 And I have about until 9.45 Eastern, so like an hour and 45 minutes. No radical. Fundamental principles of freedom, rational self-interest, and individual rights. This is the Iran Book Show. All right, everybody, welcome to the Iran Book Show. And this Thursday evening, we've got a returning guest, one of the most frequent guests on the Iran Book Show. Amosha Belja is here to talk COVID. We're going to talk vaccines. We'll talk other viruses. There are other things going on in the world other than COVID. We'll talk about RSV, malaria, and what else he's looking at, maybe even, I don't know what he can tell us about it, but biological warfare. I'm interested in how serious of a threat he thinks that is. For those of you who do not know, Amosha is a senior scholar at the John Hopkins Center for Health Security, an adjunct assistant professor at the John Hopkins Bloomberg School of Public Health and an affiliate at the John Hopkins Center for Global Health. His work is focused on emerging infectious diseases, pandemic preparedness, and biosecurity. Amosha both treats patients, goes into hospital and sees live human beings, and is also a researcher and somebody who comments, commentator and advisor on strategic issues related to infectious disease, and was everywhere, literally everywhere, both hospital and TV and everywhere in between during the COVID pandemic. So it's always, it's always an honor that you put out some time and come on the show. So thanks for being here, Amosha. Yeah, sure. Thank you for having me. It's one of my favorite venues. Excellent. So as you guys know, you can ask anything, ask questions, interview shows, ask questions that are primarily targeted. Amosha, I might chime in if I have something relevant to say. Feel free to ask pretty much anything, but be respectful. We will try to answer all the questions. I think we always do one way or another. So COVID seems to be over in a sense of, certainly in a sense of pandemic, in a sense of something that is top of mind for most people. It's probably been over for about a year in that sense, which has given us, given everybody a lot of time to really think about it and reflect back on everything that's happened. So can we, can you go through, let's say top level kind of lesson learned from what happened in 2020 and 2021? And what do you think was done right? What do you think was done wrong? Where the key, I mean, this is a big assignment I'm giving you. So we can take it one step at a time, but also kind of the key kind of decisions that tilted the whole phenomena one way or the other. Right, so let's sort of rewind back to 2019. So December 31st, 2019, China alerts the World Health Organization that they have identified a cluster of respiratory illness in a group of people that had been at a seafood market that was attributed to a novel coronavirus. Now that's what the world knew around December 31st and probably most people weren't paying attention to that on New Year's Eve. I do because I read those infectious disease updates, but that's what we knew. And the Chinese government had said at that point that it wasn't efficiently spreading from person to person. So most people said this is like the first SARS or Middle East respiratory syndrome where, yes, it's going to cause an outbreak. It's going to be disruptive, but it's not going to be a major threat because it doesn't efficiently transmit. But within a couple of days, they started to publish the first case reports, and I read the first case reports. And I noticed that one of the case patients had not been to the market and got sick like December 1st. So that told me that this was spreading outside of the market before December 1st, and that tells me that human-to-human transmission is occurring. So that changes the entire way you have to look at this. When you have an efficiently spreading respiratory virus, it is by definition going to cause a pandemic, I think, according to the way I think about it. So at that point, this is early January, we had to already anticipate that there's going to be a need for testing. There's going to be a need for hospital capacity. We're going to need to start developing vaccines. We're going to need personal protective equipment, at least in the hospital. We didn't know at that point about pre-symptomatic transmission. And we already knew from China that people with advanced age were going to be at higher risk for severe disease. So at that point, we should have been on a very proactive approach, the way Taiwan was, for example, and starting to fortify the country as best as we could, knowing that probably we're going to have 100,000 deaths no matter what happens. But we can stave off all of the economic disruption by really being aggressive. But instead, January, February, half of March, nothing happened in the United States. It was basically coming from the highest levels of the White House, that this is not going to be a problem. That we've got a couple cases that are going to go to zero. We don't want to test so much. And if we do test, we have to use this CDC made in America test. It doesn't work. And we're going to make it really hard to test people because we don't want to have big numbers. All of that really cast the dye. And I was on the show in February telling you that this is what was all happening. So it's that lack of proactivity. And then it's the evasion that happened at the highest levels of government. And I don't think that this was trickling all the way down to the CDC, because I was on conference calls at CDC. We were all talking about what we thought would happen. We had some differences on what the severity level would be and what the best actions were. But we all knew this was coming. But when the CDC finally said that in mid-February, that person got disappeared by the Trump administration, Nancy Messonnier. So it really is that that was just a horrendous amount to ever recover from. You couldn't really recover from that. And then you had governors get panicked because the federal government basically failed. And they use very blunt tools like shutdowns that would treat every activity as if it spread COVID. And then you had crazy policies with nursing homes, the exact opposite of what you'd want to do in places like Pennsylvania, New Jersey and New York, where nursing homes were forced to take contagious patients. And that led to a massive decimation of nursing homes. And it's just, it's those types of cascading failures that occurred time and time again. And I don't think we ever recovered from any of that. And it's baffling to me the closure of schools. All of that is a cascade from not being proactive in evading what they spent. The only good thing that happened is the thing that the Trump administration wants to run from now. That's Operation Warp Speed, which was a brilliant plan that saved probably millions of lives. It's the signature achievement of the Trump administration. And a lot of us doubted that he could pull it off. And to give him, to be just Donald Trump, that was a brilliant move to use the portfolio approach to really push those companies to go faster and faster and faster to get a vaccine. But now that's his most proud, that should be his most proud moment. That's what he should be running for a president on. But that's not something he wants to brag about. He wants to brag about other things, but not the one thing that actually saved lives and was a real example of leadership. Yeah, and it really is amazing to me how little there is out there, people talking about COVID, regarding those first few months and the evasion, complete evasion. And it appears that that evasion primarily was with Trump. I mean, there's this now documentation of the CDC, the Health and Human Services Secretary, even that guy who hates trade, I forget his name, the Trump advisor that hated trade, was bugging Trump, do something. This is going to be bad. You got to do something. And Trump just ignored it. I mean, just for those two and a half months that he ignored the whole phenomena. And then later on, when he would say, oh, it's just going to go away, it's just going to disappear, like the primacy of consciousness that then engages. Just that makes him not qualified to be president of the United States. I mean, just that justified him losing. But nobody talks about that. It's as if that didn't happen, or as if COVID was a surprise that hit us all in mid-March, and we didn't have that data from China in February. But you were on the show in late February, and it was clear what was going on. And it was clear to us, one can only imagine, with the intelligence reports and the kind of access that the White House has, the kind of data that they had, they knew exactly what was going to happen. Peter Navarro is his name. Yes. Thank you, Emiliano. I mean, Peter Navarro is somebody I despise, but on the early part of COVID, he actually was one of the people pushing Trump to actually do something. And even Tucker Carlson went to Mar-a-Lago to tell Trump to take this more seriously. So it wasn't anything hard. But remember, when Davos was going on at that time, Trump was negotiating a trade deal with China. He had different priorities at that point. And then I think he just was disinterested in what this might mean until it started hitting the stock market, and then he started panicking. And then the CDC really failed with the test. I don't know whose decision it was to only use a CDC test. I mean, that sounds seems like a stunning failure. And then the CDC was basically sidelined for the rest of the pandemic, and everything shifted over to other parts of the government and to the states. So a lot of that was done by the states. Do you get a sense? I mean, you interact with the CDC. Have lessons been learned? If they had to do testing over again now, would they rely, in a sense, on the market? Or would they let testing rip to use the phrase? I think that, so this kind of fell into the CDC. They don't usually make commercial test kits like this. And when the FDA inspected them, they thought this is way below par. And I think that's to be expected. But I don't think that was the CDC's decision to use that kit. It basically came when Secretary Azar, the HHS secretary, made a public health emergency declaration, which basically blocked all of the university labs, quests and lab core from making their own kind of what we call laboratory develop tests that don't have to go through the regular FDA process. They can be validated internally and used. And we do them all the time. That pathway got blocked when the public health emergency was declared by Secretary Azar. So any company or anybody that wanted to do that then had to kind of go through this onerous process to get those approved. And it's the exact opposite of what you wanted to do. In South Korea, for example, they were asking anybody that can make a test, just get a test out there, show us it works and we'll use it. And they were testing in the thousands early in March of 20. And we were doing in the hundreds per week. And they were doing thousands per day. It just was a complete setup. It couldn't have been orchestrated any worse. And it was like we were flying blind. We didn't know who was infected. We didn't know who was contagious. We didn't have any way to understand how it was spreading, what activities were spreading it. Because if you can't test people, you can't get any basic epidemiological statistics. And you sort of can't blame some of the governors for freaking out when they see what's happening in New York City, where hospitals are collapsing, where they have trucks to handle the dead bodies. That's going to freak out most governors who don't want to be blamed for that kind of a disaster. And that's how that whole cascade started. It's just incredible to think all this time has passed. But most people have kind of forgotten those first early months where the decisions needed to be made and they weren't. They were made. The wrong decisions are made. And again, do you think the relevant people in the government have learned a lesson? I mean, the kind of the bureaucracy stays, politicians change, but the bureaucrats are still there. Are they better equipment to handle it next time? I think that they know all of those mistakes. But they're very constrained because what's happened now is I call it like the CDC has been effectively captured by the White House. It's run not from Atlanta, but from the West Wing. And it's really now become a political organization. And in 2025, the CDC director has to be Senate confirmed. So that means the president is going to say who can get confirmed, not who is the best person to run an agency that we need in a disaster. So I think that they do know what to do. It's just that they're going to be thought of as another political problem for the White House to manage. And there's going to be Democrat ways to do things and Republican ways to do things when they really shouldn't be. So I think it's only going to get worse. And I think we saw a little bit of this with monkeypox or the Mpox outbreak that occurred on the heels of COVID where a lot of the same mistakes were made with testing, the bureaucracy getting in the way of actual response. That's something I think really needs to change. The last CDC director has put into place a lot of reforms. The new one is going to carry that forward. There's a bill being there's a couple bills being debated in Congress right now that hopefully will get us on a better footing. But I'm just not confident when it comes to politicians. I think they need to be removed from this whole process and unfortunately they've got their hands all over it. So what is the status of these bills? Is it likely for them to get passed? I do think they're going to get passed. They have bipartisan support in both the House and the Senate. And one is called the Pandemic in All Hazards, Preparedness, Reauthorization Act. That's a big one that funds a lot of the preparedness activities of the CDC. That's winding its way. One of the unfortunate things is Bernie Sanders is now the chairman of the Senate Health Committee and he keeps putting in things like wanting to break patents and do things like that for the people making countermeasures. But I think we've gotten sort of passed that. So hopefully that will happen. And then there's another bill, one that I was sort of involved in. A lot of my research kind of found its way into it called the Disease X Countermeasure Bill, which will allow the government to be much more proactive when they think about countermeasure development, vaccines, diagnostics, antivirals, and not be flat-footed, not wait for Congress to authorize them to do something so they can be much more forward-scanning about these threats. So those things have the best, they look like they have good chances now, especially since we have got both Republicans and Democrats on board. So in the first few months, some governors panicked, particularly early on in New York, but then the rest of the country and they really locked people down and they shut down businesses and they kept people home. But even a year later, some states were still experiencing substantial lockdowns and by that point there was no panic. We really understood I think who was vulnerable to the virus, much more about how it spread and schools were still shut down. So you can kind of understand maybe in the first few days weeks, people are panicking, they don't understand, they closed the school because they're afraid, but then as you pointed out at the time, kids are not vulnerable to COVID. They don't get very sick and yet schools were shut down. What explains and again, is anybody we thought and do you see any regret out there for the kind of lockdowns that California did and other states did that just lasted over a year? I do think that there's been regret, but not kind of universally. Clearly, people have recognized the school closure issue was wrong, that it shouldn't have happened, other than for maybe a brief period of time, if there was some, and even I, my colleagues and I, at least some of my colleagues and I were arguing against it even back in January and February, based on data that we had seen before from other diseases and what the negative consequences would be, but I don't think you're seeing like apologies from Governor Newsom for what happened in California or from Governor Murphy in New Jersey or Cuomo, that you're not necessarily seeing those types of apologies about that. I think that there's definitely regret on the schools and I think one of the explanations for the schools is most likely the teachers unions have such sway. They vote, they're very powerful because in Europe, schools were the last to close, first to open in the United States, casinos first, last to close, first to open, completely in strip bars too, I would add, but it's those were open before schools were open and I really think in the private schools were all open and fine and doing well. It was really something that was very dependent upon the power of a teacher's union in a given area, even so in the city of Pittsburgh where I live, the school board said, well the teachers can be remote, let's have the students in class, the teacher still said no when they were remote. So it really was, and you know I had friends in the health department here saying what the teachers union is doing is basically criminal, how badly they're trying to extort demands from the government to open schools. So this is something that should never happen again. I think we're going to be paying for this for a long, long time in terms of the education, the learning debt that's happened, the deficit in terms of math and science, all the psychosocial problems that happened with kids being out of school, all of that is going to really be one of the long tales of this pandemic. And one of the countries that was brought up a lot in the first year or so of the pandemic was Sweden, because they didn't lock down or at least they didn't, they didn't have a government policy of lockdowns, they asked people to stay home, a lot of people did stay home, but a lot of people didn't and there were people on the streets even when the rest of Europe and the United States was locked down. What were the long-term or the long-term consequences for Sweden of that policy? How did it pan out for them? I think they didn't do as well as you would, they didn't do the kind of middle of the road, they're not the worst, they're not the best, and as you said many people still did the exact thing that other countries were doing, but they did it voluntarily which I think, which on its face is better if you're using voluntary means to do it. They didn't quite protect their elderly as much as you wanted them to do, as they could have probably, it's not, I think it's kind of used as this kind of like this trial, the people used it kind of for political purpose to say well what about Sweden, but I think it's not really, it's a muddled case and I don't know that that's the paradigm, I always go straight to Taiwan, that's the best case scenario, Taiwan and South Korea, those countries were exemplary, didn't have to resort to any of that, but people often will, people that praise Sweden never praise Taiwan which I think is interesting. So tell us what Taiwan did, Taiwan did put restrictions on flights, right, on travel? They had some restrictions on travel, but they avoided most of those kind of stay-at-home orders, closures of schools, had a very low death rate, did really well, but the thing that characterized Taiwan was proactivity and they jumped into action on December 31st as soon as they saw that WHO and that WHO alert. So they're at a different level when it comes to infectious disease preparedness and I think I've told you this before that since they're not part of the WHO because China forbids them to be, I was part of a team that went to evaluate their infectious disease preparedness because the WHO is not allowed to be in Taiwan and it was off the charts in terms of how seriously they take this threat and how proactive, how ready they are even to the point that as I've said before that they've had a vice president with a PhD in epidemiology. I wish we had a vice president with a PhD in epidemiology but it's something completely, it's a completely different thing and the same is true in South Korea because South Korea had an experience with the Middle East respiratory syndrome where things went bad, hundreds of cases, a misdiagnosis and people were questioning the ability of the government to respond so they didn't want that to happen again. So they jumped into action very, very quickly once they had cases and I think really avoided and even Japan, all of them, all those countries just did so much better with without having to use the very restrictive measures that many Western countries did and kind of follow the China model in the United States and I think it does even though the US, the US, we use the word lockdown, I use the word shutdown because it wasn't as strict, it wasn't like in places in York where there's only certain times when you could walk your dog, they weren't showing up at your house to count how many people in your house and drag you out like they did in Canada or send drones to your building like they did in Australia or just randomly FaceTime you. So we weren't quite there thank God but it's and it was all state by state and I think it's just a reflection of panic and inability to actually think in principles about what was necessary, they just rather do the most possible and not be blamed for anything and then deal with the consequences later of all of their, the negative consequences of their actions. So at the time you advocated for policy of test, trace and isolate and then kind of cocoon the elderly. Do you still think, I mean looking back, do you still think that policy was the right one? Would it have worked if it was started early enough given everything that transpired? I think it would have worked better than what we did do. I think that as I said before that I think we probably would have had at least 100,000 deaths no matter what maybe more but what we could have done is meet cases as they come until we got overwhelmed and understood the epidemiology who's at risk and we could have done things like deploy the National Guard to nursing homes to fortify them. One of the questions that people always bring up is how do you cocoon the elderly because nursing home workers interact with the community, they may go into the nursing home after getting infected somewhere else or people live in multi-generational households. So it wouldn't have been perfect but I think there's ways to have done it and I think if you were doing it ahead of time, if you had nursing homes that had personal protective equipment, if we had the ability to test people very quickly and remove them from situations where they might be contagious to others I think we would have done a lot better. I think that when you're dealing with an as I said an efficiently spreading respiratory virus it's always going to cause this disruptive type of level of event but I think we could have done much much better at being actually addressing where the risk was and fortifying those. We certainly wouldn't have had policies in place like they did in New York, New Jersey, Pennsylvania where nursing home patients nursing homes were forced to take patients that were still contagious by the governor's orders in this place. In England they did the same thing in New Jersey, I mean it was just terrific. And then Cuomo lied about it and he tried to make those, he classified those as hospital deaths so there's a criminal investigation I think over that. So you opposed to the Great Barrington Declaration when it came out, can you tell us what is wrong with it? What maybe it gets right and what do you think it gets wrong? Well I think what it gets right is that you don't have to, you shouldn't treat every activity as if it's the same as every other at spreading a virus, this virus particularly so outdoor versus indoor that type of thing and it gets right the fact that there are differing levels of risk that a healthy 18 year old is not going to fare as bad as a 68 year old for example and that you can treat those risks, you can use those risk differentials to help craft policy or to make recommendations. So that's something that I've been saying from the very beginning, I wrote a piece in Medium in March about that before the Great Barrington Declaration about that. But I think by the time the Great Barrington Declaration came about there were questions about what would happen if you let it rip or if that's not what the Great Barrington Declaration said. But if you had unchecked spread, if you just told people go about your life as if this is minor, we were still at a point where hospital capacity was compromised, hospital capacity was horrendous in December of 2020, January 2021, February, I was working there, I've never seen anything like that in my life. And we were at the verge of collapsing, the healthcare system couldn't do anything else, that's all we were doing day in and day out. And I think what we needed at that point, by the time of when people were making these debates, it was almost too late that there was so much COVID in the community, so many people getting hospitalized that we really feared for the ability of the healthcare system to survive. And I think that's the problem I had with the Great Barrington Declaration. And I'm not one that critiqued it or criticized it the way that others did. And I don't think it should have been dismissed out of hand. And I don't think that people should, I think it should have been part of an open debate of how to think about what the best policy would be. But at that point, I think that we were in a situation where hospitals might collapse and we're collapsing, hospitals of Florida are running out of oxygen. That's just not a sustainable approach. And we're all tied together in the same health system. And if those hospitals go down, there's no healthcare for any, there's no ability to purchase healthcare or to access healthcare for anybody. And I think that's the issue. I think doing that earlier might have made more sense once, but if we were doing the correct actions, but doing it at that stage, I think we really wouldn't have been as beneficial. And maybe I don't have all the details correct of the Great Barrington. So I'm with that caveat of what details the questioner might have had about that. But I don't think it was handled well. I think the way, in terms of the debate over it, I think it was care caturized. But I think there probably were flaws. And there are aspects of it that I think I would have endorsed or I did endorse or I do endorse and others that I don't. And how do we get to a point in the United States where hospitals don't have enough oxygen and where hospitals are on the verge of collapse? Well, I think it's what you always say about the banking industry, the finance industry. It's one of the most regulated industries in the world. And in a way, the hospitals, I think, are probably even more regulated than the finance industry. It's all government related. So a hospital has 150 beds. They want to make 151. They can't just make that 151 bed. They have to apply to the state. The state has to license them. And in some states, they have to ask their competitors, is it okay if we have a need in this community to have an extra hospital bed? So you have all of that playing a role in hospitals not being able to kind of just in time expand. They have to get permission to do all of those types of things. And you also have the fact that hospitals are increasingly moving things to outpatient. We're getting better at doing things at outpatient. So they're closing beds. Because an empty bed is like in a hotel. You don't want it empty. You get rid of it. So that's been happening. And then when you need to expand, you have to get permission from the state, from the competitors. And that doesn't always happen. And then, if you want to build a new hospital, how many people do you have to bribe for the zoning to get the township supervisors, the county commissioners? All those people have to sign off environmental impact statements and people who want to do traffic studies and flood runoffs. All that stuff has to be done. In China, they build a hospital in a week. Here, it's years and years. It's like what you said about building the new subway stop, how long that takes. You just can't do that here. The ability for US to flex capacity and health care is very, very limited. And it's limited by design. But the way the government has set this up. And I mean, we bring it up, but I don't know how to fix it because it's such an entrenched problem. And it's not just with COVID. It happens with flu. It happens with RSV. It happened during Superstorm Sandy in New York City that they can't handle high capacity. And they can't expand very quickly. And they don't have any built-in capacity. I mean, you'd expect in a full-profit system, in a free market, that hospitals would prepare for pandemics and things like that. And they'd have standby facilities that could easily be expanded and could easily be used. Right. And I don't think you can... But the thing is that right now, even if they had that, they'd have to have all these inspectors in there. And then there's nursing ratios that have to be stipulated by the state government. All of these types of bureaucracy make it so hard to expand capacity on the fly. Even though it should have started to make... I mean, because we didn't just have one surge of COVID. We had at least four or five waves. And after the first wave, people like me were saying, we can't let that capacity issue happen again. But yes, it happened again in the summer. It happened again in December. As I said, in my OCON talk, it's like going through the Taggart Transcontinental Tunnel and then putting it in reverse and going back through it again, because they don't actually change the policies. They continue to make the same mistakes because they don't want to deal with the underlying issue. Yeah. I mean, I'm looking at my chat and I've got Colleen here who was in the emergency room in New York City during the height of this. She is telling it like it is to Scott who doesn't, as usual, doesn't have a clue what he's talking about. Colleen was a major factor just to give her a plug. She worked at one of the epicenter hospitals in Queens that got decimated. And she did a Big New York Times interview showing how that they did not have enough ventilators. They did not have enough bypass machines. That she can attest to it even more than I can because I was working in Pittsburgh, which was not an epicenter city about how bad it was. And people think that she's a fake person. They think she's an actress, not an ER doctor. Yeah. So, I mean, it's fascinating to me. Somebody needs to write a book summarizing all the errors and mistakes and what actually happened during COVID because it's just stunning to me how much misinformation and how much just evasion still exists out there and how many people present themselves as experts who know nothing about what they're talking about. But this is an issue we're probably going to keep coming back to because there's so much confusion and misinformation out there. And of course, another topic where there's a huge amount of misinformation of the vaccines. As you said, it's the one good thing the Trump administration did was the push for the vaccines. Of course, when they take credit, they take a little too much credit because ultimately, it's BioNTech and Moderna who actually developed these that the government didn't have much to do with that. But the incentives were there and they created those kind of incentives. What is your evaluation of the vaccination campaign, the quality of the vaccines themselves and then how they were distributed and the ultimate efficaciousness of the vaccines? So, I think that these are tremendous vaccines in terms of their ability to do what they were designed to do, which is prevent severe illness, hospitalization and death. And to do that so elegantly and quickly with safe and effective vaccines, I think is really remarkable and I think it really is a good omen for what's going to happen in the future in this field. When it comes to the distribution, I agreed with the way it was done in the United States initially, which was to what we're trying to do. Remember, our hospitals December 2020, I got vaccinated in December of 2020. I was on the third day that they were available. Our hospitals were busting at the seams and we needed to get the high-risk population vaccinated as quickly as possible because they're putting so much pressure on hospital capacity. So, it made sense to vaccinate frontline healthcare workers and other individuals who were in contact with COVID-19 patients as well as the highest-risk groups. And I think we immediately started to get relief because we weren't seeing those 80-year-old somethings from the nursing homes coming to the emergency department. So, I think that that distribution went well. I think it took some time to trickle down and there were ups and downs with that always happened. So, for example, with the vials you could get, they were regulated to only get five doses out of a vial, but we were able to get seven, but the FDA had to throw some vials out because they couldn't use those extra doses. There was a lot of bureaucracy in the very beginning, but I think it went pretty well. I think where it started to hit the problem was when with the vaccine hesitancy, the anti-vaccine groups, and kind of getting the last mile to people, some people couldn't access the vaccines very easily. They could have used primary care physicians' offices the way they're using pediatricians' offices for pediatric COVID vaccinations. That might have helped rather than it being a big government initiative because people trust their doctors. So, I think it went really as good as you could expect minus the vaccine hesitancy. Globally, I think one of the stories that's not really told very well, and I think Adam Masoff and I wrote a paper on this, is that there was export restrictions, and we talk about the developing world not getting our lower middle-income countries not getting the vaccine, but a lot of that had to do with export restrictions, not with Pfizer, Biontech, Moderna, J&J not wanting to sell it to those or to give it to them. They were actually prohibited in some countries from doing that. So, that's something that I think is another long tail of this pandemic is the way that these protectionist trade policies kind of stunted the distribution of the vaccine outside of the countries in which it was manufactured. The efficacy was off the charts when we first saw it. 95% with protection against infection, which was incredible. Nobody expected that. Again, remember, we were trying to prevent severe disease here, but you have to remember that that efficacy is derived from the ancestral strain. This virus is continuously mutating. So, it had a 95% efficacy that lasted with the ancestral strain, lasted through Alpha and some of Delta, but by the time Omicron came around, and that was expected that we would get a mutant like that, the efficacy against infection dropped. It's not very good at stopping infection anymore, stopping transmission the way it once was. That context changed, the science changed, and the vaccines don't really do that anymore. What they're useful for is protection against severe disease, and that remains the same. Side-effect profile is very low, although there are individuals who can get side-effects like myocarditis, which we can talk about, but that's a very delimited group of people, and there's ways to minimize that risk of myocarditis from occurring. The J&J vaccine did have a very rare clotting disorder that occurred with it, so did the AstraZeneca, which wasn't available in the U.S., but on balance, the vaccines saved millions and millions of lives. So what do you think explains both the vaccine's hesitancy and then the ongoing and continued physicians, doctors, so-called experts who continuously claim that you've got massive excess deaths caused by the vaccination campaign? The anti-vaccine movement, vaccine hesitancy, has been on the increase for probably 10 or so years. We saw this, for example, with Gardasil, which is the HPV vaccine. We've seen it with the H1N1 vaccine during the pandemic. We've seen it multiple times at the MMR, so they've been getting more and more bold over time, and they were poised to strike against the COVID vaccine before it was even manufactured. They already started they already started having discussions about how they would discredit it, so I think that there's an anti-vaccine movement that's growing in force, so that's always happening. What they capitalized on was the fact that mRNA vaccines, these are the first mRNA vaccines, the Moderna and Pfizer-Biontech vaccines, they were made at breakneck speed, which is a feature, not a bug, but they use that as a bug. That's kind of what they were hinging on, and then that this was a big government initiative, the government was pushing people to get vaccinated. There were certain policies that governments initiated. For example, Mayor de Blasio in New York required vaccination for anybody that worked in the city, which was the only true mandate, I think, in the United States, where it was the government saying you had to do this as a condition of entering a city. Those types of things really animated people, and the anti-vaccine movement was like Marin County, California, that's where it was very left, traditionally left. People like RFK Jr., Jim Carrey, Jenny McCarthy, all of these people were involved in it, but what they ended up meeting were kind of these people on the very far right. They kind of came around the circle and met, and I think that created this massive synergy. Some of the doctors that are out there that are advocating anti-vaccine positions, some of them are disgruntled. They were people that worked in the field, and for whatever reason it didn't pan out, and they kind of doubled down, and they're making a lot of money by spreading disinformation. I think that anybody that honestly looks at the data, even if you're a layperson, not a doctor, you can see the benefit of the vaccine. You can go to your hospital right now in your town and see the benefit of the vaccines, go to the ER and say, how many people here have COVID are in your ICU? You're going to see what the difference is. You just go back in time to 2020, 2021, you can see what the vaccines have done. I think it's not an honest position. I think it really requires massive evasion, and the ones who say that there's all these massive deaths, where are they? I don't know what they're talking about. Excess deaths in the United States are now back to baseline, which is a tremendous achievement because we had a higher excess deaths because of COVID-19 itself, which was driving excess deaths. Now it's back to normal, and they always pick countries. They always say the United States or the UK, but then there's countries that are even more heavily vaccinated that don't have it. Or look at China, what happened when China let it rip, and 1.5 million deaths is what they estimate happened in like a month. That's what the virus can do. That's not what the vaccines can do. I've looked at the data because people keep challenging me over the vaccines, and yeah, there's excess deaths, but then when you dig into excess deaths, you find that a lot of them are deaths of despair. There's a huge excess death problem in the United States, and post COVID, it's actually larger than it even was before COVID. Fentanyl, we've talked about Fentanyl in the past and kind of what it is what in this country, 100,000 people died probably last year, just from that. And then when people started driving again, there were a lot of traffic accidents, and a lot of young people dying in traffic accidents. You could find the causes. It wasn't that hard. The data is all available. And yeah, states where vaccinations are high, vaccine rates are high, have lower excess deaths, and states that have low vaccination have high excess deaths. I mean, you can find all the data. You can find it in insurance companies and insurance industry. You can find it with the CDC. I know people don't trust CDC data, but the insurance industry has no incentive in line to you. And it's all available. And none of it suggests vaccine caused excess deaths. There's tons of data, for example, from Israel because Israel has socialized medicine. So does all of Europe. So all the data is there. And you can dig into all of it and find the answers. And I think it's not a data, it's not, I mean, you can't approach it as if they're coming at this rationally. They're not. So when you show them the data, they just digs them in more, that you're just part of the, you're part of the Illuminati or whatever things that I get called all the time. That this is just, this is an emotional position that they've dug into. And you like data and stats, and they'll say, that's just your standpoint. That's not our standpoint. That's not how we think about this issue. I know the science is what I saw, my neighbor's best friend's cousin's daughter had this reaction. And that's what happened. That's what they're going to use. They're going to come back at you. I mean, that's what would happen if you debated RFK Junior. It would be all this arbitrary assertion after arbitrary assertion, like whack-a-mole. Yep. Everybody tells me that they know people who died. Everybody who's an anti-vax knows somebody who died from the vaccine. And what shocks me is I don't know anybody who got really, really sick from the vaccine. Never mind died from it. And I know a lot of people, really a lot of people in my kind of universe, not a single person that I know died from the vaccine or really even got really sick from the vaccine. I'm an infectious disease, critical care, emergency medicine physician taking care of patients in the hospital. I never saw one person. I saw one case of myocarditis that was from the COVID, but it was from an anti-vaccine kid who didn't get vaccinated from the virus. So it's just not a rational position. And I don't know how to reason people out of this because they didn't reason themselves into it. They wouldn't have an emotional fixed idea. I think that's right. So myocarditis is real. It is a side effect. It's a rare side effect of the vaccine, the mRNA vaccines. But a few people died from it. And it's very rare. Yeah. I don't think there's been any deaths documented for myocarditis, at least not in the United States. And myocarditis occurs not in everybody. So it tends to happen in teenage boys to their 20s. And it happens with the mRNA vaccines, not with the others. And it happens after the second dose. And it can be completely, it can be very almost completely eliminated if you space the doses instead of making them three and four weeks apart, make them 12 weeks apart, then there's no myocarditis risk. And if you're over 18, we had the Johnson and Johnson vaccine. It's no longer available. But we also have the Novavax vaccine. Don't cause myocarditis. So it's not a universal thing. And the myocarditis cases that happen are very different than other myocarditis cases. They're very, very mild. The people don't really have a major long-term issue from it. They get hospitalized just because we watch people when they have myocarditis. But it's not very severe. But again, this can be completely mitigated by separating the doses. And it's not an excuse not to get the first dose because it doesn't usually happen. It doesn't happen after the first dose. And again, the people that talked about myocarditis, they weren't the ones saying, let's get the J&J vaccine. Let's get the Novavax vaccine. They weren't in line for that either. So even the people that use myocarditis as this big thing actually don't actually take the proper action because that would have been advocating for the J&J vaccine or the Novavax vaccine, which they didn't do. Right. So I'm going to let's go to some of the questions. And what I'll do guys with the questions, this particularly is for you, Michael, is I'm going to focus on the ones related to COVID first. So we clear all those out, and then we'll do the non-COVID ones. And then I've got some of the questions I'd love to ask Amish, non-COVID related, but let's at least get all the COVID ones out there. So let's see. Michael says, has anything changed in the way the CDC or the rest of the government plans for infectious diseases? Has the federal government gone back to its neglect, or is it too early to tell? I think you've already answered this, but maybe just... I think there's always this risk of panic and neglect that when things are in the headlines, they're interested in it. When a phage in the headlines, they're not. And a lot of the proper functions of government when it comes to public health planning or communicable disease control requires a long time horizon. It's not just an election cycle. So I think we do run that risk. But as I said, there is legislation now that is setting the right trajectory. People know this really showed... People in my field, including myself, have been talking about this since the Clinton administration at least, not me particularly, but my colleagues, since the Clinton administration about getting this correct. Now people see what a pandemic, a severe pandemic can do in the 21st century. That's gotten them to understand that this is something they need to take seriously. Whether or not they do, whether they follow through, whether this goes past an election cycle remains to be seen. I think President Biden was elected mostly because of COVID-19. I would think that that's why people voted for him. Certainly that's why I voted for him. It's not something that I think that they're taking as lightly as they did. We'll see how well, if they slip back into that, because again, I don't trust politicians, including ones that I voted for. Mike also asks, has COVID, maybe this is not a COVID. Anyway, has COVID finally proved that AIDS is not spread by a virus? So many have had COVID, but after 45 years few have AIDS. The way I understand it, AIDS is not a discrete disease, but instead a syndrome. I think there's a couple of misunderstandings. So AIDS stands for acquired immune deficiency syndrome. AIDS is caused exclusively by the HIV virus, the human immunodeficiency virus. So AIDS is the end stage of HIV. We call someone AIDS when the HIV virus has decimated their immune system to a level that a threshold that we call AIDS. So the rest of the question doesn't make sense to me, but HIV is the cause of AIDS. AIDS is caused by a virus. And we do have cases that occur. There's probably about 30,000 cases of HIV that occur in the United States every year. We've got 35 million or so people living with HIV. There's millions and millions of people living with HIV. I don't want to quote the exact stat, but all around the world. It's the number two infectious disease killer in the world. So I think HIV and AIDS are still a major problem, especially in sub-Saharan Africa and also in parts of the United States. But we have now a lot of really amazing treatments for HIV. Yeah, so there's been a revolution in HIV. So HIV doesn't actually hit your lifespan anymore. Someone gets diagnosed with HIV. You can get them on a drug. It could be one pill once a day, which is complete or even a long-acting injectable over months where you don't have to be treated. And they don't have any decrement to the lifespan. You tell someone they have diabetes. If you diagnose them with diabetes, they have a decreased lifespan. An HIV patient on medications does not. We still have to get a handle on the new infections that are occurring. There shouldn't be occurring. There should be preventable now. We have what's called pre-exposure prophylaxis. You can give high-risk people so they don't get infected. But I think we've come a long, long way with HIV to the point where it is an eminently manageable disease in a way that nobody really imagined. I think it's it in itself is a testament to really great scientific minds working out a problem for decade after decade until they solved it. And there's still more work with the vaccine and other treatments that may come down the line. I think part of Mike's confusion is he's assuming that all viruses are spread like COVID was through the air. And of course, some viruses can only spread through the blood or through other bodily liquids. Right. So there's multiple mechanisms of transmission for a virus or for any pathogen. So some viruses can spread through respiratory droplets. Some can spread through the air. Some can spread from skin to skin contact. Some can spread from blood and body fluids like HIV or Ebola. And others can spread through fecal oral spread like hepatitis A or norovirus. So there's multiple mechanisms of action, mechanisms of spread for different pathogens. And we get pandemics typically when it's spread through the air. Right. I think a respiratory virus is the hardest for anybody to intervene on because if something spreads when people talk and laugh and cough and sneeze, it's much, much more difficult to interrupt that than if something spreads through blood and body fluids. That's why Ebola really has no ability to cause a pandemic. Yes, it can cause a very disruptive and deadly epidemic, but it is something you can intervene on. The same is true for HIV, but HIV was a little bit of a tricky thing because it has such what's a long latency period. So people would get infected, they'd have an acute syndrome, and then they would have no symptoms at all for 10 years or so, where they were still contagious. So HIV was really one of the first blood and body fluid viruses to be able to spread in that way in the manner of a kind of a slow moving pandemic. It wasn't as quick as a respiratory virus. So I think that respiratory viruses are really the only thing that can really cause a disruptive pandemic level event, although HIV is kind of an exception that sort of proves the rule because of its long latency period. But I wouldn't object to people calling HIV a pandemic because it meets that definition. It just didn't spread in a respiratory manner, but its long latency period allowed it to get all around the world before anybody noticed it. So Ian asked, what surprised me the most was how bad communication was. I tested positive in January 2021. It took 10 days for the local health department to text information about isolating past when it would be useful. What can we do to fix that? Well, this has to do with public health infrastructure, and I talked, hopefully, my OCON talk will come out or I talk a lot about how this all played out. But the issue is that health departments are not well resourced. Their core function is communicable disease control, but those aren't the political priorities. So here in Pittsburgh, the health department, they do communicable disease control, but what they're more rewarded for is finding US steel for pollution or talking about obesity. So they have people that are doing all of that, and it's distracted away from the resources for what they really need to do, and they're very antiquated. I'm surprised you got a text message from your health department. Some health departments are still pen and paper, fax machines. They've just been neglected, and what's flashy to a local politician that's funding the health department is not gonorrhea, chlamydia, syphilis, or infectious disease, it's finding US steel. It's going after sugary drinks, so that's what they're interested in, and those are the sexy things in public health, and they're not core communicable disease, and that's all distracted away, and I think we have to come back to a point where we go, where we look at the actual root of the concept, and that's what I did in my OCON talk, is talk about how did this all start with the plague and with leprosy, what were public health departments doing, and they don't do much of that anymore. If you look at the CDC's orb chart, there's more non-infectious disease stuff than infectious disease stuff now, and so it's not surprising that they aren't resourced and can't do things quickly and aren't nimble when it comes to notifying people, and I think it was not very good the way that the communication, the lag time to get a test result to understand isolation, the way they put guidance out, that's all recognized, but it's really a symptom of a larger problem. Yeah, and it's, yeah, I mean I had the same experience with information and with the lag and not hearing anything from local departments, but yeah, the CDC does things that the government should not be responsible for doing now, instead of doing the functions that are its responsibility, the functions that actually protect rates. Yeah, and they were underwater most of the time, especially just in January 2021, public health departments are underwater, they could not get to things fast enough, they just weren't enough people. Gail says it's so amazing and dishonest, massive evasion of so-called experts, I'm so grateful for both of your rational voices, thank you Gail. No one, the biggest driver of people rejecting the vaccine was probably the fear of being coerced into getting it. Once you have to choose between abandoning reality or justifying this manner of force, reality stops mattering. I definitely think that the heavy handedness wasn't helpful. I think I was always someone that promoted the vaccines as benefiting you, the person that got vaccinated, do this for yourself, do this for selfish reasons, you should want to get vaccinated so that you don't have risk for severe disease or if you do get COVID, it's going to be milder. All of that I think was a better way to sell it than the way that the government was selling it, where I think that they were really pushing hard and then I think in certain places in Europe, they did have full mandates and I think as I said earlier, de Blasio was the only one that did that here, but a lot of people took any kind of employer related requirement as a government mandate, which it wasn't, but I think this should have been something that people voluntarily should have been aligned for, just like people stood in line for the polio vaccines that Jonas Salk developed here in Pittsburgh, that's what I hope it would happen, but it didn't. And I think that they really have to think about how to communicate vaccine acceptance to the population because I do think the heavy handed tactics backfired and then just dug people in, but not because maybe people just because they didn't want to be told to do it or that that was the right thing to do, that's what the president wanted you to do. Yeah, I mean, it's, you never give up on reality. I don't care. The fact that somebody wants you to force you to do something does not mean that you need to do yourself home. Do the thing that makes the most sense for you, whether it's being caused on you or not, and then fight the coercion. But to just to say I'm not getting vaccinated because they want to force me to be vaccinated is just stupid. It's self-defeating. It's self-destructive. Wyatt says, could a scientific establishment that wanted expedited approval for a vaccine realize that they needed to discredit any other treatment, for example, ivermectin? No. I was part of that group of scientific experts. When we saw the early date on ivermectin, we all hoped that it would work, just like we hoped hydroxychloroquine would work because we wanted something that was cheap and easy to give people that would make them less likely to have severe disease. So they weren't, there wasn't any discrediting in favor of the vaccine. Who did the trials? I mean, all of the how much money was spent to do these clinical trials to look at ivermectin, to do hydroxychloroquine, we put it, it was actually put on protocols in hospitals that I work at, just as part of the research studies that we were doing real time. So I don't think anybody who is discrediting it ahead of time to make room for the vaccines or to make room for paxilivin, all of us wanted that to work. Look at drugs like dexamethasone, which are a mainstay of how we treat hospitalized patients. That's a generic cheap drug that kind of came about organically. People thought maybe this will work and it did. Why would we not discredit dexamethasone? Because they're more expensive drugs that pharmaceutical companies make. Why didn't we do that? This argument that we were discrediting ivermectin hydroxychloroquine just fails on its face because of dexamethasone, which is our workhorse. Yes. And we said this at the time. We said this while this was happening. Colleen says we were so hopeful and we used those meds in case they would work until they were shown. They just didn't work and they didn't. It's still true that when you look back at all the literature, they didn't work. But to attribute to thousands of doctors the ill will of discrediting treatment and letting their patients die or letting their patients suffer just so what? I mean there's a lot of evasion and dishonesty that went on around ivermectin and these alternative treatments. I like numbers ask when is the pandemic of the when is the pandemic of the unvaccinated? I'm not sure I understand the question but maybe I can explain the question of the pandemic of the unvaccinated at least at some point. At some point it definitely was. When we looked at people that were getting hospitalized and dying they tended to be unvaccinated individuals. But it is true that an elderly person even if they're vaccinated still has a very high risk of dying from COVID if they've got multiple comorbidities. So eventually yes vaccinated people were in the hospital with COVID and dying from COVID because that despite their vaccines because the vaccines aren't enough protection for some people that are the highest risk groups. But the unvaccinated the odds ratio of dying or that when you look at it statistically much much higher pound for pound than a vaccinated person. So in a sense it was a pandemic of the unvaccinated because they made up the bulk of individuals being hospitalized and dying after the vaccine was widely available. And in the early era when the vaccine was able to block transmission it was the unvaccinated that we're getting infected and spreading it. So in that sense I think it's true but I think it's important to remember that the high risk population and especially if some of them are listening even if you're vaccinated and you get COVID you still might need you still may end up in trouble. So you should think about Pax Lovid. We had monoclonal antibodies which are now gone but there were other treatments. So even though vaccinations tremendously reduced deaths there are still going to be people who died despite being vaccinated because they have other risk factors that outweigh the benefit of the vaccine. And that's I think that's what the the question is trying to to refer to is that there are vaccine people that have died from COVID despite the vaccine and that's because they all possess other risk factors for severe disease and that's why we boost those people frequently. I'm not somebody who thinks that everybody should be boosted all the time for COVID. I'm one of the only people that says that. I think boosters make sense in high risk populations because of that issue that you can still you can still die from COVID if it's been sometimes since your last vaccination. So high risk people need to be up to date on their vaccines. Scott says in hindsight weren't Fauci and Collins overzealously calling for a takedown of Great Barrington given what we've learned about the forecast of lockdowns? Well I do think that there was a lot of people in government positions including the NIH that were threatened by that type of rhetoric and they had wanted to speak with one voice. They had all committed to the strategy that they were following and I think that they did treat some individuals associated with the Great Barrington declaration unfairly that I said earlier there should have been a proper debate about this. It should have been discussed openly and the pluses and minuses discussed rather than try and ignore it or discredit it without actually debating it. Kelly asks hey Ron Heyamish what is your general opinion of the lab leak theory? So this is a complicated question so I think that right now I would say that the lab leak hypothesis is possible as is the natural spillover event at the food market. I think that we know that the Wuhan Institute of Virology works with coronaviruses that's the premier coronavirus research center in the world. We know that they trap bats from all over the world. We know that they do experiments and we know that they have massive issues with biosafety meaning that they do things at a lower level of biosafety than would be the case in the United States and we know lab accidents happen. We also know that Chinese wet markets are places where the first SARS spilled over where different animals are kept on top of each other mixing and we know that that food market did play a major role in expanding the virus in Wuhan. But I don't think we have any good answers beyond that. I think we won't know unless the Chinese government wants us to know and the Chinese government doesn't want us to know either answer. They don't want it to have come from the wet market and they don't want it to have come from that lab. Unless we have a defector I don't know that we find the answer to this. I think it's important. Either answer is important because if it came from the wet market we need to know what's the intermediate animal, what goes between bats and humans so that we change our interactions with that animal. If it came from the lab we need to understand how do those biosafety lapses occur, what can we do to fortify our lab so that that doesn't happen again. So either answer has an appropriate next step to do but I guess the Chinese government just does not want to be transparent. They've blocked all research into the origins. They say that this came from the United States and frozen food. That's the official Chinese position of where COVID came from. So I don't know that we ever get to the answer and all the acrimony and fighting over it is I'm kind of getting sick of it because it's kind of engulfed my whole field. But it's just something that it's very hard to know. Some intelligence agencies say moderate confidence came from the lab. Some say they don't know. Some say moderate confidence from the lab, from the market. So I don't know that we're going to get these answers soon. Yeah, everything I've read suggests we just don't know and nobody really knows other than the Chinese. The Chinese obviously know and the people in the Wahoon lab probably know. But since I read Matt Ridley's book, I tend to think it was probably more likely to be a leak from the lab. But again, it's just an issue of probability at this point unless we get definitive evidence from China. Yeah, and I think what happened was that that lab leak hypothesis got kind of bundled into a bioterrorism idea. And that's a separate issue that this was not a biological weapon or this wasn't something done intentionally. That's definitely clear. And what happened was people dismissed the lab leak hypothesis because it was bundled together. And because Donald Trump kind of bundled it all together. And that made it something that they got dismissed. But I think we lost a lot of time early on. And I think the WHO was basically blindfolded by China very, very early on. And I think it became very hard because the Chinese, the Wuhan Institute of Virology has destroyed samples from the very beginning days. They're not producing data. Now the Wuhan Institute of Virology cannot get funding from the US government. They've been delisted. So there's a whole bunch of issues that are happening right now. Did you see the RFK video where he says that COVID was targeted at whites and blacks, Caucasians and blacks? Yeah, I saw that. And not to infect Chinese and Ashkenazi Jews. I'd like to see him go to Israel and say Ashkenazi Jews were not infected with COVID. I think he'd be. Or to smell all the bodies that they burned in China. The 1.5 million people that died in a month. There was just a report today out of China that the one province, I think 170,000 bodies in the first month, they claimed there were no deaths of COVID. And it turned out they had this data that disappeared enough on the web. I mean, there were millions of people dying in China. That's a whole other story itself, how she just changed his position and just said let them all die after the draconian lockdowns where people were dying from the lockdowns there, jumping out of buildings and all of that, and getting caught on fire. And then he switched to do nothing and let them all die. So related to this, Ann says put the telegraph scientists, put the telegraph, scientists believe COVID leaked from Wuhan lab in 2020, but feared saying because it could hurt relations with China. So didn't politics trump science? Yeah, I mean, we there's definitely sensitivity about saying that was the case, but I would tell you internally everybody was running that possibility down. So even if it wasn't being stated publicly, the intelligence agencies and the governments were actually looking at that possibility right away, that that was happening. So I think there is sensitivity when you're going to say that that happens, always sensitivity on infectious disease, where it came from in the stigma that occurs. We saw that with Ebola. We saw that with the 2009 H1N1 pandemic in Mexico getting stigmatized. So people are very careful and diplomatic about how they say that. But that in the back channels, people were running that down. I just don't think we know. And I don't think we will. It's really coming on the Chinese government to actually come clean. And they will not, either whether it was from the animal market or from the lab, they will not make that available. They will not allow that information to be in the open. And I don't know that the debate gets very productive unless we get new information on the Chinese because we're just kind of running in circles. So Eric asks, how does a non-scientist argue against some of the blatantly silly things that were advocated during COVID, like wearing masks outdoors? The consensus seemed to be that if you're not a scientist, you should shut up. Well, I think you just have to look, you can actually point to the science and say, well, we know that ventilate, I mean, there's general principles that air circulation, how many air exchanges happen in an indoor versus an outdoor setting, that if you're an outdoors, how much outdoor transmission has occurred, you can look at the guidance, you can see that you can use, you can point to experts and interpret that data. It has to make biological sense. It should make common sense too. So it never made sense to be wearing, to treating the outdoors like the indoors. Everybody knows that in terms of ventilation because the issue with indoor is there's less ventilation. And I don't think you need to be a scientist to make that type of a claim about outdoor masks. I think it was silly that people were recommending that outside of, you know, big clustered protests or everybody's on top of each other. But we got mandates outdoors here in Puerto Rico, at least, and I know in several places around the country. Yeah, that's still in even in other countries, they've done that. I don't know why they've done that. It doesn't make any sense. It actually backfires. I think what we need to do is what we needed to do with recommendations or something called harm reduction, where we tell people go outside, do, you know, test yourself, do all these types of things to reduce the harm, knowing you're not going to get it down to zero, give people lower risk activities alternatives, but we didn't do anything. And like in California, outdoor dining was closed. So people just went to each other's house as any, which is much more risky. And so it's not, I think, but I think a general person can rely on common sense principles and there are going to be data that they can actually point to that's not technical. That's, that makes sense. Open a window, that makes sense. People understand that. I think it's difficult. I think people sometimes were using science as a, as a way as kind of a bully pulpit or a club to hit people over with, but I think it doesn't, you know, common sense is derived from science, I would say. And no one says, how would an ideal pandemic response look like with Taiwan, South Korea, and maybe the Isle of Man close to optimal? How can, how can the ability of everyone to still choose what they value in a pandemic still be retained next time? Well, I think you have to tell people, these are the risks. These are the risks. This is where, how you get infected. These are the actions that you take. These things are more risky. These things are less risky. And you let people voluntarily choose to do them or not. You don't make it, you don't say you have to close all the bars, close all the movie theaters. You say they can be open if they want, you can be open. But just remember that this is a, this is a high risk situation. So if you go wear a mask, maybe test yourself a couple of days after, you can do that type of thing and just give people information and let them choose just like we do when there's a really bad winter storm. There's a winter, winter road advisory. They tell people, be very careful on the roads, don't go on secondary roads, make sure you have enough gas in your car and you've got emergency supplies in your car. You can do that with a pandemic. And at the same time, you make sure that the resources are going where they need to, like the hospitals that are going to be in trouble. But you don't, you shouldn't have to get into that position. You should be able to meet it as it comes. You shouldn't be about stopping the bad consequences of the pandemic. You should be stopping the pandemic from causing bad consequences. That just came out and that's not my quote, but that came out from some UK minister, the big inquiry that's going on in the UK about their pandemic. They're doing a very public hearing on what went right, what went wrong in the UK and that came out of the hearing yesterday. And I thought that was a good way to put it. Yep. And no one, we did talk about Taiwan and South Korea earlier in the show, so maybe you came late. Jupiter says, thanks for another great show. Thanks, Jupiter. Let's see. Apollo Zeus, Big Pharma took advantage of the pandemic. Do you agree? And if so, by how much advantage did they take? Can you say the first part of that question? Big Pharma took advantage of the pandemic? Oh, no. I don't think Big Pharma took advantage. No, I don't think they took advantage of the pandemic. I think they were the saviors of the pandemic. If it weren't for Big Pharma, we would still be in the throes of it. I think that Big Pharma, you have to remember that pharmaceutical companies don't like to get involved in infectious disease. It is not lucrative. You take a drug for a small period of time. Many people that get in an emerging infectious disease, you don't know how big it's going to be. You don't know how long it's going to last. You don't know who's going to pay for it because it might be happening in a low or middle income country. It's not the same thing as making Viagra or Prozac or Lipitor. They don't get involved in infectious disease. They're very small margins on all of these infectious disease. And when you do get something good, people want to break your patents. I mean, just today, I read a financial headline that Johnson and Johnson enclosed seven infectious disease programs because they're not going to make money. People pull out of that field. So, no, I don't think they took advantage of it. I think that they had technology. Moderna and Biontech had technology. They knew it would work in this situation. J&J, all of them had technology. They knew it would work, and they stepped forward to try and use those technologies. Moderna was not really an infectious disease company. That was an afterthought. It's really about cancer mRNA vaccines. So, I think that they're the heroes of this. And I know people will say, I'm a farmer's show, but I'm proudly a farmer's show. I'll defend them the way Alex Epstein defends the energy industry. They're the ones. They're the reason that we're able to get through all of this stuff. And I think they didn't get taken advantage of. They're more likely to be taken advantage of than to take advantage of the situation. They really are the heroes. The hatred of big pharma is one of the most stunning parts of it. Moderna is not even big pharma. And Biontech is not big pharma. So, I don't know where they get big pharma from. They had no revenue before this all thing. They were the tiny little biotech company startups. They're the exact opposite of big pharma. Wyatt says, could a scientific establishment ever theoretically become corrupted enough to dismiss any studies that dispute their narrative? For example, 97% climate consensus. Well, I think that in general, there's a danger of group think that when you have all experts that believe one thing, so this might have happened with Alzheimer's disease that everyone believes this hypothesis, people who have an alternative view don't. Or I'm working on this project I'm working on is looking at how they develop the concept of prion, which is what causes mad cow disease. The consensus was that couldn't be the case. It couldn't be an infectious pro-naceous agent. And it's hard, but that's always the case. It's not that's going to always be the case. If you come up with a new theory that is different than what all the other people in your community believe, it's going to be an uphill battle, whether that's in science and medicine or economics or finance, there's always going to be some amount of inertia to move people from those positions. So I don't think that there's, I think that that may happen a lot with the NIH, where there's certain paradigms that they're going to fund and others if they're not. But I don't necessarily think that happened so much with COVID. I think the people that say that are talking about hydroxychloroquine and ivermectin, which how many studies are done? I don't know how many more can be done? Or even if you think about vaccines and autism, how much money was wasted on disproving something that was completely made up? So I don't think, I think scientists actually give people too much of the benefit of the doubt. I get sick of these, I get debunking emails from the press, like from the USA Today, I got one today. And I'm like, well, I don't even want to answer this because it's so stupid that why do I have to debunk something that's completely arbitrary? But they're like, we have to do, we want to do this, these fact-checking things. So we go out of our way to engage with silly ideas in a way that I think should just be dismissed, but I still answer those emails. Paul says, do or did masks do anything to prevent the spread of COVID, not just in public, but in doctor's offices, etc.? I think on the margins, yes, probably 10 to 30% decrease. And it's not the mask's fault, it's the wearer's fault. Most people, when you take a mask and you try to implement it in a real-world situation, people don't wear masks, they stick their nose out, they put their hands underneath their mask and rub their face, they use a mask that's dirty or old, or they're using some bandana thing that doesn't really work as a mask. And they don't wear masks in every situation. So masks that are worn completely, in N95 that's worn completely, appropriately, that's going to have an impact. But in a real-world situation, you're just not going to get that type of compliance and not that kind of quality of masks. But in hospital settings, I take care of tuberculosis patients. I wear an N95 mask, and I don't doubt that that's much more scary to me to get, I've taken care of drug-resistant tuberculosis patients, the N95 mask, little piece of thing between me and that person coughing tuberculosis, and I'm not scared. So they do work. That's not the question, it's how well they're implemented. And I do think that the mask policy became very bad here. It should have been voluntary. It should have been something that was handled much better. And I think we would have gotten better results, but they do have a role. They're not a panacea, and again, it's about compliance, and you're not going to get everybody wearing masks appropriately all the time. All right, let's see. Justin has a whole series of questions here. Okay, why put mercury and aluminum into vaccines? Okay, so mercury comes in vaccines, and certain vaccines in the form of FO mercury, which is a soluble form of mercury, and it's put in there as a preservative because we want to have multi-use vials where it keeps it sterile, that you can take more than one dose out of it. So mercury is used as a preservative as a way to extend the supply. Aluminum is used as an immune system booster. So certain vaccines, like the tetanus vaccine, have aluminum in them because your immune system reacts to aluminum and you get a better response to the tetanus. So it's used as an immune system booster. It's important. Remember that these are not unsafe products, and for example, you eat more aluminum in your food than you're going to get in a vaccine. Mercury, again, just like the autism vaccine, there's been multiple studies showing that the thimerosal that was in vaccines was not causing any problem. There are countries that they've done multiple studies where thimerosal was not in the vaccines, it was in the vaccines, and looked at no differences. Again, something where they disproved the negative. Companies took thimerosal out just because they were afraid of the perception, but they're in there for a reason to make the vaccines better. But mercury, we know mercury is bad for you. I sometimes measure very high on mercury because I eat too much fish. Ethylmercury and methyl. So a lot of people that talk about mercury vaccines, they don't draw the distinction between methylmercury, which accumulates in your body, and ethylmercury, which is soluble and comes out of your body. So you have to draw that distinction. It's not mercury as such. It's what form it's in. Is it soluble or insoluble? So that's what you're measuring in your body. Yes, insoluble mercury can be dangerous, but that's not what's in vaccines, and that's often ignored in the debate. Yes, they just lump it all together, and they can't differentiate between the two. Well, they know better. People like RFK Jr. know better, but they do that on purpose. Justin, we see FDA officials go to work for Pfizer after they leave the agency. How is that not corrupt? It's the same, but that happens all the time. You see people go from the Department of Defense to work for Boeing. There's a revolving door. Pharmaceutical companies want to hire people that work for the FDA because it helps them with regular understanding what the FDA is thinking, what the benchmark the FDA wants. I think it's rational for a big company to want to hire people that work for the FDA because they need experts in regulatory science, just like someone that works at Boeing might have worked at the FAA or something like that, just like Hank Reardon had a man in Washington. It makes sense for these companies to do that, and it's not as if everybody at the FDA, it's not as if there's stupid people in these agencies. I have friends that work at the FDA that are brilliant infectious disease doctors, so they wanted to work on certain problems at the FDA. They might be trying to perform it, move things along faster, and then they go back to pharmaceutical companies. There's nothing wrong with that. There is a revolving door with Washington that's a separate story, but people are being hired because they have expertise, and that just happens. Yeah, and this happens in every single industry. There's no industry out there where this is not happening. The regulators regulate the industry, go work for the industry. They come from the industry. They gain expertise in the industry. They go regulate, and then they gain some expertise in regulation. They go back into the industry, and they usually get out. Look at Barney Frank who's defending free market capitalism now in banks. That's right, and this is true in banking as much as anywhere else, but it's in every single industry. You see exactly the same thing. To pick on pharmaceuticals is just wrong. Is it potentially corrupting? Of course it is. Do the people who worked at the FDA have better access into the FDA? Of course they do, but that's the problem of a regulatory state. Once you have a regulatory state where the government is involved in industry, the government is involved in industry, and industry is involved in the government. You cannot have any other way. There's no way other than separation of government from the economy. There's no other way to avoid this kind of people going in and out of government. And again, every industry has it. Nobody talks about the other industries. They talk constantly about pharma as a pharma special. There's no evidence of corruption, and again, to the extent that there is, and I don't doubt there is some, it's everywhere, and it's inevitable because of the nature of the regulatory state. Regulations, the mixed economy leads to different forms of corruption. It's the same with the unions and the way the teachers' unions were talking to the CDC about. I mean, it happens. It's everybody washing each other's hands. This is crushing group politics, as Ayn Rand described it. Let's see. Justin says, please discuss RFK Junior's view of vaccines. Do you think I've kind of alluded to them? I don't think it's a rational view of vaccines. He's been anti-vaccine for a long time. He wrote that major piece in Rolling Stone on thimerosal, was all over the place going after mercury in vaccines, and he's been kind of one of the, I would, to use the word fountainhead in the wrong way, a fountainhead of conspiracy theories of on vaccines. And I think it's not rational. He will come up with studies that may support what he's saying, but if you actually look in detail, they don't. I think he has arbitrary assertion after arbitrary assertion, and it's just not really worth getting it into with him because it's not something where he's going to have a view that's actually a change. But you have challenged him to debate, and he has not responded. Well, I don't want to call it a debate, but I'm not, I wouldn't shirk from appearing just to actually point out some of the flaws and the way he thinks about things and to point out stuff, but I don't think I'll come out good because he's a Kennedy, a polished lawyer. He's going to know how to, he's got all those studies memorized, and I'm going to try and decipher them all. And maybe I will look, I won't come out as strong. I've appeared on podcasts with him back-to-back on Michaela Peterson's podcast, but I don't think that, I just don't think it would be very productive, but I would do it just to show that there is some people that would oppose what he's saying and try and teach people how to think about it. And I think the bigger lesson is showing the flaws in his thinking rather than actually pick apart whatever studies he's going to bring. I agree, I agree. Okay, Justin, why did doctors ignore my could write this as a negative side effect of M.O. and A. vaccines? I don't think they ignored it actually. It was actually the U.S. government that noticed it in the Department of Defense database. That was pretty, pretty out there very, very quickly. And in terms of the meetings at CDC and FDA, that was discussed very heavily in terms of how to think through that problem. So I don't think they ignored it. I think what ended up happening is the risk-benefit ratio fell in favor of the vaccines. And I think we could have done better at teaching people ways to mitigate the risk of myocarditis. For example, as I said, spacing the vaccines. If you're above 18, use a J&J or a Novavax vaccine and get the first dose, that doesn't, that's not a myocarditis risk. But I don't think that they ignored it. It was actually a government database that noted the myocarditis. They're the ones who put the alert out. And it's not as if they ignored side effects. When the J&J, that clotting issue happened with J&J against what I told the government, my opinion was not to suspend the J&J vaccine. They suspended it for 10 days for something that I didn't think they should have done. And they basically killed the J&J vaccine with that 10-day suspension. They actually overreacted to that side effect, which is something interesting because people don't talk about the way the government overreacted, I think, to the J&J vaccine or even to the AstraZeneca vaccine in the UK where they paused them and then killed those vaccines because of the negative press around them. So the people who say that people ignore the myocarditis, they don't really address what happened with J&J. Justin also says, how is mRNA not gene therapy? mRNA is part of DNA. mRNA is not part of DNA. mRNA is derived from DNA. mRNA is a product of DNA. The DNA gets translated into mRNA through a process, but it's not identical. And for something to be gene therapy, you have to actually go in and alter the gene, which means you have to go into the nucleus of the cell where the DNA is and then alter that. So that will be something that we do for like cystic fibrosis. We do that for sickle cell disease where they're trying to end. Gene therapy is a great thing, but these mRNA vaccines don't even go in the nucleus of the cell. They're in the cytoplasm. You just had Jim Lennox to talk about biology, but I'm giving you the biology 101. So in the cell, it's in the cytoplasm and in a human cell, there's a little membrane around the nucleus and that's where the DNA is. The mRNA never goes in there. It doesn't alter your genes. It goes into the cytoplasm of the cell and that mRNA is acted on by these things called ribosomes, which then transcribe that mRNA into the spike protein, which is then released into your body, which your immune system reacts to. So it doesn't go near the gene. So it's not gene therapy, but even if it was, that's not a bad thing. You know, gene therapy is not a bad thing. Gene therapy is something that's going to revolutionize medicine. I wish we had more gene therapy. So people use that as a pejorative and that's gene therapy, but that would be awesome if we had mRNA. That's like saying, oh, that plane goes supersonic. That's a bad thing. No, it's not a bad thing. That's a good thing. Yeah, mRNA never goes near the DNA. The mRNA, you know, again, it stimulates the production of a spike protein far away from the DNA itself. But if we could go and change the DNA to make us more immune to diseases, wouldn't that be really, really cool? That's exactly what the future holds. All right. Thoughts on Brett Weinstein? I don't know enough specifically about him to say anything. I have not watched any of his things. I know that he's on. I know he's not in favor of some of the vaccine, but I don't know, and maybe he was in favor of Iver Maxon. I don't know enough of his detailed positions to be able to say anything intelligently about him. So thoughts on Vinay Prasad? I think Vinay Prasad, so he's a oncologist in San Francisco. I think he's not a bad, I think he's a reasonable person. He has very good, well thought out positions. I think he knows what he's talking about. I think he brings out a lot of the debate in a way that he takes some contrarian positions, and I think he does it in a good way. I don't have any specific issues with him. I think he, I've never had any issue with Vinay Prasad. Do you think he's anti-vax? No, I don't think he's anti-vax. No, he's been much more, but he's much more risk-based vaccinate, talking about risk-based vaccination on high-risk individuals and probably less so on vaccinating younger people. And he's been somebody who's emphasized the myocarditis risk a lot, but I don't think he, I think he recognizes the value of the vaccine in high-risk individuals. We may differ on how much benefit lower risk people may get, but I don't, I think he's on the reasonable side of the debate, and I don't have any major issues with him. All right, let's see. So some questions that are not directly related to COVID. Michael asks, is the reason autism levels are climbing due to the rise of the tech sector? Many tech workers are on the spectrum and normally wouldn't have married and had children. Now all these neurodivergent, awkward people have got an opportunity to interact more and breed. I don't know about that, but I can, I mean, I can say that this is, you know, speaking not as a psychologist or psychiatrist, I think autism diagnosis has gone up for a couple of reasons. One, maybe there's something that's something changed in the environment that's caused them to go up. Another is that they changed the definition. There used to be a whole bunch of different other disorders like pervasive developmental disorder or, and, and other, and other things. And then there was autism. And what happened was, I think they just expanded and called it autism spectrum disorder, because then people qualified for certain benefits if they had autism, but they didn't qualify if they had pervasive developmental disorder. So that made it easier for social services agencies to get people services and they call it a spectrum. So that increased diagnosis, I think people are much more attuned to looking for it now and it's getting, it's something people are more aware of. I don't know what the cause is. It's certainly not vaccines. There's one hypothesis that I think is interesting regarding the use of antibiotics early in, because that changes your microbiome, the bacteria that live in your, in your gut, your gut flora changes. And we know that autistic people have different type of gut flora than people that are not autistic. This is something that people have been looking at, whether they can change that and that changes the symptoms of autism. I think that has a lot more plausibility than anything else I've seen is that these children get sick when they're young, multiple doses of antibiotics, probably inappropriately prescribed, changes their gut. I think there's, we're scratching the surface of understanding what the microbiome does for health. And that's the best hypothesis I have as a, as a non-psychiatrist on this issue. But I, but I also try to turn everything into a bacteria infectious disease thing, which I just did with autism, but I like to do that with any, any condition I can give you some infectious part of that. Yeah. There was an interesting article today in Barry Weiss's publication in free press on autism that, that, you know, with, with, the author claims that a lot of the new thinking is that this is something that develops in the womb already, that it's not something that develops post and it has to do with how the brain, how the brain is growing in different stages of development. But, but the bottom line is no, it may not be one thing. Autism itself may not even be one disorder. It might be multiple things right there. So there's a lot that we don't know. Yep. Yeah. Right. Let's see. Shazba asks, how much impact does diet have on a person's vulnerability to disease? Is the body pH level affected in that? I don't think the body pH level no, because it's so tightly regulated you will die if your pH level gets too far off. So the pH level doesn't vary so much between, between a person. But I do think diet plays a role in the sense that we know malnourished individuals are more likely to get infectious diseases, respiratory viruses, tuberculosis, that your resistance goes down. People who are deficient in certain vitamins like vitamin D particularly also are more prone to respiratory viruses. So we know that obese individuals are, which is a form of malnutrition, obesity does increase your risk for severe disease. So I do think in that sense it does. I would say the average American diet as long as you're getting a vitamin D probably on the margins, it's not going to make that much of a, much of a difference if you're not obese or underweight and you get all your vitamins. I don't necessarily think people need to be taking every, every supplement that any Hollywood doctor prescribes them. But I think I would stick with vitamin D is the one that I think that the most data is behind. All right. Let's see. You're not into any one of these dietary religions that are dominating America, America's landscape. Well, I think that there are diets that are better than others in terms not for infectious disease risks. But if you talk to me about longevity, Alzheimer's, diabetes, yes. I mean, I think in general, I would say the best data is around the Mediterranean diet. That's, that shows in multiple studies that people who have a Mediterranean style diet tend to have longer lifespans, less cardiovascular disease, less heart attacks, less strokes, less dementia. But I think all of the others, the data is kind of mixed. But I think that's, that's the one, right? At least I see some consensus around the Mediterranean diet. Jennifer asks, can a child's environment be too clean? Is exposure to different foods, animals, et cetera, like peanuts, I guess, really early on, important early in life? So what the questioner is asking about is something called the hygiene hypothesis where they did these studies with very rich kids who lived in pristine environments and kids who lived in orphanages who rolled around on the dirt. And what we find is that pristine environments, those kids are more prone to get asthma, allergies, food allergies, all of that eczema, all of that stuff. Whereas someone who is exposed to lots of dirt when they're a little kid is less likely to have that. If they grow up around animals, for example, they're less likely to become allergic to a cat. If they've been exposed to peanuts at an earlier age, less likely to develop peanut allergies. So there is definitely something to that hypothesis. Remember humans have only lived in civilized civilization for like a couple hundred years. Our evolution is like to be dirty to that. But one thing that people do with the hygiene hypothesis then says that people should be infected with all these viruses and stuff. That's not the case. We're talking about allergens that people in dirt, not being infected with viruses and all that kind of stuff. We're talking just about the exposure to environmental allergens. Yes, it definitely probably makes you better off. I had two cats that slept in my crib when I was a baby and I'm not allergic to cats. I don't think I'm allergic to cats and have never been around cats for any length of time. So it's not one or the other. But yes, it does look like being exposed young. I was definitely exposed to a lot of dirt when I was young. There's no question about that. Vikram asks, if there's no alternative biology or alternative physics, how come we have alternative medicine? Why do you think it exists and retains a pure for so many? That's a good question. I think it's because people feel that sometimes Western medicine is scientifically based, but it's not omniscient that there are certain things that we haven't figured out. There are certain things we don't have good treatments for and some people are looking for answers. Sometimes that answer is just talking to an alternative medicine practitioner who sits there for an hour. I'm not going to be in the room with you for an hour if I see you. That therapeutic, that's part of it and I think that they offer them alternatives that are not usually that harmful. It might be some supplement or something and maybe they get a placebo effect out of it, but they've got some answer for their problems because there are things that we can't, like the whole chronic fatigue syndrome or even long COVID. We don't have great answers for it, but alternative medicine seems to put forward answers. They may not work. Some of those people might get better on their own, but I think that provides an opening. I think that there probably are a lot of doctors that don't listen to their patients that will try one drug, another drug, another drug, send to different specialists and maybe that people get dissolutioned by it. That's I think the best case for alternative medicine or why it's risen, but there are other people who have different theories about how health works, which I think that's the negative part of alternative medicine where they still have these mystical ideas that come from the four humors or whatever it might be or homeopathy or some eastern medicine that has mystical ideas that sometimes appeal to people because they don't believe in the scientific method. Although they'll say the scientific method gave us the atomic bomb. They'll say something like that, so I don't want to do anything with the scientific method. So there is that part of it, but I think when you're talking about patients who turn to alternative medicine, it's usually because they can't find an easy answer for their problems, which may not be medical. They might be psychiatric. They might be something else and they find somebody that will at least give them some solutions, whether or not they work or not as remains to be seen. You think though that there is a need that currently conventional medicine doesn't really supply for a holistic kind of a GP, a real GP, kind of a holistic view of a patient and that there's too much of sending people to specialists who go talk to each other and there's no coordination. It seems to me that there really is kind of a, if we want to really be proactive in terms of healthcare, we need somebody who kind of can integrate all the information. Because it's complicated, right? Medicine is super complex and yet we don't have one doctor who can integrate all that for us. That would be what a great family medicine doctor could do, but they don't, not many of them exist and they're not reimbursed for that. They're not reimbursed to help you coordinate. They're reimbursed for that visit very quickly to make it as quick as possible, not to sit there with all your charts and help you do all of that. So if it's not incentivized that way, so they've kind of gone away. So it's easier for them to just on their electronic medical record, click a box to send you to a cardiologist or a nephrologist or a pulmonologist rather than that. And then just not integrated. You're just seeing all these different doctors. They're all in silos. Yes, I think that's just a major problem with how medicine and the bureaucratization of it and the way insurance companies following the lead of Medicare and Medicaid have kind of destroyed the practice of medicine and made it very bureaucratic and you get five to 15 minutes, probably max with your primary care doctor. Yeah, no, I think that's right. That's government. Government involvement in medicine is really destructive. Okay, Vick Ramos asks, have either of you tried intermittent fasting as a way for weight loss or maintenance? Any thoughts or tips? I think the data is mixed on this. Again, I'm speaking outside my specialty, but there are, I just read a study yesterday actually in a major medical journal that it does lead to weight loss, but not any more than calorie counting does. There may be other benefits to intermittent fasting. There have been studies in mice that show increased longevity. Sometimes I intermittent fast just because I skip breakfast and I eat lunch at 11 and I'm starving by five and then I'm full. So I intermittent fast by default a lot, but there's some data that it shows, but I think calorie counting is kind of the baseline thing you need to do to lose weight. Yeah, I've tried intermittent fasting on occasion and every time I've tried to have put on weight, it just doesn't work and I don't feel that great. So I just don't do it because unless I do it by accident like you, right? If I'm not hungry in the morning, I'm just not going to eat and I only eat when I'm hungry in the morning. So sometimes it turns out at 16 hours from meal to meal. So I've done intermittent fasting, but I don't have tried it on purpose. It doesn't work for me. So I've left it. And I actually just finished Peter Tia's book. I'm going to review it in one of the shows, but he argues that a lot of the fasting stuff that a lot of these doctors are recommending is counterproductive because what it does is it makes it difficult for you to gain muscle. That is, you need to eat in order to gain muscle. And if you fast for like seven days, like some people do, then the actual muscle loss during those seven days, as much as you work out, you're not going to gain muscle because you need protein for it offsets whatever benefits the actual fasting does for you. So he used to be a big fasting guy and he's turned around completely. So he's optimizing for longevity, not weight loss. So there's two different things there. So I think probably he's interested in muscle mass that you preserve your muscle mass because that's going to keep you vibrant in your old age. No, that's right. That's right. So there are two different things you're going for. And one of the things I liked about his book is he's very clear about what he's optimizing for, not athletic performance, not weight loss, but longevity. I did his podcast early on in the pandemic. He's a very smart guy. I, you know, have you read his book? I haven't read his book, but I read some of the stuff that he's done and seen and sometimes we correspond because I enjoyed it. He seems very very science driven. I mean, he seems to be driven by data and not by the kind of the and not attracted to what's sexy at the moment and so on. And the book is very honest. I mean, he deals with some of his own problems and issues in a very honest way. And he also deals with where he's been wrong in the past in an honest way and that that's admirable. Right. This is the last question, Liam. Are you optimistic about the quality of medical care in the future or will socialist policies cripple it? I'm optimistic in the way science is progressing and the technological solutions that we have with AI, with machine learning, with what's going on in the pharmaceutical industry that we're getting better and better at treating things. I think we've talked about infectious disease. We didn't talk about RSV, but we've got two new RSV vaccines coming out in the fall on a new RSE monoclonal antibody. There's a lot and we talked about HIV. There's lots of things that are happening that I'm optimistic about. What I'm not optimistic about is that the way the government controls it because it becomes much more now about equity rather than actually can you actually do something to impact the disease? That it's all about who is it going to impact? And you may find there was a recent panel discussion where someone was talking about developing an Alzheimer's drug and they said, well, you shouldn't make that because it's going to cost so much money. That's what I'm worried about. Is that type of mentality stopping people from actually doing or using those tools? Because I think that science medicine are going to continue to progress to give us better lives, longer, healthier lives, and cure diseases that weren't able to be cured. But the thing is, we can't allow this whole idea of if only certain people get it, we shouldn't have it. That's where I think that the battle is going to be fought. That's what I'm not optimistic about is this push of egalitarianism into medicine in a way that I think could stifle innovation or make people just innovate in some other field because they're not going to have a market for these products because they won't be allowed to be given. That's where I'm pessimistic. Yeah, I agree with you. I see the science is amazing. The progress is amazing. We talked about the mRNA before, but they're really using mRNA now for cancer. I mean, they've returned Moderna and these other companies are now finding uses for it. The evil big farm is where the real prospects for moving medicine forward, but the government is trying to stifle it at every opportunity. Anyway, we're at 9.45, so right on the button. Perfect timing. We've covered all the questions. John says, thanks to both of you for being the best source of information during the pandemic. Thank you, John. Really, really appreciate that. And thank you for the support. So thank you, Amish. Thank you for everything you've done over the last three and a half years. Hard to believe it's that long. And thank you for being on the show again. Colleen, by the way, thank you for being on the chat. You should come every show I do. And Colleen was handling all the guys who usually spam me with ridiculous questions. She was putting them straight. It was wonderful to see. So thank you, Colleen. Thank you, Amish. Maybe next time we don't talk about COVID. And let's figure out how to talk about all these other things, because I think there's a lot of interesting and exciting stuff out there. So next time, no COVID, guys. And biological weapons. We can talk about that whole story, too. I'd love to talk about that. That is fascinating and interesting and scary and scary. But I remember just as a note, I remember back in 79 when I was in the military, 7980, we were talking about that with the Syrians, as the Syrians poisoning the water supply. And did they have biological weapons? Didn't they have biological weapons? I mean, it's been discussed for a long time. And it's a very, very scary prospect. Thank you, Amish. Thanks for everything you do. Thanks for being on the show. Thank you, guys. I will see you all tomorrow morning. Tomorrow is going to be earlier. It'll be 12 p.m. Eastern time. We'll be the news briefing. And then we'll have, we've got an AMA on Saturday. Thanks, everybody. Have a great night. Bye.