What the lab leak hypothesis REALLY means, thinking about risk/benefit for vaccines and kids, and democracy vs. liberty…Dr. VP’s back!

 
Click here for easier navigation through this show’s key topics
 

0:00 Intro Teaching Science Communication & Ivermectin Drama

7:30 Determining whether medical procedures are appropriate and recognizing bias

11:45 The lab leak hypothesis and what it MEANS: is it racist? Should scientific debate be stifled?

23:15 Doing Mikhaila Peterson’s podcast and social media tribal polarization & how to argue scientific points effectively

26:45 Liberty vs. democracy in science and beyond, and the concept of scientific liberalism

36:06 A nuanced risk/benefit analysis of COVID Pfizer vaccine in children ages 12-15 (Was EUA appropriate? Is there real benefit in this population? Are we protecting adults?)

46:23 Dr. Z’s choice for his 13 year old daughter, and evaluating cognitive dissonance

52:49 COVID vaccine booster shots, broken down by cost/benefit

55:51 Fauci’s emails

59:20 Where did flu go

1:01:00 Changing the culture of working while sick

1:30:50 Enlightening, THEN going to medical school

1:32:47 Spirituality and burnout in medicine

1:38:00 Working with strong emotion

 
 
 
Full Transcript Coming Shortly

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– [Zubin] Hey guys, ZDoggMD. I got back Vinay Prasad back. Dude, today, we’re gonna talk about, I taught a class of yours with you.

– [Vinay] Yes, you did.

– [Zubin] That was fun at UCSF. We’re gonna talk about this lab leak hypothesis and its ramifications for science in general. We are gonna talk about the dude who had to resign from JAMA for being white and male and other things. We’re gonna talk about kids and vaccination for COVID ’cause you’ve written quite extensively about that. We’re gonna talk about Fauci’s e-mails because I think that’s interesting and I haven’t looked at that, and more right?

– [Vinay] And more.

– [Zubin] And more.

– [Vinay] And more.

– [Zubin] Yeah, so let’s just dive into it, brother.

– [Vinay] We got to start with your class.

– [Zubin] Dude, my class? It was your class.

– [Vinay] Well, thank you so much for coming and doing a guest spot, but this is a class that I’m teaching on publishing and presenting research. We do all sorts of different things. So we start with abstracts, we go through intro methods, all those sort of stock and trade things about writing an academic publication. But the last couple episodes, episodes, classes were-

– [Zubin] I love it, episodes-

– [Vinay] I do too many podcasts.

– [Zubin] You think like me, dude.

– [Vinay] I do too many podcasts. By the way, we should mention this.

– [Vinay] Yeah.

– [Zubin] We’re both wearing suits today.

– [Vinay] Yes.

– [Zubin] Why? Because you have clinic.

– [Vinay] Well, yeah-

– [Zubin] Yeah.

– [Vinay] One of us has clinic.

– [Zubin] Exactly, and I was like, “Well, I could wear a t-shirt, or I could step up my game to keep up with VP.” So the class.

– [Vinay] Okay, so the class.

– [Zubin] Yeah.

– [Vinay] Yeah, we’re the gray suit club today. That’s right. That’s right.

– [Vinay] Two for one special.

– [Zubin] JCPenney’s.

– [Vinay] Yeah, the class was good. I mean the last session of the class is on social media, which increasingly you got to teach people who are going to be scientists, how to maneuver in the rough waters of social media, and I thought there’s no better person to bring on than you. I really appreciate you doing it. I think we had a good time. I think the class had a good time. They had a lot of questions for you.

– [Zubin] Yeah, it was a real kind of awesome experience, dude, because, first of all, you have command of that material, right? ‘Cause the class was on epidemiology, and it was on like, how do you write an abstract? How do you get your research noticed? How do you communicate with the public? How do you make an abstract that’s clear that actually catches people’s attention without misrepresenting the science? I mean these are the things that they don’t typically teach you.

– [Vinay] Yes.

– [Zubin] And so I was fascinated as a learner in that aspect, and then to be able to say, “Okay, well, guys so here’s how you kind of think about communication,” and that that’s a nuanced discussion because so many scientists are just the worst communicators, so who steps in? Really good communicators who are terrible scientist. You know like-

– [Vinay] We’ve seen a lot of them in COVID, yes.

– [Zubin] Haven’t we? Right? Right?

– [Vinay] Yes, yes.

– [Zubin] So you have like the Sherri Tenpenny anti-vax crowd, you have people like Pierre Kory, the ivermectin guy, who’s a really good, have you see this guy talk?

– [Vinay] No, but he knows how to present bad information is what you’re talking about?

– [Zubin] He takes information that you and I would look at and go, “These are really poor quality studies and there’s a lot of confusion of correlation and causation and a lot of that,” and he emotionalizes it and he dramatizes it and he wraps it in a conspiracy to prevent ivermectin from happening. And then he goes on like Weinstein’s podcast, DarkHorse, and they get in a pocket about it.

– [Vinay] Ivermectin, Jesus.

– [Zubin] Pretty soon everyone’s like, “Why aren’t we just giving ivermectin instead of these incredibly effective vaccines?”

– [Vinay] You know, and then, so you’re talking about one fringe side and on the other fringe side, you’ve got a lot of people who are like, “You know, I once used the restroom at Harvard, and here’s why schools should never reopen.” And I’m like, “What?” You know? I’m like, first of all, what kind of credential is this? But it’s very difficult for the public to discriminate between people who may actually know what they’re talking about, people who have the veneer of looking like they know what they talk about, and then the content being science-y versus actual science, and I think it’s quite difficult.

– [Zubin] I like that, science-y. That’s really-

– [Vinay] Yeah, science-y.

– [Zubin] Yeah, because you can throw in scientific words, you can actually, what I noticed, because I listened to some of this interview between Pierre Kory and Weinstein on his DarkHorse podcast the other day because someone had sent it to me saying, “Hey, please respond to this,” and I’m like, “If I responded to everything that was out there, that’s all I’d do all day, and honestly, I don’t care.” Like ivermectin, study it, great, wonderful.

– [Vinay] Just do a single, large randomized control trial.

– [Zubin] Yeah, yeah.

– [Vinay] I’m sick of all these, people keep showing me little fragments of garbage data. I was like, when you have a therapeutic drug you just do a large randomized control trial. If it’s positive, no one will doubt you. And if it’s negative, go home.

– [Zubin] So this is what Kory was saying, “I’ve been fighting with these EBM people, these evidence-based medicine people about the quality of these trials and they’re this and that,” and I’m like, “So you’re saying you don’t believe, evidence-based medicine’s not a thing for you? The observational trials are fine for you?” ‘Cause that’s what I’m hearing. “Well, no, there’s all these randomized trials.” Yeah, but they’re all in multiple countries with different failures of design.

– [Vinay] I haven’t looked through the literature, but my assumption is that they’re all incredibly small, underpowered, a poor ascertainment of end points, a lot of problems with it. Then they meta analyze it.

– [Zubin] Yes, that’s right.

– [Vinay] Which is, as I call it, GIGO, garbage in garbage out. I say meta analysis is like a juicer, it only tastes as good as what you put in. You put a rotten cantaloupe in that juicer it tastes like shit, and that’s what you’re getting with a lot of meta analysis.

– [Zubin] Dude, dude, dude, you got to go on Weinstein’s podcast because what Kory was saying is, I mean, and then we do a meta analysis, which is the gold standard. I mean, it’s better than a randomized control trial.

– [Vinay] Depends on what you put in.

– [Zubin] Right.

– [Vinay] Yeah.

– [Zubin] Garbage in, garbage out.

– [Vinay] GIGO, and some people put observational studies in a meta analysis, which I think is problematic. And I guess you don’t need to look far to see the lessons in just the last few months of we thought some things did something and they didn’t.

– [Zubin] Yeah.

– [Vinay] Hydroxychloroquine.

– [Zubin] Doesn’t work. Right.

– [Vinay] Yeah. And the list goes on and on of all these interventions that were pursued with best intentions. And so the answer is simple, single, large randomized controlled trial. And if they do that, I’ll believe it, and if they don’t, I won’t.

– [Zubin] So here’s what happens I think with a lot of these guys, like they’re so emotionally invested in this thing, which it’s good intent, it’s not like they’re bad people. They’re just bad scientists, but good communicators. And what ends up happening is a randomized control trial does come out, there was one in the US, I think, and it showed no benefit. And then they start moving the goalpost. They’re like, “Well, they didn’t give it early enough. They didn’t get it at a high enough dose.”

– [Vinay] No Vitamin D, no Zinc!

– [Zubin] That’s right, there was no Zinc.

– [Vinay] If you didn’t add the zinc in, come on ZDogg. How dare they give the hydroxychloroquine without the azithro 20 days before symptoms start? I mean, come on. It’s just goalposts keep moving and moving, and then they wrap it in conspiracy. They don’t want you to know about this. Well, then why does dexamethasone is celebrated as a great triumph? It’s cheap. It’s easy. It’s off-patent. Why?

– [Vinay] And it was done in a single clear-

– [Zubin] Randomized.

– [Vinay] 3000 person RECOVERY randomized controlled trial, pre-specified endpoints. But you know, the point I want to make from the point you’re making, which is that, I think, it’s easy to point out that these people who hold, I think, fringe views often are relying on low levels of evidence, but we should not forget there are actually a lot of people who hold mainstream medical views, who also cite poor evidence, who move the goalposts. When we’ve had a number of randomized controlled trials showing that stenting chronic stable angina didn’t do what you thought, it didn’t lower MI, it didn’t improve quality of life, and in an orbit it didn’t even improve exercise tolerance on modified Bruce protocol, there are always people who come up with reasons why that randomized controlled trial is negative. What they don’t often come up with are different randomized controlled trials that are positive. And so this is sort of a human thing, which is if you do something, if you believe in it, and if you’re a, quote, true believer, you tend to rationalize away failures and you tend to be unfailing in your belief. And this one statistician puts it well, Darren Dolly, he says, “I like people who focus on problems, who don’t focus on solutions.” So if you want to study the problem of COVID, have at it. But if you want to study how ivermectin can be used, you’re too invested, you’re not a real scientist. So you want to study problems, not solutions.

– [Zubin] Ah yeah, that’s spot on. It’s absolutely true of mainstream. So I had Rita Redberg-

– [Vinay] Yes, my favorite.

– [Zubin] The editor of JAMA Internal Medicine on the show-

– [Vinay] And my colleague at UCSF.

– [Zubin] Your colleague at UCSF, and she has written extensively about this idea of stenting being, not having the outcomes we think they have. And the thing is there was a saying, I don’t know if it was Upton Sinclair who said, “It’s very difficult to have a man believe something when his income and livelihood depends on him not believing it.”

– [Vinay] Yeah.

– [Zubin] And I think there are a lot of cardiologists out there who, I mean, this is their bread and butter, right? And it can be absolutely devastating to say, “Well, oh, this thing that we did that we thought, we really believed was helping people, and we got paid to do it and I was able to pay off my student loans and I was able to get this cool Mercedes S Class, like you’re saying that it doesn’t help people and it may actually just cause harm?” Because if it doesn’t help-

– [Vinay] And speaking of meta analysis, they got a new one out at their little cardiology meeting where they blew the dust off some old trials, and they put those in the meta analysis and say, “Oh, look, revascularization works” I think, this is gonna maybe hurt some people’s feelings, but specialties where a large percentage of the revenue is driven by some class of things, be it urology and prostate specific antigen screening, be it radiology and mammography, be it-

– [Zubin] Oncology and chemotherapy.

– [Vinay] Yeah, I think to some degree, but that that’s one of the reasons why people are… Oncology and chemotherapy I think is an interesting example because oncologists receive a percentage markup of IV-infused drugs, and that percentages vary between four and 6%. But what it means is it is a perverse bias that if you have a choice that’s cheap, IV-infused or an expensive alternative, you tend to give the expensive alternative. If you can add in Avastin, toss in Avastin on the end, you’re gonna add it. That bias, I think, is more susceptible to systems where the oncologist derives some revenue from the business model, which is less of the case at university practices.

– [Zubin] Right.

– [Vinay] But it still exists. But at least we have so many different drugs that if you knocked out any few we’ll still have another 150 to give. But when it comes to like procedure lists you’re talking maybe 40% of their procedures are one type of things, the thing discovered by the screening. That puts them in a very vulnerable position to really impartially adjudicate those things.

– [Zubin] Yeah, I think that’s exactly correct because again, you have to override every core belief in order to overturn this piece of understanding. And questioning beliefs for humans is hard enough, especially when they’re core beliefs. I think the only belief that we really is not up to question is that we should question our beliefs. We should hold them up to scrutiny.

– [Vinay] But you know what I tell, I try to teach people my feeling as an oncologist, and I think my, I’m entering my seventh year on as faculty is that I’ve never become too attached to any drug I give. I try to train fellows, don’t be too attached to a drug or a therapy. Like, you need to be attached to your patients, you need to be attached to learning about the disease, but don’t be so wedded to brentuximab vedotin. Don’t be so wedded to, you know, I’ll rattle off.

– [Zubin] Man, that’s a good name.

– [Vinay] Yeah. Right?

– [Zubin] Yeah.

– [Vinay] It packs a punch. I mean, half of oncology is just memorizing all these names, but don’t be so wedded to a specific drug or drug product because don’t be surprised if in the future that drug product is found to be lackluster, it doesn’t have the benefits you thought it did. And so be committed to your patients, be committed to the process, the evidence-based medicine process. And I just want to say one thing about it, you point out this person says, “Oh, these evidence-based medicine purists are against me.” Evidence-based medicine, you can keep tossing that term out there, but all it literally means is these are people who are specializing in knowing whether shit actually works. Okay? So the people who focus on knowing whether actually works question the low quality evidence I am producing. That’s all they’re saying.

– [Zubin] Yeah, yeah.

– [Vinay] So like, if you care about whether it actually works, these are the people you want to rely on, and that’s all I hear, yeah.

– [Zubin] Okay, so this actually wraps it right back into the class that you taught, which is again, how do you present evidence that stuff actually works? And how do you really critically, and how do you communicate it? Now, this is a perfect segue. We’re gonna do a whole ‘nother show on medical appropriateness because it is a passion of yours. You’ve written books on it, I think it’s crucial, and it’s a passion of mine too. But today, let’s talk about belief because, again, we’re talking about this clinging to these beliefs and then cherry picking data, confirmation bias, conspiracy thinking, all the other stuff happens on the fringe and it happens in the mainstream. Let’s talk about a mainstream F-up of what I think is huge proportions, and I was victim of it too, so I can take full culpability for this. And that is the lab leak hypothesis, which was flood, okay, somehow this thing got out of a lab, either it was engineered specifically as a weapon or that was the early, like, scuttlebutt, or it’s an accidental leak from a, and then we know how labs work. You and I both work in labs. It’s just, it’s easy to screw up.

– [Vinay] Yes.

– [Zubin] Easy, easy. I had fruit flies all over the place I taught MCAT.

– [Vinay] If you were judged for lab leak of fruit flies they’d be everywhere. You gotta hang the little paper tape to try to catch ’em.

– [Zubin] Totally, totally.

– [Vinay] They escape, yeah.

– [Zubin] Totally, and I’ll tell you bumblers work in the lab. So we’re not, nerds are not the most coordinated people. And so I remember, my first time I ran a centrifuge. I had this like integrin mediated cell adhesion project I was doing, and I go and it goes I didn’t balance it right.

– [Vinay] Oh.

– [Zubin] The thing nearly exploded, like the tube shot out the top or something terrible happened. I almost killed it.

– [Vinay] Good thing you weren’t enriching uranium. That’s good, right.

– [Zubin] Exactly! Or handling-

– [Vinay] Yeah, a biohazard.

– [Zubin] A gain-of-function mutation, coronavirus potentially, so talk about this. You just wrote a piece on this in Medpage that I thought was very powerful.

– [Vinay] Okay, yeah. Thanks. And you did a great job of segue, but I just wanna say one last thing on the topic. The reason I brought you on, and the reason you did a great job with this class was you took people who their primary commitment is science, and you reminded them that you also need to be really good at communicating that science to a broad audience, and that will help everybody, not just you, it’ll help society. So I think, thank you for doing that. So on this lab leak, the lab leak, I think, you mentioned that you felt like you succumbed to it a little bit, and I might have succumbed to it a little bit because I host my little podcast and I had on a number of guests and I had Francois Balloux who’s a geneticist at University College, London, and I asked him specifically about lab leak. And he said that looking at the sequence you can see parallels between this sequence and naturally occurring coronaviruses. Nothing is quite perfect. We don’t have the immediate host. And then, so I said, “So do you think lab leak is likely or not likely?” And he says, “Whether or not you can actually find the virus in the world or not that doesn’t actually in and of itself prove lab leak or not. It could still have been captured in the lab and being studied and then leaked into the people.”

– [Zubin] Correct.

– [Vinay] Who are working there.

– [Zubin] Correct.

– [Vinay] And so I guess there’s a few hypotheses. One hypothesis is that this is a virus that had zoonotic transmission from some animal to a person at a wet market somewhere else. The second hypothesis is this is a natural virus that is being studied, and it somehow, as accidents do happen in laboratories, they’ve been known to happen, was transmitted to the staff. The staff went home, they were sick. Potentially there’s some intelligence reports that there were some people who worked in that facility who were sick with something similar to SARS-CoV-2, even in November. The third hypothesis is this was a genetically modified coronavirus that was being modified, so we could better learn, they call it gain-of-function, but better learn ways to combat coronaviruses. There’s a certain nucleic acid sequence to code the furin cleavage site that some people, like David Baltimore, some molecular biologists think is possibly suspicious. And others think it’s actually something that could have occurred through natural evolution. So, okay, these are the debates. The thing that got me was early on in this, and I’m not an expert in molecular biology, somebody recommended a scientist, who’s at the Broad, and she had been doing some good work there, and asked me to have her on my podcast to discuss the possibility of lab leak. And I must say that maybe I was, I’m also, it’s not always my, a lot of things fall through my cracks, ’cause I got a lot of stuff going on. But maybe to some degree, I was also influenced by the popular narrative that this was a fringe or conspiracy theory, not to even be entertained, don’t even take that seriously. And I think what happened as a result of some powerful voices doing two things. One, they tied the lab leak hypothesis to Donald J. Trump because Donald J. Trump said that that might be a case. In fact, he said something like he suspected it, and he also went beyond what I think people would, that it was somehow purposeful done solely-

– [Zubin] Intentional.

– [Vinay] To spite him.

– [Zubin] That’s right, that’s right.

– [Vinay] It’s just for me. So I think that’s why he drove a lot of people away from that idea.

– [Zubin] I agree.

– [Vinay] And a lot of people don’t like him for myriad reasons and they wanted to see him lose in the election. And I guess the question was always did we somehow put our disdain for Donald Trump, did that cloud our ability to sort of have an honest appraisal of this hypothesis? And then what happened was, of course, he lost the election a few more months go by. And then we had a couple of really nice articles, Nicholas Wade, very seasoned reporter writing in Medium a beautiful article, very long. And Don McNeil, the fired on New York Times reporter, also ousted under interesting circumstances, he wrote a lengthy article on his blog, both saying that this is something that maybe we ought to entertain. And then of course, Biden instructed the intelligence community to investigate and the Senate said they want to know. And so suddenly, and then Facebook finally lifted their ban. They had had a ban on Facebook.

– [Zubin] Yeah.

– [Vinay] Yeah. They had banned, you couldn’t even talk about this.

– [Zubin] Misinformation.

– [Vinay] It was misinformation even to suggest it might be possible.

– [Zubin] Dings your page yup.

– [Vinay] Now they’ve rescinded that ban so we can talk about it again. So what has happened? Within the course of a year, we have moved from lab leak being a fringe and-

– [Zubin] Dangerous idea.

– [Vinay] Dangerous idea that is false and should not even be considered.

– [Zubin] Correct, ’cause it’s xenophobic and racist.

– [Vinay] Oh, we can talk about that, yeah. That was the allegation, amongst other allegations, xenophobic and racist, and also factually incorrect.

– [Zubin] Factually incorrect.

– [Vinay] Factually incorrect. Demonstrably incorrect.

– [Zubin] Beyond a shadow of a doubt.

– [Vinay] And there’s a consensus among scientists that it’s totally incorrect, so you shouldn’t even talk about it. And if you talk about it you’re gonna be vanquished from Facebook.

– [Zubin] Correct.

– [Vinay] To now we have ongoing investigations, people are talking about it. Some of these news outlets are retroactively changing the headlines from the past, they’re modifying past news stories.

– [Zubin] Really?

– [Vinay] There’s people who’ve been capturing this. So I wrote this article, my article is not to answer the lab leak question because actually I’ll tell you why I’m not interested in answering it. I’m not interested for two reasons. One people say like, “Oh, if you knew it was a lab leak, it would change how you combat future pandemics, versus if you knew it was a wet market.”

– [Zubin] Right.

– [Vinay] And I was like, actually, the answer is simple. The wet market is a vulnerability and we need to clean that up.

– [Zubin] Yeah.

– [Vinay] The lab leak, whether this was a lab leak or not, it is a huge vulnerability and that needs to be cleaned up, and we need to really ask ourselves if some of this research is actually necessary.

– [Zubin] Needs to be done.

– [Vinay] Right, so I don’t know the answer. I’m not a specialist in that type of research, but I think that my understanding in what I’ve read is that they’re not exactly operating under the cleanest principles and they need some reform, whether or not this was due to lab leak in this particular instance. But yet it’s an important question to answer, and I think my real interest is how do we move? How did science get to a place where something that is an open hypothesis became effectively censored.

– [Zubin] Yeah.

– [Vinay] And I want to say one thing about censoring, okay. I see all these people bitching online about how if one person blocked them on Twitter or something like that, they were quote, censored.

– [Zubin] Right.

– [Vinay] That’s not censoring, okay? You’re still free to talk to whatever fools want to listen to you, okay? Censoring is the idea itself is banned on the entire platform, no one can talk about it. It’s not about you. A craftsperson can be thrown out of a dinner party. That’s not censor, no one’s being censored, but censoring would be a taboo on discussing certain topics.

– [Zubin] Correct.

– [Vinay] Okay. Let’s get clear on the definition. This is the censoring event. I mean, it is taboo to talk in the public square, which is Facebook for better or worse, this topic that in retrospect so quickly flipped. It’s a big problem.

– [Zubin] This thing, so there’s so much in this particular story that shines a light on the total fuckery during this pandemic of science and the scientific method and inquiry and debate and openness. So yeah, just asking the question, you were some kind of Donald J. Trump, xenophobic racist, and it didn’t help that I think there were a lot of conspiracy minded people that kind of sprung up around this idea early on saying, “Well, see Fauci and NIH funded this Wuhan lab and the gain-of-function, here’s the evidence,” so there’s a conspiracy to cover up. The minute you start citing conspiracies, you’ve already lost the argument. Just focus on what the possibilities are, right? So that was one piece of it. Then Facebook makes it impossible to talk about, which then codifies it, so even the press won’t talk about it. And then everyone just goes, “Well, the science says it wasn’t a lab leak.” How is that? Then you read later the journal of the Atomic Bulletin scientist guys, really impressive sort of thought process of, “Well, it still could be this, and here’s all the reasons why it could be, and here are the conflicts of interest and here’s what’s going on and here’s why.” Okay, great, wonderful, so now it’s still a possibility. Here’s crazy thing. The original hypothesis of wet market, like, okay the Chinese were caging these animals, bringing them from the wild, eating them, exposing themselves and then destroying the world in the process. How was that less racist than oh, you know, a high end Chinese lab studying complicated stuff had an accident? What the fuck?

– [Vinay] Your point is well taken, and it was made by Glenn Greenwald about a tweet by Apoorva, the New York Times reporter where she said that the idea of lab leak is itself a racist hypothesis. I guess, objectively looking at this question I think trying to figure out the origin of the virus is not a racist pursuit. It’s an objective pursuit wherever that came from, and I certainly don’t understand why one would prima facie consider wet market to be a reasonable and non-racist hypothesis, but a lab leak to be a fundamentally racist hypothesis. I don’t get that, I mean, that doesn’t make sense to me for the reasons you articulated. But I think it’s telling, I mean, in my article I point out this is not the only thing that in the last few months has underwent pendulum swings.

– [Zubin] That’s right.

– [Vinay] Julia Marcus and I in January, we said, if a vaccinated person doesn’t need to wear a mask, within four weeks CDC had said, “You can go hug your grandma,” they had said it earlier. And then now recently in May they went even further with their mask recommendations. So this is an hypothesis, not hypothesis, this is I think, a very reasonable statement of policy, which is once somebody’s been vaccinated, two doses, 14 days after dose two, asymptomatic you can liberalize. You’re no longer a vector of transmission. You can go hug your grandma, take the mask off. That was what we wrote, and we were really pushed hard. And then a few weeks later, everyone’s eating crow. I mean, they were incorrect. They were wrong all along.

– [Zubin] Yup.

– [Vinay] And if I were to articulate one thing that both these issues get at, which is that many people join a pile on, a majority, a group idea without they themselves having interrogated the data primarily. They haven’t gone out there and read the studies. They don’t even know. They may not have even read the article of mine that they think is so wrong.

– [Zubin] That’s right.

– [Vinay] Because people don’t read.

– [Zubin] It’s true. It’s true.

– [Vinay] And what’s the old saying? Social media is the place where people who don’t read books argue with those who write them. And you know what I mean? There’s some truth in that. Some truth to that.

– [Zubin] That’s very true. And actually, that’s actually a great point, so here’s an interesting thing. I recently was on a podcast. I hardly do outside podcasts. I think I’ve done yours ’cause I love you and your podcast is amazing. I did MiKhaila Peterson’s podcast. So MiKhaila is the daughter of Jordan Peterson. And she’s been sort of doing this podcast where she gets these really diverse ideas on. And she’s got, this is the thing with her, this is how I found her, right? I mean, meaning when we met virtually. She’s open, she’s willing to be questioned. She wants to have diverse opinions on the show. She has strong beliefs, but she’s willing to actually examine them. And her sort of whole life status comes from growing up with chronic juvenile rheumatoid arthritis, having like ankle replacement, hip, like terrible stuff happened to her, right? Then terrible stuff happened to her dad, and all of this is kind of like radicalized her around this idea that, “Hey, maybe doctors aren’t the best people for treating disease,” you know? And maybe there’s other things. So, okay. I get it. I often say that myself, right? Our medical culture’s fucked up, but you don’t want to throw out the baby with the bath water. So she was kind enough to reach out and say, “Hey, let’s talk about all the things.” So we did, we had a really nuanced conversation that was great, and she was inquisitive. We went back and forth. We talked about all the things. She puts it out, and it’s clear that a lot of the people who follow her are kind of radicalized in one way or another. All they see is that the bald guy who was taking a shit on Geert Vanden Bossche-

– [Vinay] Oh yes, that’s you.

– [Zubin] Is like on her show. So now it’s like, “Oh no, this bald shill can suck it.” You know? And so all the comments are about how much I suck. No one even watched the video. So they don’t even watch video anymore. It’s just pure tribalism.

– [Vinay] I find it, I don’t even know what to say about it because I can tell sometimes that people haven’t read things or watched things or know things, and I find it troublesome.

– [Zubin] It’s troublesome.

– [Vinay] Tough to argue. Tough to argue with somebody, who doesn’t want to read. I don’t know, I guess I’m from a certain school of academic thought which is, if you disagree with something, you gotta read it. Then you gotta actually be able to put it in your own words. And then what you want to do is you want to say it back to the person better than they ever said it. That’s how you really show ’em. You say, “You have written this article and here’s what you said, and let me do you a favor. You took 3000 words to say it. I’ll say it in 450 words.” Boom, you summarize it better than they said it, and then you say, “There’s three things wrong with it and these are the three things, take it apart.” But you don’t see that online.

– [Zubin] You never see it. You talked about it in your class yesterday.

– [Vinay] I did.

– [Zubin] You’re like, “Here’s how you learn to communicate. Take an article that you don’t know anything about, read the whole article,” and-

– [Vinay] Hey, you got to pay money for that! No, no, no. You got to pay money to take this class if you wanna learn that.

– [Zubin] That’s behind a paywall.

– [Vinay] That’s behind a paywall.

– [Zubin] That’s a piece of Vinay’s 12 rules for life. Rule one, take other people’s papers and summarize them better than they can and that way then when you take it apart at least you know their position and they know you know their position.

– [Vinay] Yes.

– [Zubin] Right?

– [Vinay] And if you don’t if you don’t faithfully recapitulate what someone else has said you’re not engaging in any fruitful debate.

– [Zubin] That’s right. That’s right.

– [Vinay] And actually, the way I like to say it is, it should be a dinner party. Like you should be able to read a paper, and if we were having dinner and you asked me, “Hey, what did that paper show on optimism and longevity last week?” I should be able to rattle off in 30 seconds, 45 seconds, what they showed and why they were doing it, that kind of thing. I think that’s the gold standard for like you really understand it so well that you can package it and put it out at a dinner party where the other person might be, you might be an attorney, you don’t have any medical background. I think that’s a good practice. But anyway, with one last thing I want to say about this lab leak. There’s democracy and there’s liberty. I think people forget the two things. So what is liberty? Liberty is the freedom to live your life as you see fit, the freedom to have broad ideas. That’s what liberalism means, classical liberalism. The freedom to engage in different ideas. You love who you want to love. You live as you want to live. And as long as it doesn’t affect me, so have at it. And democracy is the will of the majority. And we live in a world where democracy and liberalism have been largely conjoined. This is a democratic country and we’ve enjoyed a lot of freedoms, but there’s nothing inherent about democracy that guarantees Liberty.

– [Zubin] Liberty.

– [Vinay] There are many democracies that the majority can become tyrannical and suppress-

– [Zubin] India, yeah.

– [Vinay] Suppress the view of the minority. And to some degree, India does fit in many respects, especially with the Hindu nationalism. I say that as a Hindu. And you don’t have to have democracy to have liberalism. There are many autocracies that have been quite free and quite liberal. And sometimes autocracies are replaced by democracies, which extinguish liberalism in certain parts of the world. I guess what I want to talk about is there’s a scientific democracy and a scientific liberalism and we increasingly focus on scientific consensus. What’s the consensus? Most scientists believe, you saw these surveys in the New York Times, most scientists believe, epidemiologist believed, that after you get your mail you have to leave it on the doorstep for five days before your could open it. I don’t know. That’s what it was.

– [Zubin] Whatever it is. Four out of five dentists concur, right, yeah.

– [Vinay] That’s a consensus view. One of the things to acknowledge in the consensus view is that perhaps even most of the people in the consensus view have not interrogated the information themselves. They’re relying on their peers. They’re engaging in tribalism.

– [Zubin] Group think.

– [Vinay] Group think, all these sorts of phenomenon, and then there’s scientific liberalism, which is the idea that, you know what? Francois Balloux may be open-minded about lab leak as a hypothesis. He’s a very good scientist, so maybe we ought to give him the freedom to examine this hypothesis, talk openly about it, and not restrict anyone’s speech until we know for certain. And even then, even when we know for certain, let the facts persuade rather than the brute force of the platform. And I think what we have forgotten is majoritarianism in science has reached a fever pitch. If the majority thinks something’s right, they can have whatever they want. And the minority view is no longer allowed to flourish, we want to squash it out like a bug with our thumb. And so I think we forgotten scientific liberalism. It’s even more important, I hate to say, than even scientific consensus or democracy.

– [Zubin] That distinction is crucial. I think a lot of people don’t understand that they conflate the two, and in this case it’s very important. So that’s why when you think about somebody like a Pierre Kory or a Geert Vanden Bossche, it’s kind of like, okay, at no time would we advocate that they be silenced ever, not by Facebook, not by YouTube, no, debate them. They are a minority opinion. In the case of Vanden Bossche it’s almost a fringe idea that these vaccines could actually harm us because of evolutionary theory and the fact that we’re going to select mutants and all that. Okay, fine, let’s hear that. Then let’s look at the data and let’s think about it and let’s see how we would test it and okay, great. Now the problem is sometimes you get a false equivalency so some kook can come out and say, but 5G nanobots from the aluminum in these vaccines, look at the magnet sticking to my arm. Okay, that’s crazy talk, but let’s examine it. Okay, it’s crazy talk. So then you have to dismiss it. Sometimes though the mob can happen on both sides. So you have a mainstream mob, close the schools, stay home, wear a mask, all that. Now look, some of that stuff may work. We don’t know yet because we haven’t done the cluster randomized trials, but the fringe in that case is saying schools don’t actually spread the disease and you’re damaging kids, and the collateral damage is terrible. Now when the pendulum swings, which it will on schools, it will undoubtedly, I think, this is again, belief based, but also data-based.

– [Vinay] I think it will too.

– [Zubin] We’re gonna look back and go, “Oh, we probably should have entertained the fringe on that one before we did all this damage.”

– [Vinay] Yeah, I mean, I think you’re drawing a very interesting distinction between, you know, because I think like lab leak is something that reasonable scientists could have been wholly agnostic about, whereas whatever this Geert, whatever his name is, it sounds like what he’s saying is absolutely ridiculous and bonkers. And I guess the question I have is many well-intentioned people want to rid the world of clearly delusional thinking such as this 5G, whatever or there’s microchips in vaccines, et cetera

– [Zubin] Christiane Northrup, yeah. She’s a doctor who’s pushing this nonsense.

– [Vinay] And I think these well-intentioned people have tried many different strategies from explanation why that’s wrong, making fun of them on social media, mocking them, piling up on them, petitioning that they be banned or censored. I mean, these have all been tried. And I guess the truth is I actually think, just as an empirical question, I actually don’t know what works. And, in fact, if anything, some of these fringe views they have arisen in popularity, despite all these efforts. Even a lot of anti-vax views, which I strongly disagree with, they’ve risen in popularity. So at some point, those who seek to combat these views need to actually ask themselves what will do that. And it may not be all the tactics that have been tried, it may be, but they need to find a way to sort of clarify the impact of these tactics.

– [Zubin] Yeah, I think you’re right. I think in many ways pushing the resistance to these things in a blunt way actually makes them worse. And it’s funny the anti-vaxxers actually created a change.org petition. We are petitioning to have Dr. Zubin Damania’s license removed for murdering babies or whatever it was, right? And they got like-

– [Vinay] How’d they know you did that? Yeah, well, you know, no proof, no proof, I haven’t been caught yet. And they got a few hundred signatures and all the comments were like, “He’s a shill and he’s bald, and the usual ad homonyms.” And so I just was like, “Hey, look guys they want to remove my license by petition, which I didn’t know was a thing, go and sign the petition.” So I had all my followers, so suddenly it got like 10,000 signatures and all the comments were like, “Yeah, I love this guy, man. Totally take his license away, so he can say the real shit right now.” And so, these things backfire, these aren’t the ways to have debate.

– [Vinay] And then I’ll make a point on the other side, which will relate to one of the things we want to talk about which is people who support vaccinations, as of course I do. In fact, I tell people I’ve probably given more vaccines than you because I took care of a lot of people post-autologous stem cell transplant where we re-vaccinate them like a newborn baby.

– [Zubin] Exactly.

– [Vinay] We give ’em a lot of vaccines. So anyway, I’m quite familiar-

– [Zubin] ‘Cause their immune system’s wiped out and you have to refresh it from scratch, right?

– [Vinay] That’s what they say. Yes. That’s what we tell ’em.

– [Zubin] That’s the principle, yeah.

– [Vinay] That’s the principle, we had, yeah. Yeah, that they need reeducation of their T and B cells. Okay, so you know, and of course I’m a practicing physician, of course, so I have a very nuanced view of vaccines. I talk about vaccines the way you talk about drugs, which is that, you need to think about the risk benefit profile, may vary with other things. And we’re gonna talk about EUA and younger people. So the people who are proponents of vaccines, of which I will put myself in that camp, some of those people were quick to comment about our article published in the British Medical Journal that this is quote, an anti-vax article in an anti-vax journal. And I was like, if-

– [Zubin] BMJ? Yeah, the British Medical Journal, right, basically. I was like, the journal that probably only rejected your article? No.

– [Zubin] That’s right. No, I’m sorry. It was The Lancet that was the anti-vax journal. They’re the one who posted Andrew Wakefield’s fraudulent study.

– [Vinay] Yeah, that’s an interesting story. I mean, people go back to that, and I think that if you go back to the original Wakefield paper, you will find that it was never scientifically meritorious. It was always a very terrible anecdotal case report, garbage, non conclusive, no causality kind of paper. I’m surprised they published in the first place. Someday maybe somebody will find some more information about that because I hear the peer review burnt up in a fire, actually.

– [Zubin] Brian Deer wrote a whole book about it, actually. Yeah, I haven’t read it yet. Oh, I read part, I’ve read a large part of it, but I haven’t done a show on it, yeah.

– [Vinay] He did a great couple of series of articles for the BMJ unpacking the problems with that paper.

– [Zubin] That’s right, yeah.

– [Vinay] But I guess we wrote an article about emergency use authorization, whether or not this ought to be the regulatory pathway for 12 to 15 year olds, in the British Medical Journal. And this is myself, Stef Baral from Hopkins and Wes Pegden, who’s a mathematician at Carnegie Mellon who’s done some modeling around SARS-CoV-2.

– [Zubin] Loser institutions, all three of ’em.

– [Vinay] Losers, yeah, total losers. Yeah.

– [Zubin] Yeah.

– [Vinay] And many people, they said that we were anti-vax. And I guess what I wish to suggest to them is, they may disagree with our conclusion, I think we’re right, of course, I know we are, but if you are gonna try to throw us in the bucket with these people who are saying microchips in vaccines, what are you doing? You’re playing a very dangerous game because what you’re doing is you’re equating any sophisticated scientific consideration of the pros and cons of vaccines with the most fringe, delusional, derogatory ideas out there and you will make this group stronger. You don’t know what you’re doing, and I think many well-intentioned people here are coming in and they are actually making this fringe element stronger through vehemence, through drawing lines where they don’t understand, and I think they, frankly, they don’t know what the fuck they’re talking about.

– [Zubin] Yeah, I fuckin’ agree a hundred percent. It’s guilt by association logical fallacy. It’s, you and I had the same stance on the kid’s vaccine, right? The 12 to 15 is basically like, Hey, look at the risks, look at the benefits, look at the dangers of transmission in this group, look at the dangers of MIS-C and actual illness, look at any unmanifest complications, Like we’re thinking about, “Well, is this myocarditis thing a real link with the vaccine, we don’t quite know yet, and then what’s the risk of them actually getting sick?” And I think one interesting thing is I think you have a lot of pediatricians and the like pushing back and saying, “Well, but we see MIS-C and it’s devastating, and you don’t understand, these kids actually do get sick.” And then I’m like, “What about availability bias?”

– [Vinay] Yes, of course.

– [Zubin] That’s what you see here.

– [Vinay] It’s, I think, when I worked in the pheochromocytoma clinic we always wondered why the internists didn’t scream, “Why didn’t they figure out this was PHEO, it’s high blood pressure, they never thought about pheochromocytoma!” I was like, “You know, you’re working at the referral center for PHEO.” Okay, but I’ll add one caveat.

– [Zubin] The zebra clinic.

– [Vinay] Some pediatricians say what you say, many I agree with-

– [Zubin] Yeah, many, many, many.

– [Vinay] So let me articulate-

– [Zubin] And they’re quiet.

– [Vinay] Oh, some are quiet.

– [Zubin] They’re terrified to say stuff, some aren’t, some aren’t.

– [Vinay] Some aren’t, but they fill my inbox. Yeah, me too. Thank you for saying this.

– [Vinay] Yeah.

– [Zubin] Yeah.

– [Vinay] But let me articulate this problem here. Okay, so what is emergency use authorization? It’s not drug approval. After we did the trials in 16 and up there was a new regulatory strategy pursued for 12 to 15 that was you’re gonna run a small randomized controlled trial, just 1100 people in each arm, very small randomized control trial, but you’re going to do a few things with it. One, we will have already gathered safety data on near-aged people. So 16, 17, 18, those are near age. We’re gonna be having some surveillance data on those people, which will help inform our regulatory decision. You’re gonna run a small randomized controlled trial powered primarily for immunologic end points, not for clinical end points because it’s a small study, and we’re gonna leverage the combined experience of the safety of the vaccine in adults and even near aged kids, the adolescents 16, 18 people who got it, plus small randomized controlled trial immunologic end points, and that will be your path to approval or authorization. The regulatory language around authorization, not approval, is that it has to be an emergency. Now different people can have different definitions of emergency, but as we articulated in the piece, there’s lots of reasons why you would say SARS-CoV-2, older people, absolutely, undeniably an emergency, SARS-CoV-2 in this age group, very hard to convince me that it’s an emergency requiring unprecedented powers of regulation on a lower regulatory hurdle. The other thing is, whenever you think about a vaccine being approved, there’s the known benefits, the known harms, the unknown benefits and the unknown harms. And you need to look at this calculus and say, roughly, even if the unknown benefits or unknown harms are as high as they could be, there’s still gonna be a net benefit from vaccinating people. And I have a little video, I have some slides, I walk people through. When you talk about a 50 year old person, the consequences of SARS-CoV-2, even with low rates of spread because the death rate is so high, are so catastrophic that this equation just tips. And so you’re willing to take substantive uncertainty for harms to have a vaccine quickly. As you’re debuting a vaccine from 16 to 50 the rate in the population is plummeting. Look at Israel, look at the United Kingdom, look at us. So now the balance for 12 to 15 is shifting by the day. Every day a twelve-year-old, their chance of getting SARS-CoV-2 is reduced simply by vaccinating older people.

– [Zubin] Yup.

– [Vinay] Okay. The uncertainty bounds around the harms are real, they’re non-trivial, and we knew as of late April that there was the potential for myocarditis. There was a report out of Israel. There was the, Reuters broke it, I think at the end of April, Wes, Stef and I had been following, and we felt for two reasons. One, if you switch from EUA to biological licensing agreement, BLA, you will get four more months of time. In those four months of time, that’s the regulatory distinction, there could have also been other regulatory distinctions. The FDA chose not to do that. They could have asked for different sized trial, et cetera, et cetera, be that as it may, this is the regulatory distinction at the moment. In that four months, the vaccine adverse event reporting system will have four additional months to gather safety data and to calculate whether or not myocarditis has implicated mRNA vaccines. How much of it is implicated, and whether or not that potential unknown harm is big enough to offset the benefit in this age group. So, anyway, I think, I mean, there’s two points here. One point is I want to make the point, which is that like for any parent who’s made this choice with their child individually, we support your choices. Of course, you know?

– [Zubin] Right.

– [Vinay] Our argument is about the regulatory precedent for authorizing a vaccine in a vulnerable age group and what might happen thereafter because we’re gonna go to five to 12 or four to 12 or even younger. And what we want to say is you’ve got to be damn sure when you get to this age group that the safety profile is really really pristine because the potential benefits to this age group is very, very low. And that’s not just my view, that’s the view of Cody Meissner who’s the chair of Peds ID at Tufts and on the FDA Advisory Committee. That’s the view of Walid Gellad, who’s at Pitt, that’s a view of a lot of people who actually study regulatory policy. But what we were so quickly caricaturized online as is you all don’t want a kid’s vaccine ever. Well, we never said that, no, we’re saying that we don’t want you to use an unprecedented authorization pathway when you could collect more safety data. And two, we’re empiricists. You’d show us a risk benefit profile that’s favorable, you got our total buy-in. I mean, I’ve never withheld buy-in from things that are clearly favorable, but when you talk about uncertainty bounds that exceed benefit, well, I gotta rock in my shoe.

– [Zubin] Yes, and here’s another thing that we were saying is, well, there’s this societal argument about the sort of communitive benefits of vaccines. If we vaccinate this little cesspool population of kids will help protect older people, shut up dude, vaccinate the older people.

– [Vinay] Okay.

– [Zubin] Come on!

– [Vinay] So I guess-

– [Zubin] You’re gonna put kids in that bar of uncertainty to protect an old fucker-

– [Vinay] Who chose not to-

– [Zubin] Who chose not to get vaccinated, fuck off!

– [Vinay] I will say, so there’s a few things. So one is the ethical principle you’re articulating, which is it even ethically just to ask kids, yet an additional sacrifice for these kids, who’ve given up school for a whole fuckin’ year to sate your adult anxieties, is it even ethical? So that’s your question.

– [Zubin] Yeah.

– [Vinay] I’ll ask a few things, a second question. Is it even empirically true? Does it actually, will this actually translate? There’s speculation that it might, but there’s no empirical data that supports that to be the case. We’re all the people who say, “Have you proven it’s safe for me to take off the mask?” Where did those people go? The next thing I’d say is, is this within the legal statutory authority of emergency use authorization? As far as I checked, I don’t believe the emergency use authorization pathway allows you to debut a product with uncertain risk benefit profile in some group to protect another group. I think it’s to protect that group. I think it’s a misinterpretation of law and regulatory statutes, so I think that’s the other thing to say. And then the last thing I’d say is, I mean, the simple point is that I don’t think it’s even true. I mean, I just don’t think it’s empirically true. What you see right now is the unvaccinated 60 year-old right now is already being massively protected by all the people who’ve chosen to be vaccinated. Look at the population case rates, look at test positivity, we’re three tenths of 1% in this city of San Francisco. So they’re already getting protection. Do they need an additional protection from a twelve-year-old? I don’t know. And does it warrant a twelve-year-old taking potential risk for myocarditis? I don’t know, but that’s certainly, I certainly don’t think it’s for sure. I have strong doubts that it’s even true. There is no data that is persuasive. I think you can do some back of the envelope math and show what’s unpersuasive. And I think people who are doing it, they may not be following the statute of the law, and I think they have to ask themselves, honest question, are you saying this just ’cause you’re scared, man?

– [Zubin] Yeah.

– [Vinay] Are you saying it just ’cause you’re scared because you know what? People, even vaccinated people are proving that they are scared. How are they proving that? One, there’s a survey in the last two weeks that said among the people going back to restaurants and shops, there’s a higher fraction of unvaccinated than vaccinated. The vaccinated people are still reluctant to do it.

– [Zubin] Are still scared. Yeah.

– [Vinay] They’re still walkin’ around this city with their mask on outside. And you know, and then they’d say things like, “Well, what does it bother you that I’m wearing my mask on outside?” I say to be honest, “I’m not bothered by it. I’m just trying to say it out of concern for you. I want you to be,” like, I don’t know, I’m not like if you said that you I won’t use my analogy.

– [Zubin] Well, actually on that point, so I’ve had people reach out and say, “Look, I know that you think we can take the masks off and the vaccination out. My whole family’s vaccinated, but I have to medically vulnerable kids, I’m older, I know the vaccines aren’t perfect. I feel more comfortable wearing the mask for the time being would you not shame me?” And I’m like, “I wouldn’t. I wouldn’t shame you.

– [Vinay] Yeah, I wouldn’t shame you. Of course not.

– [Zubin] Not at all. It’s just, if you’re telling me that I should wear a mask to make you comfortable. Well, now you’re starting to impinge on, I think, my understanding of the science, but also my own freedom to do stuff outside.

– [Vinay] And I think to be fair, I mean, so this is another argument people make which is that, well, we need the mask mandates because there’s that person out there who’s B-cell depleted because of rituximab. And I’m like, “Look, I have deep sympathy for that person. They’re my clinic patient for God’s sakes. I’m the one giving the rituximab, that’s what I do.” But what I would say is that we, as a society, we’re always balancing restriction and freedom. And I think we have concluded that throughout the last 20 years where there have been immunocompromised people that the rest of society hasn’t forgone, we haven’t all worn masks all this time. We haven’t all never handshaked all this time and these kinds of things. And so I think there is a balance between individual, the freedom for many people and vulnerable people. But the other sort of asterisk I’d add is, many people say I have a vulnerable X. But in their mind they’re relying on the vulnerabilities that are related to other infections, but not necessarily SARS-CoV-2, right? So then I’m like why exactly is this person vulnerable? And they tell me the reason, and I say, “Well, you know, that’s actually not known to be a particular vulnerability for this virus. It’s a vulnerability for other things, but not this virus.” So I think that that’s part of the fallacy too. And then we just have to acknowledge that there’s some general anxiety.

– [Zubin] Yeah, we’ve conditioned it.

– [Vinay] Yeah, we’ve conditioned it. People aren’t, they’re not, they’re emotionally in a rocky place, and the rockier you are the more you’re on Twitter, so it’s like selecting for the rockiest too.

– [Zubin] Yeah, I mean, look, I chose with my daughter, 13-year-old-

– [Vinay] Yeah, I saw that

– [Zubin] To get her vaccinated very quickly, and the reason was partially, there’s still that sort of feeling that, but if she gets coronavirus, first of all, she’s gonna be out of school. Second of all, she’s gonna have to quarantine. Third of all, we’re gonna have to go through all the testing rigmarole. Fourth of all, there’s a very small chance she could get very sick and have something unusual, very small. Now, what are the risks, benefits of the vaccine for us? Well, let’s see both me and my wife did fine, so just looking at our genetics we’re probably okay, but you never know, she’s young, we don’t know. We don’t know what we don’t know, but I think she’s a pretty tough girl. She wants to do it. She wants to go with her friends who are also vaccinated because their parents have very high sphincter tone and she wants to be able to play with them without masks, and her parents won’t allow it unless the kid is vaccinated.

– [Vinay] Really? Yes, yes.

– [Zubin] So there are these social considerations, whether you agree with them or not. And so for all those reasons, we said, “Okay, let’s go.” And so these decisions are nuanced. They’re complicated. They’re personal.

– [Zubin] Well, shouldn’t you get a prize because, as you’ve articulated, you’ve just listened to me make my case for why I felt like this authorization pathway was not warranted.

– [Zubin] Right.

– [Vinay] You heard me, you agreed with me. Simultaneously, you and your life have made a decision that is not congruent with my standpoint.

– [Zubin] Correct.

– [Vinay] And you can hold all these things together, and afterwards we’re gonna be friends, we’ll get lunch some day, right?

– [Zubin] Heaven forbid

– [Vinay] Heaven forbid.

– [Zubin] And not only that, but see the key thing there is there’s not a cognitive dissonance involved.

– [Vinay] No, there’s not, it’s not. No, no, no.

– [Zubin] Yeah, it’s not like, “Oh, I hear you, and I agree and I said the same thing publicly, but and yes and, so this.” And that’s why I think like, I think this whole idea of like, we’re out there shaming each other about these decisions. It’s like, everybody’s got their reasons. You may not agree with the reasons, but we can have the discussion and still be buddies.

– [Vinay] I want to hit on that point, that’s so important, which is that when people debate the regulatory pathway for something and what people do once it’s approved or authorized, they’re very different questions. I have said many drugs, many cancer drugs ought not to be approved, the data’s not sufficient for approval. Once approved, I’m givin’ it. I’m not givin’ it to everybody. But what I’m saying is that like, these are different hats you wear. You wear a policy hat, you were an individual, I guess in your case, father hat.

– [Zubin] Right.

– [Vinay] You wear a doctor hat. These are different hats, they’re different ways you make decisions under uncertainty. Your decision I think is entirely reasonable. You’ve articulated some things, but I still think that it was wrong to have the EUA. I think those are not contradictory points of view.

– [Zubin] Absolutely.

– [Vinay] Yeah.

– [Zubin] That’s fascinating, what you just said. People accuse people who make decisions like what I just described as having no integrity, having no cohesion.

– [Vinay] They don’t understand.

– [Zubin] They don’t understand the opposite is true. For example, I agree with you about EUA. If I could have stopped a EUA from happening I would have actually done-

– [Vinay] Exactly.

– [Zubin] I would work to do that, and then I would have been fine with my kid not being vaccinated. Correct, it would’ve taken away the choice.

– [Zubin] Exactly.

– [Vinay] And honestly, it may have also made, on the fringe, there will be some summer camps right now putting pressure on 12 to 15 year olds to get the vaccine, right.

– [Zubin] To get vaccinated.

– [Vinay] And they will not be able to in the absence of the EUA.

– [Zubin] Correct.

– [Vinay] And so some of the social dynamics would change. Maybe the parents who are, as you say, sphincter tone is high. I can imagine it is.

– [Zubin] Yes. Maybe those parents, what will happen is, that their sphincter tone may finally relax when they see the summer comes and the case positivity goes to near zero. And so they might finally let your daughter go over.

– [Zubin] It’s happening, yeah.

– [Vinay] So I guess these are totally different spheres. The sphere where we live our lives individually, and the sphere of policy. I guess the last thing I’d say is, I don’t know, I guess I sometimes read what people, I mean, I don’t know how to put it politely, but there’s some people don’t know what the fuck they’re talking about. And that’s the bottom. They don’t know what the they’re talking about, and they keep talking to me and I’m like, “Dude.” I was like, “I’ve been in regulatory policy for 10 years. We published almost, we’re gonna be 300 papers, we’ll be passing it within the calendar year on these types of questions. You have never thought about this in your fuckin’ whole life, you’re shooting from the hip. You’re anxious, afraid, have all this stuff going on and you’re making a fool of yourself.” I’m like.

– [Zubin] Oh man.

– [Vinay] You’re losing it. And the reason I think it really matters, more than all these things, so why is this an issue that I’m actually gonna put my nickel down on? Like, why do I even care? I’m a cancer doctor, I should be going back to my cancer work, which I am going to soon. I’ll tell you about that season four plenary session. It’s called #zeroCOVID, no COVID.

– [Zubin] I love it!

– [Vinay] We’re done! Zero COVID!

– [Zubin] I love it! Yes! Fuck COVID.

– [Vinay] We’re launching next week. Okay, but why I’m putting my nickel down here is that people don’t realize that there are all the usual concerns around vaccines and then there’s this existential question, which is the public has a faith that the regulatory processes around vaccination are very, very stringent. We saw with J&J and VITT that there can be unanticipated safety effects that are catastrophic. VITT is a very unusual symptom. It’s a constellation of things that don’t normally occur together, quick. It’ll be picked up at a certain frequency very quickly in safety databases. Myocarditis is an everyday occurrence. It happens with some frequency. Finding it elevated, even twofold, threefold, fourfold it’s gonna be quite difficult. If there is, God forbid, but if there is an unanticipated safety signal at a young age and you went ahead and pushed EUA in a very vulnerable age group that had very little to benefit and there’s a safety signal so catastrophic it thwarts the overall risk benefit profile in that age group, you will have an existential vaccine crisis. All the crazies with their 5G and nanobots or whatever the fuck they’re talking about-

– [Zubin] Are empowered.

– [Vinay] They’re gonna be empowered, and a lot of people who are hesitant may even be more hesitant. You will have a crisis like you don’t fuckin’ understand and so you need to be really damn sure when you go to kids that the risk benefit profile is going to be favorable no matter what comes out that you don’t see. And that is literally what people don’t understand about this space. It is a space you want somebody who knows what they’re talking about in the studies these days.

– [Zubin] So that that’s the counter to, “Oh, you’re an anti-vaxxer, Vinay.” It’s like, no, I actually care so deeply about vaccines-

– [Vinay] I know.

– [Zubin] That I don’t want them ruined by a stupid decision.

– [Vinay] Yes.

– [Zubin] Right?

– [Vinay] Yes.

– [Zubin] That doesn’t look-

– [Vinay] A decision made out of anxiety.

– [Zubin] Made out of anxiety.

– [Vinay] Made out of anxiety.

– [Zubin] Made out of emotion, and made out a profit for Pfizer, and made out, I mean, all these different. Now, I’m not saying that’s the prime driver.

– [Vinay] Sure. I gathered-

– [Zubin] Right? Because then you’re speaking in conspiracy language. I’m saying there’s no dismotivation for Pfizer to really push this.

– [Vinay] I guess the companies will generally push their products, yes.

– [Zubin] Sure.

– [Vinay] In this case, I think they’ll probably make so little off this compared to their usual bamboozling cancer drugs. Right, right, right, right.

– [Vinay] Right? I mean, they’ll find a new way to slip.

– [Zubin] But what about the 20 boosters that?

– [Vinay] Well, okay. That’s a different question. Will we require a yearly booster? I tweeted something that says, “In my mind, if you want to persuade me that a yearly booster is warranted you’re going to need a randomized trial in adults showing that if I get a yearly booster, I’m less likely to be severely ill with COVID, hospitalized with COVID or die of COVID.

– [Zubin] Right.

– [Vinay] If you show me that, I’m getting a booster-

– [Zubin] I’m gettin’ booster.

– [Vinay] Every year.

– [Zubin] Yup.

– [Vinay] If you show me a randomized controlled trial that says after I get a booster, I’m less likely to get a nasal swab positive PCR cycle 42 hit of SARS-CoV-2, after you phoned me every week and asked me, ’cause oh, one thing, many of these randomized control trials use they call the patients to elicit symptoms and refer them for-

– [Zubin] Are you sure? you don’t have-

– [Vinay] Correct.

– [Zubin] A little itchy nares, right.

– [Vinay] And this is sort of an artifact, which is you’re gonna pick up very subclinical disease, the kind of thing that doesn’t really bother me.

– [Zubin] The 10 particles, yeah.

– [Vinay] Yeah, right the 10 part, yeah. You’re gonna pick up-

– [Zubin] That Marty talked about on my show, yeah.

– [Vinay] Yeah, so I think the question is if that is their end point of their study, then maybe I’m not sold on getting a yearly booster. But if the end point of the study is something hard, clinical, meaningful, I am.

– [Zubin] Yeah, I agree.

– [Vinay] And I actually think if I put my nickel down, I think, should I say it?

– [Zubin] Say it!

– [Vinay] I guess I think that if they did that randomized control trial they would probably be negative. I don’t think that, I think that the first shot will be so good. The first, our vaccination that we’ve already gotten, that will be so good, that’ll be unlikely a yearly booster, even with they keep chanting variants and variants and variants. Even that chance, I doubt it will actually decrease these end points, but I’m happy to be proven wrong.

– [Zubin] My intuition is exactly the same. And again, I call it intuition ’cause that’s what it is. And I think that these are such, especially the mRNA vaccines are so fucking immunogenic.

– [Vinay] Yes, exactly. You so many different antibodies and all the parts that they have.

– [Zubin] Absolutely. I mean, there’s nothing that that virus could do without wrecking its own ability to do shit.

– [Vinay] Interesting.

– [Zubin] That within the mutational parameters that’s gonna evade this thing in the near future, I think. Now again, I’m unhappy to be proven wrong on this one because-

– [Vinay] I’m happy to be proven. Monica thinks the same thing about it.

– [Zubin] Monica thinks the same thing.

– [Vinay] A lot of people think it.

– [Zubin] I think Marty thinks the same thing. Marty’s a big fan of natural immunity. He’s like, why are we fuckin’ ignoring this?

– [Vinay] Yeah, I think someday we’ll revisit this Marty question because I feel like he was a bit unfairly treated.

– [Zubin] Oh yes.

– [Vinay] You wanna talk about unfairly treated, the lab leak people, they were unfairly treated. They were banned from Facebook. Marty was a little unfairly treated, and we’re gonna revisit that in the future.

– [Zubin] I love it.

– [Vinay] When people are calm.

– [Zubin] I feel like we’re like the opposition in some great struggle, even though we’re not because we’re saying, “Hey, alt-middle, like it’s all these things are a little true, but partial.” But I would love to see heads roll for terrible decisions that have hurt our kids, for censoring really smart people that are well-intentioned, for vilifying people as bad for doing good science, these kinds of things.

– [Vinay] You know I wonder, I don’t know, I’m working on something. I wonder if people will heed the lesson, but I think the answer is rather disappointingly, no. There’s that old joke, like first they laugh at you, then they yell at you, and then they act like they knew it all along.

– [Zubin] Yeah.

– [Vinay] And I think we’ve seen a lot of that. So people say, “Oh, you know? Oh, I never said that. I knew it all along.”

– [Zubin] And going to go through the Twitter stream.

– [Vinay] What about the emails?

– [Zubin] I haven’t looked at them.

– [Vinay] I guess they’ve been FOIA requested, 3000 pages, and different people are putting out different things. What have I seen? I’ve seen that there’s an early email, I guess I’ll say one thing, I’ve only seen like some of the screenshots, and I scrolled through a little bit, but I mean 3000 pages come on, I got to go to bed. I can’t be up all night reading Fauci’s emails. One, I feel a little bit bad. I mean, I dunno, I feel bad anytime somebody’s emails are-

– [Zubin] Publicly released.

– [Vinay] Publicly released. But that said, government employees, it’s a requirement. I mean, it is a possibility of the job.

– [Zubin] Right.

– [Vinay] The next thing I would say is, I guess, a couple of emails that jumped out were emails where I think he told somebody taking care of a SARS-CoV-2 patient, “Make sure you wear an N95 mask,” early on in the pandemic, which would suggest that when you’re around someone with SARS-CoV-2 they do believe it’s aerosol, and I think that was always right. The whole mask debate, maybe like, they wanted everyone to wear a fabric mask at all times. But maybe the right answer we will find out someday was the guy who’s working in the kitchen, guy or girl working in the kitchen as a cook and line cook, maybe they need N95 when they’re working in close proximity, and maybe the people outside don’t need anything. Actually, that’s probably true, right?

– [Zubin] That’s probably true.

– [Vinay] So the truth about it is, instead of this one size fits all, let’s create “I voted for Biden” badge. Another one. Isn’t that what it was?

– [Zubin] No, that’s only, if you have three masks on, then you voted for Biden. If you have two, you were an independent.

– [Vinay] Two you’re independent?

– [Zubin] If you have one, you were kind of like, meh, you just abstained, and if you have none you voted for trump.

– [Vinay] If you have a camo handkerchief or one of those with the valve or none at all then you voted for Trump.

– [Zubin] Or just mesh. Some people just wear panties over their face.

– [Vinay] Or you cut the hole so you have the straw coming through.

– [Zubin] Totally.

– [Vinay] Okay, so I mean, one was this N95. The next thing was, there was an email from early in March where someone asked him what he thought about community mask use. And he said something very similar to what he said in that early March “60 Minutes” episode where he thought it did not confer benefit. I think that’s gonna be a tough email because the mantra now is that was a noble lie. I lied in March to prevent you from making a run on N95 masks.

– [Zubin] Right.

– [Vinay] In retrospect, what might be the case is that the second April might be the noble lie and the early statement might be representative of what he truly believed at the time. And I think we have a huge systematic review and meta-analysis under review, but I think people forget that there are many randomized control trials, clusters trials, around influenza and community mask use. And there’s a lot of data that proceeded that, and the mantra really was the consensus of the WHO and the CDC was in early March, that it was not on average beneficial. It changed a little bit, but I think the thing that changed the most is the precautionary principle rather than any particular data.

– [Zubin] Right.

– [Vinay] So I think that those masks emails will be interesting. And then the last set of emails that will be interesting is emails about what type of research was been done in Wu Han. As people keep saying, it does not have to be gain-of-function research to be lab leak.

– [Zubin] That’s right.

– [Vinay] You could just have a totally normal virus that lab leaks.

– [Zubin] Yeah.

– [Vinay] But you could also be doing gain-of-function research, and the question should be “Why the hell are you doing this gain-of-function research?”

– [Zubin] Right, right, right. What the hell? Right, and why are we funding it? And so on. I mean, and there’s reasons to do it, to try to study how viruses jumped species, become more contagious, and then how you would intervene.

– [Vinay] The best person to tell you why there’s a reason to do it is the person who’s getting the funding. That’s the thing.

– [Zubin] Exactly, exactly! Oh, let me tell you. Let me write my abstract here to get your attention. Exactly. Oh, fuck. Well, so, okay, so one thing I want to ask you before you go. The mask issue, so why, and I’ve done videos on this, influenza RSV disappeared, right? Now, do we think it’s because of lack of travel, closing schools, hand-washing, masks, viral interference, or all of the above?

– [Vinay] Yeah, I guess I would say, I don’t know how anyone can disambiguate it. I’ve seen many people claim that going forward every winter I’m gonna wear the cloth mask because look what happened to flu and colds, they went away.

– [Zubin] Right.

– [Vinay] Okay. What I would say to that is that we’ll see what happens. You can keep doing that, but one of the things that we also did this year, you may recall, we closed a lot of schools and schools weren’t the places that spread COVID but they are places that-

– [Zubin] They do spread flu.

– [Vinay] Cold and flu. The other thing we did was we dramatically shrunk and constrained our social circles, we avoided all international travel. We did a lot of things that, I’ll tell you what, we’re never going to do ever again in my natural life, I suspect not. So we’re going to go back to doing all those things. So you’re going to go do all those things and then you can wear your cloth mask, and we will see what happens to cold and flu. But I guess I’m not persuaded that the cold and flu… Something tells me, if I were to put my nickel down here, I’d say cold and flu, they’re coming back.

– [Zubin] Yeah.

– [Vinay] I think it’s gonna be bad.

– [Zubin] Mask or no? Mask or no.

– [Vinay] Mask or no, I think cold and flu is coming back. I would say mask or no mask. And when cold and flu comes back it’s gonna be, I dread the day I get that cold.

– [Zubin] Oh, it’s gonna suck.

– [Vinay] ‘Cause I’m old now, I can’t recover at all.

– [Zubin] Me too, dude, I get a cold, I’m out with man flu for like a week. and all the anti-vaxxers, ’cause I’ll do a show about it, and be like, “I got man flu.” They’ll be like, “See, it’s the toxins, bro. It’s all those toxins.”

– [Vinay] All the toxins you’re eating?

– [Zubin] Or the virus. Oh yeah, or the virus. I do wonder, I feel like, of all the things people could take away from this. The one thing I wish they did was the culture in medicine of going to work when you’re sick.

– [Zubin] Yeah, it’s gotta change. You need paid leave, you need support. We don’t have it.

– [Vinay] We don’t have it.

– [Zubin] I worked 10 years as a hospitalist, I never took a sick day. What does that say, that I never got sick? No, I never took a sick day.

– [Vinay] A friend in neurosurgery residency training, and they have like only seven residents. And then I said like, I was at least a medicine resident, there was some jeopardy system so that if you were really sick, really sick, you could call someone and they’d be summoned. And I think I had to do that once. And I was unbelievably, I couldn’t, I don’t want to describe to you how I was. It was so bad that you wouldn’t want to even look at me. Okay, but he didn’t have that in this neurosurgery training. And then I said, “So like, what happens if somebody gets sick?” And then they’re like, “Oh, that doesn’t happen.” I was like, “I mean, come on, somebody’s got to get really sick.” And then I was like, “What happens if somebody gets really sick and they just call you in the morning and then don’t show up to work.” And he was like, “You’re saying that they call me up and they say they’re not gonna show up to work?” He’s like, “I tell you what we’re gonna do. We’re gonna get in the car. We’re gonna drive to their house. We’re going to knock on their door, and we’ll grab him by the lapels and drag their ass to work.” Oh!

– [Vinay] And I was like, “Okay.”

– [Zubin] There it is.

– [Vinay] I was like, now I know why.

– [Zubin] That’s the culture.

– [Vinay] That’s the culture.

– [Zubin] That’s the culture.

– [Vinay] And I was like, “Oh, wow, okay.”

– [Zubin] That’s the culture. It’s nuts. I agree. We gotta do that. We gotta change that. We’ve got to change-

– [Vinay] We’ve got to change that culture.

– [Zubin] Policies for people at work who are sick, policy for teachers who are sick, all that other stuff. And we need to just, I was gonna say, if I hear anyone say we need to get back to normal, normal fuckin’ sucked. We need to get back to better.

– [Vinay] Yes. Better.

– [Zubin] Yeah. Better.

– [Vinay] I guess when I hear them say like, I guess there’s there’s two things like, yeah, we want to get back to normal. I think what I mean by that is like a vibrant and jubilant life.

– [Zubin] Yes.

– [Vinay] Yes. We want that.

– [Zubin] Yes.

– [Vinay] What do they call it? The new normal, which sounds to me like a total buzzkill world.

– [Zubin] Oh God, that’s it.

– [Vinay] I’m not into the new normal.

– [Zubin] No.

– [Vinay] I’m into closer to that vibrant, jubilant life. However, some of these terrible policies need to go away, okay?

– [Zubin] Yeah, exactly. Yeah, I’m with you brother Guys!

– [Vinay] Thanks for having me.

– [Zubin] Vinay, ZDogg, share, join the supporter tribe on Locals-

– [Vinay] Two for one gray suits, JCPenney’s.

– [Zubin] Boo-yeah! Montgomery Ward, son.

– [Vinay] Montgomery Ward.

– [Zubin] Honestly, it’s like a ghost organization.

– [Vinay] You know, that’s where I think Jack White got his guitar from-

– [Zubin] He got his first from Montgomery Ward?

– [Vinay] I think it was like one of his plastic guitars that he played on it was a Montgomery Ward guitar.

– [Zubin] Dude, that’s so awesome. Dude, Montgomery Ward was the bomb.

– [Vinay] It was awesome, dude, awesome.

– [Zubin] We had a local version called Gottschalks in the central valley of California. It was like Montgomery Ward light. All of them are closed now. It’s kind of like, “Ugh,” you know? Now you just get it all from Amazon.

– [Vinay] I saw that picture of you when you were young back then.

– [Zubin] With the mullet? Yeah, it was my senior picture. You know what I love is everyone was like, in the comments, they were like, “Z, your skin was so smooth at 18, you had no pimples,” and I’m like, they airbrushed that shit.

– [Vinay] Oh, did they?

– [Zubin] It was senior picture. So you go to a studio, they put you up like with the glamor shot.

– [Vinay] I see. And then some guy’s like .

– [Vinay] I didn’t know that.

– [Zubin] Because there was no digital.

– [Vinay] Somebody tweeted a picture of me from three years ago and I looked at it and I was like, “Who’s that young, man?” I was like, “Fuck.”

– [Zubin] This shit’ll age you. No doubt. It’s like the presidency.

– [Vinay] COVID, no hair cuts. I mean like-

– [Zubin] Oh, man.

– [Vinay] I need to get a hair cut.

– [Zubin] Your hair looks good though, dude.

– [Vinay] It’s terrible.

– [Zubin] I’m a little jealous, I’m a little jealous. I’m using a nice camera on you too to show the world your dapper ass watch too. What kind of watch is that?

– [Vinay] It’s a Citizen.

– [Zubin] Oh!

– [Vinay] It’s not that good. Yeah.

– [Zubin] I love it though.

– [Vinay] I’m not a, I’m not a-

– [Zubin] Why do you still wear a watch? I’m curious.

– [Vinay] You know, that’s funny. I’ll tell you a little funny story. I bought a Swatch once and it broke very quickly and I went back to the store to complain. And then the person was like, “Oh, you know, we’ll take it back, it’ll be two weeks to fix it, and then bubble,” and then, you know. And I was like, “Don’t take it two weeks to fix it, just give me a replacement, it’s such a cheap, crappy watch, and I’ll go right now.” And I was like, “Plus, what am I gonna use for the next two weeks?” And then he was like, “You don’t need to watch, you just need your phone for time.” And then I was like, “You work in a watch store, listen to what you’re saying?” What are you telling the customer? You don’t need a watch. What the fuck are you workin’ here for?

– [Zubin] Worst salesman ever.

– [Vinay] Worst salesman ever. I wear a watch because, yeah, you know what? That’s how I tell the time. I’m old-school ZDogg, old-school. I want to look at my watch and see the time. I am down with that. Sir, I respect you as an individual, even though your decision makes evidence-based sense, and I respect you, audience, for watching this much. Share the video, ZDoggMD.com/supporters to support the show. Paypal.me/ZDoggMD if you want to make a one-time donation and I’ll respond directly to your question, comment or anger. All right guys, I love you. VP, until next time.

– [Vinay] Until next time.

– [Zubin] We out. Peace.

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