Julian Dorey Podcast - #32 - Dr. John Schneider, PhD

Episode Date: January 27, 2021

Dr. John Schneider, PhD is a healthcare expert, consultant, and businessman. Currently, he is the CEO & Founder of Avalon Health Economics. Prior to Avalon, he was a founding partner of the Health Economics Consulting Group (HECG)––and later joined Oxford Outcomes following their merger with HECG. Additionally, Dr. Schneider earned his PhD in Health Services & Policy Analysis from UC-Berkeley and serves as an Adjunct Professor at NYU. ***TIMESTAMPS*** 5:52 - John’s other home (Miami); the VC/Innovator movement to Miami headed by Mayo Francis Suarez 15:39 - John’s PhD expertise in economics and healthcare explained; Money & Healthcare; The Opioid Epidemic as an example of Medical Records problems 21:48 - The contentious relationship between Doctors & Insurance Companies; Electronic Medical Records; Doctors as psychologists; John’s Telehealth Client 40:28 - Covid and the remote work movement; Masks; Bacterial vs. Viral Infections; The Hospitals’ Covid Preparation Teams; John called Covid; The leadership problem in Covid; The politicization and polarization of Covid;  1:04:32 - The Federalism Argument w/ Covid (State Government Power vs. Federal Government Power); Governor Ron DeSantis’ Covid Actions in Florida; Test groups vs. Control groups; Covid’s effects on different races & ethnicities 1:26:50 - The financial incentivization of hospitals to declare patient deaths as Covid deaths and why this is unlikely to be a major trend 1:35:59 - Why do fit Americans have to shut down for Americans who choose to smoke or choose to eat too much (and are therefore at greater risk of complications related to Covid 19); The Pandemic is making us forget about everything that came before it 1:44:12 - Science is the new religion; Transmission data; Civil Liberties Precedents; Covid Testing Problems 1:56:05 - Americans past their Covid breaking points; The struggle of small business owners; Immune Systems 2:08:58 - The vaccine (& vaccines in general) explained; Viral load 2:19:49 - Anti-Vaxxers; The sentiment around the Covid vaccine; Dispelling the autism rumors around the vaccine; Moderna MRNA vaccine vs. Pfizer vaccine 2:36:30 - Big Pharma, “Pilling up” society; The importance of drugs in the world; Personal responsibility with nutrition 2:56:07 - Telehealth in Covid & its future as a healthcare industry segment ~ YouTube EPISODES & CLIPS: https://www.youtube.com/channel/UC0A-v_DL-h76F75xik8h03Q  ~ Show Notes: https://www.trendifier.com/podcastnotes  TRENDIFIER Website: Learn more about your ad choices. Visit podcastchoices.com/adchoices

What's better than a well-marbled ribeye sizzling on the barbecue? A well-marbled ribeye sizzling on the barbecue that was carefully selected by an Instacart shopper and delivered to your door. A well-marbled ribeye you ordered without even leaving the kiddie pool. Whatever groceries your summer calls for, Instacart has you covered. Download the Instacart app and enjoy $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart. Grocer $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart, groceries that over-deliver. What are the chances of me coming in today and giving you COVID? We don't know the answer to that question. We don't know. We don't know the answer to that question. So I think that's kind

of important, right? Why can people get together can i would think it's pretty important yeah what's cooking everybody i am joined in the bunker today by my friend dr Dr. John Schneider, PhD. Dr. Schneider, to be clear, is not a medical doctor. He is a doctor of PhD. Smart doctor. Not that medical doctors aren't smart, but you get the point. He's a doctor in, he's got a doctorate of PhD in some form of economics. I forget exactly which one but hard shit anyway despite that little snippet you heard on the front i can confirm that dr schneider did not

repeat did not in fact have covet and we took the ultimate precautions before he came in he was actually supposed to come in about eight or nine days before this but he called me and said you know julian i got back from miami about two three days ago, so I really should be quarantining, and I have a scratchy throat, so he was a little spooked, and so I was like, of course, let's punt this one, but he got, as he'll describe in this episode, three negative tests throughout the week, was good to go, and somehow when he came down here into the night, developed a little cough cough that, again, wasn't COVID. But that probably had something to do with the fact that he drove down about two hours to be here at 10 o'clock at night on a weeknight

and was here until about 2 a.m. like a savage. So thank you for doing that, Dr. Schneider. And it would all be hugely ironic if that had been the case and he had come down here with COVID, when in fact I was bringing him in here to talk about COVID. Now, Dr. Schneider is the CEO and founder of Avalon Healthcare Economics, which is a company he founded, I believe, in 2012 or 2013. And what they do is they consult on the economic side specifically within the healthcare space. And his previous company that he was a partner in, he sold along with his partners. So

this is something that he has been eating, breathing, and shitting for the last 30 years of his life. And with COVID. It's also something that he eerily called a play-by-play on how this was going to go back in around mid-February. I spoke with John. I mean, yeah, it was like mid-February, maybe that last week of February, but I feel like it was around February 20th. I spoke with him on the phone, and he was the first guy to say something that made me go, whoa. He told me he thought this thing was going to last until at least July, which obviously looks incredibly wrong now because here we are. But there was nobody saying this at the time. Nobody that I could find saying, yeah, you know, we're going to be shut down until July.

He also went through exactly what he felt was going to go wrong and why. And that turned out to be awfully correct. So being a guy who is very close with a lot of people who are medically working on this thing every day and somebody who understands how the health care system in the United States works, I wanted to get a State of the Union on COVID and actually ask some hard questions and see what kind of answers you might have. And frankly, I think he had an answer for about everything. So in this podcast, we talked about Miami for about the first 10 minutes, because he's a dual citizen of the Northeast of Miami, however you say that. He lives in both places. And obviously, Miami's a different world right now we talked about that with kevin last week as well but wanted to get john's thoughts on it too

and then we spent about 25 minutes talking about john's background and the work he does so you understand exactly what point of view he's coming from but the rest of the way that last i don't know two hours and 20 minutes two hours 25 minutes was all covet and we talked about things like personal health choices and how that was all COVID. And we talked about things like personal health choices and how that affects the rest of us. We talked about things like hospitals, potentially declaring COVID deaths that maybe aren't so COVID-y. And we even talked about the vaccine in depth, which was a conversation I really appreciated because I know there is some hesitancy out there because of how quickly this vaccine was produced. I felt like Dr. Schneider gave a ton of reinsurance, at least for me, but I'll let you guys be the

judge of that. So this was a very good and might I say very, very important podcast. Anyway, if you're not subscribed, please subscribe. And if you haven't left a five-star review with a comment on Apple Podcasts and you can take a minute to do that I'd really appreciate it thank you to everyone who has and to all my people watching on YouTube right now do me a favor

if you're not subscribed obviously subscribe but hit the like button on this video and hit that bell button right there so that you I don't know if I'm pointing in the right spot right now where it's going to come up but hit that bell button where it is on the screen and down below the video so you can get a notification when I post videos on the platform. That said, you know what it is.

I'm Julian Dory and this is Drainify. Let's go. This is one of the great questions in our culture. Where is the nuance? You're giving opinions and calling them facts. You feel me? Everyone understands this, but few seem to do it. If you don't like the status quo, start asking questions. You are, I think, the fourth person I've had in here in the last month month and a half who was down in miami for an extended period of time when did you get back well so you better get

yourself covid tested though yeah a lot of exposure that way well no i haven't the last three were i guess like three weeks ago something like that so i'm i'm good now but one of them had had it while he was down there all there so he had just been getting over it maybe like a month before he'd been down there for like three months oh yeah three months but how long were you down there well i i go periodically so i go i've i've been a number of times since the since the lockdown and pandemic and all that broke um but when i go i only go for a few days at a time so i don't i don't stay extended you know extended period of time down there this this past uh christmas to new year's

break was the longest time i've been down there in a long time you know or i mean since covet because your wife's down there right well not anymore now because she they let her work from home and and actually just recently she found out she's permanent work from home. That's a whole other thing. You've got all these people now who were suddenly told, hey, by the way, you're permanent work from home. And if they don't have a nice setup like you have here, they got to figure out how to deal with that. You've done the Jersey City thing and all that. I've got – one of my employees just moved to Hoboken right before the pandemic. And now they're thinking like, why? Yeah. She got a tiny apartment in Hoboken and now I'm sure she's thinking, shit, man, what do I do?

Yeah. I've got to work from home in this shithole. Yeah. So – Can you pull that mic in just a little bit? Yeah, yeah, yeah. So it's – is that better? Yeah. So that's that mic in just a little bit? can go down there and just pretend life is normal and i think it's bringing a lot of people down there and um you know i think what's interesting and we'll probably get to this today is is that

really a problem yeah well i mean side note just as far as not just people being down there because it's a whole different world i want to ask you about that but there's also this enormous bomb going off in miami no pun intended, obviously, where you just have San Francisco and I guess started with the venture capital world like Keith Rebois and then followed up with some of the actual innovators going to Miami in droves because, by the way, a lot of these companies where even the highest talent works, they're going to be remote forever too. So they're even saying in Miami, you got Suarez, the mayor, going, okay, well, if they're going to be remote forever too so they're even saying in miami you got suarez the mayor going okay well if you're going to be remote why don't we set up pods of like the

remotes so they all at least live in the same city it's it's really crazy right right they used to be called we work didn't it yeah yeah something like that yeah actually i was on one of the flights to miami i can't remember when maybe it was back in in June or something like that. I was sitting next to a woman in first class who looked like she had tons of bags with her and everything and kept her sunglasses on on the plane. And it's just kind of an interesting person. So i struck up a conversation with her and um and it turns out you know just to make a long story short she's she just her company had just told her hey we're not doing an office anymore done done and this was in june right so this is only a few months into the pandemic so amazing how fast they learned that yeah yeah exactly so this is she's working in new york city living in New York city. And she's like, she's like, why should I keep my New York city apartment? You know,

$4,000 a month, you know, for a, a closet in New York city. She's like, and she didn't know anything about Miami. She's like, I got online. I started looking at different cities and, uh, and I'm, I'm, I just moved to Miami. I just packed all my shit up and I'm moving to Miami. Just herself. Yeah. Just herself. Yeah, by herself. She doesn't know it. And she's like, what's it like? I said, I think you're going to like it. You're going to have fun.

Yeah, yeah. But I was wondering on that flight. Again, this is months ago. I was thinking, I wonder how many of these people there are who are just, you know. There's a few. I i mean there was an article that came out over the summer i know i've talked about it on a couple podcasts but it's been a while where uh a longtime new yorker james al tucher was like big on linkedin he wrote this piece on linkedin that then got reposted in the new york post it was called like i think new york

city is gone and it's never coming back there's a really scary piece especially if you love new york like me and i think that some of the points he made in there were very on point and for now they're a reality and i think that there are some dangers to new york not being it once was. And I also think that there is going to be a delayed period of time here, and it could be five, 10 years before New York is really back to what it was. But the final point, I'm just not really sure about. That said, he went, he was a guy that went to Florida. He had lived in New York his entire life. He was raised there. And then he was like, you know what? It's, uh, it turns out it's sunny down here.

It's pretty warm. It's pretty wide open. And things are, I mean, I guess even back then when he wrote it, August, it was very open as far as corona goes. Yeah. So you mentioned that already, but I'm seeing Instagram stories of friends who live down there and they're going to clubs and stuff. Oh, yeah. And it's just like no masks, just wide open. And, you know, I kind of envy it. But is that the norm or?

Well, I mean, no, that's a good question. Well, first of all, I'm not really that bunch into the club scene in Miami, so I'm probably the wrong person to ask that question. We'll let you get away with that. I see the little wink across there. Yeah, yeah, yeah. This is public, right? The mic's hot here. So, I mean, I think the short answer, the short answer to your question is yes, it is like that. Because I follow some of the influencers in Miami, just so I know, like, if there's a new restaurant, what does it look like? Is it hot? You know, is it a cool place to go to? Is there a scene? You know, I do. So I follow some people. So I sort of get a good sense

of what's going on down there. And these influencer typetype people, they're out at the clubs and the sort of more – Miami's probably a little bit more like what New York used to be in the sense that they have a lot of – there's a lot of stuff – there's a lot of real estate between restaurants and clubs. There's like these lounge – there are these sort of restaurants slash lounges that, that become kind of clubby toward the end of the night. A lot of restaurants now have DJs. And so they're, they're sort of like this middle ground. And I guess I'm mostly familiar with that middle ground, but, but, um, but the middle ground is actually like by New Jersey, New York standards, it's pretty cool, like pretty happening. And that stuff's all wide open. Like it's wide open. They're doing a little bit of distancing with tables, but even that is pretty minimal.

People come in with, you know, it's kind of similar. There's, you know, some masking up required. But for the most part, I mean, it's pretty wide open. That state's just decided, you know what, we're going to be a little bit like, you know, like Sweden, we're just going to, I don't think they're that, I don't think they thought it out as well as Sweden did, but I think they just decided let's, let's just give it a shot. Um, you know, as you know, like Florida, the entire state incredibly dependent on tourism. so i i think from their perspective um they probably thought if we if we do this if we shut down it's the death of us yeah you know we and and also

excuse me my um miami probably um more so than any other city in Florida. But Miami's an incredibly international city. And they get people from all over. I actually, I said to my wife when I first started going, she first started bringing me down there. She's from there. So when she first started bringing me down there, I told her, this city's more international than New York. I actually, you get that feeling when you're walking around. It's a big statement. Yeah, I know. But most of the people down there are from somewhere else. And when I say from somewhere else, usually from somewhere far away. There's a lot of Eastern Europeans. There's a lot

of South Americans. There's a lot of Western Europeans. there's a lot of Canadians, there's a lot of Mexicans, like, you know, the border countries. So there's, there's, um, it's a real melting pot in the true sense of the word. And I think from, from at least from Miami's perspective, and I think the state to a, for, you know, for some slightly different reasons, they want to let that go. Like they don't, you know, and those, those people are integral to the economy. They bring with them shit ton of money and they buy expensive are integral to the economy they bring with them a ton of money yeah and they buy expensive apartments and expensive cars and they go to restaurants they just drop money everywhere they sprinkle it all around the city and uh they didn't they they didn't

like the the alternative to that um and now the rest of the state of course is mostly old people uh retirees and so forth. And then you've got just your regular residents. And putting aside the regular residents, the older people who flock to Florida are also coming from other places. And they didn't want to keep those people from coming, like the snowbirds. Let them come because the snowbirds come every year. And again, they spend an assload of money when they're down there. So that's one of the reasons I think Florida took a different stand.

But I think it's interesting to see what's going to happen. When the dust settles, was everything worse in Florida than it was in New York in terms of death rates and hospitalization rates and things like that. I want to ask you about that directly because you are somebody who you're qualified in more ways than one and more than any person I've had in here to speak on this entire topic as a whole based on what you do. So before we get into it, can you just walk us through exactly what the story is with Avalon Health Economics and what types of work you guys do in the healthcare space so that the audience has an understanding? Oh, yeah, sure. So, yeah, I mean, this is weird. I would expect that your audience doesn't know a whole lot about this space in general

because it's a very niche space. Yeah. So let's start with drugs and devices. So medical devices, everything that's in a hospital, drugs, anything that you take, not so much over the counter, but any prescription drug. All of that stuff undergoes at some point some sort of economic evaluation these days. I mean, that wasn't true 10 years ago. But nowadays, there's some sort of economic evaluation, whether it's a return on investment done internally by those companies that produce those things, or it's an insurance company saying, hey, I want to know what the bang for the buck of spending money on this thing is going to be. Or if it's international, it's the health system. So the National Health Service in the UK wants to

know, we're not going to reimburse anything or pay for anything unless it has proven value. And so value consists of both money and effectiveness combined. So I think if you look at the healthcare industry 30 years ago, 20 years ago even, there wasn't a lot of concern about value. There was only concern about effectiveness. And if it was effective, we'll find a way to pay for it. And that's just not the case now. So my company just kind of fits into that groove. And we do evaluations for medical device companies and for pharmaceutical companies. We do these economic evaluations to see sort of bang for the buck for that device or for that drug. We work for small biotech companies and stuff like that. And we also do policy work. So- Yeah, that's interesting.

Trade associations will contact us and say, hey, we've got, there's this new law. Well, for example, the Affordable Care Act, right? That's the most recent sort of big ticket. Because I talked with you about that once. This was a couple of years ago, and you were walking me through all that. And I think I'm a good example of it for the general American, because our eyes glaze over when we hear this stuff. Healthcare, when you look at it, money and healthcare are two things that literally every person in this country has in common, because you need to protect yourself and you need to be able to have money in the economy and they're probably the two topics that so few of us myself included especially on health care actually understand and know about it's it's wild yeah it's it's a lot more complicated than i think a lot of people think

and it's which is why companies like mine can survive or thrive because they, there's, there's this, this void of sort of people who really have a deep understanding of, of how all these pieces fit together. The U S healthcare system's incredibly fragmented. The talk about, you know, the expression, the right hand doesn't know what the left hand's doing. That's big time true in healthcare. Like the, about you know the expression the right hand doesn't know what the left hand yeah that's big time true in health care like the the pieces of the puzzle have no idea what's going on in fact not to get too far off topic but the opioid epidemic which prior to covid was the talk of the town right yeah um should be again too oh yeah it hasn't gone away like you know very little of it has changed in the time since the pandemic.

And it was a major problem right up to that point. And we had to just make room for COVID talk and shove it aside. But the opioid epidemic, one of the things that was fueling it was that you've got people becoming addicted to opioids and going to different doctors to get different prescriptions so they can't be tracked. Nobody knows how much they're taking. Wait, the doctors don't – this is probably a dumb question, but the doctors don't have – look through to their medical records. I guess you can stop that if you're a patient, right? You can say you can't see that? Yeah, right. You can not transfer your medical you can't see that. Yeah, right.

You can not transfer your medical records. Exactly. Your medical records don't follow you around like they do in Western European countries. So people basically would go to one doctor and say, hey, I've got knee pain. And the doctor would try to give them a non-opioid maybe toward the end of this opioid scare. And they would say, no, no, the only thing that works is OxyContin or whatever. And so the doctor would begrudgingly write them a prescription for that. Then a week later, they're going to go to their dentist and complain about tooth pain.

And the dentist will check them out and say, well, you don't seem to have anything wrong. And they're like, well, just take my word for it. I've got pain in there. I don't know where it's coming from. And they'll grab another opioid prescription from that dentist and so forth. They just kind of keep this thing going. Anyway, not to get off topic,

but that is the, I think, the sort of the story that you need to know to understand the healthcare system in the U.S. It's not connected. There's no connectedness whatsoever. So everyone's pretty much just doing their own thing, which is actually part of the problem of the – part of the COVID response that I think most people agree did not go as planned

is because of that fragmentation. I mean, there's a lot of finger – plenty of people, plenty of blame to go around. But the fragmented aspect of the healthcare system fed into the opioid epidemic and then fed right into a pretty shitty COVID response. It's also an issue just from a high level, very oversimplified view here, but it's an issue when you have competing interests in a way. Even if it's not supposed to be set up that way, you have competing interests just between, say, the doctors and the insurance companies.

Every doctor I know, everyone I know, they're always like, oh, God, the insurance company. It's a common attitude. And I'm sure at the insurance companies, it's like, oh Jesus, here comes another doctor billing fucking a million dollars for this kind of thing or whatever. But when you think about that, that's how people get the service for their health. So you literally have the two beacons of that never on the same page. And that has never made sense to me. No, exactly. And it doesn't make sense to me either. And I've devoted my whole entire career to studying it.

So yeah, insurance companies are providing a service that used to be just indemnity. So they'd cover you for your losses. Like it's a risk management problem, basically. And really insurance was for big ticket stuff, right? It was for, it was supposed to be if you if something really bad happened you're going to get some coverage um then it's morphed over in over the years it's morphed into this thing that is a little bit more intrusive into your life like um the insurance company is going to tell you whether you can take a generic you know a brand

name drug or not they might say no you can only take the generic. Um, and, uh, but worse than that, I mean, that's probably one of the least objectionable things they do. Uh, worse than that, they might tell you, you can't see, okay, you've got a new insurance company. You can no longer go to that doctor anymore that you've been going to for, for eight years. Um, that kind of thing. And, and, and the thing about that is at the end of the day, that may not have a huge impact on your health. Having to switch doctors, you might find a new one. You might like the new one better, but at the end of the day, it's a pain in the ass and it pisses people off and it, and it, it just, and they're paying a lot of money for it. So if it's, if it's like, um, you know, um, I don't know a service that you don't pay much for, right? There's a lot of things we

get for free now. Well, like a lot of people will go online to get their news from the news outlets without subscribing. And they just see like, and then they max out on their downloadable articles every day, and then they're done. They're not going to subscribe. So, all right. So, you know, we sort of tolerate that, right? But with healthcare, you're, you know, in other words, there's only so mad you're going to get at that right but with healthcare you're you know another there's only so mad you're going to get at that news organization because you're not giving them right sure but it's not vital to you either yeah yeah it's not vital to you but your insurance company is like now you're paying so much money you know thousands of dollars a month for some people um and you know and then all they're doing all they seem to be doing is preventing you from getting the services

that you need. Not all of them. I mean, it depends on which plane you're in and blah, blah, blah. But at the end of the day, I mean, it is, as you said, a contentious relationship between all three parts of that. The patient, the doctor, and the the insurance company they all hate each other nobody gets along in that equation yeah um because now we don't like our doctors because our doctors are doing all kinds of weird stuff that they didn't do before I love my doctor I just throw

that out there yeah I think the mics are hot so yeah and yeah I'm sure your doctor listens to this so he does actually yeah yeah well then you know, I think besides Julian Dory's doctor. Dr. Christou. We love you, baby. Shout out to Dr. Christou. Yeah. Besides that doctor, some people don't like their doctors. Some people are annoyed by their doctors.

Some people feel disconnected from their doctors. And the insurance companies are part of that problem. But also just that sort of general disconnectedness among pieces of the puzzle. Like why doesn't, when I go to the doctor, it always seems like they're out of the loop on stuff. Why don't they know about the COVID test I got, you know, three months ago?

Like they, you know, why do I have to be the one that keeps track of all this stuff? I, one thing we're all, I don't know if it's the word is defend doctors there, but maybe it's something that's wrong with the system is I've always been amazed at whether it's say a family doctor who just treats people of all different ages for all the regular stuff or an orthopod, someone like that that who's seeing a lot of patients a day right how they keep track of that and how they do remember oh i saw this patient two months ago and this is what they said because sure you have the notes you go review it you see how quickly and and well and organized a lot of these doctors at least take those things but there's still that

disconnect of like wait did he say it felt like that or like this or i can't remember was that a symptom or did i mean that when i wrote that i'm always amazed at how some of the best ones are able to keep it straight because you're right it's not a it is not a straight a straight streamlined process at all and it's not it's not organized it doesn't seem that way at least well and here what is it 2021 now yeah and we we're really like just getting into this electronic medical record thing i know people are people are gonna you're gonna get all kinds of hate mail saying it's been around for a while it's true it's been around for a while but it's it's only in its infancy

in terms of its full potential. Yeah. I get my bill in the mail. Yeah, I do. I still get bills in the mail. In fact, I tried to figure out a way to not get the bills in the mail, and they said, no, no, no, you can't do that. They're going to come in the mail.

Oh, and then the best is, by the way, you don't have to pay any of them because you need to wait until the insurance company settles out. Yeah. Just like, so what's the point of this whole thing? You call up to pay a bill and they're like, no, no, not yet. Yeah, yeah, yeah. No, we don't want your money. Don't pay that.

It's just going to confuse us if you pay that. And then you're not going to get your refund for a long time. So yeah, it's a messed up system. And yeah, these electronic medical records have the great potential, right? Because I should be, my electronic medical record should be in a cloud somewhere. And everywhere I go to the doctor, I either have a card with a chip in it that sort of allows them to access it, or I simply just have a password that I give them, whatever. And then like iCloud, right? It could be the same as that, right? I can access iCloud everywhere I go. My medical record should be in an iCloud or some sort of cloud, and a doctor should be

able to access it and see everything. Everything since going back to when I was eight years old. Right. And provided you give them permission to- Well, yeah, of course. You know, they say, hey, look, I've got a problem here. Have at it. Look at my record.

See if there's anything in there that speaks to you. And the thing is that what doesn't happen now is that should happen before you get to the doctor's office right the doctor should prepare prep for you because remember your doctor's like your consultant right you're high you're not dr christie he's different he's a family friend been through thick and thin with that he's loving the shadows yeah and i i think that's different he has a great doctor though yeah right now sure Yeah, and that's different. He is a great doctor, though. Great doctor. Sure, yeah.

I want to circle back to Dr. Christou in a bit. I want to find out more. Mainly I want to find out what's the matter? Are you seeing a doctor on a regular basis? No, that was just my doctor up in North Jersey because I had never lived there before. I'm like, oh, shit, I need a doctor now. Who's the man? I could call him what i really like about him is i mean you know me we both went to whippany together so i had all the shoulder industry injuries and everything and so i always

think like something's wrong with the bone somewhere so i'll call him up and i'll be like hey i got this thing and i'll be like all right come in like a half hour later and i never i never had experienced that before because you know i i had an uncle who was a doctor down here i was always my family doctor so i was spoiled in that way but i guess i had never really worried about that and then you go to a new place and you're like well i guess i'm not going to get that because no one has that type of experience and then someone you just meet he does that and it was just just a really good guy. And whenever I would go in to see him, you know, spend 10, 15 minutes going over whatever it was.

And then I'd talk with him for like 40 minutes. That's great. That's unusual. Yeah, exactly. Dr. Christie's special. Exactly. Yeah, that is good. And well, you know, I think what's so interesting is why is that so unusual, right?

You're talking about this experience and and I'm sitting here thinking, and I'm in the field, and I'm thinking, this is really unusual. It's really hard to find a doctor like that. I had some health issues in July. It may or may not have been COVID. I don't know. I kept testing negative, but I had a lot of, I had these upper GI pain and all that stuff.

My primary care doctor, she stepped up to the plate. She's just like, you know, I kept trying to call the office and everything. And she's just like, look, here's my cell phone. Text me. Oh, that's great. And so as that disease or whatever it is, I don't know what I had, whatever happened there in that two-week period, I was texting her all the time.

She'd text back. And I think we solved a lot of problems just by texting. Whereas if I had to call her office, make an appointment, blah, blah, blah. But a lot of doctors won't do that. They do not want to get into that texting relationship with a patient. And I can understand why, right? I mean, there's a lot of reasons why that could go awry. But that's the thing, like that flexibility she had she just we just kind of slid into the texting and we accomplished a lot that way just kind of sped things up we just we got cut through a lot of red tape and everything by doing that and uh it and it ended fine right everything

everything everybody was happy at the end but you know yeah i can see how that's not going to work for a lot of doctors yeah i think a lot and I could say this about other jobs too, especially what I did in the past, but a lot of the job of a really good doctor is being a psychologist. Yeah, yeah. Which is literally that care, that personal touch or actually pretending to give a shit and understanding that the patient's health is the most important thing into in the world to them so even if that's your 1 to 1 30 today that's the most important half hour of their day right and the people who get that and then can do some of the personal things like that yeah they they probably they probably develop actual relationships with their patients rather than just treating them as clients. Right, right.

You know? Yeah. And, you know, but that has to be balanced again. So there's a cost to that, right? So your doctor talking to you for 40 minutes, that's awesome. And I think there's probably a lot of benefits to that. But there's also some cost to that. It's his time.

Sure. Maybe there's a patient in the waiting room who would have liked to have gotten in there for those 40 minutes. You know, so it's finding that balance. Keeping medical care, especially in this country, has historically been that, like having that personal connection. And when you take that away, people start feeling uneasy about it, right? They get a little irritated they get they start giving their doctors bad marks on the on the report cards that everyone's asked to fill out now so um so doctors

are aware of that too so they're trying to balance that out but it's it's there there is this sort of efficiency that's crept into health care that i think most people would argue is a good thing because healthcare you know historic the whole other topic is just how wasteful uh healthcare is in terms of costs you know the costs are just not like spent in the right places a tremendous amount of waste and it's it's probably better to you know focus on getting rid of that and making it more efficient but at the same time you know you don't you don't want to throw the baby out with the bathwater. There's a lot about healthcare that is a personal thing. It's, you know, there's certain things in life

that you don't want to depersonalize. And that's one of them, which I think is an interesting challenge for all these new developers, all the ones who are moving from Silicon Valley to Miami, who are developing apps, healthcare apps. I mean, and we actually, some of our clients are doing this now.

So we did a project with a client. We did an economic analysis. They have an app that is like a PT, like a physical therapy app. Basically, you engage via the app to an actual person. There's a person who can come on every now and then. Like via chat? Yeah.

Okay. Well, yeah. And maybe even more like FaceTime. Oh, they do FaceTime? Yeah, yeah, yeah. I think it has that capability. So there's a number of different ways in which the patient can interact with the, with a person. But the main sort of, um, structure of the app is around setting up workouts for you and demonstrating to you those workouts

to, for specific PT problems. And you do them at home and you turn the app on your, I guess your iPad. So you have a big enough for your laptop or whatever. So you have a big enough picture and you're, you go through these routines and they tell you very patiently what to do. Was this invented for COVID specifically? No, no, no. It was before we, we, yeah, this was, this has been in the works for years. And I won't say that they were thrilled that COVID came along, but obviously they were like, it was, I told you so basically saying, here, see, look, I mean, now these people can work on their PT stuff at home in a very now. So you, you could say, well, there's all these, like you could, you could go on YouTube and find all kinds of exercise videos. It's not personalized. Yeah. It's not personalized. It's, and it,

and you don't, and there's always that thing like, well, I don't know if this is really the right thing for me. This thing, supposedly this app app, sort of gets around that by saying this is the, you know, given everything we've learned via all the stuff you've put in there, we think this is the right way for you to go about your physical therapy. And it's taken off, I mean, as far as I know. It's hugely popular now and and one of the things that we did was we basically showed that um that it's a cheaper way of delivering pt obviously it's a but but not just because it's cheaper to do stuff via app it's not

just that what type of client was it though was it an actual physical therapist that's where i'm a little confused the client what do you mean by client you mean the the who you did the analysis for oh uh what was the company that developed the app so oh so they just specifically did that so they obviously on their end have physical therapist professionals whereas it wasn't say jag physical therapy coming out and saying oh we offer this now no no but i mean i'm sure there are i'm sure those guys exist you know the more entrepreneurial physical therapists but no this is a company that got venture capital and everything and developed this this app and um uh what else am i going to say about i mean i would say that like the the thing about it is it's not just the the app is not where the savings occur you know in other words like you know doing at home instead

of in an office and stuff obviously there are some savings there but it's that it's the access thing it makes it so that more people can get care it's it's more accessible not maybe not to people like my mom who still a little bit challenged um with apps but um but to you know most people within that you know the the big users of physical therapy are like people between the ages of you know 25 and 45 because they're involved in stuff like you were saying you heard yeah like the box been in there a few boxing gym is a major source of uh physical therapy referrals yeah so been a regular yeah yeah yeah so that that's the um you know sort sort of the sweet spot for a company like that. So therefore, their main goal was to connect with employers because a lot of employers in the U.S. offer employer-based health insurance.

And so they could go to – Wow. So this app is literally working in the sense that they bill through health insurance just like a regular physical therapist would? Oh, wow. Yeah, yeah, yeah. Yeah, exactly. So, yeah, the reimbursement, like, it's all coded already. So, you know, PT visit of a certain kind gets reimbursed a certain amount.

So they need scripts and everything just like normal? Yeah. And if they need scripts, they're going to get it probably from, I'm not sure they can get scripts through this apparatus. I'm not sure if that, they might have to go to a regular doctor for that. But all the movement stuff that a PT does, I believe was baked into this app. And again, it just increases access. So what you have is the ability for some person who is going to have either trouble getting to a PT office or just simply doesn't. Well, trouble getting to a PT office because it's too far or because they're too busy or they have little kids. Or like, you know, 10 different reasons why it's a pain in the ass to go to a PT office or any doctor's office for that matter.

So that the app sort of brings the thing home to you and makes it more accessible. So you're more likely to do it. It's a time saver. It's convenient. It's like every technological innovation ever. I mean, I used to think about that, especially because I did, shit, with them I did at least two full shoulder rehabs

post-surgery. And so those were each five-month periods, going to the physical therapist for most of it was three days a week, and then by the end maybe it's like two days a week, something like that. I used to think about that. Man, going here, drive there to go, right? So 20 minutes across town to do it. And then changing, getting in there for an hour, getting stretched out for a half hour, leaving there for another 20.

I mean, it kills two hours of your day. And then you think about the people who have jobs, have families, responsibilities, and suddenly they have to get surgery on something. And now they have some hardcore rehab for six months. I mean, that's six, eight, 10 hours out of your week every week for six months and you're paying for it too. I mean, it's really a crazy thing when you think about it. Yeah, it is. And that's actually a really important thing about healthcare is that the time the patients invest in their care. And if you can cut back on that, then there's some efficiencies there. And that was sort of a forgotten thing for a long time. There wasn't a lot of attention paid to that.

The assumption was that people would just invest infinitely in their time and take days off from work and all that stuff. And now it's just that's changed for a whole lot of reasons that people are just much more conscious of their time. COVID too because it's like, you're already home. You're forced to be home and you couldn't go to places for a while. So people had to learn to be remote.

So now they're just, they're like, oh, well I can do this remote too. I mean, there's so many jobs in this country and my old job, I used to tell these ladies I worked with every day. They,

they went in there for Christ. They were there for like 30 years. One of them. And I used to say, die diane was her name i'm like you realize you could do this entire job at home and she'd be like you're crazy you're nuts i could never do that i'm like diane the only reason you don't do that is because the bank doesn't let you do it i'm like you could totally do it so when they went to shut down the office of COVID, she was flipping out. She's like, what am I going to do? Three days in, she's like, oh my God, this is the best thing ever. So people, then they started to look at the rest of their life too, where they were already forced to do it. And they're like, okay, well, I'll do that remote as well. And that remote as well. And now

it's like a new norm. Yeah. It's, it's, it's amazing how companies, you know, sort of woke up to the fact that, oh, I guess, I guess nobody had to come into the office to do this stuff yeah and i think that's that's a really interesting phenomenon and it does these these sort of home-based um well you know our mutual friend con oh yeah fitness he's doing he's pushing a lot of business online now uh shout out to king kong fitness he's actually great at it though because even through a camera that dude's screaming in your face like yeah he's up and you're like let's go baby yeah he's right up in your grill and i'm sure he can do that through you know any any sort of mode of communication oh i've seen it yeah and so you know guys like that are are killing it online now and of course

you know the covid but so again just like the work from home thing, the COVID is making people realize, I don't need to go to the gym to see a trainer, or I don't need to go to the gym just to work out. I can do it. I'm going to buy some equipment. I'm going to move to a bigger house or a bigger apartment. I'm going to get some equipment. I'm going to cut my gym expense. Some people are doing that. You're right. Yeah. I can't relate to those people. I miss the gym like crazy. I agree. I'm the same way as you.

I was dying to get back in there. How is it up there, by the way? How are you doing? It's good. It's good. In fact, I don't usually go in on Saturday. And the nice thing about Saturday at the gym is it's a slightly more relaxed atmosphere. And I got a great workout with ray eps training shout

out ray yeah at eps training he's he's a fantastic trainer and uh he just said hey i'm doing legs today tag along we'll do legs together so he and i worked out together but then a bunch of you know some of the old boxers were in there. Are they masked up when they're boxing? I'm, like, afraid to ask this. Yeah, no. Yeah, I mean, for the most part, yeah. I mean, I think there's the pulling down, the chin guard effect with the masks after a while. I love all the NBA coaches.

Like, on TV, they're wearing a mask. Then they go, they bark out in order. I'm like, yeah, you you know covid ignored the last like 30 seconds i guess you know well i mean that's that's the thing about the covid restrictions is that like the um you know like the closing of the of the bars like in in new jersey like you can't sit at a bar but you can sit in the same room as the bar um so it's like, wow, this COVID virus is a crafty son of a bitch. The COVID virus lays in wait for people to sit at the bar. But if you're back on a high top, it won't come back there. It knows. You were good. It knows. There's the please wait to be

seated sign. So COVID knows, gotta wait for the later day just and also kovid knows that a great place to pray on people's when they're going to the bathroom yeah so we're but we have outsmarted them those viruses by wearing masks when we go to the bathroom so we're totally protected yeah regardless of the biology there which there's plenty of science however you want to say there's plenty of science to back the whole that this is an airborne virus we know that at this point and so masks certainly seem to help right there is only so much you can do right with an airborne virus and it's it's interesting obviously that the route florida took here just because yeah you have a lot of people who are doing everything they're supposed to do in

other states where they're wearing their mask and wearing it out, wearing it in, but they're still getting it at home because they dropped their guard for one second. They take it off for one second. No one is going to wear the mask into their bed at night and sleep with it on and wake up with it still on. and so it's almost like it's an it's an unfortunate thing but i feel like at this point we're asking people to do something that really is technically not possible for the fact that you need 100 you need 100 mandated following of it not just by people doing it, but by people doing it 100% of the time. Right. Right. And I think I agree with you. The mask is, it's better for people to wear masks

than to not. And I think that we can, I think the science on that is pretty strong right now. But you're right. I mean, I've always said right from the beginning, and, you know, we, I think probably what you were getting at before when you were asking me what I do, I mean, we got thrust into this and our company, not just because we had some clients who wanted us to do some work related to this, but, um, but simply because we have a lot of clients who are in the space and healthcare space, and they just wanted information. Um, and they wanted, uh, to engage with us on it. I had people, I had former clients and just friends and colleagues and everything just calling and wanting to talk about COVID

because we being in the healthcare space had to sort of bone up on everything really quickly. Now, what kind of work specifically? Because you walk through, you do the economic planning, stuff like that, and you walk through what that was. So when it pertains to COVID, can you give an example of besides a client just calling you and asking your opinion because you're in the space, but when you're actually doing a project for someone, what that might've consisted of? Yeah. So we have a client right now, for example, who's developed a

differentiator, a diagnostic that differentiates between bacterial and viral infections. So it's an infectious disease diagnostic. And they look at that and they say, well, we should be, and it's a rapid test. So in other words, gets results back almost immediately. That's an interesting space right now too. Yeah, it is. That's a rapidly growing space. Yeah.

It is. Well, so back to this this test so um what this test does is tell you whether somebody's got a bacterial or a viral infection so and what's what's the difference between the two good question so a bacterial infection it's really only in the treatment so a bacterial and viral infection can appear to be the same in a person. It can be very difficult to differentiate by looking at them. So they can both give you a fever. They can both give you a rash. They can both make you feel like shit.

And interestingly, one is not necessarily more dangerous than the other. I think generally bacterial infections are more dangerous, but some viral infections can be very dangerous too, as we've seen with COVID. But a bacterial... So when you want to know whether... When somebody comes into the... Let's just think about the ER for a minute. There's a lot of different settings in the healthcare industry, but let's just think about the ER. Somebody comes in and you're the first doctor to see them, or maybe you're a nurse practitioner or whatever, and you suspect infection. They're sweating, they're feverish. So some type of infection. It could be viral, it could be bacterial, it could be COVID nowadays, or it could be

something else. So what you want to do is rule out life-threatening things. And one life-threatening thing is sepsis. That's a deep systemic infection in your body, bacterial infection in your body. And if you have sepsis, or you're at risk for sepsis, so patients can get into sepsis very quickly. If you're in that situation, that's a life-threatening situation, needs immediate treatment with intravenous antibiotics. So we want to know right away whether somebody's got a bacterial infection. Now, we've had some clients in the past, and there are some companies out there that have developed tests that don't just have two readouts, bacterial or viral. They might have a third readout, which

is mortality risk. And so that tells you sort of how bad is this infection. And that can be based on just the way your body's reacting. It's called like a host response. So if your body's reacting a certain way big time, then your infection is probably worse. And if that infection is bacterial, then, okay, we've got to really move fast here. So we've had a number of clients over the years that develop tests like that. And now a lot of these clients are saying we should be in the sort of COVID chain of diagnostics. And we should be not just in there, but we should be first. So when somebody presents in the ER, let's find out right away, not whether they have COVID or not.

So right now, what's happening for the most part is patients are coming in. If they're suspected COVID, usually there's a screening or something at the ER. They say, do you have a cough and a fever and all that? And they'll take your temperature. And if you look like you've got COVID, they're going to do a COVID test. Well, what these guys argue is that you should do a viral bacterial test first. And if it's bacterial, COVID's viral, right? So if it's bacterial, we know it's not a COVID issue. So then we move them over into a different stream. We triage them out into a different stream, a non-COVID stream. And then we check to see, is that a bacterial infection that could be sepsis?

Or is it because they've got a wound that hasn't healed very well, and they've got this host response going on showing that they've got an infection? They're not just adding a step to the process there? Well, they are adding a step. But they argue, they manufacture, and a lot of doctors too, that that's an important step to add because you're doing, you're helping the healthcare system. Streamlining. Yeah. You're streaming. Yeah. It's a triage, right? So you're, you're getting people to where they should go. And that, that was one of the biggest problems

with COVID when it first broke. And, and,, it was a horrifying experience for hospitals because they're like, what the fuck are we going to do when these people start showing up? Because, you know, a lot of what they did was they set up triage out in the parking lot. Oh, do you remember Morristown Medical? Yeah, they did that, right? It looked like an army base in the back. Yeah. Yeah, like a mash unit is and part of it was luck of the draw i don't know if that's really the way to say it but one of my clients from my previous job is uh don't want to give

away where he is but he's in a very prominent position in the south jersey hospital so south jersey did not get hit like nor jersey right at all north jersey was basically in the eye of the storm and what he was explaining to me a few months later was that basically all the hospitals in south jersey just by the spread of how covid happened because it didn't come to philly when it came to new york at the same time they ended up getting an extra week and he said we were all working together beginning that last week of February. Every hospital, literally, it was like a name, around New Jersey was on the phone with each other, on meetings, figuring it all out. And he said, we basically got an extra six to seven days. And that made all the difference. Because,

like you said, it was just, I mean, they were blocking it. It was zone coverage. I mean, there wasn't even blocking and tackling. It was, it was crazy. And nobody knew what to do. I mean, that was the interesting thing about this virus and we can get it, we can get into this because the whole response is nobody knew what the fuck to do. Well, actually I need to give you credit here too. You called this.

I talked to you on the phone. This was, this had to be like mid-february maybe maybe like maybe that last week of february when when the market was first hanging but i talked to you on the phone and you were explaining to me and i'm gonna forget some of the details but you're just like our system is not set up to be able to deal with something that it's never seen before those i believe were your exact words and you're like especially right now it's just completely unorganized or disorganized down in washington dc and this is going to be a cluster it was yeah yeah well yeah and and you know i think it goes back to this fragmentation that i was talking about but also you know obviously we

also had this unique situation hopefully unique where we had this giant leadership void. You know, we have politicians who just were not up to step, you know, not up to stepping up to the plate in a sort of traditional way that a leader might step up to the plate. I mean, at a, if you're, you know, if you're, you've been in corporate America, if you're a CEO of a big corporation and your corporation's facing some sort of adversity of some kind, the most common would be like a catastrophic recession or depression or something like that, you're responsible

for figuring out a response immediately. And it's gonna be your ass if you don't. And you have to step up to the plate. You have to put aside. Now, would you rather, if you're the CEO of a Fortune 100 company, would you rather just go to an island and hang out on your yacht? Yeah, obviously, right? But you can't do that because you're a leader of an organization and there's people depending on you to be an adult and step up to the plate and make the tough decisions. And that's the, that's, you know, all the leadership at the corporate level

in this country is sort of expected to do that. And if you don't, the board's going to get rid of you in a heartbeat. They don't have the time for that. They don't have the energy for that. They don't want the stock to tank because of you. And so they're watching you and they're holding your feet to the fire and you've got to behave. You've to step up to the plate you got to buck up and you got to man up and you got to do what's right and that's the way corporate america works that's why we have some of the best corporations in the world here that's not what happens with elected leaders yeah our elected leaders don't have necessarily the skills uh required to lead the country That's because that's not a requirement. You just need votes. You don't need skills. They don't have the emotional intelligence. They don't have the emotional maturity. And and so, you know, when they get to get now, that doesn't I'm not talking about, you know, Anthony Fauci at the CDC. That guy's got a great resume. He's 100% qualified. But the problem with Fauci, it's not with Fauci, but the problem with the system is that guys like Fauci,

they can't actually do anything. They don't really have a lot of power to actually do anything implementation-wise. And then they become political footballs too. Yeah. So the CDC can produce a lot of documents and data and experts and they can all get out and they can all talk about what's going on. And there are certain things they can do from a public health point of view, but by and large, they don't have a lot of power. So it really comes down to to leadership and what we saw with covid was we saw some good local leadership in some parts of the country and when i say good we could talk about what's good and what's not good yeah we started out talking about shutdowns right so it was shut down good or not but just put table that for a second and it's also at the beginning it's

kind of a different a little bit of a different context. Right, right. Exactly. Exactly. That's a good point. Because at the beginning, you know, we didn't know whether this thing was just going to like kill millions of people. Prevent defense. Yeah. Prevent defense. Everybody fade back and just prevent this thing from getting out of control until we

can figure out what the hell's going on. And that's what we had to do, right? And so that was a critical time. And during that time, you had some people in Washington literally calling it a hoax, not taking it seriously, downplaying it. But then you had other people in Washington

who were trying to do the opposite, trying to sound the alarms. And then you had a lot of local leaders who were like, okay, they can say and do what they want in DC. But at the end of the day, I've got to figure out how to keep the people in my community safe. And so this is a really interesting problem. This is not a problem that America or any country faces on a regular basis. So we had to figure out really quickly

how to coordinate all that shit. And I think at the end of the day, we still haven't figured that out. We still have this disconnect between local leaders who are trying to do one thing and not just local leaders, but you also have joining that local leader. You know, let's say a local leader is a mayor or something like that. Joining that local leader is the CEO of the hospital, not just the CEO of the hospital, but the medical director at the hospital. And you've got the, you've got to bring them to the table too. And then above them, and then above them, and then above them, there's layers and layers and layers and layers. Everybody's got to get their shit together. And it takes a tremendous amount of, I would say it's not

just emotional intelligence, it's emotional maturity. it's like everybody just needs to to just bring their a-game you know just figure out what to do like if you know um people who can help bring them in and that one thing that didn't happen that i you know i always thought um i had a friend in college and he and i always used to joke around about what we would do if we were president and and and i was an economics major and he would say all i know if i'm if i'm ever president i want you to be my you know head of treasury or whatever like uh or my chief economic advisor i'm like oh that's nice thank you i don't know shit um but the but the but the reality is that's exactly what we needed we needed someone, okay, we need to marshal together. Think about it.

The U.S. has the best universities in the world. I mean, there's a lot of good ones in other countries. But the U.S. has the highest concentration of, like, ridiculously high-ranked and high-powered universities. That's right. And what I'm talking about mainly is like the graduate side of the university, not so much the undergrad, but the professors who are engaged in research, you know, like Johns Hopkins

has some of the best infectious disease people on the planet, and they're all there. And they also happen to be 45 minutes outside of DC, if that. They're right there. They should have been brought in along with a bunch of others from around the country. And they should have had right away a big meeting of those experts.

And they went. And I guarantee you. I mean, it's always hard, right? You've been to these things, conferences and stuff like that. When you get a bunch of experts together, they don't agree on anything. Yeah. That happens, right? Yeah.

So it's not a panacea, right? It's not going to, this isn't going to be the guaranteed, you know, sort of solution to the problem. And I'm not doing this sort of retrospective or ex post rationalization. Like I think there would have been problems with that too. But the fact is it didn't happen. Think about it. That didn't happen. This is the biggest public health threat that this country's ever faced. And we didn't call an emergency meeting of all of our infectious disease experts. Fauci's there. He's, excuse me, he's a infectious disease expert at the CDC. He's involved. Great. We should have had 20 other people in there.

And might've put more trust in it too because he really you know in in the public eye and again like became a political football but you know i got so sick and tired of that guy because he changed his opinion every goddamn week and you know then just you point out this really interesting i guess you could call it a dichotomy that happened here but yeah you had the extremes form right away. There wasn't really people saying, okay, we know this is real. Here's what the data says. This is a lot worse than the regular flu. Right. Haven't really faced something like this before. Right. Here's what we can expect. Here's what we got to do to just to put the pieces in place to try to get a response going. Like, you didn't have the people saying

that. You either had people saying, we are all going or oh my god go outside like relax yeah exactly and and that that's not what we needed right we didn't need the extremes we needed that middle um that sort of educated middle and we had it we have all the people here who know about this stuff and and you know if you're concerned about the economy bring some economists in there too and let them weigh in. Like we really need, this needs to be a group think. And I don't even care if half the room's economists

and chamber of commerce people and half the room's scientists. That's okay. That would be a beautiful thing because you would mix the medicine and the business. I mean, we didn't have that. Yeah, and by the way,

those things are related. So if we just put everyone out, and this annoyed me about my people in public health, the extreme sort of people in public health who want to just shut everything down indefinitely. It's like, you know what? That's going to cause a whole host of healthcare problems related to people being out of work and depressed and no money and the economy being plunged into a recession. That's not good either. We don't want that either. Got to strike a balance. But given that we've never faced this before and given how complicated it is, the virology around COVID, very complicated, the interaction of a lockdown and a lot of sick people with the economy, also very complex. We need the best minds

thinking about this and we need a leader. Leader doesn't have to know shit. The leader just has to know how to get the best and the most out of all those people and put it together in a coherent fashion. And so the leader can get what they can out of the experts then go back talk to their advisors and talk to congress talk to senate and figure something out and and and have it be one of the things we we lacked at that time was a consistent message so oh yeah you just alluded to this you you said fasy annoyed you because you got we have different things it's true and all of them it was a problem i mean every single one of these anyone in front of a camera kept saying something different and if they weren't saying something

different it was cuomo saying we're all gonna die and we're we're all gonna die yeah i have so you know how many people we have working back here? Do you know how many people? You have to stay in your house. We have to flatten the curtain. Yeah, yeah, exactly. So, you know, listen, I think the history books are going to be kind to him when it comes to COVID. But at the end of the day, how helpful is it to just sound the alarm to that extent and shut everything down and have her? I mean, yeah, I'm sure he prevented a lot of cases

that could have happened in New York and a lot of deaths that could have happened in New York. I have no doubt about that. But- Yeah, what was with the nursing home thing though? I mean, because he drove, and that's the thing i i disagree with you in the sense that i don't think anyone's gonna have a good looking record honestly the guy who's gonna have the best chance if i were betting right now to have a okay record depending on who was looking at it is desantis and the people who don't like him when they look at him are gonna hate him for it know? So even that it's drawn along political lines, but this is actually another little leadership point within here that I wanted to ask you about,

which is you had a, an enormous fragmentation with who's calling the shots. So yeah, you have, I guess the president is the main leader of the country, of course, but states are making decisions on their own. And then I guess the governor's at the top of the chain, but you even saw, for example, Cuomo and de Blasio disagreeing on stuff.

At least they told us that publicly or whatever. Right, right. And so you had all these different – this is a big country. A lot of different places places different priorities right different personalities different politics and it's like okay well this guy's saying that that chick's saying that that none of that's the same and now everyone's going to yell at each other because by the way everyone's home so they got time to go on the internet and yell at each other about it so how i mean it i guess my theory is that in a lot of ways this was doomed to fail because we had that fragmented system where the states and the federal government can operate on a different wavelength.

And I am a huge supporter of states doing that. And you run into slippery slopes with scenarios like this because you say, well, I guess we can't do that again. And now you give the federal government all control, which is not how this country set up. But I kind of wonder if there had been one response to it and then everyone had to work on the same team because that's what it was going to be. And then just lobby their way to get their ideas in there the best they could. Maybe it could have been a better response,

but what do you think? Well, yeah, I think, I think that, well, it's, that's a tough, difficult answer to that question.

Yeah, it's loaded. Yeah, there's a lot there. But let's look at it this way. So you could, from a leadership position, so I think what you're getting at is this federalism thing. The United States is set up so that states can do what they want, right? I mean, that's the whole backbone of this country. I mean, what most people think of is the Constitution. Yeah, that's pretty freaking important.

But the next biggest thing in this country after the Constitution is states' rights and the ability of states to – but what happens when you have – well, this has happened during what i haven't been alive except for i was born during the vietnam war but you know essentially not counting the gulf war and in afghanistan i i wasn't really alive during like a big wartime effort so i don't know what that's like where there's a draft and all that yeah yeah and we're like everybody you know i my my parents knew about it my dad used to tell me stories about World War II. Oh, sorry about your dad. Oh, yeah. Thank you.

I appreciate that. Yeah, so he'd tell stories about what it was like to be a kid. He was just a kid during World War II. And he'd say – he'd talk about how unified the country was around that effort. And so like for example, in World War ii there were a lot of little things going on like um recycle you know not not um like metal was very scarce so yeah like your board over here is going to be yeah and all the electronics that you have over here um would have been you know like somebody would have said no no you're not going to get that for your podcast we need

it for the military effort and you would would have been cool. That's great. Oil, metals, like steaks and meats and stuff. I mean, it was- Yeah, yeah, yeah. Food. I mean, so much stuff was just allocated to the military, and everybody's completely okay with that. And turning out your lights along the coast, right? I didn't know about that one. Yeah, the Jersey Shore. My mother tells me this story, that because she had some relatives who lived down the shore during World War II. Oh, the U-boats and stuff.

They all had to turn out their lights by a certain time at night so that the U-boats couldn't see where the coast was. Because they didn't have, you know, the sonar nowadays kind of can look in any direction. But back then, sonar was kind of clunky and only looked in certain directions and only for so far. They had no radar. So if you're a U-boat, it's snorkel up to see how close you are to the coast. And if there's lights, they backlit a ship, then you could fire at that ship being backlit by the lights on the land so they so the country basically just said please turn out your lights by a certain time it's to prevent our ships from getting fired on by you boats did they mandate it well i don't know they mandated a lot a lot of the rations yeah

yeah they mandated that yeah they may have mandated it but think about how hard that would be to enforce right yeah because you don't remember, the police force is decimated too because they're all out fighting. They're all fighting. Yeah. So imagine how difficult it would be to enforce that. But people did it because everybody thought, okay, I've got to do my part in this cause, right? And again, I'm speaking – we're speaking on this. You and I are too young to actually have been involved in that shit.

Such an interesting time. But it must have been a very interesting time right because the country rallying together so even with states rights you still in wartime states have to coordinate right yeah we got states rights but what if california decides to put their lights on yeah then we got a problem right so i i think the i think at some, there are certain things that a country is faced with where everyone needs to rally together and work together. And I think this was probably one of them. And of course, we blew it. who, you know, survived up until now and lived through wars like World War II, some part of them, and actually my mother is one of them, I think,

is disgusted by the way things happen, by the way everything played out, just disgusted. She doesn't understand how this could have happened, right? In this country, which her parents actually fled from Germany to come here for a better life because they didn't you know they went when uh in the uh late 20s yeah they were burning deutschmarks for fire back then yeah exactly yeah wheelbarrows full of it yeah so they came they fled that and came here looking for a better life and you know i think you know for

people like my mother i think they think what the fuck happened to our country? And we're a bunch of bozos. She's disgusted by everything that's happened in the past, not just the pandemic, but the whole past four years about where we're at as a country. But just sticking to the pandemic, I think we had an opportunity

to work together and to invent a way to work together. So maintaining states' rights, people's rights. I agree with you about DeSantis. I think DeSantis is going – because what's going to happen with DeSantis – He's going to have his haters, though. He's going to have – you know what I mean? He already does.

I mean, he's got some serious haters. He's not going to lose those. But for the listeners, Ron DeSantis is the governor of Florida, and he has been a very pro let's keep things open kind of guy. And I think, you know, you and I have talked about this before. What are the repercussions of opening things up during a pandemic versus shutting things down during a pandemic? And I think, surprisingly, if you would ask me that when we had that conversation in february of course that was before all the shit went yeah yeah it was like literally two and a half weeks right on the cusp of it um it if we knew what was i would never have guessed that was a year ago

almost right that we had that convo if if you told me a year from now we're still going to be dealing with this shit i would have said no it's that's not see i would have prognosticated in the wrong direction i would have gotten one thing right and i don't think anyone would have said i would have not i would have said no way we'll be completely over it by that in fact at that time i was telling i was telling again you know when you're in this field everyone's always asking you what's going to happen and i was telling people it's going to be over by july um i was saying that in in march so you at least because yeah there weren't a ton of people going that far out i mean i i remember at the beginning talking to people like yeah so if we stay inside for two weeks

that's the maximum incubation period then the government will say all right two more just to be sure we'll be good yeah we'll be good and that that's it that was not an unreasonable stance you know what i mean like you're a smart guy i i don't i think a lot of people thought that and and um i don't know i was saying july because i was thinking about the weather and maybe once that warm weather comes to most of the country, it's going to kill it off. The virus isn't going to like that warm weather. Cold and flu season is usually when it's cold. So I was thinking we'd get in the clear in the summer. And I think the – back to the DeSantis thing.

I think back then, I think people thought, well, let's lock down and let's do it. And, you know, I think some people had fun with it, right? I mean, let's be honest. Some people thought initially it was kind of fun to watch how people were dealing with lockdown. And there was a lot of reaching out. I heard from all kinds of people I hadn't heard from. There was a lot of that at the beginning. A lot of reaching out, which was – that's kind of fun a little bit.

I mean, some people from Facebook you don't want to hear from, but – It's like a long sleepover. Yeah, it was like a long sleepover, yeah. But you're not necessarily – some of you are together because you're quarantined together, but you're not necessarily together. But it's like, oh, we're working, but we're not really working. We're on Zoom. Yeah, yeah, yeah. I remember all those unnecessary initial Zoom calls.

Like, everyone wanted to do a Zoom call. Like, people who you rarely have any contact with were like, we need to do a zoom call why we never talked we didn't talk before the pandemic i didn't fucking like you then all of a sudden we gotta we gotta get on the phone so or get on the tv screen so there's a lot of that stuff going to going on at that time everybody nobody really thought you know that any of this would happen so again back to ron desantis he stayed on message saying no no we're gonna we're just gonna we're just stay open and the problem though that i think maybe where we disagree on how desantis will be remembered i don't think desantis came into it after doing a shit ton of research. Oh, no.

He basically just, he literally rolled the dice. And things could, Florida, he's got a lot of old people. He was also late, too, at the beginning. Yeah. Like, he didn't, end of March, people were just, like, on the beach. Yeah. And that, obviously, we now know was mostly fine. But people were in the restaurants

and everything and just there was nothing yeah very late in fact he only did stuff about the beaches because uh well actually again back to this fragmentation thing the the mayor uh there's a there's a miami mayor and then there's a miami-dade county mayor which one's suarez miami i don't know i always forget he's the guy though suarez is the kingmaker right now yeah he's the guy yeah yeah sorry go ahead yeah he's um actually i don't remember which one he is but anyway those those guys had stricter restrictions because that you know obviously the biggest most densely populated city in the state but um not fort lickerdale though you ever see that map at the beginning yes oh my god because i guess that's

where they got the people on video saying if i get corona i get corona yeah you just see all these like all these all these lights flying out around the world i'm like oh man yeah yeah yeah it was yeah it was interesting so there was a joke actually toward the beginning of uh not a particularly funny joke but it was toward the beginning of the pandemic people were joking that boris johnson in um his name right but yeah yeah yeah that he was saying uh joe the joke was that he said that the UK was volunteering to be the control group. In other words, like, we're just not going to do anything and see what happens. Because he was slow as well to get on it.

Certainly by European country standards, he was very slow. And I think, you know, that joke, I think, is actually kind of, like, there's some, like, I kind you know that joke i think is actually kind of like there's some i could like i kind of like that joke because being at somebody who is involved in clinical trials and stuff like that where there's a control group and an intervention group i kind of understand the value of it you kind of need to see it's going to be really helpful at the end of the day that we have some states like alabama and florida that didn't do jack shit and then we have states like new jersey new york that did a lot it would be countries like sweden too yeah and then the country's sweden and belarus yeah belarus and so we have these like natural experiments which you know the researcher in me loves the

natural experiment i hate the fact that people had to die, but the fact that there's a natural experiment where you've got, here's one way to react, DeSantis. Here's another way, Cuomo. Let's see. Let's see what happens because we're not, it's interesting. No institutional review board would agree to a study where you randomized COVID patients to a, not COVID patients, individuals at risk for COVID to a state that had no rules and it versus a state. Nobody would, that- It's a lawsuit waiting to happen. It's a lawsuit waiting to happen. You absolutely would never get that study approved because it would mean you can't get a study approved if in one of the arms, there's going to be more deaths. And you know that a priori, that's not going to get approved. So, but at the end of the arms there's going to be more deaths um and you know that a priori that's not

going to get approved so but at the end of the day that's what we have because it was yeah it was a normal emotional and i guess some logic just whatever you call logic reaction on different ideas to how they were going to handle this thing that was like oh well this is here now yeah you know it wasn't it wasn't so much this long premeditated oh we're going to figure out this country all right you guys aren't going to shut down you're going to shut yeah it wasn't like that no no not like that at all so we have this you know we we have the natural experiment with countries but the problem with that is you know and this is all, we're all, you know, any, any international comparisons of anything that includes Sweden don't really work. Why is that?

Because Sweden is so different than the U.S. Like there's, first of all, they're all the same race. They're spread out. Yeah, they're more spread out. Their cities are a lot calmer and sort of like not as congested as ours. And if you've been to Sweden also, everyone looks the same. So I think there's a lot of stuff about our country, the diversity in this country, that make it different. I'm not saying one way or the other. I'm not saying we're worse because we're more diverse.

I'm just saying it's very homogeneous in Sweden. So when Sweden does something like... Scientifically, it's very homogeneous in sweden so when sweden does something like scientifically it's not worth as much to you right right because that's a that's a group of that's that's a group of people that's a very controlled society not not in it not in a um the china kind of way i don't mean it that way yeah i mean it's controlled in the sense that you don't have a lot of noise you know it's everybody makes the same amount of money everybody looks the same um everybody you know dresses the same like it's a it's a very homogeneous culture i'm not saying this i know this i i've got some swedish friends are gonna i'm gonna get some hate mail on this but but to me um that

country is not a good comparator to the u.s and how let me ask you on this though because this this is something we hear a lot about in headlines and i've read some stories about it but i'm not going to pretend to understand they're especially when you're dealing with viruses but really with anything i guess and correct me if i'm wrong any type of disease there are enormous differences in how it can affect people of different biological races right so with covid what's been the experience there besides the and this really has nothing to do with race other than it has to do with types of communities but people have been saying there's there was a higher impact on Latinos and black communities, especially in urban areas. And a lot of the connotation there was because there are a lot more people concentrated in those areas and not so much the virus itself. But besides that, the actual virus itself and the science, how much is that true and and how and how does it affect different people yeah good question so and these data came out from china initially

um because you know china that's terrifying yeah so we we initially got data but published in you know published by chinese scientists in peer-reviewed journals the same journals that we publish in so there's there's a little bit you know it's a little better than anything coming out of the government that said a lot of the data that they're using is coming from the government so but even in those studies we did see now the problem what's the problem it's the same thing we're just talking about with china there besides um uh you know uh there's always there's always exceptions to the rule but there's very few obese people in china yeah um now but there is a lot of hypertension in china because they you know just for some reason they they seem to be susceptible to that but much less type um well yeah diabetes i was going to say

obesity but diabetes and obesity much less in china than in the u.s, much less obesity. Yeah, like none. Much less diabetes than the US. US has a crap ton now of obesity and diabetes. It's out of control. And those two are related. So these metabolic disorders in the US are just off the charts. If we could show the audience a chart,

it would just look like that. Yeah, I'll pull that up i'll put it on obesity and diabetes just are just out of control in this country so to your question so covid seems to attack people with those metabolic disorders much much worse than it does with people without those metabolic disorders. So, and not just metabolic disorders, also seems to be a hypertension connection, COPD, which is chronic obstructive pulmonary disease. If you've, obviously, if you've got that,

you're going to be more susceptible. Asthma is something that's more common in the US than a lot of other countries, a lot more common. So you go down the list of all these sort of, the sort of health plague that the U.S. has been a leader in. We're out in front of pretty much all other countries. The only country that got out in front of us on obesity was Germany. Really? Germany started having an obesity problem before we did.

But I think we've surpassed them now. I'm not sure of the data, but I think we have more obese people. Yeah, this sounds more like a country thing rather than an ethnicity thing, though. Oh, yeah. It's a country thing. I mean, I think, yeah. Now, there is a little bit of ethnicity in there, too, because— I don't know if this is real, by the way.

I just want to check. But I've heard like in the past where they'll say, oh, someone like me, very pale skin, much more susceptible to skin cancer. That's backed by every form of data. And then I think maybe I'll get this disease wrong, but they'll say, I think it's lupus. You're more susceptible or sickle cells. One of those two. You're more susceptible if you're black than if you're white so those things there's at least been data that's been reported over the years where it's like okay specifically these are these target different races so covet again you were kind of talking more about the country but less of that when it when it comes to actual races well no i mean

there's there's like an independent effect on African Americans, maybe on Latinos too, but I can't, I don't know if they, when I say independent effect, I mean, it's African, that means after controlling for other things. So after controlling for metabolic disorders, like diabetes and obesity, is there still an effect, a race effect? There is for African Americans. I don't remember if there is for Latinos, but, but so you do find those sort of effects sometimes. And, and when you're looking at epidemiological data and COVID, so COVID is going to hit African-Americans. There is this independent effect that's going to hit them harder. It's going to hit obese people, diabetes, you know, people with diabetes. And of course,

older people, older people are going to be more susceptible to everything uh just because of their depressed um ability to fight things off yeah um uh and they also are more likely to have comorbid conditions maybe less likely to have obesity you don't see a lot of really fat old people but um that you know tend to start losing weight when you get older but you're or they didn't make it there right right or yeah or they didn't get or they didn't make it there as i you know i was you hit this thing and my feel is there's no fat people in nursing homes i mean there really aren't if you go to a nursing home everybody's frail and skinny um because they don't make it there yeah um so that the so that's part of the issue.

And that actually was one of the things that confounded a lot of the research because, you know, usually with viruses, they kind of all, they affect everyone kind of the same way. But we see COVID coming in and having these different effects on people. And that's one of the things, not just this effect, like it's not even a reliable effect by obesity. You don't say like, well, if your BMI is over a certain amount, you're going to die from COVID. That's not true either. So it's such a different virus in terms of how it affects people and who it kills versus who it hospitalizes and who it remains asymptomatic in. Like that's, it's really hard to figure that out. But generally, people with metabolic disorders tended to fare worse with COVID. And so America as a whole,

with its sort of very high rates of metabolic disorders, has done worse than other countries because of that um now there's a lot of other factors too that have made it made us do worse than other countries but but that's one of them well a couple things first thing i want to ask about is the incentivization here because we're talking about a lot right now we're attacking a lot i like this because it's very very educational but you would talked somewhere maybe 10, 15 minutes ago and talked about the fragmentation with the response and what the capabilities of the hospitals were going to be. So how much intake could they have over a certain period of time? What would a surge look like?

Stuff like that. So the stuff we were really talking about at the beginning, and you've heard again a little bit over the past few weeks with it being winter again and some surges. But what about the fact that hospitals, because they maybe didn't get hit right away, but then set up like crazy, and society set up like crazy to prepare for it, that then they weren't getting

patients in there and therefore didn't have they didn't have their beds filled they weren't making money people weren't even coming in for stuff they probably should have been coming in for and so then they get some patients patients die maybe they're they have comorbidities they're obese or they're old or something and someone's sitting there and they have a mandated thirteen thousand dollar check from the government if an already dead person they just say died of covid right how much of that is because again i try to take everything with a grain of salt that i hear because there's all kinds of political positioning and bullshit going on out there but it does seem like that has been a trend to happen in at least some hospitals around this country yeah so i mean i mean here's something to keep in mind about that

and i agree with you it's the incentives are pretty strong hospitals at least initially i'm not sure where the policy is now but initially some legislation was passed very quickly to give hospitals 20% more payment per a COVID admission versus a non-COVID admission. They needed it not just for that COVID patient, which does require more resources, right? But also because of the lack of, as you alluded to, the lack of elective surgeries, elective diagnostics, elective CTs and MRIs, all the stuff, non-urgent, non-emergent stuff that they weren't getting anymore. Yeah, some people had heart attacks at home and died because they're just like, oh, I'll just let it go. organizations uh new york times or um washington post or someone um published a story saying yeah the the big fear here is not the so much the covid patients but it's who's not coming into the hospital and they had a graph that showed like the number of of people presenting in the er with

with um heart attacks yeah and that graph showed is the precipitous drop and you have to think okay those people are not not having heart attacks there's nothing about the pandemic that's going to prevent somebody from having a heart attack you're right they're having them at home they're literally having them and not calling ems because they don't want to go to the hospital because of the fear of the covid so um so you've got that going on so hospitals are definitely suffering so back to your point though i think i've read a lot about this there's this there's this feeling and it's been fueled by a lot of different sectors of of society that hospitals are sort of upcoding these cases to covet cases to get that 20 i think that's there's

definitely some of that happening but you have to remember that if you're a hospital administrator and you're of a certain age, you've lived through a period of time where the crackdown on healthcare fraud was astounding. Bill Clinton started it. He hired something like a thousand new FBI agents who were just focused on health care fraud and and because health care fraud at that point was just out of control so it's basically doctors misreporting things to be able to doctors hospitals hospitals coding a pay i mean coding a patient as a covid patient when they're not a covid patient is health care fraud yeah the reason it's health care fraud is because um is because there's a third party involved.

There's a payer, which is mainly the government. I mean, if it's a Medicare patient, that's anyone over age 65. You're committing fraud with US government funds. And that's been so nailed down and locked in. Now, I'm not saying it doesn't happen. Obviously it happens. And of course it's going to continue to happen. You can never shut that down completely.

Yeah. Because for a whole lot of reasons, healthcare is one of those things where it's very susceptible to fraud because it's very hard to prove things. But because of the crackdown in the past, I would be really surprised if there were a lot of hospital administrators

who are consciously upcoding patients in large numbers as COVID patients when they weren't. Now, is it going to happen with a few odd patients? Absolutely. If it's a patient, honestly, I hate saying this, but if you think you can 99% get away with it, you might do it. But if you think there's a, you know, if there's more than a half a percentage chance of getting caught that's bad in this day and age you don't want to get caught the difference now is that there is such a societal push on this whole thing that again when people even question facts around covet as far as the not the legitimacy but the severity of it

they get labeled a hoaxer now because there were there were people who were hoaxers just there's a lot of them now oh yeah yeah and they're just like no no shit's like completely not real and i think it's different when you are just like hey there's a lot of things that governments are doing to take too much control that's something i'm very passionate about i'm not afraid to body bag those guys for doing that at this point but when it comes to like the virus yeah the data is the data like it it is it's not good when you have the whole media apparatus on top of it though talking about it like they almost it's it's morose it's almost like they enjoy it we have death counters on on all these channels and everything and they're constantly like hey stay safe we have all these public campaigns

and everything i just get the sense people aren't going in there and questioning you know oh that wasn't a covet death especially when you have hospitals who are barely paying their bills too so it seems like more of a one-off situation yeah Yeah, it's true. I mean, I think, but there is a little bit of this IRS effect, which is in the US that your probability of being audited in the US is extremely low, actually. It's a single digit percentage, your probability of getting audited by the IRS. Yet, the number of people who report their tax returns, honestly, is something in the 80% to 90% range. Yeah. I can't remember the exact numbers.

But there's this huge disconnect between the actual probability of getting audited and the amount of fraud, sort of, I guess, minor fraud that you might see in a tax return. I'm not talking about little things like you forgot to include XYZ or you deducted the piece of equipment here that may not exactly have been purchased for your podcast. Whatever. I'm not talking about little things like that. But there's this disconnect between the threat of audit and the actual sort of amount of misbehavior. Sure.

And there's a little bit of that now, I think, in healthcare fraud. I think there's, you're right. I mean, the chances of anyone coming by and second guessing you, especially after that person's in the ground, is zero. But the risk, it's like, I think,

well, the argument with the IRS is that most people have heard that audits are horrible. It's like getting a triple colonoscopy at the same time. And so they don't want to go through that hassle. And so they err on the side of being mostly truthful on their tax return. And I think my experience with hospitals is that's what they're doing with health care. Like, they're going to err on the side of being mostly truthful with classifying cases because, you know, at the end of the day, there aren't going to be a whole lot of hospitals that literally go out of business because of COVID. There are going to be some you know, you're not going to put everything on the line in a fraud case, especially given how some of those have been tried by a very aggressive investigative apparatus. You're not going to risk that. So I think that I think it's happening,

but I think it's relatively minor in terms of skewing the data. So I think the concern is that hospitals are going to call that death a COVID death. It's not really a COVID death. That's going to screw up the numbers. I think it's definitely influencing the numbers a tiny bit, but I think the general trends in the numbers are still pretty accurate. Yeah. The other thing that I wanted to touch on that is a very difficult thing for me to conceptualize

just because it's, I don't know if controversial is the word, but there are winners and losers in things and there's a black and white with stuff that then leaves some people by the wayside and also props up other people. And when you talk about some of the comorbidities, yeah, you know, if someone had cancer or something like that and previously had it, like that's a comorbidity they don't they probably didn't

control that it's you know it happens to some people and and you got to watch it because in that case obviously your immune system is more susceptible but when you're talking about things like obesity that are maybe more common in this country than say a country like sweden or something like that these are things that people and i hate to put it this way but technically you become obese because you eat too much right so if if you're obese and i'm not or i'm obese and and you're not like one or the other the person who's eating a lot more is gonna have a lot more health problems and and a lot more things happening to them so it comes back to some of these civil liberties arguments which again that's something we've talked about a lot on this show but why should

i change my life and everything i do because you have something that technically by the definition here, I don't want to say you chose to have it, but you made decisions in your life that you could have not made to get yourself into that position that I didn't make. And so I'm not in that position. You know, what is the balance there? That's a really interesting point. And I think that's, I've heard that I'm starting to hear that chatter with respect to COVID. You know, basically, hey, I've taken care of myself. Bring it on. I can get COVID.

I might be down for a few days. I'm going to be back at it. I'm going to be fine. So why am I suffering? Why can't I travel around the world? Or why can't I, you know, go out and go to a party or, you know, go to a club? I'm in good shape. I should be able to do those things, right?

A lot of people think that way. And there's versions of that with other things, like smoking was, you know, that was an issue with smoking for a while. A little bit different because people were like, you know, once the data came out on how costly smoking was to the health system, non-smokers were like, what the fuck? Yeah, why would they invest?

That's making my insurance rates higher. You know, I don't, I shouldn't. Basically, it's a cross-subsidization scheme, right? It's a subsidy. Yeah. I'm paying, if you're a smoker and I'm not, I'm paying a subsidy to your healthcare. It's really the same question.

You're paying the same amount, but you're going to need more. So it's going to be subsidized by me. I'm going to need less. It's all relatable. Yeah. Whether it's the bill itself or how it affects your day-to-day life, it's all relatable. Right, right. So, so COVID actually, interestingly, I'm glad you brought that up because it brought that out in a different way. A lot of, once the data started coming out saying that, you know, unhealthy people are really what we need to watch out for, a lot of healthy people are like, all right, well, then if you've got a comorbidity, and we'll explain to you what that is, if you've got that, then stay home. When you go out,

double mask, don't get on a plane. If you're at risk, if you feel like you're at risk, then you take care of yourself. The rest of us are going to go about our business. I think a lot of people feel that. I think that describes Florida, basically. And that's also a very individualistic sort of every man for himself kind of thing. It's a libertarian thing. Yeah, it's a libertarian thing.

It's like saying, look, we understand it's a problem. It's a shame that there's going to be some people who die. But why should everyone – it's a classic argument, right, in philosophy and political philosophy is sort of the collective good versus the individual freedoms. It's just getting warmed up too with this. Yeah, I think it is. It is. And you can feel these touch points and – or flash points, I should say. And the whole Florida thing.

So definitely flashpoint. This is all the shaming now too. Like, you know, it, your fellow podcaster, Adam Carolla was talking about, he was,

he, I think it was, he posted a, a picture on Twitter of him cutting into a steak at a steakhouse in, in LA saying, you know, like just getting my, trying,

trying to escape COVID for a night or something like that. And he got, he was talking about it on his podcast. He got completely shamed. If you want to go psychotic, go into Twitter comments. I don't, there are apparently a lot of these people in the world, but. I try to stay, try not to get wrapped up in that, but yeah, they're out there. Right. And they're just, they were just attacking him for going out and having a steak. And I, and I think, you know think, you know, that's what we've become, right? And we were doing that before, right? If you weren't recycling, you were getting, you know, I mean, there's, go on down the list.

Like there's a lot of things we're getting shamed and canceled for. But I think that COVID sort of bring, interesting thing about COVID is it pressure tests almost every aspect of the economy, not the economy, of society. So it's like if you've got a balloon and there's some pinholes in it, but it's not inflated balloon, uninflated balloon, there's pinholes in it, you start blowing into it, you're going to start seeing where those leaks are, but you're not going to know where those leaks, you're not going to see those holes. You can't see them, you just- Until you start blowing into that balloon. And COVID's a big blowing into that balloon.

And we're seeing all kinds of fissures. There's racial stuff. The fact that COVID disproportionately affects blacks, once we found that out. Well, now, if you're a COVID hoaxer, that's a racist thing. You don't give a shit that affects blacks negatively. That's how we label it. Yeah, yeah so you know i'm not saying these things i'm just saying this is what people are people say people are saying right so i i think covid has become this big sort of it's gone it's it's transcended public health and now it's a societal thing it's how do we deal

with something that you know make that we need to work together on but also at the same time exposes all these cracks and problems that that we haven't solved yet um and and it's just made those things worse i think you know and again at the same time it's like this perfect storm yeah we have a president who fans these racial um flames too and just like wants to stoke up all this uh all this you know sort of hatred and vitriol at the same time and so we had this pandemic come at a time when we were already you know um just like becoming unhinged about a lot of stuff that was and you know i'm not saying unnecessarily like there about a lot of stuff that was, and you know,

I'm not saying unnecessarily, like there was a lot of like, you know, the, you know, the, the, the police issues and,

you know, George Floyd and all this stuff was happening at, at the right around the same time. I can't remember if Floyd happened during COVID or before. Yeah. Floyd was like three months in, but these were things, you know,

we saw it pile up. It wasn't, it's not like he was the first. Right. There's you know, we saw it pile up. It wasn't, it's not like he was the first. Right. There's a whole bunch of precedents to Floyd. And, and, um, but the, the pandemic just kind of makes all that worse and it makes everybody on edge and it makes it, you know, we're very quick to sort of, to, to see things in the panic. I mean, you know, part of the thing also is that everybody's at home yeah that's the entire thing nobody's out doing and so everybody's just paying attention to the they're

maybe watching the news a little bit more yeah and yeah they're online more and you know um they're getting whipped into a frenzy by podcasts yeah and uh and they're they're um you know whereas you know but you think about it we're gonna forget about this pretty soon because it's been so long but before the pandemic you had a life right you'd go out and go out with friends and it's very sad you say we'll forget about that but yeah it's been we might i mean it's starting to get that it's starting to feel like that right now we're on we're almost at the one year mark of not really being able to live our lives normally. So we'll see what happens. I think the longer we go like this, the harder it's going to be to go back.

That's the thing. And that's why I keep talking about the precedents here. And it puts you against the grain of the quote-unquote science on some things. And the other thing about science is science has become the new religion in a lot of ways. There's a lot of people who got a fucking F in junior year physics who are on there spouting on Twitter like science is the greatest thing ever and we must listen to it. You have to remember there are agendas behind so much.

So you have to – I mean you're a data guy, and I think you made that pretty clear throughout this. Like, okay, what did the data sets tell me, and what is – how can we best predict how this is going to go? And so when – I've seen a pattern of whenever we see things that look like it could have an uptick during this, regardless of the bungled response and leadership and all that. Again, we thought this thing was lasting two weeks four weeks by the time we were in may we're like all right this was a colossal failure so everything since then it's been a long time and every time we see one of these positive upticks it's like okay well we were talking about this now we're going to talk about cases okay well we said it was going to do this but no it can do that we started off this whole thing

with no no don't wear a mask to wear a mask to oh my god you have to wear a mask oh my god you're killing grandma if you don't wear a mask and and it goes on and on and on and like yeah again does the data seem to back that a mask is is is a better way to go especially around people who you know let's say older people who are more at risk? Sure. Yes, absolutely. I can't really argue that. But where do you draw that line of the precedent you set? Because when you say things, and you're a really sociable guy, but when you say things like, man, we're getting far along enough here that are you even going to remember what it was like before? That's terrifying. And if you put on your tinfoil hat, and that's not what I'm doing, but, and, you know, if you did and you said, oh, well, it's all planned by all these people or whatever, well, that's a good argument for them because they'd say, well,

those people who are putting on the tinfoil hat would say, well, damn, it's almost like all these people in power want us to forget what that was like because for some reason this is the best ends to them, us being inside, and this is how they want it to be. It's crazy. Yeah, it is. And I don't know how – I'm not sure how this is going to end, but it's – another thing, another way to look at it is, are we going to learn from this? Are there things, are there takeaways from this that are going to make us better in any way? So rather than think about the negatives, think about the positives that could come out of, you know, learnings from

this. Well, we're certainly going to be better at pandemics from now on, I think. We're also going to be better at what happens when people storm the Capitol. I think, you know, because we, people do learn from stuff, you know, for the most part. I mean, a lot of things we don't learn from. But I think we're going to learn from this. And I think, but I think what the problem is, we're only going to learn from it if we take it very seriously and sort of look and see like what worked and what didn't. And that brings us circling back to what we were talking about before. Let's see. I don't want to write off.

I'm not going to be,'m not a huge desantis fan but at the same time i'm not i don't want to write him off because i want to see what what how florida stacks up yeah you want to see the numbers yeah against the other states i don't think it's going to be that bad and um and i think you know the other thing going on here is like there's a lot of there's there's still even with a year mark coming up the year anniversary coming up we still don't there's so much that scientists don't know so you were just talking about how science is not always what it's cracked up to be that's true but what happens when the science is not even there like i mean we don't need there's so many questions about cobalt we still don't know

there's a lot of weird i mean there's the new, which are going to cause a little bit of a problem, the mutations. But there's also this issue. Pull that in just a little bit. Yeah, sorry. There's also this issue where it's not just the new variants, but the issue with transmission. So we have an abstract into a conference. We're going to do a presentation, hopefully, in some time in the fall on this transmission issue. Because how contagious is it, actually?

We know it's contagious, right? A lot of people. We have a shit ton of deaths already. We have a lot of hospitalizations. We have a lot of cases. It's obviously contagious. It can obviously pass from one person to another pretty easily. But how easily?

Like how much? There's measures of that, right? You talked about the asymptomatic thing too. Yeah. And the asymptomatic thing is really important too because we don't know, for example, whether an asymptomatic person can give it to... Well, what we don't know is what is the transmission rate

different among asymptomatic versus symptomatic. We think it is. We think if you're symptomatic, you're going to be more contagious than if you among asymptomatic versus symptomatic? We think it is. We think if you're symptomatic, you're going to be more contagious than if you're asymptomatic. But we don't know the extent to which. Already, a year in, we don't know the answers to these questions. So until we can really figure out what's going on with those kinds of questions, those really disease transmission type questions, like really getting down to the nitty gritty.

Like, for example, what's the chances, you and I are about six feet apart now, so we're being good. But what are the chances of me coming in today and giving you COVID? We don't know the answer to that question. We don't know the answer to that question. So I think that's kind of important right why can people get together you can

i would think it's pretty important yeah and by the way you tested negative for coven yes i gave one seeing the cost like i'm gonna be getting for this no no i had three three negative coven tests this week i don't know if you know it was three yeah so yeah because i came back from miami with a cough of course i was shitting my pants all right i was in miami now i've got a cough but all i have is a cough i never had the fever and uh but of course i did the right thing and i went and got tested which wasn't easy now the urgent care centers are a little bit, they're handy, you know, the ones that are on the corner. You can go in there pretty easily and get tested.

So I got three tests. Now, did you do the full up your nose job or the PCR? I did the, well, that's the piece, the up the nose is the PCR. I did two of those. The rapid response one, sorry. Yeah, and then I did the rapid one too. I think the rapid one was in the nose too, I think.

I've never gotten a rapid one. I've only done the full PCR thing. So I don't know how to do that. I did the rapid one in the name of science. I didn't need to do it. I already had the two PCRs, but I was curious about the rapid one. Because the rapid one is supposedly less accurate. That's what I was going to ask.

Like I've been hearing that the thing that I seem to get from some doctors I talk to, anyone else I'm not really going to take seriously, but who knows if the doctors even know, was that it's pretty accurate if you get a positive, but it's not necessarily very accurate at all if you get a negative. That's right. Yeah. The rate of, well, the way we say that in the space is if a true positive, well, no, actually the way we think about it is a false positive, there's a 1% chance of a false positive. So that means you have a 1 in 100 chance of your positive test being wrong. But you have a, get this, ready for this, 34% chance of your negative test being wrong. Yeah. That's bad. Okay.

Yeah. Yeah. Why is that? That's what I was hearing. The reason for that is that, well, part of it's attributable to the coronavirus being a tricky virus. But it's mostly attributable to the fact that we had, like, we basically gave everyone everyone you got three weeks to come up with a test because we fucking need a test yeah now like back back in february and march not even february march we were in desperate need of good diagnostics because we had at that time well maybe maybe it was

february i can't remember the timing now but we didn't know who had this disease already like we in other words you know whenever when there's a pandemic we were talking about remember we were talking about the nursing home in seattle remember that everyone's like there's a nursing home in seattle that's got covet and we're like ah shit nursing home in seattle wow that we should be able to contain that and actually with the um h1n1 virus um i had that you did we were able to contain that pretty well like it didn't spread nearly as much as covid and there were a lot of hospitalizations for that there were but i mean it didn't it wasn't take the same it didn't it didn't transmit the same as code i remember when i was i guess that last week yeah

it was that last week of february i sat down on february 25th i have the screenshots i literally took it afterwards but some people were freaking out about coronavirus and everything and how this was all gonna drive insane and a couple people freaking out about it i'm like all right this is kind of crazy right yeah so i just went to the data that's what i like to do i'm similar to you in that way but you literally do it for a living i just love doing that and so i went to the who and like the cdc the best ones yeah and i went and i compared the data we were getting which was all out of china at that time which turned out to be all bullshit so you know that that's why the moral of the story was i was all wrong but i compared the data out of china to the h1n1 because i'm like oh shit i had swine flu it was terrible and um there were if i remember this there were

i believe 287 000 hospitalizations between april 2009 and jan January 2010 in this country and there was a death rate of 4.54 percent and I'll go check my notes on that but I didn't remember it being that high that's what it's telling me but that was hospitalizations so people who actually had it I didn't go to the hospital right I had it terrible right now I was a kid I was in good shape right so I'm the least susceptible to actually have something terrible happen but I was home for I missed like seven days of school for that. It was a long time, right? So you have to remember, there's a lot of people who aren't going in and actually going to the hospital for it. So what is the real death rate for that? But, you know, with COVID, it does

seem to be that overall there is a, it more severe and it also seems like it is less contagious because i know we've had i mean there's obviously a lot of fear around it too so more people are more likely to go in there but we've had a lot more hospitalizations over a very similar period of time right at this point you know than that number right right right yeah so i mean yeah so there's a lot we don't know about COVID still, unfortunately. And so we're going into this now year two with a lot of unanswered questions. And unanswered questions about the virus from a virology and medical perspective, clinical perspective.

We also have a lot of unanswered questions about what's the best response. We still don't have closure on that. DeSantis is still going to take a lot of flack for keeping things open in Miami. And Cuomo and Murphy are still going to take a lot of flack for closing shit up up here. I mean, it's, or praise, you know, they're both going to get flack and praise. And I think that's, you know i part of me again part of me thinks all right this is good we're getting some experimentation but part of me is kind of scared by that because if we don't know how if we don't know already which which of these methods is going to work um at this point then you know then we haven't learned much. Yeah. I mean, again, it's coming down to the time we have to process this. And one of the things I

do want to talk about in a little bit is the vaccine, which is another time-related question, because again, you don't see vaccines get produced inside of nine months or 10 months, whatever it was. And so there's a lot of questions around that and I think that that's well founded in some places not well found in other places but we'll talk about that but the other thing is because we are still alive in this you do have that clear political divide of well I'm team Cuomo or I'm team DeSantis based on what your preferences are as to what they should be doing one of the things I have noticed though over the past two months and particularly as we started to get into the fall and into the winter and I guess into the new year now too is there are a lot of people who I don't know I'm sure the political affiliations are both ways, who have passed their

breaking point. And specifically, a lot of people in the business community who sell product, whether that be your service business, like a restaurant, or you have a physical product, hardware store, whatever it is, and they're just getting crushed by this. And maybe not so much in states like Florida, but in most of the other states around this country especially in the states that have been ridiculously without data backing them at this point over the top like a new york and what's very scary to me is we've now reached this point where things are kind of coming full circle so i'm going to make some generalizations here i want to highlight the fact these are generalizations they're not

i'm not painting everything the same but if we were going to generalize when when there was a lot of anger at police officers in this country which hasn't stopped but when it was bad post derrick chauvin and george floyd it tended to be liberals were very angry at the police and conservatives defended them right right and just again generalizing but that tended to be what it was and everyone with george floyd everyone agreed that was terrible that wasn't the point it was like then are we going to paint all the cops like this or are we not whatever right now i am watching as we are past the point where all the ppp money ran out pp however you say and past the point where people have had grace periods on their rents and their leases and things like that and past the point where revenues down below a certain number are actually allowing them to stay in business and there's a massive desperation so my second generalization is think of the average small business owner in this country these tend to be people who

built it themselves or in their minds they did however however you want to say it, and they tend to more skew conservative. Now, it's not 100% at all, but let's say it's 70, 65, 70 more likely to skew conservative. These were the people who were defending police officers over the summer. And the thing about the police officers who i they've just had a really rough year they they have to do their job and their job is to uphold what they're told the law is and so what happens when you have these confidential hotlines where people call up and report people and whatever the cops get called and the cops have to go there on the basis of well was this rule broken that i'm supposed to uphold? Yes or no? Okay, whatever. So you're seeing these videos online now, and I'm not going to put because they're desperate right they're in a

corner they've had enough right and what's very scary is that the only thing i haven't seen is these people whipping out guns to shoot the cops because they're i mean they're getting physical with them sometimes too it's frightening to watch and so the reason i'm bringing this up is because yes at the beginning because we were dealing with something so unknown and, you know, again, zone coverage the whole night where we did have data also on this virus, disease, where we could see like, okay, here are the age groups and here's the data sets of who's most likely to die and what those numbers are. I mean, there was a report, I don't know if you saw this, I've cited it a million times on here, but September 10th from the CDC, it shows very clearly if you are above the age of 70 you have a

significantly higher risk with this thing which should be common sense but it's it's pronounced i mean it was they have a 94.5 chance of living if you get it at 70 and above the next age group below is like 99 point something so it's a big jump yeah so we we know that but we also know that as a society of 330 million americans 335 million americans whatever it is there are a certain number who if it was all pushed out into the open they're gonna live or they're gonna die right and it's not 90 10 we're not seeing a 10 death rate and so all these people who spent 10, 20, 30, 40 years doing everything, getting up for work every day, living the American dream, working their balls off, building something. I mean, you're a business owner. You understand this.

When that's starting to get stripped away, it seems like it doesn't really make sense. And so from the public health segment, which you can also empathizeize with you're really on both sides of this equation how much can you keep telling people to stay the fucking side yeah yeah you you i mean you can't right i mean that's the that's the short answer to that question and i've i mean with any virus i mean the the bottom line is you can run but you can can't hide, right? Because, I mean, that's an old cliche, but it really pertains to viruses, not just COVID. Look at the cold and flu season every year, flu shots and everything. We're trying to give everyone flu shots. Why?

Because we think a crap ton of people are going to get the flu. How do they get it? Well, it just transmits. Not everyone gets the flu from going to clubs. Not everyone gets the flu from going to bars. Not everyone gets the flu from going to bars, you know? And so it's, the flu transmits quite easily. I'm talking about the regular flu. And it has for centuries, transmits quite easily just through day-to-day living.

Touching a, think about it. You know, we take all these precautions, right? But then we go and grab a door handle that a million other people have touched um or you know 120 other people have touched it that day um that door handle and then you put your finger up to your face um when you get home and you've got your mask off and you got it right i mean you're going to get exposed to um you know we're talking about my cough which is just a the remnants of a cold right we've determined it's not coven right just again for your for your listeners first coffer in here

first coffer in here just got back from miami so the you know the the um how did i get that right i was talking about this with with some people they were like how did you get sick if you're wearing a mask the whole time while you're down there washing your hands all the time i'm like yeah that's a good question right i got a regular cold from from traveling um and it wasn't covid could have been the air it could have been the airplane bathroom yeah it can be that's the point you know i i got it somehow. I touched something. I touched something somewhere and I got sick. You can run, but you can't hide. You can't hide from a virus that has any sort of above average transmission rate. If it's something that's going to transmit fairly easily, there's no way you can protect it.

I think you made this point earlier. You can go and hide in the basement for the whole pandemic and then emerge and then get it. Yeah. Why? Because you've built up zero immunity to it during that time you were hiding. What about your immune systems being inside all the time? Well, so, I mean mean there's a whole science around immunity right or not just immunity but uh you know your sort of body's immune response and everything and um immunology all all the stuff that that that um is really taken off in recent

years and you know the the the consensus is that the more you expose yourself to something over time, the more immunity you're going to have to it. So let the kids play in the dirt. That's the thing now, right? I remember when I was in graduate school, this was a long time ago, one of my fellow students had a baby. And this was the first time I was really dealing with friends having babies because it just hadn't happened that much in my life. I've kind of avoided that whole thing. So up until that, I mean, it eventually caught up with me. But I went over to her house to see the baby.

She made me take off my shoes and wash my hands before coming into the house. And I thought, well thought that's it's weird i'd never i didn't yeah it never occurred to me that we need to create a sterile environment around this baby and then you know you're watching then smash cut to three weeks later i'm watching the discovery channel uh had some woman crapping out a baby on a pile of hay and you think oh wait is that baby gonna get some you get to succumb to um to succumb to severe sepsis because they were not born in a sterile environment? The answer obviously is no. So we don't, as humans, we don't need a sterile environment.

We're supposed to get sick. And the thing is, we're supposed to get sick starting from when we're a baby and then continue to get sick through our lives. But by the time we get to be your age, we've got a decent immune system. We've got a bunch of things. When you need it, too. Yeah, you've got a bunch of things that are exposed. But then when you get to be my age, it's supposed to be even better because that's when you need it even more. And then so on and so on and so on.

And eventually it's going to catch up with you when you're, when you're a lot older because you're weaker and everything. But, but for, but there should be this sort of linear sort of improvement of your immune system over time because you keep getting exposed to different shit. Now that's not going to protect you from a new virus like COVID obviously, because not there weren't a whole,

but although that said, there is a school of thought that there are a bunch of people who have immunity to COVID because of some exposure from the past that we don't know about. Like, that's the thing. Like, you can have... What do you mean by that?

Well, there doesn't... In other words, there could be something that you were exposed to in the past that triggered an immune response in your body and that immune response is able to deal with COVID, even though it wasn't COVID that caused that immune response. I'm sure we're going to get a lot of hate mail and complaints from the virologists who are listening to your podcast, but the, you know, saying that they just not scientifically sound what I said. And again, listening audience, I'm not a medical doctor.

But I do know, I read the literature a lot, and it is entirely possible that you get exposed to something, your immune system creates a host response that's lasting. So that's why you don't keep getting chicken pox your whole life. And you've got this immunity, not to COVID specifically, but to something similar to it that didn't cause nearly the same havoc as COVID,

but you've got some sort of, and that could explain your asymptomatic patients, right? Yeah. Now, what about the asymptomatic kids though? The kids don't really have had time to, you know, so it doesn't really explain that very well. But anyway, I'm just saying there's like, this is all stuff we should be thinking about, right? Kids generally do better, though, with picking up the quote-unquote bugs, though. Not that COVID

is a bug, but you know what I'm saying. Like, if you or I got a cold even, it's more likely to affect us than it is a kid who's running around and playing all the time, so to speak. Right, right. Which is also, by the way, something they're not doing now. True. But, you know, you talk about immunology and the whole point of it is to build up a defense system for your body. Right. And that is literally what a vaccine is designed to do because a vaccine is injecting you, and not all of them, obviously,

but when you get your vaccines when you're a kid, tetanus, all that stuff, it's literally, or the flu shot, it's putting some of the virus, or not necessarily, but some of, I'm going to really mess up some of the science here and people are gonna yell at me but it's basically putting some of the bad shit in there in the form of a vaccine that's a controlled specimen to be able to teach your body oh that's bad okay attack

that if it comes in right yeah yeah it's basically it's just fast tracking rather than have then have that immunology come about through generations. You're just saying, all right, we're going to fast track this. We're going to shoot into your body a bunch of stuff. We're going to trigger a host response and we're going to get you some immunity. By the way, vaccine doesn't give you 100% immunity. It's not 100% protection. It's not the ace in the hole that a lot of people think it is, but it's it's going to it's going to improve your immune system you know somewhat artificially in the sense that we're we're tricking your immune system into doing this um where the sort of clean way to do it would be to uh or cleaner way to do

it would be to have been you know just massive exposure over the years of your life and so you've got some some sort of innate ability to fight it off already um but we don't have that so uh for certain viruses and certain bad ones too polio and measles and all the stuff that um mumps and rebellious all these horrible things that we vaccinate against because they're so bad that we don't want to um we don't want that you know every man for himself kind of thing with those viruses you don't want that in our in our health system period right and it just with that you see that's just those those viruses i mean that a lot of the rationale behind those vaccines was those things not only do they cause a lot of death which is horrible a lot of loss for families and

things like that but um but they get they destroy the economy too yeah i mean those are diseases that hit working people and uh we know about that now yeah yeah and so we we we absolutely did not want those diseases uh we thought we could never advance as a country if we have those if we had those diseases and you see a lot of developing countries that have higher rates of those diseases they embrace vaccines they have no problem with vaccines there's stories about you know women in africa who will take their babies and walk you know um a hundred miles to so that their kid can get a vaccine because they know they know firsthand how know firsthand how horrible it is

when a polio outbreak or something like that in their village. So that's the story with vaccines. Yes, it tricks the body into sort of, it fast tracks the whole thing. So I think an interesting question, story coming out of this is, is the story is coming out of this is is the vaccine our ticket out of this coven thing a lot of people think it is right so a lot of people are

saying um um you know also you know the people who are really you know can very you know very cautious about the covert are saying i'll see you when there's a vaccine sure you know you've heard that right yeah so you know that's that. So what's the story with that? Yeah, a vaccine is going to help. Absolutely. It's not going to eliminate it, but it's going to make it so everybody has a little bit of immunity. It's going to boost everyone's immune system a little bit and give everyone better chances of fighting it off. And if that's the case, we don't have to worry about people getting it as

much. And if we don't have to worry about people getting it as much, we just relax a little bit and sort of go about our normal lives. So the vaccine sort of seen as a ticket that can sort of free us up and make it so that we can go back to our regular life. The problem is though, with any vaccine, a lot of people have to take take it you need this sort of herd immunity through the vaccine you need everybody on board with it you don't need now you know you you're on instagram you follow you follow memes right how many funny memes have there been about people who've taken the vaccine tiktok yeah yeah it's crazy right there's a lot of stuff out there it's funny right i laugh at I laugh at it, even though I shouldn't be. You have to laugh. Yeah, but the reality is stuff like that takes a toll.

And it sort of works on people's subconscious. And they start thinking, you know what? I'm not going to get the vaccine. I'm going to sit out the first four rounds of the vaccine and see what happens with these people. And if they're OK, then maybe I'll it and that's that's the kind of thing like we're you know we've done so well eliminating measles and polio because we forced kids to to get it as a requirement for doing anything you know sports school you know if you don't have vaccines you're not going to participate in sports and there's some people that call that tyranny which is which i am not condoning no no no we're gonna get all kinds of

hate mail it is yeah yeah no absolutely right there's that a lot of people think of that as tyranny a lot of people that's the hill that they're gonna die on like they they feel really strongly about about vaccines negatively um but the vaccine's the only way out of something really bad like polio and measles there's there is no alternative um so you know is is covid like polio and measles not really in the sense that covid's hitting a different like it's really um there's a lot of young people people your age um and a lot of people my age who are, who are unaffected by it. Yeah. You know, they can go out into a club that's where everybody's got COVID and they can go home and go to bed and it'd be fine.

Yeah. Um, they'll either emerge with something that feels like a cold or they'll be completely asymptomatic. Yeah. Um, that's not the case with measles and polio. No. not the case with measles and polio no if you hang out with somebody with polio and spend the day with somebody with measles you're going to get it and you're going to die or you're going to be you're just going to have like or you're going to have um you know permanent effects from it so covid's not quite like that right i mean it's bad no question about them not minimizing covid i'm

certainly not um uh trying to dismiss it as a serious infectious disease it's serious infectious disease, but it's different than polio and measles and some of these other things that we routinely vaccine against. So getting people to sort of, getting them on board to sort of add COVID to the vaccine cocktail that everybody gets is going to be a tough road to hoe. And I don't, I'm not sure it's going to happen. Like, I think it's going to be,

there's going to be certain people right now. You see this pent up demand. There's a lot of people I've talked to a lot of people like, I can't wait to get my vaccine. I'm going to be the first one there. But what happens when that crowd gets vaccinated and there's still another 64% of the population who hasn't that's, that's, or when two people from that crowd get vaccinated and suddenly.

Yeah, yeah, exactly. I'm good, I'm good. Yeah, yeah, it's all right. It'll pass. There was a report actually, you know, I just saw it a few days ago. It said some doctor got vaccinated and then was dead a week later. Oh, God, don't do that. Don't do that. days ago that said some doctor got vaccinated and that was dead a week later and so my of course my thinking from being a uh you know it's probably a 400 pound doctor who fell over of a heart attack

well yeah it could be right it could be i haven't seen it i haven't seen the guy but the but the there's a lot of things that you can die from and in in the course of a week also there is some if it's a doctor who treated covid patients depending i don't know which vaccine he got but if he got the vaccine that has the you know the sort of attenuated virus in it versus the mrm rna one which is that's another i don't know if we have time to get into that but that we might not today yeah but um but if he got the one that has the active virus in it and he's been um exposed to a lot of virus there is this school of thought with corona that there is this sort of viral load thing right so if you if you've been exposed a lot then you're you're more likely to be hospitalized and die from it yes when you get it so that's

different than some virus how much does the data support that in your opinion? I think it's pretty good, actually. Because I've been saying that that's a big thing, and I don't want to be totally wrong about that. No, no, no, you're not wrong about that. I think what we don't know is what are the parameters there, like what constitutes high viral load. So we've seen some healthcare workers, well, not some,

we've seen a lot of healthcare workers, but not just in the U.S but Spain and Italy um data from China sucks on that because it's sort of state reported but in China I mean in Spain and Italy we see a lot of health care workers died from covid and so the question is is it did they just get an infection just like you or i might get an infection and then they went home and disease worse than they went back to the hospital was too late and they died from it or did they did they succumb finally their immune system held up for a long time because you think they're using the protective gear and everything but you know they're getting exposed right so that's interesting did they just did their their body say

okay we got this initially and then their body's like smash cut to 12 days later and their body's like we can't keep the fight they've been working around the clock yeah yeah we can't you're losing you're not sleeping you're not eating you're not giving us what we need you're not taking vitamin d and all these supplements that now are highly recommended so you're dr cristo had me on vitamin d all day every day i knew you were going to bring this back i'm on there baby yeah that's my guy this is this this pause turned out to be like an ad just it's an advertisement it's a rolling ad for dr christo so the you know the viral load thing right that's so that that's yet another thing that COVID sort of mystified some people on. We don't really know a lot about that aspect of it and whether

that's a real thing or not, whether, well, no, it is a real thing. I shouldn't say that, but we don't know the parameters. We don't know the extent to which that is the case, like what point at which your body just says enough is enough. Can you give me some data this podcast can you just give me any data you have access on because i'll put that in the show notes for this just to yeah i mean again like it's all kind of real time because this is all brand new this year but you know whatever we can get that we can look at you know yeah if you you know after this you know if you give me a list of things you think your listeners would be interested in i can give you the you know links or whatever and you know, if you give me a list of things you think your listeners would be interested in, I can give you the, you know, links or whatever. And you can take care of it from there.

Beautiful. Well, the thing about the anti-vax or whatever you want to call it sentiment right now towards the COVID vaccine, it's twofold for me in how I think about it. And the first side is I've been very concerned about the overall anti-vaxxer movement prior to COVID that's going on in this country. And I need to check which disease it was. I'm fairly certain it was measles though. But before COVID happened in December, January, February of last year, there was a measles outbreak in the Midwest just because- It was, yeah. Yeah. So it was measles. And I'll put the link to that in the midwest just because it was yeah you have it so it was measles yeah and i'll put the i'll put the link to that in the show notes but it's because

there are enough people who have convinced themselves that you know somebody's trying to kill them with these vaccines and we're all going to die if we get it so their kids aren't going to get it right right and here's how i look at it one of the most common arguments you hear is people would be like, well, why do we have so many cases of autism now? It must be the vaccines. I've never read one of those books, so I can't say I'm fully educated on it. But let me even, even if there's no scientific data to back that, let's say some kids did get autism because of the vaccines. I always say it's unfortunately, if it were my kid, I'd be devastated, of course. And I should therefore not be somebody who's involved in the decision making for the rest of the population because I'm emotionally compromised. But if I lined a million people up in a line and I said take three steps forward, you know two people are going to fall and break their head open. A hundred people are going to take three steps forward, you know, two people are going to fall and break their head

open. A hundred people are going to take three steps backwards. It's the law of numbers. And so you're going to have, it's so sick to say and like sadistic in a way, but you're going to have some people who have bad effects. It does not make the overall goal for society worse or not the best idea to do. It does. So i've always been looking at that going this is ridiculous and then you add the internet to it and you know people talking to each other form of communities it's insane fast forward to this period though with covid and what alarmed me for a long time is a lot of really smart people i know who are not anti-vaxxers at all they have every single vaccine have nothing against them we're like fuck this thing i'm not

getting it like or at least check me in a year or something like that and i was like oh my god this is a problem these people are insane and then i actually educated myself on the absolute high-level basics of vaccine, I guess, processes, like how they're formed and how long it takes and what the test groups are like. And I didn't get anywhere near your level. But one of the common ideas is that when they're building these vaccines, building them, creating them, inventing them, they're doing it with people who agree in test groups to be a part of it, but they track

over time so you get you give a vaccine on march 1st just because like you need it to be done on june 1st if you have to check that patient 18 months later well june 1st isn't 18 months later right right so there are long-term things that we can't see now do i think this is something like i am legend where they're injecting everyone and we're becoming we're going to become zombies in two years no yeah but i understand the concern from people who are saying all right i'm gonna i'm gonna just wait on this for a while or i'm gonna i'm just not getting this because they're pushing it to everyone so fast it's almost like i understand the government's desperation because you know supposedly they want this over with but to build up trust you're you still need time to go by to be able to say like hey this works and now you you already mentioned it but there's different

types of vaccines different companies doing it people are always like oh who owns big pharma there's all these conspiracies around it and again people sitting at home on the internet getting themselves worked up about it so in your your opinion, just based on what you know, and if you can't answer stuff, no worries. But where are we right now? How trustworthy is it? And this vaccine process versus other ones, how confident are you in it where we stand? All right. Yeah, that's a good question. So, you know, first of all, just to start off, I totally agree with you that the vaccine rhetoric is out of control. Like, I think the vaccine rhetoric is disproportionate or out of sync with the science. Like,

and that's been going on, as you said, Preet, this is not a coveted thing actually this is there was there were big debates emerging years before covid in with regard to measles um measles vaccines and and to a lesser extent the other vaccines too but i think measles is sort of the time yeah measles is the thing where there were outbreaks there was an outbreak in the midwest there was an outbreak in in um marin county california because you know there were a bunch of people in Marin County who just are anti-vaxxers for whatever reason. And there happened to be a large concentration of them there and there was a measles outbreak. I don't think it was a particularly big one, but there have been bigger ones around the country. And I personally, and this is my,

I come from the science, I'm 100% on board with vaccines. They are the single most valuable public health invention of all time. Second only to, they're close second to maybe, I mean, they're a close second would be potable water or, you know, getting getting separating potable water and sewage yeah you know that that had a huge impact on sure on um uh on on public health uh but vaccines are right up there at the top with the with along with those i agree with you yeah so it is it's in that's incontrovertible so there are certain areas in medical science that are unsettled, I guess, for lack of a better word. Ironically, vaccines is not one of them. There is no unsettled medical science on vaccines.

I mean, you might be able to find a doctor, not Dr. Christou. I think he'd be on my side on this one. You might be able to find somebody to come in here with a medical degree and trash vaccines. But it's going to be really hard to find that person. If that's a legit person who has a public career of any kind, they're not going to come in and spout false hoods about vaccines. Yeah. So now, is a vaccine perfect in the sense of having zero side effects? They're going to have some side effects, but not autism. Autism is probably not one of them. There are some negative side effects to vaccines. People can have bad reactions to vaccines. They usually happen right when you get it, right before you even get home. It doesn't happen 12 years later,

like the autism sort of people are... Is that what they say? Well, yeah. I mean, yeah, exactly. So there's some people that say that the vaccine sort of sets the gears in motion for the kid to be diagnosed as autistic when they're 11 or something like that. There's a whole host of things, though. Yeah, yeah, yeah. And the rates, you know, the fact that, you know, there's higher rates of autism now than before. Well, that can be said. Look at allergies. There was a time in history literally where nobody had allergies.

Well, they did, but- They didn't know it. We didn't know it. We didn't talk about it. Now, but also they didn't, I mean, also the rates were probably a lot lower too. I mean, if, you know, so what's going on, there was also a time in history when very few people had asthma and there was a time in history when very few people if anyone had obesity so disease there's disease trajectories that we could talk about in a whole other podcast that's more of an epidemiological sort of anthropological

epidemiology thing like why does our society now have all these diseases that we didn't have and yeah and sometimes it's because they just couldn't diagnose it. Right. Like, there's a lot of autism cases. You know how many people were born with autism in 1940 and don't know it? Yeah. I mean, half of Silicon Valley is some of the most genius people in the world, and they're on some of, and I'm generalizing here, but some of them are on the spectrum, literally. Right, right. Like, it's a very odd, I guess i guess condition and is that what you call it

i want to use the right words here yeah it's a spectrum it's a spectrum disorder it's a very odd thing yeah whatever you want to call it so the numbers can skew no right right so it's incredibly hard it's a and it's as a spectrum disorder that means there's that when we say spectrum we mean that there's there's it, it can present itself in so many different ways. Yes. So the, you know, so let's go back to the corona vaccine. It's, you know, so I don't think there's any unusual risks with the coronavirus vaccine. Either one of them.

The one that is sort of more of a traditional type vaccine and then there's the new molecular engineering. The traditional one is the one that has the virus in it. Yeah, it has like an attenuated version of the virus, stimulates the immune response. Really quickly, the other one is sort of more of a sort of molecular sleight of hand in the sense that it causes a cell to look like a coronavirus cell is that the mRNA thing yeah yeah so it looks like one but it's not one uh if that makes sense yeah but it bears some of the same characteristics and so your body develops an immune response to it but it's not actually the virus so it's it's a it's a trick um more so if the other one's a trick too but um but they both work.

I don't know whether one works better than the other. We'll find out. This is the first time an mRNA test has really been rolled out in any large numbers at all. So we'll get some good data out of this. But how do you say confidently they both work? Well, because they're they're both fda approved and now fda's made some mistakes over the years for sure the fda is not perfect um i think there was a lot of pressure on the fda in this case to approve a vaccine very quickly but there was also a lot

of pressure on the fda to not unleash an ineffective vaccine that would give people a false sense of security around this virus. So the costs of, for lack of a better way of saying it, the costs of fucking this up were very high. So they're also, if it were bad, if this turned out bad, they're also done. Yeah, yeah, yeah. They're done. Yeah, yeah, yeah. They're done. Yeah, yeah. So the companies that decided to go in on this made a commitment, I think. And again, I don't work for either.

Well, full disclosure, I do consulting right now for AstraZeneca, and AstraZeneca is one of the vaccine producers. But AstraZeneca's vaccine is not one of the ones that's being distributed in the country right now. That's a Pfizer and a Moderna. I don't work for either of them. So I don't have any conflicts of interest here. I'm not trying to promote them in any way like you are with Dr. Christie. Shameless. So I'm- He just loves the show, man. Unlike this guy, I actually have no conflicts of interest here. So those vaccines are, in my opinion, safe and effective because they went through the FDA process of approval. They did some things on the clinical trials to speed them up.

The thing about clinical trials is if you throw enough money at a clinical trial, you can get it done quicker. Because basically, it's a massively parallel operation rather than the traditional sort of linear operation. So you can get a lot of patients into the trial all at once. It's very costly. But there's a lot of money flying around. There's money from government. So normally um a company like pfizer is going to develop a vaccine uh with their own money while their investors money well that's another question though but it still doesn't change it still doesn't change the patient data period so yeah no no right right right so you're right there's no way to know what long-term

effects there might be from this but um but we can use um simulation models clinical simulation models to see what the long-term effects might be we can look for indications in a shorter time period that might indicate longer problems we don't see any of that with these vaccines so So, and also that, you know, both vaccine technologies are from a virology perspective or immunology perspective are not that complicated. Like they're, it's complicated for us and for people who are not in the field. But for people in the field, this wasn't like a massively complicated engineering feed, biochemical engineering feed. It was just a brand new virus.

Yeah, it's a new virus. And so these companies know how to take samples and convert them to vaccines. They know how to do that, basically. I mean, it's a process. It requires a lot of really smart people and a lot of equipment and a lot of resources. But it's not a new

field altogether. The mRNA thing is a little bit new, but the mRNA thing is all just a different... Basically, you can think of it as a different technology to get the same result. It's still creating something in your body yeah the truth that yeah um it's just a little more fake than than the real one that has the

the actual virus so um so it's it's i guess it's tried and true technology it's been around for a long time and so um uh generally so the um so you've got that sort of peace of mind that they're not, this isn't a whole new thing they had to deal with. It's just a new virus, as you said. So and then you've got the FDA team devoting a lot of resources to this. You've got the companies, Moderna and Pfizer and AstraZeneca and all the other guys who are currently developing drugs or vaccines that aren't out yet. You got them pumping a ton of money into this. And of course, they're also looking at their asses too. They want to make sure they don't get in trouble for producing something that's going to cause a lot of class action lawsuits later on. So they've got their lawyers

looking at it. And so there's a lot of checks and balances here. So, you know, they've got their lawyers looking at it. And so, you know, there's a lot of checks and balances here. So just because the president was pushing and pushing and pushing, saying, wanting to get the vaccine, not just the president, but a lot of people were saying, we need to get the vaccine, need to get the vaccine. The vaccine's going to be the ace in the hole. The vaccine's going to get us out of this mess. In spite of all those pressures, I do think that we wound up with some decent vaccines here. I don't think they're perfect. Well, they're not.

They're only 94% or 95% effective. But that's not far off what the other ones are. I mean, measles is higher. But some of these vaccines that we get, like the regular flu shot is not even there, I don't think, right? No, no, no. The regular flu shot's way below that. Yeah. I'm going to get it number wrong. I'm not going to say it.'s it's way lower i'll check it it's south of that yeah the regular flu the problem with the regular flu shot is that it's it's based on a

strain that gets isolated but there's usually more than one strain um it mutates you know and and it's all relatively harmless but well not not actually a lot of people die from regular flu, so I shouldn't say it's harmless, but, but, but yeah, so there, there's, there are a lot of limitations to, to getting a virus right. But in this case, we had one virus. Well, now we've got some mutations, but putting those aside, we have one virus. We had, we isolated it very quickly. We're able to look at it in a lab very carefully and the vaccine development you could argue you know started started immediately even before this you know this big initiative and government money and everything these companies got on this right away the smaller ones especially like there's an opportunity yeah it's like they're going to jump

on this and try to uh everybody wanted to be at first out of the starting gates on this because at the end of the day they're making money on it yeah this is not a public service that they're offering well that's the other big 500 pound elephant in the room here you're dealing with quote-unquote big pharma and again people sitting at home a lot of time on their hands all kinds of conspiracy theories big pharma owns washington dc vice versa yada yada they're all in it for us like they'll throw all this stuff out there but this question kind of revolves around the fact that there are these enormous companies you've named some of them the pfizer's the astrazeneca's who do produce so many different drugs and so many drugs that weren't even mainstream for mainstream conditions even 20 years ago.

And now the data says more and more pump out. So people, they joke about, they don't joke about it. They morosely joke about the idea that, you know, we're pilling up society and everything or we're pushing things on people to make these companies money. You work in this space. And obviously you're economically incentivized in the sense that companies like this will pay you to do work for them so you want that to continue to happen but you're also a guy like you're a straight shooter with me and you you tell me like it is i think that's really come across well today as well so i i know when i ask you these

things like you're not going to give me some bullshit political answer but how much of what you've witnessed working with some big pharma companies or even you know some mid-level ones kind of revolves around the the chase of being enormous and making a fuck ton of money versus actually trying to get to the root of problems and putting public health itself and the health of the individual at the forefront. Have you ever had moral questions around that? Yeah, that's a really good question. That's something that is part of being in this field. Because you can't – first of all, you can't avoid the pharma company.

If you want to work in this space, you're going to work for a pharma company at some point um because they're you know that they're huge and they're everywhere and there's you know um you can't survive just on you know medical device companies for example so so you know anyone in my in my field has to work with pharma companies. What I've seen, and I've worked with a lot of different pharma companies, big ones and small ones, and I've worked with a lot of different people within those pharma companies. I'm being completely honest.

There are very, very good people working in those pharma companies. They're very educated. They tend to have advanced degrees because they're, you know, the companies need these more scientific type people. Um, they're very passionate about their work and, uh, and they're very, um, honest in, in their approach to that work. That's one thing. The other thing is the work that's done in a pharma company now compared to, say, 30, 40 years ago is heavily regulated. Yeah.

Red data everywhere. There's ISO certification for processes. Clinical trials are registered and are very transparent. Clinical trial data is very heavily managed and controlled. And it's very hard to tamper with clinical trial data it still happens but it's much like to our to my point before about health care fraud there's sort of the pharma equivalent of that now where some pharma companies been been caught over the years doing some bad things and it's consequently it's it hasn't we haven't eliminated that but it's it's

happening a lot less because the consequences are so severe. So that's good. That's all good stuff. But the main point I think that you were making is what about this sort of pressure that pharma companies have to make money and how does that influence sort of what it is they do? I'll tell you. I'll be honest with you where I see it. They will often choose new avenues to get into, new sort of market gaps that where there's no drug for X. And so we're going to get in there and sort of create a drug for X. And that's the part where sometimes I part ways with them.

What I don't like about that is there may not really be a need for a drug in that space. They will argue, well, there's some patients who respond to drugs. Or let's say it's an area where there's a non-drug. I can't think of a good example right now. But let's say it's something where there's a non-drug, I can't think of a good example right now, but let's say it's something where there's a non-drug treatment, you know, maybe it's therapy or something like that. And the drug companies will come along and say, well, a lot of times that non-drug treatment fails. And so we're going to develop a drug for those people for whom the drug, for whom the non-drug treatment fails. That's fine, right? But that's okay. But what about when there's, what about when the non-drug treatment works just fine and you try to

sort of put a drug on top of that? It may not be necessary. What they're trying to do is sort of create a market. And so they do this, right? But that's not the mainstay of their business. You're not going to like, there are very few pharma companies that I can think of that sort of thrive on that business model. Some of the big ones will have core drugs across a lot of like, you know, they'll have a hypertension drug and they'll have some cancer, a handful of cancer drugs. And then they'll have some, you know um heart failure drugs or whatever you know they got this diversified portfolio the big ones typically have that and um they might try to expand into a market where sort of where the the need for a new drug is pretty minimal um but it's going to be a small part of their business right it's not going to they're not

going to build them now there are some small players that have come along and tried to do things like that and gotten in a lot of heat for it. So, for example, EpiPens. Did you hear about that controversy? Yeah. Oh, my God. What happened there? Well, the thing EpiPen used to be just – I forget what company handled Epi epi pens but they sold it the the buyer of the epi pen redesigned it from a a cylindrical tube to an oval uh you know the cross section is an oval i don't

know how you say that i'm blanking on that but um it's an oval shaped tube they changed that's all they changed in it and they increased the price from like 120 to 600 per pen no other reason on earth to change the price of that pen um yeah except for money so i mean that was a stupid thing they got you know they i don't know if they actually they didn't get in trouble for that because that's not illegal, but they got incredible backlash. Yeah, the PR campaign is terrible. Yeah, it was a PR nightmare. In fact, I was at the Forbes Healthcare Conference in New York City. It used to be held every year in New York City, and it would be like this big sort of think tank kind of thing, group think thing, where all these experts would come in.

It was a really great conference. I hope they can get back to that soon but uh the the ceo of the company that it was mylon i can't remember that sounds close to it the the new owners of the epi pen yeah i'll stick it in the show notes. I remember this. She sat in, literally in the hot seat. I give her credit for this because she sat there and endured just blistering criticism over what she did. And interestingly, the criticism was not so much related just to the EpiPen, but the sort of negative effect it had on the industry. It affected everyone. So even though there's just that one company that did that, it negatively affected a whole bunch of pharma companies because it just, you know, it's just bad. It's not all pharma companies act like that. And so, you know, it's just, it's that kind of thing. Like there's always going to be negative stuff

around pharma companies. And I think it's only it, only it and it's always because there's some bad apples like these guys i want to say it was myelin maybe it wasn't but that you know those guys did it's kind of ruined it for everyone kind of thing yeah um martin screlli was yeah yes shakrelli or whatever yeah he was he was a bad actor and you know i don't know what he was trying to do but again you know you could argue that that had pretty serious consequences for the whole entire industry and that was just one you know nut job we didn't know what he was doing that's the negativity bias though too in any of this stuff you know we don't you don't hear about when the fbi foils a terror plot you know they follow it that's their job maybe they do it 10 times a

day you hear about it when they missed one right exactly and then it's like who's gonna get fired and it's the nature of society it's how it is with powerful institutions but it's a question that has to be asked just because people have seen the pill is the answer for so many different things and it's it's it's taken out of control it's it's it's put into kids and stuff like that so they get mad at companies like this because again these companies are trying to make money right um you remember did you know tom riley at all tom riley from yeah the boxing gym yeah yeah of course yeah i sparred with him many times yeah right i forgot about that yeah so tom i used to talk to him all the time.

He was, shit, he was the global head of finance for Novartis Oncology. So at least he was more focused completely on the cancer side, but all the different things that go into that, the regular maintenance cancer drugs that they rely on making money on that some people could give them shit for, the way I loved his approach to how he looked to invest into things because he wanted to be able and i'm going to say this not in the perfect way he would say it but he wanted to be able to take the drugs that he knew were long time stalwarts

that that doctors needed for their patients going through cancer treatments where they knew okay novartis is going to keep making this drug drug we're gonna keep iterating and making it better and then we are we're gonna we're gonna make big revenues off that he wanted to do that so then he could be able to go for moon shots right say all right I'm gonna go sink it was one project he was telling me about this car t therapy yeah yeah yeah so he he was he was like the guy bringing that in there and he was Yeah, yeah. beautiful way of doing business and also restoring putting value in the in the hands of your shareholders at the same time right it's being prudent right yeah and tom's a great a great example i didn't think of him well yeah i didn't think of him because i usually think of the the farm of people i work with and tom i i just sparred with yeah tom you punched punching

each other another story and we ironically, rarely talked about work. We talked a lot about boxing. So yeah, Tom's a good guy. Tom's arguably a good guy, right? He's a super good guy. One of the best guys I've ever met. He's a great dad. You see him in there with his kids. So that's the kind of person I,

like from working with Pharma, I know most of the people I know are like Tom. They're trying to do something good and they are succeeding and most of any of the big pharma companies novartis and astrazeneca and all that they've all got as you said like a a stable of products that are needed you know because they're always going to be there's always going to be people who i mean you can't you can't have a world without drugs at this point i mean um obviously we did at one time but life expectancy was lower it was a lot lower yeah so like certain things like you know like breast cancer for example we've that's a great success story It's a combination of diagnostics, high-tech diagnostics on the front end, mammograms and things like that, biopsies and things like that.

And good surgical treatment and improvements in that surgical treatment. And then good drugs on the back end on chemotherapy and other adjuncts to chemotherapy to keep it away. With the combination of those things, we've basically – I wouldn't say we've cured breast cancer. We certainly haven't cured it. There's still a lot of advanced types of breast cancer you can't get a handle on. But we've brought that disease from something that was devastating to – Yeah, it used to be a death sentence yeah to to something now that you're you're highly likely to survive yeah and not just survive it but

you know survive it with with minimal decrements in quality of life yeah again for most people and not everyone but um another one hiv i thought about i think about this now because you know we see commercials on TV for HIV drugs. It originally started as a cocktail of drugs. Now there's some single drugs that are essentially versions of the cocktail drug all combined. That disease, talk about a death sentence. That was a big-time death sentence. It's not anymore.

If you get HIV, you're going to survive if you get treatment um and and chances are uh most people won't even know you have it you know you're not even going to show symptoms you know on the exterior that indicate that you have it i mean magic johnson's the best example we always point to but yeah yeah but then now there's yeah and he yeah he he's the he was sort of the first to sort of really like everyone was was like, whoa, why is he still around? Yeah, he's going to be dead in a year. Yeah. And now he's going to have a normal lifespan like everybody else because of these drugs.

And so that's another example. I could go down the list. I mean, there's a lot of examples of pharmaceutical interventions that have really changed certain diseases for the better. But as usual, with everything, there's always a few that – I mean, there's a part of – I feel very passionate about health. Not just healthcare as an industry, but health as yeah why we go to the gym that kind of thing you're a nutrition guy the whole nine yeah so i don't i i i like the fact personally of of you know doing as much as you can to to improve your own health so that you don't need a lot of sophisticated medical intervention of any kind i i even though i pay the bills

basically i pay my bills with sophisticated medical intervention that's what my whole career is is really focused on in public health and type stuff and things like that but the philosophically deep down inside i'd rather everyone work really hard to find to build up their bodies so they don't need any of that stuff yeah um you know i'd love personal responsibility yeah i'd love like type two diabetes is an interesting thing to talk about there because type two diabetes is that's different than like type one you can be born with type one so type one is a different type of diabetes but type two diabetes is something you you develop over time um and you it's true that you can get type 2 diabetes and not be you know obese and eating junk food and you know all that stuff

like you can still get type 2 diabetes it's not just the disease of of you know sort of overweight yeah which is a common misconception right people don't know that but yeah but it is highly correlated with with with your metabolic health and that includes your weight and not and but not just your weight but the types of food that you eat so So if you're eating a lot of carbs and sugar, and worse is sugary carbs, like sugary cereal and stuff like that. Like if that's the mainstay of your diet, you can develop type 2 diabetes. But then if you change that, change your diet,

you can actually reverse type 2 diabetes. And so it's a reversible disease to an extent. I mean, I think if you're too far down the road, it's a lot harder to reverse. But you can reverse it at a certain stage. And that's an interesting,

that makes it, to me, a fascinating disease because drug companies are all over that. They're making, they make all kinds of diabetes drugs. And their rationale behind that,

they don't actually need one, but if they were to have a rationale, it would be, listen, not all these people are going to lose weight. Not all these people are going to reverse their type 2 diabetes because it takes a tremendous amount of self-discipline to do that. And they're not going to do it. Well, you know what? They're right. They are correct. They are right. So the drug company's philosophy is, well, if they're not going to do it,

we're going to give them a drug that's going to lower their HbA1c and maybe improve some of their other symptomology. Yeah, I don't disagree with that at all. And they're going to be better off with our drug than without it. And that's probably true, right? But me personally, I think, you know,

I would like to see those people reverse their type two diabetes through diet and exercise. But drug companies are right. They're probably not going to do that. So the drug companies in a way are sort of cynical and in that regard, and you could even see it in the diabetes commercials. And there was a diabetes commercial, diabetes drug commercial, I mean, there was one that, that actually portrayed a guy who, you know, he was a little overweight. And, you know, it was like one of those narrated commercials and the guy saying, you know, like, I try to exercise, but who's got the time for that? You know, and, you know, you show him like playing with his kids and everything, his kids crawling all over him and everything. And so, okay, that's a legitimate point, right? Like like that's the way a lot of people sort of take a pass

on exercise they say we don't i don't have time i can't in my schedule i come home from work i've got to be with my kids i got to make dinner and then then i'm tired i go to bed when when am i gonna take care of my metabolic health i guess they didn't show him throwing the football to his son but you know right right so so that's the you know like like that's that's the word drug companies come in so they're the cynics they're saying look you guys aren't going to get your shit together so we're going to give you something that allows you to to statins are another good example like although there's some i don't want to get into that because there's some controversy now on sort of the role of cholesterol and all that but but statins were at least at one

time they were like that they were like look we know you like bacon so go ahead and have your fucking bacon and here here's we got a drug for you we're gonna give you a statin it's gonna make that cholesterol go away and everything's gonna be cool i mean that's the way it is right and that's um you know we can make the same jokes about the erectile uh i wasn't gonna go there you went there i wasn't gonna do it i know but um you know but there's the there's a drug for everything yeah there's a drug for everything and and i i think um but the drug companies are the cynics in that equation and i think as as a cynic, you're often going to be sort of tarred as being the bad guy. Yeah. Well, I'm not going to keep you here all night. Otherwise,

I'd go straight into the biohacking end of things right now, but we won't go there. That's for another time. Maybe another cast. The one thing I want to ask you about before you go, though, we touched on it a bit earlier. I just wanted to circle back to it was the basically like the i guess the telehealth era that's come in here and you were walking through the example of the company you consulted for who was giving you personalized physical therapy routines and everything to do that would basically replace the physical therapist and allow you to do it on demand at home what changes changes do you think are completely permanent that you've seen that have happened? And, I mean, what's been the scope of this? Yeah, it's interesting.

We actually wrote a blog on this and have it on our website. I'm going to put that in the show notes. Telehealth. So, yeah, I think it might be either our most recent blog or the one before that. I don't remember. It's easily found on our website. Yeah, I think it might be either our most recent blog or the one before that. I don't remember. It's easily found on our website. I think, and when we wrote this blog, basically the idea is that the pandemic essentially set the table for telehealth.

Telehealth was there already. That was one of the things that came along, one of the sort of like modern technologies that takes advantage of connectivity and smartphones and so forth. Telehealth was on the leading edge of that for sure. But the pandemic really iced it. There were, all of a sudden now, people were getting prescription renewals via telehealth. You know, you don't have to go into the doctor. People are getting simple things diagnosed. I was telling you that I was just texting with my doctor. That's a version of telehealth. So

diagnostics, actually, I think the very first visit I had when I was sick in July was, was it, they called it a telehealth visit and I had to, you know, pain in my abdomen. So she, she, I held my phone so she could see my abdomen and then she had me push in certain places. She said, all right, move your hand down a couple of inches, in there. And I do that. And she goes, do you feel any pain? I'm like, no. She goes, okay, now go over here. Like it actually, I think to an extent, we did exactly what she would have done if I was in the office.

Yeah. So, sorry. No, you're good. So, I mean, so telehealth absolutely clinched it with the pandemic they are it is here it's not going anywhere and it's hugely valuable yeah and you've seen forgetting some of the names of companies but yeah i mean you've seen some things just skyrocket with this just because people start using it every day right and the doctors start using using it every day. And it's the same example like I was given with Diane earlier at my old job where, you know, people, they just assume they had to do everything in person for a long time. And now they realize some things that they don't have to.

Yeah, exactly. It's like, you know, COVID just kind of sped up this whole thing. Yeah. It goes back to this access issue too, just really quickly. Like if you can do, how many more visits can you do via telehealth? A lot. Then versus in office.

That doctor can, I'm sure it's two to one. It's gotta be. Or more. It's gotta be. That doctor going seamlessly, sitting at his desk or her desk, doing one telehealth visit for 12 minutes the next one's 18 minutes but they're

back to back yeah seamless they've got the doctor's got the computer screen hopefully again this goes back to our emr or electronic medical record issue but hopefully in an ideal world the doctors can easily call up the next medical record there's no admin person who needs to go and retrieve a paper file from a filing cabinet. So, I mean, again, we could talk about that until the cast come on. Yeah, we could go all night. But listen, this was phenomenal. I'm going to listen to this a couple times through myself because there was all kinds of data in here. And especially during this whole thing continuing to go on into perpetuity

yeah there is so much misinformation out there there are so many voices who have no qualification to be talking about it but do and make themselves sound qualified so you don't really know what's real and what's not you made the point in there somewhere about something else i think it was the physical therapy thing where you're like, you know, people, they could just go find the videos online, but they know, well, is that real or isn't it? And I wish people would do that when they look at their news and their information more and they don't. But anyway, this was extremely helpful. Thank you for coming in. It's good to see you too. Great to see you. Thank you for having me.

Yeah. It's- I think it's my first time seeing you in the flesh since the pandemic right literally yeah yeah yes i guess like last january or february but it's crazy how fast time went with this yeah yeah it's crazy but i'm glad to see you doing well we didn't even get to talk about your mindset on running a business during this whole thing during this whole time and doing well another time we'll talk about it another time that's a tough i feel for all the small business owners and it's not easy but uh you just got to double down it is it's it's a it's a crazy time and you know some people are able to handle it others through no fault of their own aren't and you know i don't really know what to say it's it's it is sad it is sad to see people

I will say especially ones who have built something for a long time just get crushed oh it's horrible yeah hopefully we're almost done here but I'll let you get on the road here thank you sir

pleasure having you thank you so much for having me in I loved it alright well we'll do it again down the line sounds good alright everyone else you know what it is

give it a thought get back to me peace All right, everyone else, you know what it is. Give it a thought. Get back to me. Peace.