Moderna For Kids, Physician-Influencers, Stanford Nurses Strike (w/Dr. Vinay Prasad)

Transcript:

– [Zubin] Everybody, welcome to The VPZD Show! I’m ZD and this is VP. What’s up, VP?

– [Vinay] It’s good to be here. It’s been, I think, we had a week off, so it’s been two weeks, so much to catch up on.

– [Zubin] We did. We’re not those like compulsive content makers. We don’t make content just to make content. We only talk when we have a lot to say, and this week we have a lot to say a lot.

– [Vinay] A lot to say. It’s been a busy week, yeah.

– It’ll give a quick- Oh, it has. I’ll give a quick summary of what we’re gonna hit. We’re gonna talk about Elon Musk. We’re gonna talk about this Twitter Doc, Risa Hoshino. We’re gonna talk about a CDC survey that called me. I’m gonna talk a bit about the Stanford nurses strike and the difficulties around staffing these days. Fauci saying the pandemic is over.

– Ah.

– Ah, yeah.

– [Zubin] He didn’t really say that, but.

– [Vinay] Who knows what he’s saying? Who knows what he’s saying.

– I’m gonna round up. Let’s just round up till the pandemics over.

– [Vinay] Or let’s just say he did a flip flop on. Another flip flop, another flip flop. All right, yeah, that’ll be good.

– [Zubin] He’s flip flopping to what I’ve been saying, but yeah. So EUA for kids vaccine.

– Yes, yes.

– [Zubin] Approaching a million dead in the US and talking about that. And a little bit on groupthink. So I think that’s what we’re gonna try to hit. We’ll see what we actually hit. So Elon Musk buys Twitter. He’s like just petting a cat, like Dr. Evil. Just oh, excellent. Now I own America’s town square that actually hardly any Americans actually are on, but the press uses constantly. What are your thoughts on this?

– [Vinay] And the press is having a heart attack. I saw some headlines saying white supremacists, Nazis, you know, horrible people will come outta the woodwork. I mean, wow. They’re really painting it to be dire.

– [Zubin] Yep.

– [Vinay] I think they are, it’s interesting because he’s onto something, you know, Elon is onto something, that of all the social media platforms, this is the platform that I think has the most relevance for the news media. They’re addicted to it.

– Yeah.

– [Vinay] They’re on it all day. They may be writing their little articles, but in the background they’ve got Twitter open. And him buying it, I think, is that he recognizes its importance in shaping the narrative in the mainstream media. And by having, you know, sort of different rules in Twitter, you might be able to allow it to go in a different direction. And I think they’re afraid of it just because of that. But it seems to me, and the thing we gotta talk about is that, you know, the core issue, the thing that led him to acquire it was that he feels like Twitter is having too heavy a hand in determining what content should be on the platform. And he thinks the hand should be very light. It should be only, you know, if you have a serious threat of violence against somebody else, if you dox them, if you incite violence, yeah, those tweets gotta go. But if you merely have an unpopular opinion about an issue, if you say something about, you know, vaccines that may be disputed, if you say something about drugs that may be disputed, he thinks a lot of that needs to be permitted. And I think that that’s different than the way they’ve been trying to ratchet up the moderation where they really are getting stricter and stricter in terms of what you can and cannot say. And I think he’s more of sort of a classic old school, free speech guy.

– [Zubin] Right and so it’s just different ways to look at this forum, right. Now it’s a private company so you can do whatever you want, right. It’s not a government-owned entity. Taking it private allows him to, you know, control that aspect of it. But what I think is interesting is like, you know, the right is like just celebrating like, oh my gosh, Trump’s gonna be back on Twitter. It’s gonna be great. You know, and Trump’s like, I’ve already got my own. Actually, you do a better Trump than me, man. What would Trump say about it? He’s already been talking about this TRUTH-

– [Vinay] TRUTH Social. He’s like, I’m gonna stick to TRUTH Social. You know, yeah. Elon’s a great guy, but we’ve got TRUTH Social. I think he said, Elon’s a great guy. But we’ve got TRUTH social, yeah.

– [Zubin] Man, I just wait two weeks to do a VPZD Show, just so I can hear your Trump, man. It’s like disturbingly good. So, you know, those guys are like, you know, celebrating and the left, the far left in particular, which by the way, here’s an interesting statistic. I heard this recently. I forget the source. The extreme lefties and the extreme righties are actually very similar. They’re equally affluent and equally white.

– [Vinay] Really, oh, interesting.

– [Zubin] And they tend, that’s why I heard in Jonathan Haidt’s piece in the Atlantic about the Tower of Babel, yeah. And so these two fringes of white, rich people actually run the conversations online because they dominate because they’re the loudest. Whereas what Haidt calls, I call the Alt-Middle, he calls the exhausted majority.

– [Vinay] Hmm, wow.

– [Zubin] Everybody else is just like, geez, man, I’m gonna shut up because I don’t wanna get a bunch of darts in my back opening my mouth on Twitter. And so the far left on this one is freaking out saying, this guy’s an online troll himself. He’s a bully. He’s gonna make Twitter into a total shit show. I’m like, have you seen what Twitter is now?

– [Vinay] Right, that’s right.

– [Zubin] And so on and so forth. And what’s hilarious is in this setting of all this, Elon tweets this meme that kind of went viral. And I don’t know if you saw this, but-

– [Vinay] Yeah, he’s in the same spot and then the access moves?

– [Zubin] Yes, yes, yes. So it’s like the year 2008. I’ll paint the picture for people since this is an audio podcast and a news show, Vinay.

– Classic news show.

– [Zubin] Classic news show. Walter Cronkite, 2022. So in the year 2008, there’s a graph or a line, left, center and right. There’s a guy, a conservative on the right. It says my fellow liberal on the left. And then it’s got me. And he’s just left of center, just a little left of center. And everybody’s smiling. Then in 2012, you have the same graph. The guy who says, me, who’s right left of center is now a little bit more towards the center. And the my fellow liberal, question mark, is running to the left.

– Hmm hmm.

– [Zubin] And the conservative is still smiling right, in the right there. 2021 , the me is now right of center. The progressive is now way on the left. And it says woke “progressive”. And he’s just saying, bigot, and pointing at the me and the conservative on the right is still smiling, still in the same place and just saying, L-O-L. And I was like, you know, this is it. Like the left went way left and did all this crazy stuff, pushed like left center people to what now seems to be the right. And the far right is just laughing the whole time.

– [Vinay] You know, I think there’s a lot of truth in the meme. I don’t know about, you know, where Elon falls on it, but there’s a lot of truth in the meme, which is that, you know, what it means to be a progressive has shifted a lot. And the extreme left politics is off-putting to many people. I mean, one of the characteristics of the extreme left politics is not just, you know, we want X, Y, or Z. It’s that if you don’t want what we want, you’re a horrible human being on par with the, you know, the worst people in all of human history. So it’s sort of this really extreme kind of splitting. And I think that itself is very off-putting. I mean, if you’re trying to build a coalition and you call anyone who even slightly disagrees with you, a bigot or some other sort of extreme term, how are you gonna build a big tent? I mean, it’s not a strategic position. I really don’t understand it, but that’s what’s-

– Yeah.

– Been popular these days.

– [Zubin] It’s a real, this is sort of the pathology of the natural evolution of sort of these human stages. So this multicultural pluralism progressivism that started in, that really kind of attained critical mass in the sixties, and now is the dominant paradigm in the West. It really is. Kind of superseded the pure scientific hierarchical rationalism that preceded it. Now it’s more like, oh, you know, all these views, actually, we gotta consider and so on. All of that’s great, but when you start to hit the apex of that, and it becomes the cultural norm, you start to see the shadow side of it. And I think the shadow side of it is this closed-mind, you know, everybody’s a racist, if you’re not thinking the same way. Now, what’s interesting about this though, is there’s a level, you know, the level prior to this sort of rationalist enlightenment stage is this power stage where it’s all about might equals right and it’s a pure dominator hierarchy. And you talk about old tribalism and that kind of thing. And looking at like, this is one of the interesting epiphenomenon of this. If you look at what happens in Russia and Ukraine, and what happened to the group minds around the West and the Russian sphere of influence and how this played out, you can actually look at the West actually kind of rallies around this idea that, no, wait, we actually are this multicultural human rights, progressive kind of ethos even containing different ethoses that aren’t fully aligned with that. But as a group mind, this is how we think. And when Russia is in a more power-like might equals right, Putin’s more of a tribalist, like, I’ll just take over this country and so on. And what happened instantly was the entire West solidified in a group mind around, no, this is not okay. And in fact, acted so incredibly rapidly to shut, you know, shut the economy down, to have these sanctions to start delivering arms. And there was a lot of alignment in the West, and that’s the kind of example of how a group mind emerges around an ethos like this multicultural, progressive, you know, “Green Meme”, if you read Ken Wilber. And it happened very fast. Whereas the Russia power sort of meme is so outdated that the West just immediately rejected it. So even though there’s a lot of pathology in that sort of, you know, progressive arm, there’s also a lot of, like Putin just assumed he saw like, he’s like, oh man, this is a West that would put their pronouns, you know, in their military. Like, they’re so weak. Like, all I have to do is do this and they will back down instantly, but he doesn’t realize that actually it’s a more advanced way of thinking when it actually functions right.

– [Vinay] Yeah, it’s interesting.

– [Zubin] So, I thought it was interesting.

– [Vinay] I guess I’m curious if, like, I don’t know. I mean, I feel like, I mean, I totally agree with your characterization of that. The response from the West has been, you know, rather, you know, by Western, by the modern standards, quite unified, you know, and quite, you know, forceful and powerful, but I guess I feel like I wanna credit the West Centrist. It was the Centrist that we’re able to do it because I think that even on the extreme left side, they’re the ones who want to go even further and create no-fly zones and push us into World War II. Am I wrong?

– Oh, yeah.

– [Vinay] You know that there’s some of those were not.

– [Zubin] No, no, you’re not. No, you’re absolutely right. Actually, let’s clarify this because even when you say a Centrist, a Centrist in the West is still full on in that post-

– [Vinay] That culture progressive, right.

– [Zubin] Exactly, exactly, so you’re right, so you’re right. But the far left would, oh, let’s have NATO with no-fly zones. Let’s end up in a conflict that, okay, so this is where, this is where I, this is where it becomes existentially threatening. You have these group minds that emerge from the sum of their parts that are unapparent to the parts. So you and I are both neurons in this great Western mind that arose, you know, and that we don’t really directly control, but we’re like little neurons in it. You know, we like, and we dislike and we vote and we do that. Those are our neurotransmitters. But now you have this big Western mind that has risen up in response to Russia’s actions, but then you have the Russian group mind, which is actually much more controlled by media and so on directly by the Russians. And the thing about group minds is they don’t have a corpus callosum that connects them. So now you have actually a situation that may be even more dangerous than the Cuban Missile Crisis, because in those days, you at least had some conversations happening. Now you have these social media enabled and media enabled group minds that you could see, they don’t understand each other at all. And one nuclear provocation, they’re just gonna be like, well, let’s just bomb these people into submission. You know, it’s a dangerous situation.

– [Vinay] So dangerous, But back to the Elon point that I think led to this, I mean, to your point, I think people who are on the far right, some of them may be celebrating. I don’t think they should be celebrating. And people on the far left, I think are the ones that are feeling kind of crushed by it. And I think maybe that is actually a little bit more accurate, but the real winner is probably most of us who are in the middle on all these issues, who, you know, because the thing about the censoring that Twitter was doing, this platforming, I guess the stuff that I’ve seen at least in COVID-19 space, some of the things that have been labeled as misleading or false, or, you know, or led to like locking people out of accounts, they’re not really crazy views. I mean, they’re views within the range that are, I think, are reasonable. You know, the lockdowns are harmful. That, you know, maybe cloth masking two-year-olds doesn’t work. I saw somebody got in trouble for that, or for saying that this person said something like most immunocompromised people are not at as high risk as they think. And, you know, that’s a really sort of debatable claim because how do we know what they think, you know?

– Right.

– Right. And a claim like that, like most immunocompromised people are not as high risk as they think. I mean, it also might mean that somebody might feel like I have a little bit of exercise induced asthma. I also am immunocompromised, which I think would be, you know, a stretch. You know, so it’s a defensible claim. It’s very vague and broad. And I saw somebody got punished on Twitter for saying that. How can Twitter go in to start to police the very gray kind of language like that? Who knows? I mean, you know, ZDogg, you’re not as high risk of a heart attack, as you think. Is that true or false? You know, how do I know what you know, you know what I mean? It’s like, it’s an indisputable claim. I see you running all the time. You say, you know, you’re trying to watch your weight. You’re not as high risk as you think. You know, if I said that to you, could you censor me? Actually, I’m exactly as high risk as I think. You know, how are we to even process such a debate?

– [Zubin] Oh, and exactly, and how can you let, so they say, well, okay, well, big tech was making the decision by committee before. Now, it’s big Elon, one guy, a billionaire. And so the argument is, well, you know, how is he gonna set up the moderation?

– [Vinay] Yeah, I guess, the difference I would, I mean, at least I think, how he would articulate it is previously, it was a committee of, you know, frankly nitwits. I mean, it’s a committee of people who just aren’t qualified to do it. And what he will say is that probably when you make rules that are more objective, like the rule is, okay, I cannot tell my followers, attack ZDogg, you know, hurt ZDogg. I can’t tell them ZDogg’s address or any personal information, okay. That’s the rule, right. You know, no doxing and no calls for violence, but I can say, you know, I love ZDogg. I think he’s a once in a generation talent or Zdogg, he’s an imbecile, et cetera. You know that to me, you know, if that’s the rule, no violence, no doxing, it’s more objective. If the rule is-

– Yeah.

– [Vinay] You know, I can’t say that ZDogg overestimates his risk of cardiovascular disease and that’s misinformation. You know what I mean? Like that’s-

– Right.

– [Vinay] That’s very subjective. And what we have allowed is the Twitter, whatever this group of people led by that lawyer who, you know, got embroiled in all this, the group of, you know, do good. First of all, they’re generally young people, young people who believe the world would be better if we had more moderation, content moderation. They’re moving into really, really murky, gray, subjective places and trying to create rules, which is impossible. Those rules will always be arbitrary, about power. They can be misused. They can be used by people who don’t know any better. I think Elon would say, I’m trying to make a few rules. My rules are much more objective. So that’s why it’s better.

– [Zubin] Yeah and you know, again, none of this addresses the issue of the fundamental problem here, which is there’s not enough dialogue and there’s a lot of like groupthink and shouting at each other and virtue signaling, which brings us to the next topic of conversation, which is related to all this. So someone sent me this piece by Sarah Burwick, who wrote on Substack, “Who is Risa Hoshino?” Were you able to look at this?

– [Vinay] I read it, but then, you know, like a lot of things, when you start reading something and it gets half, I got too queasy.

– Yeah.

– [Vinay] I got so queasy reading it but, you know.

– [Zubin] It’s bad.

– [Vinay] I mean, my one line summary is there is a person who is sort of a #ZeroCovid person, mask in your sleep, kind of, you know, an extremist in that sense, who was tweeting repeatedly, that the things they had learned from their frontline experience and that upon further pressing this person, you could not identify frontline experience that was commensurate with the claims made, ’cause this person wasn’t really working as a doctor as they described it.

– [Zubin] Yeah, that’s roughly correct. And again, I don’t know who this person is. I have not gone and investigated any of these claims, but Dr. Risa Hoshino, who’s a pediatrician, finished residency, I think in 2017, has been all over the internet, Instagram, et cetera, as a quote, unquote, influencer that came to prominence during COVID and has, you know, the tweets that were sampled here are, you know, the standard Covidian kind of angle like-

– [Vinay] Yeah, Covidian philosophy.

– [Zubin] Like one tweet says, if you had to listen to crying children all day, who are devastated that they may never recover from long COVID and not being able to tell them that everything will be okay, would you still not wear a mask, and then a mask emoji.

– [Vinay] You know what? I want to pause you one second there.

– [Zubin] Yeah.

– [Vinay] This kind of rhetoric is so stupid in a few ways.

– It’s the dumbest.

– It’s the dumbest, okay.

– [Zubin] It pissed me off so much.

– [Vinay] I mean, a few things we could say. One, the CDC’s estimate last week says that children have a 75% zero prevalence for COVID in this country.

– Yeah, exactly.

– [Vinay] Okay, so many of them have already had it. Number two, almost anybody who is a thinking person realizes that eventually 90 plus, 95 plus percent of people in the world will get COVID. And so is long COVID in kids a problem? I think the evidence is very weak. I don’t just think that, Lars Hemkens has a meta-analysis proving that it’s weak. We don’t really know, but whether it’s a problem or not, it’s inevitable. All the kids are gonna get COVID. And to what extent long COVID exists, we’ll have to deal with. So wearing a flimsy cloth mask over your earlobe, while you eat a bag of pretzels on an airplane, you know, that’s not gonna stop the quote, kids from cry. And by the way, such a dramatic image that it just smells like it’s not true, right, yeah.

– [Zubin] Absolutely, and you know, this is again, the classic posturing and virtue signaling about this stuff. Let me me read a couple more just ’cause they’re really good.

– [Vinay] Okay, oh God.

– [Zubin] And then we’ll see what the claims are here. So not sure how someone can tell me to my face that, quote, COVID is over as I stand there in my scrubs, N95 and face shield, exhausted from treating all the COVID positive patients who are either severely ill or have long COVID. Unless you’re us, you’ll never truly get it with a face palm emoji, #stopthegaslighting.

– [Vinay] What is a face shield for, by the way? What’s that do?

– [Zubin] It’s a great question. Because she’s got makeup on it and it needs to be protected against spatter ’cause she’s an influencer and this is important because the influencers, male and female, are generally attractive, more attractive than your average doctor that you’ll see in the clinic.

– [Vinay] Hey, do you think I have what it takes to be an influencer?

– Dude. I have been. I have been saying that you should get an Instagram account and just start taking-

– [Vinay] I don’t have scrubs that are tight enough.

– [Zubin] Dude! Just go out on the beach in a banana hammock and just pose.

– [Vinay] So, you know, that’s something that Twitter needs to censor, if that was. Now that’s where I agree with content moderation. It needs to be blocked from the internet.

– Exactly.

– Oh God. No one wants to see that.

– [Zubin] That’s where you’ve doxed your own genitalia. Like, you can’t have that.

– [Vinay] I wanna report this tweet for abuse on my audience. Listen, so, you know, one interesting thing that came up related to this was, you know, in the course of the many weeks that I spend rounding, you know, we’re often summoned to the bedside of somebody with COVID-19 and typically it’s blood clot because I’m a hematologist so that’s why they want me there. And you know, I wear my N95 and somebody made this excellent point that everyone was up in arms on the airplane thing. You know, now that they stripped, they did away with the airplane, you know, intermittent cloth mask mandate on the airplane. And they’re like, you know, you’ll never really be safe on an airplane, Z, unless that guy next to you also wears the cloth mask, even if you wore an N95. And then this person pointed out on Twitter that, you know, we go into the patient’s rooms all the time, the patient often isn’t wearing a mask.

– Right?

– Yeah.

– [Zubin] And we’re wearing an N95.

– [Vinay] And it’s good enough for a person with known and active COVID filling a dank, 12-foot space with COVID plumes.

– Yep, yep.

– So anyway.

– [Zubin] Or tuberculosis. I mean, like we’ve done, this is a precedent. Now what’s interesting is so she said a lot of interesting things and the punchline of this is great, but she says nine-year-old patient; sorry Doc, I lost my train of thought again. She used to be a completely healthy A+ student and star athlete. This is a nine-year-old. But she got long COVID and she’s now struggling in school, cannot walk upstairs and has constant fatigue and palpitations. Please mask and vax for you and her, okay.

– [Vinay] I guess the other thing I wanna say is everyone keeps telling that the vaccine prevents long COVID. Where is the data that that is true?

– [Zubin] Where’s the data on that?

– [Vinay] Where’s that, I’ve never seen any such data.

– [Zubin] And how can you conclude in a nine-year-old that she’s losing her train of thought? That’s what nine-year-olds do. And a A+ student.

– Sorry, I’m sorry. I forgot what you were saying. What were you saying? I mean, that happens to everybody, you know.

– [Zubin] She’s nine, like my 10-year-old, how do you even call her an A+ student? She’s in elementary school.

– [Vinay] But let me ask another question. Let’s say we got a nine-year-old in the office who does describe, like, I don’t feel as good as I used to feel or something like that, you know?

– [Zubin] Right, yeah, yeah.

– [Vinay] How do we separate? Are those symptoms attributable to having had, I’ve heard these people say that they could have even had like an asymptomatic COVID, not felt anything. Right?

– Right. And now they have all these symptoms. The other thing that happened to this nine-year-old, Z, is you close your school for 18 months.

– [Zubin] Exactly what I was saying.

– [Vinay] You don’t let them go on play dates.

– [Zubin] Yep.

– [Vinay] You make them sit in the house all day, looking at the window. I saw somebody tweet that the only, my toddler’s only friend is the dog, because we don’t have play dates. I mean, this is like cruelty to children, deprived of a childhood, which is causing the symptom, then.

– [Zubin] Okay, so a nine-year-old is a highly empathic creature is absorbing all the emotional energy around them. And here you have bat shit crazy parents. And I say this with love because they’re all my colleagues and friends and including me at sometimes, that are energizing this child with anxiety and the schools were closed and there’s no play dates and there’s too much structured time. An A+ student and star athlete at nine ought to just get the fuck out into the world and play with their friends in the street, like, why are we making them be a star athlete at nine, right? So anyways, but who knows, what’s really going on here. The punchline of all these tweets and they get worse, the tweets are progressively insane. This woman actually interviewed Paul Offit at one point, was cited as one of the more influential people on Instagram and so on, until Sarah investigated. Okay, what does she actually do? She’s affiliated with Mount Sinai or something, but it turns out she was not on the front lines the way that it was described and was actually in the public health department for schools in New York and so on and so forth. And you go, okay, maybe there’s something here. Well, the proof is in the pudding when she deleted her Instagram, Twitter and disappeared. And she’s now unfindable so, you know, this is again.

– [Vinay] But to be fair, you know the feeling that just because you delete the account, doesn’t mean you’re guilty.

– That’s true.

– [Vinay] Doesn’t mean you’re guilty. You deleted your account out of innocence.

– [Zubin] That’s true but I did a video about why I deleted it.

– Correct.

– [Zubin] As far as I can tell, has disappeared now.

– [Vinay] Well, yeah, I mean.

– [Zubin] There may be an explanation.

– [Vinay] No, but I mean, the way the article was written, I felt like it is very likely she’s guilty on all charges . However, the fact that she chose to hide, I think, even if people are shitting on you for something true or false, I can understand why people would wanna hide. So I don’t say, that like that to me is not the tell-tale. But the fact that like, you know, there’s no records of all these things that could easily be falsified, yeah. But you know, it’s interesting. The whole thing is interesting to me. I mean, obviously, you know, this is an extreme example of something that’s quite common. And let me pull out a few threads and see if you agree, the common threads. Number one, you can gain a lot of followers by having a inflexible and intractable Covidian position. There are lots of people.

– Yep.

– [Vinay] Okay, number two, although health policy should be decided by the sober appraisal of population level evidence, and thinking about unanticipated consequences and even distant consequences, people are emotional and they often respond preferentially to anecdotal stories. Okay.

– Yep.

– [Vinay] Three, telling such anecdotal stories in pursuit of your zealot philosophy will enhance the follower gain over time.

– Yep.

– And four-

– [Zubin] You nailed it.

– [Vinay] There’s no way to test the credibility of whether or not your bullshit stories are actually true or not. Yeah.

– Yes. And I will add number five, many doctors, quote, unquote, physician influencers, on social media, fall into this category of unconfirmable stuff.

– Of course, of course. They’re just like, it’s like a whole business of unconfirmable bullshit stories and threads and sick-

– [Zubin] Absolutely. Now remember you can become famous, too, and have a lot of supporters and a lot of juice for being a, in the antithesis tribe, as a physician, so.

– [Vinay] Okay, no, go on, go on, yeah.

– [Zubin] Yeah, yeah, and to some extent there are, you know, like you look at the Malones and the McCulloughs as extreme examples, and then you can look at, you know, even someone like Jay Bhattacharya who came to prominence taking a more antithesis, Centrist antithesis position. But again, he’s actually a health policy guy and yeah.

– [Vinay] And let me put lines in between even those two people like the Malones and the Bhattacharya, I mean, I guess I would say that you can definitely come to prominence having a hard line, other position, you know, sort of other position. The differences I see are some of those people use a lot of personal anecdotes. I knew a girl who got a vaccine and now she’s in a, you know, whatever situation-

– Right.

– But you know, just the dumbest thing I’ve ever heard. It’s just as bad as saying I knew a nine-year-old kid who’s feeling sad because of long COVID, you know what I mean?

– Yeah, right. Right.

– [Zubin] But with a guy like Jay Bhattacharya, you know, and my impression of him is that’s not his style of argument. It’s always like as a health economist, who’s reviewed multiple empirical studies of the importance of schools and someone who studied the IFR in children, I conclude that the net benefit is in favor. And I think the way you and I reason is often by sort of trying to draw upon, that’s why we call it a news show, empirical studies, I think.

– [Zubin] Yeah, for the most part. And also just kind of taking an epi look at like, how are people behaving? I think that’s an important thing on both sides of this thing. And why are there even sides, right? This should be a healthy, rigorous, scientific debate. We should be doing studies to try to confirm and elaborate on the, do these masks work? Like what’s going on, you know? How many cases? Like wow, the CDC actually has zero prevalence data on kids and says 75% of kids have already been infected with COVID. So that brings us probably to maybe another topic of conversation here, which is vaccinating children, the EUA for kids, maybe.

– [Vinay] Wait, one more thing on this, I wanna beat on this last thing. We’ll come to the EUA. I guess the other thing I would say is that I think there’s a lot of people who are on the spectrum of this kind of emotional abuse on that side, more than the other side. I mean, I do think there are fringe elements who are, you know, I mean, certainly there are lunatics who say, vaccines don’t work, you know, a 60-year-old shouldn’t get vaccinated, you know, there are these lunatic on the other side, right.

– [Zubin] Yeah.

– [Vinay] And by the way, you know, and somebody was like, oh, are you sure? I’m like, just look at the raw numbers, people. Come on, anyway.

– Yeah.

– [Vinay] Okay, so of course, like adult vaccination for someone who has not yet met the virus is a very good thing.

– Yep.

– [Vinay] But on, but I do think Twitter, like, let me put it differently, among all the people who are actually trained in biomedicine, I think the net vector of bias is towards the Covidian camp. Does that make sense? Is that fair?

– Yeah, I think that’s right.

– [Vinay] Like among the general population of Facebook users, I have no idea where the net vector of bias is, and if you actually showed me within the like anti-vax direction, you know, I wouldn’t disagree with you among like the general population, but the net vector of bias among the people like this person, or like, you know, she is a doctor, I think.

– Yeah, she is.

– A pediatrician.

– A pediatrician. She did complete the training. So I mean, the bias there is in that Covidian direction.

– [Zubin] Yeah.

– [Vinay] And I think that their reach and impact in the media is more than the other way. And their ability to use institutional power is stronger. So they’re the reason that like Stanford University is threatening to deport people who don’t get boosted, you know, kids on visas.

– Yeah.

– [Vinay] Their ability to create a federal mandate and fire federal employees, you know, they have more of the reins of power, real power in America, not the power to go on Facebook and talk shit, but the real power to use the levers of government and institutions to get people to comply. And so for me, the reason I single out there, I mean, I talk more about their, and also they should be better educated ’cause they’ve done all this stuff, but they’re often, you know, quite foolish about these things. And so to me, that’s a bigger problem. And I think a lot of them maybe who do see patients like, you know, maybe her stories are more dubious, but even people who have less dubious stories, I think they’re incorrect for using the stories. I mean, it’s an emotional manipulation. If you really wanna argue, you need to use data. And you know, I can tell stories, too, but I almost never tell stories. I find it, one, I find it rude. I find it distasteful. And I find like, I don’t wanna persuade someone by the wrong thing. I wanna persuade ’em with the content of the argument and not like some anecdote of a patient I saw five weeks ago or somebody who, you know.

– [Zubin] Appeal to emotion and anecdotal stuff and all of that. Yeah, I think you’re right. And that’s why we tend to, you and I in particular, tend to call these folks out and I hate to even the term call out, but like, you know, just like people will say, oh, you guys are so like, why don’t you talk this about kids instead of constantly focusing on myocarditis or whatever else you’re talking about. It’s like, well, because everybody else is pounding this thing of like, well, we can prevent long COVID, and we can do this and we can do that. And it’s like, well, 75% of these kids have already been infected.

– Yeah. And one more thing there, too, is that like the anti-vax person is not passing a law that makes it illegal for like me to get a vaccine if I wanna do it, you know? I mean, as bad as they are, they’re persuading people, maybe wrongly. They’re not passing laws that prohibit by law that like you could get, like, ZDogg’s not allowed to get a booster by law, you know, in Georgia or whatever the hell state that is.

– Right.

– Okay. But meanwhile, the zealots on the other side are literally passing the law.

– Passing laws.

– [Zubin] Yeah, like if you don’t get boosted at Stanford, you get thrown out of your remote astronomy program, you know, like what the hell? I mean, like a 22-year-old guy who has Omicron, his nose is still running. You better boost up buddy, or you’re gonna thrown outta the program. I mean, so they’re abusing the power. I think it’s really different, I don’t know.

– [Zubin] Yeah, no, no, no, no, and that’s the discussion, right. But, you know, again, there’s a guy, they run this podcast called “Decoding the Gurus”.

– [Vinay] Oh yeah, yeah.

– [Zubin] Yeah, it’s kind of a Covidian bias a little bit, but I actually met Chris Kavanaugh, one of the guys who does it on a show that I did recently with Peter Limberg’s “The Stoa”. We were talking about this culture war stuff. And I think Chris is very well intentioned in that he does, ’cause he studies cults and things like that. There is a component of the Covidian side of this, of the antithesis side that has kind of, has these kind of, he calls it the gurometer. So these kind of guru metrics that kind of bring them to prominence, like Galaxy Brain, like they feel like they have these things. They’re connecting all the dots and the conspiracies and so on and this kind of cultish kind of thing that they do. And an ingrained anti-establishment sort of piece, constant grievance-mongering like, oh, you know, they’re treating me bad. And the media’s treating me bad and Twitter’s treating me bad. And, you know, I found sometimes I actually display some of these things. I was like, I’m scoring a non-zero on this gurometer, self aggrandizement, narcism, Cassandra complex, the idea that you have a revolutionary theory, conspiracy-mongering grifting. And so there are these components and I think they’re more common in the antithesis wing, but if you look at the Covidian wing, I think there’s some of this, too , because they kind of blow up the opposition as this terrible existential threat to the world when they actually have all the power. So, yeah, it’s really interesting. There’s a lot kind of to dive into these weird things and to self-reflect on, too, go, oh, you know, are my supporters a little bit of a cult? Possibly, maybe I have to have a word with myself on that, yeah.

– [Vinay] I mean, the support is hard to control. The Rita, I mean, what’s her name? Risa?

– Risa.

– [Vinay] Oh yeah. I mean.

– Hoshino, yeah.

– [Vinay] I mean, it also goes to show you that look at how people will like retweet and promote someone they like don’t know anything about and-

– [Zubin] Yeah, that’s the other thing. Yeah, it’s really tricky. You know, Marty does that every now and again, he’ll retweet something ’cause he’ll agree with the basic premise of the tweet. And then it turns out to be like an anti-vaccine organization or something. And you’re like, oh shit, I didn’t know what the they did, but this statement is correct. And I’ve fallen into that before, too. So kind of related to that, then, this looking at kids and the emergency use authorization for vaccines in kids and Moderna is now pursuing, oh, could we be the vaccine? I mean, of all the vaccines, right? Moderna wants to be the first for young kids. It’s like, well, let’s see, the most myocardialgenic-

– [Zubin] It’s like, when you think about the youth, you think about Moderna, Moderna! It’s good for what ails.

– Good for what ails ya.

– [Vinay] Good for what ails you.

– [Zubin] In Europe, they won’t even give it to anyone under 30, in certain European countries. It’s like, well, okay.

– [Vinay] My heart aches for Moderna.

– [Zubin] Yes, they’re only gonna make $20 billion this year, you know?

– [Vinay] They’re such a little, mmm. You know, they’re such a little, I know what they’re up to. You know, here’s what I think they’re doing. You know, they know that Pfizer’s got delayed ’cause they got the third dose. Right?

– Yeah.

– [Vinay] And they smell an op and then they know that the FDA announced last week, they wanna get both of their applications side-by-side to compare. And they know that if you do that, I think, you know, they’re very likely, no, I mean, I don’t say that. I will put it a differently. I’d say there is some possibility that the FDA Advisory Committee is like, oh, well we think it’s more prudent to do three micrograms of Pfizer rather than two 25s of Moderna. Sorry, yeah, two 25s of Moderna. Right, so they’ll think it’s more prudent to do the Pfizer vaccine. And so then they’re not gonna get the market share, but if they pressure the FDA to make a decision right now, real quick and they get all these, you know, 20% of parents who would like, you know, they’d flip a car to get a vaccine for their two-year-old to put pressure on the FDA, they got an opportunity to kind of snatch up some market share. And then the other thing about this market share that I think is interesting is like the market share is only gonna be there for like three weeks. Like there’s a group of parents who wanna do it real quick for their kid.

– [Zubin] And then it’s gone.

– [Vinay] And then, that’s 20% and then they’re gone. And then there’s 80% of people who are like, don’t wanna do it or wanna wait to see, and they’re not gonna rush. And so if Moderna comes in three weeks before Pfizer, they get their market share and then they’re out, you know, and let Pfizer pick up the crumbs.

– [Zubin] Yes, it’s some gaming here. And actually that brings me to the point, like what’s the percentage of kids five to 11 that are actually vaccinated? It’s quite small.

– [Vinay] I think it’s like 24% or something.

– Yeah.

– Yeah. And like the most of it was like in the first, like exploded, like-

– Exactly.

– [Vinay] You know, rushed and then now everyone’s like dragging their feet. And now finally, do you see that, like, you know, I’d written all those op-eds in the fall, like school vaccine requirements are, you know, problematic. You wanna bring these kids into school, that’s the priority, not pushing them out, et cetera. And now LA, the superintendent of schools, is saying the same thing that, that person in the California assembly has decided not to push that bill, so.

– [Zubin] Oh, Stephen Pan, who was actually on my show.

– Oh yeah.

– Richard Pan, Richard Pan.

– [Vinay] The Pans.

– [Zubin] Yeah, yeah, yeah, Richard Pan. Yeah, it’s funny, it’s funny. Richard Pan was on my show. We were talking about childhood vaccines and the importance of them. And you know, he’s a politician. He’s a democratic legislator, legislator in California. And so, you know, when I interviewed him, he was very, very nice guy, by the way, in person, came over to my house when I was still shooting at my home and had all his bodyguards and security and everything at my home, which is part of the reason I ended up getting a studio, ’cause I was like, this is uncomfortable. At some point I’m gonna be murdered. But you know, we had the conversation and I thought it was reasonable, but it was very kind of militant pro-vax without a lot of nuance and that made me a little uncomfortable. And I think during pandemic, I’ve seen some, you know, folks like that, that are pro, that are anti, anti-vaxers, right. That it’s just, it makes me cringe a little because that’s not how you’re gonna influence people. It’s how you’re gonna build your own tribe. It’s the same as the Risa Hoshino thing. Like who’s gonna be influenced by the shit you’re saying? Like, who’s really gonna change their mind because you did some shit on Twitter?

– [Vinay] You know, I wanna go further. Like, you know, if something’s like, if you wanna be a medical influencer, you know, pick something that is like a settled science, like exercise and go influence about exercise. Try to get people up and about, you know.

– [Zubin] Yeah, and people do that, yeah.

– [Vinay] If you wanna be an influencer, don’t pick a pending emergency use authorization waiting for ver back review. What the fuck are you picking that for? You fucking influencer. You don’t understand the issues at stake. You’re not qualified to influence. They don’t just need some, you know, good looking person to sell this. They need somebody whose brain is working to analyze this. What are you talking about? We don’t need you.

– Yeah, yeah. I mean, it gets to that whole thing about influencers on Instagram and Twitter, physician influencers. You know, some of them you look at, and they’re just saying like the right things in general, like you should eat less, exercise more, watch your this, do that, meditate. I’m like, great. I mean, I could tell you that, but I’m glad that a good looking doctor with a stethoscope wearing scrubs is doing it ’cause maybe there are some muggles, non-medical people, who will listen. That’s great. But you’re right about this kind of thing. It’s like, ooh.

– [Vinay] This is like being an influencer for how to run a nuclear power plant. Like, oh! How should you run your nuclear power plant? I’m here to show you five easy steps. It’s so easy. Just remember these rods are dampening the nuclear chain reaction, you know, and you’re like, Jesus Christ! It’s like, you know, they need someone to be influencing this who knows what they’re talking about, person, you know,? Like influencing live vaccine safety decisions. That’s not for influencers. Stick to, you know, I don’t know, how to brush your teeth or you know, how to keep your skin looking youthful, I don’t know, the things that are frivolous that no one really cares about, influencing this.

– [Zubin] Man, that’s.

– [Vinay] The influencing the war in Ukraine. Here’s how I would move the anti-aircraft missiles. You know, anti-aircraft missiles. I was like, what?

– [Zubin] Oh my God. You know, what is interesting is when the Russians took over the Chernobyl plant, they were so clueless as to what, the frontline soldiers, as to what was going on there. They started digging trenches in the Red Forest, this most highly polluted place on Earth in terms of radio activity and they had to leave because of radiation sickness, according to reports from that. And it’s kind of that’s the same thing. It’s like, you go in not knowing what the fuck you’re doing. It is rocket science like that is, it’s new nuclear engineering.

– [Vinay] Did you watch HBO show, Chernobyl?

– [Zubin] Oh, it was the most terrifying thing I’ve ever seen.

– [Vinay] And that scene with like, who was it, Stellan Skarsgard, where he was like, we need a few of you to go swim through the water.

– [Zubin] Oh yeah.

– [Vinay] And then he was like, and then like, I need a volunteer. And then he says, and then like nobody wanted. And then he’s like, our people have suffered for thousands of years, but we have always rose to the task. Who volunteers now? And like all the hands, yeah.

– [Zubin] And they all step forward, man.

– [Vinay] That’s hardcore.

– [Zubin] My AP European history teacher, who I still kind of cite as a big influence because he was such a character. He used to call it the Slavic mentality. It’s like this kind of like, hey, we have suffered, we’ll suffer again. We’ll do what it takes to get stuff done. And yeah, watching Chernobyl, it was like that, those coal miners who dug tunnels under the plant to install that stuff. You’re just like, oh my gosh. So you know, and then you have an organization like the AMA that’s like trying to be super woke and is writing these crazy things about this stuff. And you’re like, well guys, like, man, this feels very incorrect as to the battles we should be fighting right now. You know?

– Oh yes. They had their, right, oh, they lost their focus on so many things. What else did the, the AMA did recently? They did something else that was crazy. Can’t remember.

– [Zubin] Dude, I mean, just take your pick. There’s a lot. You know, it used to be, and AMA is responsible for a lot of terrible things. Like, you know, keeping African-Americans out of medicine, keeping supply physicians very low so salaries could be up. And now we’re in a situation where we’re short. You know-

– And, and! Like, the entire rates, differential pay rates between disciplines are all supported by all this kind of AMA lobbying and professional lobbying. The reason why primary care is like stagnating and nobody wants to do it is because, you know, they siphon away the money.

– [Zubin] A thousand percent, yes. And AMA actually funds itself through CPT codes. They patented that.

– Oh, they patented the CPT?

– [Zubin] Yeah, yeah, so the very aspect of billing that we hate the most, they created, which actually gets me to the Stanford nurses strike.

– [Vinay] Stanford nurses, yeah, what’s going on there? I don’t know anything about this.

– [Zubin] Yeah, I’ll fill you in as much as I know. And I’ll say this, people ask me to talk about labor disputes between nurses and management, for years. All around the country, there’s a strike. I get an million emails from nurses saying, can you support us? Can you say something? Can you do this? And generally I say, look, you know, I support nurses. You know, I support frontline healthcare professionals because I’m, you know, I’m in that tribe, but I’ve also been in management, right, running a clinic. And so I know the tension and I know that you have to get all sides of a story if you’re gonna talk about it properly, as much as you can. And so with labor disputes, I tend to stay out. I go, I can’t really, I’m not gonna go there and picket with you. I’m not gonna stand at the front because I have no idea what the real issues and details are.

– [Vinay] Hmm hmm, right.

– [Zubin] And so I’m gonna violate that premise for this thing, just to talk about it, because I think it’s important in the context of the pandemic. And so the Stanford nurses have a union called CRONA and it started in like 1966 or so when it was actually illegal for nonprofit hospitals to have staff unionized. And so it was this committee for recognition of nursing appreciation or nursing achievement. And so they started as a nonunion actually, because they had to, and then it evolved into a union and in their entire history, they’ve only striked previously twice. And one was many years ago in the seventies. And the second strike was when I was a resident, a second year resident or finishing first year.

– Wow.

– Yeah, it was 2000. And I remember that strike very vividly because you have, it was really interesting, Vinay, because, you know, we didn’t know anything, we’re just residents. All we know is that there’s a vaguely antagonistic relationship you can have with nurses if you’re not careful when you’re a resident, right, ’cause they’re calling you in the middle of the night and so on but at the same time, you know, they’re teaching you the game and if you don’t learn from them, you’re a fool because they’re there at an academic institution, seeing complex patients for years, working with everybody. And they have to be a little bit standoffish with you because they’ve seen such a variety of different residents and they can behave like jackasses. So there’s a certain ethos. So when they walked off for their strike, which had no time limit on it. It was just like, we’re gonna go on strike and we have these demands, they brought in a bunch of travelers to replace them. And it was a instant shit show because these are sick, complicated patients and complex systems at a major academic tertiary center. And at the same time, there was a massive culture change overnight. Suddenly you have community nurses treating residents and interns like community doctors. So imagine what that’s like. Suddenly they’re like getting us coffee and bringing us, you know, bringing us to chart and saying, yes, sir and this kind of thing. A lot of them were from the South. There was this politeness. And I tell ya, a lot of us were like, oh, this is what it’s like in the community. Like, wow, like this is dangerous in an academic institution ’cause we’re idiots, but it’s kind of nice. Like you were like, wow, like everybody’s so nice in this kind of collegial. You know, it lasted a couple weeks until those nurses picked up the fact that we didn’t know what we were doing, but it was interesting. So there was that culture shift. But the problem with that strike is it lasted something like 60 days and it was an ordeal. It was traumatic for every single person involved. And so there’s a lot of like residual trauma from that strike and I don’t know what the ultimate decision was. So now here we are, post-COVID, and the nurses are saying, listen, during COVID we’ve had to work overtime because we’re understaffed. This place runs on our overtime. We’re exhausted. A lot of us have had COVID and had to take sick leave and now our vacation is affected so we don’t have the time off. We don’t get resources for mental health purposes. Like many of us are traumatized and have these issues. And we have to pay out-of-pocket for a therapist, that kind of thing. The staffing is still terrible because it’s not based on acuity even though there are staffing laws in California, which nurses would kill for in other parts of the country, There’s still acuity where it needs to be one-to-one. But the law says, you know, two-to-one in ICU because the patients are so much sicker and so on, you know, inflation cost, retaining high quality nurses that working on ECMO and things like that that are very hard to do. So those are their kind of premise and management said, okay, here’s the thing. If you walk off now, by May 1st, if you’re still off the job, we’re canceling all your benefits. You’re gonna have to pay for COBRA if you want healthcare.

– [Vinay] You’re getting fired.

– [Zubin] Well, you’re basically not getting paid for things you’re not doing and you’re not getting benefits anymore. That was the big one.

– Oh, I see.

– [Zubin] And so you could have, we could have a nurse with cancer, a pregnant nurse, now suddenly has to pay COBRA< which is thousands of bucks a month. And so the nurses are really upset about that. And listen, I’ve talked to the heads of their union and I’ve talked to people that are friends of mine in the leadership, at the clinical leadership at Stanford. So I’ve heard basically two sides of this. I haven’t dived in very deeply, but on the Stanford side, their concern is, well, they have open-ended strike. Many strikes now are three days, five days. They say, so they can plan. Management can say, okay, we’re gonna bring in travelers for these days. It’s gonna cost us a ton of money. That’s why we don’t wanna strike. We’re gonna negotiate. But for this one, it’s open-ended. So they said, well, we’re gonna stop covering your benefits May 1st, because we don’t know when you’re coming back.

– That’s messed up.

– It’s a disaster! So my point is, what a fucking mess. Like why did we ever get to this point? How is it that it’s so adversarial? Why is medicine treated partially like a business, partially like a calling, partially like a vocation and these nurses, they know, I mean, management always knows. They know this with doctors, right? We’ll do the right thing for our patients as much as we can, to the point where we’ll suffer and they often unconsciously or consciously take advantage of that. But then at the same time, I do feel like, wow, this is an open-ended strike is such a tough thing for, how does management even plan for that? And I understand why they’re doing it ’cause they wanna really put pressure on because otherwise they feel they aren’t heard. And it’s just a mess.

– [Vinay] Wow, so fascinating. And you really did a nice job of unpacking all these kind of different vectors of consideration. I guess, you know, it seems like that COVID and all the sort of job fluctuations around it are maybe in part, people are realizing ways they’ve been screwed and maybe in part people are realizing, how, what they really value in life, you know, from this period. And there’s this huge flux. And I guess, you know, we have to admit that nurses work very hard and I feel like, you know, I guess I think that, you know, the hospitals probably should treat ’em right. And the fact that they’re willing to spend so much money on traveling nurses really does raise the question of if you’ve got all that money for nursing care, why have you been underpaying nurses all this time?

– Yeah.

– You know?

– [Zubin] Yeah, yeah.

– [Vinay] And similarly, yeah, go ahead.

– [Zubin] Oh, go ahead, go ahead, go ahead.

– [Vinay] No, I was gonna say they also, hey, listen, it’s not so great to be a doctor at some of these places, too.

– Exactly.

– Yeah. It’s not so great.

– Exactly. So I think my point is frontline healthcare workers are really devalued across the board. The business of medicine does not treat them well, as a rule. Stanford made quite a bit of profit last year to my understanding. And so, you know, treating nurses well is a good idea. They are highly skilled and that’s the other thing is, they want a little more respect and appreciation for their training. You know, we often treat nurses like they’re data entry clerks just typing into any EHR, but these are very complex roles they’re filling, particularly in these settings. Like, I mean, even med surg can be incredibly complex. And so this idea that you want a sustainable career path for young nurses and all they see is pain, you know, and I have to say this, and this is a little, you know, really disturbing, but even just this morning, I heard news that a nurse walked into an ER in Santa Clara Valley, Kaiser, and had a gun, actually, and died by suicide in one of the, whether it was a break room or supply closet. And think about that. Think about what pushed them to that. But then think about their colleagues who have to be in the room when that happens and how incredibly traumatic it is at the end of a pandemic when everybody’s already sacrificing and all of this. And you know, of course, nurses are upset and are gonna strike and so on. And I think if anything, you know, we really ought be bending over backwards to try to see what we can accommodate that’s reasonable, because, and sustainable, because this is not sustainable.

– [Vinay] Wow. And Stanford, meanwhile, last I checked, they got a lot of money, don’t they?

– [Zubin] Yeah, they got a butt ton of money. They just built a brand new hospital, which by the way, did you know, clinicians were not allowed to walk in the front doors because they didn’t want the patients to get upset. So clinicians had to go through the back through this maze.

– [Vinay] Shut up, no way.

– [Zubin] Yeah, I’m not even shitting you. Yeah, I talked to my colleagues at Stanford. They’re like, yeah, it’s just, you know, and the thing is, there’s an interesting dynamic, too, between there’s so much politics in any major institution, right? Like I have a lot of love for Stanford. I’ve trained there. My mentors are there, but I also have a lot of just simmering resentment. And that’s just how it is. That’s how it is in these big political organizations and they’re big money makers and there’s clinical leadership that’s great. And then there’s nonclinical leadership. And then it’s just, it’s very tough. So I just wanna say publicly that I support our nurses. I cannot take sides in a labor dispute, but that hopefully that description of what’s going on was as accurate as I can get it and people can make their own decisions and try to advocate as they can.

– [Vinay] Really well put. Can I add?

– [Zubin] You may.

– [Vinay] Nothing other maybe, you know, sometimes I wonder that like these universities, they’re doing such a bad job, that it wouldn’t be so hard to really undercut them. And here’s some ways I would think about doing it. If you’re in a soft money department, which means that, you know, you have to raise your own salary from like grants and you have a field of study that doesn’t require lab equipment, like you’re computational or an epidemiologist or something like that. You know, I’m surprised there’s not like a non-profit like that they just don’t get destroyed by nonprofits, ’cause like, yeah, you can be an assistant professor at, you know, Stanford, an epidemiologist, like a hundred percent soft money, right. Or you could work for a nonprofit and get all your grants through the nonprofit and maybe have like less bureaucratic stuff to deal with. Like you don’t have to sit on all these committees and maybe more freedom, you’re your own boss, maybe, more control over the work environment. Maybe you can even, you don’t have to pay as much in overhead and things like that. And I feel like the universities, you know, at some point all the employees are gonna get wise and you know, they’re gonna say like, we really don’t need you. Obviously in medicine you could always, you know, I mean, you don’t have to work at a university hospital. And I think that these universities are, they just think that they can live off their name, their reputation forever, but I don’t know, it might blow up in their face someday.

– [Zubin] I’m starting to think that maybe the case and remember they operate, to, on the effectively slave labor of interns-

– Hmm hmm, hmm hmm.

– And residents. And on the clinical side generating a ton of revenue. It really is a system that is self-terminating. Like in the setup it’s now it, it can’t continue the way it is. And I think, you know, I remember in the old days when Stanford and UCSF actually merged because they couldn’t financially compete, you know, in the sort of, this was like 19, the late nineties and they had to unmerge because it was such a disaster.

– [Vinay] Is that true? That really happened?

– Yeah, that really happened. In fact, it was the UCSF Stanford merger. And they were, for a while, they were operating as UCSF Stanford and that was what it was. And actually when I matched at Stanford, they had just unwound that and we were gonna be Stanford again. So it was really fascinating. And again, the business of academic medicine is such a fascinating thing. It’s interesting about the soft money, you know, you’re generating your own grant money, your own salary. Why not go work for a nonprofit, you know, where, like you said, all that politics, it’s different politics, but it’s probably less onerous.

– [Vinay] Yeah, and, you know, each group could create their own nonprofit, you know, they don’t even have to, you know, pair, you know, I don’t know.

– Oh yeah.

– [Vinay] There’s lots of different models.

– [Zubin] Yeah.

– [Vinay] You know, but maybe-

– [Zubin] Maybe they’re more agile. Maybe there’s better research done that way.

– [Vinay] And what about you?

– [Zubin] What you talk about Willis? What do you mean? What do you mean, what about me?

– [Vinay] I don’t know. I mean, to some degree, you’re somebody who has beat the system to some degree, I think, I look at you with a lot of admiration because I mean, you took a huge gamble. You went in to create your own enterprise and you know, you’ve done really well, I guess, because contrary to what I read on the internet, you still got a lot of talent. Yeah, but I mean, I don’t know. It must have been hard and you know, but like, and you’re doing it in a totally new space. Maybe other people will have some confidence and do it in like, you know, these other spaces, too.

– [Zubin] See, okay. Me out of the equation, although what it was with me was I said, okay, this is what I’m actually good at. This is what I like doing. I’m gonna try to do it using medicine and try to accomplish these things in the world that I wanna see happen. And it was risky and it was scary and it was terrifying. But I had a lot of help from a lot of people and a lot of support and it never happens by yourself, but you have to make yourself open to this return on luck, right. You have to be open to taking those scary risks and so on. And you also have to be passionate about what you do. And you have to have some degree of talent in terms of what you wanna do, right. But you don’t have to be the world’s best at anything. I see people like yourself, like the minute I met you, I was like, dude, this guy, like this guy has it on these following levels. He’s able to communicate succinctly. He’s extremely smart at what he does and other things that he doesn’t do. And he’s a tremendous energy and communicator. So if you are trapped in academics for the rest of your life, that may work fine. You’ll be very successful. But the thing is, what if you suddenly said, oh yeah, maybe there’s this new thing or maybe there’s that and you threw all your energy into that, it would be risky, it would be scary. You’d worry about your family. I did all that. But then, the upside is you can transform things and live an authentic you, that you can’t do when you’re working for someone else. Now, a lot of doctors are so risk averse and they went into medicine because they don’t want that, right?

– Yeah.

– So. I don’t know, it’s almost like you need mentors to help. Who are the mentors in that space, you know? Like I try to mentor people that are going in that direction, but we need like a network of people that says, you know what? You don’t you that? Here’s a way you can use your skills and talents and your training. People feel, too, oh, I’m wasting my training, if I do this. No, you’re not. You’re taking it, you’re doing something with it that nobody’s doing, like, go do it. Or you could, you know, be a Instagram influencer talking about , you know, masking two-year-olds.

– Oh, yeah.

– So, it’s a spectrum.

– [Vinay] Yes, which brings us to the next topic. Speaking of influencers, I was reading on Twitter you know, that 20% of people who really want that vaccine for kids under six, you know, they’re very motivated and you know, they’re really motivated. I mean, they really, they really, really want it.

– [Zubin] Yeah.

– [Vinay] I’m pretty sure that they would want it, you know, without any data. I mean, I think they’d be happy to have it without like, literally they wouldn’t even need to look at the data.

– [Zubin] I think you’re right, yeah.

– [Vinay] Recently, I saw somebody had a thread that went viral and this is about the Moderna. The Moderna, now they went ahead and they submitted that EUA. They’re trying to get that market share. Wait, did we already talk about this? No, no, no.

– [Zubin] We talked about Moderna’s strategy on the EUA, but didn’t really dive in too much on the kids piece, yeah.

– [Vinay] Here’s what the thread says.

– [Zubin] Yeah.

– [Vinay] Moderna says that the vaccine is 51% effective against symptomatic disease for six months to two and 37% for two to six, that’s right. But the FDA previously said at the beginning of this whole pandemic, that if you are below 50%.

– Forget it.

– [Vinay] You don’t get approval. And also, the lower bound of the 95% confidence interval has to be above 30, ’cause they don’t just want a point estimate over 50. They want to prove that it, at least is better than 30% ’cause once you get below 30, you really start to wonder what you’re really in this business for.

– [Zubin] What are you doing, yeah.

– [Vinay] What are you doing? And even there’s also like this possibility that the immediate risk compensation will like undo sort of whatever, you know, transient gain you think you’ve gotten because people will view it as more protective than it is. And actually some people like John Ioannidis published some papers on that. But so that’s another-

– [Zubin] Wait, wait, wait, tell me more about that. So what do you mean by that?

– [Vinay] I mean, I think like the general idea is that a vaccine that’s only very weekly effective against symptomatic disease, the moment someone gets vaccinated, they dramatically change their behavior.

– [Zubin] Ah-huh, yeah.

– [Vinay] And so you actually like in the immediate aftermath, you get way more cases than you otherwise would because the behavioral change is much bigger than the vaccines protectiveness against acquiring the disease.

– [Zubin] That is really interesting, yeah.

– [Vinay] But to me that’s somewhat of a moot point because-

– [Zubin] It doesn’t matter, yeah, exactly.

– [Vinay] All these kids will eventually get it anyway.

– [Zubin] Exactly.

– [Vinay] And 75% have already gotten it already, you know.

– [Zubin] Just rip the bandaid off, yeah.

– [Vinay] But I think that was part of the FDA’s original motivation for why they had set those bars. But I do think, those bars are, you know, important. It’s important that there is a bar. If there’s no bar at all, then what are we doing?

– [Zubin] What are we doing? You know, I think that’s key actually, that idea that, oh, why not just get a vaccine that’s 25% effective is better than-

– [Vinay] Or 5% or 1%.

– [Vinay] Oh, because people take it, they don’t understand that risk and they go out and change their behavior. Now again, in the long term, I don’t think it matters ’cause we’re all gonna get this. But if you’re elderly, like if it was 25% effective against severe disease in the elderly, boy, that’d be a conversation, right? Like, why bother? I mean, you can do it, but you better not change your behavior. You better wear an N95 mask and you know, stay away from people and so on.

– [Vinay] Correct.

– [Zubin] Yeah, I really think, how many people do you know right now that have tested positive for Omicron? I mean, like I know so many people. we’re in the middle of a massive surge that’s underreported and it doesn’t matter because the hospitals aren’t filling up and people aren’t dropping, yeah.

– [Vinay] I mean, it’s just, yeah, absolutely. Just as you say.

– [Zubin] Yeah, and you know, I went to my kids’ open house elementary school the other day and they were requiring masks actually to enter the school. And you know, what’s interesting, look, you know me, we share a feeling on this, that masking kids is not necessarily an evidence based strategy. When I walked in this room with a bunch of children and a bunch of adults and they were all wearing masks, there was a psychological feeling I had that I was like, ah, you know, I feel a little better. These kids look gross to me. I don’t like ’em. They’re yucky, they’re snotty. And them wearing mask makes me feel better. I knew there was not great data on this, but psychologically it was, it felt protected.

– [Vinay] You’re probably putting your finger on the fact, like why it’s such a hard thing to quit.

– [Zubin] That’s right, that’s what it is. Because imagine you’re a teacher and you’re seeing this room full of little filthy, little vermin. It really does feel better when they’re behind the mask. Now what’s funny is, this family came in, a family of like five and they just walked in with no masks and were just talking loudly and getting up in everyone’s face. And I think they just didn’t, you know, I just don’t think they cared and it was weird. There’s like, again, a psychological, like, ooh, these people are impure. Like that immediate flash and you know me, I’m not in that Covidian camp, right.

– [Vinay] But even you felt a little?

– [Zubin] Even I felt it! I was like, okay, okay. I can be a little more, I understand the psychology, but we’re trying to transcend our baser impulses here to try to get at what’s actually good policy, right. But yeah, it was interesting.

– [Vinay] Let me walk you through the rest of this thread and tell you some of the other things I thought were interesting. Okay, so this thread, okay, so this person says, these are the results of this study, which by the way, failed the initial bar, sounds mediocre, but here’s why it’s much better than that, the person goes on. Okay, so it sounds mediocre ’cause it is mediocre. So I’m curious to know why you think it’s better. All right, quote, “We know these vaccines provide “very good short-term protection against infection, “but that’s the honeymoon phase”. Okay, well, yeah, it’s constantly gonna lose that over time, sure. “But the way these vaccines were designed “and how they work best is not really about infection”. I think that’s actually technically incorrect. They were designed with a primary endpoint for symptomatic infection. That was what they were designed for. It turns out with more time that they don’t quite do that well or durably well. We hope that they have a severe disease protection that’s more durable and it appears that that is more durable. And so what it’s doing better, but I would say it’s incorrect to say that it wasn’t designed to do that. That was the primary point of the original study.

– [Zubin] Ah, yeah, yeah.

– [Vinay] Okay, what these vaccines have been shown to do over and over is protect against severe disease and hospitalization long-term consequences. They’ve been shown to protect against severe disease and hospitalization. I’m not sure about anything longer term than that. So I think if there’s an implication that they protect against long COVID, I’ve yet to see such data. Okay, next sentence. A pediatric trial can’t be large enough to detect that. That’s incorrect. It could be large enough to detect.

– [Zubin] Yeah, it would just power it, right?

– [Vinay] Yeah, 200,000 people per arm. And the mere fact it has to be so large tells you that the effect size is very, very low. Okay, then the next sentence. But the ImmuneBridge strategy used by both Moderna and Pfizer has worked. Okay, first of all, incorrect. I mean, you can’t say that. So, but first, what is ImmuneBridge strategy?

– [Zubin] Yeah, what is ImmuneBridge strategy?

– [Vinay] When the FDA was doing this vaccine, the way they said the company should get the market share is initially in adults proved to me a reduction in symptomatics SARS‑CoV‑2. The company did that in the original study with 40,000 people per arm. And they also sort of had very suggestive results that it would also lower severe disease at that time. And then they said having proven that, when you go to younger ages, we’re no longer gonna ask you to prove again and again, you lower symptomatic disease. We’re gonna ask you just to show me, you get the antibody titers very high. That’s called ImmuneBridging. We’re gonna bridge you to lower age groups merely with antibody proof. But Z, there’s a big difference between doing that one month after the original study and doing that two and a half years after the original study, because two and a half years later, the antibody, we got a different virus we’re dealing with. We’re dealing with Omicron. We’re not with the original strain. So the ImmuneBridge will logically not work as well with time. And then this person is saying ImmuneBridge strategy has worked. And I think what he means is that it’s worked like it’s been good to do it that way, but the truth is, I mean, it’s worked, it’s led to a lot of authorizations, but has it worked? I don’t think we have robust data that it has worked like, you know, what is the robust data that a five-year-old has a reduction in severe disease and hospitalization from being vaccinated, than if they weren’t a five-year-old? And you know, then he says, we’ve seen a lot of observational studies that suggest the severe consequences. The problem with that is every single study I’ve seen of, particularly children, it is confounded by the 20% of parents who have rushed to get vaccinated. They’re very, very different than average parents. They’re the most risk averse people. So naturally, the kids who’ve been vaccinated are gonna have, you know, probably higher socioeconomic status and probably lower exposure risk, and probably like better home surroundings, like more sleep and better nutrition and all these things. So is it, you know, what’s the proof that there is a reduction in severe disease at those ages? I don’t know. I mean, it’s possible that there is, you know, I’m not saying there isn’t. It could be, but I just don’t think we’ve proven that. And you would have to prove that to actually say the ImmuneBridge strategy worked. That would be my argument.

– [Zubin] Yeah, I mean, what you’re basically pointing out is we just simply don’t have the data to make the assertions that people are making correct in the public sphere. It makes parents feel better to have something they can give to their kids because some parents have really, they are so anxious about this stuff. Like, they’re terrified. And I think it actually gets a little bit to this sort of masking in public transport, like Bay Area, Bart, and these kind of things are like thinking of putting the mask mandates back on because and they’ll say, well, we really want to protect kids under five and immunocompromised people. And it’s like, but, but, but, but.

– Yeah.

– Yeah. You know, it’s because they don’t have a vaccine, but like, are you really, like, how much are you really protecting the five-year-old when the percentage of, a chance they’re still gonna get infected. And like you said, we don’t know about severe diseases. There’s severe disease rate is already low. And like you said, the people who are likely to get vaccinated already have these other advantages. Yeah, and you know, that just brings me to another Risa Hoshino tweet, just ’cause I saw this and I had to say it . It again goes to like there’s signaling and emotion and then there’s actual science. She says, I just spent 12 hours straight in an N95 mask. Was it uncomfortable? Yes. Was it annoying? Hell yes. But guess what? Pros far, far, far outweigh cons. That’s why everyone should mask right now. I cannot-

– [Vinay] What was the date of a tweet?

– [Zubin] 3/21/22.

– [Vinay] 22! 22?

– Yeah, there’s more. That’s why everyone should mask right now, 3/21/22.

– [Vinay] If it was 3/21/20, then yeah.

– [Zubin] Yeah, you can made the argument.

– [Vinay] Then, she’s a prescient commenter, but 3/21/22 is a big problem.

– [Zubin] She says, I cannot express to you how important masking is right now. And then she says, I just really care with a sad face emoji. Now everything in this tweet is just brilliant, is just brilliant. And again, it points to everything that we’re arguing that you shouldn’t do. So I just thought I’d drop that right there.

– [Vinay] God, that emotional bomb. You know.

– [Zubin] I just really care, Vinay. I really care.

– Yeah.

– [Zubin] It’s what separates me.

– [Vinay] The thing that these people don’t understand is that, you know, we also really care, I also care. And the only difference is I care. And then I use my brain. And I don’t just care and say what other people tell me to say. That’s a big difference. You know, yeah… I also see people say that like, oh, the four-year-old would be much less likely to get long COVID if they get Moderna before. On what basis do you say that? Where is the basis for such claims? You know.

– Yeah.

– [Vinay] You can get away with the most rampant misinformation, if it supports whatever cause you want. You know, you can say whatever nonsense that’s unproven and untrue. But if people don’t like the cause, then they’re gonna label it misinformation and throw you off Twitter. And I think that’s degree, that’s part of what irritates Elon and probably why he bought the platform. And by the way, Z.

– Yep.

– [Vinay] I wish I had that kind of power that like, if I see something I don’t like, I was like, I’m just gonna buy this and change it, you know? Go to a restaurant and they give you a hard time and you know what? I just bought your restaurant. By the way, find a new job.

– [Zubin] I now own Kentucky Fried Chicken.

– [Vinay] No, you own KFC, but you’re gonna rename it, Kentucky Fried, because didn’t they change it to KFC?

– [Zubin] Oh yeah, right, KFC. I’m gonna make it back, Kentucky Fried Chicken, because that’s what I like. And I’m gonna merge it with Chick-fil-A, so all the best aspects of both chicken strategies are gonna be there. Did you hear about these, so this Avian flu thing. It’s like ripping through wild birds and domesticated livestock birds. And it’s just causing havoc. And so these Iowa, this Iowa chicken farm like killed like five million birds.

– Jesus.

– To kind of cull it. And they did it in like the most inhumane way. Like they basically baked them alive or something terrible. And then they fired the workers who were responsible for having to, they had to lay off all the workers who had to like drag these dead carcasses out for weeks at a time. I don’t know, dude, I feel like all of this is connected to we’re just, humans behave like jackasses all across the globe and it’s all connected and everything is ultimately leading to these little failure points that we’re like, oh, is this an isolated thing? It’s like, no, it’s all connected. So yeah, you know, we actually care about shit.

– [Vinay] They’re like following the Shanghai playbook on how to deal with the outbreaks? Slaughter everything.

– [Zubin] Yeah, yeah, that’s gonna be the Beijing approach now. They’re like, well, you know, Shanghai was one thing, but Beijing, I don’t know if we can do zero COVID there. Maybe we’ll just do zero COVID light ’cause like, dude, Shanghai’s been under lockdown for how long now? A month, two months.

– Who knows? It’s like, yeah, maybe two months.

– [Zubin] Oh, my God.

– [Vinay] Zero COVID is dumb. And I don’t know, a philosophy that after a healthy person has three vaccines, they should wear an N95, I really struggle with, what is the end game? Forever?

– Yeah, yeah.

– [Vinay] And then by the way, if that’s the answer, then maybe they’ll have an mRNA vaccine that’ll give you a mask grow on your face. I don’t know what it is. You need a more permanent durable solution.

– [Zubin] Yeah, they don’t have one. They’re like, well we’re just working towards endemicity which brings us to Fauci.

– Oh gosh, Fauci.

– [Zubin] Oh, Fauci.

– [Vinay] Why is he still playing a role in this? That’s what I want to know.

– [Zubin] That’s a great question.

– [Vinay] Send me a memo to RetireAt75. You know, please just have me-

– Oh man. I don’t know. I’m thinking, I’m gonna be 50 next year. I’m gonna retire then. And I’m not even sure what I do, but I’m just, I’m calling the code.

– [Vinay] You feel it already?

– [Zubin] No, yeah, it’s like, I’m just not competent in anything anymore. You know?

– [Vinay] You don’t wanna be 80 years old telling people masks don’t work and then masks are the greatest things since sliced bread in six week period of time?

– [Zubin] I mean that’s a life goal. #Lifegoal of mine. But yeah, the Fauc. I’ve always agreed with you on this that we need a rotating cast of characters.

– [Vinay] Yeah, rotating cast of characters, thank you.

– [Zubin] I mean.

– [Vinay] You don’t wanna watch the original cast of “Rent”. You wanna new cast of “Rent”, you know?

– [Zubin] Exactly. I don’t wanna see the, or you know, Lin-Manuel doing, well, actually Lin-Manuel doing Hamilton would still be awesome ’cause it hadn’t been that long, but you know. Have you seen “Encanto”, yet?

– [Vinay] “Encanto”?

– [Zubin] The Pixar film?

– [Vinay] I have not, no.

– [Zubin] It’s not great, but the songs.

– I hear the songs, are the songs good? The Lin-Manuel songs?

– [Zubin] The songs are really earworms. They’re really catchy.

– [Vinay] And you’re the expert on that.

– [Zubin] Well, I don’t know about that, but.

– [Vinay] Well, I mean, at least you’re a musician.

– [Zubin] Ish, but hey, by the way, should I start making parody videos again or just call the code on that?

– [Vinay] You know, I meant to talk to you. I recently had dinner with the guy here, a geriatrician, and he also kind of is in your line of work.

– Oh!

– You know this guy? Alex Smith, he’s a-

– I don’t.

– [Vinay] He writes these kinds of things and you know, and well, you guys could commiserate on the craft ’cause you know, part of it is like you have to get the syncopation of your new words, your new lyrics to fit the old lyrics. And that’s not so always, you know, that’s tricky. I think people underestimate that.

– [Zubin] Well and the worst part of that whole thing is say, you become known for doing parody videos, which I had been, you get a million people saying, hey, I’ve got a parody for.

– Yeah, yeah.

– [Zubin] And they send you the lyrics and it’s the most idiotic, like, do you even have a sense of rhythm? Like that word that you put there has nothing to do with the song. Like it will not fit in the pace or the rhythm of the song. It doesn’t make sense. And you have no ability to hear that. So I can sing it for you and you’ll see. But so yeah, there’s that. So it gets frustrating. Weird Al just stopped, like he stopped even listening to people who give him suggestions. He’s like enough, enough. But see the thing is every now and again, someone will say something and I’m like, that’s brilliant. I’m doing that. Like, you know, someone pressured me.

– [Vinay] I think the videos are great and they have a timeless quality. You know, some videos like we do, nobody’s gonna watch it like a year from now, right, ’cause it’s already been very dated. You know, to be honest, is that true of the VPZD show? Probably yes, I mean, it’s a very topical show so it is immediately dated.

– It’s a new show.

– It’s a new show. You know, you don’t wanna go watch Tom Brokaw from you know, ’96, you know, random, you wouldn’t do it randomly, but you would go watch “Frasier”. By the way, I’m working my way through the catalog.

– [Zubin] Oh yeah, you were saying, it’s good, yeah.

– [Vinay] You know, I don’t think I fully appreciate how brilliant it was. It was so well written, won so many awards.

– Yeah.

– Well deserved. But back to this parody thing, you know, I recently saw a parody video of something online and it was like about, you know, author submitting articles to like a journal. And some things were kind of funny, but some things were like just wrong and like off. And I was just like, you know, it’s hard to make a parody video if you’re like, just not in that culture.

– [Zubin] Yeah, yeah.

– [Vinay] You know, you get some things wrong, you know? ‘Cause this video was like about how the author wanted to buy a copy of their own article back. And I was like, I can tell you that once the author gets the article accepted, they probably don’t give a shit about having it.

– [Zubin] They don’t give a shit.

– [Vinay] Yeah, they don’t really want the copy and they don’t really need to pay the money for it. They can just use, yeah.

– [Zubin] Actually, see, that’s a crucial thing. That’s why med students make the best med student parodies.

– [Vinay] ‘Cause they’re living it.

– [Zubin] They’re living it. You know, when I was a full-time hospitalist, I made really good clinical parodies. Now it’s kind of like, well, I don’t know. I would make these weird meta parodies about meta shit and I’m not sure it would fly. Plus some asshole can go on TikTok and do a one-minute dance video and get many more, much more engagement than I would get spending $10,000 in doing all this stuff on a music video. So it’s just, it gets a little, I don’t know. I feel like I might have, I’ve done something like 70 music videos. Like on the music video-

– [Vinay] But maybe the reason to do it is if it brings you joy. Does it bring you?

– That’s right. Totally, totally and it does, it does. But to a degree. It has to be something I just think, oh man, like when we did My Corona at the beginning of, I was like, this is so idiotic, I just have to do this. Like it just brings me joy, like these lyrics are so dumb. And you know, it’s saying the kind of thing I really wanna say, which is why, let’s take a breath here and prepare, but let’s not panic and run around like chickens with our heads off.

– [Vinay] Well maybe you should do one just to see if the spark is still there.

– [Zubin] Just to try it out, yeah. I gotta think about what it is. Still, I really wanna do a thing on antibiotic overuse. Like, but with Shaggy’s, “It Wasn’t Me”. You know, like. ♪ Shorty came in and she coughin’ and wheezin’ ♪

– [Vinay] Ah!

– [Zubin] And it’s like, I gave her Z, you know, but you know. ♪ But we think it’s a virus ♪ ♪ I gave her Z ♪ ♪ But my PRIEST Score is not highest ♪ ♪ I gave her Z ♪ You know, and the whole thing. But again, it’s gonna be like 10 people are gonna watch that, but I would enjoy making it.

– [Vinay] I mean, I think what would be great and like, you needed another suggestion in your life.

– [Zubin] Oh, bring it, bring it.

– [Vinay] I don’t have a suggestion of the song, but I think the content would be if, just to sit down, and write like sort of the major events of COVID-19 pandemic and put it into a song.

– Oh, into a-

– The history.

– Oh yeah.

– The history.

– [Zubin] Yeah, maybe, I mean, and “Encanto” had that great song, “We Don’t Talk About Bruno”. And you could just say. ♪ We don’t talk about Covid ♪

– Ah.

– Yeah, right? ♪ It was our wedding day ♪ ♪ And there wasn’t a mask in sight ♪ Yeah, maybe there’s something there, you know? There’s a group, there’s a YouTube family called the Holderness Family and they do these kind of parodies that are more like broader. They’re really good, actually really funny shit. It’s a little depressing ’cause I’m like, oh, I don’t think I’m that good anymore. I don’t think I can do it. I used to make a, it would be a spread sheet and I’d have the original lyrics on the left and then the new lyrics. And you’d have to kind of really time ’em out and make sure that they fit.

– [Vinay] That’s what I’m saying. I think, that’s tricky, yeah.

– [Zubin] It’s tricky, yeah, but it’s fun. It’s a fun, it’s like a puzzle to solve and you know, there’s cleverness, there’s funniness, there’s education, there’s all the components you have to think. And it has to have a purpose If there’s no purpose, then I don’t do it. Although, that did not apply to a song I did with Sinead O’Connor’s “Nothing Compares to You”. It was “Nothing Compares to Poo”. And it was about the different secretions and odors that we tolerate and don’t tolerate in the hospital. And that was just pure. It was, you know, it’s been 11 hours and 16 codes since I took your shift away and it’s all about, you know. ♪ Nothing compares to poo ♪ As far as odors go.

– [Vinay] So when, before you were doing your parody videos, were you just singing and writing or were you doing like cover songs? What did you like to play?

– [Zubin] Yeah, no, I mean, I’d just dick around with a guitar and I like to sing in the car and I’m a shitty singer and so, you know. It’s one of those things, but you know what’s weird? Actually, I was thinking about this because I don’t do that many public talks anymore, ’cause I just don’t enjoy the travel and all of that. But it used to be, ’cause I’d have to perform these songs live as part of the show.

– Yeah, so fun.

– [Zubin] Like ah, yeah, it was a lot of fun. You had to do vocal training. You’d warm up before the show, you’d do this performance. You’d do a sound check. You’d feel like a rock star. And you get to go out and be like, and I actually took a rock star with me, my audio producer guy who was in this like kind of band in the nineties and they were on MTV and stuff. And so he was like, dude, he’s like, you’re like, what you get to do for like thousands of screaming, like doctors and nurses is like, what I did, but like with none of the pressure. I was like, yeah, it’s kind of nice. It’s like basically karaoke for the masses.

– [Vinay] That would be fun. You know, we keep talking about, and maybe the listeners will want this. We do like a live VPZD. So if you’re listening, you bring us out, do a live VPZD Show.

– Oh that would be amazing. Fly us out and do that?

– [Vinay] In front of a live studio audience.

– [Zubin] Oh yeah, oh my God. Tonight’s VPZD show is recorded in front of a live studio audience, just like “Frasier”.

– [Vinay] They can pick the topics that we discuss.

– [Zubin] Oh, that is, you know, I’ve been trying to figure out how to skin, like getting me fired up about doing speaking again. That would do it. Oh man, and I’ll take a 50% pay cut. We can share it, yeah.

– [Vinay] ‘Cause that’s what I’m doing. No but I’ll tell you, I actually burned out, too, on the thing that I would do is like a lot of academic travel and giving lectures and I burned out.

– Right, right.

– [Vinay] Because at some point it’s like, the moment you feel it’s predictable, you know, it’s not as fun. And sometimes I like purposely, well I hate to admit, well, this week I had to give a talk and I really pushed it to the last minute to make my slides because in the heat of the moment, when you don’t have a lot of time, I actually feel like maybe you’re a little bit more creative. Like you just don’t have time to fall. You know, you just have to take the slides you got and go. And then I do this other thing that sometimes when I have to give a lecture, I have asked somebody who works with me if they don’t mind putting together the slide deck. And so I let them pick what they want me to talk about. And then I look at their slide deck and then I read about it and think, you know what I mean? So that it’s like, not me, like otherwise, I feel like I am going to gravitate to the things I always say. So if they pick the papers and such, I have to read those papers and understand them to talk about it. And so it forces me to get outta my comfort because like repetition is very boring, I think.

– [Zubin] Oh, it’s murderous. So I mean, I’ve done this for how many years and like I’m talking about Health 3.0 and I’m doing all that. And so I have to switch it up and change how I do it. It has to be more spontaneous. You know, the last one I did was entirely improv and that’s scary. And I don’t think it was as good as my planned talk with slides and stuff, but at least it was authentic in the moment. And I’m doing a couple in the next couple months and it’s kind of like, okay, I’m gonna try to mix things up and experiment a bit and get the audience engagement, like having a more give and take with the audience like I do on my live shows. Remote would be a lot of fun because they often will send you down rabbit holes, you know?

– Hmm hmm.

– [Zubin] Yeah, but yeah, that’d be fun. You and me like a live VPZD or we could do like a real like, tonight on a special episode of VPZD and it could be about like, you know, Arnold from “Different Strokes”, like ends up, like there’s a creepy guy who’s trying to molest him and this whole thing, That was actually an episode of “Different Strokes”.

– [Vinay] Really, oh, I vaguely recall, yeah, yeah, yeah.

– [Zubin] Remember this? It was like, he was like, oh, would you like a piece of candy?

– [Vinay] I was born in the eighties. I have a vague rec, I don’t remember that well.

– [Zubin] It’s very foggy. Yeah, I was coming of age in the eighties and it was just, oh man, I remember that episode as, tonight on a very special “Different Strokes”. And afterwards they had like, the whole cast came out and they’re like, if you think anyone’s touching you inappropriately, I was like, oh my gosh. You could do this on network TV back in the day. That was great.

– You know-

– And everybody watched.

– [Vinay] Which reminds me of like rewatching all these “Frasier’s”. I watched, I was like, watched “Frazier” like a lot when I was like, I don’t know, in high school and a little bit in college. And you know, but now watching it again, I swear like 50% of the references, I didn’t get when I was in high school. And now I’m saying, you know?

– [Vinay] Now they’re making, yeah.

– [Vinay] They’re making more sense.

– [Zubin] I wanna go back and watch “Three’s Company”, again, for some reason. That was something that I grew up with and I didn’t get most of it because I was a kid.

– [Vinay] And what was the reason the three lived? They were just roommates?

– [Vinay] So the reason was they were broke and they wanted to save money and they were friends or something and so.

– [Vinay] What was his name, Jack Tripper, was his character name?

– Jack Tripper. Yeah his name was, John Ritter was the comedian who played-

– John Ritter.

– Yeah. Who died of a ruptured aortic aneurysm.

– Oh, that’s right.

– Yeah.

– And family sued.

– Yeah.

– [Vinay] Because he went to Cedars and they pushed Heparin, something like that.

– Something like that. It was something like that, yeah, yeah, It was a Libby Zion type of deal minus the residence and yeah, the whole thing was a mess. And, but yeah, the whole premise, it’s so, I mean, it’s so dated in that way. And yet it tells you how far we’ve come as a like society. People are like, we’re going back to bigoted racism. No, no, we’re not.

– ‘Cause that was real racism.

– Watch “Three’s Company”.

– That was much more racist.

– [Zubin] It was much more like homophobia and like, so the whole premise was Jack Tripper, in order to live with these two girls, had to tell the conservative landlord, Mr. Furley or Mr. Roper, initially, that he was gay.

– [Vinay] Oh, because, I see. Because there were two beautiful women he’s living with.

– [Vinay] Beautiful women he’s living with and he couldn’t live with them unless he was gay. ♪ Come on knock on our door ♪

– [Zubin] That’s right. ♪ We’ve been waiting for you ♪ ♪ Where the kisses are hers and hers and his ♪ ♪ Three’s Company, too ♪ Oh man. And they had the Regal Beagle, which was the bar they used to go, and Larry was like the kind of lounge lizard, seventies guy, that was their friend who was a creeper. And they, I mean,, the whole thing was misogynist and completely homophobic because Mr. Roper-

– [Vinay] That was the central premise.

– [Zubin] It was the central premise. It’s like, well, now he’s gotta pretend to be gay for Mr. Roper and Mr. Roper kept calling him a fairy and making these little twinkle fingers. Oh, it crazy stuff. Crazy stuff! But at the time everybody was like, you know, they would laugh.

– [Vinay] Wasn’t it one of the most popular shows on TV?

– [Zubin] By far, yeah.

– [Vinay] But late seventies, early eighties, it was done, right?

– [Zubin] I think it was like 1980. And I think it ended in like ’83 or something. And they had like a spinoff that lasted a minute, like “Three’s a Crowd”, that like lasted a minute. It was like, when “Happy Days” ended, they had “Joanie Loves Chachi” and that lasted for like a minute. Yeah, yeah, yeah. But yeah, you know, there’s a lot you can actually learn from going back and watching old TV? I really think there’s something there. It’s a sociological thing because there’s a lot of beauty there, too. You’re like, ah, you know, remember when you could just have fun with stuff and be like, kind of celebrate our differences without the concern of like, oh, this is gonna get us canceled or whatever it is.

– [Vinay] You know, I think those writers were free to write in a way that they never worried about that.

– [Zubin] Right.

– [Vinay] I mean, the other thing that I’m biased about is like, I don’t think I appreciated like just Kelsey Grammer, how talented an actor he is.

– [Zubin] Oh yeah, yeah.

– [Vinay] You know, he’s Juilliard-art-trained. And did you read about his life? His like sister was abducted and murdered. He’s had like another death in the family. I mean, he had a really tragic life.

– [Zubin] Had a hard life and had a cocaine problem.

– [Vinay] And they say by accounts, like when he was filming “Frazier”, he was high or hungover, just terrible shape. The moment they said action, he was Frazier. And the moment they said cut, he was Kelsey. And like, just, right.

– Wow.

– [Vinay] And you know, the way he speaks, his like-

– Cadences.

– Are perfect. I mean, brilliant, brilliant timing, brilliant. And of course, David Hyde Pierce was just phenomenal. Even the father, who I read that, like he didn’t pick up acting until he was in his forties.

– Wow.

– Yeah.

– [Zubin] There’s hope for us, man. We could have a third career, like, or a second. Yeah, I mean, there’s a lot of people who, late in life do these things that just blow you away.

– [Vinay] Well, I mean, I guess I would say that to some degree that’s already happening because you know, I mean, 10 years of go, if you’d say, are you gonna be doing a podcast in YouTube videos? I would’ve said, no.

– Hell no, right.

– Yeah.

– [Zubin] And by the way, congratulations, you got your YouTube plaque for-

– [Zubin] Oh, how’d you notice? You see that in my background?

– [Zubin] I see it in your background, a hundred thousand plus subscribers.

– Conspicuously placed, like.

– Yes, yes, congratulations.

– [Vinay] See, you don’t hang yours up in the background. You have it elsewhere.

– [Zubin] It’s elsewhere, yeah. And you know why? Because I didn’t get it until I had 500,000 subscribers or whatever. And because they never gave it to me. I had to email them and I’m like, you know, I never got a plaque. They’re like, oh, we’ll send you one. Did they just send you one or did you have to ask?

– [Vinay] No, they just sent me an automated email saying you have now qualified. Please insert your name and we will mail it to you.

– [Zubin] Oh, that’s nice, man. You’ve really grown your shit from nothing to huge in no time. And it’s all deserved, you know? It’s like, you’re not out there posing in a man bikini in a banana hammock, trying to get likes.

– [Vinay] Let’s just say, that’s an easy way to have them take that plaque off the wall. The counts will drop.

– [Zubin] Oh yeah, you have to actually send it back. You get an email saying we’re reclaiming, we’re sending thugs to come get your plaque. Actually, I wonder what happens if you do.

– Lose followers.

– Lose followers.

– [Vinay] Do you take it away?

– [Zubin] Yeah, that’s really interesting.

– [Vinay] But they also sent some note like, I think I looked it up. There’s like, now there’s like 200,000 different channels with a hundred thousand followers. It’s huge!

– Oh, wow.

– Yeah.

– That’s nuts. Yeah, I know it’s gotten really big.

– [Vinay] Like lots with a million and like, but very few with 10 million or more.

– [Zubin] Yeah, that’s a tough, that’s a tough, that’s an exponential strata, yeah.

– [Vinay] But you know, there’s not 10 million people on YouTube who wanna learn about biomedicine. I’m pretty confident. There may not even be a million. I don’t, is there, oh, I guess Dr. Mike, but you know.

– [Zubin] So Dr. Mike has-

– [Vinay] Do they wanna learn about medicine or they wanna learn about Dr. Mike? I dunno know what they wanna learn about.

– [Zubin] Dr. Mike is actually aimed more at a lay audience, you know, so he’s, yeah. You know what’s crazy? ‘Cause YouTube, I’ve not got that many subscribers, but Facebook, like two and a half million and then another half a million on DarthVader channel. And I’m like, why is that? Like what’s the, is it just like, you know, middle aged women like me? Maybe that’s, ’cause I am basically a middle aged woman. Like that’s how I walk through life.

– [Vinay] Your mannerisms, those are your things.

– [Zubin] Those are my mannerisms.

– Yeah.

– Exactly. I picked it up from my mom when she was a middle aged woman. And now, I’m just that way. I don’t know, but it is interesting. Yeah, and all the engagement is so different, too, right? Like Facebook is so different than YouTube. What works there is very different. So it’s kind of fun, but yeah, I don’t know where it’s all going.

– [Vinay] Look at this! While we’re talking and you know, we had mentioned earlier in this podcast about like the kids don’t like grades. Let me read you an actual tweet by Marc Andreessen, you know, the venture capitalist and he’s quoting KQED News. “Inside some of University of California’s “academic departments and colleges “an atypical idea is gaining steam, “de-emphasizing or even ditching the A to F grading system “and rethinking how to assess student learning”. They are thinking about these things! What are they doing?

– Wow, man, grades.

– [Vinay] Remember when MIT did away with their SAT, but then they brought it back when they realized it was actually a useful tool?

– [Zubin] Yeah and that’s happening now with SAT because of pandemic, there’s schools that are not requiring it. Now what’s interesting is a lot of, I heard an NPR piece on this recently, a lot of lower socioeconomic status folks are applying now because they took away this testing requirement and they may have really good grades, but of course, it’s difficult to compare schools. So I don’t know, I don’t know the answer to that. You need some kind of merit based thing, but I don’t know how to do it in an equitable way.

– [Vinay] I haven’t looked at all the data, but my understanding of the data is the following that like, if you’re lower socioeconomic status, it is very difficult to compete against higher income people. And that, even though we think the SAT is a barrier, it actually works the opposite way. It’s a boon because like, you’re never gonna be able to do whatever, more traveling in China, or, you know, more volunteer work or more, you know, all this nonsense that these kids say they’re doing, you know. But you can actually get a decent score and it can allow you to like really prove your competency.

– [Zubin] Interesting, so it can be an equalizer.

– It can be an equalizer.

– Yeah.

– [Vinay] And some people think it as equalizer, but, you know.

– [Zubin] Interesting, interesting. Now there was some talk about the test itself is a little biased, towards higher socioeconomic status. Like they used words like golf and . But I don’t know, I don’t know.

– [Vinay] No, I mean, there might be like croque golf.

– [Zubin] Croque, exactly, exactly. Beignet.

– Beignet. Well, that’s what I learned from watching “Frazier”. Like there’s so many words that I don’t think I really fully understood, but now that I sip Pinot with people like you, I know those words. I’ve learned them all. I’ve learned them all, dude.

– [Zubin] Oh my God, dude, you should write a book for like the lay population. Like everything I learned, needed to know in life, I learned from watching “Frazier”, and you could go through the entire book.

– Oh, wow.

– Right?

– [Vinay] Dude, it’s actually, I bet it would be a best seller. I mean.

– It’d be a best seller. Written by, of world acclaimed physician, Dr. Vinay Prasad, author of such hits as “Malignant” and “Ending Medical Reversal”.

– [Vinay] One thing he always does is drinks Sherry. And to be honest.

– Oh yeah, right. I don’t like Sherry.

– I don’t like Sherry. I mean, just a little bit, yeah.

– [Zubin] It’s good with almonds, actually. That’s what Sherry’s good for. But otherwise it’s a very odd, very old fashioned kind of flavor.

– [Vinay] The other thing, I think when “Frasier”, the show starts, he’s got that apartment in Seattle, three bedroom, and he’s like 42 years old. I’m like, how much are they paying this dude? I mean, he was doing well for himself, huh?

– [Zubin] He was a psychiatrist, right?

– [Vinay] Psychiatrist, radio psychiatrist, too, but you know.

– Oh right. he had the whole Dr. Drew thing going on.

– Yes.

– That’s right. What a great premise. And again, a spinoff, a spinoff of “Cheers”.

– [Vinay] Of “Cheers”, yeah. He’s like the longest running character and fascinating.

– Wow.

– [Vinay] All right, I gotta go do the Lord’s work. I gotta go do some work, real work.

– [Zubin] I usually say that when I’m about to go drop a deuce off in the bathroom. But yeah, that’s great.

– [Vinay] Yeah, well you never know.

– [Zubin] It can be the Lord’s work. So guys, you know what to do. Subscribe to the show, leave a comment, leave a review. It helps us a lot. Share the show, all the other things. Anything else, VP?

– [Vinay] No, I think we will try to be back soon and have much more to talk about. And maybe if they have topics they want us to talk about, rather than specific individual questions , they just are often very difficult.

– [Zubin] Yeah, we can’t answer, yeah.

– Yeah.

– Yeah.

– [Vinay] With topics or themes, that would be good.

– [Zubin] We’d love to know, yeah. You can hit me up, [email protected] and just put #VPZD in the subject line. And that way, I’ll know it’s a VPZD topic. All right, guys, we love you. And we’re out. Peace, VP.

– Until next time.

– [Zubin] Until next time.