Weighing the risk of myocarditis vs. the benefit of vaccinating young people (particularly boys) with the Pfizer mRNA vaccine.
– [Zubin] ZDoggMD, Vinay, Dr. Vinay Prasad. We’re talking myocarditis, children, vaccines, go. Let’s talk about this.
– [Vinay] Let’s do this. This is a good topic because it’s a topic that I was part of two op-eds about, about a week or two ago, one in MedPage Today and one in STAT. And I’m joined by my colleagues Venk Murthy, Brahmajee Nallamothu, Amy Beck, Ramin Farzaneh-Far, Wes Pegden. Gosh, who am I missing? And Venk, I think, a second time. So I got cardiologists and pediatricians.
– [Zubin] Brown people, white people.
– [Vinay] Yeah. We’re not discriminating these things. We’re getting everybody, all the stakeholder, everyone who’s interested in this issue, at least who I’ve noticed to be interested. And what are we talking about? We’re talking about mRNA vaccines, particularly dose two, and adolescents, particularly boys, particularly between the ages of 12 and 24-26-ish and myocarditis. And this is something that some of us have been following kind of quietly for awhile. In February, there was an initial report of a teenager in Israel who had myocardial myocarditis, myocardial inflammation after receiving the Pfizer vaccine. And since then, we’ve just seen more and more reports. By late April, Israel had announced that it was occurring with some frequency in young adults, particularly men, particularly after dose two. The EMA launched an inquiry, I believe, on May 7th. May 7th was the date that Wes Pegden, myself, and Stef Baral from Hopkins wrote an op-ed in BMJ where we said, “You might want to wait on the emergency use authorization,” I think we talked about that on a prior episode, while this is getting sorted out. And then, subsequently, we had a few more cases. The CDC put out a statement saying they’re looking, they’re soliciting more cases. And then, the vaccine surveillance had a big bump in the cases, and that they had a meeting to discuss the frequency of myocarditis and whether or not the risks outweigh benefits. And we went, and I listened to that meeting, this ACIP meeting, the advisory committee of immunization practices. And I think, like a lot of people who, the people who have I’ve co-authored this commentary with, didn’t like exactly what I heard. And so, we decided to talk about this issue. So what is this issue, I guess? Young people, particularly young boys are having myocardial inflammation, myocarditis and pericarditis, and it is occurring at rates much higher than baseline rates, at least 20 times higher, maybe even 100 times higher, but the baseline rates are very low. It’s worse after dose two. By that, I mean most cases reported after the second dose. And I guess the question that we have is is the best strategy two doses of mRNA for all these kids? Which is what the CDC has come out saying. Or is there something in between two doses and nothing, that’s a better strategy? And our op-ed explores that. And we talk about some of the reasons why there is middle ground.
– [Zubin] Yeah, and what I like about that op-ed, which we’re gonna link to is that you are talking about nuance. They’re going with this public health idea of there’s black and white solutions, right? To keep it as simple as possible. And they say the risk of myocarditis is far outweighed by the benefits of the vaccines, based on these calculations of here’s the chance of getting COVID, here’s a chance of dying or being hospitalized from COVID. And of course, we know that COVID can cause heart problems too, which we should talk about because Mandrola and you guys wrote a good op-ed in STAT about that. And the risk of myocarditis is quite low based on VAERS data and what we’ve seen so far, but in the piece, you argue a few interesting things. One is that we’re probably underestimating the actual incidence of myocarditis. And even though most do recover, and it is generally not severe, it can be severe. You can die, you can have a chronic heart injury, other things can happen, but in general, people do get better. And so the argument from CDC was, “Well, but the danger of COVID is higher.” Even in these kids, even across the spectrum, even a kid who has had COVID before, has antibodies detectable, maybe even had myocarditis after the first dose, and they would still say, “Yeah, go ahead and get that second dose.” So it’s just a lack of diving into it more. So what’s the nuance around this?
– [Vinay] Yeah. Let’s hit some of these points. So one, VAERS is an underestimate. Yeah, I think… Actually before I do that, I wanna say one point about what people were saying. There were people who said at the date of the EUA that, “We know this vaccine is safe and there will be no safety signal at all.” They said that, confidently. And we said, Wes and I, and Steph, that you don’t know that, that safety signals vary based on age, and you might have a safety signal. So the mere fact we’re talking about this, I think, suggests that some people don’t know what the hell they were talking about, which is something that I sincerely believe. So you know who you are. You were wrong. You said it was totally safe. This is a safety signal you didn’t anticipate. I saw it coming because I followed the Israeli News, thank goodness, because people send me things. Okay, VAERS. The moment they detected the safety signal, they had a New York Times story that said, “If you’re aware of myocarditis, report the cases to us,” and then the cases had a big uptake. So what does that tell you? That tells you that the surveillance system, it can be improved upon when you solicit a problem. It’s not a perfect surveillance system. It’s a voluntary reporting surveillance system. And those kinds of surveillance systems are so easy for the doctor who sees a myocarditis to say, “Huh, this can’t be. I’ve never heard of this being linked to a vaccine. Never heard of it.”
– [Both] Not gonna report.
– [Vinay] Yeah, of course, ’cause it can’t be linked. Must be just the run of the mill, random myocarditis. Sometimes it’s idiopathic. We don’t know the cause. And so that’s what happens. But then, when they tell you, “Well, hey, we’re hearing reports that it might be linked,” and then all of a sudden you get 200 new cases, it tells you that it’s not a perfect surveillance system. So that’s an important point.
– [Zubin] Right. And it can go the other way too, right? So people can over-report, thinking, “Oh, miscarriage was due to vaccine,” but there’s no increase in rate relative to the background population. So, it’s a mixed bag.
– [Vinay] Yeah. Like a nocebo effect, if you plant something in someone’s mind, it can be the other way, it can overestimate as well.
– [Zubin] Right. But you’re not to get placebo cases of myocarditis.
– [Vinay] Correct.
– [Zubin] They have diagnostic criteria for it. So these are real myocarditis cases. They just were only associated with vaccine after New York Times raised awareness about it.
– [Vinay] Yes, at least at the incidence of it went up after the awareness was raised.
– [Vinay] In VAERS
– [Zubin] In VAERS
– [Vinay] We also have some nice data in JAMA from the military that has a sort of much higher frequency, one in maybe 20K, in sort of the high risk age groups, and we have data from Israel. And the nice thing about the military in Israel is they’re a little bit better about tracking numerators and denominators. It’s a single system. Okay, so that’s one point. The second thing about myocarditis, yes, it’s a stochastic idiopathic side effect. What does that mean? It’s idiopathic. It happens to people at random. The kids it’s happening too, they can be healthy or they can have medical problems, but it’s just occurring at random. We don’t really understand who it’s occurring in or not, but it doesn’t seem to be linked to known risk factors for anything in life. It’s a stochastic adverse event. That means it happens with some sort of randomness to it. And that means that, yes, people can say most cases are mild, most cases self-resolve, but like all stochastic events, by chance alone, some cases won’t be mild and some cases will be severe. And we already see that with the first case report in the pediatrics case series, the general pediatrics, where the child in that case report appeared to have AV nodal block and had a junctional escape rhythm, so suggesting affecting conduction. And then, there’s gonna be some ongoing CDC attempts to ask if some children who passed away from sudden death, if that was linked to myocarditis or not. I don’t know if it is or isn’t, but it’s something to be explored. It’s too early to say that it’s only always mild. I think that’s a misnomer.
– [Zubin] Yeah.
– [Vinay] There will likely be some kids with ventricular dysfunction, diminished ejection fraction, and okay, so then we can talk about the risk benefit. But if you’re really talking about like a 15 year old who had COVID and recovered, got one dose, and then got the second dose, and then has myocarditis, and has some diminished ejection fraction, I would argue that that 15 year old had a disservice by getting two doses of mRNA after having recovered from COVID.
– [Zubin] That just doesn’t make sense.
– [Vinay] It doesn’t make sense.
– [Vinay] It doesn’t pass the common sense test. Now, one thing you mentioned is that there are stochastic and idiosyncratic components to myocarditis. So you don’t know which kids gonna get it. There’s no predisposition beyond being male, perhaps, and being in the age group. However, with COVID infection-
– [Vinay] Correct. That’s a key difference.
– [Zubin] There is a very clear to predisposition. If you have pre-existing conditions, including obesity, you’re more likely to be hospitalized or very sick with COVID. Now that’s not true of MISC necessarily.
– [Vinay] Correct. That’s also and idiosyncratic thing, right. But you’re making a really good point, which is the CDC, they debuted this model, and their model says a few things. They say, “Let’s assume that in the 120 days prior to the end of May, that rate of COVID persists into the future,” which it didn’t, actually. It’s much lower now. So that’s one erroneous model. But let’s assume that rate persists in the future. Let’s assume that hospitalization rate persists in the future, and let’s ask what if the kids get two vaccines versus zero vaccines. What’s the risk benefit? And let’s assume that the numbers we have are perfect accuracy numbers of myocarditis that we’re not underestimating. And by that assumption, they show, even at young ages, it is better to get two than nothing, assuming their rate of myocarditis and assuming the past rate of COVID spread. But so, we immediately call those into question. We said, “Well, let’s assume something rate closer to the Israeli rate, which is higher.” Okay. Let’s assume that instead of two doses, you ask, “What’s the value of getting the second dose for somebody with one dose?” We know one dose provides a great deal of protection, perhaps even the vast majority of protection comes from the first dose. The second dose might add a little bit to that. And so, we did this analysis. Wes Pegden led it. He published it in Medium, and it shows the analysis tips. Very quickly by altering those two conditions, it shows it’s actually kind of unfavorable in those groups. And he didn’t even alter the rate of COVID in the population, which is actually dropping, which will make it even more unfavorable. And then, your point is another astute point, which is that, why is this one size fits all? Men and women, kids with pre-existing conditions, and those without, and those who are obese and those without, we can have some personalization here. Maybe it makes sense to get two doses if you have underlying medical conditions and you’re 17 years old, but maybe if you have recovered from COVID or you never had COVID, but you’re a healthy 12 year old, maybe just one dose is sufficient. What do you need that second dose for? Your chance of being hospitalized after a one dose of mRNA from subsequent COVID is probably as close to zero as it comes in this world.
– [Zubin] In a kid, yeah.
– [Vinay] In a kid, of course.
– [Zubin] Yeah, absolutely. Yeah. So that was the beauty of that look at it, is CDC has to do this very black and white thing, and this is not a black and white thing, and many parents will email me and say, “Hey, here’s the…” It’s interesting, they always start with, “Let me give you the life story of this kid,” which is what you actually ought to be doing when you’re making complex medical decisions, which in a kid, I would argue that vaccination for coronavirus in the setting of what we know about myocarditis, if they’re a male, it’s a slightly more complex decision.
– [Vinay] I think it’s more complex. And that’s what Mandrola wrote, John Mandrola, wrote a piece in Medscape.
– [Zubin] Cardiologist.
– [Vinay] And he said, he had so many great lines, he always a great lines, but one is like, “You only have one heart and inflammation of it is always something to be taken seriously.” And he also said that, just like minor surgery, the old saying says, “Minor surgery is surgery done on someone else.” And so mild myocarditis is myocarditis in someone else’s kid.
– [Zubin] It’s true.
– [Vinay] I’m sure. Get kids hospitalized for this, and they’ve got them on telemetry. It’s something to worry about.
– [Zubin] Yeah. And you’re talking about a healthy kid. Okay.
– [Zubin] Yeah.
– [Vinay] So that’s Mandrola’s point. The other point is there was an essay in the New York Times, and this essay argued that it is better to give two doses to every kid now because, if you don’t, they will all eventually get COVID-19, eventually they’ll be exposed to COVID-19. It’s endemic. It’ll keep circling. They’ll eventually get it. And those outcomes will be far worse. And I think that statement is true, of course, that it would be worse to eventually get it, and two doses now is better. However, but that’s not the right question. The question is, well, first of all, you don’t have to give two right now. You could do one. So there’s a middle ground that you’re excluding. And two, by the time everyone, “gets it,” how long down the road are we gonna be? You’re telling me you’ll have learned nothing about the safety and how to deliver this mRNA? One possibility is that the dose in micrograms of the mRNA construct-
– [Zubin] It’s too high.
– [Vinay] Yeah. It’s high. It’s high at the adult dose that’s being extrapolated, 12 to 15, from 11 to six, they’re using a third the dose, and then my understanding is they’re using one third of that in the five and below age groups, or less than five. Maybe there is some dose dependency here, and that we can quickly do a couple of studies to show that you can get away with giving a lower dose and maybe this idiosyncratic reaction is lessened. Maybe it’s not. I don’t know the answer, if dose is driving it, but I certainly think it’s something that you ought to explore with vigor before you conclude it’s either two at this dose or nothing. That, to me, strikes me as odd.
– [Zubin] Yeah. And again, there’s an absolutism, I think, in public health messaging about this. All these kids should get the vaccine, two doses. There’s no nuance, no room for nuance. No room even to accept parental concerns. This has been historically the realm of the anti-vaxxers. My kid, my choice, my whatever, right? But the truth is, it should always be that, but we have more data for certain vaccines, more understanding of the communal benefit. In this case, the community benefit, which you can’t ignore, of vaccinating against coronavirus, there is a community herd immunity benefit, but it’s pretty small, I think, with the kids component. I think you vaccinate all vulnerable adults, most adults, as much as you can, you’re gonna have 95% of that benefit and you didn’t even have to vaccinate the kids.
– [Vinay] Of course, I agree with you.
– [Zubin] You know what I mean? It’s kind of like we’re dealing with incremental stuff. And then, the only question is what’s the harm? And the harm is we’ve talked about. There’s not even just the harm of myocarditis, there’s the harm of the kids getting side effects of the vaccine, the usual. My daughter was out for a few hours complaining and status dramaticus, and I gave her some Tylenol, she got better, right? And I made the very conscious decision, two doses for her because she is a female and we are planning to travel, and Hawaii has vaccine passports now, and she wanted to get the full dose because her parents’ friends won’t let them play without masks, unless everyone’s vaccinated. She sees the complexity of it. Is it a pure medical decision? No. Is there a component of emotional hassle, practicality? But I did know the statistics. And I said, “Well, the chance of something bad happening to her and the benefit to her-“
– [Vinay] Some of the dose directly treats the brain of the parents’ friend.
– [Zubin] In that case, it’s more effective than that bullshit Alzheimer’s drug.
– [Vinay] It is. It is.
– [Zubin] That right? It has more-
– [Vinay] It crosses the blood-brain barrier.
– [Zubin] It crosses.
– [Vinay] Immediately, knowledge of this. Crosses the blood-brain barrier.
– [Zubin] So Malone and these fringy characters here, saying that the spike protein crosses the blood brain barrier. They’re right. It does. The vaccine does.
– [Vinay] What is it called? Spike-a-nistas? They’re all so obsessed with the Spike-a-nistas.
– [Zubin] I know.
– [Vinay] But I think you’re making so many good points. Obviously, there’s no one size fits all decision. But I find it funny that people think that either you keep your head down and get every vax you’re supposed to get right when you’re told to get it, or you’re an anti-vaxxer.
– [Zubin] Yeah.
– [Vinay] And I was like, “Of course there are thoughtful people that are gonna disagree on these issues.” One thing that really cracked me up was, I felt bad for my colleagues. Venk Murthy, I saw. This guy is a cardiac MR specialist. So there’s nobody that knows more about myocarditis than this guy. And then, he’s like getting lectured by all these randos on Twitter.
– [Zubin] On Twitter.
– [Vinay] And then someone’s like, “I don’t take my advice from a cardiologist. I take my advice from an expert in vaccines.” They have some expertise. I always find that so interesting because, I don’t know, what makes this rando so much of an expert that they know who the real expert is? Who anointed this rando the ability to discern the real experts?
– [Zubin] It’s the fragmentation crisis of reality. We question the nature of reality now because we question expertise based on our tribal affiliation. Well, I’m siding with the vaccinologist now, but then the minute that tips politically, you’re now siding with the anti-vaxxers.
– [Vinay] I remember that they were like, what did they say? Something like, “Never question the CDC. They’re doing their best job. They’re making the best decisions.” But then, the moment the CDC said, “You can omit the masks.”
– [Zubin] Take the masks off.
– [Vinay] They’re like, “The CDC’s lost their mind.”
– [Zubin] Suddenly National Nurses United is like, “Wait. No, we disagree with the CDC.” Who the hell are you?
– [Vinay] Yeah, exactly.
– [Zubin] And the thing is, everybody has their own bias. Nurses are seeing people die in the ICU. They’re seeing the sickest of the sick. Of course, they’re gonna be emotionally attached to having masks, whether or not we have data that they work in the public. It doesn’t matter. It’s something. You’re doing something. Because anything that would prevent that patient dying alone and getting FaceTime from his family, which by the way, is a criminal act, which we’ve talked about, which we’re gonna look back. We talked about it in another episode about how we’re gonna look back on this and go, “Oh, we were worse than the middle ages in terms of not even doing studies on masks and stuff.” We’re gonna look back on this and go, “This was like a human rights violation that we perpetrated as a system.”
– [Vinay] I wonder if even if somebody died of the Black Death in the middle ages, I bet they probably let relatives visit that person.
– [Zubin] Yeah. And they would then die of the Black Plague.
– [Vinay] Some of them, maybe.
– [Zubin] Some of them, maybe.
– [Vinay] Maybe they even avoided it.
– [Zubin] But even that, it’s insane. We know how to keep family members safe.
– [Vinay] Oh, yes. Put them in an N95.
– [Vinay] Of course.
– [Zubin] Ventilate the room. It’s not rocket science, and yet-
– [Vinay] That’s gonna get us fired up again.
– [Zubin] Oh, yeah, yeah, yeah.
– [Vinay] But this was this mRNA thing, I think is so interesting. I tried to explain it to a lot of people from reporters to lay people, and I’m just drawn to, I just tell people, “Just do the math. Make an Excel spreadsheet, put what today’s rate or tomorrow’s rate or put whatever rate you want of SARS COV-2 spread, and then estimate for 100,000 people, this rate of spread, how many will get it, how many will be hospitalized.” These parameters are known. One of the things that’s under-discussed is that some of the hospitalization rates fallen over time and now adolescents have a path to recombinant antibody products, which might make things better for them. And then also, look on the other side of the ledger. You do the math yourself. Assume the U.S. VAERS rate, assume Israeli rate, assume the JAMA military study rate, which is something, I think, in between. And then, you do the math and you figure out what age is the tipping point in your mind. And the honest answer is so many people have such strong opinions, but they don’t wanna open the Excel spreadsheet and do the math. And I tell you, I was like, “The reason I know I’m right, is that I know how to open the spreadsheet and do the math.” And I think that’s why Wes got, poor Wes Pegden, he’s a brilliant mathematician, professor of mathematics at Carnegie Mellon, and people got a lot of pushback, like, “Who is this mathematician to tell me…” I was like, “He’s a mathematician! He knows how to do numbers, man! He’s doing the numbers. It’s a numerical question and he’s putting in numbers. Why do you think he knows the answer. That’s how!” It’s not rocket science.
– [Zubin] We’ve lost our minds in terms of expertise, you know. The thing is, people on all sides of this thing make that argument, that appeal to authority, or the appeal to expertise or anti-expertise. Oh, well Pierre Kory is a frontline clinical doc taking care of patients. What the fuck are you doing, ZDogg? Well, I talk to a lot of doctors too and have a ability to look at evidence and actually have been-
– [Vinay] Yeah, I always feel slighted by that though because I was like, “I’m going to clinic and I’m wearing that thin-“
– [Zubin] That’s why you’re wearing a goddam suit.
– [Vinay] Well, for the most of the pandemic we wore that thin surgical mask, and perhaps even in a poorly ventilated room. I was playing, potentially, Russian Roulette every time I was seeing a patient. But you know what? I believe in duty. So I’m gonna keep doing it.
– [Zubin] Exactly right. And also, getting a paycheck.
– [Vinay] That’s true. Yeah.
– [Zubin] That’s the other thing, right? If I stop working, it’s just like any essential worker. That’s a whole poverty thing. Well, you can stop and stay safe or you can be on the street, or and you can be on the street.
– [Vinay] And even though I’m a doctor and professor, to be honest with you, I couldn’t stop working because I do need the paycheck. I will go bankrupt.
– [Zubin] You live in San Francisco.
– [Vinay] Yeah. I’ll go bankrupt quickly. But maybe I’ll migrate. Quickly, I’ll have to leave San Francisco.
– [Zubin] Yeah, yeah, yeah.
– [Vinay] The first thing you do when you lose it now is escape.
– [Zubin] Exactly. Yeah, that’s one last thing we should talk about in this episode. Brett Weinstein, one of his arguments of being censored on YouTube is that half his income disappears, his family’s income disappears when he’s demonetized. You remember, he was ex-communicated from Evergreen College of whatever, and then does his show, and that’s how he monetizes. And so when he’s censored, even if you disagree with what he’s saying, which I strongly do, especially now that he’s really kind of fallen in with the more, kind of very, I consider to be delusional elements of the anti-vaccine establishment, Robert F. Kennedy and these guys. I still would fight tooth and nail for his right to say whatever he wants.
– [Vinay] Yeah, that’s what I struggle with, which is that, even people I vehemently disagree with, I don’t believe in banning them from these platforms. Because I can’t think of a way you can separate all the people who say true and useful things from all the people who say untrue and non-useful things. A lot of people say some blend of it. So who are we to decide? I would say that’s different than, I often hear people say that, “VP you blocked me. YOU BLOCKED ME.” I was like blocking you is not banning you from speaking. You’re free to preach to whatever fools wanna follow you.
– [Zubin] You’re just out of my face.
– [Vinay] You’re out of my face. It’s like saying that it’s a violation of your freedom of speech not to be invited to my dinner party. I’m like, “I don’t want you at my dinner party. Now way.” And I always think it’s kind of funny that, among people who are blocked, every single one of them believes that they were blocked because the other person couldn’t handle their brilliance.
– [Zubin] That’s right. That’s right. It’s always the case.
– [Vinay] Oh, it was so brilliant.
– [Zubin] That’s right. That’s right. Oh, my god.
– [Vinay] How do you believe that?
– [Zubin] It gets to this phrase, “Good fences make good neighbors.” It used to be these kinds of ding-dongs were at a distance. You didn’t have to block them. You couldn’t see them because they’re geographically isolated. Now we’ve reduced everything to a common village of idiots throwing feces at each other where there’s no fence. Anybody whose ideas are abhorrent to you can be in your feed, throwing feces at you. And either you block them and build a little virtual fence, but then get them gonna the PTA and being like, “This guy blocked me and he’s a menace to society” It’s crazy. I don’t know the answer yet.
– [Vinay] I don’t know. But one of the things you told me that has persuaded me, which is that you don’t spend a lot of time interacting on social media. And I’ve stopped looking. I’ve stopped looking and I’ve stopped, like if I have a thought that I think is funny and clever, I used to actually, maybe tweet that out, and now I’m like, “You know what?”
– [Zubin] Let me think twice.
– [Vinay] No, it’s not even that, it’s just like, “Screw them.” I’ll tell my friend. I don’t even need to tell it. And I worry that even our minimal participation, like even tweeting links to our stuff, I worry that someday, are we complicit with a shitty algorithm and these shitty platforms?
– [Zubin] So actually, this is a great way to end this episode because I struggle with this daily. I’ve come out very strong that I think Facebook and YouTube and these algorithms have been damaging to our civil discourse, have further fragmented us, have created this village of idiots, throwing feces at each other, have tribalized us, and are hyper-stimulating our evolutionary drive in a way that it’s damaging. There’s a story of this beetle in Australia, it’s brown and has a big old butt and all this, and it almost went extinct because Aussies were throwing these beer bottles down on the ground and the beer bottle image of it, the back end of that beer bottle looked like the backend of a female beetle, and the male beetles, it was hyper-stimulating. It looked like the juiciest, most voluptuous beetle butt, and the beetles would have sex with his bottle to their extinction almost. And female beetles are sitting around, going, “What about me?” Am I chopped liver? Because they were so hyper-stimulated. So we’re in a world now where tech has hyper-stimulated, hacked our desire for dopamine, for belonging, for tribalism, for acceptance, for outrage, with outrage porn and tribalization to where we are addicts that are at the whim of this. And so, there’s part of me that’s like, “You know what?” I am advocating my Facebook and YouTube followers to move to a platform called Locals because in Locals, you don’t play that game. You pay a fee, like five bucks a month, to be part of a tribe that you care about, and you discuss. And I set the tone for that tribe, but everybody has conversations with each other and it’s off that grid. There’s no ads, there’s none of that. And so, that’s one solution.
– [Vinay] And there’s no risk that you’ll be thrown off if you-
– [Zubin] Can’t be canceled.
– [Vinay] You can’t?
– [Zubin] Their whole thing is, “We allow free speech,” which does attract some cuckoos, but that’s okay because they’re gonna attract their tribes anywhere anyways. So this is just a facilitated community. And they have their own policies of they won’t won’t allow certain things, like you have to have some moderation capability. So you can’t be posting like, “We’re gonna burn down the government and all this other stuff.”
– [Vinay] That’s interesting. And what about anonymity?
– [Zubin] Ah, so here’s the beautiful thing. You have to sign up with your email, with an email that works, which means that I have your information in terms of email. And so, if you’re gonna be crazy, first of all, I can ban you, second of all, I’ve got your email. If you sign up with a fake email, I think they figured that out.
– [Vinay] I see.
– [Zubin] Yeah.
– [Vinay] Interesting.
– [Zubin] Which is important. You don’t have to give your real name, but you got an email there.
– [Vinay] I think one of the biggest problems for what I see with Twitter and Facebook is just the fraction of an anonymous is, and not that I want to say that… I understand why some people feel the need to be anonymous. They have jobs that they worry about retribution for any little stray thing they say, but I do worry that there are some actors who are anonymous, and running 12 accounts or something, and that’s one challenge.
– [Zubin] And state actors who do that.
– [Vinay] State actors. Yeah. And I think, the other thing, well, anyway, we can talk a lot more about it, but let’s skip it for this time.
– [Zubin] Yeah. We go off the rails real easy. All right, guys, bottom line, share the video. You know what to do. All right. Thanks, Vinay.