Dr. Jay Bhattacharya

23:59So you should be able to say to a patient, I just don't know the answer to that question. Let's look this up together. So we know when those answer this question, let's try to make this decision together, given the uncertainty based on what your values are as a patient. I think that kind of medicine would be a much more honest, much more effective medicine. What was the window that you went to medical school in? I started in 1990 and I graduated in 97. Okay. So age priori is an example of something that happened after. Yeah. For doctors who went to school, then or earlier, how do they know all the things that changed since what they learned in medical school?

24:34There are things called continuing medical education credits. You're supposed to keep taking some, you're supposed to be reading a doctor. Do all doctors this required of all doctors? If you want to maintain your license, a lot of the specialty societies will acquire that you have some of those. Sometimes it stays to acquire it, but they're usually just in your specialty. Right? You're not reading broadly and a lot of it is just, actually it's like pharma funded. Right? So like you go to some conference like where the pharma is sponsoring the conference and they tell you what you're doing. You're about the new drugs.

25:05Yeah, they tell you about the new drugs, right? I think a lot of doctors, unfortunately, I don't think they keep up, but I think that ones that do, they're like, they're getting it from their colleagues who found something from maybe they read a journal article. But usually it's like they read about it in the New York Times. It's a really haphazard kind of continuing medical education. How much of the current health world is driven by the pharmaceutical industry versus the pharmaceutical industry? Being called upon to solve a problem for the medical community? A lot of the kind of direction of thinking in medicine revolves around the availability of drugs.

25:45Right? I just give you another example, a non -COVID example. Right? So the number of people diagnosed with depression is exploded in the United States and around the world actually since the 90s. Is the world just more depressed than it was? I don't think that's the answer. I think before the 90s, there wasn't these SSRIs, these serotonin re -updicking inhibitors, these drugs that nominally treat depression, right? Before it was a very complicated thing. They read terrible drugs, they had awful side effects. You had psychoanalysis that didn't seem to do very much. I was very expensive and actually could cause quite a bit of harm, I think, in the hands of bad practitioners.

26:24And now you have this drug. Much easier. And people started diagnosing more because of the availability of the drug. A lot of doctors don't really understand this, but like a lot of the medicines they practice is related very closely to the availability of relatively easy treatments. And drugs being the main one. There could be surgeries also, that weren't previously available. So a lot of medicine is practiced because of these technologies that are available. Now again, these trade -offs here are sometimes that's a good thing, right? Yeah, sometimes it works. Yeah, and sometimes it leads to the abuses and sometimes it does both.

27:03From where you sit, looking at the healthcare system in the United States, tell me what's working and what's broken? I think if you have a chronic illness and you're relatively well off or have a good job, if you have cancer, you're going to get among the very best treatment in the world. You'll get what people think of as the right thing to do. It may or may not be the right thing to do, but if you're going to get what like honest people think as close to the right thing news you can, you might get over treated, but I think that's working quite well. If you're poor, you may have a hard time getting the most basic things.

27:37I think that's tremendously broken in the United States. They're systems of providing care for the poor, making it hard to get doctors that will see you even for relatively serious things. Emergence here is pretty good. Like you can always go to an ER, they'll take care of you. But you end up with the ER flooded with things that flow out of like our social dysfunction rather than just medical things. So it's a lot of stress on medical systems having to do with like the opioid epidemic is a good example of this, I think. Putting on your economist hat, how can that change to be a better situation for four people?

28:10What could the system do differently? I would think there should be a political consensus around this. Like we're a rich country. Why don't we just provide better care for the poor? Like on the left you have this desire to reorganize all of healthcare, even parts that are like people like. It's why it's so politically challenging to get something I go bomb a care through. It's really easy to say, look you're threatening. I'm a middle class person, I have health insurance to my employer. I like my doctor. Why do I want to change that? And that's actually a legitimate point. And on the right you probably have too little desire to like provide the care for the poor.

28:44Like what if a bomb a care for instance had been just a Medicaid expansion to mainstream care for the poor? Medicare for all that means the government is going to take over all the insurance even for middle class people. You could still always a rich person could always spend their money on whatever they want. When you have a single pair like in the UK for instance, there's a tension there. Is that right? Tell me what it is. Because there's like the solidarity, right? So I give lectures in the UK. It's really interesting what the taboo's are. And the US, the taboo is that people can't get care if they want it.

29:16Right? That's the taboo of death panels. In the UK, you shouldn't have to pay for care at all. If you charge for care then that's a great evil. And the argument is that there's this social solidarity. We all have, we're all in it together in our life. We all should get the same care. But the political tension there then is like if someone is relatively well off, they don't want to wait six months to get some surgery. And they jump the queue by paying private. It seems as you do it, but it's an illicit thing. To me, the most important thing, like the most important thing you help policy me is like how do you make care for the poor so that it's not like the second class thing?

29:53I think you could do that without disrupting the time. The fact that it's working. Yes. I wouldn't say working necessarily, but a lot of people like it. They're trade -offs again. And there's stuff where you can go to the police. You don't want to take away what someone likes regardless whether it's working or not. Yeah, exactly. The idea that people get to choose. Yeah, one thing is that then you get a political coalition together to try to protect the thing that people like. And there's a lot of conflict rather than trying to build a consensus around things that everyone agrees doesn't work.

30:21Even on the right people agree that care for the poor isn't working. So, for instance, suppose President Obama in putting together a bomb of care and just said we're going to expand Medicaid because we have 50 million people with no insurance at all. That's not right for a rich country. We're going to mainstream the care that they get so that they have access to a lot of the care that middle class people have. It's going to cost us something. Taxes might have to go up, but it's worth it. I think you could have got that through. No one in the middle class or the rich would have felt threatened by it.

30:53And we all want that. Nobody wants to live in society. You would have not wanted that. I think the only people would say, well, the taxes are going to go up. But you're saying you're spending the taxes on something useful. Instead, they tried to reform, like to change the structures of care even for the middle class. And then use some of those changes to try to finance the care for the poor to make it look like there's no change in the deficit. It just was this like, a hodgepodge thing. I mean, I think not one single Republican voted for it. If you're going to have an enduring change to our social infrastructure, you have to have basically a very large number of people from both parties in favor.

31:33This shouldn't be this political coalition that spends a decade trying to undermine it. We did this with Medicare and Medicaid in 1965. It's different now than 1965. Yeah, it is. But 1965 was a funny time. There was a tremendous amount of social strife going on then. To get in place. What do you think allowed it to happen then? I think the death of a president, a new president, that was what he was going to spend his political capital on. And then the other thing was healthcare starting to become much more useful in the 60s. And the specter of a lot of older people that had no access to care. So our parents, our grandparents, they weren't a very large fraction of the population.

32:14We had a population pyramid that looked like a pyramid back then. So you could make the political case, well, look, why wouldn't we care for our old grandparents? And healthcare wasn't quite so expensive then also. It was like $1 .20. We spent on healthcare, not $1 .00. And also everybody has grandparents, not everyone has poor people. That's true too. Yeah, I mean, it's so hard to build up like this compassionate idea around poor. Let me push back a little bit on that. I do think that people do care about poor people. I'm sure they do. I know they do. I feel like there's something about the way the system is structured that doesn't allow the thing that everybody wants to happen to happen.

32:48I don't know why. I don't know anything about it. It just seems like the political system is dysfunctional. Like this obvious middle ground where everyone can agree. Like you can keep the thing, the structure you want it for the stuff that you think is working for you, but let's care for the poor. Everyone wants that really. And we're willing to pay for that, I think. We just have to say it that way. Just put the trade off plainly in front of the American people and then they would accept it. Instead, you have politicians at both parties promising free lunches. And everyone knows those free lunches or lies.

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34:59Where do you think the incentives are at a line with the desired results in the medical system? I mean, it's just everywhere you look. Before the pandemic, one thing I worked on was on the incentives that doctors have to choose to make recommendations that will have long -term benefits for just more expensive things that might benefit the doctor in terms of the income they get. A lot of the way we pay for healthcare in this country is this system called the fee for service system. So you go see a doctor that doctors has something for you and you pay the doctor for that thing. But then there's no long -term follow -up in terms of like, was that decision a good decision for you?

35:37This is a one -time transaction. And so the time horizon then for many medical institutions is very short. That's the advice you're getting because the doctors have an incentive just to look about what's good in this interaction versus the long -term effects. Like, am I managing your care so that you can avoid having to take the statins at all? Can I help you make decisions that will give you long -term benefit? So we don't pay on kids in the doctor's best interests that you come back to see them again? Yeah, I mean, that's what we structure our system. It's not unique. A lot of fee for services is pretty common around the world.

36:16But I think that those structures are going to create misalignment between patients long -term interests and the decision making of doctors at the point of service. How could that change? How else could it work? Well, you could change the way we pay doctors, right? So in fact, there's a law passed in 2015 that is called MACRA in the US Medicare is the South Care system that provides healthcare for all the people over 65, has a major influence on how doctors are paid. So you could change Medicare -Pays doctors. MACRA does that. It says, okay, we're going to give every doctor in the country a report card.

36:49And the report card is going to, based on the outcomes on the decisions you make for your patients, long -term outcomes, a year, and on the costs. And so doctors that have low costs and great outcomes for patients will get a bonus. For Medicare, doctors who have high costs and bad outcomes, patients get a penalty. So something like that, where you've linked the payment to the things you want. That's good. That's how economics works. Right. So you could do that. Now, there's been tremendous, like, I worked with the Medicare to try to design that report card. It was an outpills thought for five years.

37:26It was, we tried to develop this report card. And there's a lot of resistance in the medical community, first to be, no one wants to report it. How do you... So it's just people don't want accountability, is that what it is? I mean, you have a system that kind of works for some people. And so people think of, certainly for people that are in the medical care system, it's like it works really well for them. Like, the doctors are among the highest paid in the world in the United States. And so you're going to get resistance when you try to change it. I think that's where we kind of are. But like, the structure of it could work.

37:54You'd have to, there's a lot of detail. Like, what do you mean by good outcomes? That's a really complicated question. I don't think those are unanswerable. But you have to answer it. You don't want to spend a trillion dollars for one day of extra life, right? You also want to make sure that you spend five dollars for 10 years of extra life. But at some point, you don't want to say these things because now you're all of a sudden talking about life as if we're a dollar value to it. Which, if we acknowledge that trade off, it should never be something so explicit. Right? It's just inhumane to think of that way.

38:24Like, but at the same time, implicitly, it's there. It's a very sensitive conversation that you have to have in order to like have a system that's designed for long -term benefits. So that's the only way you get that. Tell me about the relationship between the insurance companies and the medical system. So the insurance companies are funny things, right? So the only reason you need insurance is that you could have outcomes that are so expensive that you can't possibly afford it, yet it's tremendously valuable to get it. Right? So if you didn't have technologies like that, you wouldn't need insurance.

38:56You could just pay for it out of pocket. If you're poor, then you could have a mutual aid site or something to pay for it. Insurance exists because of those uncertainties. And yet we expect insurance to cover literally everything. The insurance companies, in principle, should be representing patients. Right? It's patients that pay for the insurance. But often they get captured by the hospital systems and by provider systems. Explain that. What does that mean? How does that mean? Well, it's like so, for instance, I would think insurers would try to negotiate the best deals with the hospitals, with doctors groups, and say, okay, well, we'll include you, but we can't pay you this much.

39:36Doctors in Denmark are earning a third that for what you're charging us. And then they would pass the savings on to the insured. Right? We spend $1 .5. That's way out of line with Western economies. Like, insurers and principals should be negotiating with the hospital systems, with doctors groups, to try to represent patients much more effectively. And yet they don't. They just sign the checks that the doctor groups want. They sign the checks that the hospital is charged. And our government does the same thing. Like, they basically government is in a major insured for the elderly. There are laws to try to negotiate better, to try to like, but in fact, what happens is, the doctors groups, the hospitals, and the pharmaceutical companies have essentially, they write what those decisions end up being.

40:25How did it get to be that way? That's a really complicated question. I think part of it is politics. Right? It's very easy for physicians and for hospitals. With some reason to go to politicians and say, look, we're really essential in this community. So they get a lot of political power that way. The payment structures are set up with like tradition in mind. We've always had F .E. for service system. And so like, reforming that to like change it, to give rewards for more longer term outcomes. Some people are going to lose. And those people are going to fight really hard to make sure that that doesn't happen.

40:59It's a really difficult challenge to transform or to reform healthcare systems because it's so personal to everybody. You know, even wars are like something that happens over there. For healthcare, it's like it happens to you now. It happens to your grandpa. It happens to your kids. You're going to fight much more. And there's trench interest all over the place. I think that's probably the most important reason. I've heard new cancer therapies that are available in other parts of the world that some rich people here fly to Switzerland or other places to get. Why would something that's getting good results be possible somewhere else in the world but not be possible here?

41:37I think part of it is like there's controversy over whether the results are good enough. Right? So like the job of the FDA is to evaluate the efficacy of certain drugs. And it has to both be safe. And efficacious is a theory not to practice this early. But that's a theory. And the efficacy standards are set by the FDA are often very stringent. Are they stringent on behalf of the citizens? So I just described as the theory of the FDA. The practice what I've seen is often not stringent. Like we talked about earlier about intermediate endpoints, cholesterol instead of long life. So you end up with an FDA that's very inconsistent in the standards they used to approve drugs.

42:17Sometimes the drugs are approved before the rest of the world based on probably inadequate evidence. And sometimes they're much too stringent and other parts of the world have approved them. That's why people might go. They're also sometimes they hear there's controversies, right? They may be a drug where like the randomized trial was equivocal. And one regulator says yes to it. And one other regulator says no, you can go to a poor country and get it because there's very little regulation at all. You know, like interferon for various things. When I was a medical student, I was a big deal of people go to Mexico or something and get treatment that wasn't available in the United States.

42:55Because there was a lot of controversy over whether it actually worked. That also I know many athletes, professional athletes go to Panama for some injections of some sort of a... You're a thorough poet and probably. If the professional athletes think it's valuable enough to fly to Panama, why would we not make it available here? There was a political movement. In fact, there was a law pass right before the pandemic called us right to try. Right? And the philosophy there is, well, if you have an investigational drug, why not make it available to people that are really sick that they might help?

43:29And I mean, I find a lot of power in that argument. The counter argument is that a lot of people will tell you things will work when they... There's no evidence that they work. People get taken advantage of it. Earlier that half of what's taught in medical school is not correct. So we're starting on a very faulty ground to begin with. So the idea of not being allowed to try something that might work when some of the things that are allowed might not work. I have no counter argument, Rick. I think I agree with you. We're in a funny position. On the one hand, we want to promise that we have a regulatory structure that's going to tell you that every drug you take is safe and every drug you take is effective.

44:11Like that's the theory. Everyone wants that promise. Same time when you're really sick and there isn't a good treatment about, well, if you're even if you're not sick, you just want to enhance your performance in some way. You want to try things even if the powers that be haven't approved them. And should you have a right to do that? As a company, do I have a right to sell you this? Imagine a company tells you, we haven't really evaluated this. We think it might work. But we're not sure. So use it at your own risk. I think it's probably okay to allow that to happen. I mean, in fact, that's what the law is.

44:43It's right to try law for some under certain conditions. But a lot of people would say, well, that's you're just allowing, you know, Charlottes and companies to take advantage of people that are in entire straights. Very, very sick and don't know what to do. And there's no real good treatment. So I don't know the answer to that question. I can kind of see both sides of it. What is economic epidemiology? Let me just ask first start with what is epidemiology? Epidemiology is a study of the spread of a disease. One of the basic ideas of epidemiology is that if you invest in or work toward prevention of a disease, you reduce the amount of the disease in the population.

45:23Completely reasonable kind of idea, right? That's in fact, one of the central ideas of public health generally. Economic epidemiology says that it's not quite so simple. In fact, a lot of the desire or willingness for people to invest in prevention has to do with the perceived or the actual threat of the disease itself. So there's a feedback loop. Prevention reduces the amount of disease in a population. The level of disease in a population determines how much prevention there is. There's a loop there, not just a simple one way pathway. And it's not a morality tale. It's just a fact, right? So like if you are very worried about certain set of diseases, you are going to be willing to invest more in trying to avoid those diseases.

46:08I'm willing to invest a lot to try to avoid having heart attacks because my dad had a heart attack when he was 56. My uncle had a heart attack when he was 36, both of them died from it. And so that in my mind, the kinds of things I'm willing to do are much more because of that fact. Other conditions, I don't know, dengue fever. I'm very unlikely to get in this country. I'm probably not willing to do very much to try to avoid getting it. Just because the risk of it is so low in the United States, right? So that's the heart of economic epidemiology. There's in fact not just a single pathway from prevention to the disease, but the other way around as well.

46:42And it changes how you look at epidemiology, I think, when you understand that both prevention and disease are social phenomena. And you have to think about that. So in other words, you don't throw the kitchen sink at everything because that's not what's best for the situation. Yeah, that's right. The more I spend on time and effort and energy and thought on one condition, the less I'm going to have for other conditions. There may be fundamental trade -offs there too. That's another important lesson of economics and applied epidemiology. That's what it means is that I could look and say, what does it mean to live a healthy lifestyle?

47:15The list is like 5 ,000 items long. That's too many items. I'm not going to do all of those things. I mean, just not possible to do all those things. In fact, it's like actually weirdly inhuman to do all those things. You end up focused on prevention of disease rather than living your life. So the economic epidemiology broadly is applying some of the ideas at the heart of economics, which is these trade -offs, to epidemiological situations, to try to understand better how disease actually spread in society as opposed to some abstract thing where I prevent disease that the disease doesn't happen.

47:50I've seen a lot of people in public health are frustrated because they have good ideas for how to prevent disease, but people don't take them up. The reason for the frustration is because they don't understand that the demand for prevention relates very closely to the level of the disease and that they're trade -offs implicit. They shouldn't be between morality play. They should be trying to help people manage those trade -offs.

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49:47www .cash .com You, along with an esteemed professor from Harvard and a esteemed professor from Oxford wrote a document that eventually was signed by 60 ,000 other doctors and scientists. Yet you were silenced. What does that feel like? It was very, very odd. In science, you write papers and you send it to a journal. Sometimes it's years. You have something you're super excited about. You document as well as you can and you send it to a journal. They'll send it to peer reviewers and the peer reviews will look at it and try to tell you what you did wrong and you have a back and forth. But you still have a voice.

50:28Eventually, hopefully, you get to publish the paper, the process of talking with people about it, people criticizing you over the paper, improves the paper. This is what I always thought before the pandemic is that this is how you change the world as you make those kinds of discoveries through that social process. I've never had a situation before the pandemic where someone told me, Jay, you're not allowed to say that. But during the pandemic, that's happened to be constantly. Okay, so I'm a professor at a fancy university. And you're talking about your area of expertise? Yeah. Yeah, it's my area of expertise.

51:04I mean, I think what I've seen is that it didn't matter what your expertise was during the pandemic. The people telling you you can't talk about this, people with expertise in your area? Not necessarily, no. Often not. Yeah. So the document you were talking about is called the Great Barrington Declaration. I wrote this with Sinatra Gupta of Oxford University. She's an amazing professor of theoretic epidemiology at Oxford. And Martin Kool -Dorf, professor of medicine at Harvard, an amazing statistician, an amazing epidemiologist. All three of you well respected, well thought of up until this document.

51:41That document is October 2020. I had some run -ins in April 2020. But we wrote that document and you had the head of the National Institute of Health. A man named Francis Collins, a very eminent scientist. He was the head of the human genome project. But he doesn't have any epidemiological expertise. That's not his area. He wrote an email to Tony Fauci, the head of the National Institute of Alluring Effects disease, a man with a lot of background in immunology, a lot of background in HIV, but not epidemiologist. He wrote an email to Tony Fauci, calling a three of us fringe epidemiologist. Friend of mine made a card that as my name, it says fringe epidemiology.

52:21So you'd never been a fringe epidemiologist prior to that? It's not really a scientific thing. The whole idea was to excommunicate the three of us from science. That sounds like that's not how science works. I thought the whole idea of science is, you have different ideas. The only way it moves forward is through discussion of a new theory. That is the theory of it. I thought the practice of it before the pandemic. I've now met people who tell me they were silenced before in fair ways. I'll just say that that is what you just described is what I always thought science was about. It's not that I'm always right.

53:02We shocked. When the Great British Declaration happened, I'm still shocked to see an email from the head of the National Institute of Health to the head of the National Institute of Allergy in Texas. He's calling the three of us for in jeopardy. He's calling for a devastating take down of the premise of the Declaration, which led to death threats. But it's just the smear. It didn't explain where the declaration was not correct. No, it wasn't an argument. It was just ad hominem attack. A smear. It was an attempt to excommunicate us. If from on high, you have the high pope of science saying this person is the heretic.

53:39These three people are heretics. That was what it was. There were other emails that I think gave some psychological insight what was going on. Tell me a little bit about the conversations you had with your fellow writers when it was happening. Were you expecting this reaction? I wasn't expecting it from the head of the National Institute of Health to the head of the National Institute of Allergy. The disease was in the population. That study in April of 2020 led to hit pieces against my family and my wife, against me, led to death threats. I knew to expect a very weird environment for talking about this.

54:17I kind of expected that kind of pushback. What I didn't expect was that the very heads of the institutions that fund and structure scientific biomedical work in the United States to be directing it. That's a huge abuse of power by this position of Stanford. In part because I've been pretty successful at getting NIH grant money. It's just part of how you become a prominent biomedical scientist in this country is by winning NIH grants. You're like a trusted source, essentially. I've sat on NIH grant review committees for years. And your motivation in doing that original study that got you in trouble.

54:58What was your motivation in doing that study? To understand what the death rate from this disease was. Pretty reasonable. And how widespread already had been. I mean, that wasn't anyone else doing this. Why were you the only one doing this? It seems like that's the first thing you would do. I have to say I was shocked. I wrote it. For the first time that I wrote my life was in March of 2020. In the Wall Street Journal, I said we don't know what the death rate is from this disease. And call for a study. I fully expected the CDC to do that study. Of course. And why wouldn't you? Because your whole experience in life up till then was, let's do a study.

55:33Yeah, it was like for some reason. Let's find out. Exactly. It was a very strange time. So by October, I'd become jaded. The university had gone after me. My own university had gone after me. What was the first conversation between you and university? What was the call you got? What happened was we did this study. We put it out as a, normally you go, often you go through this long, years -long peer -review process. But we figured we had a result that 4 % of LA County and 3 % of Santa Clara County, where I live, had already had COVID. We had already had antibodies to COVID. And that meant that there were 50 people walking around LA County or Santa Clara County that had COVID, that the public health authorities knew nothing about.

56:14And at the death rate, it wasn't 3 or 4%, it was like 0 .2%. And there was this massive age grading with really older people, really high risk. Those were really important findings. The dot lockdowns had not worked. It was early April 2020. We'd been locking down for three weeks, and yet 3 % of the population already had it or 4 % already had it. So those were all real important messages. So we thought, okay, this is so important in the middle of this pandemic that what we'll do is we'll put it out as that. And we'll call it preprint. It hasn't gone through peer review, so we're not saying that it's been through the whole process.

56:47Put it out as a preprint. Because it was an emergency situation. Yeah, and I think the preprint process is actually quite healthy for science. A lot of scientists will put out their papers as preprints in order to get feedback from scientists before they send it a peer review. There's no one's like saying this is the exact right answer. It's like, it's scientific result. Let's discuss it together. That's what the preprint process is supposed to be. And it's not uncommon. No, in fact there's been a big movement toward open science. And preprints are a real important part of that. Right? Because you don't want, I think a lot of before the old science was it took place behind closed doors.

57:19It was really easy to kill papers if you politically you didn't like the person or whatever. This allows scientists to have access to scientific community in the open. I think it's a really good movement. And it's still quite glad for it during the pandemic. So we put it out as a preprint. It led to, first of all, what we expected, which so a lot of scientists helped us improve the paper, improve the result. Actually, the result was the same, ultimately. We were right. Just clarification. Yeah. And you know, prove that the... Yeah. And so it was, I mean, in that sense it was exactly what science should be.

57:51Yeah. It's not that people didn't criticize us. People did, and they were legitimate criticisms. And that was a good... That's how it works. Yes, exactly. You're not above criticism. Yeah. But you want criticism versus your bad smear. Right. It's brass knuckles on the ideas. Kindness to the scientists. Yes. Because the work, you're not the work. Yes. You're doing work. Here's this work outside of myself. What do you think of the work? Right. And it's not your bad. It's like singers, right? Singers sing some song or write some music. And they get, especially if they're famous, they must get a lot of praise and criticism.

58:28Yeah. They have to product, disassociate. They're not the song. They're just... The healthiest version of it is we created this thing that's outside of us. We like it. What do you think? That's all. Well, that's what science is. It's just exact same thing with science. Like here's this thing I did. Mm -hmm. And what do you guys think? Mm -hmm. Right? That's the same exact thing. Yeah. Here's my theory. Right. Is that, in fact, the only way science was born? Right. It's not a way. It's the only way. The only way. It's the only way. It's the... because no one's smart enough to really understand how the material universe actually works.

59:01Like you need a lot of minds on it and you need correction. That's part of science. Right? So we got that. We put this out. And a lot of people helplessly improve the paper. It actually did ultimately get peer reviewed and put in a journal. But then I also got... Like the hit pieces against me that were written that were entirely unfair. Lies, essentially, about... So the study was funded by small -dollar donations to Stanford University where I work. Lots of people, regular people, but also like the founder of JetBlue gave $5 ,000 for the operation cost of the study to Stanford. A journalist at Buzzfeed News wrote a piece accusing me and another professor who was on the study, Johnny and Eadies, of being unduly influenced by the $5 ,000 donation to Stanford for the study.

59:46The implication was that we took the money. It's so bizarre. Why do you think this could be? I mean, I think part of it was like the result was so counterintuitive to some people. They put this lockdown... It's absolutely extraordinary lockdown place. The damaged the lives of countless poor people stopped the education of children in this country around the world, actually. Some places for years in California, my kids didn't see the insider classroom for a year and a half. They'd done this absolutely extraordinary thing. Our results said it probably wasn't needed or it certainly wasn't working.

1:00:21That's the implication of the result. A lot of people reacted to that as if it were an attack on themselves. They'd done something that needed to get done. They thought they were doing the responsible thing. Our scientific result shows that it probably wasn't the responsible thing. They reacted by this again, this ad hominem, who were trying to expel you. The press was fully on board the panic narrative. We come out with the results as the panic narrative probably isn't needed. Now we've undermined the presses that are putting this narrative together. They're not scientists. They don't have language to attack us through science.

1:00:58Instead, they treat us like we're evil villains. What's it like? What does that feel like? I mean, you're trying to do something good in the world and you're being personally attacked. It's odd. Rick, I'm a very relaxed person. My wife always says I'm too laid back, which is odd for an academic, actually weirdly. But for me, it's just my nature. I've never felt anxiety in my entire life until that moment. In a month, I lost 30 pounds. Wow. Couldn't eat. I forgot to eat. I wouldn't sleep. And especially, I felt like helpless. There were people writing stories about my family. A lot of people helped with the study, including my wife.

1:01:36One of the things she did is she wrote an email to our kids' middle school listserv, telling people about the study. And she's a physician. In the emails she wrote that if you have antibodies, then that probably means you're immune. Or something close to that. At that time, that was like seen as misinformation. It's true. It's actually correct. So you weren't allowed to say? But you weren't allowed to say. Yeah. So she didn't know the rule. And so there was a Buzzfeed news hit piece on her for writing that. With a hint that somehow I put her up to this to recruit people for this. It was really crazy because people wanted to join this.

1:02:11They wanted to know their antibody status. I was getting calls from Stanford professors wanting to join the study. Tell me about the conversation, the first conversation with your other co -authors. What was that like? I was tremendously. So there were junior professors and students that were co -authors. I wasn't on Twitter then, but they were getting killed on Twitter. They were under tremendous stress. And they were looking to us for leadership as the senior author as a study. And I tried to calm them on. So they looked, this is a stressful thing. But we've done something really important. We found a really important result.

1:02:41You should be proud of it. And still say that to them. Many of them should buy us through the whole thing. But it was, yeah, for junior professors without the protection of tenure, I mean, it was a very tough time. People was the state silent. And the NIH guy, the head of the NIH calling us for in -general intelligence, that sent a signal to every scientist. You better stay quiet or else this will happen to you. So we put the paper out. There's these hit pieces. Stanford then starts something they called a fact finding. Really felt like an imposition. For months, I had to hire lawyers. I'd never, I mean, I've been a professor for decades.

1:03:14Have they done this to any professors before this? Was this the first time this has ever happened? I don't know. I assume they must have. They must have, they had some infrastructure for this. Wow. It never happened to me before. And somebody was like, you know, I was faculty in good standing. So it was just a very strange thing. And they're like, it felt like an inquisition. They're asking me about thousand questions about my motivations and about the funding was to Stanford, right, from this Jack Blue guy. They knew that. Yeah. And yet they, the university put me through the ring around this.

1:03:44They ultimately concluded that I did nothing wrong. Then they announced the beginning of this fact finding, with supposedly with a whistleblower. We asked them what whistleblower, what did they say? They said that they told us there's no whistleblower. Because the Buzzfeed news author had written that there was a whistleblower. But it was just a made up. Yeah. I mean, I don't know what she was talking about. Because there was the university didn't tell us anything. There was no whistleblower. So they announced the beginning of this process. How could there be whistleblower if it's made up? I mean, I think what happened is like there were people at the university did not like the result.

1:04:17And so they're like attacking us. Why would they care? I mean, it sounds like it's. I mean, part of it, Rick is just hubris, right? So some of the people at the University of Stanford are helping the government make decisions at this time. They're partly responsible for the lock down. So they were afraid that they were somehow part of a great mistake. A mistake. Yeah. They're covering their tracks. Yeah. And maybe the story they would tell themselves is, well, these guys are just wrong. And they're dangerous because they're wrong. But they're not saying you're wrong. They're smearing you. It's different.

1:04:55If you're wrong, they would try to prove you wrong. Yeah. That didn't happen. I mean, you know, that did happen, but it was a public thing where like and then the paper improved as a result. Right. But there was also this smearing. There was also this depreputational destruction on top of that. And the university instead of trying to address that by telling people who were faculty in good standing instead, they hold this process. And at the end of it, after they clear us, they don't say anything. They issue no problems. So they announced the investigation, but not the results. Right. They didn't call an investigation.

1:05:27They called it a fact finding. Okay. So they were very clear about that. But they're like, it felt like an acquisition. They announced the acquisition. They don't announce the results. The acquisition at the end of it. Do you know if that happened at either Harvard or Oxford tier two fellow writers? At Oxford, I published and say too much because it's first and after story to tell. But she went through it a terrible time. And it was tremendously stressful for her. And at Harvard, Martin No longer works at Harvard. Also, the story to tell. So I won't go to the details. But yeah, it was tough. And a lot of the 60 ,000 people, it's many of sign that declaration, the great branch of declaration, they lost their jobs for signing it.

1:06:08They lost the ability to work with colleagues on grants. They lost social position as a result of signing. They were a lot of... Is it an now mainstream understanding that you guys were not wrong? I think that in the public at large, people mostly understand that we were right. They won't necessarily know what the great branch of declaration is. But they understand that there was something wrong with the public health response to the pandemic. That in fact, we didn't do a good job protecting vulnerable older people when we harm children. That's the substance of the declaration. Everyone, I think, understands that.

1:06:41There's still the academics and the bureaucrats who designed and implemented the pandemic response are still trying to maintain that it was still the right thing to do at the time, giving the information they knew at the time. Just because they don't want to be wrong? Or they believe it? It's hubris. I don't see how they can look at what's happened in the last three and a half years and can claim a success at all. So some of them are just... They're just pig -headed. They're going to go to their grave saying that they were right. Some of them are looking for scapegoats. Well, it would have worked except for these terrible professors that undermined it.

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1:08:37Based on these people still being in power, what happens next time there's a pandemic if there is one? We locked down again. Just to be concrete, there was an inquiry going on in the UK, COVID inquiry. And it's been fascinating to watch. They've had a number of the key players in the pandemic decision making in the UK. And the line of questioning from the people that are running the COVID inquiry, the official COVID inquiry in the UK is why didn't we lock down earlier? Why didn't we copy China more? Why wasn't our lockdown more draconian? One of my colleagues, one of my friends, Carl Hennegan at Oxford University, he testified at this UK COVID inquiry.

1:09:20And he was essentially treated like a pariah because he wanted a more measured approach. He actually didn't sign the Great Britain Declaration, but he was advocating for better protection of vulnerable older people, not harming the lives of young people. And he got absolutely grilled. Whereas the people that decide on the lockdowns have just gotten to essentially pass, we're going to lock down again, Rick, the next time. With the results of the US's reaction versus let's say Africa, or let's say Sweden, I know, did something very different. It's funny, it's like Africa had among the lowest COVID death rates in the world.

1:09:58Really? Why would that be? It must be the most heavily vaccinated. No, they're not the most heavily, they've actually probably least heavily vaccinated in the world. How could that be? There are about 3 % of Africans are over the age of 65. And this is a disease that hits old people the hardest. I had an uncle and a cousin, both over 70, die in India from COVID. It's a disease that really hurts older people. The death rate is something in 2020 was something like 4 or 5%. So there's no place in the world that had a younger population that had high death numbers? From COVID. The problem is that there are many places in the world that had high death rates because of the lockdowns.

1:10:43Those killed young people. I see. Actually, they also killed old people, both. I see. And Sweden is a great example, a great counter example, right? Did Sweden lock down? No. They knew what happened in Sweden. So Sweden had a policy. They didn't close schools for kids under 16. Did Africa lock down? Some parts of Africa locked down. And there were a difference between the places that lock down versus not. No. No difference. In fact, some of the, so let me just tell you about Sweden, because Sweden's a great example, right? So they didn't close schools. They didn't shut businesses down. At the beginning of the pandemic, they made the same mistake that we made in New York City.

1:11:21They said COVID infected patients back to nursing homes in Stockholm. So you have a big death rate early in the pandemic. But through the rest of the pandemic, they had a much better job giving older people resources so that they could be protected even when the disease is spreading. For instance, they had sick leave for workers that, if they're sick, they could stay home without having to worry about being their family. So Sweden was more in line with what you were suggesting? Absolutely. And as a result, if you look from the beginning of the pandemic to now, they have lower age adjusted all cause excess deaths.

1:11:54Let me just put that apart. Age adjusted means accounting for the age of the population. So we can compare Africa and Sweden if you do the age adjustment. All cause excess deaths means not just from COVID, but deaths from everything. And excess means, well, compared to what you had right before the pandemic, last five years before the pandemic, how many deaths would you've expected? How many did you get? Right. That number is lower in Sweden than it is in all the rest of Europe. And it's much lower than it is in the United States. You can say, okay, well, Sweden has this different healthcare system, the different social system.

1:12:28So that's not a good example to compare with the US. But you can compare Florida and California. So Florida has open schools. In fact, I was involved with, there was a lawsuit against the government or Florida and the Department of Education Florida because of the decision open schools in 2020. I was an expert in that case. We won that case and they opened the schools in fall of 2020. Disney World is open in the summer of 2020. Disney Land is closed. California, my kids don't see the inside of a classroom for a year and a half public schools. And the all cause excess deaths, age adjusted all cause excess deaths are lower through the whole pandemic in Florida than California.

1:13:07Florida did a better job protecting human life than California did. I'm just adding a lestraconian way. Without the unemployment hitting the poor, without kids' lives being restricted so much, without all of the kinds of policies that we followed in California, they still got better results. And I'll tell you why. I think it's very unintuitive to people when they tell them this results. It's surely a lockdown would work. You keep people apart from each other, disease won't spread. The reason they have better results is because the lockdown is a very classist thing. It's only a certain class of people.

1:13:45People aren't going to lose their jobs when you lock down. They can replace the job with Zoom that really can afford to lock down. When you lock down, essentially you put poor people in a major bind. And you make them make decisions that are very hard decisions about like if I go out to work, I might get sick, but I stop to do it otherwise I can't feed my family. That's like the fundamental decision. And of course there are essential workers that have to work to keep things going. What makes a worker essential? That was such a violation of norms. Public health does not have the right to tell you...

1:14:21You're essential or not? We just don't have the right to do that. And yet we took that upon ourselves, let's say, because I've heard from musicians, I've heard from poets that are just... They can't believe that they're called an essential. Actually, weirdly, a lot of people wanted to be in essential. Professors didn't want to teach, right? So they're essentially saying we're not essential. Right? So it's a very weird thing. Like the essential, essentially meant that you are well -authed in racial or laptop class. And that's high social status. Right? That's non -essential. Whereas essential is low social status.

1:15:00People who have an actual job. Yeah, that actually have to work. So you have these tremendously unequal societies. You lock down and people in the upper class, the laptop class, think that it's a virtue to stay home and say, well, most of the world don't have the economic means to do that. And of course they're not going to like starve their families. They'll go do what they have to do to keep going. And the disease then will spread anyways. How were suicide rates during the pandemic? So in 2020, suicide -dality went up. A lot of like thoughts of suicide went up. I think there was a CDC study in June 2020 that found that one in four young adults seriously considered suicide during the pandemic.

1:15:4418 to 24 was one in four. A huge increase. But there wasn't increase in, in completed suicide in 2020. But starting in 2021 and 2022, you're starting to see a big increase in ER visits with suicide attempts and increases in even in completed suicides in the United States and in country after country that did lock down. Depression, anxiety at levels that are just unprecedented. Tell me what herd immunity is. How does it work? So herd immunity is a mathematical concept. And it's a mathematical concept that has a physical analog that's just undeniable. It's just a scientific fact, right? So imagine you have a society that's completely immune naive.

1:16:25They've never seen a disease. Is it called herd immunity because we think of it as it related to cattle at one point in time? I don't know the history of the term. It's really unfortunate that they have that term actually because people can misrepresent what it is. Well, it's something that affects all animals. It's not even just a human thing. Yeah, it's a biological fact. But let's supply it to humans. You have a country or society or a world that has never seen a disease before. All right? And it's an infectious disease. One person gets the disease and they go out and do their thing. And the question is, how many additional people do they infect?

1:16:59Well, every interaction they have might result in a transmission of the disease when nobody in the population has immunity. But suppose now instead, a lot of people have immunity that's this new disease. And a new person gets it. Every interaction they have will be often with people that have already had the disease. And so there's no risk of transmitting it. Let's just talk about immunity. Before we get to herd immunity, with many illnesses, once you have it, you get sick. Yeah. You heal. And then your body has antibodies that now knows that disease. It remembers the disease. And it couldn't prevent it or at least prevent it from being as strong of a response next time.

1:17:43Is that what immunity is? That's what exactly what immunity is. Now, it's not just antibodies, but other cells. Our bodies remember, in a sense, like our bodies are a history of all the disease that we've been exposed to. So we adapt to the environment. That's a version of adoption. Absolutely. And in fact, if we didn't have immunity, we would have been dead as infants. Yeah. We actually get antibodies through our mom's breast milk. Right? And then our bodies, when we're little, when we're doing babies, are quite good at adapting to new things that are exposed to. Also, all babies would just die.

1:18:16Just like, you know, how kids are good at learning new languages, much better than adults. Kids are also better at dealing with new biological exposures. It's like a clean slate. Yeah. There's just plasticity to their immune system that can just deal with new things. But once you've dealt with a new thing, your body remembers how to deal with the next time. The vaccines work this way too, right? We expose people to some little bit that doesn't make you sick, but the trains your immune system to remember how to deal with it. It's just a version of immunity. And our bodies are built that way. Now, that's the biological concept immunity.

1:18:51The epidemiological concept is that if population has a lot of people that have this immunity, then every new additional person to get to the disease is less of a threat. Then there's a side. You can't spread to all the people who've already had it. Exactly. There are less potential places to spread. Exactly. And that's what herd immunity is. I see. herd immunity is just that basic biological fact. But it's a mathematical fact, right? Right. It's a very simple thing. Is there anything that happens, and I'm not saying go to zero, but is there something? Is there some number that when 70 % of a group gets something, the likelihood of the other 30 % getting it, go down, not just based on the math, based on something else.

1:19:34Is that possible? I mean, that's exactly what happens with most many, many, many diseases. A lot of diseases are endemic in poor countries that aren't endemic in rich countries. So the physical separation of poor in rich countries reduces the spread, protects the 30%. Right? So that's why, for instance, if you go to some country, you may look up the set of immunizations you need as someone who's immune naive going into this setting where the disease is endemic. I see. Right? So that happens. That physical separation can happen, and just the fact that our world is so unequal causes that to happen.

1:20:09But then also the other thing happens. There may be people who have some resistance to a disease just naturally, maybe because, for instance, they've been exposed to similar diseases. And they're also just unknown biological reasons why some people don't are particularly threatened by some disease, and while other people are, there's a lot of heterogeneity. So both of those things happen. When young children get a cold or a flu, does that then make them stronger for the next time they get a colder flu? Or will they more likely prevent getting a colder flu next time based on that? So both happen, right?

1:20:44So you can have some diseases. I'd like the other coronaviruses are a good example. There are four or five other coronaviruses circulating in populations causing colds. And have been for a long time? Forever. Yeah. I mean, I think there's a theory that in the late 1800s, there was a new coronaviruses entered the population and caused a massive pandemic. But now it's just a common cold. I see. What happens is you get exposed to that virus as a kid. Your body remembers how to deal with it. It doesn't protect you from getting infected against that coronavirus forever. That may be variants or whatever.

1:21:21But the next time you are infected with the virus, you remember your body remembers how to deal with it. And since you got it first when you're a baby, your body was really good at dealing with this new threat. And so you're going to get it again when you're four, you might get it again when you're 10, you might get it again when you're 13, but it's just a cold over and over and over again for these other coronaviruses. The problem with this virus was most people had never seen it. In fact, everyone, no one had seen it before. How does the virus appear out of space? Like how does that happen? That is a whole other story.

1:21:58I think, you know, this is disputed, but I'll just tell you what I think. What I think happened is that we have this pandemic preparedness industry. It's funded by the United States government in part. The theory of it is that in order to prevent the next pandemic from happening, we should go out to the wild places and find the viruses and pathogens that are in the wild places and bring them into labs and play with them to see how likely they are to infect humans. Play with it means like sometimes to alter their functionality so they're more likely to infect human cells. Why would you do that?

1:22:32Because by doing that, you can say, okay, how many mutations are needed so that it can infect a human cell? If it takes 100 or thousands of mutations that are unlikely to happen in the wild, then that's a virus we don't need to worry about. It's a pathogeny we don't need to worry about. Just throw it off. But if there's only a couple of mutations, a few mutations that are needed and all of a sudden can infect a human cell, well, then we better prepare for this thing that might come from the wild place and infect humans around it. You used the word huger, Sarah. It's just the first thing that comes to mind when you tell me this story.

1:23:05It is an absolutely insane program, but that is what we've done actually for the last 20 some years. Is we've had a program to try to prevent. Has it ever worked out well? I don't think of a single example that they can point to of having prevented any. Actually, you know what? You might even say COVID is an example of a success story. How do you mean? Well, why do we have a vaccine for the COVID four days after we first discovered the sequence of it? That's odd. Yeah. And that is because this virus was a virus that this pandemic preparedness industry had been studying before, including in Wuhan, is the research that had been done around coronaviruses and around particularly viruses very similar to this one, that lead to the vaccine being developed, the vaccine target being developed so rapidly after the discovery of the virus.

1:23:55All that I think is entirely uncontroversial. Everyone agrees with that. The part that is controversial is the virus itself was the pandemic preparedness industry itself, the research that was being done in it, the cause of the pandemic. That's the lab leak hypothesis. The lab leak is not even an interference thing. I'm working with this thing with pipettes and a mask and my mask slips because it's a boring job and I get sick. I go home, I get my wife's sick and she gets the kids, everyone gets a kid's sick and it spreads. That's a lab leak. That's one theory. The other theory is that it's in some bat, in some wet market in China, right in Wuhan, and it's spread from there.

1:24:35Those are the two theories. I suspect that it's the pandemic preparedness industry that's deploying, right? Based on the four -day response? There's a lot of data points. There's molecular biological evidence. There are features of this virus that in my view are not possible that have happened through evolutionary processes. If we know that it's not possible through evolutionary means, what would be the benefit in creating that? A thing that can't happen through evolution. We create it so we can protect ourselves from it, but it can't happen naturally. It leaves me befuddled. Rick, if you ever read the story of Pandora's Box, right, you have this box, you want to understand it, so you open it.

1:25:24And all hell comes out of it, right? I think a lot of science is just driven by pure curiosity. What if we put a fear and cleaver's sight into this place? What would happen? Maybe we know fear and cleaver's sights are important for entering human cells in this way. What would happen to this virus if we allowed it to do that? Maybe that's an evolutionary response. Maybe it's possible to get a fear and cleaver's sight and do a virus that way. I think they're just asking why questions, but they're playing with fire. There are some scientific questions we don't allow ourselves to ask. So we banned nuclear testing.

1:26:00The scientists would tell you that there are things we learn from nuclear testing allows us to keep our nuclear arsenal fresh. But we say, no, this is scientific knowledge. We don't really want to explore because it's bad for humans. Even the exploration itself is bad for humans. We have these conventions that prevent research on chemical weapons. We just say, this is a scientific area that's outside the bounds of human curiosity.

1:26:26You mentioned peer review earlier. Tell me about the peer review process. Your experience with the peer review process? How does it work? Strengths, weaknesses. So peer review is there's nothing magical about it. So I write a paper. I have some idea. I go collect data. I do this. How many times have you been this? I think I've published 170 papers in my life. I write this paper and I say, OK, I want other people to believe this paper. I want people to change it. You're presenting a case. You're making an argument. Right. And so I send the paper to a journal. A journal is just a place where people collect these papers.

1:27:00And so the editor looks at it and says, well, this isn't really right for the journal. Well, I don't think this is true. And then rejects it. That's one possibility. In fact, that's modal possibilities. Sometimes the editor says, well, this is interesting. Or maybe other people will be also curious about this. But I don't know if it's true. So then they send it to people that they trust. Other friends of theirs generally or other people with some reputation in this field that presumably know something about the paper I've written. Often they have to send it to like 20 people to get three to agree, but you know, that kind of thing.

1:27:32I know this because I've been an editor of a journal, or a sociator of a journal. So I send it and then these experts who agree to review it will look at it. And they'll just, my experience of peer review is they'll be very nitpicky. Well, this doesn't look right. This doesn't look right. And then also make a recommendation to the editor. Take the piece or don't accept the piece. Often they'll say, well, if they can address all these questions I have, then take the piece. And then the editor has a choice to make. They send back the authors along with all of the questions, the reviewers that have.

1:28:02You change the paper, you answer the questions, and eventually there may be more than one round. The editor says, yes. So you're all working together to advance science, essentially. Yeah, I mean, that's the idea. Like now we have multiple people who have some expertise in this looking at the paper. That's the ideal, right? A lot of times it's perverted, right? So for instance, a paper comes into an editor. It's challenging something that editor wrote 15 years ago. And the editor doesn't like that because they don't want their paper to become obsolete. And so they just say, I don't want it. I'm not interested.

1:28:36This can't be right. There's pharma money, this special issue is funded by pharma. And so they send it to like friendly reviewers. They're friends with the person that's sending the paper in. Or their students or their enemies with. I mean, there's like sciences filled with humans, right? So there's all these like petty intrigues. And that can alter the process. But even at best what it is is just a few people, five people thinking about this paper together. And saying, well, this is, they've answered my questions. It doesn't mean it's true. It's just we've answered your questions. Then it's published.

1:29:12It's a great day for celebration because like you've gone through this years long process to finally get this paper that you've worked on for a long time out. And the world at large looks at it like, oh, it's, it's true. It's not necessarily. It's always a theory. It's a theory that has been pulled apart and tested by knowledgeable people. And they're on board with it. Yeah. But nobody knows what's true. Yeah. And there are other things it's really bad at, right? So there are examples, for instance, of people making things up entirely, making up data. This happened during the pandemic, actually, with some of the top medical journals on, there's a paper on hydroxychloroquine.

1:29:52With data, as best we can tell, was can tirely made up or very close to entirely made up. Really? Yeah. They found that hydroxychloroquine didn't work. It's based on other things. But like there's, there's this paper that was published in the New England Journal of Medicine and in the Lancet with these fraudulent data set that found that, they haven't happened often. I don't know how often it happens. There is a major reproducibility crisis in the psychology literature, for instance, finding that a lot of the papers there were not reproducible. How did they get this result if it's not reproducible?

1:30:26Was it made up? Was it because it's just some fluke? There are a lot of incentives to like make stuff up, actually. What are the incentives? You can get tenure, you can get eye social position, people will look at you like you're, you published in these journals. That's the reason. Did you have something just happen at Stanford, the president at Stanford had a step down for falsifying data? Yeah, I mean, very close to that. So he published papers in the early 2000s, where there was some of the key pictures were photoshopped. The photoshopped meaning what? Okay, so you have a picture of a neuron and you copy the picture of the key neuron, you put it in another place also in the same picture.

1:31:10To tell a different story than what you actually saw. The defense is, well, it's just to make the story clearer. But yeah, it's like it's photoshopped. That was the allegation and it was true. But now the defense was, well, look, the result is still right and it was part of what we just did at the time. Like this was accepted among by the journals at the time. So that means the peer review process accepts certain things that if you tell regular people about it, you go, what the heck? Well, how can that be? That happens all the time. Like there are norms in science that are, that shouldn't be norms.

1:31:46And all the peer reviews agree that it's a norm and then we just don't even think about it. We have blind spots. You don't actually send the actual data to the peer reviewer. The peer reviewer is just reading the paper. They're not trying to replicate your result. They're taking your word for it that there is no... So nobody tests the data. The data is just always accepted. Yeah, so well, the open science movement, which I've talked about before, the norm is that if you have a published paper, you also make the data publicly available so anyone can go check. But that doesn't make it true. Even still, but at least there, now someone can go check.

1:32:25Yes, I want to go check. How many people are going to test data in paper? If it's a really controversial result, you'll get a lot of people. If it's the modal result, no one will look at it ever again. Tell me what it was like editing. It's hard to get people to agree to review a peer review of paper. It's completely fangeless. Generally, it's anonymous. And you have to read carefully somebody else's work. That's not advancing your career. And so getting people to review a paper. And then when the peer reviewers come back with lots of questions or criticisms that the author think is unfair, and you have to tell the author, like, why can't I take the paper?

1:33:00They get very upset with you, the editor. So in a way, it's like a thingless job. But on the other hand, it's like you get to see new results. You get to see people discussing important topics about that that you care about. It's actually in that sense, great fun. Can you remember the most interesting story that you got to edit for a journal? I mean, there have been some results I was looking at around like the way the disease spread in nursing homes, that was quite interesting actually. They tracked people using their phones, nursing home workers, from one nursing home to another, because they work in multiple nursing homes.

1:33:38And they show that that actually spread the disease, the COVID into multiple nursing homes, because of the way we structure our nursing home labor. I thought it was a really interesting result. Really interesting. Yeah. So it's suggested a policy we could have done. We could have restructured nursing home labor so that we reduce some of that. What would you say we've learned from the pandemic that's going to make the response to the next pandemic, if there is ever one much better than last time? I can tell you what I hope. We've learned, and I can tell you what fear that we haven't learned. So first of all, the pandemic policies that are best suited for the relatively well -off are not well -suited for the poor.

1:34:20I call it trickle -down epidemiology. The theory is that we protect the laptop class and that automatically protects everybody else. That's a lie. And we've learned that doesn't work, I think. And we've learned that those social disruptions of the lockdowns harm the poor, the working class, and children in ways that are not recoverable. Right. So just one example that we haven't mentioned is like what happened to the poorest people in the world. The UN World Food Program in early April 2020 did an estimate suggesting that 130 million additional people would face starvation as a consequence of the economic dislocation caused by the lockdowns.

1:35:01We close schools all over the world. Let's just take Uganda. We close schools for two years in Uganda. There's no Zoom school for many of those kids. They don't have electricity. Many of them never came back after two years out of school. We have accelerated inequality into the next generation. And if you look into why they didn't come back to school, a lot of the families were thrown into such dire poverty that they had made the decisions whether to like send their kids into sexual slavery or child labor. Why would a family do that? Because the alternative was that the kids would starve. The family would starve.

1:35:36We put a tremendous number of people into dire poverty with the lockdowns. That is I hope a lesson that we've learned that you can't just stop the world and think that it's going to be good for health when for the vast majority of the world, billions of people, it's tremendously bad for health to have the world stop in that way. I think we've learned, at least I hope we've learned that when you have a situation like we had with COVID, that you can't just say some scientists with actually really narrow expertise, epidemiology, verology or immunology, should be able to make decisions for everybody else.

1:36:16The world and infectious diseases even are much more complicated than that. And they need many, many, many minds with many different kinds of expertise. I remember at the early days of the pandemic, because I have this economics PhD, people would tell me, why are you talking? Like my friends would write to me saying it's not time for economics. I was actually talking about epidemiology then, but that idea that we shouldn't have other people with different expertise. We should have had poets, we should have had philosophers. Will you never know where you're going to get information? Like the idea that the only people who have any information is the believed expert in that area.

1:36:53I think it's a small way of thinking. And you had this like scientific bureaucracy that was, hubris was the watchword, like you had Tony Fauci going on CNN's complaining about Rand Paul's criticizing him saying, look if you criticize me, you're not simply questioning a man, you're questioning science itself. Let me think about that. Why would you think that about themselves? Like to put themselves in a position of like, you know, just God -like position, we should not be trusting people. Where do these decisions come down, especially on a global basis? I understand it when it happens in a country, but when the same things are happening all over the world, how does that happen?

1:37:31How does that work? The World Health Organization issued a report in February 2020 saying that what the Chinese did worked, the lockdowns in January 2020 had worked and they recommended the world lockdown. And country after country followed that advice. They looked to the United States also, a tremendous number of people, epidemiologists, the scientific community, a lot of science of the world runs through the United States. And you had top scientific bureaucracy in the United States fully endorsing a lockdown in March 2020. Advising governments everywhere, they also have a lockdown. Is a one -size -fits -all solution globally ever a good idea for anything?

1:38:13No. I mean, well, you know, I can't say that. Is there any case where the right thing to do in Africa is the same as the right thing to do in the Antarctic? I guess I could think of a few things, right? So like, you know, we want to make sure that antibiotics are available if there's a bacterial infection, right? That's the right thing to do everywhere. You want to vaccinate kids for measles everywhere, right? Beasles of deadly disease for kids. That's why the vaccine is such a boon. But to answer your other question, I think for the vast, vast majority of decisions that we make, what's good for one country is necessarily good.

1:38:49And certainly what's good for rich countries is not necessarily good for a poor country. In Africa, they stopped vaccinating children. They stopped malaria control efforts. They diverted those things into COVID control. Well, COVID is like very far down the list of problems in Africa, right? Malaria is a much bigger problem in Africa.

1:39:14We took public health resources and divergated from things that really mattered to something that didn't because we were scared.