just had Omicron and recovered. We want to give him a fourth dose ’cause uh, ’cause our shareholders, I mean the pandemic,” I mean come on, get out of here. You have no data. I don’t want to rant too much. I’ll let you go first.
– [Zubin] I got to say this about fourth. Since when does the CEO of Moderna and the CEO of Pfizer make public health policy? They’ll go on the news and say, “We require, we will be needing a fourth dose for X, Y, and Z.”
– [Vinay] I’ll tell you when, I guarantee you that all these people in the administration, Peter Marks at FDA, my only question is when he leaves the FDA at the end of this term, is he gonna go work for Moderna, Pfizer, a hedge fund? Who’s he gonna go work for? ‘Cause all these people are participating in the revolving door I think, that’s my worry.
– [Zubin] No yeah and you’re absolutely right. And the thing is you can get branded an anti-vaccine activist just for saying that, like for daring to question the financial incentives here.
– [Vinay] I do think that, you’ve mentioned a few times that people are critical of us and et cetera, I really don’t think that that’s most people. I’ve recently had the opportunity to talk to a lot of ID doctors, a lot of academics, very senior people and I really feel that most people are where you and I are. There’s obviously a group of zealots online, for them being anti anti-vax is just as tribal and important as it is for anti-vax people. Like these anti-vax people, it’s part of their identity. It’s the thing that they get up and they think, how can I slap an MR vaccine away from a child? They might think that. And then the anti anti-vax is how can I slap the person who wants to slap the booster, or how can I slap a fourth dose into an 18 year old? I mean they’re both kind of delusional, they’re delusional, they have their tribe, they’re online, they have all these puppet accounts that they retweet each other and praise each other. They’re angry at you. I don’t think the root of their anger is your views. I think the root of their anger is that you’re able to run a one hour show that’s very engaging and that they’re not ’cause if they, whatever your view is in life, if you’re an anti, whatever, if you’re a compelling speaker, go out there and work on your craft. You want people to believe something, go out there and do it. I just saw this article, last thing I’ll say, I just saw this article, it was about Emily Oster, she’s the economist at Brown. She’s a very rational thinker and I think she’s quite smart and this article was taking a big dump on her and it was like, did you know when she wrote her second book, she gave a talk in front of an audience that’s libertarian right of center? And I was like, her book is called “Cribsheet”, it’s about parenting, it was several years ago. I was like, she’s not in cahoots with the far right. She just gave a talk. Why did she give there? I’ll tell you probably why, ’cause when you write a book and if anyone asks you to come talk about it, you’re like, “Oh great.”
– [Zubin] You go do it.
– [Vinay] You go do it ’cause beggars can’t be choosers, you just take whatever you get. Anyway, this article was on and on about Emily Oster and she’s this, she’s that and here’s what really I get to, like what I get stuck on, here’s what I tweeted. “It is embarrassing to write this creepy piece about a colleague”, ’cause it is creepy, dude, it’s like getting into what she did five years ago. And I said, “If you want to close schools, mask toddlers and slaughter hamsters to satisfy Lord Corona, just make that argument directly, you don’t need to bring Emily Oster into it.” And that’s what I keep coming to which is like if you want to boost 12 year olds with, and by the way, it’s the same side mode. The mRNA vaccine is supposed to be a platform that you can easily swap out the part in the middle, you can easily put the new sequence in, and that’s why we use it, like it’s so easy to change. And if that’s true, why the hell are we still getting the same old ancestral sequence that’s gone? So anyway, but if you really wanna keep boosting people with the same old crap without any randomized data like a damn fool, you’re free to make the case and be a fool elsewhere, you don’t need to bring Emily Oster into it or anyone else or ZDogg.
– [Zubin] No because there’s a political angle, like you said, they’re attacking her because she spoke for a libertarian group or whatever. Who cares who you spoke for dude? Give me a break.
– And five years, and it was a book, and it was about a book called “Cribsheet”. The book is crib, what was the collusion in “Cribsheet”? Were they trying to, I mean what was the right wing plot?
– [Zubin] Yeah, they wanted them to sleep on their belly instead of their back. It’s like oh my God. That’s exactly it and what I did notice, what I do notice, by the way, you’re absolutely right, there’s a silent majority and I say silent majority because they don’t make a lot of sound that agree with a lot of the rational stuff that’s been going around, the Oster’s, the you’s, et cetera, saying, look, yeah no, we’re actually with you and actually a lot of them are doctors, a lot of them are public health people, they’re quietly because if you open your mouth, you attract the loud, crazy people. And I’m saying this honestly, crazy people. I had this one person on my show a few years ago, I deleted all the episodes we did with her, we did one, I deleted them all because somehow when that whole Twitter thing happened, I noticed she had tweeted and she’s like, “Oh, now he’s gonna go”, like she’s attacking me. She’s like, “He’s gonna go sign up an account on Parler and Truth and Trump”. And I’m like, wow, you are completely insane, like you’re kidding me?
– [Vinay] Like, what does it say about someone’s brain that they like, like they can’t even, like ZDogg, if I were to look at your point of view, your point of view has been, first of all, you featured a lot of people across the spectrum, that’s one thing. You have Offit one week, you have Marty the next, I mean you have a range of different people, that’s a fact. Number two, you’ve consistently been a passionate advocate for vaccination. At the same time, you’ve also acknowledged people’s legitimate concerns. If anything, that makes you a more effective vaccine advocate than these zealots because zealotry is not attractive. Fundamentalism is not as attractive as acknowledging people’s real concerns. So anyway, you’re this person and now suddenly you’re gonna be on Parler or you’re gonna be on what is it called, Truth Social, the new Trump, what is it?
– [Zubin] Right, the Trump Twitter.
– [Vinay] Trump Twitter.
– [Zubin] Trump Twitter, yeah.
– [Vinay] And by the way, I don’t think he’s even tweeted once on it but yeah, this is the Trump Twitter.
– [Zubin] And you know what’s funny? So my assistant, her son just decided, you know what? I’m gonna get ZDogg an account on Truth because I want to hold it in case some bot steals it. And so there is a ZDoggMD on Truth. I don’t even have access.
– [Vinay] Telling the truth.
– [Zubin] Telling the truth.
– [Vinay] Truth with a PH or something.
– [Zubin] Truph. Oh man, that’s excellent. Yeah, but the other thing that you mentioned is people, okay if you do somebody’s job better than them people don’t like that. So if you’re out advocating, you’re doing critical thinking better than a lot of people who are paid to do critical thinking and people, they don’t like that. So they’re going to find a reason to hate on you and do all that and look, that’s all fine. I think you’re spot on that like, when I get stopped on the street and it happens a lot which is weird. People will tell me, “Thank you. I work as a scientist, I do this, I do that, thank you for like speaking truth that we’re all afraid to say because we’re gonna get deleted.”
– [Vinay] You know, to be honest with you, I think that you call ’em the silent majority and some, and like in the last few days I’ve kind of been like, hmm, maybe I’m gonna join this silent majority because the headache of giving your point of view, I mean let me put it differently, like you, I think there are definitely, I do feel like to comment about issues where I have expertise and I think differently than others. And I feel like if somebody was saying exactly what I wanna say the same way I’d say it, I probably wouldn’t feel so obliged to comment, but I often don’t find that. That said, I think if you do a video, if you do a Substack post, you’re the one who told me about this way to put videos on Twitter and I’ve been trying it. Actually, it’s very effective, very effective. So okay those have been effective. I think if you just tweet 140 characters, it’s really impossible, Z. I think you’re totally right. I mean people read it, I don’t know maybe they read your thing and they’re like, like you had written whatever you said about Cal Academy, we’re just gonna blow shit up in our backyard and they probably read it as say, “I hate museum.” Like, I don’t know what’s going on, like they can’t even read.
– [Zubin] No nuance.
– [Vinay] No nuance and maybe they can imagine you’re saying it, I mean I can’t even, I don’t know.
– [Zubin] Dude, dude, this, okay, I want to double down on this for a second, that is the problem. Like I know people who are so angry with you because they read a tweet, a tweet or a couple tweets, and they’re imagining your voice, they’re imagining stance, they’re imagining your politics. They’re creating all this artificial context whereas there’s real context that if we talk to you, you will know that context. That’s why I’m so glad you’re putting video there because it is, it’s you in context with nuance, able to express body language, and the thing is you’re naturally good at that, you’re a great communicator, so people can see in your expression and how you actually are trying to intend to communicate because humans actually communicate beyond language. There’s all this right brain stuff that happens with body language and stuff. So I think that’s really, that was really the primal reason I think I instinctively deleted Twitter because I realized my style of communication does not lend itself to that. But now I’m gonna use it just for posting the videos that my team’s gonna do. But at some point, I may do what you’re doing, which is just video posts, like so there’s none of this ambiguity.
– You were the one that suggested this to me and I’m going in that direction. Well one, I’m pretty close to being like 100% outgoing. I made the mistake of actually trying to explain something to someone the other day, I don’t wanna say what day, but I immediately regretted it and I was just like, I was just like, I don’t know, inevitably somebody made some snarky comment about like, “Oh, you know, you don’t understand this type of analysis.” And I was like, are you out of your fucking mind? I was like I have published so many papers on this analysis. I was like, shut up. I don’t understand this analysis. I was like, get outta here. I was like, you don’t understand this analysis and then I tried to, so I swallowed my pride and I tried to put it really nicely, but then ultimately I was like I’m not gonna persuade someone who just literally just cannot understand this basic concept. I think that’s the problem in the modern age where I don’t know, like people don’t know what they don’t know.
– [Zubin] Yeah, Dunning-Kruger.
– [Vinay] Yeah, they don’t know what they don’t know, but I think we’re, I mean, look, if you ask me how do you solve this situation in the Ukraine? I’ll tell you the answer I have no fucking clue.
– [Zubin] Yeah no clue, no clue.
– [Vinay] But that doesn’t stop, I see these other people, they used to be COVID experts, now they’re saying we need a no fly zone or we need to ban pharmaceutical, they have all these suggestions and I’m like, I don’t know. I was like given your track record in COVID I just really wanna, I’m gonna have to not follow you on this. If I had to bet, I’d bet it’s the opposite of what you’re saying, but okay. But why are they even talking about these different domains? How can anyone take them seriously?
– [Zubin] Yeah and you just brought up something that’s interesting this idea of, well ’cause here is a domain we can discuss, there have been proposals that pharmaceutical companies should stop giving essential or non-essential medicines to Russians.
– [Vinay] Are you reading my, are you hacked my computer?
– [Zubin] Yeah, totally. Are you writing something about this?
– [Vinay] Oh, tomorrow morning it’s gonna drop. It’s called “An Unethical Proposal from an Ethicist”, but there is an ethics professor.
– [Zubin] Oh, is Art Caplan doing this? Oh my God. Please tell me more.
– [Vinay] Let me read you this quote. I mean this’ll probably come out the day after but here’s what he says, “How far should non-cooperation with Russia go? Very, very far. All research both ongoing and new must cease immediately. Whatever can be done to minimize harm to existing subjects in a short period of time ought to be done but that is it. Similarly,” this is the key part, “No sale of medicine or therapies ought to be occurring, be they life-saving or consumer products. Putin will see to it that shipments go to the military or are sold on the black market for revenue and there’s nothing pharma companies can do about that, can do to stop that.” Here’s what I think he’s actually saying. Imagine there’s a 68 year old man in Russia right now with lymphoma and we can give him curative drugs. He’s saying we should not send those drugs so that this guy will die. A 20 year old with testicle cancer, curative drugs we have, our pharmaceutical companies make, don’t sell ’em in Russia, let that guy die. I looked up the UN charter on what are war crimes and it says, “Intentionally directing attacks against the civilian population as such or against individual civilians not taking part in hostilities”. And to me, what Art Caplan is suggesting, not giving them pharmaceutical drugs, not Putin, an average Russian who they themselves may be protesting the government or victim of Putin’s autocracy, the average Russian, he wants to like let them die. It is literally taking a direct attack against a civilian in the nation. It’s the kind of thing we condemn Putin for. I think it’s crazy. What kind of ethicist is this guy? Is this an ethicist or is he an anti-ethicist? Where is he going with this?
– [Zubin] I mean he’s behaving like he’s blinded by emotion again and anger. That’s not a scientific approach, to angrily deny a 68 year old or a 20 year old with testicular cancer in Russia, dude, anybody, look, you don’t have to be a genius to realize that Putin shrouds everything in a bubble of his own information design. The average Russian may be pro-war, you don’t even know, but the truth is that’s not their fault. And so you’re gonna, so we have power in the United States.
– [Vinay] And some Russians are anti-war. They’ve gone on their news show at great risk to themselves.
– [Zubin] Great risk.
– [Vinay] Great risk to themselves. And to be honest, like a lot of places, I suspect that most scientists who work in a country are actually quite neutral about politics as long as it doesn’t interfere with what they wanna do.
– [Zubin] Yeah right.
– [Vinay] But I mean can you imagine, it’s like basically like going, it’s like going to some random person in Russia and saying, “Oh, I’m sorry, you’re gonna have malignant hypertension this month because our ethicists say we’re gonna cut you off of your Lisinopril habit.” I mean what are we doing?
– [Zubin] Yeah, you’re gonna have thyroid storm or myxedema coma because Art Caplan says that it’s unethical to give you medicine. And the thing is, again, like the kind of power, there is a war going on. The United States and the Western world is using economic power and dependency.
– [Vinay] But there’s a big difference I think, which is that like who is using the economic power and the sanctions? The United States government in concert with other governments are making calculations at a high level using political scientists and using people who specialize in foreign policy.
– [Zubin] Purportedly.
– [Vinay] Purportedly and not rando medical ethicist saying that, like that, that you know, that we should cut off their supply of chemo drugs. And by the way, you really think some 68 year old with like untreated cancer is gonna be able to put the screws on Putin. How are they gonna be able to muster up, they’ve got untreated cancer. How are they gonna put the screws on Vladimir?
– [Zubin] They’re gonna march in the street.
– [Vinay] I mean they need the chemotherapy I think to give them the strength to be able to put up resistance. They’re not gonna be able to do it with depriving them of medicines. This is the dumbest idea.
– [Zubin] Yeah, it’s dumb, it’s unethical and it’s ineffective. So you have all of that, you have all of that. Like look even, look McDonald’s leaving the country, that’s marginally effective, but it’s more a symbolic gesture, but pharma stopping deliveries of medicines, that’s just, like you said it’s an economic war crime in a way.
– [Vinay] It doesn’t target Putin. It just targets the people taking the medicine.
– [Zubin] That’s right, that’s right. You wanna target Putin, just target Putin dude, the oligarchs, there are ways to do that. Of course, he’s gonna get medicine from wherever he wants.
– [Vinay] Exactly right so you’re just hurting the poor people in the country.
– [Zubin] Yeah, yeah, it’s just really, it’s really, I mean Putin doesn’t give a damn. Well again, I’m mind reading. Forget it, forget I said that. That’s an emotional statement. But yeah so that kind of thing, I think again like gets into this armchair like so everybody’s on Twitter saying, oh, we should do this and we should do that. Look, I made my mistake, I did my ranty angry video, but I said, “Look, I’m ranty and angry.” I was already ranty and angry about Twitter, I was ranty and angry about Putin basically ranting and raving about him, but at no point do I claim to have any answers at all ’cause I have none.
– [Vinay] I got a new one for you. This happened while we were on our little hiatus or maybe it didn’t, I’ll tell you anyway. Number one, Michigan State University, my alma mater, it’s announced that indoor basketball games, we’re dropping mask and vaccine mandates, yes okay, but inside the classroom, you gotta mask up. And then here’s the third part of the argument, the president is actually an infectious disease physician, he’s an ID doctor. He’s an ID doctor, yeah, he is. And I was like, does he know?
– [Zubin] Wow.
– [Vinay] That it might spread at the basketball game. I mean I don’t know if he, but like you either drop both or you drop neither, but you certainly don’t drop this order, that’s pretty dumb.
– [Zubin] Oh man, that is just nuts. So again from the annals of what the fuck?
– [Vinay] I think you nee to know this, that masks do not work when university presidents are catering donors. They just don’t work. They don’t work when we’re dealing with donors if you know what I mean.
– [Zubin] They don’t work at the French laundry. They don’t work, there’s a lot of places masks just simply don’t work.
– [Vinay] Well if you hold your breath, they don’t work. And little kids, they can’t hold their breaths so they definitely work in younger kids. But if you get to be like a mayor, like once you get to be mayor or above, governor, mayor, they don’t work anymore.
– [Zubin] It’s just assumed that your breath holding skills are sufficient to manage transmission. I wanted to back up to the fourth booster thing for a second because you’ve probably looked at this data more than I have.
– [Vinay] What data? There’s two, yeah right.
– [Zubin] What are they basing this fourth booster recommendation on? Is this severe disease protection? ‘Cause that’s all I care about. I don’t care about infection.
– [Vinay] Well I mean, I guess the one thing I would say is you’re absolutely right in like the end point you want, that’s number one. Number two, we have literally no randomized data. These are data that’s population data comparing people who’ve chosen to get the fourth dose versus those who have been reluctant to get the fourth dose. In one of those pre-prints that’s currently available, it’s a Pfizer study from Israel, indeed, people who got the fourth dose have a lower rate of symptomatic SARS-CoV-2 than people who to three doses. But here’s the problem, Z.
– [Zubin] Oh my God, this is so obvious, yeah.
– [Vinay] They look at the hazard rate day by day and what you wanna see is that in the beginning, day one, two, three, they have the exact same risk of COVID because of course the booster could not have taken effect yet. But what you see is on day one, there’s a huge difference, the people who got the booster doing better than those who didn’t and it actually gets a little bit smaller by day two, three, and then it gets bigger over time. But what that tells you is that you have unmeasured confounding, that they are are fundamentally different people.
– [Zubin] Exactly, yeah, the minute you told me the study design, I was like, oh yeah, so basically the gung ho covidians who are hiding out in their cellars are the ones going and getting that fourth booster course. So of course, day one, they see a benefit.
– [Vinay] Oh yeah day one, yeah right, day one they see a benefit. And then the anti anti-vaxxers are saying, “So see how good it works?” I was like see how good it works? It can’t possibly work that fast.
– [Zubin] It works so good, yeah exactly.
– [Vinay] The next study was like a healthcare worker study that they published as a letter to the editor in New England Journal and I mean the problems with this study are one, they have a lot of surveillance testing. And I think, I’m trying to remember the exact wording of the letter, but it said most of the infections that were averted had “like negligible or absolutely trivial symptoms”. Like it’s not only is it not averting severe disease, it’s averting like whatever we talked about, like negligible trivial symptoms.
– [Zubin] PCRitis, yeah exactly.
– [Vinay] Or Barack Obama tweeted that he got COVID, which tells you even the presidents will get COVID. And he said that he had this “scratchy throat”, scratchy throat. So at this point, we’re giving boosters to like avoid a scratchy throat. It’s a bit much, you know?
– [Zubin] Make no mistake, VP, the scratchy throat was, it was obnoxious. I was there with Michelle and we were eating chips and it hurt, it hurt a little bit. Yeah I mean that, it’s true, it’s true, it’s absolutely trivial. Do you remember when George W. Bush choked on a chip watching like?
– Yeah, I remmember, he syncopized, he syncopized and his vagal tone was so high ’cause he was so fit.
– [Zubin] ‘Cause he was fit. Now my friend has a theory that George W. Bush actually started drinking again when he was in office ’cause he was a former alcoholic and because of the stresses of office and that’s why he kind of went so crazy and kind of little bit goofy, off the rails. And that whole sinkable thing was just nonsense, he passed out or something, there was a drunken something. But again, that’s pure gossip and a total lie, but just this idea of choking on a chip.
– [Vinay] I’ve not heard of.
– [Zubin] If George W. had gotten a fourth booster, he wouldn’t have choked on that chip according to the hazard ratio day one.
– [Vinay] Day one.
– [Zubin] Day one. By the way, the probable reason that day one they were doing so well is they were all at home having all the B symptoms from the booster.
– [Vinay] Oh, that’s interesting.
– [Zubin] You start to wonder.
– [Vinay] They’re taking the day off. I saw somebody, or, well I’ll have to think about that, they didn’t get tested for COVID because they thought it was the vaccine symptoms.
– [Zubin] Oh yeah, that’s a possibility too. But I mean that’s illustrative of like all the confounders in a non-randomized trial, yeah.
– [Vinay] I mean non-randomized trial is called garbage. I mean what is it talking about? It’s just called garbage. I mean, yes, if you’re really, really good, you can do sort of a non randomized study with some causal inference if you’re Miguel Hernan and if you have a situation where there is no strong confounding by indication or motivation to get the treatment for one type of person versus another. But if you’re doing these kinds of studies, they’re hopelessly, hopelessly confounded. And also, last I checked, here’s how much money Pfizer has to do the randomized trial, a shit ton ’cause they have like $80 billion from the vaccine. And also, you know what? I’ll be right, like unless you show me a randomized trial of a 39 year old, healthy who gets a fourth dose and has a reduction in severe disease or hospitalization, I’m not gonna be excited about getting a booster for myself.
– [Zubin] No way, yeah, agreed. So actually relating to this, the idea of confounding factors in non-randomized trials. So have you caught up with any of this Ivermectin stuff so far as the data starts to trickle out?
– [Vinay] I haven’t. I knew there were ongoing randomized trials but I haven’t kept up, I’m sorry.
– [Zubin] Well, at some point, we’ll do an update, but there’s nothing encouraging about Ivermectin.
– [Vinay] That’s what I figured.
– [Zubin] It’s just not, and again, it’s like come on guys, the confounders are there in your face staring at you.
– I recently had the misfortune if talking to somebody who was a big advocate for early treatment and I regretted those 15 minutes of my life ’cause they had a really sort of intense look in their eye and they’re like, “You know it works.” And I was like, “I would know it if you showed me some convincing data, but I don’t know it actually.”
– [Zubin] I would love early treatment to be highly effective. I mean what is the, at some point, we’ll have to review the data on Paxlovid and Molnupiravir so far. I mean it seems to be slightly in short supply.
– [Vinay] Molnupiravir has a little bit of a problem with that mutagenesis but the Paxlovid data I reviewed and my thing was I was like, oh looking good. The effect size a little bit smaller than an initial estimate, sure, but the problem was it was in a trial, the data that I’ve seen to date and the package label is on a trial that’s only in the unvaccinated. What’s the data for the vaccinated? And there is a study, but it has not published or disseminated the results. So I actually don’t know what’s the data in the vaccinated and I’m really curious because obviously I suspect it’s not gonna have the same bang.
– [Zubin] Magnitude of benefit, yeah, yeah. Well that’s interesting. I mean, at least we have that, but now, so the mutagenesis thing with Molnupiravir is really interesting. I’m a little surprised that that was even allowed to be used if there’s a concern that you’re gonna generate more variants with the use of this drug.
– [Vinay] As a general rule, I’m not a fan of things that are called mutagens.
– [Zubin] You mean you don’t like to sit on the corner and smoke a pack of Marlboro reds? Come on, dude. That’s just a rite of passage, that’s a rite of passage.
– [Vinay] Oh, I got a good story for you, okay?
– [Zubin] Oh yeah.
– [Vinay] I’ve been meaning to talk to you about this. Did you see Ashish Jha, another brown guy, another Indian.
– [Zubin] Fellow brownie.
– [Vinay] Fellow brown guy,
– [Zubin] And guy at Brown, at the university Brown.
– [Vinay] And he’s at the university Brown. He is now the new covid czar.
– [Zubin] I saw that.
– [Vinay] Okay so I want to make one point and, okay so here’s what I think, and I did a video on this and I was like, look, I got nothing against the guy personally, I’m sure he is fine. And to be honest, I’m sure they’re gonna pick somebody who I don’t really like a lot ’cause somebody has said some things that I disagree with, and this guy said some things I disagree with, he was kind of pro school closure, but at least he had the decency to admit he was wrong later and he should’ve pushed harder. I kind of dislike the fact that I feel like he’s always just kind of parroting the centrist point of view. And lately, I think he has been cozy with the administration. But here’s what I want to point out. He’s a guy in health policy, infectious disease, he might have done a little bit of it, but it wasn’t his wheelhouse pre-COVID. COVID comes along and he starts tweeting like the threads and those threads get the appeal of reporters and he like makes himself available for phone calls and quotes and then he goes on CNN and he does like a good job of I think talking neutral, calm, kind of calming presence and being middle of the road on CNN and he gets a lot of media appearances and the media appearances catch the eye of the White House. The White House puts him on some like secret email called it’s like Updates and Announcements, and that gives him the advantage so he can write an op-ed like five minutes after they announce a new policy ’cause he kind of knew it was coming. He was criticized for this by Willie Gelad in the New York Times and he said, “I categorically deny receiving talking points from the White House although I do receive updates and announcements.” And I was like, that’s called the talking point.
– [Zubin] That’s a talking point.
– [Vinay] That’s a talking point. Okay, but here’s the point I want to make to you, if there was no Twitter, this dude would not be the White House czar. He is on the TV ’cause he’s on the Twitter. He’s in the White House ’cause he’s on the TV. This is all the same. And so here’s the thing, Twitter is not real life. It’s not the midpoint of real life. It’s full of crazy people, but it has real power ’cause this dude got this really important job just ’cause he started tweeting a lot and that’s kind of scary if we think about it, that’s really scary.
– [Zubin] Dude, okay, okay, okay, lots to say here, my gosh. Okay, okay, first thing, the minute I reactivated my Twitter account, which by the way, took away that cursed blue check, thank God, that separated me from the filthy unwashed masses with my celebrity status.
– [Vinay] Look at you now, you’re an animal, you’re an uncheckmarked animal.
– [Zubin] I’m basically a low born.
– [Vinay] You’re like Bane in the third Batman, you’re born in the hell of the pit climbing.
– [Zubin] I’m like Hermione Granger, I’m a mudblood. It’s exactly Bane, that’s hilarious. So the fact that Twitter can give you this power, when I reactivated my account, I changed my handle description so that people were clear. It says, “This account is not checked. I’m just here basically to post and ghost, you can check fall for new videos and in the link below is a way to DM me”, not through Twitter but through an email that’s set up through link bio. I immediately got an email from a reporter from a major newspaper asking me to do an op-ed on omicron BA.2.
– [Vinay] Really?
– [Zubin] Yeah, immediately and that’s what Twitter does. And I looked and that person had followed me on Twitter like the minute I restarted the account. And so I realized, oh, now I told them no because I don’t write and I have no business writing an op-ed about omicron BA.2, bu there you go, right? So imagine I’m like somebody at any institution and that happens to me. Ooh, yeah, I’ll write an op-ed and then the next thing, even if I’m not fully qualified to do it, the next thing you know, I’m on CNN and then I’m a reasonable communicator. Next thing I know I’m on the White House Task Force. Now the thing is, you could say, oh, these liberals, this is what Biden does and he’s just picking, but then look at what Trump did. He picked what’s his name, remember his White House?
– [Vinay] Scott Atlas.
– [Zubin] Atlas.
– [Vinay] And it was because Atlas was on TV.
– [Zubin] Exactly, Atlas was on Fox News and the president watches Fox News. So I don’t know what’s going on with our leaders, but that’s not the way you find experts.
– [Vinay] And this is what would happen. They’d be in the taskforce meeting and you’d be like eating a cookie and drinking coffee and they’d be like, “ZDogg, wastewater cases are up. You got any solutions?” And you’d be like, “Oh, who you masking?” And like, “Oh, we mask two year olds and up.” “You think about one year olds?” You’re like, “Hmm, hmm, think about one year olds?”
– [Zubin] Eating your free, your government donut.
– White House cookie.
– [Zubin] White house cookie. Oh man, that is basically.
– [Vinay] Do you have macadamia nut?
– [Zubin] What is this cheese? It’s wonderful. We’re joking about it but the funny thing is, it’s not funny man, this is exactly-
– [Vinay] And then none of them were wearing masks and they’re all talking about, oh, well we got to mask up. We saw the State of the Union. Look at that, State of the Union was a super spreader event. I mean, look at that, look at that, they’re all hugging and kissing.
– [Zubin] Yeah, yeah. And you know what? Good on them for doing that. Bad on them for not.
– [Vinay] I mean good on them, like an 84 year old living life, sure I’m proud of that but then they go back to their district and they slap a mask on a four year old, I think that’s stupid.
– [Zubin] Yeah, yeah. I still cannot get over how conditioned our children are here in the Bay. And you know what they, so I talked to my daughter, I actually did a show with my daughter, my 14 year old.
– You did, what?
– [Zubin] No, I didn’t release it publicly. I released it only to my paying subscribers because putting it behind a pay wall, it turns out-
– I better add myself to that camp.
– [Zubin] You know, what’s amazing? So here, I’ll give you free access, just remind me. You have enough to look at, but I’ll send you the link to the thing, but so what’s funny is all it takes is a five dollar a month fee to weed out every single fucking psychopath, every hater. They won’t pay five bucks. They’re like, “Five bucks? Oh no.” Even if they, they would get access to videos that I do that are so off the rails, like they could use all the stuff against me, like, “Oh, he said this in a video to his supporters, and they won’t do it, they’re like, “Five bucks? Oh hell no, no, I can’t give ZDogg five bucks.”
– [Vinay] I hate him so much. I hate him so much that I’ll think about, to be honest, that’s the one thing that I’m surprised with is like, I was like, like anyone else, I’ve got people who I dislike, sure, but in the course of a week, I’m so busy, Z, I’m so busy, I just can’t even think about ’em. I have so many of my own goals and tasks and I’m hard on myself for not achieving all the things I wanna do and I just don’t got time. And honestly, every minute you have for your hater is a minute you’re falling behind in your own craft.
– [Zubin] Well you know it’s how they win is they take your time and your mental energy.
– [Vinay] That’s why you have to ignore, totally ignore.
– [Zubin] Yeah, you have to ’cause they’ll infect you.
– [Vinay] Even trying to teach them basics is hopeless because their brain don’t work no more.
– [Zubin] It’s hopeless. You know, you see Steve Kirsch out there, that guy, the Ivermectin guy, he’s like challenging Marty to a duel and he’s challenged me to a duel. If you spent one second thinking about people like that, it’s one second too many.
– [Vinay] I’m really, I’m still stuck on this early treatment, early treatment, early treatment. They also are the same people who are like, oh, the IFR is so low at young ages, it’s super, super low.
– [Zubin] It doesn’t matter.
– [Vinay] But yeah so then I’m like so wait, I keep coming to my own thing, it’s such a mild disease that a healthy person should have nothing to worry about, but you sure as hell need to take this fist full of vitamins and minerals right now, like that’s really important. Like it can’t both be-
– [Zubin] Right, right, but a nanogram does of a vaccine is a terrible idea.
– [Vinay] How many colds and flue have you had in your life?
– [Zubin] Dude infinite.
– [Vinay] Okay, how many tablets have you taken?
– [Zubin] Dude, I barely take anything for that shit ’cause none of it works.
– [Vinay] Of course, of course, that’s the prior. I mean the thing that people started taking was Tamiflu. I was wise, I never took it and now we have data that it doesn’t work.
– [Zubin] Yeah, yeah. It’s crazy to me that you would want to do something that hacks your physiology, AKA treatment, as opposed to something that actually uses your own immune system, which is vaccine. And even that again is not a one size fits all, but yeah, it’s crazy. So my daughter in this thing, she was describing her experience with her school and masking and it was really interesting, like going deep in it. And a lot of her teachers are very politically active and so they’re quite virtuously signaling about different things and she found it a lot of pressure. And she said, “I’m gonna wear a mask because I’m in middle school and I don’t even wanna talk about it. If I mention it even to my friends, they’re like, “What is your dad an anti-masker or something, like what’s going on?””
– [Vinay] Well, I will admit that I’m sympathetic because like I’d rather wear a mask than have to have a conversation.
– [Zubin] Oh, hell yeah, right? Or have to let them see my facial expression.
– [Vinay] My look of like oh my God. But the other day somebody was like, “But you know if you look at the totality of the evidence” and I was just like, “I just have to stop you”, I was like, “You do know that I have looked at the, I published a systematic review of every article? And then this weekend I read the Cochran Update on Physical Barriers for Respiratory Viruses so I have in fact reviewed the totality.” So in this conversation, the person who hasn’t reviewed the totality, it’s you actually, I don’t know if you know that. And I’m pretty sure that most of the most ardent believers, they haven’t even read a single study and they’re probably not, the other thing is like, I can’t imagine reading a mask study if you don’t read biomedical studies for a living.
– [Zubin] It’s really difficult, yeah. It’s difficult to tease out. when I read those studies, I have to read really carefully and slowly and it takes time and there’s a lot. So sometimes I’ll call you up or I’ll call up Paul Offit and I’ll be like, “Dude, so how do you interpret this?” And they’re like, “Well like this” and I’m like, “Okay, I was right” or no, “Ooh, I missed that. Okay, I got that wrong.” So it’s hard. So you do have to rely on expertise, right? There is this death of expertise idea that we no longer trust experts, we think we’re all experts, the Dunning-Kruger in full effect. It’s frustrating because at some point you look at some experts and you see there’s blindness there. You’re like, they’re in a box, they’re not looking at policy, they’re not looking at the bigger picture, but at the same time, you have to rely on that. Like I don’t want, the Russians are occupying Chernobyl right now. They basically have 200 of the staff there working 24/7 because there’s nobody else who knows how to do that shit. So you have to rely on expertise a lot of the time.
– [Vinay] Yeah, the problem is like Twitter, it makes it difficult. Like for instance, like some of the most quoted virologists are like people who have like just finished their doctorate and have never run a lab and have never published many papers and have never really done health policy and have never done the complexity of science and seen things evolve over time. And so you get some newbie who, they can put a lot of, well we’ve all seen, you can put a lot of stuff in your Twitter bio to make yourself look really good, but you don’t necessarily have the chops.
– [Zubin] Yeah, yeah.
– [Vinay] Now what else has happened? Oh, I don’t know if I should mention this. There was a very interesting, John Ioannidis, he’s poking the bear. Early on in the pandemic, he wrote that thing that the pandemic is an evidence-based fiasco, we don’t have great evidence for things. He didn’t sign the John Snow in the GBD, we’ve talked about that on this show, he didn’t sign either, but what he did recently was he did a citation analysis of John Snow in GBD authors and he also looked at their Twitter accounts and how many followers they had and all this kind of stuff and he published a paper in like BMJ Open or something or BMC, BMJ Open, I think and it’s really annoyed a lot of people because it found that the people who signed the John Snow memo, I think had sort of like lower citation counts, like less sort of an academic pedigree, but they had way more Twitter followers and potentially Twitter influence.
– [Zubin] Oh, that’s great. That is great.
– [Vinay] But then what happened to him was like all the usual suspect haters, they started hating on him. And when they hate on the journal article, they can write like these lengthy, I don’t know rapid replies or whatever. And somebody sent it to me to read and I started looking at this and I was like, I swear to God, Z, this shit’s like 40,000 words. I was like this is so long. And I was like God, I was like, this is such a, you have to reconsider your whole life if you’re writing 40 grand, the dude wrote a 3,000 word article, you take it or leave it, you don’t need to get it, but you’re writing 40G words fighting him. And obviously, after the first seven G words, you just say the same stuff over again. It’s the same stuff over and over again.
– [Zubin] You know what it is? This is it, I’ve realized because I’ve had open letters written to me that are like 20 million words about all the wrongs that I’ve had and all the people I’ve platformed and this and that and I think what it is is that these people have no ability to communicate. They have no ability to do what it as you and I do, which is communicate science clearly, concisely and effectively. And so they talk and talk and talk in the way they know how, which is typing. If you actually pulled them aside and put them on camera and said, “Okay, explain what you’re explaining and let’s have a conversation”, they would just flounder, they would fall apart. And I think that’s why.
– [Vinay] I felt bad for him like responding to all this. And then I also was like, I was like-
– [Zubin] Poor John.
– [Vinay] And can you imagine how few people are actually gonna read this?
– [Zubin] Nobody. I think it’s hilarious that he even decided to do that. It’s kind of like a here you go, I just went and did this.
– [Vinay] I felt like, I mean obviously, I felt like he was kind of pushing them a little but I mean I don’t know, I mean there’s a point to it, there is a point. You may not like the point but there is a point.
– [Zubin] There is a point, there’s a point, it’s an interesting angle and John has, I imagine, suffered quite a bit during this thing with a lot of hate thrown his way.
– [Vinay] Lot of hate, lot of hate. They hated that white suit he wore. I thought it looked good, man. I like a good white suit, crisp white suit.
– [Zubin] Have you looked at the Greek Isles? John, I imagine, is Greek. That shit is painted white. But white is the-
– [Vinay] A crisp white suit in that heat, you need it.
– [Zubin] You need it. Look, if we had actually painted all the roofs in the US and around the world white, we wouldn’t have global heating right now brother, because that shit would just be radiating into space. Speaking of which, speaking, oh, go ahead, sorry.
– [Vinay] No go on, go on.
– [Zubin] Yeah so speaking of which, this is a side note, James Webb telescope, holy fucking shit. This is where like okay, you take 10 billion dollars, which is a lot and cost overruns and government bumbling and all that but you turned it into actual science that went flawlessly. And I don’t know if you’ve been following this thing at all, but dude, oh my God. So let me take a second just to explain what these guys were able to do. They took a massive mirror made out of beryllium and they folded it into the nose cone of an Ariane rocket. They tuned the rocket perfectly to this payload to allow it to be delivered at this location a million miles from Earth that is a stable gravitational well, the second Lagrange point that allows it then to use less fuel to stay stable so that it extended the life of this mission like to 20 years from originally projected five years. This telescope unfolds in space with about I think 10,000 or something moving parts, all of which could be critical failure points that would scuttle the $10 billion 20 year mission, it all goes flawlessly, it unveils a nanometer thick fricking sun shield that shields it from heat from the sun because the telescope views in infrared. And why infrared? Because as the universe expands, it pulls the wavelengths of light apart from distant galaxies and into the infrared spectrum, this sort of heat spectrum, and we’ve never had a good telescope that can look at that in space that has the capacity of this. So the first test image that came out was just a calibration image of these 18 mirrors that had to be positioned perfectly and it shows just casually, a star that’s like 2,000 light years away that basically the light left the time that Jesus was born and is just now getting here and it looks like fucking blindingly bright. And then just, hey, take a peek in the background. What are those little stars back there? Oh, they’re not stars, each of them is a galaxy and it’s visualized in a resolution that is fucking ridiculous, and that’s just the calibration image. Like we’re gonna see shit that’s gonna change our view of our entire place in the universe because a bunch of scientists spent some of the commons to go out and do this, like only fucking humans would do something so crazy, like it’s fucking brilliant, I love it.
– [Vinay] So we can do all that but we can’t boost some nursing home patients? You can put this foldable origami thing in space, that’s amazing. I love looking at those, you know when I was a kid, they had this program that if you wrote a letter to NASA, they’d like mail you back some photos from Voyager. And I would do that and those were some good photos. And back then, they’d mail it on like a real photo paper, it looked good.
– [Zubin] Oh man, dude, NASA knew how to inspire like awe in kids. I was a big astronomy buff as a kid and I remember writing to a magazine called “Odyssey Magazine”, it was kids’ astronomy stuff. And I was like, “Hey, I was wondering, you guys mentioned that Pluto had a moon. I had not heard of that”, ’cause there was no internet, right, “What is this all about Pluto having a moon?” And they wrote me back this big typed letter all about Charon, the moon of Pluto and all this shit. Now we all know about Pluto ’cause of that probe which by the way, I was like so riveted, because I remember just asking this question as an eight year old of this magazine and it’s like that kind of awe in like how shit works right that ought to drive science, technology, engineering, and medicine, people into that field. And yet I feel like to some degree, I hope we’re instilling that in kids now. There’s just so much noise.
– No we’re not, it’s so bad. I mean God, I don’t know. I mean, especially after the pandemic, I mean you’re absolutely right that like it was inspirational back in the day, but after the pandemic, when people think public health, they think the people who make like Kyrie Irving sit on the sideline with a mask on. It’s really a bad look. We look like idiots and we’re the same people who like make you wear that thing to the door and then if you protest, they’re gonna mob you on Twitter. I mean I think they’re gonna be embarrassed. I worry we’re gonna get scientific brain drain, but you know, we already have problems. Like if you really run a lab, run a research team like I do, the biggest problem is you got to always get the money. I’m like a Mary Kay Cosmetic salesman looking for somebody to fund. I mean it really is really tough. It’s tough. I bought the kit, now I got to go sell it myself.
– [Zubin] You’re basically that dude from “Hustle and Flow”, man. You got to put in a little fake bluetooth in your ear. ♪ It’s hot out there for a pimp ♪
– [Vinay] You know academic medicine is one of the few jobs where when you negotiate your pay, I swear to God, this is true, they’re like, “Oh, you know, well we’re gonna offer you this.” And you’re like, “Oh, is there any room to negotiate?” And like, “Well you can, you could ask for more, sure, but you know you’re gonna have to come up with that money yourself.” And so you’re like, yeah, it’s a lot of work to try to find that money. So why don’t you lower it actually, lower that pay?
– [Zubin] My life would be better.
– [Vinay] Yeah, easier.
– [Zubin] Especially in San Francisco where the cost of living is so low.
– [Vinay] Well you just need a good tent and you need to find a good park and you’re good.
– [Zubin] And I understand crime is legal now in San Francisco so you can just walk into a Walgreens and take what you want, right?
– [Vinay] Up to $900 just is yours for the taking. I was waiting in line the other day and I was just like I’m tempted to just walk out not because I wanna steal, but I just don’t like waiting in line. I saw this where, this tweet that was terrific, where it was like, “San Francisco, where crime is legal, but a kid showing his face is illegal.”
– [Zubin] So I recently read an article in SF Gate Magazine that was talking about these posters that have been put up all around town and the poster was shaming people who wear the tech bro jacket, like the Patagonia with like your company’s name on it or whatever and they’re like, “You realize you look like a Republican, right? You realize that?” I’m like, wow, only in San Francisco is like that an epithet, you look like a Republican. And the other thing they were saying is, “Stop complaining about crime in the city and how San Francisco’s going to hell. It’s racist when you do that.”, like all this shit. I was like, wow, this is hilarious. Only in San Francisco, man.
– [Vinay] It’s racist?
– [Zubin] It’s racist to complain about crime because-
– [vinay[ My understanding is that racially minority groups are often the groups most concerned about crime.
– [Zubin] Yes, exactly true actually.
– [Vinay] And my other understanding about San Francisco is that when you walk down the street and then there are piles of poo, you really don’t really care the cause, you just wish it-
– [Zubin] You just want it to go away.
– [Vinay] You just want it to go away.
– [Zubin] It’s a public health issue at that point.
– [Vinay] Oh, that’s ironic. We do so much to prevent errant respiratory droplets, but we don’t do anything to prevent the errant feces in the city. Isn’t that interesting? You’re like, oh, you have to wear an N95 in a sea breeze outside, but you could step in a pile of human excrement. It’s an interesting public health decision.
– [Zubin] Oh yeah or the fact that when I lived in San Francisco for medical school, I lived in front of a Muni station and my windows would be crusted with like all the dust that Muni, it would kick up and from the rail and the electrical stuff that it interfaces with. And I used to have to keep my windows closed because I would see it build up in the house and I’m like, I’m not breathing that stuff. So there’s that, but mask up outdoors with an N95 because of a virus that you’re immunized against with four boosters.
– [Vinay] One year ago. Yeah four boosters. Ah, so actually I’m gonna see you tomorrow is the last thing.
– That’s right.
– [Vinay] We’re actually gonna see each other tomorrow, face to face.
– [Zubin] You know what, no masks. Of course, we’ve never worn masks when we see each other face to face.
– [Vinay] No, we always wear.
– [Zubin] And yeah, we’re gonna be interviewing a mystery guest. It’s gonna be a lot of fun, yeah.
– [Vinay] Okay anyway, we did a thing, it’s good to talk to you, pleasure as always.
– [Zubin] It’s a joy. Subscribe to the show. Share it everywhere you can. Check out both of our channels, ZDoggMdShow and Plenary Session and we are out, thanks, VP.