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COVID-19

COVID-19: Current state of affairs, Omicron and a search for the end game

Below is the transcript of The Drive episode #189 “COVID-19: Current state of affairs, Omicron and a search for the end game” by Peter Attia MD. In it, Dr. Attia discusses many topics with Dr. Marty Makary and Dr. Zubin Damania (aka ZDoggMD).

The most common words and topics that came up during this episode were:

TopicCount
immunity73
data67
vaccine64
covid49
natural immunity32
public health15
young people14
Fauci13
severe disease11
United States8
wear mask7
Francis Collins6
South Africa5
SARS15
fatality rate5
circulating antibodies5
neutralizing antibodies5
health officials5
second dose5
severe illness5
monoclonal antibodies5
boosters young people5
gain of function research5
memory b cells5
New York4
laboratory data4
common cold4
immune system4

The video above is just a screenshot and audio. You can also listen on Dr. Attia’s episode #189 page on his site. The episode is 2 hours and 45 minutes long, so if you prefer to read what was discussed, the full transcript is below.

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Dr. Peter Attia0:11Hey, everyone, welcome to The Drive Podcast.
Dr. Peter Attia0:13I’m your host, Peter Attia.
Dr. Peter Attia0:14This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness full stop, and we’ve assembled a great team of analysts to make this happen. If you enjoy this podcast, we’ve created a membership program that brings you far more in depth content. If you want to take your knowledge of the space to the next level. At the end of this episode, I’ll explain what those benefits are. Or if you want to learn more now, head over to peterattiamd.com/subscribe. Now, without further delay, here’s today’s episode.
Dr. Peter Attia0:50Welcome to this week’s episode of The Drive. This week, we have two guests simultaneously being interviewed, something I don’t do often. My guests this week are Dr. Marty Makary and Dr. Zubin Damania, aka ZDoggMD. Both of these are close friends of mine who have also both been previous guests. And I wanted to have Marty and ZDogg back on to talk about COVID, which is not something I’ve done a podcast on in some time. In fact, when I did my last podcast on COVID, I really thought that was kind of the end of it, and I was sort of done talking about COVID publicly. I would obviously continue to stay as up to speed as necessary on all things relevant to my patients, but I really was kind of done with talking about COVID policy and things like that. But truthfully, in the past, I would say month, I’ve become a little bit frustrated with what I’ve seen around kind of shoddy science and even worse, messaging around COVID. So I thought it was time to revisit this. So this episode, we talk about a bunch of things. We talk, obviously about Omicron and what’s known and understand that these podcasts are always dated, right?
Dr. Peter Attia1:46So the date of the recording of this podcast was Monday, December 27. And by the time this podcast is out, it’s already been a week. Three months from now. We’ll know things we don’t know today. That’s just the nature of things. But nevertheless, we talk about what is known today about Omicron. We talk about what we understand about vaccine, both benefits and risk, focusing on the mRNA vaccines here and specifically looking at the differences between Pfizer and Moderna, especially in the subset of young people, and further stratifying that by gender. We also talk about natural immunity, something that seems to be a very taboo subject matter, but it’s a very important thing to discuss a lot of time trying to explore what is the end game here? What is it that we’re hoping to achieve from a policy perspective to get to living in a world that looks more like it did in 2019? Is that even going to be possible? What is the difference between a pandemic and an endemic. So this is a very conversational interaction. It’s partly an interview, but really in the end, it kind of just a discussion between the three of us just by brief background. Marty is a Johns Hopkins Professor and public health researcher. He’s served on the faculty of Hopkins at the School of Public Health for the past 16 years and served in leadership at the who. He’s a member of the National Academy of Medicine and serves as the editor in chief of the second largest trade publication in medicine called Med Page today. He also writes for the Washington Post, the New York Times, and The Wall Street Journal. Zdog is a UCSF Stanford trained Internet and the founder of Turntable Health. He’s also the host of a very popular podcast, ZDOG MD Podcast, as well as the co host of an excellent podcast called The VPZD Show. And that’s with Vinay Prasad, who, by the way, has also been a guest on this podcast. And we reference Vinay here. In fact, I would have loved to have had Vinay on this podcast as well, other than the fact that it would have been pretty cumbersome to have four people on a podcast. Final thing to know here is that because we recorded this on December 27 with the aspiration of getting this out as quickly as possible, our video team was not in town, so we did not do this on video. And we don’t really have the staff this week to put out show notes. So we’re doing this to be as quick as possible and responsive as possible to some of the questions that many of you, I suspect, are asking. So I hope you’ll accept our apology that this will be an audio only podcast and there won’t be show notes beyond just a number of references. So without further delay, I hope you enjoy my conversation with Marty Makary and ZDoggMD. Marty, so awesome to be sitting here with both of you. As you know, not a topic I have been spending much time on, certainly publicly. Obviously, anyone who’s taking care of patients has to be paying attention to what’s relevant to them. So that’s permitted me the luxury, I think, of being able to offer my opinions to patients, my interpretations. But I did feel I need to go a little bit deeper in the past few weeks and thought I’d reach out to you guys and we could do this as a discussion because you guys have been spending a heck of a lot more time on this than I have. And in the last five days, I’ve been drowning in this substance. Luckily, I have wonderful analysts who have been able to organize information for me. But anyway, let’s just start with helping me understand and the listeners understand kind of what we know and don’t know. And one of the ideas that we had talked about at the outset, which I think you guys agreed was a good thing that we can try is for the listeners helping people differentiate between what we believe is fact or what is knowable and then what is opinion, because I think we’re going to very easily go back and forth between those two. And I think people expect that right. On some level, people want to hear our opinions, but I think they also want to know when that’s separated from fact. So hopefully between the three of us, we can always kind of remember which of those pillars we’re playing in. But what I’d like to do is kind of start with some basic questions for you guys. So we’re recording this on what is it, the 27th? Right. And obviously, a lot of what we’re talking about is in flux. Part of what’s prompting this is Omicron being a new surge. What do we know about this virus, this particular mutation, and how it differs from Delta? And do we want to call the original one Alpha or OG? What do you guys call that?
Dr. Marty Makary6:00First of all, great to be with you, Peter, and great to see you again here. So I think we can compare Omicron to Delta, because Delta represents sort of the worst of the previous strains. And now we’ve got some pretty good laboratory data that tells us that Omicron is not infecting lung cells, neither individual cells or what we call organoids in a lab, which is a cluster of similar tissue types at the same efficiency. It’s about 90% less efficient in replicating in those lung cells. So we’ve got laboratory data now confirmed by three independent labs that it’s not infecting those cells as well. That’s why we’re not seeing the cough and the severe disease and the systemic illness like fever, as frequently with armor crime. We’re seeing more of the upper respiratory stuff than Naries the Broncos symptoms. And by virtue of that, you’re going to blow it off more. And maybe that’s one of the drivers of it being more contagious. But we’ve got the laboratory data. We’ve got epidemiological data looking at South Africa, looking at the numbers down now over 35% off their peaks. I’ve got a shorter length of stay there, observed about two and a half days versus eight days. Hospitals were not overrun in a country where you could argue semi limited resources. And we’ve got bedside observation. So we’ve got epidemiological data, laboratory data and bedside data that all fits that it is, in fact, no longer an open question. This is a more mild virus.
Dr. Zubin Damania7:26I guess one of the questions that I have around the mildness of the virus, because there is also that I think it’s that Hong Kong data that you’re pointing out, that you have a lot of upper airway replication, some multifold over the OG strain and Delta. But this idea that it’s a milder clinical syndrome is a little complicated by the fact that in South Africa, you have a lot of high zero prevalence of previous infection. And so the question is how much of this is we have now a degree of natural immunity and some vaccine immunity in South Africa, and what you’re seeing is a virus that’s more replicable, maybe a little less pathogenic, maybe a little less disease, but in the setting of a much more immune population, because if you’re looking at the kind of the three precepts of a pandemic, it’s a very transmissible virus that causes a lot of disease that we don’t have great immunity for. So those three things, and it looks like with Omicron, we have a very transmissible virus that may cause milder disease that we have quite a bit of immunity to already. And so all those things may collude to make this less of a problem than Delta in terms of what we care about, which are actual outcomes.
Dr. Peter Attia8:33At the risk of asking maybe a naive question, is it still reasonable to say that this is absolutely a COVID variant, or at some point, will mutations of the OG strain, the Delta lineage, get so far away from those strains, presumably in terms of virulence as one metric, that we really ought to be thinking of them more as coronaviruses and not necessarily COVID-19? Where would that line be?
Dr. Marty Makary9:03Look, I think that is the ultimate question. Is COVID going to be the fifth seasonal coronavirus, as I know you and Amisha Dolphin had postulated early in this pandemic as a reminder to those listening for coronaviruses that circulate year to year. That account for about 25% of the cases, the common cold. This may be the fifth, and it may be in this version now, the Russian flu, which was 18. 80, 19. 91. Many are now postulating that that was a horrible pandemic of a flu season preceding the Spanish flu, and that may have very well been a coronavirus that turned into one of those four seasonal coronaviruses that we live with today. So we may have essentially a fossil of a previous pandemic that mutated to a seasonal mild coronavirus, and it may be, in fact, one of those four existing viruses.
Dr. Zubin Damania9:55Yeah, I think this dividing line is interesting. Right. Because it really is. At what point do we decide that’s the case? Because a seasonal cold can actually kill somebody who is medically fragile with comorbidities. We see it every winter as hospitals. We admit it’s an impending sense of doom. It’s like winter is coming every time in October. We know that just standard flu, standard seasonal cold, the coronavirus stuff that we already have, the adenoviruses, even RSV and adults can cause a very nasty syndrome if you have a lot of comorbidities. And it fills up our hospitals because the hospitals operated capacity. So at what point is where we are now considered very different from that? And that’s a really awkward question.
Dr. Peter Attia10:39Another interesting question. And again, we’re clearly now in the editorial phase, but again, we’ll come back to some data later. But if you were thinking about this through the lens of evolution, Omicron would be by far the best of the three so far. Like, if you’re putting your virus hat on and you’re saying what’s in the virus’best interest, you have the perfect virus. It is highly communicative and not lethal. And, in fact, the worst viruses are the ones that are a little harder to spread and kill their hosts. So is there any evolutionary argument to suggest that we would expect this to be the evolution of the virus, that as it gets more evolutionarily fit, it should be killing people less and it should be spreading more?
Dr. Zubin Damania11:26It seems that that makes evolutionary sense on many levels. And actually, if you compare it to SARS, the OG, the SARS one, SARS one seemed to have a little higher case fatality rate, affected a different Swatch of people. But the way that it spread, you could detect it symptomatically when it was contagious and when you were asymptomatic, you weren’t contagious. So we were able actually to stop that virus through behavior restrictions, testing for people with what we consider now to be hygiene theater pointing. And this is editorializing pointing a temperature gun at somebody’s head back then may actually have worked with that. But if you look at them, the success of the virus that wasn’t a very successful evolutionary virus, whereas this one, oh, boy, spreads when it’s asymptomatic causes severe disease, just in typically more vulnerable people. But there are so many people that are vulnerable that you end up causing a pandemic level of drama. But as you start to evolve, it to Omicron where, man, it spreads so fast that everybody pretty much has a date with a Macron at some point. But it causes less severe disease. We think based on the data that Marty citing and emerging information, well, that’s a very successful virus, and that virus gets rewarded by being part of the pantheon of our seasonal biome that affects us every year. And I think it would be very unsurprising if that’s the Mo of evolution in this case.
Dr. Marty Makary12:45I like the temperature gun reference for some reason, those temperature guns scare me as much as they it may be that Amicron is nature’s vaccine. It is far more mild. And for the 93% of the population living in poor countries in the world, they don’t have access to a vaccine right now. And it’s going to be very difficult. So a lot of people out there are going to get vaccinated essentially by getting Amicon. And it’s ideal to get the vaccine over getting the infection. But it may be sort of a silver lining of this variant, and it may be how a pandemic ends. We do know from a Johns Hopkins study that’s now on the preprint server that your T cell immunity, which is the most underrecognized part of the immune system in the entire COVID discussion that is still solid against Omicron, just as it was against Delta. The crossover is very high, and that if you get Amicron, you’ve got T cell immunity to Delta and vice versa. That’s now pretty.
Dr. Peter Attia13:49Can I jump in here on something? Because I’m glad you brought this up, Marty, and I suspect both of you will have a lot to say on this. Everybody’s heard the expression what gets measured, gets managed. What we can measure, we tend to fixate on. And unfortunately, when it comes to measuring immune strength, we really have one tool in the toolkit, which is to measure circulating antibodies which are not the same as neutralizing antibodies, which are part of the B cell immunity. And then you have this other thing that you’ve alluded to, Marty, called T cell immunity. I don’t think we need to go into it in great detail. I did a podcast with Steve Rosenberg that was cancer focused, but we had a totally in depth discussion on Bcell versus Tcell immunity. So we’ll send people there if they want the primer on it. But the upshot is we don’t have a laboratory test to measure Tcell immunity. We don’t even have a commonly available test to measure neutralizing antibodies. We just measure circulating antibodies. So we can’t really even measure what memory B cells are doing. Do you think that’s a little part of the problem here in that we’re kind of flying blind and making a lot of assertions about immunity based on arguably the least important thing that you could measure? And again, I’m editorializing in my question a little bit, but what do you guys think about or push back on that if you think that we’re undervaluing circulating antibodies.
Dr. Marty Makary15:13I definitely think that we are undervaluing circulating antibodies and cellular immunity as a broad group. That is the memory B cells, memory T cells. Listen to our public health officials from day one. They talk about the antibody levels jump up and then we see them go down. And then initially there was a fear of reinfection. Well, we didn’t see it clinically at the bedside. Then when the vaccines came early on, they said, you really have to get that second dose because look at the antibody levels just go up tenfold of what they go up after the first dose. Well, that’s good, but it’s good for activating your memory B cells and memory T cells. It’s good for the cellular immunity. Antibodies come and go. That’s in the textbooks, right? They linger for months in the system, and then they wane. And by having this intense fixation on only one aspect of the immune system that is antibody titers, what we have done is we’ve created a scenario where we’re chasing our tail to keep those levels high, because when they’re higher, you’re less likely to test positive. So what we have created, we’ve created this expectation that the vaccine is somehow failing. Now when you test positive, even though that cellular immunity is still strong, in preventing severe illness.
Dr. Zubin Damania16:25And it creates an almost a cascade of surrogate markers that don’t really measure what we’re directly interested in.
Dr. Marty Makary16:30Right.
Dr. Zubin Damania16:30Because if you have the surrogate marker of OK, neutralizing antibodies, and then that’s trying to treat a surrogate marker of cases, PCR positive cases. But what do we really care about? We care about people in the hospital filling up, the hospital, sick, dying, maybe we can say long COVID is in that question Mark of things we care about. And so how do we really look at that? I think what Peter’s question really points out is do we have good measurement criteria to look at? Are we actually immune against severe disease, which is that sort of innate memory response that as anybody’s, Wayne, you still are able to Mount this, which means, hey, you’re still going to get cold and flu symptoms, you’re still going to potentially be infectious during that period, but it’s not going to settle into cytokine storm Ards and being prone to ICU ready to die. And that’s what we care about. And I agree. We talk about things like Tcell detect, which I actually don’t know much about. It’s one of these commercially available tests. I don’t know if Marty knows more about it, but I really don’t think we have good outpatient commercially available tests outside of research that measure these things.
Dr. Peter Attia17:36In the study that we’re and I’m not really that involved. I was involved in some of the planning of it. But there’s a study that’s going on at the University of Indiana right now, and it’s specifically looking at long term B cell and Tcell immunity. And in speaking with the investigators, there the assays to measure that degree of function are quite complicated. I mean, these are not things that are amenable to commercial testing with any rigor. So I do feel pretty confident in saying that we don’t really have the tools to measure those things. I forget who I heard say this, but I’m paraphrasing somebody. They said measuring circulating antibodies and saying, you know, everything about a person’s immunity is sort of like looking at a person’s bank account and saying, you know, everything about their net worth. It’s probably correlated. Right. But especially with a wealthy person, like their checking account is really not representative of their net worth. Their checking account probably doesn’t have $0 in it. They’re probably not overdrafted, but it’s unlikely that a billionaire is going to have hundreds of millions of dollars sitting in a checking account. So I think that’s sort of to your point, both of you, I think, created a series of metrics that are problematic, especially when I haven’t heard a clear articulation of what the end game is. So this is now a macro question. Right. Which is I had to go out somewhere today, and it’s actually pretty unusual for Austin because Austin really doesn’t care about masks or anything like that. But I was surprised. I went in and the woman said she took my temperature, and so I got the temperature gun in the face. And then she said, we’re wearing masks. So she handed me a mask. And I don’t argue with people over that kind of stuff because I feel like that’s her pay grade, right? That’s her job to tell me that’s, fine, I’ll wear a mask and whatever. But I keep thinking, what’s the end game here is the implication, because if you’re making me wear a mask now, shouldn’t it be implied that you’re going to make me wear a mask forever? Because how do you extract yourself or walk back from this position of temperature, gun, mask, etc. So when it comes to what is the end game, what can we all agree as a reasonable line in the sand beyond which the world goes back to 2019? I’m having a hard time understanding that. What do you guys understand with respect to that?
Dr. Zubin Damania19:56From my end? So much of it, Peter, is an emergent property of how we’re measuring stuff. It’s actually the question that you asked in the beginning. It’s like if we care about cases and neutralizing antibody levels, then it’s going to be an infinite number of boosters and masking into perpetuity. And even though the data is very questionable and all this stuff, we keep doing it. This is a policy question. How do we want to be in the world? How do we want to live our lives? What’s the difference? Quantitatively and qualitatively between 2019 before we had this pandemic, but we would have severe flu that would overwhelm hospitals in the fall and certain places would go on divert. And we’ve all worked. I’ve worked in those facilities. When that happens, it sucks. Every medical person grinds their teeth and gnashes everything. But we get through it. And we don’t disrupt society. We certainly don’t close schools. We don’t inflict masking on the public because we would never think to do that as a policy. So this is really a policy question. How do we want to be in the world? And I think that’s where all the division that’s been sewn on social media, through mainstream media, alternative media, all this disinformation misinformation, I don’t even know what that even means anymore, has created an environment where we’re so atomized by tribe that even the policy questions become tribal identifiers. So we need to kind of really see that clearly from a perspective of a more holistic, integral perspective where we can go, okay, this is what’s happening. All right, well, what do we really care about? We care about people not dying, not filling up hospitals, and we care about our economy working because health actually is correlated to wealth, which is correlated to longevity. I mean, these are things that are clear socioeconomic status, education matters for that. So this is how we have to look at policy, not a reductionist. How many cases can we prevent? And I think there’s political stuff here that happens and it just becomes a complicated mess.
Dr. Marty Makary21:48Can you imagine, guys, if we tested for influenza every flu season when, say, four years ago, we had 41 million flu cases in a matter of a couple of months. Can you imagine if we graft on a daily basis the number of newly diagnosed flu cases and we’d create mass hysteria? Now, it doesn’t mean we blow off flu or we don’t take it seriously or we don’t tell people some reasonable strategies, like if you’re around someone vulnerable, be careful. If you think you’ve been exposed, wear a mask. If you have symptoms, stay home. That’s kind of how we live with the respiratory pathogen. Ten to 25% of the population will get infected with a respiratory pathogen every year in perpetuity because there’s a whole bunch of them. There’s rhino virus and Ekinovirus and influenza and Para influenza and the four coronaviruses we talked about if a parent brought their kid in, say, for their newborn evaluation, the first Pediatrics visit. And the pediatrician said your child will develop five to seven pediatric respiratory infections during their childhood. I mean, you could blow that up into a headline, but the reality is we’re not going to eradicate pathogens from planet Earth real quick. Peter, you mentioned something about we were talking about the antibody tights and sort of chasing our tail. This just came out a day before Christmas from Britain, from the UK. Now, this is from the UK Security Agency. They’re pulling the data. They’ve got great data. So the vaccines, as they have had them with the primary series, are 70% effective against symptomatic Covid. Ten weeks after a booster, it goes down to 35% for Pfizer and 45% for Moderna. So within ten weeks, you’re seeing even the booster wear off against your ability to test positive or have a symptomatic case. But those memory B cells and Tcells are still working. The cellular immunity is still protecting against severe illness. So if we keep chasing antibody titers, you might be getting a booster every first Monday of every month when you show up at work and it still won’t work.
Dr. Peter Attia24:08:00I was thinking about something this morning, guys, that I thought could help us kind of anchor a little bit into the evolution that we’ve undoubtedly all experienced. So if I think back to March of 2020, I actually pulled my kids out of school about two weeks before the lockdown, two weeks before this got kind of insane. I was like, you know what? I don’t know anything about this virus. I don’t like what I’m seeing outside of the United States. We’re going to keep our kids home. Oh, my daughter was furious. How could you do this to me? Blah, blah, blah, blah, blah. So I look back at that, and I think that was the wrong thing to do because it didn’t matter. But I didn’t know better. And I think it was a reasonable precaution in the absence of any information. Right? Like, if this turned out to be as bad as SARS one, meaning it was as lethal as SARS one, but as infectious as SARS two would have been a good thing to do. Turned out it was overkill. So I was thinking about how many times has my view of this problem changed? And the answer is many. And I think part of it comes down to a framework around what tools do we have at our disposal and what knowledge do we have about how to reduce morbidity and mortality for COVID? And I was thinking about this because the first time I delineated this was in the spring of 2020. And now when I do it today. So tell me if you guys would add two or subtract from this. So I break it into three broad categories. The first is preventing infections. The second is treating infections, and the third is providing supportive care for people who end up in hospitals. In the preventing infections, you have two things, basically vaccines and behaviors. In the treating infections, you would have existing drugs versus new drugs and then supportive care. So back in the spring of 2020, we had no vaccines. We had behaviors, but we didn’t know which ones were right versus wrong. Being indoors, being outdoors, wearing this type of mask, that type of mask, we didn’t know anything. Stands 6ft apart. Stand 16ft apart. It was just a whole bunch of made up stuff. On the treating infection side, we obviously had no new drugs, but we had a whole bunch of existing drugs and drugs, and there was a whole slew of ideas around, well, would this drug work? What about remember rim disavowed? We talked about that so much. And then, of course, you had half these drugs became totally politicized, et cetera. And then in the supportive care side of things, we didn’t know anything, right. It was like, is this Ards? Should you be oxygenating? The bejesus out of people steroids must be horrible. I mean, we really knew nothing. You have a whole bunch of empirical insights. And when you consider where we are today on that front, I mean, I just kind of jotted out a bunch of ideas. It’s kind of amazing that in less than two years, we have multiple vaccines with pretty clear ideas about which behaviors reduce the spread of infection and which don’t. On the treatment side, we have a pretty good sense of at least one existing drug that works, which is fluvoxamine. We can discuss if there are others. And we’ve got at least two new drugs that seem quite promising. I’m more familiar with the Pfizer data than the Merck data, and you guys can probably speak much more to the therapy side, the supportive care side. But it seems to me that ICU doctors and nurses have a way better sense of what to do today than they did a year ago. Let alone 18 months ago. Anything you guys would add to that framework? Because I think it’s important to differentiate between what the world looked like in the spring of 2020 with respect to those data points or those parameters versus what it looks like today. So would you expand or subtract on that?
Dr. Zubin Damania27:45:00I can say a couple of things here. That’s a really good framework. It’s interesting because in the prevention framework, you could also throw in, hey, what about things like vitamin D, treating metabolic syndrome, diet, exercise, those kinds of things which are a little softer.
Dr. Peter Attia27:58:00We call it lifestyle. But no, I like it. I like it.
Dr. Zubin Damania28:00:00Like lifestyle modification, which I remember in the early days you were talking about things that you did. Things I did, too, were because I said, this is more like OG SARS, because we didn’t know what the infection fatality rate was. I was sitting there exercising like a lunatic, and I stopped drinking alcohol, and I did all these personal things to try to improve my metabolic condition. So that’s a piece of it. And then there’s a question of chemo prophylaxis. Some have been these policies, drugs. They’ve been advocating that they’re more prophylactic as well. You could take it, Ivor Mctin, once a week and prevent this. I mean, it’s worth exploring. I don’t think there’s data that we have. But your comment that this has evolved so quickly is absolutely a beautiful vindication of the scientific process when it’s allowed to unfold. I think people who have politicized this a lot on both sides say, oh, nothing’s. Doctors aren’t really trying to do anything to treat this. We haven’t really learned anything. No, the opposite is true. Multiple good vaccines, things like dexamethasone in the hospital that have really improved mortality, and we’ve actually thrown out things that don’t work, which is actually just as important because those things can actually cause harm. So the question of hydroxychlorquin, for example, Ian Edison’s metaanalysis showing that maybe we actually cost lives by giving that much hydroxychloricin. These are things we need to actually really dive into. And it comes down to this, Peter, like, let’s say the IFR, this is how I think about it. If infection fatality rate, let’s say it’s zero. 2.3 somewhere in that range, which seems reasonable, although we don’t have the exact data. How many people in the US are roughly at risk then of dying based on the population of the US and the IFR of the disease? And I did a back of the napkin calculation a few months ago that was roughly about 1.4 million Americans. If that thing was the actual IFR of the disease, if we didn’t do anything that’s at the current state of the IFR, that’s how many people would die, we’re at what, $800,000? So the question is, will we get to 1.4 or will it not reach 1.4? And if it doesn’t, what of those three buckets? What did we do to actually improve that. And I suspect it’s a mix of vaccines, Therapeutics in hospital lowering IFR by improving hospital care and some behavioral stuff, like maybe avoiding big crowds when something’s surging, something like that. But that’s kind of my current thinking on it. The goal is get that down from 1.4 million as much as we can without destroying the fabric of society, which will actually push it back up towards 1.4 through ancillary damage in terms of substance abuse, overdoses, mental health problems, suicide, that kind of thing.
Dr. Marty Makary30:39:00Yes, it’s amazing what we have in our toolbox, how far we’ve come scientific innovation. To me, what’s almost equally amazing is how we’ve not incorporated many of these new Therapeutics into common practice. And that is probably a glimpse as to what’s broken with our broader health care system. The average 17 year lag for new evidence to get broadly adopted into practice, and we’re seeing that play out now. Maybe it’s truncated, maybe it’s a three year lag, but it’s too slow for a health emergency. Yes, it’s amazing how much we’ve learned, but it’s also amazing how we still have doctors telling folks, oh, you have COVID, tough it out, stay at home. You know what we should be telling them in order, based on evidence, a list of things, and in no specific order, fluvoxamine reduces mortality by 91%. Bunny, a steroid inhaler markedly reduces hospitalization vitamin D has been found to be correlated with severity of illness in a German study in hospitalized patients. Hypertonic saline is an age old treatment that’s been used to sort of rinse out the nasal cavity, and it’s been used by doctors for a long time with many viruses. And you’ve got all of these things that are not being adopted broadly. And to me, we are still suffering from significant groupthink. We’ve been burned badly with groupthink and medicine throughout this pandemic, and the failure to warn about it in the surface transmission idea in the Draconian and Barbaric practice that doctors and hospitals were complicit in to ban people from visiting their loved ones, to say goodbye, closing public schools, Ironically, with a less contagious strain out there, ignoring natural immunity, not talking about fluvoxamine. And I just saw another White House briefing. We’ve never once heard our public health officials talk about it. The group thinking not spacing out the doses. Maybe we wouldn’t be talking about boosters as vigorously if we would have spaced out the first two doses as we should have.
Dr. Peter Attia32:47:00By the way, I want to make a comment on that. When the vaccine started rolling out, I spoke with three immunologists virologists. I won’t name who they are just for the sake of protecting their identity, but I explicitly talked to them about this, and I said why the four weeks between first and second shot that seems at odds with the little bit that I know about the immune system. They said there is not a single reason to do that. Other than they probably did the trial that way for the sake of speed. But they said if you can drag your feet as much as possible between those doses, do so. And I was like, well, do you think it’s worth saying that? And they’re like, no, not going to say that. Just drag your feet as much as you can show up three months later saying you forgot to get your second shot kind of thing. So, yeah, there’s a little bit of this going on. By the way, I do want to go back to one thing you said, Marty, that I have generally found the evidence to not be favorable, which is vitamin D, at least supplemental vitamin D, because my patients ask me about this all the time. I’ve said, look, don’t confuse your vitamin D level that you acquired being in the sun, playing sports outside with the vitamin D level that you can get by taking 40. 00, 50. 00. Iu of vitamin D. I don’t think those are the same. I think vitamin D might be a surrogate for health through other means. Did this study that you’re citing specifically look at outcomes being improved with supplemental vitamin D, or did it simply associate or note the association of higher levels of vitamin D and better outcomes?
Dr. Marty Makary34:27:00The latter. So out of all the things I mentioned that has the weakest evidence that was sort of a retrospective review of hospitalized patients just looking at their levels and they found some correlation. But it doesn’t imply causation necessarily. All the other stuff has randomized controlled trial data behind it. The vitamin D thing was a retrospective review.
Dr. Peter Attia34:47:00Yeah. So my take on that has been in my practice has been not to prescribe vitamin D and instead to get outside and exercise in the sun and get it that way. Zubin, do you have a take on any of those?
Dr. Zubin Damania35:01:00Yes, that was my take on the vitamin D. P. Two. Is there’s a correlation causation situation there? There is definitely something going on with naturally acquired vitamin D that seems, at least in a correlative way, protective. One thing that I think is interesting. So fluvoxamine again, I think when you’ve been through the hydroxychloroquine Ivor Mctin mill, the group thing starts to shift and go Therapeutics just simply don’t work, especially if they’re repurposed drugs. There is a lot of groupthink in medicine and people are then unenclined to look at these pieces. The other interesting thing about this particular pandemic that makes it tough, Marty, is that 99.6% or whatever of people are going to get better no matter what. In other words, staying home and doing nothing, they’re probably going to be just fine. And so it becomes this question of how do we tell the whole world to take Budesonide and fluvoxamine and all of that the minute they get sick like Amicron, it’s going to infect everyone. And I’m getting tons of emails, hey, I have cold symptoms. I’m at home. Should I go get monoclonal antibodies? Because Peter has his defined patients. I have like millions of patients who email me and I keep telling them I’m not your doctor. But what I always say is, look, you have to look at your risk factors. You have to look at your age, you have to look at where you infected previously. How did you do with that? There’s so many intricacies. Whereas it would be nice to say, you know what, if you have these symptoms here are low risk, high yield things we can do. And I don’t know, Marty, do you think some of those things on your list are applicable to, say, anyone who gets covered, or would you risk Stratify?
Dr. Marty Makary36:31:00Well, we’ve got to risk Stratify because one, it’s just overkill somebody who’s young and healthy. The German data just came out that between the ages of five and 17, not a single healthy person died prevaccine. So when you’ve got someone vaccinated, it’s probably an indicator of overuse if we’re using some big guns in that population. And I made a comment about doctors being slow to adopt some of this stuff. And I just want to be clear, we have put doctors in a terrible situation in the United States. We have put them in a very bad situation by putting them on the front lines of this pandemic without any good data for a long time. When this pandemic happened, it hit this country and every single person, all of our friends and everybody and everybody who emailed you Cuban. And by the way, sorry for telling people who email me just to email you. Maybe I’ll be telling them to.
Dr. Zubin Damania37:28:00Yes, just pay me a nickel every time that happens. And then as Peter says, if you do a wallet biopsy of my bank account, I’ll have like at least a dime in there. It’ll be great.
Dr. Marty Makary37:38:00But we were all getting the questions. How does it spread? Do masks work? How long are you contagious for? Can you spread it precinctic all the basic questions of COVID. We did not have answers because our gigantic $4.2 trillion healthcare system could not do the basic bedside clinical research. I remember Peter was even doing a quick video about somebody, please do this study. We were all saying the same thing. Labs were mostly closed because there was no PPE. The NIH was unable to pivot their $42 billion to answer these questions quickly. So what we did is we had a vacuum of scientific research and all the doctors are on the front lines without any data to really answer these questions. And that’s when the group think began. And guess what ended up filling that vacuum? Political opinions. So we just did this study of NIH research funding. Last year, less than 5% went to COVID Research. Three months into the pandemic, 0.5% of the NIH budget went to COVID Research. The average time for them to give a grant was five months to fund a research team to then start the research, 257 grants on social disparities with COVID, an important topic, but only four on how it spreads, and one on masks, which hasn’t even read out yet. So the most basic questions doctors needed evidence for that was not being conducted.
Dr. Peter Attia39:06:00I want to go back to something that you guys have both now alluded to. And I talked about this a little bit on the podcast with Rogen, and I think it’s worth mentioning again because it’s a fundamental issue that I think we’re going to talk about many times this afternoon. David, Alison and I had a discussion a couple of months ago, and he put this very eloquently, and it’s something we all understand. But I think I like the way he phrased it right, which was always know the difference between science and advocacy. And as we explain these differences now, I think people will inherently understand it. But again, we’re now talking in the realm of opinion. My opinion is perhaps the greatest disservice that has come out of this has been that line has been so blurred to be nonexistent. So science is messy, science is uncertain. Science speaks in probabilities, and science constantly changes in the face of new information. Right. So science is a process, not a thing. Science says this is what we know today. With this degree of certainty, as new information becomes available, the new truth will be this truth is not a constant within science. Right. Truth. We hopefully converges on greater certainty. And so when scientists speak, it doesn’t really sound that reassuring. I mean, we know this because we interact with scientists a lot. They never give you a straight answer, because if they’re doing their jobs honestly, outside of really well known phenomenon, we have to speak in uncertainty. I think for understandable reasons, advocates can’t do that. They don’t have that luxury. Right. If you’re a public health advocate, your job is to communicate something with complete certainty. But if you’re observing this as a member of the public and you don’t know the difference, how do you know what to make of this? Is it safe to say that Anthony Fauci is an advocate in COVID and not a scientist?
Dr. Zubin Damania41:13:00This is the central thing that’s going on here. I think, Peter, I think you’re absolutely right, because what it is, if you look at Fauci say, or you look at Francis Collins so recently leaked email, Francis Collins talking about the Great Barrington Declaration, which was a bunch of scientists, including someone who’s been on my show, Jay Bodice, saying, hey, as a matter of policy, we think the following things should happen that would improve outcomes in this pandemic based on our interpretation of what the best science is right now, there is no the science. This is our policy interpretation. Right. And what Francis Collins roughly wrote in this email was, hey, did you see these fringe epidemiologists coming up with this Great Barrington Declaration. Oh, by the way, one of the fringe guys is a Nobel Prize winner at Stanford, Mike Levitt. And if you haven’t seen it, we need to do a devastating and decisive takedown of this. And I don’t see it out there yet. And so basically saying ultimately what I interpret this as, hey, I disagree with this as a policy. We need to put out something that takes it down as a policy. And there’s not a discussion of, oh, let’s discuss the underlying science. Let’s actually have a discussion about policy. Like, does it make sense to treat healthy people that are young, the same as elderly people at high risk? These are the conversations we ought to have. Instead, they acted as advocates. Well, our position is, do the lockdowns, make people mask, promote whatever it is we’re promoting, and that’s our policy. So we need to advocate for it in no uncertain terms, which means a devastating and immediate takedown of these, quote unquote fringe epidemiologists. And that is as clear an aspect of the difference between policy, politics, and science. But this is a scientist who represents one of our largest scientific public agencies. So that was really concerning to me. I’m curious, Marty, what you think of that?
Dr. Marty Makary43:06:00That was chilling when I saw that email from Francis Collins to Falchi, and it called for a devastating takedown of another opinion. Basically, they control the currency of academic medicine, which is NIH funding. When you’ve got the head of that talking about taking down ideas and taking down people, this is probably the greatest lesson we should learn from the Pandemic in addressing. How do we avoid groupthink in the way that it’s burned us time and time again, we’ve got to openly talk about the corruption of science itself, how there has been a shutdown of scientific discussion, how you cannot talk about certain things. It started with Google suppressing any search of Wuhan lab leak. And they admitted this openly. They said we suppressed any searches because we weren’t sure and we didn’t want people to get the ideas. If they weren’t sure, well, that’s not their role. They did the same with the Great Barrington Declaration, took down Dr. Bodice Aria. I was skeptical of the declaration early on, but look at what’s happening in Sweden now and tell me if there wasn’t some truth in what they were talking about. Martin Caldorf, very well known vaccinologist from Harvard on the CDC ASIPP committee, basically dismissed openly. He told me this and he said I could say this publicly. I’ve written about it in the Wall Street Journal, dismissed from the committee for having a different idea. He was upset about the JNJ pause being too prolonged in creating vaccine. Hesitancy asked to leave the committee. Fda bypassed their own expert advisors, called VERPAC on the boosters for young people. Vote CDC with their expert advisors on boosters for young people, told that committee, specifically, you’re voting on older folks. We’re not holding a vote on boosters in young people. And then they go ahead and authorize and recommend it for young people to senior FDA officials quit, including the head of the vaccine center at the FDA, academic bullying. How many people have reached out to us and said, thank you for talking about natural immunity. I see it in my patients. I can’t talk about it. I’m told we have to keep one message, and that is to get everyone vaccinated. And thank you for speaking up. I can’t do. So why is the NIH not done a study on natural immunity? They keep saying, we don’t know. They’re ignoring the 141 studies that have been documented by the Brownstone Institute. It’s not that hard. Go to New York where people have the infection, interview them, test their blood. I mean, why is my research team doing this without NIH funding? Because the NIH is not only not funding it, they’re not doing it, and they’re relying on two really flawed studies that the CDC put out. This is the distortion of science itself, shutting down scientific discussion. And that should be our greatest lesson.
Dr. Peter Attia46:04:00I want to come back to something you said about natural immunity, because now I want to kind of get into let’s talk about what we know. So let’s start with that. What do we know about naturally acquired immunity?
Dr. Zubin Damania46:15:00It’s interesting because there are multiple studies showing that natural immunity is actually a real thing. It’s a real phenomenon. It generates very good protection against either reinfection at a lower rate or severe disease at a much higher rate. And then there are a couple of studies that are CDC sponsored studies that Marty has reviewed in depth that say the opposite. And what’s interesting is, as a matter of policy, then the policymakers in the US have chosen to go with that approach saying, listen, it doesn’t matter if you’ve had natural immunity. You still need two vaccines and a booster. And by the way, you cannot space them out beyond a certain point or they will not even count for the mandates that we’re talking about. So where policy actually contradicts evidence that we have, it becomes at this point, it’s pure advocacy, pure policy, and that distinction between public health and science, where public health says we have to speak with a monolithic voice that simplifies complexity into binaries. Otherwise no one is going to listen because Americans are too stupid. That’s the subtext versus actual scientists who are like, wait, no, wait. And those are the emails we get, right, Marty? The people who can’t even talk about this nuance because they’ll get censored in their own academic institution. So back to you.
Dr. Peter Attia47:27:00Well, I do want to ask a technical question. Is there a precedent for a respiratory virus to not generate natural immunity? In other words, what would be your prior on this if you knew nothing? Again, this is so outside of my wheelhouse, guys, I’m not an immunologist, but more importantly, I’m not a virologist. I think that’s the real question, and none of us are. So do we know if it’s actually the norm, that once you have a virus, you tend to develop natural immunity to it? I mean, that was sort of my understanding from medical school. But have things changed significantly and what would be our expectation here?
Dr. Zubin Damania48:05:00Yeah. So just real quick, strep throat, which is a bacteria that can reinfect you and reinfect you so you cannot have a viable vaccine. Respiratory pathogens in general, you can get reinfected, but your immunity against severe disease tends to be quite strong.
Dr. Peter Attia48:22:00Alternatively, when they’re just changing, right. Of course, like the flu you could get theoretically every year. But that’s because you’re getting a novel pathogen effectively, correct?
Dr. Zubin Damania48:31:00That’s right. And even then, even the novelness of the pathogen is actually not as novel as a real phase shift in the antigens you’re presented with, like maybe what happened in H, one N one swine flu or a new bird flu. So, yes, it’s a spectrum all the way up to measles where it doesn’t change that much, even though it’s an RNA virus and you can get true permanent sterilizing immunity from natural infection for the rest of your life. And that’s why we don’t even vaccinate people who were born before, say, 1960, because we assume they all got measles and they have immunity. So, Marty, I’m curious. Your thoughts.
Dr. Marty Makary49:02:00Yeah. Look, I think one of the little known secrets is we all have our group of go to people. We’ve got our immunologists, our vaccinologists are infectious diseases experts, and we go to them frequently, and we learn to trust the judgment of many of these. And I even heard Paul offered on your podcast Zuben, talk about how there’s that spectrum. So let’s look at the hot coronaviruses, what I call the hot coronaviruses. The cold ones cause the common cold and they’re seasonal, the ones that cause severe illness or the hot coronaviruses. There’s only been three in history, and that’s SARS, MERS and COVID-19. Now SARS was studied 17 years out and the natural immunity was solid. Merses was studied three years out, and the natural immunity was solid, probably longer. But that’s just the time point at which they study the viruses that no longer circulate. Why would you study it much longer if it’s no longer in circulation? So the starting hypothesis, in my opinion, should have been natural immunity appears reliable. We don’t see people getting reinfected with severe illness on the ventilator in the ICU. And once we start seeing that, we can change the starting hypothesis. But let’s use the starting hypothesis that natural immunity works, at least in the time that it’s been around. And what you had was a series of studies come out from early on, two months into the pandemic. Rhesus monkeys were re challenged with the virus and they did not get reinfected. The Cleveland Clinic then came out with their big study of hospital workers who were around COVID all the time and found no reinfections, and the vaccine did not add anything to their immune protection. Then you had the Washington University study, which actually did bone marrow biopsies and looked at the activated T cells in the system. The very difficult experiment that we talked about is not as simple as a blood draw. And they concluded that immunity from COVID is likely lifelong, it’s lasting. And study after study kept coming out. Then we got the biggest study ever done out of Israel, a population study showing that natural immunity was 27 times more protective, adjusted for age, than vaccinated immunity.
Dr. Peter Attia51:18:00Tell me a little bit more about that one, Marty. That seems difficult to quantify. Can you tell me a little bit more about what that actually means?
Dr. Marty Makary51:26:00Sure. So what they did is just they have all the positive testing data, as the CDC does, but they won’t release it of people who test positive and then subsequently testing positive again. They also have all the vaccine records. So if you tested positive and did not get a vaccine, they looked at the rate of testing positive again, and there was something like a 13 fold difference, but adjusted for age, because we know every age group is different, it ended up being an age adjusted 27 full difference. Now, when that came out, it was a few weeks before the data came out on boosters reducing hospitalizations by tenfold and people over 65. The tenfold reduction in hospitalizations with a booster in older people. Dr. Fauci immediately described it as, quote unquote, dramatic data and wrote up a lot of policy around that immediately. The data on natural immunity being 27 times more protective, not mentioned once ever by public health officials. There’s a general fear I hear in my private conversations with public health leaders that if they talk about natural immunity, people might just go out there and try to get the infection. And we don’t want them to do that. And I agree we don’t want them to do that, but we can be honest about the data and encourage vaccination at the same time. Look how many careers we’ve ruined. Teachers, nurses, soldiers getting dishonorably discharged. They have antibodies that neutralize the virus, but they are antibodies that the government does not recognize. That has been a tragic misstep, and I think it’s one of the reasons why the government has lost credibility.
Dr. Peter Attia53:01:00There’s a lot I want to talk about there. But can you talk about the two studies by the CDC that suggest that natural immunity is not lasting?
Dr. Marty Makary53:11:00These studies would not qualify for a 7th grade science fair. The methodology was so poor.
Dr. Peter Attia53:18:00Is that factor opinion, Marty?
Dr. Marty Makary53:20:00That is my opinion, but I think any honest scientists will tell you that the conclusions cannot be derived from the data. The first study was a study looking at a narrow two month period in the state of Kentucky, and they looked at reinfection rates, and they didn’t say anything about whether or not they had symptoms or hospitals or anything. And the rates in both the vaccinated and natural immune group were exceedingly low. They were 0.1% over that two month interval. But because they were both so low and they weren’t equal, one happened to be 2.3 times higher than the other in the natural immune group. So they concluded those with natural immunity, we’re 2.3 times more likely to get the infection again. It’s too small a sample. So what happened was the CDC has data on all 50 States for 15 months. The pandemic at the time, they did something called fishing. And anyone in research knows this technique. You find some small sliver of data in some locale in some narrow time window that supports foregone conclusion that you’ve made before reviewing the day. So they found one state over a two month period that supported their hypothesis. Why don’t they release all of the nation’s data on reinfections? They’ve never done that. In the other study, they surveyed people in the hospital and asked them if they’ve had the infection in the past, and they make conclusions about population level risk by serving people in the hospital. You simply can’t do that. How can you derive a population level risk without knowing the denominator? So both were highly flawed. No one really defended them, except for a lot of politically appointed physicians were just kind of mum about it. And yet these numbers get quoted all the time, like the Maricopa Mass study, highly flawed. Wouldn’t make its way into any hasn’t been published in any Journal that has a review process, just the little MMWR rag that CDC puts out.
Dr. Peter Attia55:16:00Now, has there been a meta analysis, Marty? Because one way to address a body of literature this vast because, as you say, there’s always going to be I mean, you’re always going to find a signal and you’re always going to find noise. A good process. Meta analysis could sift through that. Has someone done that definitive meta analysis on this question?
Dr. Marty Makary55:36:00Yeah. So Martin Cudlorf, who was the Harvard Professor, now he’s at Brownstone Institute, has summarized the 141 studies on natural immunity. And so when Fauci gets on the TV and says, we just don’t know about natural immunity, well, do the study. How hard is it? This is not the Riddle of the Sphinx. You can figure out how many people have been reinfected from the original days of New York and had severe illness. And when this issue was coming up, I reached out to Zubin and I said, hey, are you hearing about reinfections after somebody truly was sick? Not just an asymptomatic test, but they were truly sick from COVID. Have you heard of anyone coming back to the hospital on a ventilator or dying? And look, I’m sure there’s some rare case out there. But he said, no, look, I haven’t heard about it. It’s becoming like Bigfoot. Everyone thinks they’ve heard about it, but there’s no good documentation anecdotally.
Dr. Peter Attia56:32:00I think we see the opposite. Right. I mean, I know many people who have been reinfected with COVID, and I can say without exception, every one of them had a much, much milder course the second time. Now, some of that’s confounded because some of those people also got vaccinated. Right. So they got the first illness prevaccine. That was pretty bad. That was, again, in a healthy young person that could still be like a bad case of influenza. Some of them just went on to get another COVID a few months later, pre vaccine. Some got vaccinated and got another COVID. But I think the point here is this is knowable. There are some things that are not knowable. There are some things that are knowable. This falls in the bucket of knowable. And therefore, it’s frustrating when we don’t have information on things that are knowable or when we claim we don’t have information about things that are knowable.
Dr. Zubin Damania57:21:00And I think this points again at Marty’s assertations that as a policy, we haven’t chosen to devote resources to this. And it is a central question. And I think our anecdotal experience, again, speaks to the difficulty of preventing reinfection with a mucosal pathogen like a coronavirus. And that’s why you can get a cold year after year, but you don’t die. That long term immunity prevents severe disease. And we see that anecdotally. Now, speaking of anecdotes, one thing I want to say about that, everybody has an anecdote of somebody who broke through vaccine or did this or that and ended up getting sick and died. Hospital people are really good at this because they see an enriched sample. So they’ll be like, well, there was a pregnant mother who was 20, who had no problems, died of COVID and this and this and all that, that can happen. But when we now have an Internet where these anecdotes can be amplified into larger level distorting sort of data sets, I think it influences a level of fear and policy decisions then that spring from that. And that’s something we have to kind of tease out by actually doing science, actually studying the stuff directly, and saying, okay, no, this is actually a well designed study that says, actually, no, it can happen, but it’s a .1% risk. And so do we make policy to prevent that risk? And the answer is probably not because it has costs.
Dr. Peter Attia58:38:00Yeah, this gets back to I’ll just keep harping on this idea of science versus advocacy. Science versus advocacy. Again, on the other side of the spectrum, you have a whole group of people who are saying, hey, vaccines are horrible. They should never be used. Nobody should be vaccinated. Natural immunity is the only way to go. Vaccines don’t even prevent illness because look at all these breakthrough cases. And again, I think a very arrogant approach is to say, shut up. Vaccines cure everybody. Put your head in the sand, you knuckle dragger. But that would be an advocacy position, right? A scientific position would be like, no, you’re absolutely right. Vaccines, it’s a probabilistic game. Vaccines reduce the probability of infection, the severity of infection. But that’s all probabilistic. So if you take 100 vaccinated people versus 100 unvaccinated people on an individual basis, you can’t make any assertion that’s what science is. And again, I go back to this thing, which is you look at all of the amazing things that have happened in the last two years that really speak to the scientific method. Imagine this pandemic took place in the 16th century before we even had the scientific method. So let alone the capacity to generate drugs and all these other things. Totally different game, right. And yet to think we have monoclonal antibodies, we have novel antivirals, we have vaccines, we’ve got all of this stuff done in less than 24 months. What bums me out. And I’ve said it before, opinion, not fact. I think that this is a pirate victory for science. I think it has what’s the expression like we’ve won the battle and lost the war from a scientific perspective.
Dr. Zubin Damania1:00:28Right.
Dr. Peter Attia1:00:29Which is, yeah, you know what? 800,000 people died instead of 2 million. That’s an awesome victory. But it came at such an erosion of trust that the next time one of these things comes around when you actually do need to take really draconian measures, good luck with that.
Dr. Zubin Damania1:00:48This idea of the Pyrrhic victory of science, I think, is really central here, because one thing you said about advocacy, this advocacy position, maybe it’s a good advocacy position to say, no vaccines, you’re dumb if you don’t take them. They’re absolutely essential to ending the pandemic. The only way through is with vaccines. But even that is an advocacy position is ineffective because how does that work? It generates psychological reactance among people who have ideological and moral reasons to be skeptical of these vaccines, whether they are politically aligned with someone, who’s skeptical, whether they don’t like authority, telling them what to do, whether they distrust science, whatever it is, that approach to advocacy only serves to shore up people who are already agree with you, and it creates reactants and others, which is the problem with mandates, which is the problem with the inflexibility of recognizing natural immunity. So even as a policy standpoint, all we’ve done is served to do exactly what you said, Peter, which is erode our trust and ability to understand science. And then the next thing that happens is potentially a huge disaster if we had a supercomputer to calculate all the downstream effects of what we’ve done during this pandemic. So let’s say we saved a million lives, let’s say, but how many did we cost in terms of future distrust, in terms of childhood vaccines? That now people are reluctant to get because they’re so burned by this whole thing with the COVID in terms of all the whatever screening for cancer we didn’t do during the time that COVID was going on, substance abuse, the mental illness, the further fragilization of our children through this culture of safetyism and overprotectiveness and teaching them that words and people who disagree with you are evil and violent and so on. So that’s something that I think if we don’t wake up to that, then it doesn’t matter how good our science is. It’s not going to actually affect anything in a positive way.
Dr. Marty Makary1:02:41You may have seen the Brown University study that just came out. I’m going to read the conclusion. We examined general cognitive childhood scores in 2020 to 2021 versus the preceding decade. We find that children born during the pandemic have significantly reduced verbal, motor and overall cognitive performance compared to children born prepandemic. We are in uncharted territory. We are playing with fire. We’re now going to have a generation now living with this. We’ve got a mental health crisis declared by the surgeon general and children. We’ve got a 51% increase in self harm admissions to a hospital among young women. We have yet to comprehend how significant many of these restrictions have been on the most vulnerable members of our society, and that is children who don’t vote, who have been subject to so many of these policies.
Dr. Peter Attia1:03:37One of the things about this that is odd to me is again, when you contrast 18 months ago with today is based on what we know, these proposed policies and mandates don’t even make sense. So let’s talk a little bit more. Let me get a little more data so I can create a thought experiment which, you know, I love what is the best available evidence we have for how much a vaccinated versus unvaccinated individual reduces the ability to spread an infection to some other person. In other words, how much do vaccines reduce the ability to spread the infection?
Dr. Marty Makary1:04:20I think one of the great mistakes we made as a medical community was to suggest that somehow being vaccinated was going to eliminate that risk of transmission. And we’ve set that expectation. And now people run around saying they don’t work, when in fact, the vaccines are very effective in downgrading this sphere of illness. But the transmission piece now it’s pretty clear, is not significantly affected by the vaccines because the virus lands in the mid coastal area of the nose and upper Airways replicates and you blow it off faster than the systemic immunity can kick in. Now, the natural immunity is more based in the local area of the mucosa. And so therefore, that’s why some think it’s more effective. But when you look at this Lancet study that just came out about a month ago, the peak viral shedding was equal in those vaccinated and unvaccinated. The difference is the window of contagiousness was more narrow among those vaccinated. So we’re talking one day versus about three days on average.
Dr. Peter Attia1:05:29Again, this is a very crude assessment, but we could say there’s a 66% reduction in transmission. If you believe all things are otherwise equal, you could.
Dr. Marty Makary1:05:39But if you show up to the same day care center or the same workplace every day, you’re still going on one of those days be shedding virus at a high level.
Dr. Peter Attia1:05:49Okay, zooming. Anything to sharpen that analysis? Because again, to me, that’s a very jugular question when I think about a policy decision. Right?
Dr. Zubin Damania1:05:59Yeah. I think it’s interesting because there are two ways that I think we can see a reduction in transmission. One is the narrowing of the window, which Marty talked about. The other is that there is including in current data, and I can’t cite the specific studies I’d have to dig them up. But there is a reduction in symptomatic infection overall, which means the operative question becomes when a vaccinated individual is asymptomatic. And I’m not talking about precinctomatic like they’re eventually going to develop symptoms. And often we found pre symptomatic people are quite contagious, but they’re asymptomatic, but they would test positive by PCR, say, are they infectious? And this is in the realm of speculative now. Right. But the answer is probably not. And the more people that are vaccinated around them, probably even the less infectious they’ll be because those people have an innate resistance even to infection, unless the inoculum is quite high, which is why Delta was kind of a real drag. If you look at vaccine numbers with Alpha vaccine very effective. But then the combination of waning neutralizing antibodies plus a very high RNA virus in the form of Delta made it more likely to break through in terms of infection mucosal replication. So again, I think there’s those two main mechanisms by which but then you have the emergent phenomenon of a community effect, and I’m not using even the term herd immediately anymore because it’s gone by the wayside. It’s more that there’s this community cocooning effect, and you see it in a place like, say, the Bay Area where the vaccination rates are 90 plus percent. There really aren’t that many cases. And if I talk to my friends here, they’re like, yeah, there’s a few really morbidly obese elderly people that are in ICU, but in general, it’s not happening. And kids are doing just fine even prior to being vaccinated. And schools are opened up and stuff is happening. There is this kind of effect. So I think it’s more complicated than has currently been measured easily. But that doesn’t mean we can’t measure it if you say it.
Dr. Peter Attia1:07:59Look, let’s just take the most extreme. Like, let’s say it’s reducing transmission by two thirds and it’s clearly reducing severity of infection by at least 90%. I think that would be a fair assessment in some demographics, probably more than that. But it’s a good log reduction in severity and then you take on top of that. Do we have effective agents to treat it? I think the answer is we have lots. So now imagine a different world. Imagine a world in where you had a vaccine that didn’t reduce severity of illness by more than 50%, but it reduced transmission by 99%. Would we want to at least discuss whether there would be a different policy view?
Dr. Zubin Damania1:08:51Yeah, that makes perfect sense, because if the main goal is dropping transmission, but it’s not. But for the people who do get sick, they still get very sick. Then your policy changes to, hey, you know, as many people as we can get vaccinated, the better it is. That’s a true herd immunity kind of goal there. We can do that measles, et cetera. But if it’s the opposite, then your calculation of policy changes dramatically. And here’s why I think it does at this point. Like you said, we have treatments, we have prophylactics in the form of vaccine. We have prophylactics in the form of an N 95 or can 95 mask. We have prophylactic in the form of you don’t go to that concert or go out to eat if you really are that paranoid. Right. So at this point, we’ve shifted from a community level decision risk to an individual level decision. I can get vaccinated if I want to prevent severe disease in myself. I might have a little cocooning effect on my family. That’s fine. So we don’t want to minimize it, but we don’t want to maximize it either because it may not be true in a maximum sense. If it’s true, it’s on some continuum. And then if I don’t want to get sick and I’m high risk, I don’t have to go to that thing. Or I could wear a can 95 or 95, and then if I do get sick, I’m going to demand the right monoclonal that is amicro sensitive and fluvoxamine and all the other stuff. Right. So at this point, we’ve turned something from out of your control entirely to something that becomes a much more individual decision, which is why policies that use the mechanism of the state to actually influence your behavior, maybe less effective, less relevant and backfire in a bigger sense. And it goes with colleges, too, when you’re mandating kids be double vaccinated and boosted quarantine for ten days in their room getting DoorDash if they test positive. Well, why? Who exactly are they harming? Their own risk is low. Their professors are vaccinated and can wear masks. So it’s kind of like at this point, what are we really doing? So the underlying situation matters to what policy you want to actually instill. Yeah.
Dr. Peter Attia1:10:53And I think what I’m struggling with is you could paint two extreme cases. So again, you imagine a scenario where the vaccine does not really reduce transmission but really reduces severity of illness versus a vaccine that really reduces transmission but not so much on severity. Of illness. Well, again, any person with common sense could say you have a totally different set of recommendations. And if you’re going to waive a policy hammer, you’re going to do it totally different. In those situations, it seems to me that we’re using the wrong policy tool. Again, opinion, not fact. We’re using the wrong policy tool for the tools on the ground.
Dr. Zubin Damania1:11:32Even when you talk about kids, which I’m sure you’ll talk about, the policy tools we have are not concurrent with the situation on the ground in terms of these parameters that Peter discussed.
Dr. Marty Makary1:11:42Peter, I think that’s a very reasonable opinion. But here’s a fact that is the Therapeutics we have today have cut COVID deaths to zero in the clinical trials. And once they get distributed, remember, they were just FDA approved. Once they get distributed and out there, no one should be dying of COVID right. Now, with rare exceptions, with all the state of the art care, with the randomized control trial data behind it and Paxlavid and Moly prevailed, no one has died from COVID in those clinical trials, period.
Dr. Peter Attia1:12:14Now, in fairness, Marty still relatively small, right? The Pfizer study only had about 1000 in each arm. Is that correct?
Dr. Marty Makary1:12:22Yeah, a little over 600 in each arm.
Dr. Peter Attia1:12:23Okay, so we used to have a joke when I was at the NIH, at the NCI, whenever a small trial would come out and a phase two that showed an amazing result, the patients would say, can I get that drug before the results change once the larger trial comes out? So just to set expectations. Right. People are going to die even still through these drugs. But I think the point is, when you look at this protease inhibitor, which is the new Pfizer drug, and this RNA replicating blockade, that’s the Merck drug, they’re kind of remarkable. And presumably we will come out with another set of monoclonal antibodies that will be reactive to whatever strain is relevant. Just as Regeneran was very effective against the OG, reasonably effective against Delta, I think we can talk about how effective it is against Omicron. But yes, I think your point is kind of what we’ve been saying, like, oh, my God, we have tools today we couldn’t fathom twelve months ago.
Dr. Marty Makary1:13:24So good point. Now, 23 people died in the placebo arms collectively of the momentopivier, and Paxlavid trials, zero died of COVID in the treatment arms. Now, it may not end up being that dramatic in a real population, but whatever it is, it’s very impressive. It’s very impressive. Then you add to that the GSK Veer monoclonals. Problem is we’ve got the monoclonals out for the Delta variant. We just can’t sequence quick enough to know what to give people. That’s the dilemma.
Dr. Peter Attia1:13:54Well, especially, by the way, Marty, sorry to interrupt. When you start stacking these things, this is where it starts to get very Bayesian. You’re vaccinated, you have access to monoclonal antibodies. You have access to a new therapeutic. You have access to existing Therapeutics is in fluvoxamine, and you have ICUs that are ninjas compared to what they were two years ago. That’s right. That’s five pieces of Swiss cheese you can put on top of each other, and you still have to try to get a piece of pencil through there is pretty tough.
Dr. Marty Makary1:14:27That’s right. And you add fluvoxamine. We’re all in agreement that Therapeutics now are matured once they’re actively available everywhere, it changes the calculus. So if people were jumping out of an airplane and some people chose to use a parachute and other people chose not to, you would say people not using a parachute are making a very poor decision. And you might even mandate parachutes of anyone jumping out of the plane. But if the plane is flying at a very low speed, only 15ft above an inflatable mat, that changes the calculus on the entire necessity of instituting martial law to require parachutes or whatever the mitigation is. And right now, it’s as if there’s this mild illness that people with immunity can develop, and we’re bringing all of heaven and Earth down to lock up these College students in solitary confinement for ten days, requiring them to get a booster just so they can go to class, despite no evidence that boosters right now help young people and maybe some evidence that there’s harm now that could change. But that’s the evidence to date. And look at what we’re doing to ourselves. We’ve moved to a second pandemic after covid 19, which is a pandemic of lunacy, which is this overreaction to mild illness.
Dr. Zubin Damania1:16:01What becomes so frustrating, Marty, is when we talk about this stuff and you and I are pretty aligned on this, and this is opinion based on the best evidence we have. So it’s a mix of sort of editorializing. And I will get emails from, say, an ICU doctor who will say, but I’m still seeing sick people in the ICU. And to which I will reply, okay, so what in our societal policies would actually prevent that, short of locking everybody up in their house and forcing vaccinations on them and then telling them they can’t do anything that they normally do and what’s the cost of that? And the same ICU doctor will tell me, well, my son is actually having a lot of anxiety in high school right now, has to see the counselor because he was kept home and away from his social network. And then the pressure of using Zoom and he’s an introvert, and it didn’t really work out. I’m sympathetic to that. It’s like, okay, now multiply that by how many millions of kids we’ve done this to for something that eventually, it seems to me and I’m editorializing is going to be fully endemic in the sense that you have a respiratory pathogen to which initially we had no immunity or limited immunity. We now have much better immunity against severe disease. We get reinfected every year like the common cold. But people who get very sick have a series of Therapeutics at their disposal to prevent them from dying. Some old and frail and comorbid people will die like they do from a common cold. But we don’t have to really change society over it because it’s another common pathogen that we have next. Do we really need to vaccinate every single child for this when every single child, every single season after they’re born, is going to be infected naturally? They’re not going to get severe disease because their parents pass along some degree of immunity even in breast milk. And as it is, we’re blessed that the kids don’t get very sick typically from this unless they’re very sick otherwise. And so they’re going to develop immunity in less than a few years. We won’t even need to vaccinate anybody because all adults will be exposed or vaccinated, all children will be exposed. And we’ll have another common circulating endemic coronavirus. So that’s what I think is where we’re headed. And yet. So why are we destroying our society in the process and generating so much division? We’re squandering our community for this thing. That just doesn’t make sense to me. Now that’s editorializing.
Dr. Peter Attia1:18:17Well, I’m going to keep editorializing for a minute, and then I want to come back to something you said, Marty, which is let’s now look at the data around the risks of vaccine, because again, I think one of the challenges of the scientists being conflated with the advocates is that no one is allowed to ask that question. Right. As though somehow statins like, let’s take a drug that I mean, just demonstrably reduce the risk of cardiovascular disease. You’ve got to look far and wide to figure out over the right time horizon. If you give statins for a year, you might not see a benefit. But demonstrably the biggest sea change we’ve had in the reduction of risk for the most prevalent chronic condition in the developed world. Would anybody with a straight face say that there aren’t risks of statins? Nobody with a straight face could tell you that statins don’t harm some people. And there’s nothing bizarre about that. Right? There’s nothing odd to say that. I mean, like, don’t we talk about this every time we give patients a drug? You give somebody a prescription for something. Hey, let us know if you develop a rash. If you do, it could be really severe. Please call us right away and let’s stop it. You might be one of the 4.9% of people that is susceptible to this side effect. Right. So somehow it’s become impossible to have the discussion if you’re coming at it from the advocacy point of view that there might be a risk associated with a vaccine until something like the J and J thing came along. And then the response seemed the exact opposite. So this is the thing I’m struggling with. Okay, so this is a long rambling question, because I don’t understand something. I don’t understand how when the first J and J data came out and said, I believe it was six cases of VTE and 7 million doses. So about one in a million incidents, the drug was pulled, the vaccine was pulled. And in a moment, we’re going to talk about myocarditis with Medana. Nobody wants to talk about that. Why the difference? I’m asking for opinion because we can talk about what the facts are, which we’ll get to. But the broader question is help me understand the difference, because I’m getting questions from patients of mine saying I don’t want my 18 year old son getting a third mRNA booster, which is being mandated by his University. Do you think I’m crazy? To which I say, no, you’re not. Here’s the data that tells me you’re not crazy.
Dr. Zubin Damania1:20:54And I’ll let Marty answer this, but I just want to say this. I think it comes down to the difference between peacetime and wartime vaccine communication. And again, this is advocacy versus science. So in peacetime vaccine communication, you have children who need to get these series of vaccinations in order to prevent common what would we become? Common diseases like measles, mumps, etc. And if we didn’t get a certain degree of herd immunity that happens, which is above 90 odd percent. And so the messaging has always been, hey, listen, there are very rare side effects of these things. And by the way, they can be quite serious, but they’re very rare. But as a community benefit, pretty much the risk of your child is so small and the risk of the communicable disease is small, right? In an absolute sense, absolutely small. But if we don’t do this as a community, we’re going to have a problem. And you see it when vaccine rates drop below 90%, you see measles outbreaks and that sort of thing. So the public health messaging has always been a zero tolerance for antivaccine discussions. We don’t talk much about the risks of them because we just need to do this and they’re mandated for schools and so on. Now, there’s merits and demerits to that approach, but that is the peacetime approach to vaccines, the wartime approach, where you have uncertainty, you have changing data, and you have risks and benefits that are stratified by age and comorbidities. We’re applying the same peace time approach, which is vaccine absolutism with no quarter. And anything you say against the vaccine is taboo. So it becomes almost an unspeakable curse, like in Harry Potter. You can’t use them or you’re excommunicated from the tribe of medicine and it has become a tribal thing. Well, now I think it’s become this kind of absolute thing that they’ve applied in wartime to something that it just doesn’t apply to, which is this vaccine, which, as you mentioned, has risks that actually are worse for younger people and benefits that are much less for younger people. So we ought to be looking at it clear eyed. So I’m sorry, Marty, over to you. That’s just my rant.
Dr. Marty Makary1:23:00No, you’re spot on here, because what we now see in this tribalism of medicine and we’ve seen it in the group think of so many aspects of COVID that the establishment got wrong. And the reality is we’ve got a few people making all the decisions uncovered a very small group of non age diverse, non ethnically diverse political appointees with political allegiances making all the decisions on COVID for the country. And quite frankly, I think they’re detached from the life of a young person in Baltimore City who was barely hanging in school pre-covid. Okay. It’s not as easy to hand that person an iPad and say we’re going to do remote learning as it is in the Hamptons or in Santa Barbara County. So what we developed was this sort of tribalism whereby if you would question anything that might result in an answer, even, albeit scientific, that could threaten to vaccinate every human being with 2ft message, then that needed to be suppressed or squashed or ridiculed or labeled an anti vaxxer, it could be natural immunity. I think that’s maybe how I initially got sort of seen as, hey, is he one of us with the vaccine community? Last year I was calling for lockdowns beforehand, warning of this thing, wrote the first piece calling for universal masking to keep society semi open. And then the vaccine roll out came along and I said, hey, wait a minute, it needs to be simply age based. And those who have natural immunity need to step aside in the vaccine line so we can save more lives. And let’s just focus on the first doses because the immunity is pretty good for three months. We can save more lives. Tens of thousands of people could have been saved if we adopted those policies. And some people would suggest, hey, wait a minute. If you’re saying hold off on the second dose, you’re kind of anti the vaccine. And if you’re telling people with natural immunity they can wait a little bit, based on the data, that’s kind of anti vaccine, and if you’re asking about the myocarditis complications, trying to understand the rate of them, that could scare some people off, and therefore you might be putting an anti vaccine message out there. The VAERS data system, which is the self reported system the FDA set up, is such a shoddy poor way to track complications that it’s basically unreliable. It’s overloaded. And yet at the same time, it’s very cumbersome to report into that. Most doctors that tell me about a complication say they haven’t reported it to theirs. You really get almost no follow up. There’s been deaths in children in the United States immediately after the second dose from myocarditis. And the CDC says they are going to investigate one of them. That was several months ago. We never heard anything. So if you ask questions. It’s almost as if how dare you? Now look, the vaccine still makes sense in a certain context, in a certain way. In young people, it’s often to present MISC and hospitalization more than it is to prevent death in children. But it’s nuanced. It’s not a one size fits all strategy, especially with those who have natural immunity.
Dr. Peter Attia1:26:16So let’s talk a little bit about that Z dog van I did a great video on this just the other day, but let’s talk a little bit about what we know. And now let’s just talk, in fact, for a moment. Right. Let’s not editorialize anything. What do the data suggest with respect to the Pfizer vaccine and the Moderna vaccine with respect to the incidence of myocarditis in males and females below the age of 40 and stratify that as much as you see fit.
Dr. Zubin Damania1:26:45So I’ll give the high level and Marty can dive into the details because he’s a vastly bigger nerd that I’m capable of being. But I’ll say this, the party line has been that and you’ll hear pediatricians around the country telling their patients this when asked about vaccine. They’re kind of reiterating what CDC says, which is the risk of myocarditis in young people from a vaccine is exceeded by the risk of natural COVID infection causing myocarditis. In other words, if they were to go out and get natural infection, they’re exfold more likely to get myocarditis than any risk of myocarditis from either of the vaccines, Pfizer or Moderna. Now, this is in the setting of not knowing the denominator of how many people are actually infected with COVID out in the community. They’re just looking at kind of hospitalized patients and so on. And of course, those patients are sicker. Of course, they have more cardiac side effects and so on when they’re infected with COVID.
Dr. Peter Attia1:27:47There are two counting issues there, just to clarify. Right, Zubin? The first is you have a negative selection for patients and then you have an underestimation of the denominator.
Dr. Zubin Damania1:27:57That’s right. So in other words, we don’t know how many people got infected with COVID out in the community. That did just fine. We’re guessing at that or using incomplete tools. And so that’s part of the problem in the calculations. Whereas with vaccines, we can say, oh, these guys got vaccinated and there were this many cases of myocarditis, and they were hospitalized for this many days and they had this kind of cardiac function at discharge, and these were the complications and so on. So you can actually look at that data. Now, looking at all that same data that was available, the European authorities said, you know what? Actually we see a bigger risk with Mederna for myocarditis, especially when we have FISA, which seems to have less myocarditis. So we’re just not going to recommend Madurna for men or people under 30. Now, that’s a huge difference between us and European policy based on data sets. Now, this is where the newer data comes out that Marty can talk about saying, hey, this may not be true, that actually natural infection is more myocardiogenic than the vaccines.
Dr. Marty Makary1:28:52Yes. So we generally recognize this rate early on to be somewhere in the range of one in $7,000, and that is young boys and young men. So in the age group 15 to 25, the rate was about one in 7600, according to a New England Journal study. After the second dose, the complications, 90% of them were clustered around the second dose and the Mile carditis cases, the vast majority of which were mild, but two were severe in the New England Journal analysis out of Israel. And one person died. That is a 22 year old died. I know you can barely say that because of the sort of trigger that it creates. But look, by and large, this is a safe vaccine. But for parents asking these questions about vaccinating their kids against an illness that has an ultra rare rate of death in healthy children, this is a reasonable conversation to have. Maybe the rate of death from the vaccine parallels the rate of death from COVID in a healthy child. Now, the CDC reports there are 668 deaths over two years. So let’s say roughly 300 some deaths a year from COVID everyone under age 18, all children. Who are those kids? We believe, many of us believe that they are nearly all in children with a comorbid medical condition. Now, they’re still important members of our society. We need to do everything we can to protect them. But it does change the calculus now for healthy kids when we recognize that the vaccine is not halting transmission. So to subject all healthy children to a vaccine when the risk of myocarditis can be as high as one in 7000 young males and boys, then all of a sudden you’re talking about a very nuanced decision where some pediatricians might say, you know what? How about we do one dose? There was a study of kids five to 17 in Germany that just went on the preprint server. Of all the deaths in Germany over the 15 months the pandemic right up until around March, March, April, there were zero deaths in healthy children. No healthy child has died. 100% of the deaths were clustered in kids with a comorbid condition, 100%. So that changes the calculus now to a parent that says, hey, my kid is healthy. I’m a little concerned about the rare side effects. I’d like to talk about the data. This is a conversation. It is not a one size fits all strategy, as we are being told, especially when you get to boosters. Here’s the New England Journal paper from December 8 looking at boosters and no boosters in kids. Well, I call them kids because I’m on a College campus in people under age 30. Okay, in people under age 30 who are vaccinated with the primary series, there were zero deaths. This is population data from Israel. Zero deaths after the regular primary vaccine series. You cannot lower that any further. You cannot lower the number zero further with a booster? Well, they looked at those with boosters and as you would expect, zero deaths in that group. And then in Germany, I looked at people really essentially over a period when there was no vaccines and the rate was also zero for healthy kids. That tells me the kid has a combination condition. Get the vaccine. Otherwise, for healthy kids, it’s a nuanced discussion.
Dr. Peter Attia1:32:37If you look at the circulation paper that came out in July of this year, the knock on this is it doesn’t distinguish between Pfizer and Mederna. So we’ll talk about that in a second. But I think to me, the most interesting table in there is the one that stratifies by age, and then it does risk and benefit male for female, which again, seems to me a very reasonable way to think about this. Right. So when you looked at twelve to 17 year old males and females and again, this is all mRNA vaccines we know now, I think can we say that unequivocally the Moderna vaccine is three to four times more likely to be associated with myocarditis or myophericarditis at least.
Dr. Zubin Damania1:33:21At least. Yeah.
Dr. Peter Attia1:33:22Okay. The supplemental data that came out literally two days ago looks like it’s five times worse, but let’s be conservative, say three to four times worse. So keeping in mind, I’m giving you blended data. Twelve to 17 year old females, eight to ten cases of myocarditis per million doses, males, 56 to 69 cases. Blended benefits, saves 38 ICU admissions, saves one death. So here’s where I’m struggling right now. If you look at this and you say, look, you’re going to give 70 cases of myocarditis to save a death. What’s the natural history of those 70 cases of myocarditis? So, Zubin, how many of those kids make an unremarkable recovery? How many of those kids are going to have a chronic issue with their heart? They’re going to have a reduced EF for some point of their life. And will any of those kids die?
Dr. Zubin Damania1:34:20And this is the thing, we don’t have enough data to be able to actually answer some of that. I think there’s a degree of uncertainty. And when you’re talking about the quality life you’re saved in a kid, if you’re going to in any way impinge on their ejection fraction of their heart in the future or cause any scarring or cause what, we may even be under diagnosing, whether there’s arrhythmia happening, it becomes a really open question that this ought to be looked at very carefully. Now, Marty may have his hands on some of the more specific data on the outcomes. You mentioned the 22 year old that died. It’s also a little difficult to peg causation sometimes because some of these kids had also pre existing cardiac abnormalities. We always think about sudden cardiac death in athletes and children and whether to screen or not and those kind of things are outstanding questions. But even if this were to provoke that to happen, say if they were to get myocarditis you’re impacting a child and tons of life years that are affected, as opposed to, say, a 90 year old who maybe the vaccine gave them a fever that pushed them into cardiac arrest. I’m just speculating. Right. It’s a very different quality of life years saved kind of calculation. So I don’t have the specific data how many of these kids go on to have chronic problems or even the hospitalization risk. Right. So a certain percentage of these 86%, in one study that I saw get hospitalized for average of about three days. When you hospitalize anybody, you put their life at risk because they’re in the most dangerous place on the planet, because medical errors happen, infections in the hospital happens, complications happen. That’s why staying out of the hospital is a good idea if you can do it. So you have to look at that as well. And I just don’t I haven’t seen the data that compellingly says, oh, this is the answer to that.
Dr. Peter Attia1:36:09The argument I hear, by the way, because a few days ago I saw something that was ranking colleges or something like that. And I made some snarky comment on Twitter like, can we start ranking the dumbest colleges? When I was going to put my alma mater, I’m going to put Stanford and Hopkins there, which are two of the idiotic colleges, in my view, by the way, this is opinion, not fact, who are mandating boosters for kids and not letting them back to campus without them. And I couldn’t believe the people that were just furious with me. How could you possibly suggest this? Of course, those kids need to have their third shot. And the argument was they’re putting so many other people’s lives at risk by not having booster shots. I’m thinking, explain that to me again. Every six months I do something stupid, which is I engage on Twitter. I need to create sort of like a testicular tasing device that is hooked up to the Twitter app, where anytime I look at Twitter, I get like 120 volts TASE to my testies and it just says, don’t ever do that again. Don’t ever go on Twitter. Nothing good comes of it.
Dr. Zubin Damania1:37:29It’s a Dec device, guys. Direct epididimal current. And when you apply at least 73 Joules to your jewels, it will dissuade you from ever clicking on that stupid app. Actually, just real quick on this, because this is the thing, this is the tribalization. So what you did is you behaved as an outgroup to the in group of whatever public health doctory types that are on there. And this idea that triple vaccinating these kids at Stanford, and by the way, closing campus for two weeks because of Omakron, which is what they’ve done.
Dr. Peter Attia1:38:03How have we got this far in the podcast without Marty? You referring it to Omacold because this is your term. Right. So we’re going to close the campus for two weeks because of OMA Cold continues to Ben OMA Cold rips through.
Dr. Zubin Damania1:38:18Marty is cashing in his royalty money from every time someone says OMA Cold. And at this point, the argument is they’re protecting professors. They’re protecting other people in the community. And this is my take and I’m editorializing. We have no data that that’s actually at scale. True. We talked earlier in this podcast about the transmission effects with younger people, too. First of all, who are they exposing? Well, it’s professors and family and community. Okay. Those professors and family and community can make the decision to triple vaccinate, to wear a mask, to stay away from big crowds. In fact, a lot of the professors are teaching remotely as it is. So who are they really exposing? Other kids their age who are low risk, who also have been vaccinated. And if they don’t get a booster or they get a booster, what’s the marginal benefit? How many cases of myocarditis will you cause where that kid is out of school for three to six days in the hospital? We don’t know the long term effects of it, although I suspect they are generally mild. But that’s more editorializing. These are the questions you have to ask. So when people behave in that rubber stamp way. Now, I’m guilty of it, too, because I editorialize in this way. I think this is crazy. I think these schools are out of their mind. I think we’re promoting a culture of safetyism and fragility in children, and we’re teaching them that this is okay to do. And who’s doing it? People with power, the elderly Uber class that can sit at home on Zoom. They’re doing it to young people who this is their chance to be in College and engage with other young people in person. That’s what College is. It’s not about learning. That’s a side effect. It’s about the other stuff. So that’s my take on it.
Dr. Marty Makary1:39:49The who has put out an official statement very recently two weeks ago saying that universal booster programs threaten to prolong the pandemic they recommend against these booster programs, and they warn that they will increase global inequities because 93% of the population of poor countries has no vaccine and one dose is better than no dose. So they’re taking a global perspective. Now, look, people ask me, I’m over 65, should I get a booster? The answer is if you haven’t had the infection, yes, it’s going to reduce your risk of hospitalization. But if you just bring up what the who has already concluded somehow that’s considered an outlier idea that we cannot discuss in the United States. Who tells people under age six they should not be wearing a mask? The European CDC says that kids in primary school should not be wearing a mask. Many European countries have restricted or banned Moderna vaccine from anyone under age 30 because of the risk of myocarditis.
Dr. Peter Attia1:40:57So all of that suggests that in many ways, the United States is lagging behind in terms of implementing scientifically wise policies, suggesting that we’re making errors in our policy that are ill informed by science.
Dr. Marty Makary1:41:14Certainly the FDA bypassed their technical experts, what we call the Verpack, which is their external advisors. So the Verpack had to vote on boosters for everybody. They voted against it. They voted 16 to two against it, in part because of the stuff we’re talking about myocarditis and other concerns and a lack of benefit demonstrated.
Dr. Peter Attia1:41:35And that was in what age group, Marty?
Dr. Marty Makary1:41:37That was for everyone over age 18. So it was boosters across the board.
Dr. Peter Attia1:41:42Oh, yeah, I see. The second wave of boosters.
Dr. Marty Makary1:41:45So they voted it down. The experts said, no, these are smart people. Then the FDA made a second internal push in the agency weeks later, and they chose this time during this process not to convene their experts, to circumvent their own experts because they didn’t want the input of people who were opposed to it. And they unilaterally authorized boosters for young people. Cdc did the same. And so what we now have is this dramatic vigor of enthusiasm around boosting every 16 and 17 year old in this country with really a lot of experts saying, hey, we are not on board with this and the world is not on board with it. And so that’s where we ended up, where we are today. It’s group think. If you think about it, when I’m a Kron. Came up, it was almost like, here’s an opportunity to push boosters in young people. Fisor puts out a Press release saying that, hey, if you get a booster, it will help with Omicron. Okay. Nobody knew anything about Amicon at that point. There was speculation. It was mild. Now we have a lot more information the next day after Pfizer’s press release about an experiment they did in the lab without releasing the underlying scientific data. The next day, the CDC rigorously puts out a strong recommendation to boost every 16 and 17 year old. Is that what we’ve come to now? Pharma puts out a Press release, and the next day, we bypassed all of our internal experts, and we have this bandwagon effect of colleges and universities, which are supposed to have smart people requiring boosters in a population that Germany found does not have any deaths in five to 17 year olds without any vaccine. I’m not recommending that. But what are we protecting them from?
Dr. Zubin Damania1:43:38And again, this is not measles. This is not sterilizing immunity. This is not highlevel herd immunity that we’re giving them by vaccinating them.
Dr. Peter Attia1:43:44Again, I’m so troubled by this because of what I think about as the long game. Right. The long game is I mean, how many times has Anthony Fauci said an attack on me is an attack on science. I actually had to go and look some of those things up because I’m like, no, he didn’t really say that. That’s just a meme. Nobody would actually say that. He’s had a rough year and he didn’t say it once, and he didn’t say it twice. I lost count of how many times he has said that. So there’s a part of me that’s very empathetic to Anthony Fauci. Right. I think that’s a horrible position to be in. He was sort of thrust into this position as the world’s, or at least the nation’s expert on infectious disease matters in a moment when nobody knew anything. So he’s having to sort of wear a mask. Don’t wear a mask. But I think the lack of humility in expressing uncertainty and the doubling down and then the statements around, I mean, I have to tell you, I didn’t want to get too political today, but I was very disheartened to see how vociferously he denied NIH funding gain a function research in the Wuhan lab.
Dr. Marty Makary1:45:02I don’t really understand how you can deny that Francis Collins still thinks it’s unlikely it came from the Wuhan lab. I mean, the head of the NIH just said that last week.
Dr. Peter Attia1:45:13How do they not just deny it? You look at his exchange with Senator Rand Paul. This is beyond denial.
Unknown1:45:21Right.
Dr. Peter Attia1:45:22This is attacking anybody, showing you the evidence that your Institute has funded gain a function research in a particular lab through an intermediary. Like Where’s the ambiguity here?
Dr. Marty Makary1:45:33Well, Where’s the humility? People are hungry for honesty right now. And if I were Anthony Fauci or Francis Collins, I would say, look, we were out there parading around gain of function research, giving grand rounds and lectures around the country, writing op eds about the importance of doing gain of function research. We came at it from a perspective that was a little old fashioned back in the days when it took months to sequence a piece of the gene. Now we can do it in 20 minutes. There’s no need to Frankenstein up viruses just to study them. We feel terrible. We don’t believe the dollars from our research funding went directly to do this type of research, but they went to the lab. And for that, we’re sorry. Let’s agree now to ban all gain of function research in the future, in perpetuity forever of all kinds, and let’s make that an international treaty. They could show leadership on that, but instead, it’s almost like they’re defending it. Yeah.
Dr. Peter Attia1:46:32And what I struggle with, and I think you’ll both appreciate this. I know you will, because I’ve heard you both speak on this is when bad outcomes happen in medicine, the doctors who get sued versus the doctors who don’t get sued. It doesn’t come down to the grievousness of the error. It comes down to the arrogance and the humility with which the physician interacted with the patient. Every one of us I know have made mistakes with patients. And when you say to that patient, I really screwed up, I mean, like, I sent you to get a CT scan and it wasn’t even supposed to be your scan. That was a clerical error on my part. And you got exposed to radiation, unnecessarily, or even the most extreme examples of errors that have happened. You go to that patient and you say what you did and you fess up. And if you want bonus points, maybe even explain what could be done different than next time so that it doesn’t happen to somebody else. I don’t think there’s a scenario under which a physician under that situation has been sued. You start lying and you start posturing and you start denying and you start in the face of overwhelming evidence and you sort of make the person feel like they’re crazy. I mean, guess what? There’s going to be a little packet coming to your way from a lawyer. This is like the highest order example of this, right?
Dr. Zubin Damania1:47:54That’s a really good analogy, actually, because we’ve all been in those positions. And I tell you, I’ve thrown myself at the feet of patients, families saying this was a mistake I made. Here are the things we’re going to do to make it better. I’m sorry. Again, I have not been sued. Knock on wood. But with Fauci, it’s interesting because I’m going to play Fauci advocate for a second. Here’s a guy because I was part of a documentary that hasn’t been released. Prior to COVID, they had interviewed Fauci and hotels and some other people about vaccine advocacy and the anti vaccine movement and things like that prior to COVID. And he has just been kind of folaid by a lot of the sort of more activist conspiracy angles on things and really did feel like science itself was under attack to some degree. Now you throw in, okay, he’s under a lot of political attack. He gets all this hate mail and all of this. He’s probably doing what humans do, which is entrenching solidifying his position and becoming an absolutist, which is not what we need. It’s not what we need. If he had Insider, a good therapist, they could probably tell him, Dude, bro, this is not good. You need to be honest if you think masks shouldn’t be used because we’re really trying to save them for health care professionals, just tell the public that. And I think that’s it. These are human beings. He’s 82 and we forget that 81 now. 81.
Dr. Marty Makary1:49:13Wow, you just had a birthday.
Dr. Zubin Damania1:49:15Nice. Happy birthday, Anthony. I was on a call with Anthony Fauci during Ebola that I was invited to, where he was trying to talk to public health people about, hey, here’s how we can think about Ebola. He was rational, he was calm, he was logical, he was sciencebased. He defused a lot of fear. I thought it was brilliant. Right? And so to kind of see this transition is difficult and to be clear.
Dr. Peter Attia1:49:38And I’m glad you said that, by the way. I’m not saying I would be one bit better. Just want to be clear. Everything I’m saying to be critical of advocacy versus science here, I’m sure I would be doing the same thing. I’d probably be worse. He seems to have a much nicer disposition than I do.
Dr. Zubin Damania1:49:53I agree.
Dr. Peter Attia1:49:54Yeah, but it doesn’t change the fact, right? What’s the aspiration here? And maybe this shouldn’t be all on one guy’s shoulders, because your point, how exhausting is this? Like, I’m sick of this and it’s not my job.
Dr. Zubin Damania1:50:06Yeah, me too.
Dr. Peter Attia1:50:08I am sick and tired of this, and I have the luxury of getting to focus on stuff that I actually find interesting. So, yeah, maybe this shouldn’t be one guy.
Dr. Marty Makary1:50:19It shouldn’t be one guy. We should not be putting our entire faith and trust in one individual. We should be hearing about multiple different medical opinions. And we should have from the start. I called in. As you know, I was very nervous about the pandemic and what it could do beforehand, following what was happening in Wuhan and calling doctors there. And as editor in chief of MedPage Today, I wrote some pieces and was reading articles coming in, and it was pretty clear to me that our country needed to wake up. So I had some relationships with the White House for my work on price transparency, made a phone call into the White House and said, this was in February before the pandemic. I said, look, this is going to be really bad. We need to drop all kinds of contingency plans as a country, stop non essential travel, get testing up. And all this stuff went through the whole gamut, and they were shocked. And they said, what you’re saying here would be a major shift in how we’re approaching this. And I said, yes. Look, I’ve talked to the experts, and I believe firmly in this. This is stuff we need to do. About a week later, I got a call back from them, and they said, well, good news. We got a chance to talk to Dr. Anthony Fauci, and he says, we’re going to be okay. Now, look, we all make mistakes, and that’s okay. But you’ve got to evolve. When the data came in and he had hedged his bet watching SARS one, that is SARS in 2003, it just petered out in Asia, and he kind of hedged that. That’s the way it was going to go. And you had every media outlet going to him saying, hey, do I need to worry? Do I need to worry? And as you know, as a physician, it’s much easier to give reassurance than it is to say, yes, I’m very concerned. So that’s how I don’t know whether or not to blame him or Meet the Press and Face the Nation and all these that just incessantly ran one opinion and not that of Amisha Dolja and so many other infectious diseases. Doctors with the chops to say, hey, they’ve got a different perspective.
Dr. Zubin Damania1:52:20Can I ask something heretical at this point, though? At this point in the pandemic where we have Omicron and we have a vaccine, we have Therapeutics, does it even make sense to push such widespread testing, whether it’s antigen testing or PCR? I want to throw this at you guys and see what you think, because I’m curious. The answer to this.
Dr. Peter Attia1:52:39I’ll share with you my opinion. I don’t think so, because one of you has already made this point, which is there really isn’t a precedent for tracking rates of infection for respiratory illnesses. What we pay attention to and as has been noted by many people, what we pay attention to is hospitalizations, severity of illness, death. So morbidity, mortality effectively is the statistic that matters. And somehow infection rate has now become a metric that matters. So you can measure it. What get measures matters. We don’t measure influenza infection rates. I’ve never taken a test for it. I remember when I had H one N one in 2000, what year would that have been? 9910. I had it. I never got tested for it. But we finally put two and two together because my LFTs hit a thousand. I mean, I was sick as a dog. I was literally on the verge of getting a liver biopsy before my dog went, wait, I think that illness you had a month ago or two months ago was H one N one. Let’s wait another month before we stick a needle in your liver. And sure enough, my LFT is returned to normal. I’d fully support, I think, or at least noodle, the idea a lot more that what if we never tracked infection rates and we used it as epidemiologic data. Right. So we did some sampling, perhaps so that we could understand movement, new strains and things like that, maybe even use it to develop predictive models that might tell us when there might be an uptick in hospitalizations. But it no longer became a metric. Like, you didn’t see it on the news every day and people didn’t talk about it as the thing that needed to go to zero.
Dr. Zubin Damania1:54:21On top of that, I think there’s the personal downside and upside of testing. So I’m a young person. I have a few symptoms or I’m screened. Let’s say I’m screened asymptomatic to do whatever I need to do at school or whatever. They screen me with an antigen test and I’m positive. Well, now I’m stressed. I have to quarantine for ten days or five if you’re listening to CDC’s advice on hospital workers, which apparently is different, and it’s been deep downgraded in terms of time, because of need. I’m sitting there freaking out. Let me see. Do I get monoclonal antibodies? Should I take this? Should I do that? Whereas my pretest probability of anything happening to me is so low. And in fact, the pretest probability of this being a false positive is quite high in an antigen test. Isn’t that causing a degree of harm and cost? And it might be. Now, the upside is, of course, that person, if it was a true positive, can stay home and doesn’t infect other people. But if it’s already so widespread, does it really make a dent in something like Omicron that’s so transmissible now with an old person who is symptomatic, you’re going to test them anyways, because at that point, they do need therapies in the forms of monoclonal, fluffy, et cetera. So again, it’s stratified by risk, it seems, but mass population testing.
Dr. Peter Attia1:55:32Another way to think about this is don’t order a test unless the outcome would change how you’re going to manage the patient. And in the case of Therapeutics for someone who’s symptomatic, the answer is, yeah, might be worth testing. I think the idea of asymptomatically testing athletes is one of the most ridiculous things I’ve ever seen. Like, we’re going to just test everybody in the NFL and NBA and NHL and NC two Ma and is like, serious. What is the logic of this?
Dr. Marty Makary1:56:01If you test athletes or anyone in the population for meningococcus bacteria in their nose, 10% of the population will come back positive because that bacteria lives in a colonized non virulent form.
Dr. Peter Attia1:56:17We have to put these people in a neuro ICU. Marty, do you understand how deadly that bacteria? Can you imagine what the neuro ICU rate is going to do at this point? But by the way, what if we just checked everybody for staff on their skin? How many people are walking around with MRSA on their skin?
Dr. Zubin Damania1:56:37Quite frankly, guys, you’re not invasive enough. I would do urethral swabs on everyone to screen for gonorrhea and chlamydia because God knows if you have an asymptomatic case of chlamydia, I mean, your nuts could fall off again. I like Peter’s basic medicine, internal medicine idea here. Don’t do a test unless it’s going to change your management in some positive way.
Dr. Marty Makary1:57:03Look at what we’ve done to physicians. And this is what I’ve sort of the complaint that I hear from the infectious diseases doctors I respect. We’ve done a terrible thing to physicians in the United States. We put them on this singular mission to block viral replication, Hunt it out, find it, block it at all cost. And what we’ve lost track of is treating the entire person. And we’ve lost track of the sustainability of any system to do this. If we start mass testing everybody in the population on it. You could test every child, every day when they show up to school in perpetuity. It is going to create a burden that’s unsustainable. It’s going to bankrupt our system. Look at what we’re doing right now with the mixed message coming from public health officials. Thewhitehouse look, I don’t have a political bone in me. But this has been an endemic problem with government regardless of any political party, Red Party, Green Party, doesn’t matter. No party. You’ve got the government right now saying if you want to gather for New Year’s or whatever, you need to do this massive testing of people coming in. And at the same time, they have a very limited supply of about 500 million tests that will be rolling out over three months, which is about 160,000,000 tests a month. You would need one to 2 billion a month to do what they’re saying. So they’re telling you to do something and then you don’t have the tools to do it. It’s putting people in a very difficult decision, paralysis. And then we’ve got we put doctors on this crazy mission of Hunt out all viruses, block replication at all cost. We’ve done a terrible thing to the entire medical community right now.
Dr. Zubin Damania1:58:48Yes. With no end point point.
Dr. Peter Attia1:58:50Has anybody in the driver’s seat signaled what the end point is? Because I do think that is an important question. Let’s use a totally unrelated example. So a person who’s working their tail off to make more money because they believe that at a certain dollar amount, all their problems are going to be solved. Once I have this amount of money, I don’t have to work this hard. I don’t have to act this way. I don’t have to ignore my family. I’m sort of making something up. Right. You always have to ask, tell me what’s going to change. So tell me, when you have that many dollars and you retire, what’s going to change? So how many dollars do you need and how will it change things? So when you bring that sort of silly analogy back to this, I really haven’t heard a clear articulation of that, which is not to say one hasn’t been made in defense of those who would make it, but I haven’t heard it. Have either of you?
Dr. Zubin Damania1:59:46I haven’t heard it recently. It’s been an evolving thing. In the beginning, it was a bend the curve until we get better Therapeutics and possibly a vaccine, which we don’t know if it’s going to work or not. Then once we had a vaccine, okay, just try to get to the point where we have enough herd immunity from vaccine and natural immunity that will get to that point. Well, then it turns out that shifts with new variants. So now the question is, oh, well, now with Homicron, the variance is so contagious at this point, we have to go back to the same things we were doing before, which is masking and forcing people to vaccinate, including children and so on to get to I don’t know what so that our hospitals don’t get overwhelmed. But no one I have not heard of public officials say, oh, this is how we transition to an endemic virus, or this is the goal where we’re going to have a virus that lives with us forever, and it’s going to be okay. But we just have to get to that point, which means let’s not overwhelm our hospital. So maybe we should shore up our staffing, maybe we should pay nurses and doctors a little bit of overtime, bonus, whatever it is to get them through this. That’s the thing. And we haven’t even calculated in like how many lives were saved from the and this is kind of irrelevant. But looking at the area under the curve, how many lives were saved from preventing influenza for two years? Basically what we’ve done, and then how many lives were caused by substance abuse, overdose, economic disaster, and in the Third World, starvation from economic problems and so on. So we don’t look at things holistically, and then we don’t have an endpoint. So even if we looked at them holistically, we’d have nothing to shoot for. So it’s been quite frustrating.
Dr. Marty Makary2:01:14It’s so hard because people are conflating two different problems that are happening simultaneous in the United States right now. One is the sort of residual COVID-19 public health threat, which is mostly Delta, but it’s the virus infecting the ten to 20 million Americans who are still at significant risk. These are adults who have no natural immunity and no vaccinated immunity, and they continue to show up in the hospital and go on ventilators. That is a problem. That is a real problem, and it’s very precise. It’s about ten to 20 million adults with no immunity whatsoever. And they’re going to keep showing up in the hospital, and it’s going to be during the viral seasons. We can’t downplay that. That is still a problem. We still got to encourage them to get vaccinated. But the separate thing going on is that 250,000,000 Americans have some form of immunity and they’re at risk of mild illness. And we’re waging World War Three to transiently beat back a mild infection or one that doesn’t result in hospitalizations. And we’re not putting that in context. And if you say anything to say, hey, we’ve got to learn to live with this. It’s like, hey, there are still people dying. But yes, that’s a very precise group of adults with no immunity and some very older people who are UN boosted, who are coming to the hospital, about 7000 Americans a day are coming to the hospital being hospitalized with COVID. About 7000 of them have no immunity. These are adults often with a risk factor like obesity, which we don’t talk about. And about 700 or so are unboosted older people. So that is a very precise problem that’s addressable. But look at what we’re doing to the 250,000,000 American or everyone else out there. We’re holding them hostage right now saying you’ve got to take this seriously and go and make significant sacrifices. Here’s what I think the end point is. People are fed up. They’re pushing back. And here’s what the Australian Prime Minister just said. Now, if you remember, Australia had the toughest lockdowns maybe in the world, Draconian.
Dr. Peter Attia2:03:26This is where sort of zero COVID was a goal.
Dr. Marty Makary2:03:29That’s right. Yeah, that’s right. So they did a total 180. I mean, they saw people just protest this and say, look, we don’t want to live like this. They did a total 180 on their lockdowns. And the Australian Prime Minister just made this statement very publicly. He said, we’ve got to get past the heavy hand of government. We’ve got to treat people like adults. We have to move from a culture of mandates to a culture of responsibility. That’s how we’re going to live with this virus in the future. And that could not summarize it better, in my opinion.
Dr. Zubin Damania2:04:08All of this relates down to the form and function of COVID. So our response. Right. So the form takes all kinds of different forms as masks and mandates and lockdowns and schools and so on and so forth. But what’s the function of it? The function of it is to obtain some outcome that we all agree is reasonable. Well, I think it’s reasonable to say we don’t want our hospitals to have bodies piling up in the Er parking lot. When and how did this happen? Well, occasionally it did happen in certain areas, but on mass it has not. Is it happening now? Well, so far we’re not seeing it with Omicron. How do we prevent it? Well, targeted, focused protection of the groups that Marty mentioned that are still at risk is the highest yield way to do it. Boosting and triple vaccinating an 18 year old College student is not a high yield way to do it, especially when the rest of the world is still begging for vaccine. So there are policy solutions to get the function that we want using forms that are less disruptive. And I think I don’t know, Peter, you shared with me like what Ontario’s hospital numbers look like and their ICU utilization, and yet they’re going on lockdown. And I looked at those numbers and I was like, man, Peter, like I’ve taken calls with more ICU beds full than that. Why would they shut down an entire province for this? I mean, I’m curious what your thoughts are.
Dr. Peter Attia2:05:35Well, again, it comes back to the price that will be paid for this. Do we have data on what the last year has done to the vaccination rates for children vaccines like MMR and things like that? Have we seen a noticeable shift? So the kids who should be getting those vaccines now, what’s happening? Are we seeing it go up, down?
Dr. Zubin Damania2:05:57So I don’t know if Marty has the specific data, but I’ve seen articles written about this. And at least on an Anecdotal level, kids going in for routine vaccinations have dropped dramatically into the more like the 80% ish range because again, parents are frightened and there’s also a backlash against vaccines in general. It’s a complex scenario, but what will the outcome of that be right. That’s a huge open question.
Dr. Peter Attia2:06:22I’ve said this now at least twice, but I just can’t say it enough, which is what is the long term consequence of this for a generation? All the people who have been marginalized, all the people who have been dismissed in their concerns, all the people who have been told you are a horrible human being for questioning a vaccine, you are a horrible human being for not getting a booster shot. I mean, wonder what the so let’s assume, let’s come at this from the lens of the people in power want to stay in power. That’s a natural human reaction. I’m sure if I was in power, I’d want to stay in power. So if you’re in power, you want to stay in power, and presumably staying in power has something to do with the people who put you in power, keep you in power. Don’t you think there would be some logic that would say, I want to make sure that if I want to stay in power as long as possible, I should take the most long term view of doing what is best. And yet you just see this doubling down on things that seem less and less logical. In other words, with a very myopic view of power, again, totally not the right way. One should be thinking about this. But just as you know, we’re trying to think about Omicron through the lens of evolution. I’m just trying to think of the natural history of power and wanting to consolidate it and preserve it as long as possible. This is not even in the best interest of those in power.
Dr. Marty Makary2:07:56Peter, is just so logical, right? It’s just one of these things where it’s please don’t be so logical, because what you’re saying is making so much sense. I think people at very high levels got a taste of what it’s like to be King, and they’ve got the keys and they don’t want to hand it back over. It’s just a theory, but I don’t think our policy makers are getting good medical advice. Look at what happened as soon as Amazon cropped up in South Africa. Immediately, our public health officials retreated to the one blunt tool that they know, which is we got now giving one a third dose across the board, including young people now, older people there’s data and young people there is not data to support. It masks half of New York City closed down. What about Therapeutics? What about learning to live with it? What about all these other things? And what you saw is this retreat to the same blunt tools that we’ve had and not start talking about PAX Levit and fluvoxamine and treatment and learning to live with it.
Dr. Zubin Damania2:09:02Peter, again, your rational thinking is not exactly how politicians actually tribalize in our world now where it’s tribal identity and it’s a badge of identity to say, oh, no, I believe in this and this and this and this, regardless of what the long term outcome is, I know it will rally my base. I know it Williams, right. It’s the people who on the left feel this way about all these responses because it’s been politicized that way and the right feel this way. So in a way, they’re playing broadly to their base. Like, what do they do when Alma Cron happened? They stopped travel to South Africa because that’s easy. That’s a politically expedient thing, except for the South Africans who suffer and the Americans who have family there and others. And of course, Omicron is already everywhere, which we were saying from the beginning. So that blunt tool did absolutely nothing. But it’s politically expedient. If you look at what say, the administration is doing now. Well, the key thing is keep case numbers down, because if case numbers are high, then it’s going to be much trickier to get reelected. Say, well then, so what do you do? You want to make sure you get as many people vaccinated and do the kind of blunt instruments that try to reduce cases, which is surprising that they’re actually encouraging testing because that’s going to actually increase the number of cases. Trump was very explicit. He’s like, don’t test. You won’t see any cases. Don’t let the Diamond Princess dock, because it will triple our cases. He was at least quite explicit about it, what he was doing. So I think it’s quite complicated. And there’s this weird political tribalization that makes it irrational to people who are looking at it from an objective standpoint.
Dr. Peter Attia2:10:35You said earlier something that I think is also interesting, which is like sort of what did you call them? The Covidiates and the Covidians. Covidians. Right. So I can’t describe myself as either I know the caricature of what both of those represent because I’ve interacted stupidly against my better judgment with both of them. And I feel like I’m trying to understand what’s your guess on how many people are in the middle? On the one hand, this is a conspiracy. The whole purpose of this thing is so farmer can make more money, blah, blah, blah, blah, blah. The only thing that works is Ivermectin you’ve got that whole sort of group, and then you’ve got the people we’ve largely been talking about here, sort of. Everyone needs to have a booster every Monday, and we never, ever want to see the world as it was in 2019 again, until this virus goes the way of smallpox.
Dr. Zubin Damania2:11:32Yes.
Dr. Peter Attia2:11:33This virus will one day be in a Museum. And until that time, it is a zero COVID policy world. So how many people are not at one of those polls?
Dr. Zubin Damania2:11:44That’s the operative question. And I’ll tell you, my experience with my platform is we have created what we call this alt middle, and it’s not a politically central position. It is the synthesis position. So if you consider Kovidians to be the thesis position. Peter Lindberg of the Stoa talks about this, the thesis position that lockdown zero COVID vaccines for everyone mandates closed schools. That position is thesis. Antithesis position is the other position. You described the Ivermectin Therapeutics. This is all about control. The thing is not as serious as we think, et cetera. What is the synthesis of those positions? Where do you find truth? Everything is a little bit partial. So this alt middle perspective is you can call it the center, but it’s really a synthesis position, an integral holistic position. I would say, and every single political group says this, that there’s a silent majority of people who actually, if you really ask them and you tell them, well, let’s think of it this way. Forget about all the sound bites, forget about Twitter, let’s just talk. They will espouse an alt middle synthesis position or will resonate with it in a way that is really quite profound, which means common sense is there. I think critical thinking is there if you walk people through it a little bit. And to a one, I’ve never talked to a thesis or antithesis person in person that hasn’t ultimately settled on a more synthesis position. So it makes me think there’s hope. But the way we’re doing it publicly is we’re rewarded for polarizing into one of the extremes, covidian, covidiot thesis, antithesis. And what we need to do is change our basic structure so that we reward a more alt middle kind of perspective. I don’t know how to do that, honestly.
Dr. Peter Attia2:13:27It’s very similar, by the way, with kind of woke ideology. On the one hand, you have the people that in theory the woke ideologues are there to rally against, right? The true racists, the true sexist, the true people who think trans people should be killed or something like that. So you have those people and then you have kind of the woke ideologues. And I think you have most people in the middle that think this is crazy. Why can’t there be shades of Gray here? Why is this such a bipolar issue with no, as you say, no dialectical synthesis?
Dr. Zubin Damania2:14:06So this is why a podcast like Rogens is so popular, because he actually very often espouses a synthesis rationalist position, even when he entertains kind of people on the show that are really more antithesis or more synthesis, like a Peter McCullough vaccine guy. When you were on the show too, I was watching him going, oh, this is the synthesis position. You’re poking fun at all the extremes of this. And there’s not very many rational people in the United States who would really want to hurt a trans person or really want to exclude somebody based on their sexual orientation or their race consciously. They would not want to do that because we’ve had progress. We’ve had decades of progress on this. What we see, though, is that in order to belong in an atomized world, in a tribe that you can identify with. You take a much more extreme us versus them position. And I think the woke ideologues are in that. And what it does is it diminishes real racism. Real inequity the fact that we talk about covidiates. Well, are you going to call a black person in Baltimore who’s afraid because of Tuskegee and a long history of medical abuse, of getting a vaccine, you’re going to call them a covidiate. How are you going to reconcile that with your apparent wokeness? Right. So it just generates a ton of cognitive dissonance until you can see this from an integral perspective that all this stuff has a bit of truth and partiality to it. And you’re always trying to synthesize something that’s evolving like an organism towards something that’s more true. Which means you also have to assume in most people good intent, which we have trouble doing because we are tribal creatures that like to villainize out group. And so getting over that, assuming good intent, I think you might have said this on Rogen. And if we were able to actually get in people’s head, maybe Rogan said that and assume, oh no, they’re actually well intentioned. Well, that already levels the playing ground that now you can have a conversation.
Dr. Peter Attia2:16:00I remember that. That was a really great insight from Joe, which was you could totally eliminate racism or at least distill it down to the true racist if you had mind reading software. Once you had mind reading software, this issue of intent mattering because we were debating whether or not intent mattered, which of course it does. Right. But yeah, that’s a fair point. I want to say something else. This is kind of a Mia culpa. I feel my tribalism more than I’ve ever felt it around this. I remember a few months ago somebody sent me an image of a woman on Twitter. I think she was a pediatrician and she’s clearly we’re going to zero COVID philosophy. Or at least I shouldn’t even say. That was my inference based on what she had just posted, which was a picture of her and her three kids at a grocery store. They were in masks, face Shields, PPE. And this was not in 2020. This was like literally this summer. And her comment like she was posting this picture very proudly with her and her three kids and making a comment like this is how we roll 95 face shield. You couldn’t see her kids. You literally would have seen more of them if they were girls in Rio. That’s how little you could see these poor little kids that looked like they were none of them over ten. And I can’t tell you why, but I got really pissed. I got so pissed at her. I don’t know her. I don’t know anything about her. I don’t know her story. I mean, I replied on Twitter and some snarky response to the effect of please tell me your kids are immunocompromised like, why on Earth would you do this to them otherwise? But that particular interaction has stayed with me so far because of how much it worries me about what I’ve become in this. How have I become so angry at both extremes here?
Dr. Zubin Damania2:18:07First of all, I’m really impressed that you have enough self awareness to recognize that, because most people don’t. I’m with you on this. I think what you’re expressing is the righteous indignation of the alt middle. It is this like, wait, this is insane. Just like when you see somebody talking about this whole thing is a hoax and you need to take Ivory and bid for the rest of your life, that’s insane. And it generates a kind of a moral outrage, right, based on our own moral palate of what we find valuable. Now, what I’ll add, one other piece of this is that this has been potentiated by a collective anxiety of contagion, of Marty calls it the pandemic of lunacy. That is, we are social creatures, too. So as much as we try to hide from it, we’re connected to others. And this general level of anxiety and panic and disruption and social fabric tearing, it feeds back on us as individuals because we’re also part of a whole, and that generates that. And that’s why things like Twitter really weaponize this. Like, I try to stay away from Twitter now because I know I feel it. And if you think of this as a nuclear reactor and I’m about to blow, I’m going to go to go Chernobyl, and the top is going to blow out. It’s going to be fall out all over the country. The person who is my graphite control Rod is my wife. Because what will happen is I’ll see something on Twitter, and it’ll be like, you, Peter. It’ll be like a family of people, like, stay hashtag, stay home. And they got 13 pronouns in their description, and they’ve got 14 masks on their avatar, and they’ve put somehow, like, bend the curve in their name. And I’m so triggered because I’m just outraged by they don’t see the other downstream side effects of their approach. And I’ll start ranting and raving to my wife, and these people are idiots. I bet they’re all over Stanford where you work and this and that and the other thing. And she’s like, could it be possible that and what you’ll do, she’ll go, could it be that person is going through this and this and this, and they’re seeing it this way, and they’ve been also paralyzed by fear from this, and you’re demonizing them as a bad person, but they’re actually a good person. And you can just see she’s lowered the control Rod. And suddenly I have empathy for this person, and suddenly I’m like, okay, all right, but we’re humans. That’s just how we react. The thing is, we’ve potentiated it on mass now with technology that hacks our dopamine drive to go in Groupout group. So I don’t know. Marty, what do you think?
Dr. Marty Makary2:20:20It’s a really good point that you’re both raising here, and I think we need to do everything we can to stand against tribalism. I think all of us can do that. We can be role models to others. We can listen to others. We can admit when we’re wrong. I mean, these are characteristics that are being completely lost in the Echo Chambers of cable news and hearing what you want to hear. So you’re living in an alternate reality because Big Tech is feeding you news that actually makes the other side look like they’re crazy, right? Because that’s how the news has framed their position, and you can’t see it any other way. So I love the Rogan interview with Peter, and I think that’s part of what we’re not talking about in society that we need to talk about. And we got to fix this, because the next pandemic is probably going to be more severe. We’ve had a number in our lifetime. I mean, beginning with polio, older patients. Tell me what it was like going through the polio epidemic. H one N one SARS, Myrrs Ebola Zika. I mean, we’ve gotten lucky. We’ve skimmed the trees on a couple of these. But the next pandemic, that’s going to be a major serious pandemic, maybe antimicrobial resistance, which is increasing each year. Maybe an influenza virus. This covid 19 virus had an overall global case fatality rate or infection fatality rate somewhere around 210 of 1% somewhere in that ballpark. Right. Well, what if it’s 2% with a strain of influenza, and we’ve got this polarized Echo Chamber of hearing news and the politicalization of the human immune system, where the BNT cells have joined the Republican Party and the bodies non neutralizing antibodies have joined the Democrat Party. We can’t do this in the future. We’re going to need diverse opinions, an open form of discussion, honesty, humility. And I’m concerned where we are leaving in terms of our situation at the end of this pandemic here.
Unknown2:22:23Yeah.
Dr. Peter Attia2:22:23I got to be honest with you. I’m not optimistic. I’m going to probably focus most of my energy on controlling myself, which is the easiest step on that is literally not looking at Twitter. I spend very little time on Twitter less than I really don’t spend much time on it. The problem is, like, any amount of time on it seems to be annoying. It’s like you could spend 30 minutes a week on Twitter. And I have to think it’s an anti longevity agent right there. There’s got to be a study that will demonstrate that an hour a week on Twitter will shorten your life expectancy by a year and more importantly, will reduce your happiness all along the way. Because I think there are people who are really good at Twitter who just love to be incendiary, and it doesn’t bug them, and nothing bugs them. They just love to carpet bomb for fun. But if you actually think you’re trying to make a point and engage, which sometimes I do, I think there’s no upside.
Dr. Zubin Damania2:23:26Yeah, I agree. It’s a bad format in general. For that you said something that I think is key that I wish more people would say, which is I’m going to focus on me so much, especially with guys. We’re so bad at dealing with our own internal States, whether it’s emotional States, whether it’s cognitive States that we repress, deny, and then project everything out into the world, and we create the world that we hate because it’s a reflection of our internal state. And there was an Indian Sage, Nisargadata, who said, some dude asked him. The book was like, a bunch of Americans come to him and ask him a bunch of questions of this guru in India. And this one kid asked him, it’s in the 70s or whatever. And he’s like, man, there’s so much war and stuff. We need to reform the world, man, the world is so broken. You’re sitting here in this cave meditating. What’s wrong with you? And he’s like, Listen, buddy, he’s like, don’t be talking about I don’t know why I’m suddenly doing my dad. Don’t be talking about the reforms, okay? Mind the reformer itself. Look inside you’re, creating your own situation. Until that internal conflict that’s generating this unhappiness is pacified, you’re never going to see the world that you want to see. And I think there’s a lot there, which means we have to be self aware, okay? If Twitter is bad for us, if it really hacks our neural circuitry that causes us on discomfort and lack of longevity, which I agree with you, Peter. For me, it does. That’s why what I do is I dump and run. I do the Rogan. I like, dump a video there. I was like, okay, guys, have fun with this. And I’m out. And then every now and again, I’ll be sitting on the pot and I’ll open up Twitter because I’m like, hey, what’s going on on Twitter? And I’m like, oh, shit, this went nuts. This is not good.
Dr. Peter Attia2:25:02Another thing I want to maybe this is a better question for you, Marty, but what can parents do? Because that’s the demographic I find myself most concerned with right now is this group of what are we going to call alt middle folks who absolutely believe in science certainly understand the benefits of vaccines, understand why we needed to do what we needed to do 18 months ago. But today, I mean, these are the calls I get a lot of is, hey, my kids still are wearing masks every day in schools. They’re not being permitted to play sports if they’re not vaccinated. These are healthy twelve year old kids that are not permitted to play sports unless they get vaccinated. I feel very fortunate. I live in a state that doesn’t exactly believe in the government controlling you. And therefore, from the minute we’ve been here for 15 months, school has never been shut down for a day. Our kids are not in masks or it’s masks optional. So my kids are not in masks. No restriction on sports, that kind of stuff. I feel very fortunate. What do the parents do who don’t live in these States? You said earlier, Marty, this is only going to change when enough people get pissed about it. And the policy makers basically realize, oh, my God, I’m going to get voted out of office as a result of this. And by the way, how do you do that with health advocates? Because they’re not really on the hook for votes. You have sort of two layers of this here, which makes it a little more complicated, right?
Dr. Marty Makary2:26:36Yeah. Well, I think a lot of people are getting fed up right now, and this country has a democracy, and the democracy does work. It can take time. But elections are already showing polling right now that people want a reasonable approach. And for parents, they should demand an endpoint to restrictions in the schools. If there is a policy that they have no control over, they should demand an endpoint. When we put in so many restrictions in schools, be it the Plexiglass, which Ironically, could reduce ventilation and air flow in the classroom, and kids have to cover their faces with a cloth mask, which the study run out of Stanford and Bangladesh showed had really no impact at all in transmission, just such a poor quality mask or a vaccine mandate or a booster mandate, which is what the bandwagon of the lunacy of what colleges are jumping into right now. They should demand endpoints to these things. At what point? Watch the Pharma industry change the language. And I predict this will happen from a booster to annual boost. Have you gotten your annual booster? It may be. Then we get a new variant. They pop up a new booster in a six month interval, the language will change to are you up to date? Like it’s software. And people that are chasing this may be getting boosters. They may look back in 20 years and realize, hey, I just got 15 boosters. For what? People should demand an endpoint. They should demand criteria to remove the masks. They were put in place with no criteria to remove them. They should ask their pediatrician about a single dose of the Pfizer vaccine for their child. That’s a reasonable option. It can depend on a lot of factors, and maybe they have concerns. Maybe their pediatrician sees a risk factor in the child and thinks one dose would be safer spacing out the doses. Ask about natural immunity. People with natural immunity should feel good about their immune protection. So I think these are the things people need to talk about and ask about and vote on come election time.
Dr. Peter Attia2:28:49I want to ask both you guys this question. Who are the people that you find to be voices of reason in this. Who do you like to read? Who do you like to listen to? Zubin, you work pretty closely with Vanilla Prasad. I find him to be just another amazing example of a thoughtful person in the middle who’s rational any other folks we can point people in the direction of. Besides the two of you guys.
Dr. Zubin Damania2:29:14I’m personally a fan of Doctor Monica Gandhi, UCSF infectious disease doctor. She’s been a voice of reason, calm. She also has a really beautiful maternal kind of wisdom about her that she gives off. That’s a good contrast to a lot of the talking heads that are guys. And she’s very smart about it. And actually, if you talk to her offline, she is very much obsessed with getting us back to living instead of living in fear all the time. And part of the reason she was such a big advocate of even cloth masks in the early days of the pandemic, as she felt that, look, if it lowers an Oculum a little bit, it will prevent some severe disease. But the main thing is it will get people out there, stop these lockdowns, open up our schools, these kinds of things. And so she’s a pragmatist, very smart and data driven Gal. Marty, who’s on your shortlist.
Dr. Marty Makary2:30:00There’S really just one person, and that’s Dr. Anthony Fauci. In all fairness, he is a true gentleman if you’ve ever interacted with him. And he’s a very nice guy. I just have had different opinions on how to manage the COVID strategy on almost every single aspect of the pandemic. But to answer your question, Monica Gandhi is terrific. She’s got a great sort of feed that she puts out. She’s got a site and a Twitter feed that’s got great information. Amish adults from Johns Hopkins. Peter, you’ve had them on, I think early in the pandemic. He’s as correct as I think everyone’s been wrong. Every expert has been wrong. Every expert missed India and Delta and so many other things. But he’s been as correct. I think Martin Kaldorf, he’s the gentleman from Harvard who is now with Brownstone Institute, puts out great information. And I would say more importantly, I do not listen to anyone who’s a politically appointed physician, anyone current past or future. If someone trying to become a politically appointed physician or was, I just block them right out. And I go to these go to people who I trust.
Dr. Zubin Damania2:31:17Can I add a couple here? It’s interesting because I agree, Marty. I actually will even take it a step further and go someone who’s very politically angled on social media, who’s taking very strong political stances. I don’t trust them either, just because they aren’t able to disambiguate that tribalism from their recommendations. I actually am a big fan of John Mandorla. He’s an epdoc cardiologist on Twitter. He’s done good work in this space and has been very rational. The other person and I don’t know, Peter, if you know this guy or if you guys have had conflict in the past because he’s more of a vegan dude who I used to have a little bit of beef with. But now I’m convinced he’s been very rational on this pandemic. Is David Katz actually out of Yale? And he’s really written extensively, very heterodox like stuff that would get you booted out of the tribe, basically saying, hey, we should look at the big picture here. We need to look at the harms and the benefits to society. And he’s been very rational and has written very eloquently an alt metal synthesis of this pandemic.
Dr. Peter Attia2:32:17The only thing I would add to that guy is, by the way, I don’t even know everybody on the list that you guys have mentioned. That’s how little I’m personally paying attention to this, but I’ll now start paying attention to some of those folks sporadically. I have no desire to spend too much time on this. As a general principle. I have no trust in people who can’t change their opinion. So when I encounter a person who says the exact same thing over and over and over and over and over again, and when you ask them, do you feel differently about this now versus six months ago or a year ago or 18 months ago, the answer is no. Double down, double down, double down. No matter what they’re talking about, it doesn’t guarantee that they’re full of shit, but it increases the pretest probability significantly.
Dr. Marty Makary2:33:07Yeah. Like school closures last year, if anyone who called for school closures has not come out and said, you know, we got this terribly wrong and it disproportionately affected poor and minority communities, I feel terrible. Then I’ve written them off.
Dr. Zubin Damania2:33:23Yeah, it’s hard to trust them, actually. What Peter is pointing out, I think, is something that I talk about when I talk about alt middle, which is you should be able to question every single one of your beliefs, because if you’re sticking to one single view, you’re probably missing something. The only belief that I think is a little bit beyond question is that you should always question your beliefs. So it’s like a metabolitef about belief. I think people who hold that where they hold their beliefs loosely based on new evidence and persuasion and so on, but they’re not wishy washy. They’re not just going with the windows. I think those are the people that are the most trustworthy and who are able to call out their own biases and say when they’re wrong and also celebrate when they’re correct and go, Listen, this gives me some credibility. I was right about this and this and this. I was wrong about this for these reasons. And this is how it’s changed my thinking.
Dr. Peter Attia2:34:12Yeah. The best investors will tell you they have very strong convictions, loosely held. And so I’ve always loved that mantra. Right. Strong convictions, loosely held. And what’s interesting is I assumed we’d be 50% sort of fact, 50% opinion. I think we’re a little more on the opinion side. But what’s really interesting is there’s nobody who’s successfully running a hedge fund on the mantra of, I’m always right, because in the hedge fund space, it kind of doesn’t matter what you think. It matters how much money you make, and the dollars always decide. So if you just say, I’m always right, I’m always right. I’m never willing to change my point of view in the presence of new information. You’re going to end up losing money eventually. If you can be malleable and say, this is my point of view based on the available data, hey, there’s new data, I’m going to change my point of view. There’s just no comparison in the long term success of those two investment strategies. And so it all kind of shakes itself out. It’s very interesting that in policy, in medicine, even the system of reward is so uncoupled from the outcome that there’s mass confusion around this. And that’s why it’s very difficult to suss out the really good critical thinkers versus the not so good critical thinkers.
Dr. Zubin Damania2:35:37That’s a great point. Great analogy, actually. I think more people would benefit from having some of those endpoints sync with that kind of thinking in medicine. Because you’re right, they’re disambiguated. They’re completely disengaged. In fact, it’s even hard to know what outcomes like if you’re talking about improving a healthcare system. Okay, so what are your endpoints? What are you trying to do exactly? Well, we want a lower hemoglobin a one, C. Okay. But is that really what you want? Or do you want this 62 year old Hispanic grandfather to be able to see the graduation of their kid with decent faculty, decent vision? Okay, that’s a different endpoint than a hemoglobin a onec. So how are you going to do that and how are you going to measure that? It’s a complex human system. That’s where it becomes so interesting and difficult. But how is it that different than the financial system? The financial system is exceedingly complex. It’s just the measurement outcome is dollars. It’s much simpler in that sense.
Dr. Peter Attia2:36:28The measurement outcome is unambiguous. It’s very binary, and it’s very unambiguous.
Dr. Marty Makary2:36:34And you see it in the style of patient management among physicians in the hospital. I mean, think about being on rounds in the ICU. Peter, when we were doing that together, the doctors who say, I thought this patient was not going to benefit from steroids, but now it looks like they have a nice response. Let’s go ahead and continue this therapy. The people who constantly pivoted reevaluated evolved their position based on information, they were the best doctors, the ones who shut down suggestions by a student on the team who says, I read this and they said, it’s a dumb idea. That’s not going to work. Those were early predictors of not just who is going to be a great physician, but who’s going to be a great person down the road. And then the one criticism that irks me, that gets thrown at the government, and I’ve got plenty of criticisms for the government. But the one criticism that I hear that I’m not on board with is when they say, oh, they’re flip flopping. Well, they should.
Unknown2:37:36Yeah.
Dr. Marty Makary2:37:36This is not some political philosophy you got to dig in on. They should constantly be changing.
Dr. Peter Attia2:37:43I’m glad you said that, Marty, because I completely agree with that. And I think it’s a very important distinction to make. To me, it is not a problem when an advocate or policy maker says, this is the way we’re going to do things. Actually, this is not the way we’re going to do things. We’re going to change. Situations change. Right. No new taxes. Guess what? When George H. W. Bush said no new taxes, there wasn’t a recession going on. There was a recession going on. It wasn’t a popular thing to do. It got them out voted. But politicians get hammered when they change their mind, which is why I would never wish being a politician on my worst enemy. But it is a bit of an unfair criticism when we say in defense of the criticism. Now, I will say this. It’s because it’s typically done with a lack of transparency.
Dr. Zubin Damania2:38:31Yeah. Relating to that is an interesting piece of this is this idea of persuasion. So how are you going to persuade somebody of something you think is important based on the data that you have if you do not show them that you’re flexible in your thinking but firm in your convictions, loosely held, and that new data would change your mind? And I get a lot of emails saying, you’re the only person who convinced me to vaccinate. I was so angry with Biden or whoever for mandating this. And they talk to me like I’m stupid. And it seems like they don’t recognize myocarditis and all these other things, but you guys talk about it, and yet you still say, okay, I think this is important for people like yourself and so on. And so I get email after email saying, you have convinced me. But then in the same breath, I get the dogmatists saying, hey, you’re like some kind of antivaxxer. You’re holding back the cause. And it’s like, well, I wish you could look at my inbox then, right? You do need that flexibility. And I’m not saying I’m perfect at that. There’s things I need a lot of work on, but at least it’s on the radar.
Unknown2:39:29Right.
Dr. Zubin Damania2:39:29And I think Peter thinks this way. That’s why we all kind of gravitate to each other, right? Peter and Marty and me, we were like, oh, no, there’s something about you get the vibe. This is someone who thinks independently and is able to change their mind and is curious and so on. And I think that sets an example for other people that you’re mentoring or teaching or whatever. And we see it in the hospital all the time, you know, those attendings. Right.
Dr. Peter Attia2:39:51Gentlemen, I feel like we could keep talking, but I feel like we’ve also sort of provided, I think hopefully some a some information for folks with respect to omakron a little bit of clarity around what we do and don’t know about the utility of vaccines, the potential risks of vaccines. I think we’ve also shared our biases. Right. I guess we haven’t explicitly stated it, but I think we’re all pretty anti mandate, at least given the current facts. One of you made this. I think it was you, Marty. It might be a reasonable idea to mandate parachutes if people are jumping at ten 0ft. It might be entirely another thing to not mandate parachutes when people are jumping from 15ft into the water. So you have to know the situation. You can’t just say we must do this. We must never do that. So I love that analogy. And I think given where we are now, I realize the amount of criticism I face for being against mandates, but I think you got to let your conscience has to speak on this. And I think it’s wrong.
Dr. Zubin Damania2:40:54Yes.
Dr. Marty Makary2:40:55We got to treat people like adults.
Dr. Zubin Damania2:40:56Strong convictions, loosely held.
Dr. Peter Attia2:40:58Yeah, that’s right. Maybe in the presence of new information, I’ll change that conviction. But given the evidence I have today, it’s a pretty strong conviction.
Dr. Zubin Damania2:41:06Yes.
Dr. Peter Attia2:41:07Gents, thank you so much. And I really hope we don’t have to do this again.
Dr. Zubin Damania2:41:11I hope so, too. I hope we can just talk about what it was like in the hospital back in the 90s and 2000s, because that’s funny and concerning on many levels.
Dr. Peter Attia2:41:23And if you do figure out how to get that epididimal Taser thing working, you let me know, because I really could use that device.
Dr. Zubin Damania2:41:30Listen, guys, I am the patent holder for the Pkg, the prostato cardiogram. I put a couple of leads, one on the perineum couple on each testicle, and I get a Pkg. Sometimes you go into PFIB where your prostate is just fibrillating, at which point you get a high output failure. I haven’t fully thought it out, but I’m hoping to think, Peter, through your connections, I can get an investment in Marty, to your political connections. I can get some buy in from policy. But the PK prosthetic defibrillator in every closet, I think, is what I’m hoping for, policy wise.
Dr. Peter Attia2:42:03You’ll mandate it, of course, right.
Dr. Zubin Damania2:42:07With operative the word man in there because it’s mostly for men. But again, I want to be gender neutral about this.
Dr. Peter Attia2:42:16All right, gentlemen, thank you.
Dr. Peter Attia2:42:18Enjoy the remainder of your holiday season.
Dr. Marty Makary2:42:20Okay. You, too. Good to see you, Peter. Good to see you. Xbox.
Dr. Zubin Damania2:42:23You, too. Happy New Year, guys.
Dr. Peter Attia2:42:25Thank you for listening to this week’s episode of The Drive. If you’re interested in diving deeper into any topics we discuss. We’ve created a membership program that allows us to bring you more in depth, exclusive content without relying on paid ads. It’s our goal to ensure members get back much more than the price of the subscription. To that end, membership benefits include a bunch of things. One totally kickass comprehensive podcast show notes that detail every topic, paper, person thing we discuss in each episode. The word on the street is nobody’s show notes rival these monthly AMA episodes or ask me anything episodes. Hearing these episodes complete access to our private podcast feed that allows you to hear everything without having to listen to spiels like this. The qualities which are a super short podcast that we release every Tuesday through Friday, highlighting the best questions, topics and tactics discussed on previous episodes of The Drive. This is a great way to catch up on previous episodes without having to go back and necessarily listen to everyone steep discounts on products that I believe in, but for which I’m not getting paid to endorse and a whole bunch of other benefits that we continue to trickle in as time goes on. If you want to learn more and access these member only benefits.
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