 Hi, everybody. This is Nicholas with Reason. I am joined by Zach Weismiller, my colleague at Reason. Zach. Hi. And today's guest is Vinay Prasad. He is a professor of epidemiology and biostatistics at University of California, San Francisco. He's the author of two books, including one on ending medical reversal or getting rid of bad medical practices and malignant. And he has been an outspoken critic of the public health establishment during the COVID period. Vinay, thanks for talking to Reason. Thanks for having me. Let's get right to it. You have a very popular and urgent sub-stack, really. Vinay Prasad's observations and thoughts. One recent article that we wanted to talk with you about, because it opens up the conversation we're hoping to have today, about what went wrong with the official COVID response, what went right with it, but most importantly, how do we make sure we don't screw it up the next time when something like this happens and we build on our successes rather than replicating our failures endlessly? But this is from February 17th and it's headlined, public health should lose your trust. Can you kind of summarize the argument there? Yeah, I think this is an article that sort of makes the argument that we should trust institutions insofar as their past performance. And unfortunately, public health, by that I mean the institutions of public health, the CDC, the National Institutes of Allergy and Infectious Disease, NIAID, which Tony Fauci ran, and even some local public health officials should lose your trust because of their poor performance. And I go on to detail, you know, seven domains where I think we can all agree, they really underperformed and maybe even in fact told us some falsehoods along the way. I'm happy to run through those. Yeah, well, why don't we, Zach, do you want to start with like what you find most pressing? But you know, one of the questions I guess that we'll come back to again and again, Vinay's, how much of this is that public health authority didn't have good information and they weren't willing to cop to that? So they were, you know, they thought it would be too complicated for people to understand, well, you know what, you know, masks don't work or they would give an issue, you know, in order early on or they would talk about how don't bother about wearing masks because they're not really important. And then somebody like Fauci a little bit later says, well, I was misrepresenting what I thought to be true because I didn't think people could understand. How much of it is official dissembling and how much of it is kind of government or public health authorities not being able to cop to the fact that they don't really know what to do and they're giving you their best case scenario at this point in time. Well, I mean, let's just run through that example. So Fauci early March 2020, he says, you know, on 60 minutes very prominently, we don't advise community masking, we don't know if you might be touching your face and have some compensatory behavior that sort of undoes any benefit masking might have. Six weeks later, he goes and says, you know what, I was I was telling you something false. Initially it was a noble lie. I'm telling you the truth now, which is that you ought to cloth mask, tear a piece of fabric and put it over your nose and mouth. The irony is actually it was the second time that he was lying. It was the first time he was telling the truth. You know, the first time he was going with the pre pandemic body of knowledge, he was going with multiple randomized trials from influenza. The second time under sort of a heavy pressure campaign from I think advocates that we ought to do something, he started to recommend a mask that now we know clearly cloth masks. I don't think anyone debates. They don't work and they didn't do anything. We have a Cochrane review that just came out that says any community mask recommendation doesn't appear to work in all of the pooled studies and that's the highest quality evidence we have to date. So your question is, you know, did he know he was lying the second time? I suspect he did actually. And why was he doing it? Well, one reason is if you go and say, well, you know, I'm not sure, but we've shifted. We think maybe give it a shot. People may not really comply. So you have to really sell it. The problem with that, I think is that we live in a free society where you don't get to deceive the American public because it is a democracy. We should be presenting, you know, fair and balanced information so people can make the right choices. The second thing that's a problem is you only get to lie once. I mean you lose all credibility and he has become a polarizing figure. He thinks that's because there's some conspiracy against him, but to some degree it's the result of his own actions. Can I ask to follow up and to balance Fauci say with Donald Trump who, you know, who convened a panel of experts, including Fauci that, you know, we're having dally press conferences, was it problematic that Donald Trump at the beginning of the pandemic was saying, hey, this isn't a big deal. This is going to be over by Easter. Don't worry about it too much, et cetera. And was Trump, do you think Trump was acting out of noble lies or was he acting out of, you know, he just, he couldn't admit that he didn't really know what was going on? I think whole textbooks could be written trying to understand what makes Donald Trump check. And I think he's a harder person to sort of interpret. You know, I think he may have genuinely believed that the pandemic would blow over. I mean he was wrong. He certainly wanted it to blow up. He wanted it to be the case. Right. He was wrong to believe that. I don't think science would suggest that that would be the case. In fact, everyone was saying that this is going to be a long and year long and multi year long problem. But I think we have to acknowledge one thing, which is that he is such and is such was such a polarizing figure. It was such an anxious time that many people really anchored into doing whatever the opposite he said. So if Trump says schools are safe, they got to be dangerous. If Trump says don't need to wear a mask, it's got to work super well. And I fear that to this day, so much of our pandemic legacy is merely doing the opposite of what he says. But you know, even a broken watch is right twice a day. And some things he was right about schools, he was right about masks. He was right about the topic that is still kind of a live topic at this point, because masks thankfully are mostly in the rear view right now. But vaccines are still an active issue. And it's there's become a lot of over time. There's been a lot of confusing messages about it. There's kind of the data is confusing for the layperson. And to get into that conversation, I'd like to just play you some of the montage of clips of the CDC director, Rachelle Walensky talking about vaccines over time and get your reaction to that, you know, in the context of what you were just talking about, the proper way to communicate publicly and the way that if you're constantly, you know, backtracking or fudging things, then it can kind of bounce back on you. But here's Rachelle Walensky. Is that if you're fully vaccinated, you are protected against severe COVID hospitalization and death and are even protected against the known variants, including the Delta variant circulating in this country? Just last month, the CDC and the FDA both said we would not need booster shots. What specifically has changed in the data that has changed your guidance? Right, several things. So first in the last six weeks, we have seen Delta in this country. We have seen now evidence that we've been looking at just over the last week or so that has demonstrated that the vaccine is starting to wane in its effectiveness against infection. I don't want to say never, but we are not necessarily anticipating that you will need this annually. It does look like after this third dose, you get a really robust response. And so we will continue to follow the science. A new vaccine with a new approach for most Americans, that means one COVID-19 shot once a year each fall. We are simplifying our message. The message is you need to get your fall booster vaccine. So go ahead and get it. If you're over the age of 12, if you've received your primary series, if you're more than two months out of your last shot, you can get an updated vaccine. And so we've intentionally simplified the message, so it's very, very clear. What do you think of the job that the CDC and Rochelle Lensky have done as it pertains to the vaccine rollout? I think it's been very poor and deeply troubled. It's the characteristics of a speaker who's decided what she wants the public to do and then reasons back to the sort of messaging that she should deliver rather than somebody looking at the scientific facts and just telling you what we know and what we don't know and what we're still uncertain. We can go back to the beginning, the first six months of 2021 as vaccine rollout started to take place. You know, in the first four months, we were supply constrained, meaning not everyone who wanted one could get one right away. We made a number of mistakes around who should be prioritized. We prioritized a lot of young, healthy people, over older people. We made mistakes about dose two, the United Kingdom stretch dose two out, which actually provides more durable antibody levels and has better safety than putting the two doses together. Those doses were arbitrarily picked very close together because we needed the trial to result quickly in 2021. By the summer of 2021, it was apparent from Provincetown, Massachusetts and other instances that you would get people who were vaccinated were still able to catch the virus and transmit the virus. That means all the mandates that happened in the fall, which was when Biden pushed the mandates, were medically unethical because you cannot compel an intervention on a third party. If it provides, sorry, you cannot compel a medical intervention on somebody unless there is a benefit to third parties. But by the fall of 2021, we knew that that wasn't the case. Now I want to point out, we could have made Pfizer answer the question. In the randomized trial Pfizer ran in 2020, we could have asked them to swab people randomly and their households randomly, and we would have had an estimate of transmission. But over and over again, you'll see that to some degree both administrations give the companies the benefit of the doubt the easiest path forward. Now let's talk about boosters. This country is unique that we have a singular focus on boosting everybody from 12-year-olds to six-month-olds to 86-year-olds. Whereas in Europe, a number of nations have focused primarily on older, vulnerable people. That makes a lot of sense, the European strategy. Our strategy does not make sense, not supported by evidence. She's being criticized by people like Paul Offit, who he himself makes vaccines. And her rhetoric throughout all this is always too certain and states things that she does not know to be true. I mean, there are video clips of her saying, we know you can't spread the virus. She didn't know that to be true when she said it. And it turned out not to be true. And can I ask about that? I mean, at the beginning, and we interviewed Jay Bhattacharya a while ago, and one of the things he was saying, which corresponds with what you're talking about, is that the public health authorities at the highest levels oversold the vaccines. The vaccines definitely work to reduce the severity of, you know, they might reduce transmission. They definitely reduce the severity of the COVID that you get if you've been vaccinated. And that's really important, because a lot of people are now just saying like all vaccine, you know, the vaccines don't do anything other than, you know, cause people to go insane or die. But that they oversold from the beginning the efficacy of the vaccines in terms of stopping transmission, et cetera, because they didn't have faith that people would get the vaccine if they had merely been told, get the vaccine and you won't die from COVID. You might still get it. You might even be hospitalized, but at much lower rate. Do you think, was that the original problem that the authorities knew these vaccines are not traditional vaccines and that they keep you from getting something, but they thought that message was too complicated to sell to the American people? That's a tough question. I mean, I definitely think you're right in the sense that older people do benefit. I mean, the benefit of the vaccine in first quarter 2021 is tremendous for eight year olds, seven year olds, 60 year olds. I think one of the challenges is we to this date don't really know what the lower limit of benefit is, how much benefit young people are getting, particularly young people who've had COVID. We're not honest. Even people like 40, right? I mean, I mean, you're kind of talking about how it's, there's like it, there's a slope that gets pretty quickly if you're over 60 or whatever COVID vaccine is much more important than if you're under 40. Yeah. And that's particularly true with boosters. And it's particularly true once you've already had and recovered from the virus. And so those are sort of salient points. I think there may have actually genuinely had some optimism that this could halt transmission because hope springs eternal among human beings, but things that would have led them to doubt that is that we continually get reinfected with coronavirus. It evolves in such a way, you can get it multiple times in your life. And they didn't build into the studies the sort of the way you would actually document halting transmission, you know, those sort of random swabbing of people to see that transmission is halted. And I want to point out a few things. I think transmission is lowered with COVID-19 vaccines. And the first half of 2021, it was dramatically lowered by vaccination, but escape variants like Omicron basically blast right through vaccines. I mean, you can get infected with Omicron even if you've had the vaccination. We still believe it has a reduction in severe disease. So it's good that you had gotten it, but it has no ability to curtail spread. And now the idea that each additional booster will do something. I think some people believe like, you know, it's going to prevent variants from forming. That's naive thinking. I mean, there's eight billion people on the planet, a hundred billion interactions. The virus is going to be with us for 10,000 years. And any boosters you give is going to be like spitting in the ocean. It's not going to do anything for viral mutations. You designed a study that looks at, it's called COVID-19 vaccine induced myocarditis in young males, systematic review. And we'll get a little bit more into this myocarditis issue in a second because that's seems to be the most salient concern that people have on the safety side of the vaccines. But the interesting aspect of this study is it's designed to age, well, it's designed to stratify among a bunch of different variables. One is age. One is the brand of vaccine you got, the manufacturer. Another is with type of dose you got. And I got to say that this is one thing that's been really baffling to me about the entire pandemic is the lack of stratification in multiple areas, not looking at very specific subpopulations or vaccine brands. It's like everyone must do the same thing and act as if they're at identical risk. Before we get into the study, do you agree with me on that? And if so, what explains that kind of one size fits all approach that seems to have covered many areas of the pandemic? Yeah, no, I totally agree with you on the premise. And I think this is the original sin of the pandemic is that people like Jay and Martin who proposed some sort of differential protection, more protection for those who need it, less for those who will have better courses with COVID-19, keep schools open like the Swedish approach, that sort of focus protection that was demonized in this country. We needed a one size fits all lockdown. And all of our policies since have been one size fits all. The 18 year old man has to have the exact same number of doses as the 88 year old woman. Actually, maybe you have four instead of five, for instance, but almost the same. And the point of our article was what we're talking about, where's that tipping point trade off? There is a risk of vaccines. It is myocarditis, inflammation of the heart. It's non-trivial. I mean, people can say it's mostly mild. I think that's a very dishonest thing to say because if you're a healthy person taking a medical product, you don't want to end up hospitalized with inflammation of your heart muscle. I think it's a very severe outcome. And there are some people who have suffered very severe myocarditis episodes. And that's something that we have to minimize and take seriously. It's a serious safety concern. So where's the tipping point in terms of risk benefit by age? And I think that was what we were talking about a little bit before. Certainly men are at higher risk than women of myocarditis. Moderna appears to be higher risk than Pfizer, perhaps because the dose is higher. Men in a certain age group, the 16 to 24 demographic, yeah, you see here, they're at the absolute highest risk of myocarditis. An 80-year-old woman is at a very low risk of myocarditis. For her, the net benefit of the vaccine is large. But when you talk about a 20-year-old college man, what's the risk-benefit balance of dose one? Dose two, dose three, and dose four. And does it change? Because each additional dose is not providing as much benefit as the first dose. And I think very likely it does change along the way for a young man. And our policy is actually detrimental for young men to keep getting perpetual boosters. That's not just my opinion. That's the opinion of Jay and Marty McAree and many others. And we published a peer review article on this. So I think your point is well taken. Medicine has always treated 20-year-old men different than 80-year-old women. We don't take the same blood pressure pills and we don't take the same statins. We need different vaccine policies as well. It's amazing too when you look at the CDC data or official data on the number of deaths from COVID or with COVID or however you want to measure it. And when you're looking under 18, I mean, it's still, I think, under 1,000 for the United States out of over a million deaths attributed to COVID. I mean, I guess we go back to this question again and again. And if we could ask them, we would. But I mean, is it that people like Fauci or Rochelle Walenski and whatnot, is it that they don't understand what you just said and that this affects people under 21 differently or under 20, that it does people over 60? Or is it that they don't care and they don't think that any of us are smart enough to be like, well, if I'm over 60, I probably should get the vaccine. If I'm under 20, I can wait or I have to weigh in more factors. Yeah, this is why I wrote the article. They should lose your trust because if they really don't understand that, then they're grossly incompetent for the job because this is a basic medical fact that risk will vary 1,000 fold by age and that the risk benefit calculus of a vaccine with the harm may tip. And if they do understand it, but they nonetheless try to have force, a one size fits all message, they should lose your trust because they're being dishonest to you. And you can fool some people for some of the time, but you can't fool everyone forever. And eventually, more and more people are going to come out and pointing to these errors. And that's going to lead to a bigger problem, which is a cataclysmic loss of trust in public health. So I do think they've made a huge miscalculation and just proof of that. You have the resignation of Marion Gruber and Phil Krause. This is the director and deputy director of vaccine products at FDA post they held for decades. They have resigned over this administration's booster policy in the fall of 2021. That should signal to people that this is heavily disputed among experts. These are the vaccine experts of the FDA. They're being steamrolled into a one size fits all policy. And I just want to point out who benefits from that policy. The company benefits a great deal because it's a huge perpetual market share. And who's hurt by that policy? Well, I think that 20 year old man who attends a little art school, who's being forced to get a booster and one in 10,000, maybe one in 20,000 will get vaccine induced myocarditis. And that person may have already had COVID and stands to gain nothing from that additional booster. So that man is harmed. I want to contrast what the official line or advice is about the vaccines with what you are saying, because what it more or less is, and I'm going to play the clip of Rachelle Walensky in a second talking about myocarditis and display some of the CDC's messages about this. But it's basically like, okay, this is a, there's a mild risk. But in the big picture, you know, you can get myocarditis from the infection itself. There's lots of other bad things that can happen from the infection itself. So we need to just simplify the message and say you're better off getting the booster than not. So let me play this clip from Rachelle Walensky and then have you respond to that line of argumentation of this rare but mild myocarditis come in. And we heard about this yesterday at the advisory committee on immunization practices yesterday. But what we do when we do this is we look at the risks and we look at the benefits. And to just put this in perspective, if we have a group of 12 to 17 year olds who are working to vaccinate over the next four months, and we can vaccinate a million of them, which would be great strides over the next four months, we could expect 30 to 40 of these mild, self-limited cases of myocarditis. And for that, if we were to vaccinate all one million, we would avert 8,000 cases of COVID, 200 hospitalizations, 50 ICU stays, and one death. And so we raise the risks as well as the benefits, these extraordinary benefits of vaccines as we make these recommendations. And it is why we at CDC have made the recommendations to vaccinate and had co-signers from so many other medical organizations, including the American Heart Association. So that on its face, that argument makes sense. Is there something wrong with her math? Yes, that's exactly right. So I mean, her premise is correct that every time you take any medical product, you got to weigh the potential upside against the potential downside. And even if there's downside, if there's more upside, it's still in your best interest to take it. So we all agree on that premise. But the problem is, there are errors in her math. All of their math is nothing but errors. A few things they conceptually get wrong. One is that you don't have to give, in their modeling, a lot of the times it's all or nothing. It's either four boosters or no shots at all. I personally think that the vast majority of adults benefit from dose one. Dose two is when I start to struggle with from 20 year old men. And dose three and dose four, I have different cut points. So it can vary by dose, depending on your modeling. Number two, we only really know with sort of good precision, the reduction in severe disease in the first two doses. That's what we tested in a randomized fashion. For boosters and for the fourth, the bivalent booster, we're doing sort of retrospective looks. In other words, we don't actually run an experiment to see what the efficacy is. We just let people get it. And we go after the fact and say, hey, let's compare people who got it to people who didn't get it and see how they do. Okay, let me bring up like this slide real quick, because I know that you analyze this. This is a CDC slide. And it's to the point that you're talking about, they're saying that per million doses, this is of the bivalent booster in 12 to 17 year olds over six months, there's the numbers of hospitalizations. ICU admissions prevented zero to one death prevented. And then in red at the bottom, zero myocarditis cases. So that's the message coming from the CDC, but you're saying that these studies are just their garbage, they're not designed properly. Yeah, so I mean, this is a model, it's based on like all the models we've had in the pandemic, you know, wildly inaccurate oftentimes, it's based on your assumptions. And so what they're assuming is rape hospitalization from the past that are going to go forward into the future unchanged. But of course, that's going to be different because more people have had and recovered from COVID. So that's going to be lower. What they assume is a vaccine effectiveness so that this bivalent booster will lower your risk of severe disease that they're actually getting from an older age group and extrapolating to a younger age group. They're getting it from this sort of backwards looking kind of study that has a bias in it. And that bias, of course, you know, Zach and Nick, the biases that people who choose to get the booster are different than those who don't in other ways than the booster. I mean, they're usually more precocious people, they're people who may have higher socioeconomic status, they may more likely to be liberals who live in certain cities, you know, for instance, and those other differences might play the role, not the bivalent booster itself. So you have a sort of dubious estimate of hospitalization, dubious estimate of vaccine efficacy, extrapolating to a younger age group. And then let's talk about the harm side of the ledger. She says zero harms out of the 48,000 doses, but they can't actually believe the harm will really be zero. It will be something when you give it to more people and allow more time for follow up. My best guess as to what that something will be is one in 10,000, because that's a very nice estimate from the third dose in roughly this age group from the Kaiser Permanente group. So again, you know, these types of exercises modeling in science, it's the most malleable science, you can bend and flex it. And I can make my own analysis that would probably reach a different tipping point than hers. The problem is that the person doing this modeling has already decided on the policy. They've already decided that these vaccines have to be given to this age group, and then they do the modeling. And that's very problematic because if we know where we want to go, we can get the model to give us the result. Is there any world where this, you know, in an alternate universe, how would this have been accomplished? How would quality studies have been accomplished? Because you do understand, like I can understand from their perspective, we're in an emergency situation, it's a pandemic, people are dying, getting hospitalized all the time. So we don't have time to do these high quality randomized control trials might be the argument. Is there anything to that? And you just kind of have to deal with the uncertainty. Yeah, so I think it's a partial argument. And there's always two things they say, we don't have the money and we don't have the time. The money I think we'll all concede they have because Pfizer and Moderna have 100 billion reasons they can make this happen. The time is the question, how long do these studies take? And my answer is the following simple thing, they debuted this bivalent booster in the fall, I believe in September, and we still have 14 percent uptake nationally in age groups. So, you know, what's the point of rushing something that nobody wants anyway? The next thing I'd say is that randomized studies actually don't take as much time as you think. Just think about the initial vaccine trial, which was launched sort of in the summer of 2020 and yielded a result by the fall. If you increase the number of people you give it to, you'll get a result even faster. I think it's inexcusable that they don't do, they don't make the company do those studies. The company is going to make money for, you know, year after year, billions of dollars, they can afford to do it, we can have the infrastructure to do it. And by doing those studies, I think you will learn the reality. And my guess is the reality is that the benefit of these products year after year after year is going to be smaller than what they think it is. Can we talk a little bit about the relationship between the pharmaceutical companies and the government and the policy? Because you've written that, you know, one of the great successes of the COVID pandemic, which has been really obscured, is the fact that the disease was sequenced very quickly and we brought effective vaccines to market incredibly quickly, you know, shots into arms. But that seems to be, you know, very, one of the reasons why that's kind of obscured or it moves to the back is because of the conditions that were attached to the development and the follow-up of the problems. Could you talk a little bit about what went right with Operation Warp Speed and then where, you know, you've mentioned a couple of times that Pfizer and Moderna and other vaccine makers aren't required to do continuing kind of studies and things like that. But, you know, talk about what went right and then why it's, you know, the follow-through is not where it should be according to you. Yeah. And I guess I just want to say that what we're getting at is sort of an age-old principle of medicine, which is we have interventions that work really well in very sick people, that sometimes the manufacturers, of course, their interest is to just use it in more people. And as you get to people who are less and less sick, they work less and less well. And at some point, the harm's outweigh the benefits, we see that with, you know, stenting heart attacks, works wonderfully, stenting people with just a touch of angina, you know, might not work well at all. And that's the age-old principle of medicine. So let's talk about Operation Warp Speed. I think it was, you know, remarkable success. They really expedited the development of the mRNA vaccine in a time frame that even the optimist thought was implausible. And there's no doubt about it. I mean, people at the time, and it's weird because it's not long ago, but it feels like a million years ago, but people were talking about, you know, three years, five years to really get a vaccine that's up and working and things like that. And, you know, there it is in a few months. There it is, right around the election. Yeah. Well, just after, right? Well, we can talk about that because Pfizer made an addendum to their trial. But it was remarkable that they were able to run the randomized trial in such a short fashion. Operation Warp Speed was a success. They were sort of given money to make sure they wouldn't suffer losses and so that they would take that investment risk. And I have no doubt about it that the vaccine saved many, many lives, including American lives, particularly older, vulnerable people. Now, the questions we're arguing about today is a different question. That was 2020, the fall. We had a Delta wave that led to horrific deaths. The vaccine had come out a few weeks sooner. We would have averted some of those deaths. We could talk about that. But right now, we did at reason. I mean, the fact that like the FDA took Thanksgiving weekend off to pushing things back. Even by the day, I'm sorry to interrupt, but it's... No, you're right. We have two agencies, particularly the CDC, but also the FDA. They exist for exactly this type of situation. And then they were like, well, you know what? It's quittentime today. We'll see you on Monday. It's insane making, to be quite honest, but... It's insane. And the original Pfizer study was going to have a statistical look at 30 events, and then they moved it to 60 events in an amendment that actually delayed it until after the election. And these two choices, I detail in that essay you put up, actually significantly delayed vaccine rollout. It could have come out several weeks before. And I think you're right that when it's an emergency, you don't take any days off and you work around the clock. And if we need to reschedule people's shifts, so be it. But now we're in a different situation. I mean, I think we all agree there was a COVID-19 emergency. But does anyone think there's an emergency for healthy 12 to 15 year olds in 2023, February? I think I'd be hard pressed to find anyone who can genuinely look you in the eye and tell you there's an emergency. So I think the EUA authority, that emergency use authorization, should not be allowed for bivalent boosters in a 12-year-old because they're not facing any emergency. We can go back to the traditional pathways of drug development. And so I guess the debate about vaccines has been so polarized. They're either, as you point out, they're going to murder you in your sleep and cause you to have every problem. Spoons will be sticking to your head and stuff. Yeah. Or they're a panacea and you should get as many as experts recommend. And if they recommend them every two months, you should get them every two months, even if you're six months old. So these are the two extremes of the debate. But the truth about medicine is that all medical interventions work well for some people. And some people, you can do too much of a good thing and get into trouble. What do you think went into the, I guess the negotiation is the right phrase for it. But what went into the negotiation between the government and the pharmaceutical companies in terms of saying, okay, we're going to immunize you from a bunch of legal liability, and I say this as a libertarian. I understand where that's coming from and it makes sense. That's one thing. And then to say, we're not going to force you to do continual studies on what's working or to what extent, to what population and things like that. Were the government negotiators, are they just completely captured by the pharmaceutical companies? Or again, and I guess maybe this is the wrong question asked because I don't know that we can answer it. Or are they captured by the regulators or are they just being mendacious? And they're actually servants of the pharmaceutical companies. And they're pretending that they don't know what they should be doing. I think many people have talked about this problem in FDA. I mean, we did an analysis in the BMJ where we looked at where do the reviewers at the FDA go when they leave the FDA? And the answer is more than half go to the pharmaceutical industry. And we saw it with Stephen Hahn. He's at a VC firm that has investments in Moderna. Scott Gottlieb, he works on the board of Pfizer. And I suspect you'll see that this cast of characters will soon transition to these same firms whose products they expedited. I think many people view the client as the pharmaceutical company, not the American people, and they view their job to streamline these things. You talked about indemnification. I think indemnification made sense at a time where you were getting frivolous MMR lawsuits for measles, mumps, and rubella all the time. But does indemnification still make sense when you're getting preschools, mandating vaccine boosters in young children so kids can go to a summer camp or a daycare? I personally think I'm not comfortable with letting some mid-level bureaucrat in an upstate New York summer camp decide what vaccines should be mandated. I think they should be legally liable for any consequences of that mandate. Could you also, you touched on this earlier, and it's a really important point that when the vaccine does not actually help a third party, there's no grounds for a mandate from a public health perspective. Could you just explain that a little bit? Because that's another dynamic here that I think has gone missing in a lot of these discussions. And it's absolutely central to what is a legitimate kind of public health model and mandate and what we've been experiencing. Yeah. So I guess I want to say one thing right off the bat, that even if it does affect third parties favorably, you should still weigh the risks and benefits of doing it. But if it doesn't affect third parties favorably, you can't start. You can't pass go. And what I mean is medical products that pills you take, vaccines you take, devices you put in your body, they can only be like an ethical prerequisite to mandate it. They can only be considered for mandate is if they provide a benefit to third parties. And that third party benefit has to be so large it outweighs the loss of individual freedom and autonomy. And this is not a new principle. This has been there for 50, 60 years of medical ethics. And when they did mandate this vaccine, they knew that it could not prevent transmission. So I think they didn't have the ethical prerequisite to mandate it. All the booster mandates I think are ethically troublesome. It doesn't halt transmission. Some people say, well, it transiently reduces transmission 20%. So therefore, there is a benefit to third parties. That doesn't make a lot of sense because when we're around for two years, we're all going to get COVID anyway. So what is the benefit of potentially delaying it by three weeks or something like that? And, you know, for the individual, you can make that decision. You can say this is, I think, or I believe, or I know this is going to reduce my chance of hospitalization and death or whatever. What are the best examples of a mandated vaccine or public health intervention that fits the ethical criteria that you just laid out? Yeah. I mean, I think I would say the measles vaccine fits that criteria. And I'll tell you why. It does because if the amount of children who are measles vaccinated is above a certain threshold, measles will literally go away. We won't have an outbreak of measles at all. But it takes that certain threshold to be hit. And so you can argue that by getting it to that threshold with compulsion, with mandates, we actually benefit a lot of third parties because no kids are getting measles. And so that's a sterilizing vaccine. Those mandates are often in place in school districts. And I think it fulfills the ethical prerequisite. This doesn't because you can mandate it all you want and people are still going to get COVID-19. Now, some people argue that actually we should have a new version of mandates that if I think it's in your best interest, I should be able to mandate it on you. The problem I have with that is it's a slippery slope so I can come to your house and tell you what you should eat and tell you to take your blood pressure medicines and actually supervise you swallowing them. And that's something that no one has ever accepted in medicine. And it's something that I think nobody wants. And so we don't do things. I mean, we let people make bad choices. You can drink too much. You can smoke if you want. You can eat poorly. We let people make those bad choices. That's what it means to be in a free society. But we only mandate it if there's a compelling benefit to third parties. The last thing I just want to say on this issue is I think even if it stopped transmission, I wrote editorial saying that in America, in the political climate we're in, the juice wasn't worth the squeeze. I mean, the political consequences of forcing a very novel product on a huge or on a chunk of American people would have long-term deleterious implications. And the last thing I want to say is I don't think the mandate actually increased uptake that much. There's a trend in uptake pre-mandate. They mandated it. And then they take credit for anything post uptake. But it was going to go up anyway. I estimate probably 2% to 3% of people got it just by virtue of the mandate. And a lot of people got it from the workforce. And that's a hard one. Although it is also true that, I mean, in a historical context, the uptake of the COVID vaccine is just off the charts. It took polio vaccines, MMR, et cetera, decades to get to where the COVID vaccine basically got in less than a year. We're the most pro-vax society in any time in human history. Yeah, you're right. And I think that's something people miss because we talk so much how anti-vax we are, but no one has ever uptake a vaccine as quick as this. If I just may, I mean, to go back to Trump a little bit, part of the confusion, people like Fauci, who's taking a massive amount of abuse, and I think legitimately so, Walensky, whatnot. But Trump, it's very peculiar the way that he was, hey, I'm doing Operation Warp Speed, but I don't really believe COVID is that serious. And I don't know about these vaccines. And now, because Ron DeSantis is anti-vaxing, Donald Trump seems to be pro-vaxing. From the very top, there was this kind of ambivalence about what do we do that I think, as you were pointing out, a lot of people, if Trump is doing it, then I'm against it. And vice versa. I mean, I completely agree with you that in those months, when you watch Trump in the press conferences, you may have felt more uncertain and more nervous because he discussed it so flippantly. COVID's no big deal. Just maybe some, maybe bleach will help. I don't know, maybe bleach will help. Maybe light will help. I mean, he's speculating in front of national audience. And so of course, that's going to be unnerving when people are seeing casualties and hospitals overwhelmed. He doesn't give you the feeling of somebody who's following all the details. And you do worry that he had secondary motives, which is obviously he was facing a reelection. I think the combination of the most divisive president in human history, an election year, and I think that's a recipe for a disaster. But the reason I particularly put maybe more blame on Fauci is, presumably, he defines himself. He's the adult in the room. And yet he didn't want to have debates. I mean, look at how they demonized Jay and Martin. He quenched opposition. He put out his own statements that DeSantis reopened schools in the spring of 2020. That was the right decision. But he opposed those. And so, I mean, I expect more from people who are the adults in the room. Yeah. And, you know, he's retired. A lot of these people have moved off the stage of public opinion. But Francis Collins, obviously, at the NIH is also a big, you know, a big player in that of trying to squelch debate. Could you explain briefly why even, you know, kind of like, you know, people were liking this to a war event. And, you know, you don't have long debates during wartime, et cetera. But one of your arguments is that exactly at these moments when we are most, you know, you know, struggling with what to do next and the future is uncertain, our state of knowledge is incomplete or unclear at best, you've argued that that's exactly a time when we need to be opening up debate. Could you talk a little bit about that? Yeah. I mean, I think, I mean, for me, it's an obvious point that when you're facing a situation you've never faced before and making decisions that are larger than have ever been made in human history and unprecedented, that that's an opportunity where smart people will have the most disagreement, not the least disagreement, it's the least settled. And I think what you need is, and I suspect maybe this applies to war too. I mean, if I had a bunch of generals around a table, I want somebody there to argue why we're not doing the right thing. So I can hear the counterarguments and think about it. And even if I do what I'm going to do anyway, I do it knowing some things that I might have been blind to. I think Scalia famously used to have a clerk whose only job was they disagreed with him, but they provided a balance. In science, it's so desperately necessary. I think that, to me, the failure of scientific debate has been the greatest failure around the pandemic. Podcasts, this video that you're all doing, we all did a better job than universities. I mean, Stanford, Harvard, my own institution, I can't think of a single debate we've had on visitor policies, masking in the hospital, school closure, masking in communities, vaccine uptake in policies. We've had zero debates. I'm in the Department of Epidemiology. Who should be debating this? It's not the universities. And why are universities not debating that? I think that's part of a broader trend where ideas that people disagree with are viewed as violence and not something to contend with and outwit and persuade. And I think that's a huge problem. So you had Fauci and Collins. They had a point of view, a policy they wanted to advance. Debate would threaten to reveal their errors and they chose to quelch debate. I want to point out one more thing. They're in a unique role. They're both somebody who's appended on TV telling you what we should do with schools and they're the head of the agency that gives scientists their funding. Our funding is dependent on their institution. And so any scientist who may feel like they disagree has to weigh the professional repercussions that they at least believe could happen in their mind. And I think in the future, no one should hold both those jobs. If you want to be appended, be appended, but don't control the NIAID budget. It's an unnerving situation to be in because I had that same sense as all this unfolded during the pandemic. And I'm just a guy trying to figure out what to do for myself, for my family, communicating to other people. And you see this playing out. You see that debate being squelched. You see the messaging that is inconsistent. Anyone who's paying attention, you don't have to have a medical degree to notice when Fauci is saying one thing about masks and then flip-flopping and saying something else about masks. So I buy your thesis that we should not trust public health anymore. They should lose our trust. But it does seem like a really dangerous place to be because then what do you do in the void there? You are left with the people on Twitter, the people on the podcasts. And I have a sense of who to listen to. My rule of thumb is kind of like, are they consistently getting things right? And trying to the best I can do, look at the numbers for my demographic, trying to age stratify the best I can on my own since the CDC is not doing it. So how do we operate in this world going forward? Gosh, it's unnerving. I think I mean, I share your view. But if you would imagine, if there's people talking about whether or not there's an escape of bird flu or something like that, if that were really to happen in this year, I think it will be totally destroyed. I mean, you'll just see some states doing the exact opposite of other states. There'll be fierce political contention around this issue. There'll be revolt from a huge chunk of the citizenry over any action, even an action that is actually the wise action for a different risk that's totally different. People may revolt over, I think we are so weak and vulnerable. So there's two parts of the question. One is, how can they rebuild the trust? Trust to be lost in a moment takes decades to re-accumulate. The second thing is, what can an individual do? The second part first, what can an individual do? I mean, I used to also trust the CDC and my trust is shattered. And so what that means is, every time I make a personal medical decision, I have to do a lot more homework. And so I have less and less trust in experts. And I don't like to live that way. I mean, I'd like to have some trust in institutions and experts makes my life harder to go decide if the Bible and booster is right for me and figure out who I can follow and not follow. And I'm somebody who's trained in evidence-based medicine. I'm trained in this sort of stuff, but it's still work. So I lament that. And I think we all are going to have to think of ways that we can work on that. For the building trust back, I think we can talk about some structural fixes, but it's going to take decades. I mean, I think that the harms were done. It's going to take decades. Most of my fixes are, the CDC, look at their roles. Their job is to keep track of the death statistics and also to tell you what you ought to do. We need separate groups. I mean, the people keeping track of the statistics, just keep track of statistics and report statistics on a website that any American can download. They made mistakes in their statistics. They were incorrect about the number of kids who are dead and they had to provide a revision. And of course, their errors always go in the direction of their policy. And so an observer might say, this is not a random error. This looks like bias. Like you're lying to me to get me to do what you want me to do. And the only way to do that is to build a firewall. So the people who try to advise you are different than those keeping the statistics. I think there needs to be a third group, which is the group that sets out to evaluate the policies. And they should be separate from the group that institutes the policies. The CDC says school should wear masks. And by the way, our new study that we published in our own journal says that that was a good idea. I mean, what am I to think? I mean, you said to do it, you did the study and you put it in your own journal and it has tons of flaws. We need separate checks and balances in public health, just like we do have in government. But it's also, I mean, I think what you're saying is something that a lot of people miss too, is that it is going to take decades, but it's structural and systemic. If it wasn't Fauci, if it wasn't Francis Collins, it's likely we would have still had similar mistakes made because when you have centralized control and centralized power and centralized knowledge, the possibility of bias and of just bad decision making being really negative, the consequences of that are much more likely. I totally agree. I mean, as much as I do blame them and I do blame them at a personal level, and I do think some of them should be fired, and I've written that. But I think you're right, that it is a structural problem and you could have replaced them with other actors who would have made similar, if not worse, or different. We've replaced, yeah, I mean, we've replaced one president with another and error continues. So it's, you know, meet the old boss or meet the new boss the same as the old boss. I mean, part of my impression was that one of the saving graces here in the United States was the fact that we do have this federalist system where different states could try different approaches. So we had Ron DeSantis here in Florida trying something else, radically different than what California where I was living at the time was doing, and was in contradiction to the CDC guidance. And with the vaccine question, I don't think DeSantis is necessarily anti-vaccine, but the Florida is certainly taking a different approach in terms of what its state level agency is recommending for different ages in terms of the vaccine. And so I just wonder if that, given the current state of the CDC and the FDA, if that is part of the answer is continuing to devolve power down from them, just make them less powerful, give them less authority to impose mandates, issuing guidance or keeping track of statistics is one thing, but imposing any sort of either mandates or gatekeeping is where we really seem to run into problems, especially once you get up to the federal level where you're talking about 330 million people. That's a superb point. And I just, I mean, I totally agree with you that if you want to strip them of powers, I will support that. And I was the opposite view maybe five years ago, but I just want to point out one way that kind of backfired was the school reopening because Biden came into office and he said he wanted to reopen schools within a hundred days and not even high schools. And he had difficulty because a lot of local typically left of center jurisdictions decided that they want to keep them closed for the rest of the year, despite the fact teachers were getting the vaccines first. And so decentralized authority can lead to innovation because I think Florida did more things right than California, but it can also lead to chaos because I think San Francisco schools is an unmitigated disaster. But your point is well taken that I think, I mean, the core question This is why humanity is damned, right? You know, we either have too much power or too little power. Nobody, nobody follows what I want. Well, you know, it's a it's a trade off because you kind of and you don't always that that's the whole point of that kind of more fractured system is when you don't have kind of the best and brightest or the most honest at the top, the best you can hope for is that somebody at the bottom is going to figure it out and you can see, you know, in real time that it's, it's, you know, Florida, it's sort of working out San Francisco, not so much. And I think this is a good time for me to point out that Zach is smarter than you because he left California and moved to Florida partly for many reasons. But one of them was certainly play the factor. Yeah, he is smarter than me. Some of us don't have the luxury. But I just want to say about this topic. I mean, I think we need to separate the role of scientists from the role of politics. You know, scientists can articulate what the trade offs are and maybe do a good job of that. But we saw scientists routinely overstep their role and also make policy choices, which inherently require values and input of the public. Only the public can decide, I think, if lockdowns are worth it or hospital or visitor policies are worth it. It's not a scientific question. But we saw over and over the public with steam rolled. And I think that's a great problem. And, you know, to take it back to specifically people who are identify themselves and our public health authorities, you know, one day they would be saying that, you know, if 10 people got together to complain about vaccine mandates, that's a super spreader event. They should be arrested the next day 10,000 people might get together to protest George Floyd's killing, you know, which I think is eminently worth, you know, demonstrating against. But then they would be like, no, no, that's not a super spreader event because it's all about cost and benefits or whatever. That is, you know, public health as a concept has really taken it on the chin rightly because of the way that public health authorities and spokespeople talked during COVID. Can we push a little bit more on the FDA issue? Do you think ideally, and this is an old libertarian, you know, kind of rocking horse, you know, should the FDA have a monopoly on what kinds of drugs or medical devices or practices are authorized and made legal in the United States? Or should they be at best, you know, kind of, you know, recommenders? Or should they be one, you know, for medical devices in Europe, there are a number of different agencies that can recommend that a device is safe and can be brought to market. What is your sense of how far should we devolve power away from a one-size-fits-all decision-making process at, you know, at the federal level? I think there's two legitimate things you could argue here. One, there can be a group of people who have more libertarian bent who argue that the FDA's role should be maybe to put a stamp on something to rate it on a scale. This is the good housekeeping model or the underwriters laboratory model of authorizing something. And largely let the public doctors in concert with the people they trust make sort of healthcare choices. And to some, in some ways we've moved towards that model because we have a right to try legislation and there's some advances in that space. So that's one worldview. I think there's another worldview where people who believe more in the power of regulation should say something like, well, like the FDA is basically trying to prevent sick desperate people from making choices that could harm them. And so they need to really make sure that these products actually work and that the benefits outweigh the risks. And if and only if they meet that criteria, should they be allowed to be sold on the U.S. market? That's the regular way. And then let's just talk about where we are. We're in a middle ground that neither party is happy because the regulator side is not happy because the product's coming to the market. There's no assurance you'll live longer or live better. Many products actually will be found later to have serious safety concerns or withdrawn from the market because they didn't enforce an efficacy requirement. The booster in a 12 year old might turn out to be a huge miscalculation and they were wrong. So they advised you to do something with the imprimatur of the agency that turned out not to be correct. In the meantime, they do stifle innovation because they're setting all these hurdles that keep small biotech firms off the market. So neither do they protect the public nor do they allow for the power of the market. They're the worst of both worlds. They're sort of a world of crony capitalism and then they later go work for the company. So I think your argument is well taken. No matter where you are on this philosophical spectrum, I think the place they've decided to pitch their tent is indefensible. Where are you though? Are you to lean more towards the market or more towards the regulatory model? I always say that people don't believe me, but I always say that I'm a progressive on these issues. I lean more to the regulatory issue and I've written two books on how it could be done. Over the years, I guess, disappointment after disappointment makes you worry that they won't be able to get their act together even in a perfect world. It is. I recommend that people go look at your books because a huge part of your kind of intellectual work, your project, is how does medical practice get better because bad interventions hang around basically as long or longer than good ones. So it's like, okay, how do we change this? That's a really difficult question and it's one that I think a lot of the times we just take for granted because we're living longer for the most part and we seem to be getting it right, but there's a lot of mistakes. An issue that I saw some of the FDA regulators or advisors struggling with as this was playing out, I watched some of the meetings about whether or not to approve the vaccines for the youngest age group, six and under or six to 12, I think might have been the cohort. And there were people that wanted to vote yes, but they were expressing, I want to vote yes, but I don't want this to mean that the schools are all going to mandate the vaccine. And then of course, that's exactly what happened. There was this pipeline of the FDA gives the emergency use authorization, the CDC then recommends it, and then the local school districts or even the city of San Francisco say then you have to give your kid the vaccine to get into school or if you're in the city of San Francisco, you have to show proof that they're vaccinated to go to a public venue. How is there a way to break that chain of events? Because to me that seems like the biggest problem that I saw occurring over and over again of going from we're going to give people access to this thing to require them to get it. Yeah, I mean, I think that was a catastrophic problem. Thankfully, a lot of the districts that did mandated have backed away from it when they saw what it's going to do to schools, which is it's going to lead to the expulsion of tens of thousands of children, predominantly black and Hispanic or disproportionately black and Hispanic and poor. And so they finally came to their senses on the 11th hour. But in my mind, that's an example of something that the evidence was so weak, I felt. And then the risk in that age group was so low, I felt like you couldn't in good conscience actually say there's an EUA authority to be used. I mean, you need more data to really even know. And as a provider, I think you would have, how will you really counsel a six year old who just had COVID a month ago, who can look that family in the eye and say, I know what's right for you. And nobody knows the answer. So they could have abdicate their duty because, you know, no one else can make them generate evidence. But your point is well taken that there can be caveats expressed. But the moment they cast that authorization, it's going to lead to mandates instantly. And I think the only checks and balances I can see in the system would be one, I think we do have to remove some of the indemnification. Because if school districts were able to be sued, if a 16 year old athlete who had COVID got the booster that they were mandated to and then had myocarditis, I think they would have a lot of pause and they would be much less likely to mandate products under the auspices of EUA. I think you might be able to say that nothing under the auspices of EUA should be mandated by anybody. Maybe that needs to be able to be a rule. But I do think we get into a problem when I mean, I know people write to me, their kids are going to a summer camp in upstate New York and they have mandates beyond what even the CDC recommends. So who is making these decisions? That's a dangerous place. You have written multiple times over the past couple of years about, you know, what the experience with the pandemic and with lockdowns and with EUAs and whatnot. You know, how that is, it is setting the stage or you look forward to a future where a lot of democratic norms and a lot of personal liberty, economic liberty, you name it, ends. How are you feeling about the kind of health of the body politic? Has the, you know, has the COVID experience kind of weakened us so that we're going to be more sheepish in the future or has it kind of kicked in a set of kind of cultural antibodies? You were talking earlier with us about how, you know, now people are as likely as not to say, screwed you to whatever the government says. Where are you on this, this kind of concern right now? Yeah, I'm, I'm very worried about what's outlined in that piece. And, you know, just think about it. We still take our shoes off in the airports. I mean, I don't know if that has done anything or has any net expected value versus the thousands of hours that it has caused an enormous amount of personal embarrassment. But beyond that, beyond that time, it's accomplished much more than that. I mean, that is a good thing for the country to be doing. But yeah. But we still do it. So what's the argument in that piece? The argument is that we have a situation where who decides that their emergency powers end. It's the governor. It's the president. The president has announced that this emergency will end in, in May. If you have a situation where an elected official decides when they get to have massive powers, and they decide what the emergency is, and the media can shape our impression of the emergency, perhaps with misleading statistics or misleading anecdotes, how might that be misused? I think the potential for misuse is tremendous. That, that piece outlines a hypothetical scenario. I hope it never happens that, you know, the governor of a small state around an election says, hey, the hospitals are filling up with cases and we have to declare, you know, we're going to see, we're going to stop motor vehicles because, you know, we can't just have extra car accidents in the hospital. We don't have the space or other restrictions they could place, restrictions that could happen around voting or election cycles. I think we have underestimated the threat of these powers to be used by an unscrupulous actor. And I think no matter where anyone sits on the political spectrum, you can all imagine somebody you don't want to have the power to declare unlimited emergency powers. And I think we should be more cognizant of that. Yeah, I mean, but do you think, you know, coming out of this, and I guess, you know, it's legitimate to say we're coming out of it, you know, at various points, Joe Biden has declared that COVID is over various states have, etc. But do you feel, do you feel like we're a little bit stronger, like we're a little bit more cognizant of these threats? Or do you feel like, no, this was actually kind of setting us up to be even more complacent, going future or more docile, if something, you know, and maybe it's maybe it's not a pandemic, maybe it's an, you know, an economic catastrophe or something like that. But, you know, how do you feel? Do you think we're, we're in a better position to save that offer? We're, you know, we're more likely to flow with whatever the government says. I hope we're in a better position to stave it off. But I guess my bias is that I'm surrounded in pockets of people who still believe a lot of the things that are wrong. I mean, I still go to a workplace where maybe 15% of people are masking all the time. I went to the gym, and people are wearing cloth masks while working out. I saw somebody wearing an N95 and a sauna. I see people who are, you know, chiding others for not getting used to it. Part of this is about like Rucker Hauer at the end of Blade Runner, you know, it's like the thing you see, nobody, no human should see. Does this square, like when you, you said that, you know, at least in terms of drug regulation, you lean a little bit more towards the progressive end of things. Or do you have a personal politics and, you know, how does that factor into your kind of framework and approach to these types of topics? Well, I'm a lifelong Democrat. I'm a Bernie Sanders supporter. And so to see my side get these issues steadily incorrect has been catastrophic. I mean, we got, we're the side that's supposed to say we care about poor, disadvantaged minority children. We did the single greatest discriminatory action in quarter century, which was close their schools for 18 months. And guess what? They all got COVID anyway. And guess, and most of them got COVID before they got vaccines because uptake is so poor in that age group, because the data is so weak. And so what have we done? We're the group that says we're, you know, we believe in scientific principles. The same people who say that are critical of the Cochrane report on masking because it didn't yield the conclusion they want. And so I guess COVID-19 has been a profound disappointment that my side has any moral or scientific superiority over any other side. And, and now I'm, I'm, I'm without a party. To vanize an earlier point, we have a magazine that you might want to subscribe to. We have a newsletter. Yeah. To the earlier point about states of emergency, just persisting endlessly. This is from February 28, 2023. So yesterday, California just ended, that's, Governor, I should, I should be more specific. Gavin Newsom ended the state of emergency because that's the situation we're in is that one person has the ability to do that with no democratic check on their powers. And I agree with, with you that this is a looming threat coming out of this that needs to be taken seriously. And I hope there's more kind of focus and, and, you know, effort, especially at the state and local level, since that's where these things seem to drag on and on again. Like, why should a state of emergency be able to just endlessly persist until the person who declared it says it's over? It seems like there should be, you know, a regular check in maybe from the legislature to say, okay, are we really still all on the same page here? I mean, I know that the California legislature has the power to do that, but it's almost got to be like baked into the state of emergency itself. Or else I'm afraid that we really are going to fall into that sort of trap whenever the next catastrophe hits. Absolutely right. No, I couldn't agree more with you. Yeah, and that's a place where the kind of structural reform where, you know, every state of emergency, no matter what has a sunset clause, you know, whether it's, you know, two weeks or 30 days or 90 days or that it has to be renewed. God, you have to do that when you lock people up, you know, on psychiatric holds in California, you know, you got to drag them in front of a court at least to keep them after a certain point. And the principle there is when you deprive people of liberty, there must be some check on your ability to deprive them of liberty. And what we did in the pandemic was, in many ways, we deprive people of liberty. And some core human liberties, the liberty to go and visit your child when they get chemotherapy and have both parents be there. We deprive them of that liberty. We deprive them of liberty to go to shops and restaurants and go out. And there has to be checks on those sorts of deprivations here. Okay, I guess we should wrap up. But Vinay, what, you know, obviously you're doing this in your work, but, you know, give a quick spiel on how do we remember the past, not so that we endlessly replicate it, but so that we learn from it and actually, you know, take the best parts of the path and add it to new knowledge so that moving forward, we're not stuck in a loop where we're just endlessly replicating the worst aspects of recent trauma. I wish I had the answer to that. You know, he who forgets history is condemned to repeat it, the Santayana quote. You know, I'm trying to do my small part, which is we do research, and we want to do research on these issues that better clarify which of these things helped, how much they helped, and what we lost in the process, what worked, what didn't, what were the errors made, who made them, and when, and we're going to work on putting that in the peer review literature. It's a small part, but that's a literature that's enduring, hopefully will be cited, and hopefully will persuade people. And I think we have persuaded a lot of people because I think more and more people start to see things the way that the three of us see things and many others who follow you all. But there's still people out there who live on a bubble. They may think that school closure was wise, or that if anything, we didn't mask hard enough, or the real source of misinformation is Joe Rogan rather than the CDC director. I think that the CDC director and Fauci did more for public trust and help than Joe Rogan could do in a thousand lifetimes. I mean, it's not even close. And so that's a battle of the ideas that still has to be won. And until you win that battle, I think it's going to be difficult for people to acknowledge the mistakes they made. But then the last thing I'll leave you with is, I mean, I remember when we went into Iraq and Afghanistan, and I remember there were just a few voices who said that that might be misguided. And I also remember just, within the decade, it was such a hot issue that if you had cast a vote for that war, you couldn't be a presidential nominee. And you ended up losing. That's Hillary lost to Barack Obama. And so I do think most of our COVID response will age in that way, that the pendulum will swing greatly. And there are a lot of people who stayed on the sidelines who do agree. And I think they're going to come out of the woodwork. And I think we will see a big change. Well, thank you. That's a kind of haunting, but also powerful note to end on. Vinay Prasad, thanks for talking to Zach Weismiller and myself of reason. Thanks for having me.