Do we need to wait for kids to get vaccinated before returning to school? Have lockdowns had the intended effect? The answers are more complex than they seem.
Dr. Z: Hey everyone, Dr. Z, welcome to the show. VP, Vinay Prasad back in the house. What’s up, doc?
Dr. Prasad: It’s good to be back, good to be back.
Dr. Z: It’s not good for me to be back. I’ll tell you why, man. So I went and got Moderna dose two yesterday, four weeks apart. I’m like the first one was a piece of cake, a little sore arm, a little Fauci ouchie they call it. I don’t know why they’re giving Fauci credit for the vaccine, though.
Dr. Prasad: He didn’t really do too much-
Dr. Z: Not that much. So I had the Fauci ouchie, then I get this one. I get it at noon. By about 8:00 PM, I’m getting ready to go to you know, put the kids to bed and do all this. I start feeling terrible. Like my arm is throbbing. My head starts hurting, and I start having chills, and I’m like, “Oh, here we go, number two.” Dude, all night awake. Just febrile, 101.5, like just achy. And it’s like having a bad cold, or a flu, without any of the congestion or cough. But the thing is so much of it is how you… So all day today, too, same thing. Right now I feel like crap. But it’s framed in your mind as, “Oh yeah, my immune system is kicking ass right now.” Like the first one kind of primed it, and now the B cell clone army is like dropping hella cytokines everywhere. So the thing is clearly not a placebo.
Dr. Prasad: You got the real stuff. They kept it cold. They kept it the right temperature.
Dr. Z: That’s right. It wasn’t like gently warmed over butane or something. This is the real thing.
Dr. Prasad: There was no drops in the cold storage, that was the real stuff. Your experience is like so many other doctors. I see them go and they tweet about dose two known for a fraction of people having these kinds of adverse events. And some people have even said that healthcare workers who get the second shot should get a paid day off work the day after.
Dr. Z: Interesting. CNN just did a piece because so many people are complaining they’re getting the second shot they had to do a piece on why it’s worse for the second shot. This sort of immune priming and all that. And, again, I’m so grateful to be in a position to be suffering these symptoms. And so we’d scheduled to come here, and I was like, So VP, there’s a couple possibilities. This is the vaccine because of temporal correlation, the fact that I have no other exposures, or I have full-blown COVID. Do you wanna just roll with this? And you’re like, “Yeah, of course.”
Dr. Prasad: I’m pretty confident it is the vaccine.
Dr. Z: It sure seems to be, that’s the signs of it. Now you had one dose and had bad symptoms, right, so far?
Dr. Prasad: Yeah, I did. I don’t wanna go too public with… No, I’m happy to. Yeah, no, I suffered some adverse events. I’m not known for being a complainer, except maybe I am though, I don’t know, except on this show. But yeah, no, I felt the AEs, I felt it. I knew I got something, it wasn’t nothing. I got something and I felt it. And I had a little difficulty sleeping, and I had, as many describe, the sore arm. It was quite sore, actually. I couldn’t even lay on it to sleep. I had to sleep on the other arm. So I think they’re not trivial side effects. However, the benefit is vast. It’s a great benefit. So I’ll take it any day of the week.
Dr. Z: And you gotta think, I mean, the amount of immunogenicity of this thing just judging by how I feel right now, I feel like I have a flu, which means I’m getting the interferons, and the cytokine response, and everything that that would go with that minus the actual infection. That’s the brilliance of these things. Now, but this actually segues perfectly into a recent piece you wrote. And I’ve been getting this question a lot. People are saying, “Well, we shouldn’t start schools until we get kids vaccinated.”
Dr. Prasad: That’s the newest thing. First it was we shouldn’t start schools until they’re ventilated, until everyone has masks, and then it’s until the teachers are vaccinated, until the kids are vaccinated, and then maybe it’s just we shouldn’t have schools at all. I don’t know, the new world. We all learn from books, and learn on the go.
Dr. Z: Just keep moving the goalposts until the teachers union over here is just like, “Excellent.”
Dr. Prasad: Hey, they’ll be 18 eventually, so they won’t need school. They’re all gonna grow up soon.
Dr. Z: You know what, we all… It’s just like surgeons say all bleeding stops. All schooling stops eventually. Right, eventually. So you wrote a piece talking about that. I love you to walk us through what you think about kids and vaccines, because I think this is a good discussion to have.
Dr. Prasad: And I guess it fits with your experience. I think you know. The title of my piece is entitled something like kids can’t wait for a vaccine to go back to school, or they needn’t wait. And I guess I come at it in a few directions. One, a practical question, which is, let’s say they were to wait, how long might they wait? And the answer is Pfizer, the Emergency Use Authorization, allows people 16 and above to get the vaccine. We have ongoing clinical studies that have enrolled down to 12. I have found an article where Tony Fauci is quoted as saying that if those are positive, they’re gonna look to nine. And if those are positive, they’re gonna look below nine. And so what we’re talking about in another article that appeared in the Economist is realistically for younger kids we’re talking 2022. And 2022 is, last I checked the calendar, a ways away. It’s a ways away. So that’s one thing that it’s just gonna take a while. The next thing is what is the actual risk to children, particularly younger children, particularly children under the age of 16 or 15? And we know in a couple of lines of evidence there’s a nice paper in JAMA in the fall that looked at the risk of death to a young child, 5 to 15, who had passed away from SARS-CoV-2. And the answer was about one in a million kids passed away from SARS-CoV-2. Now, that’s an unfortunate end point, but to put it in perspective in that same age group the risk of suicide in non-COVID times is typically 10 times higher. So yes, kids are not invincible from it, but realistically their chance of dying from SARS-CoV-2 is not out of the ballpark with other respiratory viruses in that age group.
Dr. Z: And one thing we wanna say about that is when you talk to doctors who care for these children that are in ICU, almost invariably the children have other conditions, whether it’s severe obesity, diabetes, other issues that put them at higher risk. So you could almost start to think, Well, those are the higher-risk children and other children are maybe less high-risk for that.
Dr. Prasad: Yeah, I think that’s right. And I think that the other piece of evidence that will support that claim is “The New England Journal” letter of the Swedish experience with just 1.95 million kids, 15 ICU visits. And most of those kids did have a comorbidity or another predisposing condition. So what’s the probability a healthy kid will get sick and succumb to this virus? I think we’re talking very, very low. The other line of evidence, I think, is the IFR study. So there’s been some meta-analytic estimates of the infection fatality rates. So of all the people who’ve been infected the probability one would die, when we’re talking about ten-year-olds the estimates that are in this paper is something like 2 in 100,000. So that’s of 100,000 kids infected maybe 2 would pass away. And to put that in perspective, when you talk about people who are 80, it’s 7,500 times as much.
Dr. Z: Wow.
Dr. Prasad: So we’re talking about 20 percents in that group.
Dr. Z: How do you think it relates to maybe influenza mortality in children just as a reference point?
Dr. Prasad: You’re never allowed to say that word, my friend. You can’t compare.
Dr. Z: We’re gonna get banned.
Dr. Prasad: SARS-CoV-2 cannot be compared to any other thing on the planet.
Dr. Z: Except for SARS 1.
Dr. Prasad: A SARS 1 maybe, and maybe MERS.
Dr. Z: MERS, right.
Dr. Prasad: But if you go beyond that, you’re not, but I think the reality, I think, you make a fair point, which is that I know it has been controversial when people have said it. But I think when we’re talking about children, it is generally not controversial to argue that SARS-CoV-2 in kids is roughly, roughly the same as influenza, maybe even less severe than influenza, seasonal influenza in kids. That’s not to say that it’s not a serious virus. We’ve gotta be very clear when you’re talking about a 7,500 times increased risk in eight-year-olds, we’re talking about maybe one in four 80-year-olds passing away of the virus who get it. That is unlike any influenza, that’s really, really severe. But we have to have the perspective to recognize that this is something with the steepest age gradient, I think, anyone has ever seen. By that I mean, it’s far more deadly in older people than it is in younger people.
Dr. Z: And so one other thing, ’cause as I talk to you now my head is throbbing. I feel febrile. Imagine you do this to hundreds of thousands of children. Just by sheer happenstance, you’re gonna have a certain number of complications, just in terms of febrile complications. Did you talk about that in your article?
Dr. Prasad: Yeah, I think I did. I guess we’re building these pieces of evidence. So one piece of evidence is like, “Look, if you’re gonna wait for schools to reopen, you’re gonna wait along a long time.” And every day you wait, you’re losing something. There’s a trade-off. The next piece of evidence is that the risk to the kids absolutely is very, very low. And it’s within the realm of risks we accept when we send our kids in 2017, 2016. Those are the kinds of risks you run when you send your kid to school. They could get into traffic fatality on the way to school. They could die of the flu.
Dr. Z: Meningitis.
Dr. Prasad: There’s so many risks to children the moment they set foot outside the door.
Dr. Z: Wedgies.
Dr. Prasad: Devastating.
Dr. Z: Swirlies.
Dr. Prasad: Devastating. Only to us nerds.
Dr. Z: I know. Maybe guys, I’m playing my… I just revealing my hand a little bit here that yeah.
Dr. Prasad: It’s TMI.
Dr. Z: It’s TMI, yeah.
Dr. Prasad: But so, those are the two pieces. And then the point you’re making here I think is a good point, which is we do not know what the side effects will be in kids. We just don’t know ’cause we don’t have the data yet. And there are differences around dosing and there’re differences around how kids may tolerate that. They may tolerate it differently, maybe even better, it’s possible. But let’s assume they tolerate it the same as they tolerate Moderna dose two in adults, the same sort of rates of AEs. I think we’re talking, and I think I documented the piece, we’re talking about grade three fevers, which is like, I think, 104 degrees for less than 24 hours, and grade four, which is 104 degrees for two days, for more than 24 hours. We’re talking about of a million kids, you might take that risk of death from one, and let’s say you drop it to zero, because there’s a 95% reduction in COVID, and there appears to be almost a full protection against severe COVID. So let’s say to save that one life, you gotta inoculate a million kids with vaccination to save one life. And you’re talking about maybe 14,000 kids suffering grade three fevers, and maybe 880 suffering grade four fevers, which is more than one day. And I guess when you add in the myalgia, when you add in the arthralgia, when you add in the sort of headache, the fogginess, all these things, I mean, I think you have a tough sell. You have a tough sell to parents. You have a tough sell to the public to tolerate that level of side effects to avert a very rare outcome. This is assuming that it does the same thing. And then the last thing I’d say is right now vaccinations are authorized. They’re not approved, they’re Emergency Use Authorized, which is a special pathway of the FDA that allows expedited access to things in chemical, biological, radiologic emergencies. And this is an emergency, no doubt about it. This is a full-blown pandemic, but it’s an emergency for adults. Is it really an emergency for children? And I think one might argue, and I lean and I’m sympathetic to this argument, and that’s why I kind of raise it, that the EUA is appropriate for an adult vaccine in the setting of an emergency, but an EUA might not be appropriate for a childhood vaccine given that the risk to kids is so low. And if that is true, and the FDA pursues a more aggressive regulatory standard of traditional approval, that will require further evidence and further delay the time until vaccines are available, so-
Dr. Z: If you’re waiting for schools to open for that to happen, you’re gonna be waiting forever.
Dr. Prasad: You’re waiting for it to go.
Dr. Z: We talked about this a little bit, and I think I’m increasingly convinced that we don’t need to wait for kids to be vaccinated. It’d be nice to have a lot of adults vaccinated, as many as we can, especially high-risk people, and stratify from there, but kids. Offit, when we were first talking about vaccines on the show early in the pandemic, he said, “You better damn well know what your risk-benefit is when you’re giving healthy kids vaccines.” And he’s spent his life looking at giving healthy kids vaccines. And so I’ll ask him on Friday when he comes on the show what he thinks about this, because he can understand the risk-benefit, and as can you, and I think make a compelling case, and say, “Well, okay, well, how can we think about it?” Now, this doesn’t mean that if you wanna get your kid vaccinated, and it’s approved, you shouldn’t do it, that’s fine.
Dr. Prasad: I think these are challenges with the path to approval. And the difference between authorization and approval, and which is the right regulatory pathway. And I think that I can imagine there’ll be people who argue the opposite, and say that until the epidemic, the pandemic is under control, it’s an emergency in everybody. But I would contend, I would counter-argue, I would say something like if there are a big group of adults who are choosing not to be vaccinated, I’m not sure that justifies you calling it an emergency until they have done their due diligence and been vaccinated before you can declare it an emergency for this pediatric group where the risk-benefit profile is fundamentally different.
Dr. Z: Yeah, I mean, you have like 40% of nursing home workers declining the vaccine.
Dr. Prasad: I don’t know what’s going on there.
Dr. Z: I don’t know what’s going on.
Dr. Prasad: I read something recently where somebody said that, “Look, you’ve treated them like shit for so many years.” You’ve treated these workers very poorly. We have to be honest about that. They’re underpaid, they’re undervalued. These nursing homes represent a failure of our society. It just shows that we’re callous towards older people. We push them aside. And so, and they weren’t given PPE in the early part of the pandemic, so maybe these are reasons why they might be distrustful.
Dr. Z: And I think, and I’ve talked about that on the show, definitely, and I have a lot of compassion for that viewpoint. I think if we’re being completely blunt, which I’m gonna be, you don’t have to agree with this. There are a lot of people who work in the nursing home population that are just simply not educated in anything at a high level of science. And so there’s a lot of misinformation floating around, and they’re as vulnerable to it as anyone. And they see complications, they see results of complications in patients that are there, so they’re more on edge about that. They don’t wanna be guinea pigs. They’ve been abused, they’re undervalued, underpaid, understaffed. And yet it’s the most important population in terms of outcomes, I mean-
Dr. Prasad: No, I think you’re absolutely right. I mean, we’re talking about 50% of all US deaths are occurring in this setting. And so vaccinating the people who are in that place, and the people who provide care. And often these people who work in nursing homes often work in multiple nursing homes, which is obviously a recipe for potential viral spread between nursing homes. But I think you’re right in the sense that you’re approaching it with some compassion. You’re trying to ask like, why might somebody there… They’re not not getting the vaccine because they wanna be a bad person, a viral vector. They’re not getting the vaccine because of some misunderstanding, or some apprehension towards the medical field. Many cases there may be some basis for that.
Dr. Z: Yeah, I think so. And then you can make the same argument from an equity standpoint with African-Americans who are very reluctant more so than other racial groups to get vaccinations when you have histories of abuse and so on. And so folks are not behaving irrationally, but we do need to do a better job, I think, of teaching and being compassionate with it. There’s so much, man. I mean, and you experience this all the time, we’ll talk about this in the latter half of the show, but the amount of shaming and nonsense that goes on from people on social media towards those they feel are not behaving. Like even me just saying, “Well, I don’t know that the nursing home population has the higher level of education that would be an immunologic.” Like many doctors don’t, but that is a fact, it’s probably a fact. I think it’s hard to, you can argue it, but I think it’s a tough one. But to say, “Oh, look at this person killing grandma in the nursing home, because they’re just evil.”
Dr. Prasad: That sounds like a good tweet.
Dr. Z: It’s great tweet.
Dr. Prasad: It’s a great tweet. You got all the RTs for that, but I think you point to something that’s very real, which is there are many people who I believe heart is in the right place on the other side of the issue. They’re the anti-anti-vaxxers. They don’t like the anti-vax messaging, and their heart is in the right place. I mean, they really want to persuade people to see, I think, the wisdom of some of these strategies, particularly this strategy, but there is an empirical question which is separate from intention, which is that how do you effectively persuade people? And as much as we wish everyone used empathetic, consistent messaging, the reality is when I look on Twitter, and I’ve gotten myself in trouble for pointing this out to others, that they’re throwing a lot of grenades. They’re just saying you’re stupid, you’re dumb, you’re an idiot, you’re killing people, and other derogatory names. And I guess, I don’t know this to be true, but I suspect it that being insulted is not a good path to bringing somebody into the fold and into sort of thinking about the communal sense of good here.
Dr. Z: It’s really not, and what’s interesting is I’ve had to do a lot of soul searching on this one, because as a comedian-ish, sometimes.
Dr. Prasad: As a funny person.
Dr. Z: As yeah, funny ha-ha or funny. But-
Dr. Prasad: We’re laughing with you. Don’t worry.
Dr. Z: Oh God, I hope so. We’ve done a lot of pretty hardcore vaccine stuff. My producer dresses up in a wig and pretends he’s anti-vax Janet and comes at me with crazy stuff. Now, that’s funny, but all that serves to do is rally our own anti-anti-vax tribe. It doesn’t convince anyone on the fence. If anything, it infuriates them, it entrenches them in the fact that we don’t understand, we’re not listening to them. We think we’re better than them, all the other stuff. Now, what I’ve been getting lately because I’ve changed my approach, mainly because I’ve awakened a bit to the why of the anti-vaccine sentiment, and I understand it more than I did. It’s hard still for me because I’m so conditioned in the science, which can be a blind spot too. But now I get messages saying, “Hey, you know what I love? I wasn’t gonna take this vaccine. I am now because you calmly.” Well, our show, and the guests, and the back and forth, where they say, “You seem to not have a massive dog in the fight beyond trying to do the right thing. You’re patient and you explain it.” And you explain why you think it’s rational to not wanna get the vaccine, which means let’s talk about why we can convince you to do it. And that’s very different than what I used to do, because again, who was I convincing? I’m not gonna convince a delusional 2% on either side of this thing. So you gotta shoot for these people that are like, “Man, I’m so confused, and I have plenty of reason to distrust this.” I mean, everything from mask flip-flopping early on, which we’ve talked about, and all the other public health.
Dr. Prasad: But I mean, I think you’re onto something, which is that I will admit that my own thinking on the art of communicating publicly on these social media forums has evolved over time. Naturally, if it didn’t evolve, that would say something’s wrong with me. I think the discussion we just had about the pediatric vaccine is actually quite pro-vaccine. And I’ll tell you why. For people to perceive you as somebody who is impartially adjudicating the risk and benefit profile of a vaccine, I think you have to be honest about the fact that that may vary by age. And if your stance is an extreme stance, as I think many people are on the Internet, which is that everyone should get the vaccine right away. And it should all go through the same authorization pathway, this EUA irrespective of age, I think that reveals potentially a blind spot in your reasoning that maybe it is not the same in a five-year-old as it is an 85-year-old. And acknowledging that, it’s just to show that this is a nuanced and complex issue, and that’s how you ought to think about it.
Dr. Z: Yeah, but you know if we’re talking about “The Coddling of the American Mind”, there’s only good people and bad people. So you either stake out… Actually, this gets to the point, I would not trust someone who was exclusively party line on anything, which is why I just hate it when politicians… I mean, that’s why McCain was popular.
Dr. Prasad: I think he was for his reason.
Dr. Z: Because he would be like, “I’m not just like straight going down a ticket. I’m saying I think this, and I think that.” I’m an issues person, I look at things rationally. Lovely, why can’t we all do that? The same with vaccines, like Offit, early days, this is a pro-vaccine dude, but he’s like, “We gotta really be careful with giving healthy people a vaccine.”
Dr. Prasad: I think he’s known for being THE pro-vaccine dude. He’s the guy-
Dr. Z: He’s the guy that like a fur protestor throws blood at. He’s the guy the anti-vaxxers want, you know…
Dr. Prasad: And didn’t he write that book about that? Like one of the all-time great vaccinators in history. One of his first books.
Dr. Z: Hilleman, Maurice.
Dr. Prasad: Yes, Maurice. Hillerman, right?
Dr. Z: Hilleman, Hilleman, yeah, that’s right. He’s done a documentary, too, at some point, I’ve shared a link to. And he’s a very rational guy, but of course, he has a bias because he’s a scientist, but at the same time, he’s able to go, “Well, you know, we…” You trust him.
Dr. Prasad: I’ll give you another example that I got myself in a little bit of trouble about, which I think but I don’t think I ought to be in trouble is my piece that we talked a little bit about last time, which was two vaccines, 14 days, asymptomatic, you can take a liberty in life. You can go hug your grandmother. And you said you were gonna go hug your mom. And you’re probably still looking forward to doing that, ’cause you just got yourself done.
Dr. Z: And they just got vaccinated, luckily.
Dr. Prasad: That’s a good feeling.
Dr. Z: It really was a way better feeling than getting vaccinated yourself. I mean, you’re just like, I would suck the-
Dr. Prasad: You’ll suck the mRNA right out.
Dr. Z: This toxic mRNA.
Dr. Prasad: And give it to your mother.
Dr. Z: Exactly, and then she’ll anaphylax from the blood type. Incompatibility.
Dr. Prasad: But it just shows how much, that’s true love, you really care.
Dr. Z: I’m willing to anaphylax my poor mom.
Dr. Prasad: But one of the criticisms I got about that piece was, I mean, there were numerous and vociferous criticisms, that’s always the case, many of which I think are deeply inappropriate, like ad hominem, personal comments, or the allegation that somehow I have some perverted motive, like I want people to die or something. Like that’s what I’m in the business of.
Dr. Z: Exactly. Like they think you’re a butthead for all the wrong reasons. You’re a butthead for all these other reasons, but they’re like, “Well, no, he wants to murder people.” No, no, no, that’s not why I’m a bad person. There’s a whole other list of things.
Dr. Prasad: I’m sure you could find some reasons there. But I think the view, the hard line view, that some espouse that after vaccination “nothing changes”. You ought to social distance, and not meet up with anybody, and not go on dinners, and not meet other vaccinated people for a dinner at your house. That is a view that some espouse. I push back a little on them on Twitter, and I say, “What criteria do you want to see before you will relax?” And some of them said, “Well, I know you’re wrong, but I can’t actually delineate what is the criteria I want to see?” I was like, “If you can’t delineate what the criteria you want to see is you’re not arguing in good faith. You don’t know what you’re talking about.”
Dr. Z: Emotional arguments.
Dr. Prasad: In my opinion. So you’re waiting until MedTwitter tells you it’s okay.
Dr. Z: That’s what it is, that’s what it is. I mean, it’s a tribal badge of identity, which we’ve talked about, I think, to resist. You’re either a super fearmonger or your super denial, and your avatar is either a bunch of masks. Now it’s like 12 masks.
Dr. Prasad: Oh, that was a whole nother. So I don’t know how we got on this, but obviously, there’s that quote by Fauci that said, “If one mask is good, two is better.” There’s a study from a few weeks. I mean, I think it was a couple of weeks ago. I think it was JAMA internal medicine study that looked at if you wore a second mask, it would improve the fit and filtration, and they tracked it with some particle size. But that’s rather indirect evidence of the question, which is that if you made this a mandate, would it change population outcomes? Yet, for a moment, everywhere on the Internet two masks was the craze. If one is good, two is better. And I remember somebody said, it’s attributed to Fauci, the quote is, “It’s just common sense to wear two masks.” If it’s just common sense, where was this common sense 10 months ago, my friend? This is not common sense. This is something new.
Dr. Z: You know what’s funny is all these conservatives were putting up avatars with like 20 masks on, like they’re just stacked up like this.
Dr. Prasad: They’re trolling.
Dr. Z: They’re trolling, they’re very good trolls.
Dr. Prasad: But I mean, they found a legitimate place to poke fun. But now Mike Osterholm went and he said that he disagreed with the recommendation. And then I think Fauci five days later he walked it back in an interview where he said there’s no data.
Dr. Z: Osterholm has never been a big fan of public masking I don’t think to a high degree.
Dr. Prasad: I’m curious to know. I’d love to talk to him about it, but I guess I don’t… I’ve read his letter. He had a letter in “The New England Journal”. So I get a sense of where he’s coming, but I don’t know exactly where he falls.
Dr. Z: I think his thing is this is largely aerosolized around the sides of the mask. You’re not gonna stop it with these kind of third-grade cloth masks.
Dr. Prasad: He’s one of those everyone needs an N95 premium.
Dr. Z: Or just don’t see people.
Dr. Prasad: I see, I see. I’ve seen his repeated calls for repeat lockdown. Well, anyway, so I wrote this thing, and I stand by my article. My article will be, I think, in time it will age well, because I think people will see the wisdom in it. And also, I had sent it to so many people who are experts in infectious disease it’ll make your head spin, and they all support it privately, of course.
Dr. Z: Of course. Of course.
Dr. Prasad: But one of the people who was like really harsh with me, said a lot of mean stuff, and I was like, “Oh my goodness.” I was like, “Well, who is this person?” And then I was like looking through some of the pictures online, and I was like… This person showed the routine mask that this person favors. And I swear to God, it looked like a trench warfare mask from World War I. I was like, “I’ve never seen anything quite like…” It was a heavy duty. I’m no expert but it was a heavy-duty mask.
Dr. Z: A full Darth Vader ventilator mask.
Dr. Prasad: It was something like that.
Dr. Z: You know you’re dealing with just it’s a tribal badge at that point. You can’t fight that because you’re attacking an identity belief instead of actually arguing rationally science. Which honestly, I get a lot of messages after our shows, and I think you do too maybe people will send you. And they’re like, “Hey, I really liked that show.” And why did they like it? Because two reasonably calm, incredibly handsome.
Dr. Prasad: They never say that to me.
Dr. Z: They’ve never told me that, no one has ever told me that. And discussing rationally the ins and outs of things without really getting crazy partisan, or angry, or anything like that.
Dr. Prasad: Well, I guess I’m not a partisan. I have no interest in it.
Dr. Z: I don’t have an interest in it.
Dr. Prasad: I have no interest in it. And I guess my interest here is like on these issues. My interest is I love thinking about risk, and I love thinking about risk on these low probability events. We talk about one in a million. It’s real probability but it’s a low probability, and the human mind is great at distorting such events, either make you think it’s zero and neglect it, or make you think it’s orders of magnitude larger. Like our brains are good at processing day-to-day risks, the kind of risks like is it gonna rain today? Am I going to fall down this ravine? Am I gonna get food today? They’re not great at these kinds of risks, and emotion so often overrides.
Dr. Z: That’s right, because I think it’s limbic. I call it you know. This John Haight paradigm of elephant and rider. So elephant is a risk detector. It’s this limbic, primitive brain, and it’s designed to detect threat. It has a negativity bias, which is why news loves negative. And if it bleeds it leads, and all that. It’s all because that’s how they’re hacking our own wiring. And the truth is that’s how we mis-estimate risk. So Daniel Kahneman wrote the book “Thinking Fast and Slow”, and it’s really about how we have distortions in our thinking and understanding risk and thinking illogically, so we oughta work on growing our ability to do that. I think that we oughta be teaching kids in school this. We oughta be looking at ourselves. I find myself making errors all the time, and then noticing it now for the first time. Whereas before you just go with this, yeah, well, you know, blah blah blah And then you, “Wait, now look what I just did. I did appeal to authority.” You’re noticing all the errors that you’re making. I think that means we have to teach people how to do it, teach ourselves how to do it.
Dr. Prasad: I agree with everything you said, and I’ll add on one more thing, which is that when you take people and you put them in a pandemic situation, you exacerbate all these errors, I believe. Like you’re taking people, you’re depriving them of their social networks. You’re depriving them of in-person interactions. You’re leaving them in their house. You’re often depriving them of childcare or schooling. You’re depriving them of a lot of things that play with your mind, make you more anxious, concerned, frustrated, tired, sleep-deprived, uncertain about the future. And then you ask them to reason about low probability events. And it’s so easy to demonize, to hate, to think this is irrational. But when you really think about just the raw numbers, you might think about it differently. And so, I don’t know, at a time where we needed in-person interaction the most we have it the least.
Dr. Z: I had Jud Brewer who is a psychiatrist, who studies mindfulness and did some of the seminal fMRI studies on monks and stuff who practice advanced meditation. And early on in the pandemic I had him on, and he said, “What we’ve done here is we’ve taken a physical contagion, which has risks, which we’re over-estimating mostly.” This was early on when we didn’t know entirely, even then I think he was right, fully. But he said, “Now there’s the social contagion, which comes from we’re all locked down, and a news anchor can sneeze on your brain from thousands of miles away and infect you with fear.” And that changes how you work, so now you’re so afraid. You’ve been conditioned repeatedly. Now VP goes on Twitter and says, “Actually, once you get this incredibly effective vaccine,” which I’m feeling the effects right now like you can probably loosen some things with permission of the other party. Of course.
Dr. Z: I mean, come on. It’s not like you’re going and assaulting them.
Dr. Prasad: You’ve invited them to your house for dinner, they’re also vaccinated, and they can say. I’ll give you a good example of it. I don’t know if we talked about this last time, but I thought about a little bit more, and I thought about something even more interesting. It was a hospital. This is a trainee emailed me after this, and the trainee said to me that after this brouhaha about what can you do after vaccination the hospital sent an email to all the trainees. And it said, “When you are on lunch you are not allowed to sit two trainees and have lunch together. You got to either eat lunch apart, go outside.” And this is an East Coast city where it’s super cold. So I don’t want… Let’s just say this trainee did not appreciate this recommendation, and I don’t think the recommendation was strictly adhered to. But this was the recommendation nonetheless. It’s the policy that you’re not allowed to have lunch together. And I was thinking about it initially how it’s a foolish policy for a lot of reasons, but we talked about it on the last episode. But then I was thinking about it even more. And I was like, there’s one more reason that’s it’s a foolish policy. The hospital can only control the resident interaction while they’re at work. When they go home from work, they can have dinner together, and the hospital has no control over it. So whatever delta is on the policy, whatever benefit the policy provides, it has to be it prevents in-person interactions at work that would otherwise not happen outside of work. But the reality is the more you prevent it at work, you may actually increase it out the work.
Dr. Z: You push it out of work.
Dr. Prasad: Have more dinners outside of work. And the net result may be not only is it a policy that robs you of humanity, and the one break you get when you’re a trainee. You know how-
Dr. Z: Oh, man. It’s such a crucial thing. You look forward to it.
Dr. Prasad: You look forward to it. Not only does it rob you of all that, but it may not actually even change the interaction frequency, ’cause we’re just gonna do it after work and get a beer.
Dr. Z: It’s funny that you say that, because when outdoor dining was before they shut it down again in California, I went to an outdoor place with my kids. We were eating there in Redwood City outside, beautiful-
Dr. Prasad: Sinner, you sinner, you horrible-
Dr. Z: I’m a sinner. I’m a sinner in the hands of an angry God. And there I am sitting eating my octopus, which by the way, I don’t eat anymore after seeing My Octopus Teacher on Netflix. You should watch that. Oh God, that thing is sentient, and really smart, and actually weirdly lovey, like you wanna give it a hug, and then the tentacles will get on you.
Dr. Prasad: So back when you used to eat octopus.
Dr. Prasad: That’s right, so I was eating this octopus with my kids, and I see there’s three, four people sitting at an adjacent table kind of talking loudly at each other. And they turn, they go, “Are you ZDogg?” I’m like, “Yeah, I am.” We’re all residents at Stanford, and so on. Oh really, oh cool, so you guys like hanging out. How’s the COVID numbers? Ah, you know, it’s busy. So y’all are just like all at the table here, no masks, just like shouting at each other. So I’m down with that, but this is, I’m sure this would not be policy at Stanford within the walls of Stanford.
Dr. Prasad: I suspect that.
Dr. Z: Like you said, it’s the same thing. It’s the only time they get to connect.
Dr. Prasad: And for many of us in residency, you know how hard it is. I mean, I don’t have to bore you. And those were the encounters that gave you the motivation to go back the next day. And I don’t want to get too specific, but I guess I think the takeaway point is that if you really think that you’re gonna vaccinate all these people, and their behavior literally will not change, I question your thinking on that. I was like, that’s not right. Of course, they’re going to behave differently. Of course, they are. What are you talking about?
Dr. Z: You don’t understand humans.
Dr. Prasad: You don’t understand humans, what are you talking about?
Dr. Z: Dr. Prasad: I don’t know what you’re talking about.
Dr. Prasad: What are you talking about?
Dr. Z: What I really don’t like is the manipulative aspect of it. Well, no, we’re gonna say this, because we know the public will take it this way. And if we set the bar here, they’ll reach it here. So I got an invite from CDC to speak about vaccine hesitancy in a virtual thing they’re doing. I’m trying to figure out who the audience is, but there was a 95% part of me that just wanted to ghost them, and it was just because I’ve been so frustrated in general with communication. But then I thought, “Well, if I ghost them, then I’m not doing my part to actually contribute to the betterment of communication.” But it’s been frustrating-
Dr. Prasad: You don’t wanna be associated with the CDC anymore. They’re rehabbing their image too.
Dr. Z: Instantly as soon as the Biden administration started, there were 13 pronouns in every email. I was like, “Oh, that’s an overnight change.” But it’s amazing how now they are actually reaching out and doing all this. But I guess my question is really, how do we start to have a more rational public health policy? For example, you wrote a piece on lockdowns.
Dr. Prasad: Oh yes, it just came out.
Dr. Z: Now, I imagine this is gonna be a controversial piece. Because if you say anything about lockdowns that is negative, you are no longer a good liberal. If you say anything about lockdowns that’s positive, you’re no longer a good conservative. So this is a tribal identity badge.
Dr. Prasad: Well, I hope I will… Well, it’ll only be controversial among the people who don’t read it, which is probably a fair chunk of people these days. But because the piece actually says the answer is I don’t know, that’s my answer. I don’t know. And I think I start by framing the piece around there are two recent studies that came out, and one says that you know. Well, one is what is a lockdown? And they define it as universal unessential business closure and stay at home order was the definition that they employed. And one paper said that we looked at these 12 countries, or something like that, and we failed to find a benefit from lockdown. And another paper says that there is a benefit, it lowers R-naught by, I forget what it was, like 2/10 of 1%, or something. I’m sorry, 2/10 of 1 point. So like from 1 to 0.8, or something like that. And I started to think about it, and I actually spent a lot of time thinking about how you would do the research. And the more I thought about it my head hurt, because I realized that, well, how do you define lockdown? You can define it in so many ways. And which countries do you look at, so many. Which regions do you look at? And then you have to make some analytic choices. For instance, one is lag. If I institute a lockdown on a Monday, when does it kick in? Does it kick in tomorrow, three days from now, five days from now, seven days from now, nine days from now? You have the choice to lag your model whatever you want. I started thinking about how you define lockdown, what countries you look at. And then I started thinking about the fact that lockdown is a lot like an aspirin. A lockdown is different every time you take it. If I give you a lockdown, the first time I give it to you, it might work really good. But if I give it to again, and again, and again, there might be diminishing return, ’cause you’re not participating.
Dr. Z: It’s tachyphylaxis to lockdowns.
Dr. Prasad: Right. Maybe, and also, what’s the… And so this just classic effect modification or interaction, there’s some difference between how it works over time. The other thing is it may work differently if it was deployed recently in Perth, Australia, when there was one case documented, probably a handful of cases not documented. And they want a lockdown to go from handful to zero. So that might work, maybe, maybe not. But what if the caseload is 1 in 1,000, 1 in 100, as it has been in some US places. A brisk… does it work the same there? I don’t know the answer. And this whole essay explores like nine different ways that this is a very difficult question. And the other dimension of this I kind of explore is lockdown is not the only thing we did. We locked down sometimes. I’ve seen some parks here they remove every other swing. Boom, gotcha, COVID. Gotcha, take that. You think you can spread swing to swing?
Dr. Z: Oh, hell no. R-naught just went from 1.5 to 1.49999.
Dr. Prasad: We got you. We take the rim off the basketball hoop, boom. They closed a toboggan track in Canada. I actually don’t know what that is, but-
Dr. Z: A toboggan is like a sled.
Dr. Prasad: I know what a toboggan is. Do they have like a, do they have tracks for this?
Dr. Z: We have a lot of Canadian fans on this show, so they’re gonna have to weigh in. They’re gonna weigh in and be like, “Eh, it’s…”
Dr. Prasad: It’s really important, eh.
Dr. Z: It’s a real hoser, eh.
Dr. Prasad: It’s a real-
Dr. Z: Sorry, sorry, sorry about that.
Dr. Prasad: They’re gonna give you shit for that.
Dr. Z: Canadia, sorry.
Dr. Prasad: I’m gonna put my Roots sweater on, avoid the wrath. So I mean, the point I wanna make is we’ve probably done, I don’t know, 10,000 different things, maybe more. We’ve closed things, opened things, had mask rules, inside/outside, kids, young, old, different climates, gatherings. They banned gatherings over 10, over 20, over 50, over 100.
Dr. Z: Travel.
Dr. Prasad: Travel, border closures. I mean, so many things have been done. Some of them may do something. Some of them may do nothing, but I actually fear that the vast majority of things we’ve done we will never know the answer. And so the whole point of my essay is to point out, I mean, I have some specific recommendations of how in the future when we deploy things we gotta deploy them in a way that we can learn something. I call this that we basically done a multi-trillion dollar experiment, and we have no idea which specific things when work, and which things are just things that sap morale and don’t get commensurate benefits in caseload reduction. And that’s a tragedy, that’s not much better than people who lived 500 years ago. They did all this shit and they don’t know what works.
Dr. Z: I mean, you just do cocaine, there’s ghosts in your blood, man. I mean, that was the old doc. There’s a meme about that. Like old time doc, and it’s like, “Hey, you have ghosts in your blood. Why don’t you do cocaine about it?” But yeah, no, it’s true. You know it’s interesting. You can contrast the vaccine science that’s been done, which has been done reasonably well.
Dr. Prasad: I think the best that we’ve done, with all these other things, which I actually wanna say, I’m not saying I don’t believe it works. Although I’m willing to say I don’t believe cutting every other swing did shit. I’m willing to say that was stupid.
Dr. Z: You’re going on the record.
Dr. Prasad: I’m going on the record that cutting down every other swing didn’t do anything. That wasn’t the place where COVID was gaining ground. However, a lot of these things are possibly the place where COVID was gaining ground, and possibly your intervention helped, but I don’t know. And that means when I don’t know, I mean, a very bad spot as a policymaker. When do I deploy it? How do I deploy it? Where does it work, where doesn’t it work? And I actually think we’re not gonna learn it this year, next year. It’ll be a decade before anyone has any sort of ideas about this. And I don’t even think we can study it in the moment. I think the temperature is too hot. People cannot study this in a neutral way. They’re too angry, they’re too venomous. They’re not there yet.
Dr. Z: I’m with you. I mean, I think there are a lot of missed opportunities, but I think it will wake us up to future approaches when things cool down. Like you said I think people are just too… Like Mr. Gas Mask, that’s a lot. You’re not gonna have a rational conversation.
Dr. Prasad: Mr. Gas Mask needs a hug. But unfortunately they won’t me let do it even if I’m vaccinated, that’s the challenge about- Challenge about that.
Dr. Z: You’ve seen “Hamilton” or no.
Dr. Prasad: Yeah, I love it.
Dr. Z: Love it, right. When you were talking about all the essays that you write, I was like. ♪ Why does he write like he’s running out of time ♪ ♪ Writing every day and night ♪ ♪ Like he’s running out of time ♪ You’re basically Hamilton and I’m your Burr. I’m thinking you know. I’m thinking I’m gonna wait for-
Dr. Prasad: I feel like you’re Lafayette.
Dr. Z: Oh, Lafayette! What was it? Imagine your tactical, strategical brilliance, da-da-da, Lafayette. Dude, did you see? So it came out on Disney finally, and so the world was watching it.
Dr. Prasad: I think I watched it again on Disney+.
Dr. Z: On Disney+. I saw it in Vegas. It’s such a great.
Dr. Prasad: I think I saw it live once. I think it was when I lived in DC, maybe.
Dr. Z: Oh, you saw it there?
Dr. Prasad: Terrific show. Boy, he’s a talented guy.
Dr. Z: I mean, Lin Manuel is. I mean, “Moana”. He did all the music for that. I mean, you can stop right there. You’re welcome.
Dr. Prasad: It’s interesting. There are people who do certain lines of work where I bet the ratio of people who like Lin Manuel Miranda to people who don’t like him, it’s probably like 99.999, it’s as good as the Moderna vaccine. But when you’re in the business of academic ideas in medicine, which I fear is the business that I’m in, that ratio, it’s like J&J vaccine. No, it’s not.
Dr. Z: There’s a really funny meme where it was like two really ripped black dudes. Like abs and everything. And it was like-
Dr. Prasad: Press release abstract?
Dr. Z: No, this one was actually, it said Moderna and then another ripped dude, a little slightly smaller, and it said Pfizer. Actually, it was the other way, Pfizer, huge guy, Moderna, pretty big still, and then this fat Indian dude with a mustache, and his gut poking out, and it just said AstraZeneca.
Dr. Prasad: Oh gosh!
Dr. Z: With those aviator glasses.
Dr. Prasad: Well, I don’t want to let this myth go out. I will say that they’re all out of the park good.
Dr. Z: Yeah, out of the park good. Novavax, Johnson & Johnson.
Dr. Prasad: They’re all good, because obviously, being hospitalized and having severe COVID, and death, zero, zero, zero, zero. Zero, zero. Symptomatic COVID, it is what it is, but what we really wanna avoid is the really bad complications, and not having to keep that so cold, that’s pretty good.
Dr. Z: Yeah, that’s huge. And with J&J, the one dose thing, that’s huge.
Dr. Prasad: One dose is good.
Dr. Z: It’s gonna be interesting because they’re doing a two-dose trial to see is it better? But since it’s an adenovirus vector, you wonder if people will have an immune response to the vector and won’t have a good boost for the second dose. So I’m gonna see what Offit thinks about that, but-
Dr. Prasad: That’s a good question, that’s an Offit level question.
Dr. Z: That’s Offit level. There’s minor deities, Vinay Prasad.
Dr. Prasad: There’s my pay grade and there’s Offit’s pay grade.
Dr. Z: When it comes to virology. And what I like about Offit too, it always feels like it’s an Offit fan club when I talk to you, for me anyways, ’cause I’m a fan, but he likes to point out all the times he’s wrong, which is often. It’s rare for a scientist to do that. I don’t know, I’m gonna have to get Peter Hotez to admit whenever he’s wrong. I gotta get him on the show. The bow tie is very intimidating with Peter, man, and these science communicators. Speaking of which like, have you ever been… So you’re a really good science communicator. But it’s interesting is your audience is actually a higher level audience than say going on “The Doctors” and being like, “Well, the thing about Botox is right.”
Dr. Prasad: Yeah, I mean, all three of them are higher level. All three of them are really, really esteemed people. The three people that listen to my show. No, go ahead, you’re gonna ask.
Dr. Z: I was gonna say, so have you done any of this bigger media stuff, and what do you think about it?
Dr. Prasad: It’s not my interest in life, and I guess I haven’t. Very rarely in my life I’ve been asked to do some cable news bit, and I’ve always artfully dodged by pretending to be what my critics say that I don’t know anything. No, pretending to be busy, or not that I don’t feel like. And I guess the reason I dodge is not because I have anything, too much against them, but I think I do question the format. I do question the format. You can’t really do justice to something in five minutes, or three minutes, or whatever a little bit of time they want you to do it, and especially, if what you’re doing is nuanced, complicated. I mean, there are different types of science messaging. There’s saying the thing that most people believe, that’s a very popular type of science messaging. It’s not my interest. In fact, I find it, not that I have anything wrong with it, ’cause I often do believe what most people believe on most issues. In fact, that’s how I drive my car and live my life. Consensus.
Dr. Z: It’s called consensus. So I do agree with most people on most issues, but the things I wanna spend my time on thinking about, writing about, and talking about are places where I think there’s rationality failures. Where rational people are slightly on the wrong side of the issue, and I’m drawn to that just because that’s fun, that’s try to get people who are rational to come over.
Dr. Prasad: I see. So this is an interesting, and this is a little meta-conversation on this, because our audience will mostly tune out, but I don’t care, because it’s important to me. I get invited on these shows all the time. I tell them no, ’cause the couple of times I’ve done it, you’re reduced to a soundbite. It feels clownish, you can’t get into nuance. Whereas on my show, I control everything. I can say it how I wanna say it, and-
Dr. Z: And at the length you want to say that.
Dr. Prasad: And it is longer. It does take longer to have a rational conversation where rational people might disagree. So it’s interesting ’cause Marty Makary, who was on the show yesterday, he’s gotten really good at both. So he can go on Fox, and be like, “Well, Britt, the thing about the virus is it’s crazy that we’re vaccinating such, and so, and such.” But then he’ll come here and be like, “Here’s all the data on this, and here’s the 20 things.” And so he’s good at like straddling that. And then you have people who will go online and accuse both of us of being attention-seeking whores. Like the problem with VP is he’s attention-seeking. And I’m like, “You don’t understand attention-seeking.” Attention-seeking is going on every single daytime TV show-
Dr. Z: To say things people already know, or repeating what the next person says.
Dr. Prasad: To appeal to the lowest common denominator, and all of that.
Dr. Z: And then tell some personal story about yourself that may or may not be relevant to the discussion that they have, right?
Dr. Prasad: That’s right, now wait a minute, now you’re starting to offend me, ’cause that’s all I do on my show. Let me tell you about my shot. It hurts a lot, I have a headache.
Dr. Z: Well, that’s different, because we went into something. And it’s also not the venue. But I guess what I want to say about it is when I grew up in the 1990s watching a lot of TV, I was of course born in the 1980s, and when I grew up in the 80s and 90s, and even the early parts of the 2000s, the medium of television was the only medium. I was glued to it. I watched, boy, I learned about so much of how fancy people live from “Frasier”.
Dr. Prasad: Totally, the “Lifestyles of the Rich and Famous” with Robin Leach. And by the way, so I was watching “ThunderCats”, original 1985 “ThunderCats” reruns with my youngest daughter and rediscovering how incredibly cheesy and horrible it was. But we were laughing like-
Dr. Z: And was is it ThunderCats ho, and they shout?
Dr. Prasad: That’s right, thunder, thunder, thunder, ThunderCats ho! And Lion-O, the lead guy.
Dr. Z: Now I don’t know this much.He has the sword of omens.
Dr. Prasad: I know there’s a sword involved.
Dr. Z: The sword of omens can give him sight beyond sight, and so there’s a scene where he’s like, “Sword of omens give me sight beyond sight,” and he looks through and he sees these mutants showing up. And he’s like, “Mutants,” and then he takes the sword down, and they’re right there. I’m like, “What’s the point of having clairvoyance?” And my daughter started laughing. She’s like, “What? What kind of like telescope is this?”
Dr. Prasad: I don’t know, like a very wimpy binoculars-
Dr. Z: It really is, so you were raised on TV.
Dr. Prasad: I was raised on TV, and I guess what I was trying to say was, I mean, where I wanted to go with this is to say that I know that there is a place for these kinds of short segment stuff, but to be honest with you, as I’ve gotten older and as the availability of media has changed, I don’t consume any of it. Maybe I don’t go on the show, because I don’t like the show. I don’t watch the show. And in fact, I don’t even like short interviews, 20-minute interviews, these interviews that a lot of podcasts put out that are highly cut, highly edited. I hate it. I like the raw, long-form, two-hour podcasts where they just talk, and the person who is a popular person talks so long they no longer can use their talking points. They have to be real at some point.
Dr. Z: That’s what it is, it forces authenticity and some degree of creation from a void. You’re just there in a moment creating, that’s what I love about it. You’re not in this talking point, ’cause that’s the thing. I’ve been on “The Doctors” a couple times. They actually asked me to like kind of co-host for a month, and I was like, “No.” But the couple of times I did it I did get to actually say what I wanted to say about this concept of Health 3.0, and I felt good about it. But then I did another one where I debated the Raw Water Guy.
Dr. Prasad: I don’t know this. Oh, I remember, they were getting all that water from like-
Dr. Z: From like some, well, and they weren’t treating it. And they’re like, “Raw water, it’s got natural bugs in it.” And so they had me debate this guy, and it was just pure theater, and I felt dirty. I felt bad for the guy, because the guy was goaded. It was almost like being on “Maury”, and just they’re like fluffing you up getting angry. And I get in there.
Dr. Prasad: And it’s like, “And you are the father.”
Dr. Z: That’s right, I’m like, “No!” Exactly. I’m like, “Listen, Mr. Raw Water, I live in Las Vegas.” And he’s, “You need some of our raw water.” I mean, it was the stupidest thing, and that’s what they do, and then I don’t watch that kind of stuff. Just like social media, I don’t use Facebook.
Dr. Prasad: But you really don’t use any of them.
Dr. Z: I don’t use any of them.
Dr. Prasad: You drop your thing and you go.
Dr. Z: And I leave and I engage with the audience, that’s what I use it for. But I don’t use it to share photos of me, and this and that, it’s not what I’m interested in. So what’s interesting is now is Facebook’s algorithms have gotten such that they’re trying to ding you for things other people say in your group. So we have a supporter group. It’s paying subscribers. If somebody posts something on there that’s misinformation-
Dr. Prasad: Oh, let’s talk about that.
Dr. Z: Trigger, right? Then Facebook can dis-monetize your entire group and close it down. And this happened to me with no explanation. Suddenly, I couldn’t access the group, and I’m like, what is this, and then it just so happens I have long-time contacts at Facebook, so I can email them. And they go, “Oh, this is crazy, let’s fix that. It was a false positive on our algorithm, whatever.” But what happens to the woman who does quilting? And this is her sole source of income, she’s done. She has no mechanism to appeal, it’s crazy.
Dr. Prasad: I think, I don’t know, the position we have given these companies is too much. I’ve written about it a little bit. I can’t speak to political topics, because I don’t understand them well enough, and it’s not my domain, but I can speak to scientific topics. And I guess when it comes to scientific topics, you need a scientific academy capable of discussing views that are not held by the majority, that are provocative, controversial. People who hold the majority view can always say that the minority viewpoint is killing people, because everything about medicine is about life or death. So if you believe X helps people, and I believe X doesn’t help people, and I say, X doesn’t help people, you can say, you’re killing people. And I can say, you’re killing people, because it’s about life or death. And I wonder who ought to be refereeing these things? Should it be the employees of these giant tech companies who may be, I wanna use the right word, they may often be fresh out of graduate school. And that’s not bad. Actually, the people fresh out of graduate school are often the most innovative thinkers. They’re brilliant in many ways. Creativity is probably peaking in those years, potentially.
Dr. Z: And they haven’t been conditioned.
Dr. Prasad: They didn’t learn the wrong things, but there’s some things they don’t know, which is they don’t have experience. They don’t have the wisdom that comes with being in a field for a long time, where you see how debates have gone for a long time. So the debate that you and I felt was a fresh debate in 2007, that we were alive for, and we saw how people felt about it. And now we know what it’s like in 2017, 10 years later, how did the debate play out? And when you don’t have that experience of having seen academic debates happen over the course of your career, it’s easy to say this is too much, this is too much, and not realize in retrospect some of those things are actually very prescient moves. So anyway, so when it comes to science-censoring, I guess I’m troubled by it. I’m troubled by who does it. I’m troubled by this example. I think the word misinformation has been so abused, that it actually no longer means anything. I was telling you before we started that somebody didn’t like my vaccine article, but they refused to tweet the link. They screenshot a part of it, and then they tweet that. And when I confronted this person-
Dr. Z: Cowardly.
Dr. Prasad: Who I thought was somebody who believes in enlightenment values, reason, and the ability of the audience to decide who is right. There was kind of an evasive answer as to why they didn’t link to it. But one of the commenters pointed out that we don’t link to disinformation.
Dr. Z: Oh, good Lord!
Dr. Prasad: And I was like, “Well, you know what? It’s disinformation in your eyes, but you are incorrect, my friend,” because it is in fact very correct. And I think we owe it to people to… I think more than any belief you believe in, I believe in allowing people to use their brains to figure out what’s right or wrong, and that means Facebook can’t be trigger happy with this algorithm. That means people should actually give the link to your opponent’s argument, if you’re gonna debate them.
Dr. Z: That’s the simplest thing. Put a link, “Hey, there’s an opposing view here.” That’s fine. They did that on a shirt I posted. They sell these like Alt-Middle shirts, and we have a shirt that it says vaccinated, and it’s got a 5G tower and all this. So what happened was someone got in Twitter prison for even mentioning the shirt.
Dr. Prasad: Really?
Dr. Z: Because it said 5G and vaccine, and that was all it took to trigger the algorithm to go misinformation. I’m like, “This is a pro-vaccine tongue in cheek joke shirt.”
Dr. Prasad: I saw somebody had a shirt that said, “Don’t worry, I’m vaccinated.” But now with the new messaging, they’d be like, “But still following all the-
Dr. Z: But still have four masks on.
Dr. Prasad: Every precaution I otherwise would follow.
Dr. Z: That’s right, we cut out every other swing.
Dr. Prasad: I guess to me the most disingenuous part of this debate was you know. We know a lot of doctors in our lives.
Dr. Z: Too many, I would say.
Dr. Prasad: Too many, that’s the problem, that’s bad dinner party. Everyone thinks they know every damn thing.
Dr. Z: And it always goes to medicine.
Dr. Prasad: It always goes to medicine, which sometimes I like. But I don’t know anybody who’s practicing what they preach on this issue. That’s what gets me every time.
Dr. Z: See, that’s the thing. I don’t know if it was you I was talking to about this where we say, “Oh, we’re talking about what we’re saying we’re doing on Twitter,” and the virtue signaling of the 20 masks in the avatar, but then they’re going and doing the opposite.
Dr. Prasad: Yeah, I know.
Dr. Z: And it’s because, it’s again, I think they’re using their own calculation of risk-benefit, which is what you would want them to do.
Dr. Prasad: And one of the things that is a benefit is the benefit of human connection, which it turns out is a real thing. It’s a real thing.
Dr. Z: That, and it’s hard to quantify.
Dr. Prasad: But what is the price of, I mean, your parents, they’re in their eighties, right?
Dr. Z: Yeah, my dad is, yeah.
Dr. Prasad: What’s the price of hugging your mother? I mean, it’s worth a lot of money.
Dr. Z: It’s worth and-
Dr. Prasad: It’s worth a lot of stuff to a lot of people.
Dr. Z: The parents are conditioned in fear now. Like they’re nervous even after vaccination. Should we all be wearing masks, should we? And I’m like, “Well, we gotta understand risk in the end,” and you know. What’s crazy is how bad I feel right now after the second vaccine, like I don’t want COVID. Imagine what COVID is like?
Dr. Prasad: Rough fall.
Dr. Z: I’m telling you guys right now, if you can get the vaccine, and you’re in line, in the right part in line, go get the vaccine , ’cause you do not want the full-blown-
Dr. Prasad: You don’t want COVID. No, of course not, it’s a terrible-
Dr. Z: Now what’s interesting is actually even one of our supporters, we were doing a show the other day, their child diagnosed with MIS-C. And it got IVIG and all that. And it’s interesting. It’s a rare thing, but when you have a pandemic, you still see this stuff, and then it conditions you. You’re like, “Well, I don’t want my kid to get MIS-C,” even though you know the risk calculation technically is not very high.
Dr. Prasad: Very similar to the point in the Haidt book about how at a time where child abduction was dropping to record lows, parents were most unwilling to let their kids walk to playgrounds alone. I mean, a lot has changed about the risks that parents are willing to let children take. From I’m sure when my parents grew up in the 50s and 60s, to when I grew up in the 80s and 90s, to now 2020, where the risk is very different.
Dr. Z: Yeah, it’s much lower. You’re not sitting in the back of a station wagon without a seatbelt. Everything’s gotten safer. I mean, it’s Pinkerism, right? It’s like Steven Pinker’s “Enlightenment Now”. Things are getting better, yet we don’t feel that way. Largely, because I think we have media that does that, and our own, the way we’re wired is to detect downside, and fear the risk, and threat detection.
Dr. Prasad: That’s funny you say that about station wagons, because when I was growing up we had a rule. Seat belts in the front seat, but backseat, obviously, you didn’t need them.
Dr. Z: You’re safe, there’s a seat in front of you.
Dr. Prasad: Although, we literally got in a car accident when I was a young kid, and I was in the back seat, and I ended up on the windshield.
Dr. Z: Oh my God!
Dr. Prasad: And we still didn’t wear, we still didn’t our lesson. They still didn’t learn. We still didn’t learn. You know, and it just goes to show.
Dr. Z: Well, they just had those lap belts back then too, and those will just cut you right in half.
Dr. Prasad: I don’t think that anything will be saved, those lap belts. That was another interesting, yeah, they didn’t believe in the shoulder harness in the backseat.
Dr. Z: It’s really fascinating. The world gets safer, and yet we feel the opposite. Now we have big problems, there’s huge problems. But I don’t know, man. Optimism is warranted. Look at this pandemic, dude. It’s been a shit show, but we got like five vaccines of ridiculous efficacy.
Dr. Prasad: I wouldn’t have guessed it. I have to say I would have been a little critical that it would come so quickly, and as efficacious as it has been. But you know what, people find a way to be pessimistic. Every I read the paper, it’s like, “It’s not a hundred percent.” I was like, “Oh my God, what do you want, man!”
Dr. Z: Just say the V word, variant, and the press just loves it. They’re like, “Wait, we’re running out of…” You can just imagine Mr. Burns with his cat, like just sitting there. “Well, Smithers, it looks like the pandemic’s going a little too well. What’s new, variance? Oh, excellent, variance.” Vaccine escape.
Dr. Prasad: And then even though, they talk about it, and I think it’s something to think about. However, we have Pfizer data, a pre-print, we have Moderna data showing that even the known variance, South Africa/Brazil, are covered. Although six-fold lower, still neutralizing titers are quite good.
Dr. Z: So severe disease probably prevented.
Dr. Prasad: That’s what I believe will be the case, and we shall see. So I’m still optimistic. I have an optimism, but I do know this what “The Wall Street Journal” said, I’m pretty sure it’s “The Wall Street Journal”. It said, “According to a not peer-reviewed pre-print, the Pfizer vaccine still has this neutralizing antibody.” And then I was like, this not peer-reviewed pre-print is by Pfizer, the company that made the vaccine! So you know what’s gonna happen in peer review? Nothing! It’s the Pfizer team. They’re really fucking good at this. Can I say that? They’re really good at this. They didn’t screw up. This is the answer. You don’t need to say all that not peer-reviewed. That not peer-reviewed stuff is for like the academic who’s publishing some retrospective tart review paper. It’s not for when Pfizer tells you that this is the real thing.
Dr. Z: Man, I’m so glad you went off the rails for a second, because I told Marty on the show yesterday, I go, “It’s fun to get…” When you get Vinay riled up by the end of the show, he starts going off the rails, and it’s the best thing.
Dr. Prasad: Off the rails.
Dr. Z: It’s the best thing, he’s just like, “Pfizer, fucking.” And I do the same thing, but I do it from the beginning of the show- I see.
Dr. Prasad: all the way through.
Dr. Z: I got too dis-inhibited. Well, maybe that tells us you were wrapping up.
Dr. Z: No, it’s good stuff.
Dr. Prasad: But, I mean, my point is that they’re putting in all these caveats to put in caveats, but the reality is this is Pfizer telling you this. It’s done in their lab, the same people who made the thing work. And for all the faults, I’ve been the most critical of the industry, these are the sorts of things they tend to not to screw up. They know the stakes.
Dr. Z: They know what they’re doing, exactly. Awesome, man. Anything else you wanna hit?
Dr. Prasad: No, I think we covered all the things that we are safe about to talk about.
Dr. Z: I’m sure I crossed like three or four lines. I was like, “Oh, there’s this, and then there’s that, and I’m gonna get canceled again.” It’s worth it.
Dr. Prasad: I think the less attention paid to people who dislike content the better. There’s plenty of content. And I guess the last thing I’d say is people who don’t like my op-ed, people who don’t like whatever our point of view is, write your own op-ed, write your own point of view. This is a war of ideas. I’m gonna keep fighting my war for whatever ideas I happen to believe in in the moment. You fight your war, but I’m gonna win, I’ll tell you that.
Dr. Z: I’m gonna win, ’cause I’m smarter than you, exactly.
Dr. Prasad: No, I didn’t say that. I think I have good reasons for what I believe.
Dr. Z: There you go. I mean, if you didn’t believe that, you wouldn’t take the time to write.
Dr. Prasad: That’s it. The things I’m writing on are things I’ve thought about, and I have a good reason why I think that way.
Dr. Z: That’s right, that’s right. Now, speaking of good reasons, if you guys don’t have good reason to support the show as a subscriber on Facebook. You like how I segued into the pitch?
Dr. Prasad: Yeah, you should.
Dr. Z: On Facebook, Locals, or YouTube, then I don’t know what is a good reason. But even if you don’t have that, just share the show, leave a comment, tell us what you think about what we’ve talked about. Check out Vinay’s “Plenary Session” podcast, because it’s fantastic.
Dr. Prasad: You could be the fourth listener.
Dr. Z: The fourth listener. You too could be the fourth listener, exactly. And we’ll see you next time, brother.
Dr. Prasad: Yeah.
Dr. Z: And we out, peace.