Dr. Fauci on How Diseases Have Shaped the Course of History

0:00I'm recording this on a Monday, and Monday is our grocery store day in our family. I usually pick my kids up from school and we go over to Whole Foods, get all our groceries for the week. Although here very shortly, we're going to go over there to get our Thanksgiving turkey because they've got a bunch of great options. Turkeys start at$1.49 a pound if you have Prime with organic birds at$2.99 a pound. And they only carry no antibiotic ever turkeys that will bring quality to your table at a great price. Whole Foods has great everyday prices on all your Thanksgiving essentials, whether you celebrate with a massive family or just a few close friends.

0:36Everything they sell has high standards to help you shop with confidence. Enjoy so many ways to save on your Thanksgiving spread at Whole Foods Market. At Designer Shoe Warehouse, we believe that shoes are an important part of, well, everything. From first steps to first dates, from all-nighters to all-time personal bests. From building pillow forts to building a life. For all the big and small moments that make up your whole world, DSW is there. And we've got just the shoes. Find a shoe for every you from brands you love at brag-worthy prices at your DSW store or DSW.com.

1:18Welcome to the weekend edition of The Daily Stoic. Each weekday, we bring you a meditation inspired by the ancient Stoics, something to help you live up to those four Stoic virtues of courage, justice, temperance, and wisdom. And then here on the weekend, we take a deeper dive into those same topics. We interview Stoic philosophers. We explore at length how these Stoic ideas can be applied to our actual lives and the challenging issues of our time. Here on the weekend, when you have a little bit more space when things have slowed down. Be sure to take some time to think, to go for a walk, to sit with your journal, and most importantly, to prepare for what the week ahead may bring.

2:10Hey, it's Ryan. Welcome to another episode of the Daily Stoic Podcast. Got up very early this morning, got my son off at school, drove to the painted porch, hopped in a car. There's a driver waiting for me. I drove two and a half-ish hours to Houston, where I am about to give a talk. Then I'm here in this hotel room, which I will not spend the night in. I'm in this hotel room for about 30 minutes before I go on stage. I'll be in the hotel room for a couple hours before I head to the Houston airport, hop on a flight to San Diego. We're doing another talk. And then I'm back, I think before like 10 o 'clock PM tomorrow.

2:54So a little glimpse into my life. Just had a long family trip. We were in Florida and then we went to Disney World, etc. It's funny, my son's doing this thing now where he doesn't like that I tell him to wash his hands and he wants to, he goes, can I just use hand sanitizer? And I was like, look, there's nothing wrong with hand sanitizer. But it's funny, there's a New York Times piece just about this, about how hand sanitizer is not bad. I mean, it's better than not doing anything, but soap is much better. And I was sort of going like, look, dude, you know how I make my living, which is that I go around giving talks and I can't do that if I'm sick.

3:35And so here's what happens. You go to the bathroom, you touch freaking everything in the bathroom for some reason. Then you don't want to wash your hands. Then you pick up something because we're at Disneyland. There's thousands of tens of thousands of people from all over the world. You're going to get something. You get sick. You think that's fine because you just have to get to miss school. But then I can't do my job. And my job is how we paid for the strip to Disneyland. So I was just I was trying to have a little basic conversation with him about public health. Because when I was like, wash your hands, you could get sick.

4:06He's like, does that mean I miss school? He was just thinking about how the decision impacts him personally. And I was like, haven't you seen this happen? You get sick, then your brother gets sick, then your mom gets sick, and then I get sick. And then I go to the office, I could get our employees sick. I could go give a talk on stage, the people I meet backstage. I was just trying to explain to him, show him how the individual health decisions that we make have impact on other people, which of course is a very stoic idea. Mark Sreus, of course, lived through a plague, the Antonine Plague. But the Romans had only a rudimentary understanding of public health.

4:43And most of us only have a rudimentary understanding of public health. I'm recording this the day before, I think, Health and Human Services Secretary will be up for his confirmation hearings. I won't get into my thoughts on this person because I prefer not to speak about this person. But that leads me to today's guest, Dr. Anthony Fauci, a physician, scientist, and immunologist, former NIAID director, chief medical advisor to multiple presidents. President George H.W. Bush once said that Dr. Fauci was his hero. The idea of public servants, nonpartisan individuals who work for the greater good, the common good, as Mark Struis talks about over and over again in meditations.

5:33Dr. Fauci served the American public health sector for more than 50 years, has acted as an advisor to every U.S. president since Ronald Reagan. And this discussion we have, I thought was really important because talking about this idea of how interconnected we all are, the invention of public health, the role of public servants, public service being very different than politics. Do I understand this is going to be a controversial episode? Yes. Are some of you going to be inclined to put nasty, crazy comments on here? Sure. But I have come to understand from my writings on media and such that there are multiple viruses out there, not just viruses like COVID or polio or whatever, the flu, but there are viruses we can get in our mind.

6:22And the person I was alluding to earlier is a person who's not just caught a very toxic virus, but spread a number of toxic viruses, including the virus of antisemitism. And it's been fascinating to me to watch that happen in overdrive since COVID. And it calls to mind a quote I've used many times from Mark Schruess, where he talks about how there are two types of pestilences, two types of plagues. There's ones that can affect your character, your mind, and then one that can affect your body. And Marcus probably died of the one that could affect your body, but he tried to stay clean of the one that could affect your mind, the one that makes you cruel, the one that makes you indifferent to how your actions affect other people, the ones that makes you fall prey to conspiracy theories and nonsense and all of this stuff.

7:06Dr. Fauci seemed like a nice person. I don't agree with every decision he made in the pandemic. I certainly don't agree with every decision. politicians I voted for did either. I think COVID was a massive public health failure. There were some big successes. There was also some enormous failures. I just look at an event that killed a million and a half or so Americans, millions of people all over the world. And if you look at that and you think, oh, we overreacted, I don't know what to tell you. This episode is not for you. The Daily Stoic is probably not for you. My work is probably not for you.

7:44You can do what you want. I think about how my decisions, the decisions I make personally and in my family affect other people. And I think that this idea of creating systems and structures and programs and things like vaccines, et cetera, where we make inconsequential individual decisions, but cumulatively have a big impact on the public health. Well, that's just about one of the greatest philosophical, medical, and political inventions in human history. And that's what I wanted to talk about in today's episode. Oh, and a slight backstory on the recording of this episode. So we were supposed to do it on one day, and then he canceled the morning off because he came down with COVID, which I heard about before it was a news story, which I thought was interesting.

8:28And then he had to cancel again a couple weeks or months later because he found out he came down with West Nile virus, which also we heard about before it went public. So this was a long time coming. It's not coming out right now for any timing reasons other than he was nice enough to schedule the interview and then reschedule it twice despite his health issues. So I thought that was interesting. Anyways, you can check out his new book, On Call, A Doctor's Journey in Public Service. I also really liked the book, The Great Influenza. That was one I read during the pandemic. Michael Lewis's pandemic book is really good.

9:06And then I read and recommended a book, I'm forgetting the title, but I thought it was really good on the race to invent the polio vaccine, which I would encourage everyone to read also. I found it very fascinating. Anyways, let's just get into this. I got to go downstairs. I got to iron my sweater and then run down and do my talk. That's my day today. Enjoy this episode. I'll talk to you all again soon.

9:31I was getting worried about you because the first time we were supposed to do this, you got COVID. And then the second time you got West Nile, I was worried that this might be bad for your health. Just the fact that I was on your schedule. I would do anything to get out of it, even get sick, right? Yeah, exactly. West Nile sounds rough, though. No, it was really a terrible experience, Ryan. It's a terrible disease. About 80 % of people, mostly young, otherwise healthy people do very well and sometimes don't even know they're infected. They either are asymptomatic or get a mild flu-like syndrome.

10:10But particularly for people who are older than 70, 75, or who have underlying medical conditions, it's a very serious disease. I mean, it can have lasting neurological deficits. I mean, people now that they've known I've gotten infected have emailed me and telling me about their own experiences, and particularly people who are older, like I said, 70, 75, 80, who actually have a significant degree of mortality associated with it. And for those who survive, often they have neurological deficits. They can't walk well. They can't use their limbs as well as they could. That's the reason why when I recovered, I wrote that op-ed in the New York Times calling for more research on trying to get a vaccine and drugs.

11:07And I wasn't criticizing the biomedical research community because I was the director of the institute that should have done that for over 38 years. But I think the only way we're going to get a vaccine is if we do an international study involving countries that have a higher incidence of West Nile because the incidence on a yearly basis is so inconsistent. It's very tough to put together a meaningful clinical trial that will get you consistent results. Well, I imagine it surprised you a little bit. Obviously, you knew that it existed, but I imagine that wasn't your first guess for why you were feeling the way that you were feeling.

11:50Well, no, it was so sudden. I put two and two together because we have a lot of I live in the middle of Washington, D.C., in the northwest section. There are a lot of trees around and in the summer, a lot of mosquitoes. And this year, the swarming mosquitoes was much more than I had noted in previous years. Um, so the idea that there was some West Nile virus around, you know, 46 to 48 of the states have had cases of West Nile this year. When I got sick, I, you know, my physicians thought it was some form of sepsis. So they put me on antibiotics. Fortunately, they also drew a serology for West Nile.

12:37and I was on treatment for several days for a sepsis that I didn't have. They were assuming I had a sepsis that was the site of which was unidentified. And then finally, after six days in the hospital and five nights when I went home and didn't improve at all, all of a sudden, the diagnosis came back with the blood test and we stopped the antibiotics. But then what began was the very long, arduous road to recovery, which actually took a month and a half to two months to really recover. It's fascinating to me and kind of terrifying just how much of history is shaped by a little bug or a flea or a bite, a mosquito, just the idea that this little thing until relatively recently, we didn't even know where these things were coming from.

13:32I am fascinated by the way that global events in history is shaped by these, you know, the right person at the wrong place, the wrong person at the wrong time. History is a history of disease and illnesses and viruses. Well, you know, diseases and outbreaks have shaped civilizations from the beginning of and before recorded history. No doubt about that. But the point you make about mosquitoes, I mean, if there was one animal that was responsible for more deaths than any other. It absolutely is the mosquito, no doubt. I mean, that's, it isn't even close. You know, people worry about snake bite deaths and shark deaths and things like that.

14:16That's nothing compared to what mosquitoes do. And yeah, our understanding that mosquitoes carry illnesses is relatively recent, right? We used to think it was like, what do they call it? Miasma or something? Like just like these vapors or odors, but it was, it's been the mosquitoes the whole time. Well, at least for some diseases. Yeah. We've driven so many species into extinction, and yet we leave the mosquito unscathed. Yeah. There's a lot of them around, Ryan. Sure. Well, history being shaped by disease, that's, I guess, where your work and my work intersects. I write about Stoic philosophy, and it wasn't until the middle of the pandemic that I made the connection.

14:56It was obviously there the whole time. But, you know, Marcus Aurelius, the emperor of Rome, the great Stoic philosopher, is the emperor of Rome during the Antonine Plague, this event that shapes not just the course of his life, but human history. And his doctor is Galen. His personal doctor is Galen. Yeah. Interesting, isn't it? It is. Well, just that we have the same problems. Like, they would have been overwhelmed by the idea of a plague or a pandemic. It would have exacerbated not just public health, but itself was exacerbated. There's this great new book out called the Pax Romana. And one of the things it was looking at is there had been a series of droughts which had led a number of refugees to travel great distances inside the Roman Empire, which is what had led to the spread of the Antonine Plague.

15:46So the interrelatedness of all these different things is fascinating to me. Well, yeah, I mean, there are so many, you know, overlapping, confounding factors. In the modern time, Ryan, the idea of the global spread of pandemics is related very much to the remarkable ease with which one can travel around the world by airplane. I mean, back before there was that type of transportation available, if there was an outbreak someplace in the Far East or in Africa, it would take forever, if at all, before it got to the Western Hemisphere. Now, you get on a plane and 18, 20 hours later, you're anywhere else in the world.

16:36Sure. So you're right. I mean, it goes back to, you know, historic times with the plagues that you mentioned. And yet, as we get more modern, even with antibiotics and vaccines, we still have transformative outbreaks. You know, 1918 pandemic influenza, you know, killed anywhere between 50 to 100 million people in a world in which the population was one third of what it is today. So if you did the math and extrapolated that to today's population, that would have been a horrendous toll in suffering and life loss. Yeah. And I think the Antonine plague, you know, we think of because of the influenza or we think of COVID, we think, oh, these things last a couple of years.

17:23But I think the Antonine plague was like 15 years. So just imagine the threat of that overhanging a society for more than a decade, just how demoralizing and confusing and disorienting something like that would be. Yeah, for a number of reasons. One, you don't know what it is. That's the first thing, which is, as you said, extremely demoralizing. And there are no interventions. I mean, back then, there were no antibiotics, no vaccines, and no treatment of complications. I mean, no intensive care units, you know, no good medical practices to help people with complications from the underlying infection.

18:03Yeah, they believed that the burning of incense might ward off the vapors or the germs or whatever. They had some sense it was transmittable, obviously, but how they did not understand. And this one historian was talking about just how strange Rome must have smelt. right you have bodies piling up in the streets decades of you know people dying you have the poor sanitation of that time and then you just have incense burning everywhere that death would have literally been in the air you could smell it and how how surreal and horrifying that must have been yeah for sure he has a quote that that struck me during the pandemic maybe you already know this one but but i found it to be very true the the only sort of overt mention that marcus really makes of the plague in his meditations is he says, look, there's two types of plagues.

18:53There's the one that can destroy your life, and there's the one that can destroy your character. And that struck me as him observing something fundamentally true about the pandemic experience that we just went through, which is that you can be infected by all sorts of things during a pandemic, not just the virus that is making people literally sick. Well, no doubt about it. I mean, the stress that a pandemic puts on society brings out the very best of us and in some respects, the very worst of us. I think one of the real historically consistent negative aspects about outbreaks is the stigma that is associated with it.

19:39Like, who is to blame? Someone needs to be blamed for this. And if you happen to be getting sick, there's even a stigma associated with the illness itself, because they think that you're going to spread it to someone else, so you're stigmatized. And yet you also see a lot of heroes and heroines in outbreaks the way we saw, you know, just most recently in COVID with the health care providers who put themselves early on when they didn't have good personal protective equipment, put themselves at considerable risk of exposure, illness, and even sometimes death in doing their job. So pandemics are extraordinary experiences when you're bringing out different elements in society that were always there, but that get magnified during an outbreak.

20:34Well, I also feel like we all have this part of ourselves that doesn't like when things are true. So like, I'll see this with my kids, right? I'll go, hey, they want to go somewhere to go, hey, it's closed right now. You know, it's nighttime, it's closed. And they'll get angry at me being the bearer of the news that I have nothing to do with, right? And I think you watched during COVID and you watch in all sorts of crises where there has to be some kind of response or there are consequences to something happening and people deciding that they want to blame other people for the unavoidable reality of a situation.

21:11That strikes me as maybe a historical perennial part of pandemics and public health crises, not just wanting to blame an individual who you think is causing the illness, but wanting to hold someone accountable or responsible in terms of your resentment for consequences that you don't enjoy having to deal with. Absolutely. And we've seen that with COVID. COVID was particularly noteworthy in the annals of outbreaks because, at least in our country, it took place right in the midst of a profound degree of divisiveness in society, where we weren't pulling together as a society with a common enemy, namely the virus.

22:00It was almost as if we were fighting with each other, which the worst possible thing you can do when you have an outbreak of an individual single pathogen, SARS-CoV-2, which is, as we know now, looking back, has already killed 1.2 million Americans. and that you have the kind of not only disagreements, but actually attacks on each other for recommending a vaccine or recommending wearing a mask. That seemed almost inconceivable that the politics of the day was inserted and influenced greatly whether a person would or would not do something that would protect their health, like get vaccinated. Yeah.

22:53Extraordinary. Well, I was thinking about public health, right? We think of it as this thing that's kind of always existed. But of course, it's an invention. And you might say kind of a modern invention, right? It's a series of solutions or a methodology. It obviously differs between different public health crises. But the idea that society can solve or significantly address a collective action problem like a virus or any kind of disease, that wasn't always with us. I mean, your point about the Roman Empire is when a plague happened in medieval Europe or a plague happened in the Roman Empire, it just was what it was.

23:36There wasn't anything you could do about it. But we we have invented this thing called public health that not only allows us to deal with those things as they're happening, but more impressively prevent some of them from happening in the first place. Right.

23:56Thanks to Toyota Trucks for sponsoring this episode. When I bought my ranch in 2015 out here in Basko County, I drove my car about halfway down the dirt road that we live on, thought this isn't going to work, stopped, parked it, walked the rest of the way home, borrowed my wife's car, drove into Austin and bought a truck. What I bought was a Toyota Tacoma. And this truck wasn't just transportation getting me to and from my house. It unlocked a whole different style of living for us, not just on the ranch, but in our little Texas towns. There were places I could go now that I couldn't go before, especially out here in the piney forests, through the fields, and on the unpaved roads like the one that I lived in.

24:42We got to go deep into the hill country's wild beauty. We've driven all the way out to East Texas. We've driven across the country. And by we, I mean not just my wife, but both my kids who I drove home from the hospital in that truck. Toyota trucks are built for those who understand that the best adventures happen when you're willing to veer off course. Because you never know when you'll end up on a Toyota adventure detour. And of course, this is stoicism too, because every detour, every obstacle is an opportunity. But it's helpful if you can handle the difficulty inherent in that. If you've got the resilience and the right companion to make it wherever the road takes you.

25:21Discover your uncharted territory. Learn more at toyota.com slash trucks slash adventure dash detours. We just took our kids to an outdoor performance at the Nutcracker. They had a snow cone and then they went insane in the car ride home. And one of the things I try to remind myself when that's happening is that I don't control my kids' behavior, especially when they're too far gone like that, but I do control how I respond, right? That's stoicism, but it's also what Dr. Becky talks about. Dr. Becky is a clinical psychologist and a best-selling author, and she founded Good Inside, which is there to give parents practical, actionable tools for handling those everyday challenges with confidence.

26:04My wife introduced me to Dr. Becky's books. I love them. I've recommended them a million times. I've had her on the podcast. And as it happens, Dr. Becky is hosting two live Q &A events for good inside members. I am one of them. She signed me up for it about a year and a half ago. I've loved it ever since. On December 1st, you can join Dr. Becky for her How Not to Raise Assholes event, which is about avoiding entitlement and raising kind, empathetic kids. And on December 15th, she's hosting her How Not to Lose It over the Holidays event, which I'm sure we could all use. As I said, I'm a big fan of Dr.

26:41Becky. She's been a great influence for me as a parent and just as a human being. And Daily Stoic listeners can join for 15 % off with code STOIC15. You just got to head over to goodinside.com to catch the events.

27:02How do you think about public health as an invention? Like not just this thing that people take for granted? No, I mean, the word that you use is interesting as an invention. It kind of really evolved when the realization of how an infectious disease or even a chronic illness, because public health is not only just infectious diseases. Right. I mean, public health is the epidemic of obesity and the negative effect of things like smoking on health. Lead in the water. Exactly. That's all public health. And the discipline of public health does go back a very long period of time. But the structure that it has now, I mean, we have multiple schools of public health in the United States, usually located physically within the confines of a medical center.

27:58When I was going to medical school, there was almost no schools of public health. Wow. And that was, I mean, that was a long time ago. I went to medical school, 62 to 66, and we had a lot of good medical schools, but we didn't have schools of public health. It became an important discipline, you know, over the last 50 to 60 years. Yeah, that's sort of what I mean. Yeah, you're right. Things like an aqueduct that brings fresh water to a city, that's a public health invention. But we do kind of take for granted how modern and recent a lot of the breakthroughs in public health are. And you certainly see this just in like a statistic about the decline in infant mortality.

28:41Like Americans used to take it for granted that maybe not all your children would make it to adulthood. And it was a lot of hard won innovations and small breakthroughs that got us to where we are now. Well, I think, I mean, there are many factors that have diminished dramatically the childhood mortality and the young infant mortality. But without a doubt, vaccines is right high above that. I mean, prior to vaccines, you're absolutely right. That was the reason why people had so many children, because they knew that a certain proportion of them likely would not make it. Yeah. We've seen that throughout history, not only, you know, in our own country, but throughout the world.

29:27I mean, one of Lincoln's children dies from drinking contaminated water from the well at the White House. Like the idea of how history was impacted by these sort of public health failings. We kind of gloss right over it as though these things weren't preventable. But I guess, thinking about it, the reason I'm calling it an invention is that it strikes me that it's all built around a somewhat fundamental paradigm shift or an insight that we have, which is that our health is not independent from each other, that the health of a society affects the health of an individual. One of the most beautiful lines in in Mark Surrealis's meditations, and maybe he's speaking about this during a plague, is he says, you know, what's bad for the hive is bad for the bee.

30:15The idea of collective health that are that our fates are tied up in each other. I mean, I don't think society always believed that. No, they don't. But it is absolutely true. I mean, particularly when you're dealing in the area that's my area of infectious diseases, you know, when you have a decrease in the proportion of people who get vaccinated against a highly transmissible agent like measles, when the vaccination level goes down to below a certain level, you can get outbreaks that would then involve the vulnerable. So it's almost as if the society can protect the individual vulnerable ones by having a blanket of protection over the entire community.

31:05And when you diminish that blanket by decreasing the percentage of people that get vaccinated, for example, against something like measles, then you not only endanger yourself, but you create a danger to the entire community. I read a book about the invention of the polio vaccine a few years ago, and it struck me that even then people were struggling with this idea of why should we be made to do this experimental thing? How does it affect me? Like the idea that we've always been on board with collective health is not really true. I think people struggle with the idea of why should I do this thing that may or may not help me?

31:50Because we struggle with the idea of, hey, if we all do it, we all get safer. Yeah. I mean, there is that issue. It's called societal responsibility that some people want no part of societal responsibility. They are part of society, but they pull back on any societal responsibility that they have. And that's really unfortunate because that leads then to some of the negative consequences that you see in public health. Yeah, that's true. And I think there's part of the human psyche that wants to think, well, I'm not vulnerable to this thing, so why should it matter? And it's almost like the failure of imagination to be able to think, but I have children that I care about, or I have grandparents that I care about.

32:42I have people I've never met that I might care about in the future. You know, it's like we lack the imagination to have the frame of reference to be able to think, oh, this thing actually is in my interest to do. Yes, exactly. But I was curious about your experience. You talk a lot about it in your book about the AIDS crisis. That strikes me as another example where society is able to go, well, this is a thing that's affecting people that are not like me or people who have a lifestyle that I don't approve of. They deserve it or they're bringing it on themselves. But again, it's a failure of imagination to imagine how this thing could spread through society and affect you, how actually it may affect someone you know or care about because you just don't know everything about them.

33:31And then the other element is, hey, if society can solve this vexing problem for this group of people that maybe doesn't affect you, are there not positive benefits that could ripple through society in the same way that it doesn't seem like going to the moon is going to be good for anyone? But actually, society develops a capacity through solving that really tough collective action problem that has a bunch of positive ripples. The AIDS situation is an interesting situation because I think you hit upon something where people would say, does society have a responsibility to try and counter HIV by developing of life-saving drugs and methods of prevention and pre-exposure and post-exposure prophylaxis, but mostly treatment that are now life-saving?

34:25And the answer is an absolute yes, even though in society there will be people based on their lifestyle that would be almost impossible for them to get infected with HIV. That gets back to what we were speaking about a moment ago, is what your societal responsibility is. Because, sure, it might not affect you, but, you know, how many times have I seen an adult say that to find out that their child is a young gay boy or man who's actually now at risk for getting infected? Well, it turns out through a series of tragic social circumstances becomes an injection drug user and gets infected. Or gets a blood transfusion.

35:12That's not a situation now, but it was at a time. Yeah. Yeah. So that's what I mean. It's like a failure of imagination. we lack the ability to think about how someone else's fate could become our own or become interconnected with our own. Even though we know invariably are on a long enough timeline, we are all kind of interwoven with each other. Yeah. Again, it gets back to what I was saying about, and I feel strongly about that, about societal responsibilities that we have, not only within our own society, but I think also even globally. If you want to talk about HIV, and one of the most extraordinary endeavors that our country has undertaken in the arena of global health was during the presidency of George W.

36:08Bush, when we put together the President's Emergency Plan for AIDS Relief, or PEPFAR, which is purely directed at the developing world. PEPFAR is not something for people in the United States to benefit from. It was a program that I helped develop with the president back in 2002, 2003, in which we originally aimed when we saw that the drugs that we had developed from 1987 up beyond 1995, the year 2000, that took a disease that was almost universally fatal and turned it into a disease where people who took their medicines could lead essentially a normal lifespan. The problem with that was another issue that I think you were alluding to was the disparity in health throughout the globe.

37:03I mean, we in the developed world have access to life-saving drugs for HIV. And yet in the year 2000, 2001, 2002, the people in sub-Saharan Africa were in the same boat that we were in in the early 1980s when we had no drugs. But now there were drugs, but they didn't have access to it. So the program, which was PEPFAR, was put together initially to prevent 7 million infections, treat 2 million people, and care for 10 million people, including AIDS orphans, for the tune of about$15 billion over a five-year period. That was in 2002, 2003. Fast forward 20 years, and that program has now spent over$100 billion, has involved 50 nations when we started off with 15 nations, and is estimated to have saved 25 million lives.

38:03Now, that's a truly historic example of societal responsibility at the global level, not just in your own country. There's an image one of the middle Stoics talk about that I think about all the time. He calls it our circles of concern. And he says, you know, we're all born selfish as babies. You know, we just take, take, take. And then we start to develop an affinity for our parents. And then there's, you know, the people that live near us. There's the people who live in our neighborhood. There's our fellow citizens. There's the people who resemble us. He's basically illustrating this circle, series of concentric circles.

38:45And he says that the work of philosophy, and it's funny because people think of stoicism as this selfish philosophy, says the work of philosophy is about pulling those outer rings inward about starting to care about people that you've never met or people who haven't even been born or maybe even animals like just the or the environment generally the philosopher peter singer picking up on this metaphor talks about expanding the circle so you can think about is expanding your circle or pulling the outer rings inwards but just this idea that you should care about people who don't look like you who live far away from you who you'll never meet who maybe haven't even been born, that strikes me as not just the fundamental premise of most public health, but also the most basic insight of moral philosophy, which is you have to care about other people.

39:36It really does come to that, isn't it? It goes back to some of the tenets of the Bible, you know, love thy neighbor as thyself. Yes, but people struggle with that, and I struggle with why they struggle with it. Having met a lot of that resistance and having been in the captain seat in a number of public health crises, why do people struggle with that? I don't get it. Seems so obvious. Well, human nature sometimes is not what we would optimally think it should be, but that's part of the spectrum of our species. Well, it's like we naturally struggle. And then, And of course, there are people who exploit the fact that we struggle with it, right?

40:19Because they can make very persuasive cases as to why you shouldn't care or create clever arguments that let you off the hook so you don't have to care. It's tricky. But the fundamental premise that we are interconnected and that almost there's a selfish case for caring about it because those 25 million lives that were saved, what do they contribute to the global economy? What might one of those people go on to invent? And don't you want to live in a world where government and the medical community has the capacity to solve really tough problems, like the capacity that we developed during COVID, during Operation Warp Speed?

41:01That strikes me as something that will probably be dusted off and used again for other things, or at least hopefully, right? Well, yeah, I mean, of course, the answer to your question is you are absolutely correct. But the other thing that the response to COVID really, really underscored is we always talk about investments in basic and clinical biomedical research. Sometimes when you are investing in it and it's fundamentally basic, you don't know what the ultimate positive spinoffs of it will turn out to be. I'm not so sure a lot of people fully appreciate in the history of vaccinology. If you look at how long it takes from the time that you've identified the pathogen that causes a disease to the time you have a vaccine that could prevent that disease, it ranges anywhere from 5, 10, 15, 20, 30 years from the time you do it.

42:04Most recently, the average is around 7 to 10 years. The sequence of the SARS virus was made public in a public database on the 10th of January of 2020. And because of the investment in platform technology, I'm talking about the mRNA technology, which people think was invented overnight. It actually goes back to the first paper that showed the feasibility of an mRNA vaccine was published in 2005, 15 years before the vaccine was started. And the immunogen design that made for the perfect, very, very effective vaccine immunogen is work that was going on for 20 years, mostly work when we were trying to develop an HIV vaccine.

42:59And yet when COVID came along, the vaccine work was started within days of knowing what the sequence was. And in an amazing feat of biomedical research, less than 11 months later, we had more than 30 ,000 people in clinical trials and the vaccine was shown to be safe and effective and began going into the arms of people in December of 2020. I mean, that is extraordinary. By any stretch of the imagination, that was made possible not only by the scientific investments, but by the operational aspect of Operation Warp Speed that did it in record time. That to me is, as you were saying, the kind of almost unimaginable advances that you can get out of investment in science.

43:58So for the next time around. No, I volunteered at a couple of vaccine clinics here in the little town that we live in. And it was just amazing to watch this small, I live in a town of about 8 ,000 people, to watch this town, which you wouldn't think would have much in the way of logistical capacity, suddenly organize, you know, not just reach out to members of the community, process their data, get the thing, put it in people's arms. It was amazing to watch something work, you know, just the scientific breakthroughs and then the logistical process. It's a marvel that we sort of gloss right over.

44:38Yeah. Well, when you say something worked. It really, really did work, Ryan, because the Commonwealth Fund did a study that showed between, I know, November 2021 to March 2022, something like that. I don't know the exact dates, that in the United States, vaccine was responsible for saving 3 million lives, preventing 18 million hospitalizations, and saving$1 trillion in healthcare costs. they did a similar study internationally and it was found that globally somewhere between 14 and 19 million lives were saved by that vaccine so it's unimaginable it's almost incomprehensible the scale of that achievement and and i was thinking about this just the other day so so you know going into 2020 it feels like all these things are falling apart it feels like Our institutions are failing us.

45:34And in many ways they did. And then to come out of that, not that many years later, with what actually happened, the scale of the achievement and the accomplishment, and for the general vibe of society to be, we really fucked that up and we did too much. And that we didn't take from that a strong sense of our own capacity to solve tough problems and come together and do tough things. I don't know if I'll ever be able to wrap my head around that. It doesn't make any sense to me as a person who studies history. Yeah. I imagine it's a bit vexing for you. I'll give you another Marcus Aurelius quote.

46:14You can tell me if maybe you relate to it a little bit. So Marcus Aurelius is the emperor of Rome. Some people like him. Some people don't like him. You can imagine. He writes in Meditations, he has a quote. He says, the nature of this job is to earn a bad reputation by doing good deeds. What do you think about the somewhat thanklessness of public service? How is that felt? I imagine you haven't always been beloved by the communities you are trying to help. Yeah, you're absolutely right. You know, it is because when you try to convince, codger, push people to do what it is that you know scientifically is to the benefit of their own health, often there's a pushback and resentment of that.

47:02And that's, you know, very interesting that public health officials, physicians, nurses and public health officials are under attack now from extremist elements in society for what they did during the outbreak of trying to develop vaccines, get vaccines distributed, having people practice good public health practices, such as physical distancing, the wearing of masks. There has been almost an inexplicable pushing back on that, where all of a sudden the villains are the people in public health. I mean, that seems unimaginable, but you have health care providers and public health officials who are being attacked and tried to being discredited for what they have done to try and save lives.

47:59That's sort of what I meant is like, what you're mad about is the virus. You're mad that a virus exists. And you have decided that since you can't blame a faceless, invisible thing, you want to blame the medical community who is telling you the facts about it. That's exactly the case. It is somewhat of a variation of shooting the messenger, as opposed to understanding that it's the message that's the problem. And in this case, the message is the virus. And that's not to say that the messengers always get it exactly right and explain it perfectly. Yeah, I mean, I think that's another important confounding issue, that when you're dealing with an evolving outbreak that changes in the information you have available from week to week and month to month, there is a misunderstanding of what science is.

48:55You know, science is a process that gathers information, facts, data and evidence to then allow you to make recommendations, to do guidelines, to what have you. And when you have a moving target, like we have with some pandemics, and a classic example of that was COVID-19, where what we learned about it over periods of weeks to months changed because we didn't have all the information we needed. And not only did the information change, but the virus changed. We had multiple variants over a period of several years. Now, science, as we know, is self-correcting. And when information changes, the scientific process gathers that information and then reflects it by information it gives to the public.

49:48If the public thinks that this should be immutable, that it can't change, that's when you get into the trouble. because they confuse the science that's the process of gathering changing information with information that is immutable. You know, they think everything is math, like two plus two equals four in January of 2020, and two plus two still equals four in November of 2024. But the COVID virus, SARS-CoV-2, is quite different now in 2024 than it was back in 2020.

50:47setting. Enjoy personalized comfort for better sleep night after night. It's the final days of our Black Friday sale. Recharge this season with a bundle of cozy, soothing comfort. Now only$17.99 for our C2 mattress and bays plus free premium delivery. Prices higher in Alaska and Hawaii. Check it out at a Sleep Number store or sleepnumber.com today. This message comes from Capital One. The Capital One Venture X business card has no preset spending limit, so the card's purchasing power can adapt to meet business needs. Plus, the card earns unlimited double miles on every purchase. So the more a business spends, the more miles earned.

51:21And when traveling, the VentureX Business Card grants access to over a thousand airport lounges. The VentureX Business Card, what's in your wallet? Terms and conditions apply. Find out more at CapitalOne.com slash VentureX Business.

51:40So how do you deal with a self-correcting mechanism or criticism where, you know, with COVID, you know, people maybe thought it was an overreaction. But you talk about this in the book, you know, the gay community in the 80s thought that the government wasn't doing nearly enough and you can't be immune to feedback or criticism. So what did you learn from that other crisis that informed sort of how you take the concerns of a community seriously? Yeah, well, it was very clear. And that was, as I say in the memoir, it was one of the best things that I have done in my long, long career was to, even though the gay community predominantly in the early years of HIV were frustrated by the rigidity of both the scientific process and the regulatory process in getting drugs for them, that they pushed back and became very disruptive, iconoclastic, theatrical to gain the attention of scientific and regulatory officials and even the leaders in government to be able to put more resources that the scientific and regulatory community essentially backed off on them and felt that they didn't want to be intimidated by them.

52:59But one of the things that I did, which is, is again, was something I feel good about of the things that I've done is I put aside and looked past the confrontation and the disruptive nature of it and listened to what they had to say. And what they were saying was making perfect sense back in 1985, six, seven, eight, nine. And I said to myself, if I was in their shoes, I would be doing exactly what they were doing in trying to get a much more flexible approach to this emerging plague that was killing so many of their friends and that they were at risk getting infected. So the lesson learned, you got to keep an open mind and listen to what people say.

53:49Sometimes what they say doesn't make any sense and it's wrong. But many times there's a kernel of truth in their concerns and you really need to listen to them because you'll wind up probably making better choices if you hear the concerns of a wider group of people, which is what we did with HIV in the early years. There's probably an analogy there, I imagine, not being a doctor, but to a doctor where a patient is telling you about a symptom and that's masking another symptom or a deeper thing. And if you think you know, you can't see or hear what's actually going on. In writing, there's a rule, which is when somebody tells you something's wrong, they're always right.

54:34When they tell you how to fix it, they're almost always wrong. And so the idea is that if a reader is saying, I don't like this, it's not working. They are right. It's not working. But you, the professional who has more experience in the thing, you have to take that seriously. But then you have to trust yourself as far as the actual methodology for fixing it. And so I imagine there was something there where they were alerting you to the scale and the scope of a problem and the need, and you had to wrangle the health establishment to be able to address it. It wasn't to say that they got to decide or direct how the response was, but they were telling you something that only they could tell you about that something needed to be done.

55:19Yeah, no, no doubt about that. You hit the nail on the head. I mean, one of the examples was, you know, the idea of the restrictions in the entry and restrictive criteria for getting into a clinical trial. It worked well for diseases that were chronic and that weren't killing 98 % of the people. It wasn't work. I mean, one of the activists who turned out to be a good friend of mine, Larry Kramer, who was a very well-respected playwright and author and an award-winning, I mean, he wrote a lot of very important work. And a brilliant instigator. I mean, he was one of the most confrontative people, but he had some really important facts.

56:11He was saying, you're talking about be patient. We'll be developing these drugs and we'll get them out to you. But the regulatory process says it will take four or five years to do it. And he would say, do the math. All of my friends who are infected, they have about 10 to 12 months before they die. So what are you talking about? Be patient. It's going to take this amount of time. We've got to be much more aggressive in getting things done. And he was right. He was right. Yeah. The ability to know what criticism to listen to and what to tune out must be very difficult in something like public health, which is not political, but fundamentally involved in a political world.

56:59Right. Well, then you're getting into something that's really interesting. You know, is that if you follow the scientific, as we say, follow the science, there's no room for politics in that. And we've seen every time politics inserted itself into a scientific or public health process, it's not gone well. You know, a typical example is that during COVID, the idea that the far right Republicans felt that it wasn't a good idea to get vaccinated. And the vaccination rate in red states was much lower than the vaccination rate in blue states, which led to what was inevitable, that there was more hospitalizations and deaths in the red states than there were in the blue states.

57:53And that is really horrible. Even though they have less population density. Well, yeah, I mean, it's just it was terrible because as a physician and a scientist, you know, I'm a very nonpolitical person. And, you know, it doesn't matter to me, Republican, Democrat, I'm neither. But it just seems to me that if a person risks their lives and the lives of their family by not making use of a highly effective intervention like a vaccine, and turns out that they ultimately die because of that, that's such a tragedy that political ideology had them make a decision that led to the loss of their life. that's really, really unfortunate.

58:42Yeah, no, I was thinking about this the other day. We don't have to name the specific individual, but I was thinking about a certain activist who once fancied himself to be opposed to pollution and other environmental toxins. There's something inherently pollutionary about poisoning public perception in a way that damages public health. Do you know what I mean? Like there's lots of pollution. isn't just dumping toxins into a river. It's also propagating toxic and harmful ideas that make people do things that are not only not in their interests, but have damaging effects to public health as a whole.

59:25No, I agree. But I think when people like the subtitle of your book is a doctor's journey in public service. I think when people think public service, maybe it says something about where we are today as a society, but public service seems like a synonym for politics. But you're making a distinction between public service and politics. Oh, absolutely. Absolutely. In fact, you have to separate the two. I mean, public service gets involved in different policies and people shouldn't confuse policy with politics. There really is a big difference. You could have policy based on sound scientific principles.

1:00:04Once you get politics in there, you know, often it is at variance for what the evidence and information is. You know, there's a saying that when you mix science and politics, you wind up getting politics. Yeah, it overwhelms anything you mix with it. Exactly. Yeah, I think people think talking about anything that pertains to the public good is politics, and it's not. Absolutely not. And when politics gets inserted in there, not infrequently, there's a distortion of what the data tells you you should do. Also, when people talk about getting involved, they seem to think that that means running for office, as though that's the only way one can contribute to public life, is by engaging in the profession of politics.

1:01:02Yeah, a big misperception. Certainly. No, we need a lot more public servants and probably fewer politicians. Yeah, I would think that would be important, you know, public service. But, you know, you don't have to be. It's very interesting. I often say that you can enact public service without officially being a public servant. I mean, you think of like my entire career was working in the federal government at the National Institutes of Health. So I was officially a public servant. But people in other arenas in life can serve the public without officially being public servants. As we wrap up, what are some examples you would push people towards doing?

1:01:45If someone wants to be more community-minded or wants to make a difference as far as public health or public service goes. What do you think maybe is underrated? Well, what's underrated, I think, is community service at the community level. A voluntary community service can have such an important positive impact on society. I mean, even some of the official jobs, I mean, physicians, nurses, law enforcement individuals are public servants in so many respects. Yeah, there's that. I think it was Barney Frank, the congressman, he said, government is just the word we made up for the things we do together.

1:02:26And I think we need a greater understanding of government, not as a political entity, although it is staffed ultimately by politicians, you have to run for office. That's the system we have. And it's a good system in that sense. It's better than, I don't know, hereditary rulers. But the idea that government is also like public health and invention, a thing that we came up with to solve the vexing, timeless, perennial problems of human society, be they diseases or disagreements or environmental improvements, trading platforms, etc. We invented this stuff for a reason because life without them was worse, much, much worse.

1:03:08Exactly. Well, Dr. Fauci, this has been a complete honor. Thank you for all your work for a lifetime of public service. I thought your book was fascinating. I'm glad you made it onto the platform this time without getting another infectious disease. Thank you, Ryan. It's really been a pleasure being with you. I appreciate the opportunity of being on your show with you. Thank you.

1:03:36Thanks so much for listening. If you could rate this podcast and leave a review on iTunes, that would mean so much to us and it would really help the show. We appreciate it. And I'll see you next episode.

1:04:04Look, ads are annoying. They are to be avoided, if at all possible. I understand as a content creator why they need to exist. That's why I don't begrudge them when they appear on the shows that I listen to. But again, as a person who has to pay a podcast producer and has to pay for equipment and for the studio and the building that the studio is in, it's a lot to keep something like the Daily Stoic going. So if you want to support a show but not listen to ads, well, we have partnered with Supercast to bring you an ad-free version of Daily Stoic. We're calling it Daily Stoic Premium. And with Premium, you can listen to every episode of the Daily Stoic podcast completely ad-free.

1:04:51No interruptions, just the ideas, just the messages, just the conversations you came here for. and you can also get early access to episodes before they're available to the public. And we're going to have a bunch of exclusive bonus content and extended interviews in there just for Daily Stoic Premium members as well. If you want to remove distractions, go deeper into Stoicism and support the work we do here. Well, it takes less than a minute to sign up for Daily Stoic Premium, and we are offering a limited time discount of 20 % off your first year. Just go to dailystoic.com slash premium to sign up right now or click the link in the show descriptions to make those ads go away.