Did COVID Break Our Brains? (w/Dr. Vinay Prasad)

– [Zubin] Vinay Prasad back on the show.

– [Vinay] It’s great to be back, great to be back.

– I love it because I know that like just even having you on just juices up the antagonism on Twitter.

– [Vinay] Good, good, I’m glad. I’m glad to get the clicks.

– [Zubin] Oh yeah, that’s what we’re all about. See, and people accuse us of this actually, it’s like your contrarians because you know, you’re captured by your audience and you know they love that and you just want the clicks, bro. It’s like, no, we’re contrarians because, well, first of all, we’re not contrarians, right? 90% of what we think plus is mainstream.

– [Vinay] Well, I would say one more thing about that. Somebody pointed this out to me, a colleague of mine, and he said, “People act as if your views are new or novel.” And they’re like, if you go back and you read my book, “Ending Medical Reversal” and you read every paper I’ve published from 2009 to the present day, you’ll see a very consistent philosophical viewpoint, which is one, human beings often do things that they think make the world better. Most of those things actually don’t work. A small subset of them do work. The way to separate those is really well done studies. When you jump ahead of evidence, when you get ahead of evidence based on hope and optimism, you often make a mistake. That’s the whole theme of “Ending Medical Reversal” and that’s a lot of what I’ve been saying throughout this pandemic.

– [Zubin] It’s been very consistent and the thing is what you point at is this idea that emotion blinds us as humans or belief or ideology or whatever it is. And as a good example of this, this morning I got, I get a lot of hate mail, but occasionally one really peaks my interest. So this one was like, “Hey, when these mandates happen for kids and you’re to blame for it”, I’m like, wait, what did I ever say we should mandate?

– [Vinay] I thought you were critical of the mandate.

– [Zubin] No, but it doesn’t matter because I’m pro-vaccine, that’s all it takes because his ideology was triggered. He says, “I hope you commit suicide because the world will be better with you dead.” And so I looked at that and I was like, this is interesting. This guy really thinks he’s right, like he’s doing good in the world by sending this email. He believes it deeply to whatever evidence you were to show, it’s like where you didn’t even watch the show where I talked about mandates. So it is interesting people are driven now by this kind of broken brain thing, which we’re gonna talk about in this show.

– [Vinay] Well somebody told me like, you know, “I don’t know why you defended Ivermectin.” I was like, me? I was like, I took the biggest crap on it, I was very critical of it.

– [Zubin] Talk about hate mail.

– [Vinay] Yeah, I was like at least get my position correct when you hate on me. But of course, I was very, I tried to preserve the equipoise to run the randomized study. But you know what you’re saying reminds me of something Bill Maher was saying in his show, which is that he asks the audience, and his audience is of course left of center, what should we do with the people who enabled Trump who allowed this kind of stuff to happen? And he says one out of every two shows he does somebody in the audience shouts out, “Kill them.” And he points out that this is a bad place we’re getting to as a society where you don’t just disagree with someone, you want them dead, like this person was like wishes you to be dead, that’s, I don’t know what to say, that’s very bad, I mean that’s dangerous.

– [Zubin] I think it digs right into that coddling of the American mind thing where you actually view ideas that fundamentally challenge your unconscious or conscious ideology and beliefs as evil, like this is a danger to the world, like words are violence, right? It’s like you write anything on Substack, there’s 30,000 people on Twitter who are ready to call you an evil person who’s dangerous.

– [Vinay] It’s so funny that like the people who have habitually disagreed with me are the most ardent followers of my Substack posts. They’re the ones who are reading all the way to line number 72. It’s such a theater. I mean, let’s be honest, what’s going on, you know some people disagree with some people on some issues and then they go around looking for something that they can complain about and create some sort of anger mob about and that’s what, it’s happening everywhere, all across society in every different space and it’s really kind of just sad behavior because I’m living in perhaps a bygone era, but you know what I like, Zubin? I like to hear ideas that I’ve never thought of. I like to hear ideas that initially sound unpalatable to me, but over time I think there might be some truth to that. I like to hear views that I agree with and views I disagree with. I like to have my thinking evolve. I think it’s actually kind of fun. That’s why I’m in “The Academy”. That’s why I try to do all this work ’cause I enjoy the nature of discussing ideas. Who’s left? Who still enjoys talking about things? People are very reluctant to talk about things, reluctant to talk about COVID. Even at the hospital, people don’t want to talk about COVID policy, people don’t want to talk about all sorts of things. There are increasingly more and more subjects that are the third rail of American life.

– [Zubin] I think it really digs into social media as one of the root issues here because it becomes a performance issue, a tribe issue. So we have all divided into these subtribes, these little memetic, like based on our idea ideology. And then what we do is the goal is really rally that tribe and villainize whoever’s not in that tribe. So if VP’s outside of the tribe, then what the other tribe will do is that they will follow you on Substack, they will relined by line and go, “This is ridiculous.” Then they’ll find a few experts in their tribe and go, “Talk about this guy.” And then they’ll go back in time and they go, “You remember in 1998 as a student in elementary school he said this?” That kind of shit happens to me. Like someone will resurrect a tweet from like two years ago and be like, “I always knew he was a bad person. Look what he said.” And the tweet was something, it was something like, “Four out of five doctors agree. Try to be the fifth doctor and always try to find holes in what’s going on, right, don’t just swallow the groupthink.” No, “Are you against consensus?”

– [Vinay] You’re against level one consensus.

– [Zubin] “Are you a chiropractor?”, like this kind of stuff.

– [Vinay] But you know I mean it’s across American life. I was reading about some editor of some news magazine or something that no one wants to read and this person was like fired for tweets that they wrote when they were like 16 or 17 or something like that. I guess to some degree, we’re fortunate to have come up in an age where there’s no permanent record of everything I ever said when I was 16 because no one should be held to that standard. But also like, I don’t know, everything must be interpreted like how things were at the time, things are easily misinterpreted, things are easily twisted. There’s a whole group of people who won’t, “review the security footage with your own eyes”, in other words, they just take as gospel what other people say the interpretation of the footage is and they don’t actually review the primary source material. That’s a fundamentally sort of anti-intellectual idea.

– [Zubin] Yeah, I think we’re in that kind of, in that kind of zone now. So speaking of anti-intellectual, let’s talk, what do you think, should we do baby vaccines, baby, meaning like five to 11, I consider them babies.

– [Vinay] Yeah, let’s do it. It’s in the news.

– [Zubin] It’s in the news FDA VRBPAC Committee, our boy Paul Offit on that committee, deliberated and said, hey all right, let’s go ahead and say this is okay from a safety efficacy standpoint, over to you, CDC, for the final who should get it?

– [Vinay] 17-0-1, one abstention.

– [Zubin] Right and the abstention was a dude, was it a guy from NIH, right?

– [Vinay] I forget where he’s from. Yeah.

– [Zubin] Yeah and why did he abstain, do we know?

– [Vinay] He put out a little summary of his reasons, but his reasons were I think a few good reasons actually, these were brought up during the panel discussion. One, I guess it’s worth saying that like I think every single member of that panel felt very strongly that we ought to make the pediatric vaccine available at this dose and this schedule for kids with co-morbidities that put them at high risk of bad outcomes from SARS-CoV-2. I think that was where like everyone agreed on that. Then the next question is like kids who don’t have co-morbidities that put them at high risk of SARS-CoV-2, there’s at least two chunks there, there’s kids who’ve never been exposed to the virus and kids who’ve already been exposed to virus, this person’s point was that current CDC estimates say that maybe 40% of kids have already been exposed to the virus and cleared the virus and he was saying that the proposition that this vaccine will provide a net health benefit to those kids is a little bit more uncertain and likely smaller than the kids who’ve never been exposed obviously, because they’ve exposed and recovered, they have some natural immunity, we can say it, right?

– [Zubin] Plus, they’ve kind of shown that they didn’t die and they didn’t get MISC and they didn’t get long COVID presumably.

– [Vinay] Presumably, yeah, and very plausibly within the next 10 years, they will be reinfected with the virus with milder and milder every time they get reinfected illness, because this is an endemic virus.

– [Zubin] Right, like other coronaviruses.

– [Vinay] Like other coronaviruses.

– [Zubin] Yeah right.

– [Vinay] The second point he made was that we are wedding ourselves to this dosing schedule three weeks apart in this EUA action and we already have some evidence from the adult data that the durability of those antibodies is going to be waning. And his concern was that it’ll be even worse in this group and we’ll be in a situation where we might be talking about a booster for a child six months from now or two boosters or three boosters and he thinks that there might be an opportunity to kind of do this a little bit differently now so that we can have more durable immunity. And then I think one of his other points that he made verbally that he didn’t put out in his typed statement was that we’re talking about a vaccine construct based on a sequence of the virus that is now quite old, I mean, it’s not the most current sequence of the virus, it’s not the Delta strain sequence. And so he talked about what are the implications of vaccinating against that? I think those are sort of the central concerns. There are other panel members who brought up other concerns. But I think the group they’re most concerned about are the healthy kids, no co-morbidities, especially the group who haven’t cleared it, but I think even to some degree the group that have not yet had it, because of course the risk benefit proposition is going to be a little bit more uncertain and a little bit more tenuous to balance in that group, healthy kids.

– [Zubin] Right and then looking at myocarditis as the main risk, we don’t really even know the rate in young kids younger than 12, right, because we just don’t have enough numbers?

– [Vinay] I mean the sample size of this study is

– [Zubin] 3,200?

– [Vinay] Yeah and I think it’s like 1,518 verse it’s like a two to one randomization or something like that, but it’s not big enough to even find the highest estimate of myocarditis in 12 to 15. I mean it’s not big enough to even find events in the ballpark of one in 2K, one and 3K, one in 1K even to some degree. Its’ sample size is too small to rule out safety events that occur with even considerable frequency, one in 5K I think is considerable. And so yes, we have no idea. So they have models in, yeah, that’s the point I wanted to make to you and this is the point I made on my Substack which listeners should check out.

– [Zubin] Check out line 72 where you compared the vaccine to slavery.

– [Vinay] Who knows what it says in there.

– [Zubin] Right.

– [Vinay] I don’t think it says that.

– [Zubin] No, it does not.

– [Vinay] It does not say that. So the point I wanted to make here was, what was the point I wanted to make here?

– [Zubin] No, you were talking about, in your subset, you were talking about myocarditis and safety signal in the kids study, which is small.

– [Vinay] Which is small, oh and then the modeling. And so I guess the point I wanted to make was the most persuasive case for emergency use authorization was a series of models presented by FDA staffers showing that under a range of assumptions, it was very likely that this vaccine would confer net efficacy. And what I thought was quite interesting was every single parameter that went in that model did not come from the current pivotal, randomized controlled trial. In other words, like the things that went into the model were if a kid gets sick with COVID, what’s the chance they get hospitalized? Well, that’s from population data. What’s a chance that kid will get sick with COVID? That’s from historical data. If a kid gets the vaccine, what’s the probability they’ll get myocarditis? Well that’s from a different age group and it’s from observational data and not a single parameter actually derives from the study for approval. And so that creates a very interesting regulatory point that I think few people have pointed out, but I tried to point out, which is that for somebody who was an ardent proponent that we really need to get this quickly and we really want and I want to give my kid this right away ’cause I’m concerned about this, that person has a legitimate grounds to say, what took you so long? Why did you need this study? Because the entire model that supports approval that you’re hanging your hat on, every parameter is already done. You had all those parameters months ago. You could have approved it based on the model months ago because the model is apparently what persuades you. Meanwhile, the other person out there who’s a little more skiddish, who wants more safety data, they want more information, that person will say this trial is simply too small to give you any useful information. There’s zero severe COVID. There’s zero MISC. There’s zero myocarditis in the trial ’cause the sample size is too small. So why don’t you wait until you get a bigger trial? So you see nobody is sated. The person who wanted it based on preliminary data, they could have had it months ago. The person who wants more data, they probably want a bigger study or they want some more population data. And that to me is very interesting from a regulatory perspective. There are not many instances in my mind where the case for regulatory action is made predominantly, in my opinion, based on the modeling rather than the pivotal trial data. Usually it’s the pivotal trial data that drives the registration.

– [Zubin] Yeah and the modeling of course has so many different assumptions that you have to bake in and like is this Delta level transmissibility? What’s the prevalence in the community? And that will tip very easily from myocarditis-

– [Vinay] Zubin, I thought all models this pandemic have been spot on?

– [Zubin] They’ve been pretty much

– [Vinay] Spot on?

– [Zubin] Yeah, Imperial College, all of ’em

– [Vinay] Just right on the number. You’d quibble about a few decimal places, right, But these models have all been spot on.

– [Zubin] You know what we should do? I’ve been wanting to do this. I’ve been wanting to go through all my videos and do A Real Doctor Watches, a supposedly real doctor talking about the pandemic and start in like January of 2020 and just go, okay, yeah, that was right, that was right, you’re off, no, that was wrong, you’re crazy, oh my God, how deluded are you, and just with the retrospectoscope look back. And I bet if anybody did that to anything, you would find the same result, which is complete chaos.

– [Vinay] Oh that’s fascinating. Well that’s a really, first of all, that’s a great idea, you shouldn’t have just said it now because-

– [Zubin] Well now I’m gonna have to do it.

– [Vinay] People can scoop your idea.

– [Zubin] Oh, they’re gonna do it? Well let ’em do it, let ’em do it. As long as it’s done.

– [Vinay] To be honest, we’ll talk about this but nobody on YouTube has a track record of even talking about the pandemic among doctors right? That doesn’t even exist. Talking about medicine among medicine, it kind of doesn’t exist. But I think it’s fascinating and maybe I’ll steal your idea, but here’s how I would do it. I have a pinned tweet. My pinned tweet is every op ed, podcast, commentary I’ve done on the pandemic, including the videos that you and I have done and I want to say, I literally think that every single one of those things like I stand by it, I think they really hold up and I urge somebody to go through and read all those things and see what you think, if they hold up or not.

– [Zubin] I think we should do that because there were, there things I know I’m like, man, that was right, that was right and then there’s stuff I’ve said where it’s like, oh, you know, I think this thing’s pretty much over and once the vaccine happens, it’s like, oh, Delta happened, hrr.

– [Vinay] Okay, so at least you’re honest. I always try to avoid making any speculation about the future. But here are some things I think we got right way ahead of everybody, allowing people to die alone is criminal.

– [Zubin] Criminal.

– [Vinay] We were way ahead of everyone. When they were all panicking, we said that, we we’re right, we’re gonna be vindicated. Two, school closure, we were way ahead of everyone. You were even better than me because you brought on expert after expert after expert and you did your damnedest in the fall of 2020 to push that issue. We were right about, I think, we had a very nuanced approach on masks. We weren’t zealots in either direction. I think that’ll hold up. We weren’t zealots on masking kids. And then the other place I think we’re going to be vindicated greatly is that we are both consistently pro-vaccine, particularly adult vaccine, we’re also about honest conversations at younger ages, and we’re also kind of skiddish about the downstream consequences of mandates. And I think all those things will be born out.

– Man, you just basically summarized the entire ethos of the show, your show and it’s great. And by the way, I mean folks, if you haven’t seen Vinay’s channel, he basically stole all the ideas I gave him and basically is crushing it.

– [Vinay] I have to admit, first of all, you were the one who, I give you all the credit, because you were the one who pushed me to actually like commit to doing something on YouTube and I did steal your stuff, which we’ll talk about, which is that you and I are now, we’re like the only people who actually talk about like actually substantive medical issues in the days.

– [Zubin] Well wait a minute, you don’t want to do a video on like what your day is like as a heme-onc attending.

– [Vinay] What I ate for breakfast, what car I drive.

– [Zubin] My life as a med student renegade.

– [Vinay] We’ll talk about that.

– [Zubin] No, no, no, but all joking aside, I actually literally watch your YouTube channel and go, okay, that’s what I’m talking about today, but I’m gonna dumb it down ’cause I don’t even understand it. Like you’re just, you’re too smart for your own good sometimes. Well, the problem is this is your life’s work, this is what you do.

– [Vinay] Regulatory science. Well some of these issues are my life’s work. Other the issues I’ve been dragged in kicking and screaming.

– [Zubin] Like what? Like what’s an issue that you?

– [Vinay] Like social policy in schools is not an issue that’s in my wheelhouse naturally. And how did i get into it? I don’t know, I guess I remember in the summer of 2020 distinctly, I remember when Trump said what he said, that he wanted them to reopen, and I don’t know as any good progressive or liberal, my baseline understanding was that I thought schools had something to do with the quality of people we turn out in the society. I thought they had something to do with like a ladder of mobility. And I was shocked when my tribe, my progressive liberals, were sort of vehemently against opening schools. And that led me to go down the rabbit hole of like read everything I could read and talk to Alasdair Monro from the UK and Vlad Kogan, a policy expert. But I would say that like school policy that wasn’t in my wheelhouse, but vaccine approval, drug approval, the evidence for masking, those are strictly in my wheelhouse, like that’s the kind of stuff that I do day in day out for 10 years. School’s a little bit different. Political ramifications a little bit different, but I’ve been asked to comment about long stream consequences to science and stuff.

– [Zubin] It’s crucial to the discourse that we have different voices talking about this stuff who are actually educated in the stuff they’re talking about. And it doesn’t mean that you have to be a pediatrician to talk about kids vaccines, I don’t think that’s necessary. It’s nice, that’s why we get Paul often on the show and he has a very, his stance is really interesting, he’s like life is full of risk so you have to decide, are you willing to take the risk of MISC, long COVID, COVID with a bat coronavirus out of Wuhan or whatever gain of function, we’ll talk about that, or the very small risk of vaccine. His estimation of myocarditis risk may skew on the low side.

– [Vinay] Yeah I think because he uses a denominator that’s not appropriate. He’s not using the boys in that age group 16.

– [Zubin] Right, right, right, the very specific.

– [Vinay] Yes, the very specific. And of course, I mean medicine is personalized so like I’ll tell you what? You tend to know on average if your patient is a 16 year old boy versus a 42 year old woman. I mean you that’s something you know. And so if you know that, you should leverage that for your analysis I think.

– [Zubin] Come on, kids are just little adults, yeah.

– [Vinay] But I’ll say one thing about this pediatrician thing. You know one of the things I wrote was “The Atlantic” article where I pointed out that the evidence for masking kids two through whatever was like totally lacking and it’s totally lacking. It’s gonna be a great pandemic failure that we never ran any cluster studies. But one of the pushbacks I got was like, why are you letting this not pediatrician comment in “The Atlantic”? It’s all about platforming these days, this kind of rhetoric, why are you letting him even write this article? And then Alisdair Monro from the UK, he pointed out I think nicely on Twitter that he was like you do know that like pretty much this guy’s thinking is like in line with like every single pediatric expert on this topic in the United Kingdom. It’s kind of in line with half of Western Europe.

– [Zubin] Well that’s the thing. We seem to ignore the European experience as valid in the United States.

– [Vinay] It’s strange to me as a liberal, all these years we’re always like, oh, Medicare for all, single payer, and those are the things that I’m like on the side of like universal healthcare, et cetera, and where do we get our model? Like who do we point to? We point to look at Germany, look at Sweden, look at a good job they have with their nationalized healthcare, look how good they’re containing costs. And now in the pandemic, when it comes to policies around children, we ignore them, we act like they don’t exist. We act like Sweden wants to murder their population. It’s really a cognitive dissonance I’ve never seen.

– [Zubin] It’s a belief-based ideology, again, it’s that same thing of what came with that email, go kill yourself. It’s the same thing. It’s like your ideology does not vibe with mine right now or my tribes’ more importantly, because if we were in isolation, first of all, we would fall apart ’cause we’re social creatures. So in the absence of meaning anymore, we don’t have a collective mythology anymore so we find it in these sub-tribes. And then in order to make sense of the world, we have to interpret data through the lens of the tribes central meme, whatever it is. And if it’s I hate Trump or if it’s I love Trump, then it’s just gonna, it’s gonna split into different things. Just like Ivermectin seems to have been picked up by the right. Why? It makes no sense. Why would a medication be politicized or masking picked up by the left, like why?

– [Vinay] I don’t know. I mean the sense I have about masking is that because Donald Trump didn’t do it so we’re gonna do it really hard. And I almost imagine a counterfactual world. Imagine if Donald Trump came out with a big mask that has an American flag on one side and MAGA on the other side and he said, “I am really firmly committed to masking. We’re gonna mask everyone. We’re gonna mask every two-year-old and above. We’re gonna do this. It’s gonna be huge, it’s gonna be great, that’s how we’re gonna keep the virus away. We can all go back to work, we’re just gonna mask through this and get through this. If he pushed masking like that, I bet what you would hear is liberals would say, you know what, actually, there are no clustered randomized trials. They’ll say what I’ve been saying. There are no clustered randomized trials. We probably should study it. There are probably some downstream harms on language acquisition. We don’t know for sure, we need to keep it, it would just flip the whole narrative. And what if he pushed lockdowns very hard? I think you’d see great different, “The Academy”

– [Zubin] Authoritarian accusations, yeah.

– [Vinay] I think that would be one and I think The Academy, of which I am a part, university professors, strongly oppose Donald Trump. And in the academy, now there is such a strong, overwhelming, I think at least on social media voice that we ought to do these restrictions more sooner, earlier, harder. Had Trump come in favor of those restrictions, I think The Academy would have split in half and it would have been half the people pro restrictions, half against it. It would’ve been quite interesting.

– [Zubin] It is interesting. And that feeds right into this idea of the chilling effect, right, where if you’re not in, so if you actually disagree with the predominant tribe that you’re in and you say something, you watch on social media how you get beaten down. And it’s not just beaten down, it’s personally attacked. It’s like, you’re a bad human being, you’re dangerous. I can’t tell you how many times I’ve been called dangerous. I’m like, I’m five foot five, I couldn’t hurt a fly.

– [Vinay] I’ll tell you what I find most baffling. One of the accusations that, among the personal attacks against me, is that like I don’t have a clinical practice, I don’t see patients, like-

– [Zubin] That’s just wrong.

– [Vinay] I’m on service three months a year. I’m running clinic every Monday. My fellow even asked me, he was like, “You know for a guy who doesn’t see patients, according to Twitter, you’re sure on service a lot.”

– [Zubin] Yeah, exactly.

– [Vinay] And I’m like, what is this? And ironically, some of the people who they themselves are most concerned about misinformation have eagerly and gleefully latched onto this outright lie about somebody who they disagree with on policy issues. It’s a delusion like I’ve never seen.

– [Zubin] Yeah and it’s quite a mob, a mob attack I’ve seen on you which I enjoy watching from the sidelines because the thing is I know you, so it’s like I know who you are, I know what you stand for, I know that you can take it because you’re not the kind of person who falls apart in the face of personal attacks. You are quite intellectually and emotionally sound. Yes, you have a temper because I have one too and sometimes we get angry, but that’s okay, that’s normal, human, but it is kind of, it’s interesting because from a sociological standpoint, it’s like, wow, the same tribe that we emerge from will turn on you if you at all kind of consistently, and you’ve done it consistently, you’re saying, hey, you’re challenging some of our core beliefs, that drugs just pretty much work if the trials say they do, that medical reversal’s not a thing because we’re better than that, these kind of things.

– [Vinay] It’s so interesting to me because I guess, yeah, the attacks are most vociferous from people of whom I’m probably very close to because look at the themes of my books. The themes of my books are very critical of the pharmaceutical industry, very critical of runaway capitalism, very critical of deregulation in support of really thoughtful regulation, that’s the themes of my books. And I do identify as somebody on the political left and yet in this pandemic I see, I do think that many issues that we on the political left should have gotten right, we got wrong. We f**ked up schools. I mean that is the greatest screw up of the political left I’ve ever witnessed, the schools issue. I think there’s already public opinion polling that’s gonna show the Democrats gonna get hurt by that, by being on the wrong side of the schools issue. Schools, it’s such a catastrophe. I mean I think it’s hard to overstate how much of a catastrophe the schools decision was. And I do think we got it wrong because we are too focused on that one man and we weren’t focused on the kids. And I’ve said that before, that we hated him more than we loved the children. And that irked people, but that was, I think there’s some core truth there.

– But it’s true.

– [Vinay] It’s true, and not only is it true, like there’s data to support it’s true. Vlad Kogan has a paper in the American Enterprise Institute where he’s actually documented week by week sentiment around schools and he shows the moment this man opened his mouth, the public sentiment flipped on a dime. And also all of the data suggests that it is true. One, the places that closed for the longest are left-leaning, they’re places with strong school unions, et cetera, the unions have routinely opposed reopening under even I think quite generous circumstances. It’s been a fiasco, San Francisco, Chicago, Washington, D.C., many cases they had to have like brute force applied to them to actually reopen. So that was one issue. And then I think also, I think we were a little bit too, like if you want people to do something like distance and mask, you should at least acknowledge that under some circumstances, it makes less sense. Outdoors in the breeze don’t make so much sense. After your double vaccinated and boosted, don’t make much sense. When you’re two years old on an airplane screaming, you know, my understanding of being a liberal is to have some compassion and I see all these videos and some of them are going viral and maybe some are sort of manipulations, but I do think that if there’s some screaming toddler that really doesn’t want to wear the mask, instead of throwing the family off the airplane as people have said, maybe the compassionate thing to do is just be like, let’s just take this plane off, it’s one kid not wearing a mask and you know what the WHO, they don’t recommend it. And you know what, also across Europe right now, there’s no masking of kids in airplanes. And so have some sense that, this is just like being a doctor 101. It’s public health 101. I don’t know, what do you do when your patient like, you will have some patient that doesn’t take every single medicine you’ve given them on every single minute of the day. Do you disavow them, throw them out, never see them again? No, you meet them where they are, you try to make progress, you throw out some medicines that are kind of marginal and you pick the ones that are most important and you really try to like work with them on that. That’s called being a doctor. This idea, also on the political left, I’ve heard people say, “If you didn’t get vaccinated, you shouldn’t get healthcare.” Have you heard this?

– [Zubin] I’ve heard this, yeah, or you should have to pay for it. I actually tweeted, I retweeted an article that was proposing that and I said, “Well, this is interesting. Has a lot of baggage here. What do you guys think?” And I got appropriate responses, which were like, that’s insane, like that idea is insane.

– [Vinay] The whole purpose of the Affordable Care Act was to say, it doesn’t matter how you got ill, we will take care of you, we will not discriminate, the whole field, it’s like a core principle of medicine, if somebody cuts themselves committing an armed robbery, do you not stitch them up? If someone has committed a crime, do you not provide medical care? Of course, it doesn’t matter what someone did, you’re a doctor, you have an oath, the oath transcends all of this. We don’t make people pay higher premiums if they eat Twinkies all day and smoke. These are very complex behaviors that are the end product of a system that is unjust in innumerable ways, from the media information people are given, to wealth inequality to like deep-seated problems and you cannot punish individuals for all of these systemic factors. That is what it means to be a liberal. The liberal side has totally forgotten that.

– [Zubin] A classic liberal. Again, I think you said the word compassion. That’s really what it is. And there’s tons of conservative thought that actually is very, that’s why I think so many conservatives are deeply offended by the response to the pandemic because it is unfair. It penalizes poor people, people who are actually vulnerable, which you would go, oh, well, that’s like, isn’t not liberal thought? No, it’s just like compassion, that’s just compassion. And so this idea that we’ve been uncompassionate. So what happens now is we have this pandemic of mental illness in kids that’s getting worse that was already accentuated by social media and screens. So what did we do? We took them out of school and put them in front of social media and screens for a year and made the adults around them go crazy and be at home and now you’re stuck together with like parents that you don’t, you’re not used to being with all day or some extended family and it’s crazy shit. And you don’t even have good wifi because you’re in a low socioeconomic status and so you’re actually even more, it’s just basically schools becoming this very dysfunctional vacation.

– [Vinay] You know, somebody told me that like one of the things you’re pointing to is that some people, they themselves may be quite unhappy in the moment. And somebody was pointing out to me, they’re saying like, somebody who like was very critical of me, like went after me really hard, they’re like, “Did you see this person’s other tweets?” I was like, “No, of course not. What do I have time to follow people who dislike me? No, I don’t have time for that.” And then they’re like, “Well, these other tweets reveal that they’re like going through some hardships and stuff like that.” And so I think, I also like try to as much as I can, be a bigger person and like let some of this go because I think other people are suffering in different ways and one of the ways in which in the modern world, if you’re suffering, is you want to go online and you want to beat up on whomever, whoever it was who tweeted the thing of the day that you didn’t like or whatever.

– [Zubin] Okay this is like I’m gonna triple down on this point. You know, I get the death threats. So one time I got a death threat and I was like-

– [Vinay] You do?

– [Zubin] Oh yeah, me, yeah, all the time.

– [Vinay] For what, for being pro-vaccinations?

– [Zubin] Whether it’s vaccination, whether it’s saying something that’s politically offensive to another side, by being in this kind of radical-

– [Vinay] But you’re alt-middle.

– [Zubin] Exactly but alt-middle means you see everything as true but partial. So you may find something true on a side that the other side is just, no, that’s never gonna be true, right absolutist thinking. So it triggers people to send me these kind of kooky, sometimes thinly veiled death threats, sometimes just overtly I’m gonna find you and murder you for what you’ve said about this. So I actually responded to one of them and I’m like, Yeah, I’m just curious, first of all, if this email is real. And second of all, why so mad?” And just kinda made it clear that I was gonna listen to them, right? Oh my gosh, they write back this whole thing, “Yeah I’m really, I look back at the email I sent you and it’s clearly crazy. I’m sorry. This is what I was feeling. This is why I was feeling it. This is what I’m going through.” And it’s a whole life story. And I was like, “Oh shit, I actually feel this outpouring of love for this person.” This is, like yes, dysfunctional, to some degree inexcusable, but at the same time you go, oh. Now if we actually just assumed everybody was having the worst day of their life when they send a crazy, or they’re just, there’s something going on in their life, we’d be a lot better off, but we don’t do it. If we taught our kids that, then all the social media bullying, Instagram FOMO bullshit. It’s like, dude, think about that. Next time you see a chick on Instagram, little daughter of mine, who by the way, they don’t have Instagram, they don’t have any social media, I don’t let them have it until they’re 18, just like no way.

– [Vinay] I actually have never been on Instagram. I don’t even know what it looks like.

– [Zubin] It’s garbage. I’m on it but I use it purely for, I just do my educational pieces and I run. But like beautiful Instagram model having the best day of her life takes a picture and you’re like, “Man, that’s the life”. And then you find out six months later, she’s died by suicide. You know, it’s a pattern, like we rely on these superficial signs of what we think are success whereas inside the turmoil and all that that we’re repressing and denying and projecting and doing all this. I think until we actually are able to introspect and turn the lens on ourselves, we’re never gonna fix these systemic issues that we, ’cause they’re an epiphenomenon of us. But that’s a whole nother conversation.

– [Vinay] No, I think that’s a very interesting thing. I mean the one thing you say that it makes me think about is like I guess I’m disturbed to hear that anyone would wish you like personal harm. And I guess the reason I’m really disturbed about it is because I just, you know, I mean I can’t imagine you even getting into a territory where people are so, where passions are so high, but the other thing I think is like it’s a strange thing to wish away people you disagree with to wish they didn’t exist or to wish they died or to wish like that they are, I don’t know, not allowed to speak. I mean, if you have ideas you’re really passionate about, and I have ideas I’m really passionate about, like my reversal work and my cancer drug policy stuff, those last four chapters of that book, like I would do anything if we could implement that stuff, and around COVID some of these things, I’m passionate about these ideas. Like I don’t want people who disagree with me to like not exist, that’s not fun, it’s not fun, it’s not fair, it’s not just. I like want to persuade some of them and then I want to have the other ones know that their ideas are losing. I want them to like live and watch their idea be destroyed by my better formulation and more articulate version. Yeah, I want to watch them watch it die, but just like to end that idea, to show why that idea’s wrong and maybe that they will eventually acknowledge it. And I will say that there are a few moments in like, many years ago I had this thing where I was like one of the first people very critical of like the genome-directed cancer therapy. And I wasn’t critical in the sense like of course I prescribe all these drugs, I think they’re very useful, but I was critical of like the media landscape that made it feel like every cancer patient will get a genome drug, which is just strictly not true. And I would say that like you guys are exaggerating this, you’re embellishing it. And then finally, to kind of prove my point, we did a paper where we like estimated what percent benefit from these drugs. And the answer was like, I think at the time, like nine percent or something or eight percent, or I’m sorry, were even eligible for it, like could even take the drug, was like eight percent and four percent had tumor shrinkage, et cetera. So something, it was less than 10% or something like that or 10%, it wasn’t 50%, it wasn’t 70%, right? And so we published that estimate, and that estimate like people don’t, like now, they won’t see it as provocative ’cause you ask them and they’re like, they feel like it was always true. But at the time it was quite provocative because people’s intuition was like 50% and we published 10% and we just took all the air out of the balloon and the people who vociferously and passionately disagreed with me, now they, well first, they like laughed at it, they were angry with it, and then finally they acted like they believed that all along. And that’s one of the ways in which ideas, like when your ideas triumph over other ideas, like the school closure thing, we were both on that early, there’s a paper trail, like how early we were on how important it was to reopen schools. Eventually, when the majority of people, and it will be the vast majority, I’ve been saying, it’s gonna be like 99% of people will see that as a huge screw up, they will act like they were always for school reopenings. They won’t see that they were ever against it.

– [Zubin] Yeah, it’s true. This is the evolution of ideas. That’s why you need the discourse and you need the person, now what’s interesting is like, I think a lot of people in the professional misinformation business really like to argue that same thing, the Semmelweis argument, that like no, we’re just ahead of the curve here, the mainstream is completely wrong, we’re sounding the alarm that these vaccines are gonna cause cancer and longterm risks and this and that and the other thing. But I think the problem there is, again, you can argue those things, so let them speak, let the Von Dem Bussche’s and these Robert Malone and these guys, let them talk. I think what we have though is an information ecology that’s so fractured around tribalism that the average Joe can’t distinguish a fringe view said by someone with decent credentials from a more, it’s not even accepted, it’s just a more consistent with the data view.

– [Vinay] Yes, yes. It’s such a good point.

– [Zubin] So how do you?

– [Vinay] I recently saw somebody say that like, people like John Mandrola, cardiologist, you know, Kentucky, published an estimate of myocarditis as one in 6,800 roughly in the middle of other estimates and now like pretty close to probably what the true estimate is. They were like, he fuels the people on that fringe anti-vax side by giving them ammunition and he like encourages them and entrenches them, makes them stronger. And then they said something like when you’re being retweeted by some of the names you said, when you’re being retweeted by those people, you have to ask yourself what kind of person you are, right?

– [Zubin] That’s right, I get that too, yeah.

– [Vinay] Okay but then the counterargument I think is that if you pursue truth, you cannot judge truth based on who retweets it, who likes it. If you say the sky is blue and Donald Trump likes your tweet, is the sky not blue? You know, you have to pursue truth, that’s one. Two, is it, actually, an empirical question. Is it the case that people who truthfully pursue safety signals are the ones emboldening people critical of products or is it the people who want to not talk about it, want to downplay it, want to use false denominators, want to mislead on myocarditis, want to ignore myocarditis? There’s somebody who was arguing with me about this myocarditis, they deleted all their tweets where they said like it’s not real early on, you know? And so like I would say, my opinion is that you being so dogged and unwilling to be honest about myocarditis actually emboldens them more because they’re actually saying, like look, the mainstream establishment doesn’t want you to know about this. John Mandrola is honestly pursuing something that he thinks matters. And I think it’s a mistake to, I guess it’s a mistake always to choose your views based on what people you dislike may think. You believe what you believe and it’s up to other people to react to it. But it’s really I think dangerous to suppress safety signals because you worry how it’ll be misused because I think you’ll actually lose a lot of trust.

– [Zubin] That’s the thing, it’s about really honest transparency. One of the things that I did early on that I think I was incorrect, which we’ll talk about, we can talk about it now, was this idea of gain of function research and could this be a lab leak thing? And early on, I kind of really felt in to the mainstream narrative on this and was like, you know, they’ve probably looked at these sequences, it doesn’t seem reasonable. We know that other SARS-CoV-2, SARS-CoV-1, MERS, they came from legitimate animal hosts. That’s where this usually comes from. And I would publicly say, that’s nonsense, it’s misinformation, it’s ideologically based and there’s a little tinge of racism here. That’s how I felt at the time. And then became convinced more and more that no, no, it’s an equally likely possibility that this thing was, or we ought to be looking at it very, very carefully instead of just taking this narrative. And so I had to alter my viewpoint. So how do I judge my old self? I have to judge my old self based on did I try to do the best I could at the time? And so what was my thinking like, was it biased? Can I see it in retrospect? Did I see it at the time? That’s kind of how I think of it. So for me, I’m always looking for truth, but I’m also looking for how I’m looking for truth as a kind of meta phenomenon. Like, am I doing that correctly or am I ideologically biased or what’s going on?

– [Vinay] That’s such an interesting thing. I mean, to some degree, I think all of us, we all guard and have guard rails on our thinking that conform with what expectations are in our communities. Like there places you cannot let your mind go or at least you can’t say you let your mind go there. And I think that was one there were strong guard rails on. I mean every bit of establishment made it seem like that we knew. And I guess, I mean to some degree to be fair to you, you’re not a sequencing expert. I mean I’m not a sequencing expert either and every sequencing expert had written that very strong condemnation in the Lanset where they came down very forcefully. Now, that letter’s not looking so good. But they did come down and they’re like, stop talking about this, that’s what I said. And then Facebook banned it and they’re like, okay. I don’t know, I think I mostly stayed out of it because I have no clue.

– [Zubin] Yeah, I’m not smart enough in that field.

– [Vinay] Yeah I don’t know about like, I still don’t know, but I do think the new NIH letter by Lawrence Tabak is out and basically saying that this eco whatever, EcoLab or EcoHealth or whatever, that they were doing research. There’s a big debate on what gain of function means. But to me, it’s like where you juicing that virus or not? Were you juicing it up to like infect? And I don’t know, it’s looking like maybe they were, NIH-funded juicing that up.

– [Zubin] You know, it comes to really talking about compassion, I have more compassion for people who are very skeptical of authority after that event, because it’s exactly that, I listened to these genome sequencing experts. By the way, like I did a master’s thesis at Berkeley in genetics on Drosophila. So when I see these experts, some of whom I know who they are, saying, no, I’m like, okay, I buy that. You know a lot more about this than I do so I can then publicly say, I don’t think this is natural zoological transmission, zoonotic transmission. And now I’m like, wait. So every single expert has their own bias. And in fact, sometimes we’re so in our own crap that we, we can’t even see the bias. We’re the easiest people to self-deceive because much of our identity is tied into this particular belief. So that’s something that we have to recognize. Now it doesn’t mean that all the crazy misinformation people are correct. It just means, hey, you shouldn’t be penalized for asking questions about stuff with good intent and with discourse.

– [Vinay] Did you have a lot of fly paper in your lab to catch the stray Drosophila?

– [Zubin] So it’s a funny story. I used to teach MCAT down the road. And so I would go there with like files of these fucking fruit flies, because I had to, I had to screen them for wing mutations. And one time, one of them like broke open in my backpack. And to this day, in that facility, there’s fruit flies in the facility, like to this day. And the reason I know this is the guy I used to teach with, the guy who hired me, this guy, Dale Schmidt, lovely human being, he passed away recently of a brain tumor. So I went to his memorial in Berkeley. This was just as things were starting to open after vaccines were happening. Even in Berkeley people weren’t wearing masks and they were hugging and it was beautiful, right, it was the spring of hope. His son told me, “Yeah, Dale used to complain nonstop that Zubin back in 1994 brought fruit flies and they’ve never left.” And I’m like legacy, legacy.

– [Vinay] You can all tell them because of their mutated wing.

– [Zubin] That’s what it was. I was like the X-Men of Drosophila.

– [Vinay] I had a friend who worked in a Drosophila lab and he was like, oh, meet me in lab after work, we’ll go get a drink or something. And I’d go to that lab and there’d be like all these stray fruit flies lab all over. And I’m like what is this thing? And then I forget, how did you anesthetize them or something?

– [Zubin] The CO2 gas.

– [Vinay] That’s right, CO2, you knock them out with CO2. And then can you refrigerate them too or something?

– [Zubin] Yes. So when you put them in the fridge, it slows their development.

– [Vinay] I see, yeah. So he’s like pulling all these fruit flies out of the refrigerator. I was like, what is this?

– [Zubin] Dude, dude, that scene, I’ll tell you that’s when I knew research was not for me. You know you find, is this my authentic me? No. I used to have to make the fruit fly food, the agar medium that you put on the dish that they eat.

– [Vinay] And what do they like? They like vinegar.

– [Zubin] Well, what they like is fermented.

– [Vinay] Fermented sugar.

– [Zubin] You take auger, sugar, yeast and you make it into this big vat and you’re stirring it and I was like a line cook, right, just making this fruit fly medium. And I swear to God, I was so hungry at times, I would reach into this vat, yeah, it was awful, and I’d just be like, oh, molasses was one of the components. And I’d just be like, glug, glug, drinking raw molasses.

– [Vinay] No!

– [Zubin] I was desperate. I was in college, I had no food.

– [Vinay] So you’re eating the same thing as the experimental subjects?

– [Zubin] Basically, I became, I started to look like a fruit fly. I had variegated eyes.

– [Vinay] I think there’s a Kafka novel in here somewhere.

– [Zubin] I believe you’re correct. Yeah, yeah, I mean there you go. Jeff, what’s his name, the guy who played “The Fly”?

– [Vinay] Goldblum.

– [Zubin] Goldblum, with the back hair, ew.

– [Vinay] Well anyway, so back to what we were talking about fascinating walk down memory lane. What were we saying, COVID broke our brains?

– [Zubin] COVID broke our brains. What’s that about?

– [Vinay] Or should we talk about Fauci, gain of function? COVID broke our brains, I think COVID broke our brains because I think that’s the theme of what we’re talking about is that it was difficult for people to be impartial on school reopenings. I think even to this day, one of the things that I, strangely, I don’t get a lot of hate email, you know, but I guess it finds other ways to reach me.

– [Zubin] Twitter.

– [Vinay] There’s Twitter, yeah, probably Twitter. But people were critical of my Atlantic article and I had a MedPage article about that on like the evidence for masking kids. And I think, I guess I would just wish someday somebody will like, if the academic profession will want to actually be honest about like how we didn’t have really good evidence for doing that, we didn’t have any cluster randomized trials and that they were like huge differences across Western Europe and this country. But I think many people just cannot acknowledge that. They view it as like, and they view it as a dangerous idea to even talk about that. And that to me, is like one of the ways in which our brains are broken a little bit, like we’re so wounded that we can’t even.

– [Zubin] Yeah, let me ask you a question. So let’s say they ultimately do these trials.

– [Vinay] They’re not going to, but go ahead.

– [Zubin] They’re not going to, but let’s say they do and they find that okay not only are even a crappy cloth mask, any kind of face covering is super effective at dropping the R-naught of this virus and would’ve saved hundreds of millions of lives or whatever it is, right. How would you respond as the stances that you’ve taken? How would you interpret that? How would you stand up and talk publicly about that? How would you feel internally about that?

– [Vinay] I guess I would say that that information would be so powerful, it would extinguish a lot of the ongoing debates. And had they done that study early in the pandemic, you would have saved those lives because all these governors would have fallen like dominoes and they would have had to do it when you have that kind of clear convincing evidence. They may have put up some resistance, but even the governors who are unwilling to go on the mask mandate, I’ve not heard a single one of them say vaccines don’t work. To some degree when you show them ironclad data, they do swallow it, and if you really show that, but I will tell you it won’t show that and I think here’s why it won’t show that. Because even in Bangladesh when the population had no preexisting immunity and no vaccination, the cloth mask failed, absolutely failed.

– [Zubin] Surgical was better, yeah.

– [Vinay] And surgical worked, surgical worked. That data point, if we knew that in March of 2020, that would have saved many, many more lives. And even to this day, the CDC should delete every cloth, I just went to get coffee before I came to meet you-

– [Zubin] Everyone was wearing a cloth mask?

– [Vinay] Why are we doing this? Like, if you’re going to wear the mask, wear the mask that worked. Why are you wearing the inferior mask? There’s no shortage of surgical masks now. In fact, you want some, just go to the ocean and scoop up a handful.

– [Zubin] They’re around a turtles neck.

– [Vinay] Unfortunately, yeah.

– [Zubin] No, it’s absolutely true. And I always wore surgical masks early in the pandemic before vaccine. After vaccine, I stopped wearing masks and then I started wearing cloth when they made it mandated, because I’m like this is a placebo. But I could be proven wrong on that by data but they’re not gonna do the trial.

– [Vinay] So that’s the other thing. After vaccination, there are no relevant data at all so that needs its own study. I also had a, I think I had a box that was a really old of surgical masks and I wore that early in the pandemic and it’s just a better mask.

– [Zubin] It’s a better mask. It’s more comfortable too. I actually like it.

– [Vinay] It’s more comfortable. It’s easier on the ears. It’s not a garbage piece of cloth.

– [Zubin] A diaper.

– [Vinay] It’s not some stupid cloth mask.

– [Zubin] Hopefully, we’ll learn something out of this, but I actually do think, I think as we wake up a little bit to how much suffering and how little compassion there’s been, maybe we’ll have a collective awakening. But I’m an optimist actually about that. I think it’s necessary actually. But we’ll see. Again, but you can’t silence people.

– [Vinay] I think it’s a mistake. I think it’s really, I don’t know.

– [Zubin] We do have to be careful, you and I both though, not to interpret legitimate discourse that disagrees with us as an attack on us personally, right? So sometimes my instinct is to interpret it that way and I have to stop myself and go, no, this is actually a really, this is a person putting out a valid concern and I’ll often respond to those and say, yeah. Not on Twitter ’cause I don’t engage on Twitter.

– [Vinay] I would say that the classes of personal attacks are, it’s not just true for you and I, it’s true for anybody who’s been personally attacked this last year is like speculating about motives. What is Jay Bhattacharya really after? What’s Z-Dogg really after? He’s after this. So I’m like what kind of worldview you have where you and all your friends are honestly pursuing the truth, but anyone who has sees it any way different, they’re out for some secondary gain? That’s a perverted view. Okay two, speculating about who you are, what you do, where you live, what you eat, what you do, all of this personal stuff. Three, just the dismissive, like, oh, everything that person says is wrong. Really? I was like, you know what? Even somebody who many people dislike, Donald Trump, he said we should reopen schools. You know what, he was right about it. So everybody is not, no one is wrong about every single thing.

– [Zubin] Right, right, right. And there is this kind of stereotyping that happens too. Like I know like if I get attacked on Twitter, there is a 90% pre-test probability that the person who attacks me is self-describing with 13 pronouns, a rainbow flag and some other things, and they’re not gay, not a minority and not a woman. And so it is this interesting kind of, we were talking about virtue signaling in previous, like this idea that to your tribe, you signal that I am part of the tribe by saying, this is what I feel like I should say. But there’s a thing, even vulnerability signaling.

– [Vinay] That’s what I wanted to talk about, yeah, performative vulnerability. This is something new I’ve been seeing a lot on social media.

– [Zubin] Tell me about this.

– [Vinay] I guess, I don’t know, it’s important to acknowledge that all of us have good days and bad days, I’m sure that’s true even for a bubbly person like yourself.

– [Zubin] Shut the fuck up.

– [Vinay] You probably have some bad days.

– [Zubin] Many, many, although I’ve been getting better as I get older. My emotions are more experienced as energy than they are as something with cognitive attachment.

– [Vinay] Interesting.

– [Zubin] So in fact, and this is a quick aside, quick aside, the other day, somebody, that’s what it was, I was doing a live show and somebody left a comment during the live show that I read and I was like, man, that really triggered me, like that really made me mad. So I was sitting watching TV with the kids and I started feeling this like anxiety, you know, like that you get when you’re kind of personally attacked. And then I was like, what is this? Oh, it’s that comment that was made and look, oh, look how it’s manifesting. Why, what’s the cognitive belief I have? Oh, that she’s right and that I actually am a bad person because I said this thing. Oh wait, no, let me feel into that. And then you just feel it as this vibrating energy and go, I’m just gonna allow this to exist here. And it just passes through you as energy. And instead of wrapping you into a cognitive neurotic loop of thought. And so that’s something that only in my, through introspection have I been able to do, but earlier I would have gotten in a pattern of just, okay, I’m gonna stop the movie, now I’m gonna go upstairs and write some angry emails or do some tweets or try to project my way out of this.

– [Vinay] I mean I feel similar to you in the sense that as you get older, I think my emotions have come like a lot, like I used to feel, I don’t know a lot more emotions when I was in my 20s and now it’s like, and like when I wake up most days, most days, I tend to be a chipper person, for better or worse, and it got a lot, and I didn’t tell people this, I think about moving from Portland to San Francisco.

– [Zubin] Oh yeah.

– [Vinay] You know people are like, oh Portland’s so gray, it’s so cloudy. I was like, Portland has two seasons. We have the summer, which is like three months of, at least San Francisco, three months of like Bay Area weather, and then we have the winter of nine months where I like describe it as like, it’s like sleeping under the mister in the produce section but the mister is like always going for nine straight months. And it’s not a rain, it’s just a mist and it’s like dark. But I would ride my bike to work every day and I’d like get heartbeat up and stuff and so I was always pretty happy. But then I moved here in like one week, I was like, oh my God, it’s like a fog was lifted off me. I was like, wow, I was really having some seasonal effective disorder, I didn’t even know it.

– [Zubin] We are so deeply connected to our environment and when we’re not sensitive to it, it just rules us. So when I lived in San Francisco in the Inner Sunset for UCSF for four years, fall all the time, miserable, depressed, suicidally depressed third year of medical school. When I moved to Stanford down to the peninsula to do residency, it was like a cloud had lifted. And then, eight years later, however, 10 years later when I moved to Vegas, I was just like, okay, it was 320 days of sun, and not just sun, but bright high UV content, like I was overjoyed most days. Yeah, it’s crazy. We’re really deeply tied to our environment.

– [Vinay] I think it’s true. And so, now I think like my bad days I wake up and my enthusiasm to work is low, but I still probably do a lot of work on those days. But then the days I wake up when my enthusiasm is good-

– [Zubin] Oh, crushing it, crushing it. You’re one of the most productive people I know. So you were saying the vulnerability.

– [Vinay] So I guess what I wanted to say about that was, I don’t know, I do think there is a danger if you process all your emotions through social media and I see increasingly there’s a new type of, there used to be conspicuous consumption, then, there was like conspicuous production. So like conspicuous consumption like in the ’80s, like I bought a sports car, conspicuous production in like the last decade was like, oh, look at my dinner I cooked for my family and it’s like so wonderful dinner. Now the new thing is like conspicuous vulnerability and it’s like, you know, my cousin’s dog died or my cousin’s friend’s person died and this person meant a lot to me and I’m gonna take the day to reflect or I didn’t get my grant funded or I didn’t do this and I’m just tweeting this, I’m just saying this, I’m just posting this to show you all that even successful people have off days, that we all struggle, we all do this. And I’m like, ugh, I’m like, of course, yes, it’s a nice message to send, but come on, it’s so performative. Like, you’re all doing it now. What happened? Five years ago, no one did this. Now everyone, I didn’t get this grant, I didn’t get this. And I was like, look, I published, I publish like 40 academic papers a year. If I published every rejection I got on Twitter, I’d put like two out a day. I’m like got another paper, got another paper. I don’t even think about it for one second, you got to move forward and get these papers out the door, come on.

– [Zubin] Man. It’s a circus performance, and again, it’s a tribal thing. It’s what Brene Brown calls vulnerability Barbie, like she got typecast by doing this TED Talk about vulnerability and shame, which was a really good talk, one of the famous talks, but then she was like, oh, you’re vulnerability Barbie, right? Like you made it cool to be vulnerable?

– [Vinay] It’s like vulnerability porn. And then people add to it and they have like the, I don’t know what to think. And I’m like, I don’t know-

– [Zubin] There’s an inauthenticity about it.

– [Vinay] I think it’s inauthentic. And like I don’t know if you really are grieving, you don’t got time to write your 25 tweet, you don’t go on it. You’re in your bed under the covers crying. You’re devastated. And you know what, somebody told me, this young person, younger than me, he told me that like he thinks that the younger generation, they only know how to process their grief through this.

– [Zubin] Man, that’s bad. Because the thing is they, emotion, my friend Angelo calls it energy in motion, it’s really an energetic thing that you feel in the present moment. If you try to escape from that feeling by projecting onto social media or creating a persona or adding cognitive layers of thought to it, the emotion doesn’t go anywhere, it just festers. You know it’s there, that energy doesn’t know where to go and you carry it around. So what I’ve learned is now, like sometimes I’ll just be driving and something will trigger an emotion and I’ll just like start crying in the car, which is weird because then you look at like people left and right and they’re looking like what the fuck is this guy doing crying?

– [Vinay] And the radio’s playing “Don’t Stop Believin'”

– [Zubin] Exactly. ♪ When the lights go ♪ I’m like oh my God, it’s so beautiful. What’s interesting is the emotion is so pure that I can’t even add a cognitive explanation. I don’t know what triggered it really, but you just let it go through and then 30 seconds later, it’s like you’ve been through a rainstorm and it’s passed and there’s sunlight. It’s crazy. So this is only in my elder years that this has started happening. It used to be you would just feel like, you’d feel something and be like .

– [Vinay] And stifle it and not deal with it.

– [Zubin] Stifle it or come up with a cognitive explanation.

– [Vinay] Yeah and like I don’t know, sometimes you have to work through your grief, it takes years, and sometimes you have to think about it and try to get to the root of what it is you would have done differently, what you miss, what you really, what really pains you and put your finger on what pains you, sometimes it’s not so easy. And it’s not processed through this fake world of people who mostly don’t really know you and don’t really care about you. I find it quite sad actually.

– [Zubin] It is very depressing. And actually, one thing you said about putting your finger on the emotion, which by the way, none of this is what we were intending to talk about, it’s perfect. We misinterpret that energetic pattern often. So what you said about like, oh, I have this thing and I need to get to the root of it. Often when you get to the root emotion, it’s something like fear of abandonment or fear of helplessness or fear of intimacy, it’s something like very core, fear-based that you’ve called anger or irritation or frustration.

– [Vinay] Or that you’ve made about someone else when it’s about you.

– [Zubin] Yes, yes, yes. It’s always ultimately about us because other people don’t control us. We’re in full control when we actually realize, actually, nobody’s in control, things are just happening. And when you let that go, then you really have control. You’re like, ah, yeah, of course, it’s called equanimity, you’re just like this is just how it is.

– [Vinay] I think that’s one of the things is that if you think you’ll be happy when something happens, you’re never gonna be happy ’cause there’s always gonna be that thing on the horizon. You gotta be happy in the moment.

– [Zubin] That’s the root teaching of all spiritual traditions too, a desire and aversion are the core of suffering. It’s like always grasping for the next thing. Did it make you happy? Maybe for 30 seconds I had dopamine and then I’m like, what’s the next thing I’m gonna do?

– [Vinay] You know why I like coming over here? ‘Cause I like talking to you, ’cause I like talking to you.

– [Zubin] I like talking to you too.

– [Vinay] No because it’s like, I don’t know, it’s rare that you talk to somebody who I feel like, I feel like we always have a good conversation. And someone was asking me like what’s your perfect day? I was like, for me, my perfect thing, dinner party, six people, six good people, good people. You know who you are. You know who you are in my life, six good people who know how to not take themselves too seriously, have a laugh, a deep laugh, not get hung up on everything, I don’t know, I don’t want to hear any complaints and I don’t want any record of what was said, I don’t want any pictures of the dinner. If you take out your fucking phone, if you take out your fucking phone to take a picture of the dinner you’re not coming to my dinner party, okay? I want a dinner party so popping that you won’t even think, like for you to think to take your phone and take a picture of whatever you’re getting, that’s a shitty dinner party. A good dinner party, the conversation is so brisk, you wouldn’t want to take your phone out.

– [Zubin] And so present in such a flow state and yep, yep, yep, yep. And there’s authentic vulnerability. This is what I mean by that, you’re you without fear. Be like, oh I don’t want Vinay to see this side of me because he’ll think I’m X, Y or Z.

– [Vinay] I don’t want anyone to screenshot this, screenshot it.

– [Zubin] It’s like no, I’m not even thinking about social media. Next week, I’m going on a six day meditation retreat, I’ve never done one, with that guy Angelo I was telling you about, I did shows with, and it’s in Monterey, and we’re not supposed to speak and it’s gonna be really interesting because you’re left with yourself in silence. And the hardest person to be with can be yourself so this’ll be really interesting, I’m gonna come back either destabilized or awake.

– [Vinay] I once had somebody close to me, she did this for like 14 days and she told me that it was like incredibly transformative.

– [Zubin] Yeah. The people who have done it, they say that. And you can hack that with certain psychedelics, but I don’t think it’s the same. I think there is, the process of being there with a good teacher and a group of people, so there’s an energy that happens with a group of people that are all there for the same reason, so it’ll be interesting. And some of them are supporters of the show ’cause we of set it up as this like supporter retreat. So it’ll be fun. Hopefully, I don’t get stabbed, the kind of emails. Oh by the way, the email thing, one other thing on that.

– [Vinay] I wanted to ask you, go on, finish your thought.

– [Zubin] I point out these like negative emails because I think they make good stories, but the emails that I typically get are so inspiring, like you just go, huh, you can’t even believe it, right? I know you get these too where you’re just like, oh my gosh, like I feel so inspired to continue trying to do what I’m doing because this person sees me for who I am and they’ll say it in an email. They’ll take time out of their day to say, “I really appreciate what you do with X, Y, and Z. I just wanted to let you know.” And you’re like what the fuck? You can’t even believe it.

– [Vinay] I guess I would say a couple things. One, I guess, to be perfectly honest with you, I probably only read like 10% of the stuff that people send me because-

– [Zubin] It’s too much.

– [Vinay] I got too many things to do and then I got to focus on what I want to do because otherwise I take away from my goals. But the next thing I would say is like the thing, like the thing that I feel always good about is I have this person from Switzerland, Geneva, Switzerland, Timothy Olivier, he is coming to work with me for a year. And he came because he like read my book on cancer drug policy, he’s an oncologist. And that to me totally makes my day ’cause he like, he’s read my writing. So he knows how I think and he’s smarter than me in lots of different dimensions so he’s pushed my thinking in a lot of things and he like messaged me, we’ve worked on a bunch of papers. I always like talking to him ’cause like our starting off point is like already here so we can talk about like this other stuff. And I’m so delighted that he’s gonna be coming here and spending a year as a study abroad scholar. It totally makes my day, it makes my year.

– [Zubin] My God, that’s amazing. And like it gives you this sense that like, okay, this is authentically who I am, they see who I am, they’re who they are, I appreciate that, we’re gonna work together.

– [Vinay] And we found each other in this universe of people where we’re the only two weirdos who are interested in this like very niche topic.

– [Zubin] Yeah similar things happen and you’re just like, holy crap. Really, it’s remarkable. That’s the beauty of this social media and internet. That’s where you’re like okay, yeah, that would never have happened.

– [Vinay] It’s like where every 10 people with any niche interest can get together, including all the crazy ones.

– [Zubin] It’s true and then you get a real micro tribe going. But we need that. We need some degree of that because it’s never happened in human history where it’s been that easy to do.

– [Vinay] Let’s talk about two more things. We got to talk about Joe Rogan.

– [Zubin] Oh yeah Rogan, yeah. So the Rogan episode with Gupta, we both did shows on this. So my take was, I was actually surprised it was more of a dialogue than, “cause I read like Gupta’s piece, he’s like, “I thought Rogan was gonna come and punch me” and it was all like garbage CNN like trying to make a thing out of this.

– [Vinay] Fuel their base.

– Fuel their own base.

– Their left-leaning base.

– [Zubin] Exactly, they’re ideologically captured by their own audience and so on. And then Rogan’s side was just like, all the guys that support Rogan were like, “Oh man, Rogan, crushed Gupta and showed him what was up” and they would cut out like pieces where Gupta was like ba ba ba ba ba. So what’s your take on all that?

– [Vinay] One, I think it was a good discussion. It’s always good. And I don’t know, that’s why people like Rogan’s show. Everyone’s always wondering like what’s the secret to Rogan’s show? I was like here’s the secret to the show, he actually talks to someone for three hours. You never hear Elon Musk for three hours, you never hear Jack Dorsey for three hours. You never hear Sanjay Gupta for three hours. I’ve never heard these people talk for three hours. And everyone who’s on media, I would imagine, I mean don’t go on TV or anything, but like they are good at talking for 10 minutes, five minutes, but when you talk for three hours, you force them to be who they really are. All the catchphrases have to go away at some point. So that’s why I think he’s good at, and on certain topics, I think he is good at eliciting the person to talk about themselves, Joe Rogan. And I think in my mind that the most interesting part was of course this discussion of like, did he take horse dewormer? And I think he is onto something which is that Joe Rogan, of course, comedian podcaster, CNN, major reputable news network, okay, the standards have to be very different between you and I talking and like if we were actually, if we were a CNN. And I think that my view of Ivermectin was, you know, we did a video on it and I’ve done other videos and then like it’s basically like I’m skeptical of all medical products until they have really good randomized controlled trials. They are ongoing with Ivermectin. And so I’m really careful to say, like I wouldn’t prescribe it, of course, I never like to prescribe things while they’re not having definitive robust studies. And that’s also why I’m also critical of like the masking two olds or 18 months, right, same principle. But I also am very scared to say, you shouldn’t say Ivermectin is deadly or horse dewormer or animal paint or whatever these kinds of pejorative things ’cause if you’re running the trial, who’ll want to enroll? Who’ll enroll if you call it all these nasty terms? So anyway, so I think he did not in fact take a veterinary product, he took a human product, and they kept calling it and many, and the Washington Post has an op-ed where many, many quotes that they said where they kept portraying it as a veterinary product. CNN is in fault. And I know why they’re doing it. They’re doing it because they’re leaning into the culture war, they’re leaning into the culture war to portray him and his supporters as right-wing, crazy, which I don’t think he even is, I think he’s probably left of center.

– [Zubin] No, he self-identifies as kind of progressive left, like a Bernie supporter, likes Andrew Yang, wants universal health care.

– [Vinay] Maybe on some issues like hunting and guns, he may be slightly off different.

– [Zubin] He’s a lot like us, I think. He’s just a critical thinker about certain things and has his own biases.

– [Vinay] And has like, he doesn’t fit perfectly in any tribe.

– [Zubin] Correct.

– [Vinay] I think that’s part of it.

– [Zubin] And he’s distrustful of authority, I think, yeah. That’s his innate, yeah, which seems to be a core value around here.

– [Vinay] Yeah, I’m also getting there, I’m getting there.

– [Zubin] I’m getting there too.

– [Vinay] I’m getting there. Yeah, so I the point he made to Sanjay Gupta I think is very apt which is like don’t you think it’s a problem for your news network to lie? And he kept pressing him on that question. And I think it’s a real big, I think he’s really onto something, which is that if we are to trust any news source, we cannot have them fuel a culture war and lie. I mean CNN should have just said, “Joe Rogan”, first of all, I don’t know if he got a vaccine or not, I forget.

– [Zubin] I don’t think he has. He’s not admitted to being vaccinated.

– [Vinay] That’s another weird thing which is like did everyone have to tell you what they did? I don’t know, I’m happy to let some people I don’t want to know about everyone’s vaccine status. I’m not carding you at my dinner party.

– [Zubin] Exactly, right, exactly.

– [Vinay] ‘Cause I’m confident that mine is working.

– [Zubin] ‘Cause you’re vaccinated, right?

– [Vinay] Yeah ’cause I’m confident I’m gonna do fine.

– [Zubin] Exactly.

– [Vinay] So I think they should’ve just said, Joe Rogan took all these things. I think he took vitamin D and all these other things.

– [Zubin] Yeah, Z-Pack and Prednisone and Ivermectin and yeah.

– [Vinay] And like I wouldn’t prescribe any of those things, but sure, I mean, you know, he took it, but he didn’t take horse pace. And I think there’s another irony which is that many of the people who are like really dogging Ivermectin, I saw that one of them said that like you shouldn’t prescribe it until there’s like well done randomized controlled trials. And I was like, weren’t you the guy tweeting about masking two olds last week? I was like, so weren’t you the pro-masking two year old person? So I was like yeah, you should be running some randomized trials there too. Yeah, of course, like we need to have like less uncertainty. And then the other irony is that like in the beginning of the pandemic, people were throwing hydroxychloroquine around like Skittles. They were Harvard, one of the Harvard hospitals, it was in their own protocol. And I tweeted, like this is ridiculous, let the trial run, don’t put it in your protocol. And then I got push back from Harvard people that I know like it has in vitro evidence, blah, blah, blah, the same things they say about Ivermectin now. And I was like, come on, you were on the bandwagon of some unproven substance. We need some principles in medicine. The principles are it’s okay to have bioplausability, you need to do randomized trials before you debut products with few rare exceptions.

– [Zubin] I think that’s not too much to ask for, but it has been during pandemic because this is an emergency, Vinay. We got to just throw all the book at things whether or not they cause harm or not. Wasn’t there some data that like the hydroxychloroquine-

– [Vinay] Yeah, it kills.

– [Zubin] It kills people.

– [Vinay] I think Catherine Axfors and John Ioannidis have a metaanalysis showing increased death of all the Ivermectin randomized trials. So it probably killed people. I think they estimated something like-

– [Zubin] Sorry, the Hydroxychloroquine.

– [Vinay] Hydroxychloroquine, right, in pooled analytic estimate, it had an increased mortality. And cowboy medicine is never good. We also have those news reports of like the doctor was like, oh, I just tossed on some TPA. I was like, you don’t just toss on TPA. Like that’s not a kind of drug-

– [Zubin] Little bit of a bleeding risk there.

– [Vinay] Little bit, yeah partners toss on some TPA. Come on, I mean, I don’t know, are you gonna slaughter a goat too? Come on.

– [Zubin] You know that’s probably more effective because it creates a placebo effect that’s much more powerful. Like if someone brings a goat into my hospital room, I’m on a ventilator, I’m on like 20 of PEEP, I’m ready to like have barotrauma. You see a goat, they cut the goat, blood’s everywhere, this guy’s chanting, I’m gonna be like damn, if this doesn’t work.

– [Vinay] You’re like, turn down that PEEP. I’m ready for an SBT. I’m ready for my spontaneous breathing.

– [Zubin] Exactly, you’ve got that guy from Indiana Jones Temple of Doom, he’s like ripped out a heart, Shakti De Kali Ma. By the way, that movie was so racist. Have you seen it recently?

– [Vinay] No, I haven’t seen it recently, but I remember as a kid where people were like, “Oh, is that what India’s like?” I was like, “That’s not what India’s like.” Come on.

– [Zubin] I asked my dad ’cause we saw it together. I’m like, “Dad, I’ve been to India. I don’t think it was like that.”

– [Vinay] I didn’t see the snake appetizer.

– [Zubin] Totally, totally. He’s like, “Nobody’s eating these snakes. Nobody’s eating these bugs. What is this nonsense?” He was so pissed, my dad was, when we saw it in the theater in 1984 or whatever. But now I watch it back and I’m like, no, the most racist component on that was Short Round, the little Vietnamese kid who they pick up in, they pick him up in like Beijing or something, “Hey, Dr. Jones”. You’re like dude, I don’t know if that’d play today.

– [Vinay] Oh yeah, wow. Yeah, I think a lot of these things would-

– [Zubin] Would yeah, well the times change. It’s just like we were saying, to bring it full circle, when you’re young, you do some crazy stuff, the times change.

– [Vinay] I watched a comedy special from 2008, I’ll only tell you what it is off-air, and I was like oh my God, every one of these jokes today, it was like whoa.

– [Zubin] If Chappelle’s getting canceled for the transgender stuff on the Netflix special, dude, that stuff will get you like, if there was a jail for thought crimes, guy’d be like getting life, he’d be in solitary.

– [Vinay] Oh my gosh, I really, I don’t know how comedians navigate these waters because I guess, I don’t know I was thinking about comedy. This is a random thought. I’ll tell you anyway. I was thinking about comedy and I was like what is really good comedy is like, mediocre comedy is when you say the thing everyone’s thinking but no one says, but great comedy is when you say the thing that everyone hadn’t yet thought about but they know it’s true and no one says, that’s like the sweet spot of comedy. When you’re just like, you know, and you find an observation about life.

– [Zubin] And there’s a surprise component because you’re like, you feel an internal sense of connection and then you’re surprised you’ve never thought of that and that triggers the energetic release of laughter. So it’s really quite a cascade that happens. And there’s so much subtlety to it to be like, are you aligned with this comedian? Have they already created this flow state and are you in that path? Because how you deliver it then is different. So there’s so much subtlety to it that I never, I’ve not studied it, it’s just something that like you know I used humor as a way to cope with whatever bullying or feeling out of place in Clovis, California when I was growing up as this weird kid.

– [Vinay] You were the little comedian.

– [Zubin] Yeah, I was the little class clown guy. In fact, I was, I was our class clown. And it’s funny, the female, we had a male and a female class clown. The female class clown, I didn’t even know who she was. Our high school was so big, I’m like, who the hell are you? You’re supposed to be funny. Like let’s have a funny off right now. Like immediately I was getting competitive. I’m like, come on. But it was all ego, it was all like trying to keep people under control by using comedy. If they’re laughing, then you’re controlling the conversation type of thing.

– [Vinay] You know you talk about Netflix and Squid Game was so popular. I’m not supposed to tell you about-

– [Zubin] I haven’t seen it yet.

– [Vinay] I’ve watched like seven episodes. It’s dark, man. It’s dark. I mean I guess the other drama that I think of, the Korean best picture “Parasyte” and then Squid Game I think follows, there’s a lot of connections there in the sense that Squid Game is about people on the down and outs in society, they owe people money, they borrow, they’re gamblers, they’re criminals, they’re on the down and outs and they’re given this opportunity to essentially play a children’s games, except the penalty is death and the prize is a lot of cash, but they’re doing it because they’re desperate and their lives are broken. And I think what makes the show so good is that all of the games are literally very dark, you’re very tense when you watch it, you don’t know who’s gonna live and who’s gonna make it, as well as the backstory of the characters are very heart-wrenching. And it’s really done really elegantly. But I think it’s also telling that what does it say about America that we are so drawn to this narrative of like, in “Parasite” too, when people are on the down and outs of society, what are desperate people willing to do? And we’re just so captivated by these things. I think in part because many people are feeling very desperate.

– [Zubin] Feeling that thing. Well you know there’s an anime that I watch with my kids called “My Hero Academia” and yeah, it’s an interesting subject. It’s like a Harry Potter thing, but with heroes. So these kids who in a society where like there are 80% of people have super powers, like this mutation happened and people get super powers, some of them go on to just be cops and stuff or just like a doctor, like they have healing powers, but some of them decide they’re gonna be superheroes. And so there’s schools and the academy that they go to is like the Hogwarts, it’s like the gold standard. So this little kid’s born without any power, he has no, they call them quirks. But he’s always, he’s like in love with like the lead superhero, this guy All Might, who’s like an American, well, he’s trained in America, so he’s like ha ha ha ha, like his moves are like Detroit Smash, but it’s Japanese so you watch it in the Japanese with the English subtitles. Anyways, so long story short is All Might through a series of events discovers this kid has this heart that just wants to help people, he’s a true hero inside, bestows on him this power and then he has to go through all his training. And so all the backstories of the villains even are these heart-wrenching, like, you’re like, oh my God, this poor person.

– [Vinay] Oh, you have sympathy for the villains?

– [Zubin] Yeah, they’re like a victim of their circumstance. And of course, they would behave this way. If I were them, I’d be doing exact same thing. And so you have this general sense of compassion, which is why the show is really good, like it compels adults. Like I was like, oh, this is actually really good, like it’s a true like uplifting, it’s like a positive Squid Games.

– [Vinay] Yes, yes, yes, positive. It’s so interesting. I was recently asked to like give some lecture, it’s actually in another country via Zoom and it was about like implications of the pandemic like beyond health and that led me to sort of a lot of thinking about like pandemic implications on democracy and things like that and I talked to this political scientist, Vlad Kogan, who’s been on my show many times about some of these things. But I think like Squid Game, Parasite, the pandemic, I think it’s clear that all the things that were there before have gotten a lot worse, income inequality, wealth inequality, upward mobility, opportunity, schools. These are all ways that, this is like the most regressive response we’ve seen. And that’s things like people have pointed out on your show and many people have noticed, but I think the implications for society over the next 10 years are like non-trivial. And I don’t know, what can the average person do? I think that’s something, I don’t know maybe worth saying. Like one, people you disagree with, you shouldn’t hate, you shouldn’t want them dead, you should be a little bit more tolerant of ideas that you don’t initially hold, you should maybe be a little bit less tribal, you should maybe do a little less signaling and a little more listening and try to meet people a little bit more in the middle. The mandates, let’s talk about that for a second, then I got to go, we’ll get lunch or something, oh don’t say that.

– [Zubin] Yeah, we always get recognized out here.

– [Vinay] No, you get recognized and then people are like, oh, I think I know you. You get recognized, I don’t get recognized.

– [Zubin] It’s my neighborhood.

– [Vinay] Prefer to keep, yeah, keep it that way. But what was I saying about?

– [Zubin] Oh, you were talking about mandates.

– [Vinay] Mandates, oh yes. I think, you know, I don’t know, I’ve written a lot about it, you’ve talked a lot about it. I mean it’s easy to be in the moment and think that the only goal in the world in the next 10 years is to get vaccine uptake high. And I think getting vaccine uptake high is a worthy goal, we ought to do that. Now, the moment you start introducing mandates and firing people from jobs and kicking out healthcare workers who have been working in the pandemic, even when they were unvaccinated taking a lot of risk on their own shoulders, you start to, things will cut both ways. I mean, it’s clear that these mandates have increased the fraction of people who got vaccinated ’cause a lot of people cannot afford to lose their job, that’s why they’re getting vaccinated. Some people have quit over it, a non-trivial percentage of people, one percent or something. But in a lot of hospitals, like they are the glue that keeps things going, like we need those people. Things are like not as good in clinics because they’re gone. And a lot of people are dropping out of the labor force for lots of reasons that we don’t even know, like their desires have changed, et cetera. But I do think that one of the consequences of the mandates is what will it do for vaccine uptake? But another consequence is what will it do to how people vote in the future? The left has aligned itself with these mandates. They’ve aligned themselves with strong masking recommendations. I think we will see in the Virginia election next week, like, will they pay a price for that in the polls? And we’ll see in 2022 and we’ll see in 2024, if they’ll pay a price for these things. And I think it’s easy to go on social media and feel like you have a finger on the pulse of what people think, but there is, all the polls are getting more and more inaccurate, there’s a lot of preference falsification, like people are unwilling to admit how they really feel about some things. And I think I have a lot of reason to feel a little bit nervous about what people are, what do people really think and will they vote, how will they vote next time?

– [Zubin] Well, you know, it’ll be a good wake up call, I think for people who feel a certain way about where the world ought to go and they find that, oh, they’ve actually been voted out of-

– [Vinay] #zerocovid’s been voted into the garbage can.

– [Zubin] Exactly right, exactly right. Lockdowns and all of that. I think it’s good. What I actually think and this is a good way to end all this maybe is that there are a lot of people who are waking up a little to like, hey, what is this all about? Like, why am I even doing this rat race of a job that I hate? And a lot of these guys are in healthcare ’cause healthcare is a shit show for a lot of people because systemically, it’s terrible. So they’re good people wanting to do the right thing, maybe they’re even called to that profession, but boy, it’s just been impossible to, what you said earlier, hey, what’s my best day, what do I really like? Your dinner party, right? I think about that in healthcare sometimes. Well, what’s my best day as a hospitalist? Oh, it’s when the paperwork is minimum, there’s a team of really smart people that we’re pushing and pulling on each other, we’re supported by a larger team, we have time to spend with the patients and we have the tools, resources and autonomy to do our job and then that bad is liberating, that your sense of moral elevation. You’re like, my God, I was called to do, this is beautiful. So there are a lot of people who have not seen that much at all in their work and they’re like enough.

– [Vinay] Yeah. I think like one narrative is like healthcare workers are quitting because they had to care for COVID patients. I think that’s true in a lot of cases. But another narrative is they’re quitting because they realize that a lot of this stuff has been forced fed to us. I’ll tell you one thing I got a lot of emails about when we talked about it, and I did read some, was about that letting people die alone part, that had happened a lot and still kind of happens a little bit and a lot of doctors wrote to me saying that like they knew it was wrong, they didn’t want to enforce those rules, but the hospital administrators made them do it. And I was like, oh man. I was like, you know, I guess I would say there’s like nothing worse than like imagining being a doctor and someone tells you some stupid rule that you know is just morally wrong, garbage, and you like don’t even feel like you have the power to, like medicine needs to be a field where that doctor should have the power to crush that rule and do whatever they want for the best interest of their patient. And if it’s not that field, then it’s not run by the right people.

– [Zubin] That’s the moral injury of it, you know? And the idea of again, tools, resources, autonomy, they don’t have autonomy. Like, oh no, this is terrible for the patient, it’s terrible for the family, it’s gonna create psychic wounds, it’s unethical, it’s unnecessary.

– [Vinay] It’s unnecessary, it’s unnecessary.

– [Zubin] Like we have the PPE. Like why are we doing this? Oh because Billy Bob, the administrator.

– [Vinay] Some risk averse bureaucrat-

– [Zubin] Risk management in the hospital’s like it’s the whole reason I don’t have 20 more music videos. Hospitals have shut down my ability to film in them because their risk management departments-

– [Vinay] Well not if you are a YouTube influencer.

– [Zubin] Oh yeah, yeah right. If you’re like a young college just med school YouTube influencer.

– [Vinay] I’ll just say real quick. So Zubin got me to actually do some videos because I had been in the podcast stuff-

– [Zubin] You’re crushing it, by the way. It looks great, it sounds great, it’s wonderful.

– [Vinay] It’s a work in progress. He’s the one who knows all the little errors on it. But one thing I was curious was, I was like, well you know what content is out there that I will be interested in? So I was like what are the other doctors putting out? I want to watch something where some doctor talks about some drug or some product in neurology or whatever that I might find interesting. So I’m looking for that. I asked people for recommendations and I’ve got like a bunch of younger people on my team, research team. And then they like oh, watch this channel, watch this channel, watch this channel. And I guess the more I’m going down this rabbit hole of like what is the medical content of YouTube, it is literally like hundreds and hundreds of med students, by the way, is this the new loan forgiveness program, medical students have to become like film their whole lives and post it on YouTube? But there are hundreds of medical students, they film like life as a medical student, they’re filming like, I don’t know, some people are filming as their residents on shifts and stuff. I was like, listen, if you’re a resident on a shift, forget about the camera, focus on the patient, focus on the patient, focus on the patient. You can’t be getting the camera around. What are you doing? And the medical students filming like their day. And by the way, they’re doing a much better job than I was a student, AKA waking up late and like I’m not doing all the meal prep for the week, et cetera, and all these things. But I don’t know, I was just like, I don’t know, I feel like it’s a, I don’t know.

– [Zubin] It’s this theater again, you know? Be honest, if this had existed when I was a medical student, I would absolutely have done this because I was that type of histrionic, theatrical person in those days and I needed my ego to be expanded by other people knowing that I’m in medical school at UCSF working really hard and here’s my day.

– [Vinay] Our channels wouldn’t have been that popular ’cause we’re not that good looking.

– [Zubin] That’s true. That’s the main thing.

– [Vinay] I would’ve been like 200 followers.

– [Zubin] I know and they’re all other guys.

– [Vinay] I know and it’s my mom watching, my mom’s like, “Oh, I loved your video. You should eat better.”

– [Zubin] Exactly, I get that now.

– [Vinay] I don’t know if I’d do it because it’s, it takes away your time and when you’re not, you should be immersing yourself in the, this is gonna sound so bad, okay, what do I think? One, you should be immersing yourself in what it means to be doctor, and that isn’t just studying the stupid things the make you study. It’s also really learning about medicine in a deep way, a rich way, reading beyond what they’ve asked you to read and that should kind of be your focus because when you join a profession, a guild for the first time, there’s a period of time where you are really sort of a Swiss army knife. You can learn and cut and sew and do all sorts of things that eventually your mind will gel. And like I don’t have the innovative ideas I had when I was 26 or 27. I remember learning a little bit about biomedicine, but still having a lot of open questions and I think that’s like a really ripe creative period in any profession. I think they’re missing out on some of that when they come home and must edit these videos for ungodly amount of time to put all this stuff, you know, we don’t edit our videos, but like I can imagine.

– [Zubin] Yeah, we don’t edit, we just put ’em out. It’s ’cause we’re lazy really.

– [Vinay] Yeah really. And also that’s one, and then the second thing I worry about is like, if you turn your whole life into a commodity for others to like judge, what does that do to yourself as a person? If you turn your grief into a commodity to sell to other people, what does it do to your grief? It poisons these emotions. These are deep seeded human things that like they’re not meant to be given away.

– [Zubin] And it’s an external locus of control you’ve given away. Now what they think of me is my self-worth.

– [Vinay] Yeah and why do they need to?

– [Zubin] I’m my hardest critic as it is. I don’t need anyone else criticizing me. Like to actually feel it, you know what I mean? So that kind of thing I think, at some point, we need to have a national intervention on that and just say, you know what? Get back to work.

– [Vinay] Get back to work.

– [Zubin] When you have something to say, come out and say it. By all means, I want doctors on YouTube teaching.

– [Vinay] Right, that’s what I want to say. Like yes, there are many issues that are real and legitimate that they may think about. And when you think about it, articulate it, formulate it, discuss it with your peers, when you’re ready, put that out there. But I don’t want to know about how you make your coffee and I don’t care about how you cook the chicken for the week. And what is this and what are you spending all the time on this?

– I mean their target audience must be people who are trying to get into medical school and want to see what it’s like, but the truth is, and I had that person in real life.

– [Vinay] Your parents.

– [Zubin] My parents was one, although I tried to ignore anything they taught me, oh no, no, no, I’m not gonna be like my parents. But there was this guy, this Indian kid, he was a second year at UCSF, I’m not gonna say his name, and he shows up one day, I’m at Berkeley, he’s a friend of one of my housemates. I was pre-med, but I didn’t really know what that meant and I was also music and I’m like, I’m gonna be a rock star. And this guy shows up and he’s crazy and he’s got crazy hair and he’s Indian, he’s like a Swami and he’s smoking a ton of weed and he’s like growing weed in his room and I’m like who is this guy? And he’s like, “Let me tell you about medical school” and he just data dumps and I’m like this guy, he hates authority, he questions everything, he thinks most of what we doesn’t work, he’s at one of the top med schools in the world, he’s really smart, but also crazy, I want to be him.

– [Vinay] That was your inspiration.

– [Zubin] That was my inspiration. And I’m like, if he can do it, I can do it and it was true. And one of the advice he gave me, he’s like finish in three years because it shows that you can actually handle the workload, finish college. So that day I was like how can I arrange my credits? And I finished in three years. And so those kinds of influences were, now it’s like some YouTube, you know what you need to do? Create a meal plan. And then you need to organize your life.

– [Vinay] Use the Anki cards, use these flashcards. I don’t know what these fucking flashcards, sorry, I don’t know these flashcards are, these flashcards, we didn’t have no flashcards. You know what you do? You read the book, you put it in your brain, there are no flashcards, there are no flashcards. What’s this flashcard?

– [Zubin] And now it’s just fear of missing out, like you see this perfect student doing everything perfect.

– [Vinay] They eat better than I eat. I don’t have time, I don’t even eat breakfast or lunch.

– [Zubin] I have a wild king salmon that I’ve gently braised with virgin olive oil extracted from a teat of a mountain goat. And I’m like how did that happen?

– [Vinay] Let me just say one thing about medicine which I think that they all miss, which is like, I don’t know. I was like, you know what? No offense to the trainees, but you don’t know what it’s like to practice medicine when you’re a student, you don’t know what it’s like to practice medicine as a resident, you don’t know what it’s like to practice medicine as a fellow. You really only kind of get a sense of practicing medicine when you’re like five or six years into a job and I’ll tell you what practicing medicine means, it is not a memorization business. You have memorized a lot of facts and you’ll be surprised at how many facts are in the back of your mind that every once in a while they come up and you’re like, oh my God, I hadn’t thought about that in 15 years or something like that. That’s one, two, what really it’s about, it’s like working on the craft of talking to someone and figuring out who they are, what they are, what they believe, what they value, what risks they’ll take, what concerns them, what doesn’t concern them, what they want out of life and what bothers them and what they’re hoping for in the treat, like you’re trying to figure out who this person is. And then you’re trying to figure out what is, of all the things in Western medicine, which is this like incomplete, fragmented view of the body that is still 1,000 years from now is gonna look antiquated, of all the things we have, what are the sort of labels and diagnoses and categories we can kind of take these complaints and put them in, how parsimoniously can we fit that? Then, what are all the therapies we have? What is the delta effect of those therapies, which may be subject to bias and misinterpretation, and how might those help the person or hurt the person? How do they comport with their values and preferences? And finally, what’s the kind of treatment plan you would recommend for this person knowing who they are? What are the options you’d give them? What are the kinds of ways you’d counsel them to walk through these choices? And then the agony. Then you’re at home at night, you wake up at two in the morning and you’re thinking about that person and did you forget to think about this or that? Are you thinking about the person that you lost a follow up and where they are in their life or the person you cured of Hodgkin’s lymphoma who never came back to your clinic or the person who died and you wonder what you could have done? And that is medicine. It’s like all consuming human endeavor that is like probably the most beautiful job there is and it is not what they’re posting in their little videos, that’s not even close to the act of medicine, I think.

– [Zubin] Fuck. Man, I think you pretty much just summed up what this all means for us as doctors, that’s what it is. And if you listen to that, I’m gonna pull that rant out and put it out by itself because if you can listen to that and you feel that right deep there, you should go into medicine or you should stay in medicine. If you don’t, if you’re like no, that’s not for me, abandon it now, like go do anything else you’re interested in.

– [Vinay] And then one thing I’ll add to it is that and if anyone tells you something that you need to like have this like pit bull tenacity to get to the bottom of the fact, interrogate the fact, question the fact, probe the fact, until you come to yourself, believe it deeply or reject it outright.

– [Zubin] So in other words, think for yourself. Yeah, that’s middle in a nutshell. Dude, ha, we went like 30 minutes longer than we were going to so this is great. Oh man, it’s always a joy dude.

– [Vinay] Pleasure.

– [Zubin] Haters gonna hate. Let ’em hate and watch the money pile up.

– [Vinay] That’s not really the mantra of my life, but.

– [Zubin] It’s 50 Cent’s mantra. To me, I’m an optimist, he’s half dollar. Guys, I love you. Check out Vinay’s channel. How do we find you on YouTube?

– [Vinay] I guess it’s at my name, @vinayprasadmdmph.

– [Zubin] Perfect or just search Vinay Prasad and I’m sure you’re the main guy that’ll show up. And dude, his YouTube channel is awesome and I’m gonna take full credit for it 100%.

– [Vinay] You should get full credit. You pushed me to do it.

– [Zubin] Yeah, except he actually does it better than I do, it’s amazing. And then share the video, support the show if you want to or don’t. I love you guys, more love, more love in the world, less assumption of evil and more discourse. Okay guys, we out, peace, thanks man.