Booster Shots, Kids & Masks, Vaccine Mandates & More (w/Dr. Vinay Prasad)

– [Zubin] Z-Pac, ZDoggMD, Dr. Vinay Prasad, VP.

– [Vinay] Pleasure to be back.

– [Zubin] What is up, son?

– [Vinay] It’s been awhile.

– [Zubin] Listen, just having you here is gonna get me canceled on Twitter.

– [Vinay] I hear that, yeah.

– [Zubin] I’ve had doctors, “Oh my God, VP blocked me, he said stuff about kids and he’s not a pediatrician.”

– [Vinay] Oh boy.

– [Zubin] “Can we cancel ‘The Atlantic’ for featuring his piece?” What even did you talk about in the Atlantic?

– [Vinay] Yeah, I’ve seen a lot of calls to unsubscribe to “The Atlantic.” They must have lost, I don’t know, 10 or 15 readers over this. But what did I write? I wrote an article about the case for masking young children. Of course, you know in this country that the AAP and the CDC says mask kids two and on up. And even though the WHO says don’t mask a child under six. And I wrote an article about, what do we know about masking school-aged children? And I think people have overstated the evidence. We really don’t know a lot. And we don’t know if it slows the spread of the virus in schools and we really don’t know what the long-term downsides might be to these kids. And so that was the article, it was written in “The Atlantic,” and people got a little hot under the collar.

– [Zubin] It was purely saying we haven’t scienced this up. Can we talk about that?

– [Vinay] Correct.

– [Zubin] It’s not saying, oh, don’t mask kids or whatever, whatever, whatever. And you know, a lot of people reached out and they were like, “Well, but you know, does VP know that kids get sick and he’s not a pediatrician so he doesn’t understand that we’re seeing these kids in the hospital?” And yet these are in areas, like the areas where the most aggressive masking stuff is, where the highest vaccination rates are, where there’s already a cocooning effect from adults being vaccinated. But yet that’s where the most outrage seems to be.

– [Vinay] Yeah, and I think those were two of the points that I heard. One of the points was there are many kids being hospitalized right now in some states. And my counterargument to that is, the point I’m making about masking the kids in school is, if we really don’t know if that helps, and if it turns out that that doesn’t help, then you can be spending great deals of political capital getting that to happen and you will still have the problem of the kids coming in to the hospital. And if you really wanna reduce that problem, you’ve gotta do things that work and not things that merely appear to work, but you don’t know for sure they work. And so that’s why I’m pushing for cluster randomized trials. The next thing I’d say is, he’s not a pediatrician. Well, true, but one can’t train in everything, But what is VP’s skillset? VP is somebody who studies the evidence and the quality of medical evidence and empirical appraisals of medical evidence. That’s what I’ve been doing for 10 plus years. And that puts me in a very good position to judge the evidence here. And also many pediatricians agree with me. In fact, probably the majority of pediatricians in Europe agree with me, and that’s why the United Kingdom has never masked a child under the age of 12 in their schools as a mandate ever, through Delta wave, through nothing. They’ve never done it. They’ve never masked a caregiver taking care of a baby in daycare in the United Kingdom in the entire pandemic. So our masking policies are far beyond our peer nations and that is not justified by good evidence. And that’s the point of my “Atlantic” article that rubbed some people the wrong way.

– [Zubin] Well, I’ve lost three viewers over this, VP, for having you on.

– [Vinay] They’re gone.

– [Zubin] You know what’s funny is kids are smarter than us, I’m just telling you. I mean, they’re dummies, like they do really dumb things, but they’re way smarter than adults. ‘Cause my 13-year-old comes home, by the way, finally back in school, because guess what? She’s in public school in the Bay Area and they’ve been shut down forever. But guess what? The private schools have been wide open because-

– [Vinay] It’s always this two-tiered system.

– [Zubin] It’s a two-tier system. So she comes home after the first week of school and she’s like, “Dad, I have a question. So they make us mask in the classes.” I’ve no problem with that. Honestly, they don’t care, right? They don’t care. They wanna see their friends. They don’t care if-

– [Vinay] They’d rather be in school than be at home, of course.

– [Zubin] Dude, my kids are so happy, it almost brought tears to my eyes. Oh my God, I dropped my ten-year-old off at her elementary school. Again, public, all public. She runs, I see her run to this gaggle of girls and they’re hugging and chest bumping. And I’m like, God, it makes you wanna cry.

– [Vinay] I gotta say this. I mean, I think that what that shows you is that this last year where it was closed, that was one of the greatest policy failures ever.

– Of all time.

– Of all time.

– Of all time.

– It didn’t need to be closed. And what we did to these kids, it serves no purpose. Anyway, we can talk about some of it.

– [Zubin] None of it, none of it. So, she comes home and she’s like, “Dad, so I have a question. They make us mask in class, that’s fine. Then for lunch, we take our masks off. We sit like this, like sardines. We’re spitting and shouting at each other and sharing food. And the very next period, they send us outdoors at our Olympic-sized track to run a mile with mandatory masks on.” And actually, she had to stop and tripod to catch her breath, so she takes the mask off. Her PE teacher yelled at her for taking her mask off. But they can shout at each other this close at lunch. So she’s like, “Does this make sense? Is it scientifically valid?” And I’m like, “What do you think?”

– [Vinay] I think what you’re highlighting is a terrible story, but it reveals the naked contradictions in our policy. I mean, the American Academy Pediatrics policy on masking two-year-olds is that they wear the mask in daycare, except the two hours they take a nap and sleep side-by-side in a room often with limited ventilation. So, what am I to think? Does the virus take a nap, too? What am I to think of these policies? Are people really alleging that everybody in the United Kingdom, they just don’t love or care about children? That people in Norway don’t care about children? Because these policies are very different in our peer nations and other nations that, surprise, surprise, they care about children, too. The reason their differences is we have never invested scientific capital in studying to learn which of these policies helps. I think it’s fair to say, it’s very plausibly the case, that masking outdoors didn’t help anybody, because outdoor transmission of COVID is so fleetingly rare.

– [Zubin] Even with Delta.

– [Vinay] Even with Delta. Outdoor transmission is not the place where it’s happening. That’s one. Two, children, children have much lower risk of acquiring the virus and lower risk of bad outcomes. There’s an elegant study that Alister Monro tweeted from the United Kingdom that looked at the risk of hospitalization for COVID based on whether or not you’re vaccinated and based on your age. And it really shows that kids under the age of 18 who were unvaccinated, or kids under the age of 12 who are unvaccinated, their risk of being hospitalized with COVID is less than a 40-year-old who was vaccinated. So why are we imposing such burdens on them if the 40-year-old would happily go to a bar, happily fly across the country, happily go on vacation to Hawaii or wherever? Why are we imposing such great burdens on children? It’s irrational. And I guess that was the thesis of my “Atlantic” article. Some people were able to process it, but other people revealed I think an inability to hear things and see things and read things that conflicted with their preexisting views. And so just like they canceled their subscription to “The Atlantic,” I suggested that they really need to cancel their subscription to their eyes and ears because what’s going to reveal information to them that they might not like.

– That may be contrary.

– May be contrary.

– [Zubin] That may be contrary. It’s been frustrating because the other criticism I think that you get a lot, I get it sometimes too, is that, why are we so contrary? It’s like everything we say is contrary to whatever mainstream is saying. Everything we say is contrary to what media is saying. Is it just that we’re contrarians? How do you think about that? ‘Cause I know how I think about it.

– [Vinay] I guess what I would say is that that’s… If you were to make a map of all the views I hold, you would find the vast majority of those views-

– [Zubin] Are mainstream.

– [Vinay] Are mainstream. Why do we spend time using our talents, if you’ll call them talents or skills, focusing on some issues-

– [Zubin] I prefer burden.

– [Vinay] It is a burden. It’s a burden of knowledge. But why don’t we focus on some issues, not other issues? Well, there’s a lot of issues that are irrational views held by irrational people. We could beat our head against the wall on them, but we’re not gonna change their minds ’cause they are irrational people. There are a lot of rational views held by rational people. We could preach to the choir. We could become cheerleaders for those views. But again, we’re not going to be changing anyone’s mind or pushing anything differently and we’ll just be adding to what people already say or believe.

– [Zubin] I believe we call that virtue signaling.

– [Vinay] Yeah, we call that virtue signaling, yeah.

– [Zubin] Talking about irrationality in irrational people, that’s futility.

– That’s futility.

– [Zubin] So what are we doing?

– [Vinay] So what we’re doing is we’re picking issues where rational people, people who are normally thoughtful, careful, willing to reconsider their views, are holding irrational beliefs. And that’s where I put my energy because that’s where I feel my talents are best served. And in this case, I think it is not, I don’t know how long it’s gonna take, but very soon people will wake up and they’ll say, “Did you know that for 18 months during this pandemic, we literally masked two-year-olds in daycare for the majority of the day? And did you know, we never ran a cluster randomized trial of masking kids? We actually have no idea if that slows the spread of SARS-CO2.” Their compliance is quite poor because the compliance of adults in very carefully watched settings, a paper from JAMA that appears about stadium use, shows compliance is three out of four, even when you’re watched and you have to do it. What is the compliance with two-year-olds? What is the benefit of masking when they take it off to nap? And where is that magic age? So the other thing I cited in my “Atlantic” piece was data from Catalan in Spain, where the mask mandate started at six and they show the rates of SARS-CO2 at every age group. And so five, you know, they’re not doing it, and six, they are doing it, and you see the line. And this is a classic type of study design called regression discontinuity, which means that if you implement something at an age cutoff, what you should see is a step down, like the risk should be going up, up, up by age, and then you get to six, it goes down, because the masks have an effect. And then it goes up, up, up again. But what you see is a very straight line and where you put the masking had nothing to do with the spread of SARS-CoV-2 by age, suggesting that we might be doing this, it might make us feel better, but it might not actually slow the spread of the virus. And so then the thing I’ll connect it to is if somebody is going to say, “VP’s message is putting kids at risk,” that is contingent on the idea that you know for sure this works. And my whole message is you don’t know for sure this works. Do the things that work, and to do the things that work, you have to apply science.

– [Zubin] Ah, science, what’s that? I haven’t seen science in a while.

– [Vinay] I know what #science is.

– [Zubin] Follow the science.

– [Vinay] I know follow the science, I know what #science, I know what science communicators on Twitter are. What I don’t know is who’s a real scientist left. I don’t know who they are.

– [Zubin] Yeah, yeah, yeah, it’s very hard to find. Tell me about this Bangladeshi mask study that everyone’s talking about.

– [Vinay] Yeah, so I think first of all, it’s an impressive effort, a cluster randomized control trial, 600 villages, 300,000 people, randomized to one of three strategies. One, the usual care strategy, do nothing, two, cloth masking, and a third strategy of a surgical mask. And what they found was, the primary endpoint of this study, is if you have symptoms consistent with SARS-CoV-2, you are invited to submit blood and we check the blood for antibodies against the virus. So, serology confirmed, symptoms. There’s a secondary endpoint of just having symptoms, but it turns out that most people who just have symptoms, they actually don’t test positive for the virus. So, that’s not a very useful endpoint. That’s just like, do you feel like you have symptoms? The better endpoint is like, do you feel like you have symptoms, and did you have COVID? And what they find is that if you did nothing, the rate of SARS-CoV-2 in this community at end of study was 3/4 of 1%, 0.76, so 3/4 of 1%. If you wore the cloth mask, it was 3/4 of 1%. It was 0.74. No statistical benefit from cloth masking in this arm, despite a 30 percentage point improvement in masking. Surgical masks was statistically significant. It was 0.67. And so the moment I saw this study, I thought, boy, we screwed up because we have been recommending the wrong mask, and we could have recommended the right mask had we done this study earlier. And the last thing tied to kids, the mask kids wear, where guess what mask it is? It’s a cloth mask.

– It’s a cloth mask.

– [Vinay] Right, so what people are willing to tell me is we know for sure that kids benefit from masking, even though they’re not just little adults, they’re not just mini adults. They are different people with different behavioral patterns. But the mask they’re wearing is the mask that didn’t even work in adults. It’s a bizarre claim.

– [Zubin] Wow. You know what’s crazy is from the early days when I was quite skeptical of cloth masks, like very overtly skeptical in the very early days of the pandemic, I said, “I think cloth masks are garbage.” This is all intuition based.

– Of course.

– [Zubin] I think cloth masks are garbage just because they have wide pores, the virus is small. Surgical masks, I mean, that may be a thing, but of course they don’t wanna spare them from frontline clinicians. So, what’s the point of even doing anything at that point? And then Monica had the theory that, well, at least you reduce maybe a little bit of this. So maybe you still get infected, but there’s-

– [Vinay] I guess I got suspicious the moment someone told me I could take a dirty sock and cut the heel off and have a mask. That was a clue for me.

– [Zubin] It’s like, well, so I can basically make my face look like an Ice Cube video from the early ’90s and somehow that’s gonna prevent the spread of this, right? So again, it’s rational people behaving irrationally is where we’re pointing out.

– [Vinay] And I guess the Bangladesh study, it can do a lot of things right now. I wrote that article about it and one of the things I said is right now the CDC should go to their guidance and do find and replace, and every place that says cloth mask, delete it and put surgical mask. Because no matter how you feel about this issue, if you’re the most ardent mask proponent or even the most vigorous mask skeptic, why would you continue to recommend the mask that was inferior to the other mask? Just at least let’s recommend the better mask in this study. Can we at least agree on that?

– [Zubin] And spin them up production-wise.

– Yes.

– Right.

– [Vinay] Now, I think there are other problems, which is one, this study was adults only, so I don’t think it extrapolates to kids, end of story. Two, this is a study that occurred in a population with a 0% vaccination rate and probably a baseline seroprevalence, we don’t know for sure, but it’s probably very close to zero because it was 3/4 of 1% at the end of the study. So, it’s gotta be pretty close to zero at the beginning. Does that extrapolate to San Francisco with a 80% one first dose vaccination rate? Does it extrapolate to highly vaccinated states like California? I don’t know.

– [Zubin] It may extrapolate to Alabama, but it won’t.

– [Vinay] And it may extrapolate to Alabama before 30% of them have had COVID already. What’s their seroprevalence now? I don’t know what it is.

– [Zubin] It’s gonna be higher with Delta. I mean, Delta is like the great seroprevalence equalizer. Everybody gets it. Well, so here’s a question. So, apply the same thinking to the new Biden mandate say about vaccines. Now, how do you rationally think through the mandate? ‘Cause I think about it fairly emotionally, and my emotional thinking is this, and I’ve done a video on this, which is why are we giving up on actually having rational conversations with people? Because when you do, when you come from not that, “Follow the science, you’re killing grandma,” the shaming and all that, my experience is they actually listen. Like you said, you’re never gonna convince the irrationally irrational. They’re beyond hope. But the rational people that are maybe behaving in a way that isn’t in their best interest, according to what we know about vaccines, you can sit down and go, “Okay, let’s align on morality here and belief and come to a decision based on understanding and compassion.” I really firmly believe that that works because I see it in my email box all the time. Now what’s your rational breakdown of the mandate and is it a good idea what’s going on?

– [Vinay] Yeah, so I guess it’s a good question. The way I view it is that what he’s doing is he’s applying a lot of pressure on people who are unvaccinated to get vaccinated, and he’s mostly doing it through employer-based mechanisms, either through OSHA or direct through his federal purview, and the threat is loss of employment. And the way I view it is, you can argue it from a legal point of view, you can argue it from a right space point of view. I just argue from an empirical point of view. So, I think about how many Americans are there, there’s 330 million Americans. How many Americans have already gotten one dose of the vaccine? I think I checked a day ago, it’s 209 million Americans. How many Americans have already had SARS-CoV-2? And it’s really difficult to get that answer, because we’ve screwed up, to be honest with you.

– [Zubin] We haven’t measured it.

– [Vinay] What a negligent society, to be honest. I think it’s total CDC negligence. They should have been doing serial seroprevalence this whole time so we should be able to go to a dashboard and find the answer. I looked on their website and they have a very crude estimate. They say maybe 20%. There’s another paper in JAMA network open about dialysis patients, about 18%. So, presumably, ostensibly, maybe 60, 70 million Americans have already had the virus, where there’s at least 40 some million cases logged into the database as like they actually sought medical care, but there’s probably this huge bottom part of the iceberg that we don’t know. And of that, what’s the overlap between people who’ve had COVID and who’ve gotten vaccinated? There’s some overlap, but there’s also some difference because people who may have had an actual infection, which by the way, you’ve been good about, it’s really good, right, many of them have not been vaccinated. So, I will conservatively estimate another 40 million people have natural infection and they have some immunity from that. And then the other thing to point out is that 50 million Americans are under the age of 12, and so they can’t be vaccinated no matter what you do. And so we’re talking about 30 million Americans and that’s about 9% of the population that the mandate could potentially impact. But there are a few more things to discount. One, retirees. If you’re retired, you’re not under the thumb of these policies.

– Not mandatable, yeah.

– [Vinay] You’re not mandatable. Ironically, you’re the people who are most at risk of the virus, so that’s the population they really need to go after. The next thing is that the curve never plateaued. It’s still going up and up and up. Every day, somebody is deciding to be vaccinated. That never stalled. And so the question is like, how much more will the mandate push beyond the people who would have otherwise gotten it anyway? At the end of this, I come to, what’s the maximum upper bound percentage that all of these policies can do? What more people are gonna get vaccinated? And what about those people who are gonna quit their job and get pushed out of the workforce? That’s the negative side.

– Especially in healthcare.

– [Vinay] Especially in health care. Some of these places, they can’t afford anybody. I say 3 to 7% is my guesstimate for what he might be able to achieve with all this brute force pressure. And I don’t know about what people will leave the workforce, probably less than 1%, but the bad consequences, those people are going to be tremendously bad consequences. They are going to have an entire… They have like a death sentence on their life. Where are they gonna work? Are they gonna be employable? How much unemployment are they gonna require? Are we gonna give them unemployment? What’s gonna happen to their children and their ability to feed their family? And you’re gonna make them more politically isolated. Who are they gonna vote for in the next election cycle? Are they gonna be angry? Are they gonna lash out? Will there be acts of violence? And all these things are like the negative, unintended consequences of this policy. So I put it all together, and I think just as a pure policy analyst, it’s not inherently convincing to me that this is a wise strategy. I guess I’m not sold.

– [Zubin] Yeah, see, that to me makes a lot of sense. And what we don’t talk about is the real emotional reactance cost of that action. So we’re saying, okay, Biden’s gonna go and signal that he follows the science and he says, literally, “We’ve been patient, we’ve held your hand.”

– [Vinay] That was not good.

– [Zubin] “And you’ve refused to listen.” He’s telling rational people this as well as irrational people, right? So, what happens when they hear that, a concept called emotional reactance, that was actually seen in the 1918 pandemic with masking, people when they’re told what to do by someone they don’t like or trust or an authority figure, they can react in a way that’s like pushing it right back. And I’m seeing this by email, people saying, “Look, I was going to get the vaccine, and then this guy says, ‘Well, you either do it or…’ And now I’m like, I know it’s irrational, but I don’t wanna do it. Please talk me down from the ledge.” It’s crazy.

– [Vinay] I guess one thing to point out is like you and I have a certain standpoint where we’re trying to use reason and explain the risks and benefits and tolerate some differences of opinion.

– [Zubin] And tolerate some unvaccinated people. It’s just part of what happens.

– [Vinay] It’s gonna happen. Some people are just not gonna do it, no matter what you do.

– That’s right.

– [Vinay] Unless you wanna do very horrible things that will hurt society more than help.

– [Zubin] Exactly right.

– [Vinay] And yet we always get emails. Our inboxes are full of people who are like, “I got vaccinated because of your mantra.”

– [Zubin] That’s right.

– [Vinay] And I think with Biden, one of the things we have to, the truth about it is he is very frustrated. I get it. But why is he frustrated? He’s facing inflationary spending that’s gonna happen. It’s about 5% of inflationary spending. He entered the office with this idea that, “That last guy, he didn’t follow the science, and that’s why this thing has gone on too long. I can end this thing.” But now look at it, he hasn’t ended it.

– [Zubin] It’s gotten worse.

– [Vinay] It’s gotten worse. So I think from his standpoint as a politician, he feels nervous about the situation. And I say this as somebody, I’ve said this before on this podcast-

– [Zubin] You’re a progressive.

– [Vinay] I’m a progressive. I’m far on the left on most issues. I’ve written two books that are, if you read those books and you think about drug policy and if VP’s world of drug policy went through, that is the most progressive agenda you’ll ever hear. So I’m a progressive and I am sympathetic that government can be used as a force of good. But I do think we cannot discount the fact that the president is under extreme political pressure, and the faster this ends, the quicker it ends, the better it is for him. But I think that there will be consequences for these actions that may not manifest themselves in two years or three years or four years, but maybe in 10 years, and that’s not good for society.

– [Zubin] I don’t think it’s good for the Democrats, because what’s gonna happen is all these emotionally reactant people, they’re really fired up. I mean, they are pissed.

– [Vinay] And what’s gonna happen if there’s a new booster that’s a different mRNA construct? And let’s say, hypothetically, it’s actually pretty good. Are they gonna have the political capital to mandate that?

– No.

– No.

– [Vinay] I think they’ve just burned it all.

– [Zubin] They’ve burned it all. And here’s the thing. So people will say, “Well, but we mandate seat belts, but we mandate childhood vaccines, but we mandate PPD for healthcare workers, but we mandate…” So, how do you think about that?

– [Vinay] I guess what I would say is some of the mandates, like occupational mandates where I think that’s one arena, but the other arena that’s probably more fitting is like the societal mandates, like seat belts and like childhood vaccines to go to school, et cetera, those did work. But they didn’t work in six weeks. They worked over the course of years. And I remember as a child, we had a policy, don’t go after my mother for this, but our policy was seat belts are only necessary in the front seat. They weren’t necessary in the backseat. That was just the attitude when I grew up.

– [Zubin] I jumped, bounced around in the back in a station wagon, rear facing in a Buick Estate Wagon, bounce around without seat belts, and only started wearing seat belts later in life.

– [Vinay] I think some of our seat belts in the car, they got stuck in the crevice of the seat and we never found them again.

– [Zubin] Never found them, and they don’t even have a shoulder belt anyway, so they would have bisected you anyway if you’d got in an accident.

– [Vinay] I think we had a Dodge Caravan that if you got hit, it would throw you out the backseat, on the street, right?

– That’s awesome, yeah.

– [Vinay] It’s like one of the classic flaws. But I guess my point here is that, yes, it is possible to use these kinds of compulsive forces to change behavior, but it doesn’t happen overnight. And this, he needed to happen quick. And sometimes when you need things to happen quick, these brutalist force things are just not gonna do it for you.

– [Zubin] Yeah, that’s it, because by the time these things actually were to work from those incremental, which by the way, I’m not even convinced needs-

– [Vinay] Yeah, I’m not convinced.

– [Zubin] Because what’s gonna happen is people are also naturally gonna alter their behavior. I think the Delta wave did encourage a lot of vaccination and then it levels off and so on. It’s natural human behavior. The Delta wave will come down, something else will happen or not, right? And this will push its inevitable march to endemicity where I’m not even sure you would need a vaccine because every child who’s born-

– [Vinay] Was gonna get it as part of-

– [Zubin] Is gonna get naturally infected and then they’re gonna have immunity by the time they’re a teen. No one’s gonna die of it, except the rare, rare person that would die of a cold, right?

– [Vinay] I guess I think that some of the things that are different now in terms of the thinking was I think people had this kind of magical idea in January that once we get to 60%, the virus will just go away or something like that. And I think now we are settling in for the realization that whether you’ve been vaccinated or not in the course of the next 7 years or 10 years, this virus is gonna meet you. You have a date with this virus. You can get all the vaccines and boosters you want, you’re gonna have a date with meeting this virus in the course of your life. That’s what an endemic virus means. Now, I’d rather meet the virus when I’ve been adequately vaccinated, as I have, so I wanna meet it on that terms, but I’m not gonna avoid meeting it. And I guess this blends into like what’s going on in college campuses and this delusion.

– [Zubin] Yeah, tell me about this, what’s happening on college campuses, because I feel like we have again taken rational people and caused them through fear and unreasoning and tribalism to behave irrationally.

– [Vinay] Yeah, so, I mean, I don’t have a good explanation for what’s going on because I think-

– [Zubin] What is going on? What are they doing?

– [Vinay] What is going on? What is going on? Many of these college campuses have required everyone to be vaccinated, everyone to be masked in classes. In fact, I’ve heard it so stringent that if you’re in a class and you wanna take a sip of coffee, you’re not even allowed to lower your mask to sip the coffee, you’re not allowed to, you have to go in the hallway and sip the coffee.

– [Zubin] I would quit college. College was all about sipping coffee loudly in class.

– You need it.

– Heck, yeah.

– [Vinay] This is the one of the most addictive substances on earth. I need it.

– Exactly.

– [Vinay] Okay, you’re not allowed to do that.

– [Zubin] We need to get a cigarette after this, by the way, speaking of addicted. You really wanna be addicted.

– [Vinay] We don’t smoke though.

– [Zubin] We don’t, but we want to.

– [Vinay] We don’t, we really don’t.

– [Zubin] We wanna be cool.

– [Vinay] I guess, I mean, I wish I were cool. I’ll never be that.

– [Zubin] So speaking of cool, back to college.

– [Vinay] Back to college, back to college. Test weekly or some stringent testing of an asymptomatic population. And what they do is when they have test positivity, they’re just enacting more and more rules. Brown, you’re not allowed to have indoor dining, only takeout dining. You’re only allowed to hang out with like two other people. There’s some college in Connecticut that I think it’s like incredibly draconian. You have to wear a mask outside. Duke, you have to wear a mask outside.

– [Zubin] At Duke?

– [Vinay] Vaccinated, asymptomatic, masked person, outside. What are we doing? And here’s the thing. These are pockets where they’re doing extreme measures, and then you go off campus.

– And everybody’s like.. I mean, in Duke, you think in North Carolina that… Come on.

– Come on, come on.

– [Zubin] Here’s the funny thing, we think, oh, this is just these college campuses. Stanford University Medical Center, my wife tells me now that, first of all, you have to be vaccinated.

– Of course.

– [Zubin] So that’s fine, whatever. Second of all, you have to mask, fine, that’s cool, whatever, surgical mask, hey. Third of all, you have to test every week.

– Yeah, I know.

– Every week!

– [Vinay] And here’s what I think people are missing. Somebody was like, “It gives me comfort to know that you’re testing negative every week.” I’m like, “Sure, you may feel more comforted by it. But the question is, is there empirical evidence that as a result of doing this, fewer people are getting sick?” And the answer is no. And we have forgotten, these companies have hijacked their way into doing this. These companies have bamboozled all these college administrators into paying for this offering models that suggest it will make the campus, quote/unquote, “more safe,” or that if you didn’t do it, you’d have an unmitigated disaster. Parents are buying into it as well. Where is the empirical evidence? Where’s the randomized studies that this actually does anything? And some of the people who are vocal proponents for this are consultants for or being paid by these companies. This is the same problem we have in the pharmaceutical industry that I’ve written about. I say this because the evidence is, frankly, lacking. And what is the goal? These college kids are going to encounter the virus over the course of 7 to 10 years. What are you trying to accomplish right now? Somebody says, “Well, we don’t wanna exacerbate the Delta wave.” The Delta wave is not in liberal Connecticut with a 90% vaccination rate. The Delta wave is not on Stanford campus right now. The Delta wave is in places where they’re not gonna do this because they don’t have the political capital to do this. So, the places where they’re making your daughter wear a mask running outside are not places suffering in the throes of a Delta wave. They’re not places where the hospitals that are at capacity. The places where that’s happening, they’re not doing those things. So, what is the schizophrenia we suffer from?

– [Zubin] I really think that so much of it is just tribalism, virtue signaling, trying to show this kind of hygiene theater. We just went downstairs there and we had to put our masks on. We’re both vaccinated. People are like all awkward in the elevator. The whole thing is-

– [Vinay] We went to get a cup of coffee. How many times did I take my mask on and off?

– [Zubin] And put it on, touching your face, putting the mask on.

– [Vinay] Looking for it in my pocket.

– [Zubin] Both of us highly vaccinated.

– [Vinay] With strong immune systems so we’d probably make really good titers.

– [Zubin] Oh man, my antibodies, dude, I can just smear them on the wall, I got so much extra. Speaking of which, tell me about this FDA booster, these two cats at the FDA. So by the way, your YouTube channel, people should check it out. How do you find it?

– [Vinay] I don’t know. It’s Vinay Prasad MD, MPH or something like that.

– [Zubin] Vinay Prasad, just search Vinay Prasad.

– [Vinay] Something very catchy.

– [Zubin] VP, MD, MPH.

– [Vinay] Something very catchy like that.

– [Zubin] It’s really getting a lot of attention because you talked about these two FDA, they’re not just randos at the FDA.

– [Vinay] No, they’re two people that really matter. They are the head and the deputy head of Vaccine Research and Review, Philip Krause and Marion Gruber, and they both resigned. And it’s been reported in multiple news outlets that the reason of the resignation was political pressure by the Biden administration to approve boosters on a very fast timeline and that they felt that that was unwarranted. They published in the last week in “The Lancet” a long and stinging rebuke of the case for boosters. And I guess-

– [Zubin] Across the board or just with the-

– [Vinay] They’re focusing on healthy people boosters.

– [Zubin] Healthy people, right, yeah.

– [Vinay] So far the boosters have an EUA for people who have had solid organ transplant or a, quote, “equivalent immunosuppression.”

– [Zubin] That’s a high level of immunity.

– That’s like no immune system.

– [Vinay] Yes, it’s not somebody with just a touch of asthma.

– [Zubin] Right, or an elderly person even.

– [Vinay] It’s not, it’s not. But I think in clinical practice, people may be stretching it, but it is certainly a very high level of immunosuppression. The immunosuppression that I encounter on bone marrow transplant service around somebody who’s gotten B-cell depleting therapy, but not the average person. Now we’re talking about boosters for the average person. That’s a different ballgame, and I think it’s a very important discussion, ’cause we’re gonna be talking about millions and millions of inoculations. There is a potential for benefit. It’s theoretically possible a booster will lower the risk of severe disease. It’s also possible that that’s more likely to happen in an 80-year-old than a 28-year-old. It’s also possible that there’s gonna be some more adverse events you did not anticipate, such as myocarditis might be a little bit higher with dose three than dose two, and it might preferentially affect boys in a certain age group just as it has with dose two. And I think when you wanna approve a booster, you really need to know that the upward benefit exceeds the harm. And I think the whole point of these articles is that we don’t know, and we’re basing these kinds of decisions on a lot of fragmented confounded data that comes out of Israel of vaccine efficacy. It has a lot of problems with it.

– [Zubin] What’s wrong with that data? Because Monica was talking a little bit about it. They only used Pfizer. They vaccinated everyone all at once, three weeks apart.

– [Vinay] I guess there’s so many problems. One problem is like we don’t vaccinate all people equally. We start with the frailest and oldest and vaccinate other people last. And so if you look at vaccine efficacy at nine months, who got the vaccine nine months ago? It wasn’t 20-year-old people, it was the oldest people.

– I see.

– [Vinay] Okay, so that’s that one thing. The second thing is, is like the people you’re comparing it against, vaccine efficacy is the ratio of rates of infections among those vaccinated against rates of infections among those not vaccinated. But among those not vaccinated, as time goes on, a higher fraction of them have natural immunity. And so they cannot be infected. But the real efficacy of the vaccine is if you have not yet been infected, is it better to be vaccinated or not vaccinated and what’s the probability of benefit? And so they’re not always capturing the thing of interest. There’s some other confounding. Another challenge is now they’re giving boosters, and then they say, “Well, people who got boosters are less likely to be infected than people who didn’t get boosters.” But who are the people who are eager to get boosters? That’s not the average person. It’s the person who’s the most prudent, meticulous, fearful, reluctant to go out. They have different behavioral patterns. And so this is all really… There’s one solution. Oh, sorry, go on, finish your thoughts.

– [Zubin] I was gonna say I can confirm that the people who are interested in boosters are the most anxious, most fearful, most masked up, most living in a bubble people.

– [Vinay] Most on Twitter.

– [Zubin] Most on Twitter. But I will literally get emails that are like, “I’m 35, I was vaccinated in January, I’ve been living in a bubble even with the vaccine. When can I get a booster? Do you think I can get it off-label?” It’s that level of fear.

– [Vinay] I have sympathy for these people because I think-

– [Zubin] We’ve generated a fear contagion.

– [Vinay] Yeah, the media has done it. I wish that everyone could see that graph that Alister Monro tweeted from this UK study of risk of getting SARS-CoV-2 by vaccination status and by age. Because you see this huge gradient by age and you have to put it in perspective, a vaccinated 20-year-old person, a vaccinated 30-year-old person, an unvaccinated child, your risk is not the same as a vaccinated 80-year-old or an unvaccinated 80-year-old. That’s a catastrophic risk. You need to see these risks and think about it in terms of your life and other things risks you tolerate. Life will never be zero risk and you can’t let the media sensationalism drive an irrational decision that takes away something important to us, social connections and getting outside.

– [Zubin] Social connections, which has a huge cost when you take it away, depression, all these things. They actually manifest physically in the form of health. You had said, “Okay, we have a solution for this, there’s a way out of this.” We were talking about the Israeli data. What was that?

– [Vinay] I think it’s a randomized controlled trial where you just take a lot of healthy people and your randomize booster/no booster, and you see is there a reduction in hospitalization. But what we learned today was in documentation that’s gonna be presented this week at the Vaccine Advisory Board, that Pfizer is making the case that they are going to try to justify a third dose shot based on an uncontrolled study of boosters in people who have gotten two doses, using the antibody titer as the endpoint.

– [Zubin] Aye, aye, aye.

– [Vinay] And it’s a non-inferiority study, so they don’t have to be better than you were after dose two, they’re just non-inferior to what you were in dose two, which I think is an incredibly soft endpoint, weak analysis, historical control, just not acceptable in my mind for the widespread vaccination of millions of people.

– Wow.

– [Vinay] And this is not exactly why, but this is the issue over which these two people resigned. And these are people with 30 years of experience at the FDA. When they resign, it’s a big deal. If they resigned under Donald J. Trump, the internet would have broken. It would have been so many tweets and angry, the whole internet would be down, because that’s how angry. But because it’s happening in this administration, people are not getting worked up about it, but it’s a huge deal. You cannot run a political system that puts so much pressure on these people that they resign. I just don’t think it’s acceptable. I think it’s a catastrophic error.

– [Zubin] Paul Offit came on my show a while back and I asked him about boosters and he says he does not think that it is a good idea that Bourla, the CEO of Pfizer, is coming out and saying, “Yeah, we’re planning a booster.”

– I remember that.

– In the absence of FDA.

– [Vinay] The timeline was, the first thing Bourla said it, they got pushback from CDC and Fauci. Then they had the meeting at the White House. Then the surgeon general came out and said it, Fauci came out and said it. And then the FDA said, “Hey, easy tiger.” They walked it back in “The New York Times.” It’s been quite a roller coaster ride. This is exactly, we had been worried all this time that the heavy hand of politics is going to weigh on the FDA. This is the moment.

– This is the moment.

– This is the moment.

– [Zubin] This is when it’s happening.

– [Vinay] This is when it’s happening, this is when it’s happening.

– [Zubin] It’s the equivalent of if Trump had somehow pressured FDA to approve the vaccine before the election.

– [Vinay] He wanted to do it.

– [Zubin] Yeah, he wanted to, I know. But think of the shit show it would have been, right? The left would have lost its mind, you know? And no one on the left would have gotten that vaccine, not a one. They would have been like, “This is a Trump vaccine. I’m not doing it.” But now what’s happening is to say, “Well, no, we need a third shot.” In Israel, they’re talking about a fourth shot. And this is all Pfizer, by the way.

– [Vinay] Yes, right.

– [Zubin] By the way, I’m team Moderna, just because I just, again, I didn’t choose Moderna, Moderna chose me.

– ‘Cause you own stock.

– [Zubin] Yeah, I own stock. It’s just, NIH, I don’t know, or a German company, I’m a jingoist, I’m like USA, baby. But it is really distasteful what we’re seeing, and those two resigned because of it, and this was something that you talked about I think very eloquently.

– [Vinay] It’s been in multiple news outlets. That was at least one of the key reasons. It would be great to have them testify. And then I guess what I would say about this booster is this is the threshold. What will be the fourth booster, fifth booster, sixth booster? If the endpoint is non-inferiority antibodies, then there’s no end to it. There’ll be 100 boosters.

– [Zubin] What do we really care about? We care about people getting sick, hospitalized, dying. Even infection, I’ve said this, I don’t care. It’s just gonna speed it towards endemicity.

– [Vinay] And one more point about hospitalizations. David Zweig has a nice article in “The Atlantic” about like the threshold for hospitalization has fallen. Among hospitalized patients, the percent requiring oxygen has declined over time. We’re hospitalizing less sick people over time.

– [Zubin] Oh, I felt that too, in what I’ve heard. ‘Cause everybody seems like, “Oh, I spent a week in the hospital just ’cause. My sat was 92 and they were like, ‘We want it to be 95.'”

– [Vinay] At least 92 is worse than… Some people will spend the week in the hospital, 96, 97, 98.

– [Zubin] Because you know, science.

– Be safe.

– Right.

– [Vinay] But I guess I think you’re hitting on a point, the booster, the colleges, these policies don’t make sense, if your worldview is we gotta live with this virus forever. It’s gonna get us in our noses. The best thing you can do is get people some vaccine in them or some natural immunity so that they have better fighting chances of when they encounter it again. Again, I wanna be clear, I’m not endorsing people like seek-

– [Zubin] Go out and have a party with COVID.

– [Vinay] That was silly. That would be silly. I’m not endorsing it. What I’m saying is that if they happen to have already acquired it, you can ease up on the massive vice-like pressure you’re placing on them.

– [Vinay] The jack-booted thug on your neck, yeah.

– [Vinay] You can maybe settle for one dose, settle for a compromise, make some antibody that you’d give him some credit. Even Israel allows them to get their pass if-

– [Zubin] Immune passport, yeah.

– [Vinay] So we don’t have to crush them with this. That’s not gonna get-

– [Zubin] And they hate it by the way.

– [Vinay] I know, and I guess I do feel bad for them.

– [Zubin] You’ve been through COVID. You’ve been through COVID.

– I know.

– [Zubin] And then they’re saying, “Well, you gotta get two doses of this thing that’s gonna make you feel crap.”

– [Vinay] How is this follow the science? I mean, I really wonder. Let’s pick it an example. You have a 16-year-old boy. He’s had COVID, he recovered from it. And you’re gonna tell him he needs two doses to attend public school, which is what some districts are doing. How is that just? I think that’s barbaric, that’s insane, it’s so insane.

– [Zubin] You know what it does? It drives the most vulnerable people to the disease. We’re talking about people in the south, high obesity levels, lots of metabolic disease, African-Americans, Latinos, these populations that are skeptical of this thing, right? Then they say, “Well, now you gotta get it. What’s natural immunity? I don’t know what that is.” And so on, follow the science. Well, now they’re even driven further away because of the psychological reactance and the distrust, which is actually deserved because these guys aren’t following what rational people oughta do in this situation looking at risk. And you’d mentioned earlier, risk. Nobody looks at risk for themselves accurately. Half the emails I get, people just misapprehend risk. The other half, they’re saying, “Listen, I’m at no risk because I’m 50, but I’m ripped. I run a mile a day, I do this and that.” And that I’m like, “Well, but even that, you gotta understand it’s an age gradient. You can be in the best shape as a 90-year-old and still die of COVID.” So, we really oughta be spending our time talking about that, educating that, compassionately. And the other problem is we’re so tribalized, we think our side is good, the other side pure evil. How is that gonna function in the world? ‘Cause it’s not accurate.

– [Vinay] Maybe we should talk about that Mandrola, Tracy Hoeg, Allie Krug paper.

– [Zubin] Tell me about this. John Mandrola, really rational cardiologist out of Kentucky.

– [Vinay] Genuine good guy.

– Genuine good guy.

– Genuine good guy.

– [Zubin] We followed each other for a long time on Twitter.

– [Vinay] Thoughtful guy, super nice guy.

– [Zubin] I’ve actually hit him up for cardiology advice for my dad who has AFib. He’s just a really good clinician who’s one of those guys who does not do something unless it’s indicated.

– [Vinay] Right, right. These four authors were very interested in the rates of myocarditis, particularly for boys, particularly for younger people, and they performed an analysis of the vaccine surveillance database that came out with a rate of myocarditis after dose two of 1 in 6,800, that was their rough thing. What they did was they got all the reports. Mandrola, I think as a cardiologist, adjudicated the reports. They’re looking for people, the time course fits, these kids had elevations in troponin. They may have had electrocardiogram disturbances. They may have had MRI, but not necessarily, ’cause MRIs don’t fall from trees. They’re not easy to get, a cardiac MRI in a child. Okay, so they had their standard, the thing. One of the authors I think made an app where he put all the reports in the app. So you can go and check to see if you like how they coded or if you don’t like it, you can code it however way you wanna code it. And they published this pre-print and I think it was a good and noble and well-intended effort to try to estimate this thing. And the end result, they get 1 in 6,800. Well, that’s comparable with “Science Magazine” reported that Israel said the rate was between 1 and 3,000, 1 in 6,000 a few months ago. Norway says the rate is about 1 in 10,000. There’s a paper out from Ontario government, Ontario, Province, in Canada, that says for a slightly higher age group, the rate was 1 in 3,800. My point here is just that their estimate is more or less in the same ballpark of many other estimates from many other countries with many different authors and many different datasets.

– [Zubin] Now these are higher estimates though than what say has been pitched by CDC or whatever, 1 in 30,000.

– [Vinay] I think that, yes, but I also think, it’s been a while since I checked the last CDC estimate, but I thought it was like 1 in 14K was the last.

– [Zubin] Oh, okay, yeah.

– [Vinay] I guess I would say, it’s actually, when you start talking about these kinds of numbers, it’s just not like substantively higher.

– [Zubin] Yeah, these aren’t order of magnitude differences.

– [Vinay] Right, it’s not order of magnitude difference, that’s a good way to put it. And I guess, okay, fine, they have their estimate, and like all these estimates, it’s not perfect. And you know why, like who we we should be angry at? How do we live in 2021 and we can’t even know this answer? We should be able to actually know this answer, right?

– [Zubin] Right, well, it generates distrust because then how do you trust the VAERS database if you can’t even figure out how prevalent myocarditis is. Are we missing other side… I don’t think we are, but the question is-

– People feel that way.

– People feel that way.

– [Vinay] We just don’t have a great surveillance system. And one of the limitations of VAERS is that it’s easy to attribute things not due to the vaccine, to the vaccine.

– That’s right.

– [Vinay] But the thing that they did as a strength was they got this cardiologist to look through the reports and in his best judgment, does he think it’s related? It turns out that kids don’t just have spontaneous troponin leaks all the time. So, he’s got some things going for him. Anyway, I don’t want to belabor the point about the paper. That’s not what interests me. What interests me is the response to the paper. It’s an estimate in line with other estimates. It draws attention to this fact, this is something that needs to be studied. In fact, there’s at least six post-marketing commitments I think to study this, including one where they measure random troponins in kids to look for subclinical myocarditis that doesn’t even present. This is a big issue. And also the reason it’s so important is that the risk of the virus as you go down in age, it falls by order of magnitude as you go down. It’s a log fold slope. So these small risks really do matter a lot in decision-making. Anyway, so they publish their thing. And then the backlash comes on Twitter. They’re anti-vax, I’ve heard them called. Some people said that if you, quote-unquote, “misuse VAERS,” which I don’t believe that they misused it, but that you should lose your medical license, that they should lose their medical license. Then it gets even worse. One person was like, “I won’t even have a beer with John Mandrola.” I was like, “You won’t even have a drink with the man? Goddamn, you hate John Mandrola.”

– [Zubin] That’s the final straw.

– [Vinay] And I guess what I think is I’m really troubled that these aren’t just bots and they aren’t just whackadoodles.

– [Zubin] No, these are big people on Twitter.

– [Vinay] These are real doctors, real colleagues, and they’ve lost their shit, they’ve lost it. They’re so disinhibited, they’re so locked in their worldview, that they think this guy should lose his medical license. We’re in a dark place.

– [Zubin] Well, they did the same thing to Jay Bhattacharya in the beginning with this seroprevalence study.

– [Vinay] I think they’re still after him, that he should be banned from Stanford.

– [Zubin] And the medical boards are putting out letters to their people at ABIM, which by the way is a corrupt, horrible organization.

– [Vinay] I know, I follow Wes on this.

– [Zubin] Yeah, Wes and Paul Teirstein, who’s been on my show. They’re a money-generating entity that’s just all pure just corruption, as far as I’m concerned. Again, you know, take that with a grain of salt, but I get angry about it.

– [Vinay] Yeah, they say don’t spread misinformation.

– [Zubin] They send it out and say you can’t spread misinformation. What does that mean?

– [Vinay] I guess, yeah, like you shouldn’t sell a crystal to ward off COVID, sure. But can John Mandrola have an intelligent discussion about the rate of myocarditis even if you disagree with his rate? I think that’s fair. In fact, I think we need more of that. And if you come after this guy’s license, if you call him names like this, first of all, not a lot of people have as thick a hide as John Mandrola. Let me talk about this guy’s hide. I see this dude just get abused on Twitter, and you know what he does? He just says, “Thank you for your feedback.” I swear to God, I’ve never seen-

– [Zubin] He’s such a good guy.

– [Vinay] I’ve never seen someone get beaten so hard and then just smile and thank the person. That’s just how much emotional reserve and how much identity he has, like how comfortable he is in his skin. But that’s not everybody, and there are a lot of people out there, fellows, residents, junior faculty, mid-career faculty, and they don’t have a hide like that at all. You call them one thing, it takes it to heart and they can’t sleep for a week and they never wanna comment again. And we have driven all those people out of the conversation with this lunacy.

– [Zubin] Yeah, whatever this MedTwitter thing is, which I don’t participate in.

– [Vinay] I wanna talk about this MedTwitter.

– [Zubin] Yeah, please. Oh, by the way, one thing.

– Go ahead.

– [Zubin] Mandrola versus Mercola. So Joseph Mercola-

– [Vinay] Oh, yeah, he’s that crazy guy.

– [Zubin] Crazy guy, no, he’s crazy, I’ll say it.

– [Vinay] I don’t know, I don’t know enough.

– [Zubin] He’s not crazy. He’s actually not crazy. He’s very smart. He makes millions selling into the anti-vaccine establishment. He’s like one of these cult people and has made millions, has hundreds of employees in Florida. The city that has all these employees wouldn’t censor him because he’s an economic force there. So this guy can say whatever he wants, keeps his medical license, keeps whatever board certification he has. I assume he’s board certified. Mandrola gets threatened by someone like Jen Gunter online and says, “You should lose your license for doing a study.” Does this make any sense? Again, rational people behaving rationally versus an irrational irrational. I mean, it’s crazy.

– [Vinay] Yeah, there is no shortage of people who say things that don’t make no sense at all. They’re over here. Mandrola is a participant in a legitimate debate about risk benefit at magnitudes that the human brain, we have to be honest, we’re not good at thinking about 1 in 10K risks. We’re not good at 1 in 100K risks. We did not evolve to really be adroit at 1 in 100K risks. You have to play this ballgame of very rare risks to be good at it. And I think a lot of the people who are chiming in, who are throwing stones, who are carrying the pitchforks with the mob, they don’t play this game. And I’ll say one more thing about MedTwitter. I gotta say this, MedTwitter is outta control. MedTwitter, it was a good force pre-pandemic. Why is MedTwitter good? It was a lot of people who got behind a lot of things that I agree with, a lot, which is like our society has to be more fair. It has to be fair to people who are poor and people who are marginalized. The pharmaceutical industry, they have led to notorious excesses. They’re taking a lot of money. And vaccines, childhood immunization is one of the great boons of society and it’s done a lot of good. And so I think those are some core tenants that we all believe in. And so I was like, my book, “Ending Medical Reversal,” is probably within the philosophy of #MedTwitter. My book, “Medical Malignant,” is also within the philosophy. And I agree with all these things. But when you’re faced with this pandemic, there are few things that have been turned on its head. The pharmaceutical industry, which was once awful, they came out with this breakthrough mRNA vaccine in a time span you would never have dreamt of. It was amazing. But now they’re trying to push the booster and they’re trying to take advantage of it, as they do. That’s their business. A tiger is a tiger, my friend. And vaccination is wonderful, again, but this time it cuts differently. It’s most wonderful in the oldest people. And as you get younger and younger and younger and younger, the potential balance of harms and benefits, it gets to 1 to 10 to the power of 5 and 1 to 10 to the power of 6, and 1 to 10 to the power of 7. And people brain don’t work good at 1 to 10 to the power of 7. They’re just not used to dealing in this world. And Mandrola is coming in with his own point of view and he’s trying to kind of add something here. And MedTwitter is falling back to the old algorithm, which is toddler vaccination, good, childhood vaccination, good. In fact, here’s a few ways in which they’ve been so distorted. I tweeted previously maybe about a month and a half ago that people should not vaccinate children off-label while these studies are ongoing with a lower dose. And some people said, “What does he know? He’s not a pediatrician. What does he know?” And then they go on and on, and then it becomes a referendum on me. They’re like, “Where does he work? What does he do? What does he eat for breakfast?” I was like, “It’s not about me, it’s about this issue.” Okay, so then they said this. Then a few weeks later, the vaccine got full approval. So now if they wanted to, they could, but then the AAP says, “Don’t do it.” The FDA says, “Don’t do it.” And they don’t have the wherewithal to recognize that, “Hey, VP, a guy who studies drug regulation, drug policy, and rare adverse events, and has done a lot of work in this space, he was right about this.” Instead, they have some new thing that they’re angry with me about. In five years from now, I know what’s gonna happen with this masking kids issue. We’re all gonna come out of this thing, and we’re gonna be like, “Jesus Christ, what did we do?”

– What did we do?

– [Vinay] And we didn’t even know if masking two-year-olds, we didn’t let babies have caretakers see their face for like 18 months and we never did a study. We really screwed up.”

– Screwed up.

– [Vinay] That’s not what I was gonna say, but.

– [Zubin] What’s happened is, again, it’s rational people behaving irrationally and not knowing it.

– Not seeing it.

– Not seeing it.

– No insight.

– [Zubin] And this is a thing, I have a little prayer I tell myself, and I’m not a religious person. My prayer is let me always be uncomfortable when it becomes clear to me that I’ve deceived myself. That’s one thing where I wanna just really feel pain. Like, oh my God, I self deceived on this. I missed something about my own bias that I didn’t put out there, that I didn’t say, “Oh, this is my bias,” right? And that’s not something that’s conditioned into us. It’s the opposite. It’s like we wanna self-deceive as much as we can, as long as we fit in the tribe that has the same self-deception. So, this vaccine thing is a great example, and I was part of this before COVID. I was very much in that, “Hey, if you’re anti-vax for kids’ vaccines, you’re outta your mind. The data, we have this, come on, you’re outta your mind.” And I paint it with that brush. Then COVID happens, and I see the same brush being used to paint any subtle questions about that. I’ve been called an anti-vaxxer on Twitter.

– [Vinay] I know, I know, we’ve all been.

– [Zubin] Are you kidding me?

– [Vinay] I think they’re doing a disservice because if everybody who has any nuance thinking is an anti-vaxxer, then who are you standing for? You’re standing for vaccinated all costs prior to data. I even think they’ve gotten over their skis on kids 5 to 11. We’re running a randomized trial. When you run a randomized trial, if you want to approve it now without the randomized trial, just approve it now. But we’re running the randomized trial for a reason. You have to look at the results of the randomized trial. They’ve already judged it in the court of public opinion. Every day I see people say, “When is it coming out? When is it coming out?” No, the question is, what are the results? And let’s consider the results. That’s a scientific point of view. And why are they so eager for vaccines for 5 to 11? “The New York Times” has some story like parents are desperate for it, they’re desperate for it. They’re desperate for it because of “The New York Times,” the misleading coverage that sensationalizes the risk, and you’re doing it because you are benefiting from this and many of your journalists, for all their talents and their incredible wizardry with words, they’re not good at 10 to the power of 5, 10 to the power of 7 risk. They’re just not good in that ballpark. And so I think it’s a huge problem. It’s a huge crisis. Part of the reason why people are pushed away from mainstream science is this heavy-handedness when it’s not appropriate. Mandrola’s treatment I think is despicable. I mean, I really do. I’m embarrassed by it. I’m embarrassed that, you know, I will say I’ve gotten a bit of it. And one thing I wanted to tell you was about this thing where somebody said… It’s not just the bots, it’s not just the random people. I found like a full professor of medicine at the University of Michigan said, like in some tweet thing about me, “I know what his problem is. He did his undergrad at Michigan State University.”

– [Zubin] Oh my.

– [Vinay] First of all, I’m proud to have gone to Michigan State University, go green. And I had a lotta fun there and I enjoyed the band. And I’m saying like, “Why are you mad at me? You’re mad at me because you think that we don’t need a cluster randomized trial for school-aged children. You will be wrong, I promise you that. You will be wrong in a few years. I know I’m right. However, you’re not taking it out on the issue. You’re taking it out on my alma mater, which by the way, a lot of good people went to that school, and they’re not gonna be too happy with you.” And this is a professor at a… How disinhibited are you? How anxious and broken are you in this moment that you are saying this publicly? That’s not good.

– [Zubin] Oh, that’s just straight insanity, man. Wow. I wouldn’t mention ever publicly that Pierre Kory graduated from a Caribbean medical school. That was not something that would even be on my radar to say. Now, listen, though speaking… Okay, that’s insane.

– [Vinay] Yes, but that’s not why he’s wrong. But I mean, what is he wrong about? I mean, well, we’ll find out. We should do the trials, that what our position is.

– [Zubin] Let’s talk just quickly about what’s happened with ivermectin in the sense that, okay, you and I have-

– [Vinay] I haven’t kept up on it a lot.

– [Zubin] Neither have I, neither have I. It’s less about that. It’s more like we’re still waiting for these randomized trials, et cetera, that’s great.

– [Vinay] I think one came out and was negative.

– [Zubin] Yeah, that’s right. I actually don’t think it’s gonna… I mean, my intuition is we’re not gonna see an effect, but.

– [Vinay] I guess that’s always a safe bet because most things don’t work.

– Most things don’t work.

– That’s the thing, most things don’t work.

– [Zubin] But here’s what I think has gone wrong here. Monica brought this up on the show, too. So now what the press does is they’ve decided, okay, we’re gonna take this kinda lefty stance, because it has gotten politically tribal. It seems like righty people are really big fans of ivermectin and kind of a little against vaccine, lefty people are like, “Ivermectin is horse tranquilizer or horse dewormer and people who take it are idiots and rednecks.” In fact, the FDA said, “You’re not a horse, don’t take this.” That was like their campaign. This is so shaming and belittling to people. And so they’ve gone the opposite way, right? They’re shaming people for considering, looking at these sources on the internet that seem credible and considering trying to get ivermectin. This is insane.

– [Vinay] It’s insane. Ivermectin, there is a horse paste and there’s ivermectin, a drug that has helped a lot of people with helminth infections.

– [Zubin] And now you’re stigmatizing it. You’re actually stigmatizing a drug that saved how many millions of lives around the world?

– [Vinay] I know what they’re doing. They’re leaning into the culture war. They’re leaning into this culture war, and this culture war is red versus blue. They leaned into it on masks. If they hadn’t even drawn attention to what Donald J. Trump was doing with masks, it wouldn’t have lit up on the left and become so anathema on the right. They lean into every one of these decisions. Masking school kids, DeSantis is doing something different than other states. He’s not mandating it, but I don’t believe he’s prohibiting somebody who chooses to do it, to do it. I don’t know exactly, but somebody can correct me on that. I don’t think he’s prohibiting it. He’s just not mandating it. He’s prohibiting people from mandating it. That’s another can of worms. I’d just like to just leave it all alone, leave it all alone, and do a cluster randomized control trial while you’re leaving it all alone. But they lean into these things, and now they’re leaning into it like, ivermectin, it’s horse paste. What are they gonna do if actually, what are they gonna do if one of these randomized trials is positive?

– Oh man.

– [Vinay] Oh my God.

– [Zubin] It’s not like they’re gonna apologize, not like they’re gonna print a retraction.

– [Vinay] I don’t know what they’re… But I think the distrust is going to… The one thing that we were talking a little bit before was about the roots of these problems.

– [Zubin] That’s right, that’s right, let’s talk about that, the roots of our sense-making crisis. That’s really what it is. We cannot make sense of things anymore.

– [Vinay] Yeah, we can’t make sense of it, and here are the roots of it I think. I think there are a lot of people who do science communication on social media who are good, but sometimes, but they’re increasingly tribal and they have difficulty with these new kind of concepts, like a vaccine with this different age gradient, these kinds of things. We’ve had years of income and wealth stagnation, worsening wealth crisis, a growing group of people who feel like they’re being left out of society, and those people are less likely to accept things in the traditional canon, like vaccines, and they’re drawn to things like ivermectin. And then they feel like they’re getting shit on by the media and things like that. We’re just deepening all these things.

– [Zubin] There’s several roots of this, and I think one of them is the meaning crisis. So, we no longer have religion as a source of meaning, really. Most people are much more flexible with that stuff. So, what happens is society then shifts to finding meaning in tribal identification. And the internet then accentuates that by allowing people around the world proximity to each other. So you really get annoyed by someone that you would never have even been in contact with before, because so much stuff is local, right? What happens in a local town in Texas, everybody thinks kind of similarly, they’re all behaving the same way with masking. But now they’re on Twitter next to a guy who’s like, “Wear your damn mask,” or whatever about abortion or whatever about whatever. And so these local issues now, good fences make good neighbors. You’ve torn down the fences. Now you’re just pissed at everyone. And then you form into tribes, which are rewarded on social media, especially Twitter. So MedTwitter is now this very lefty tribe of witch-hunting lunatics, whereas before-

– As they see it.

– [Zubin] Exactly, exactly. So we find our meaning in these tribal identifications. And then it’s all been weaponized through hacking our innate tribalism that social media does by rewarding our dopamine centers when we get engaged in these things. So, you put all that together-

– Yeah, that’s well put.

– [Zubin] You seem to be at a threshold of disaster. But I would say this, I’m actually rather hopeful. And the reason is every time humanity seems to be at the threshold of disaster, we go from a caterpillar that looks like it’s eating itself to death, destroying its environment, and is just the worst parasite, to suddenly a phase shift where the next paradigm emerges and it becomes a butterfly, where the tables are turned. It’s now pollinating the same thing it was eating. It’s like this beautiful thing. We’re there because we’re seeing the failures of this previous paradigm, this divisive paradigm. And people like yourself, people like Mandrola, who are actually saying, “Hey, wait, wait, wait, wait, we know what’s right, rational people behaving rationally. I’m not gonna virtue signal and say the things that are good. Let’s look at where we’re wrong and try to see if we can right that.” And the next way of thinking is much more inclusive, much more whole, much more real, and it will tip a culture change eventually to one of integration instead of division. So, that’s what I think is gonna happen.

– [Vinay] Wow, that’s so well put. I do agree with you, that I think a lot of these tribes, and even politics, is filling that gap in our soul that religion once held, and I guess not to go too into it, but I’m kind of a religious person too, you may be surprised to know, because I’m also somebody who’s a strict, pure scientist.

– [Zubin] I’m not actually.

– [Vinay] You’re not surprised?

– [Zubin] I’m not surprised, no, no, no. I find the most passionate people have some belief. I don’t know what it is.

– [Vinay] Yes, yes, yes. I guess what I think is, so I agree with you about the problem and I agree with you that the social media is exploited and I think it’s making it worse. The only thing I think is I think it’s gonna play out differently. So, here’s my bet. No, I don’t know, here’s not my bet. I hope it doesn’t happen. I pray it doesn’t happen. But I think there’s a non 0% chance it’ll happen. Here’s what I think is gonna happen. I think we don’t realize that democracy is very fragile, and I’m not talking about the Capitol riots, because I don’t think that’s how it’s gonna play out. If I were to guess how it might play out, I think what you see on the left, people whom I used to be, I still am, I’m a progressive left person, we used to be people who like stood for like, I don’t agree with what you say, but I will die to defend your right to say it. And we’re not that people anymore. And in fact, a number of surveys show that our ability to tolerate social media censorship has gone through the roof. We’re really comfortable, like delete that guy’s post. That’s wrong.

– Totally.

– [Vinay] That’s wrong, Mandrola says 1 in 1,600, it’s actually… I saw somebody say that it was totally wrong because the real rate is 1 in 14,000. I was like, okay, what do you want? You wanna hang this guy for 1 in 1,600? You think it’s 1 in 14,000, okay, close enough.

– [Zubin] Come on, yeah.

– [Vinay] Okay, so I think that our tolerance of censorship is higher. I think our tolerance of the brute force of government in times of crisis is higher. And you saw vociferous and passionate the forces of the left saying, “We want more lockdown, more restriction, more mask mandate, more of these things.” And it was the right that actually went the other way. And actually, it didn’t have to be that way. One could imagine that if Trump announced in March, like, “Yes, we’re gonna do shelter in place, and by the way, I’m putting the troops in the streets.” then I think the left would have actually, they would have flipped their view.

– [Zubin] Revolted.

– [Vinay] And they would have been the whole time be like, “Lockdowns are too much and too excessive.” They literally anchored to I think the opposite of what he said.

– That’s right.

– [Vinay] So anyway, here’s what I think is gonna happen.

– [Zubin] Trump derangement syndrome. It’s a real thing.

– And it’s still going on.

– Yeah, it is still.

– [Vinay] You don’t cure yourself of that. It’s a lifelong ailment. It’s like herpes.

– [Zubin] It gives Trump what he wants most, to be thought about all the time.

– [Vinay] Yeah, he’s achieved that, marvelously. So what I think is gonna happen is, the average flu season is about 40 to 60,000 deaths, roughly 40,000 deaths. There’s inevitably gonna be a flu season with 80 to 100,000 deaths in the next 15 years. And if you had a politician in office who was unscrupulous, this politician could do the following. They could say, “Look, by the way, hospitals down there, they’re overwhelmed, actually.” Some pocket in America is gonna have overwhelmed hospitals. Why? Because ICUs always run at very high capacity ’cause that’s how you keep the profit and nonprofit.

– [Zubin] Exactly right.

– [Vinay] So they could say you have overwhelmed hospitals, and there’s gonna be some anecdote of a couple of kids who died. And then they’re gonna say, “How many kids have to die?” And the answer is even one kid dying is one too many. It’s one too many, it is. That’s what people say right now. That’s why you have to do all these things. So they say, “One kid dying is one too many, hospitals are overwhelmed. We’re announcing, I’ve called upon the governor to do shelter in place. And either he does it or she does it, or we’re gonna do it for them, because we can’t have this again. We can’t have SARS-CoV-2 again. This is a national emergency.” Then maybe the governor will go along with it. And then they’ll say, “You know what? You have to install on your phone a tracking software so we know your whereabouts at all time, because we can’t have you breaking the rules of shelter in place, right? So you can install that on your phone,” And then they’re gonna say, “You know what? Cases are still going up. There’s still more kids coming in. Let me show you an anecdote of this boy not doing well, this girl not doing well. How can we live with that? We’re gonna have to put the troops in the street. And we’re doing this for public health. You asked us to do this last time. We didn’t do it, we screwed up, we agree. We’re doing it this time.” And then they say, like you go on Twitter and you say, “This is too much, this is brute force. I don’t even know how many people. What’s the denominator? How much of a risk is this?” Then they say, “You know what? Social media is over. You’re shutting it down. That’s misinformation. You’re committing misinformation. You’re killing people with your speech. You’re dangerous, so your account is deleted. And if they won’t comply, we’ll storm their offices and we’ll take over the social media account.” And then the last thing you do is suspend elections because the Constitution says the presidential election is guaranteed to occur on that date. But I don’t think it mandates the path by which states pick the president. And the states can actually come up with delegates in other ways than a direct popular vote. And so I guess what I wish to portray in this nightmare scenario is that I don’t think it will take that much for people to misuse the excesses of this pandemic to really achieve whatever political dominance you want. And you don’t need a bad flu season. You don’t need a lot because as we see, what percentage of the kids who are hospitalized require O2? What percentage of the kids who hospitalized… Statistics are very difficult to get. So all I need to do is just show you a few videos of a few kids on the vent and it’s over. You have no fighting chance. And you can’t even question my facts. You can’t question the policy. Because you yourself have said, “If it’s a matter of life or death, I can censor your speech.” So I will do so.

– [Zubin] This is how so many people actually feel, and the mandates have made it worse. They actually feel that this is ultimately a step-wise end of democracy. I actually think we’ll wake up, that democracy isn’t even the right answer.

– [Vinay] I see.

– [Zubin] I think there’s something transcendent of democracy, I don’t know what it is yet, or else I would have already been advocating it. But I think that pure democracy in this sense has led us into a system where money determines who gets elected. The elected people are thinking only of their next election. It’s just like our fee-for-service medical system. But one thing I remember this quote of Princess Padme in “Revenge of the Sith,” as Palpatine’s taking over the Senate. She says, “So this is how democracy dies, with applause,” something like that. Because people have been so conditioned that at this point, he says, “Well, we just need to do this for the safety of the empire.” And they’re all like, “Yes.”

– [Vinay] That’s well-put. I just hope that the future autocrat that seizes power, I just hope they like me. Hey, let’s end by talking about Twitter real quick.

– [Zubin] Oh, yes, so tell me, tell me, what the heck? So many people have hit me up and they’re like, “If you have VP on your show again, you’re basically complicit in, first of all, anti-vaccine sentiment.”

– That’s inaccurate.

– [Zubin] “And some kind of right wing conspiracy.”

– [Vinay] I’m progressive left.

– [Zubin] “I’m also really mad because he blocked me and I did nothing to him.” So what’s going on, dude?

– [Vinay] I guess, wow. It’s funny that this is the tactic that people use, which is the new tactic, but I guess you want me to talk about the blocking? I guess the blocking is like, why do I block people? I block people like for being rude or insulting, or not just to me, but like if I see somebody else, third-party tweet something and somebody says something super personal or caustic and not about germane to the argument.

– Block.

– [Vinay] I might just block them because I was like, why do I want a poisonous person at my dinner party? And that’s the thing that I think we forget. Blocking is not censorship. You’re free to go on Twitter and you go on your own feed and you can say whatever you want, and I can say whatever I want. Blocking is you’re coming over to my dinner party and you’re shitting on my rug. You’re coming to my house and you’re doing it right on my doorstep. And what I’m saying is like, this is a tool that they’ve given that allows me to say you can do that wherever you want, but not on my doorstep. But then the second thing I would say is, to be honest with you, like the most number of people, first of all, I have I think like 100,000 followers and only less than 1% are blocked or less than 2% are blocked. And I would say the other thing is like, a lot of these people, they’re like, “Why did you block me?” And I was like, “Dude, I didn’t block you.” There are a lot of third-party apps that block people. And what you do is, if you find a tweet that you find is particularly poisonous for the conversation, you can click on that tweet and hit like nuke. And what it does is it blocks anyone who supported this very caustic sentiment, including all the people who liked it or retweeted, et cetera. And I think it unfollows you if you happen to be following them, it would unfollow that. And I guess I’ve clicked on that button a few times. A lot of people with a lot, when you get to a certain number of followers, you look at your feed and it’s just a bunch of garbage. And so what do I think are inappropriate? They quote tweet you just to drag in their own little army. They screenshot you and mischaracterize your argument because they don’t appear to have understood it. They make it always personal, something about you or something. And to be honest, some of these people, blocking it does them good. You’re thinking about me too much, and I’m helping you cure you of your disease.

– [Zubin] Cure you of your disease, your VP derangement syndrome.

– [Vinay] VP derangement syndrome. I don’t know why you’re suffering from it so bad that you’re researching my undergraduate and then disparaging everyone-

– Disparaging everyone.

– [Vinay] Everyone who went to that college, which by the way, I’ve done okay for myself since then.

– [Zubin] Yeah, man, Mr. UCFS, hoity-toity. Books, two books, all these papers. Now that reminds me. So, I’ve noticed a lot of people who attack you, and this doesn’t happen to me as much cause I’m an idiot, but you, okay, yeah, you write a piece in “The Atlantic,” yeah, you’ve written two books, yeah, you have all these publications about this subject of data.

– Evidence.

– Evidence. It’s kind of what you do.

– Yeah, medical data and policymaking, right, it’s what I’ve always done.

– [Zubin] They’ll bitch and moan at you, but not a one of them has actually done those things. Not only have they not done it, they can’t, they’re incapable of doing it. So you could say, “Well, you go and write your own “Atlantic” piece. I’m not more connected than you. I’m just better than you at writing and at reasoning. If you’re better than me at that, you can go and publish. I’m sure ‘The Atlantic’ will publish it.”

– [Vinay] Yeah, I’m sure.

– [Zubin] But they can’t! So to some degree, it’s pure ego. And listen, I say this as someone who used to be a lot more ego-driven than I am now, I’m still quite ego-driven, but back then I could recognize, oh my God, I’m a horrible person. I just feel it, and I’ve had to work on it. But you see it play out in this projection on social media.

– [Vinay] I think your haters suffer from the same thing, which is this guy goes and he makes a video, and the video runs for 40, 50 minutes, extemporaneous speaking, no notes, eyes on the camera. And I don’t think people, they have no clue how difficult that is. It’s the same for these late night TV shows, like Bill Maher and Stephen Colbert, like when they interview a guest, people don’t realize it’s so much talent to get this person to talk when you’re supposed to talk and not talk when they’re not supposed to talk and be interesting. And what I wanna say is like, yeah, if you feel so strongly that we oughta mask all these two-year-olds, and you know what, I urge you to ask yourself why you’re not going down to one, then you write your little essay and you submit it to “The Atlantic.” And then you write your weekly column for MedPage and you write your books. And I think you’ll find that it’s not so easy for you to do these things and it’s a lot easier for you to hate on me for doing these things. But if you really wanna win the battle of ideas, which is what I wanna win, I don’t just wanna win. We all live and die, but I wanna win the ideas. And for me, winning the ideas means I’m gonna destroy your arguments, and I’m gonna come at you in every which way. If I believe in something, I’m gonna write a paper on it, I’m gonna publish a peer review paper, I’m gonna do an op-ed on it, I’m gonna do a podcast on it, I gonna do a video on it. I’m coming at you from all angles. And if you wanna win the idea, come back at me.

– Come back.

– [Vinay] And I love it, it makes me hungrier.

– [Zubin] Oh, that’s great. Oh, man, ooh, I love that stuff so much. I mean, that’s really what it is, you know? Yeah, and you’re right, you’re right. I think there is a component of people… Okay, the last thing I really wanna say. This is important to me. We don’t change systems. We don’t get to that next phase shift of turning from caterpillar to butterfly. It’s an interesting analogy that my friend, Daniel Schmachtenberger actually makes, we don’t get to that without waking ourselves up, like really being able to look inside and go, “What makes us tick? How much of this is egoic striving?” You mentioned that you’re religious. I’m quite spiritual myself. I’m trying to wake up as much as I can to what I actually am, which is not this stuff. Then how do you operate in the world from that awakening? That’s what transforms systems, because then you have unlimited compassion, unlimited patience, and also unlimited emotional drive to do exactly what you’re saying, which is win the battle of ideas when you really feel like this is a hill worth dying on.

– [Vinay] Yeah, and why are these the issues that I’m wasting, not wasting, but focusing on now? I’m still doing my other stuff, my cancer medicine stuff that I’m interested in, but why are these the issues is like, I don’t know. We happen to be alive at this moment.

– [Zubin] We’re called to do this now.

– [Vinay] I think we are. And you know why? I really do think that if we go this whole pandemic and we mask very young children and we never do a cluster randomized trial, we will have done a disservice, not only to all these kids, but a disservice to everybody who ever faces a pandemic. I really do think if we go forward with the boosters and there’s a rare AE, and it turns out that some subpopulation probably has a net deleterious effect, we’ve not just done damage to all those people who suffer the rare AE, we have poisoned the faith in vaccines for a generation. And so I think these issues matter, they matter a great deal more than the usual things I rail about, cancer drugs, which do matter, but to less people. We’re in this position where we happen to be able to evaluate this evidence and reach our own verdict, and I feel like I’m not drawn by any group because I care very little about what other people’s opinions are. I know very strongly what my opinion is. I’ve trained for many years to read a big stack of papers and come to my own opinion. I don’t think a lot of people have done that. I think they follow what other people do and that’s how they arrive at their opinions. I know which of my opinions are based on bad evidence, and I acknowledge that usually when I talk to people. And so, yeah, I feel like you only get to do this once and you gotta do it and you’ll regret it if you don’t speak out on these issues. And I guess I would say for all the people out there who are quiet and they see John Mandrola get lashed and they feel like they agree with John, they think he’s a reasonable guy, but they don’t wanna comment because look what’s happening to him. I was like, “He needs you to comment now more than ever.”

– [Zubin] This is exactly what happens in which hunts. The people who are on your side become quiet because they’re afraid when that lens turns on them. And this is exactly the kind of behavior that Haidt talks about in “Coddling of the American Mind,’ this online witch hunt behavior. Oh, you’re a heterodox thinker. You’re violating the dogma, and this is exactly, and these are the people who will be like, “Oh, look at these two. They think they’re so spiritual and all that. They’re not real scientists.” But they’re the ones behaving irrationally, right? Yeah, I love people take a crap on Fran Collins, too, for being an evangelical Christian and a scientist, and they think the two are so discordant.

– They’re not.

– They’re really not.

– [Vinay] I take a crap on him for lots of reasons, but that’s not the one.

– [Zubin] That’s not the one.

– [Vinay] That’s not the one, but I disagree with him. I think that I admire him for that and I actually admire him for having said that. And I think he shows how you can reconcile those points of view. His funding strategies, I disagree with.

– [Zubin] Right, right, right. And that’s the other thing, there’s not black and white thinking. You don’t love or hate Francis Collins.

– [Vinay] I don’t have personal feelings toward him.

– [Zubin] It’s just, okay, here’s the things that I love, here’s what things I disagree with, and so on. That’s how we oughta be seeing it, is a kind of true, but partial.

– [Vinay] The last thing I wanna tell you about blocking.

– [Zubin] Oh yeah.

– [Vinay] You know, I said like a year ago, anyone who doesn’t wanna be blocked, send me a note and explain, like, “Hey, I’d love to engage with you.” Or like, “I don’t know how this happened.” And I’ll tell you what, ever since I offered that, over the years four people have done it.

– [Zubin] Yeah, that’s it.

– [Vinay] ‘Cause you know a lot of people, they just take satisfaction in, what is the word? What is it I always like to say? Everyone who is blocked, they feel like the reason they were blocked was their own brilliance.

– [Zubin] They always say that.

– [Vinay] I was just too brilliant for my time. I was too brilliant.

– [Zubin] He couldn’t handle the truth.

– [Vinay] He was just looking around on the internet and he’s like, “This random person is so brilliant.”

– [Zubin] I’m gonna block them. You know what’s funny, so now I have my app for blocking is my assistant who goes through comments and I’ve given her criteria. It’s all the same criteria you have.

– Ad hominem.

– They’re vicious.

– Vicious, yeah.

– Ad hominem attacks.

– [Zubin] They’re attacking other people. They’re crapping on my rug, man. Like “The Big Lebowski,” man, this guy peed on my rug.

– [Vinay] I know, my rug, it pulled the room together.

– [Zubin] It pulled the rug together, man. And this guy, rug pee-ers didn’t do this, man. So, this idea that then you clean up the room so that other people feel like, “Okay, this is a comfortable room I wanna be in.” That’s the sentiment. I wanna set an all middle tone. People who think integrally can feel comfortable. If it’s full of garbage people, garbage people’s… Let me change that.

– [Vinay] The comments, the garbage comments.

– [Zubin] They’re not garbage people, garbage comments, people behaving in a garbage way.

– [Vinay] But what happens is then your followers end up arguing with these people.

– [Zubin] Oh, yeah, it’s so distracting, too.

– [Vinay] Again, it’s the dinner party analogy. Everyone is free to have their own dinner party, but you don’t have to come to my dinner party and harass my guests.

– [Zubin] And by default, because you’re an idiot, your dinner party is gonna suck and there’s gonna be three people there and they’re all gonna be assholes.

– [Vinay] And I was like, yeah, and the reason why you have no followers is your content offers no novelty, no ingenuity. You’re not gonna analyze anything interesting.

– [Zubin] And you’re a terrible communicator.

– [Vinay] And a terrible communicator often.

– [Zubin] Now again, these are things you can work on.

– [Vinay] I know, but they don’t wanna work on it.

– [Zubin] You’re not inborn this way. You can change, right?

– [Vinay] And oh God, the credentialism.

– Oh man.

– Oh, that’s so painful.

– [Zubin] Man, I know.

– [Vinay] It’s none of this, none of that, none of this, none of that.

– [Zubin] Every now and again, I’ll dip into credentialism in a bad way. Like I find myself-

– [Vinay] We all do because when you’re angry and heated.

– [Zubin] When you’re angry, yeah, and the problem is when you’re surrounded by highly credentialed people. If we had a dinner party, right, who would show up? All these asshole professors and new people with MD PhDs and all these people from these schools, and then we’d sit around, “Can you believe they’re listening to this clown who trained at X?” And that’s how people talk because they’re in a way kind of defensive. They’re also kind of sad a little bit that we sacrificed so much to go to these schools, and we’re just the same as everyone else in the end, right?

– Yeah.

– [Zubin] Because it’s true. And so we have to, again, like I say, my little internal prayer is that I will be very uncomfortable when I do something that I think is probably not right or I self-deceive myself. And that’s something I put out there. I have fallen into that occasionally. That being said, I think we did a thing here.

– [Vinay] It was good.

– [Zubin] Man, we kind of ran the whole gamut of everything. We always do that. If our goal is to be viral, you don’t do what we just did. You just talk about one thing and you inflame and you make sure you go, “I can’t believe this is happening.” But that’s not our game here.

– [Vinay] My goal is just to have a good in-person conversation, which is very difficult to do these days.

– [Zubin] It’s almost impossible.

– [Vinay] It’s almost impossible. Nobody wants to meet in person and nobody wants to have a good conversation.

– [Zubin] Oh man, dude, every time I get a text from you and it’s like, “Hey, I’m kinda in your hood,” ’cause that’s how these things go down, “you want to hang out, have coffee?” And I’m like, “Yeah, and can we do a show too?” It’s like, “Yeah.” It’s like a joy, man.

– It’s a joy.

– [Zubin] Because, again, we’re having a conversation. And you know, you and I even don’t agree on everything. We don’t have to.

– We don’t have to.

– [Zubin] We understand each other’s motives are good.

– [Vinay] Like I told you not to get that tattoo, but you had to do it, didn’t you?

– [Zubin] Listen, a male tramp stamp will be a thing one day.

– Just wait it out.

– [Zubin] When I’m 60-

– [Vinay] All fashion ebbs and flows, you know?

– It does.

– It all comes into fashion.

– [Vinay] When I’m 60 and people are like, “You got a tattoo where?” I’m like, “Yeah, right here where all the kids are getting it right now.”

– [Vinay] And it’s faded.

– [Zubin] And it’s faded, and it says, “Follow the science.” Could you imagine getting a stupid virtue-signaling tattoo like that, like “Mask or die.” And then 10 years later when they find the mask-

– [Vinay] I bet somebody’s gotten a #FollowTheScience tattoo.

– [Zubin] No doubt, no doubt, no doubt. I would get a tattoo that said follow science, not the science, but science as an approach I think is reasonable. Even that, there are transrationalist ways to look at science too that defy rationality. But that’s another conversation. Dude, all right.

– Pleasure.

– [Zubin] Okay, go check out your YouTube, just search Vinay Prasad on YouTube. I’ll put a link, I’ll put a link, I’ll put a link. I’ll put a link up of all the other stuff. I love you guys. I love you guys. Love you, VP. We’re out, peace.