Pivot - Big Covid Questions, the Nursing Shortage Crisis and a Friend of Pivot on the upcoming Elizabeth Holmes Trial

Episode Date: August 24, 2021

Guest host Dr. Jeffrey Swisher joins for a medical (and Swisher) themed episode. What does full FDA approval of the Pfizer vaccine mean for public health? What about antibody treatments? Team Swisher also discusses the nursing crisis, and the Biden Administration’s new plan to lower prescription drug costs. Plus, Friend of Pivot John Carreyou joins to discuss what’s to come in his new Theranos trial podcast, “Bad Blood: The Final Chapter.” You can find Dr. Jeffrey Swisher on Twitter at @jeffreyswisher, and on substack at jeffreyswishermd.substack.com. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Support for Pivot comes from Virgin Atlantic. Too many of us are so focused on getting to our destination that we forgot to embrace the journey. Well, when you fly Virgin Atlantic, that memorable trip begins right from the moment you check in. On board, you'll find everything you need to relax, recharge, or carry on working. Buy flat, private suites, fast Wi-Fi, hours of entertainment, delicious dining, and warm, welcoming service that's designed around you. delicious dining and warm, welcoming service that's designed around you. Check out virginatlantic.com for your next trip to London and beyond, and see for yourself how traveling for business can always be a pleasure. to get your customers to notice you, Constant Contact has what you need to grab their attention. Constant Contact's award-winning marketing platform offers all the automation, integration,

and reporting tools that get your marketing running seamlessly, all backed by their expert live customer support. It's time to get going and growing with Constant Contact today. Ready, set, grow. Go to ConstantContact.ca and start your free trial today. Go to ConstantContact.ca for your free trial. ConstantContact.ca. Hi, everyone. This is Pivot from New York Magazine and the Vox Media Podcast Network. I'm Cara Swisher. Scott Galloway is still out trying to get cast in The Bachelor. So I'm joined by my brother, Dr. Jeffrey Swisher, chair of the Department of Anesthesiology at California Pacific Medical Center. Jeff, how are you?

I am great. How are you doing, Cara? Good, good. We have a lot to talk about today. I'm bringing in my brother because many people on Twitter have called for it, really. I know. I want to thank all my fans on Twitter and Dr. Subramanian in particular, and several have asked for me to be here, so great. Well, I am only here not because you're my brother, because you have a lot of information I need. As you know, I'm stuck in a house with our mom because we got near my cousin's partner who had COVID and here I am. So I have a lot of questions. I kind of feel like what Donald Jr. must feel like or, you know, Meghan McCain or something, you know, as far as nepotism goes, but I'll take it.

You'll take it. But here I am. You've got to get me out of this house with Lucky. Anyway, so let's start just, but before, let's start with a couple of things. There's an update on the story about Catholic priests. You and I are both lapsed Catholics. And Grindr, the conservative news blog, The Pillar, put out more reporting on cell phone data that seems to show priests using the gay hookup app. Not a surprise to either of us, of course. The first report led to the resignation of Monsignor Jeffrey Burrell in late July.

There have been two reports since then. The latest reports didn't name names, but claim more use of the app in the U.S. and at the Vatican. So, what do you think about this? I mean, it's, you know, we haven't been in a church in years, but what is this outrage of, is the bigger outrage priests violating their celibacy or the privacy? Well, okay, first off, I don't think you were ever confirmed. I don't believe you were. Yes, I was. Really? I don't remember. I think I remember. Yes, I had a white dress. Yes. All right, that's fine. So, Jeffrey Burrell, now, he was the guy, wasn't he the head of the U.S. Conference of Bishops? He's the guy who wanted to deny Joe Biden the ability to take

communion. Isn't that correct? Yes, there is a hypocrisy going on, Jeffrey. Yes, yes. A great hypocrisy. He's also the person who was extraordinarily anti-LGBTQ rights. He wanted to deny them adoption rights. He wanted to do all kinds of pretty horrible things. This is often the case. And often self-hating hypocrites. So he deserves it? He deserves privacy violations? Well, no, actually. So there's all kinds of yuck here, right? I mean, the fact that Tiller, which is the organization which looked into him, were tracking his cell phone movements,

they were tracking which sites he visited from, I suppose, metadata, and actual data itself. I mean, the fact that that's available should scare everybody. So I don't think there's any winners here. I mean, I think it's gross on both sides. I think this group of people has an agenda, you know, this bill, it's sort of the concern, they're sort of attacking Pope Francis. There's a whole fight going on within the Vatican, a more liberal wing, just like there is in this country, like everywhere else. And they are using this, which has, you know, been an issue for many years. In a lot of ways, it's not the same as the scandals around pedophilia, because these are presumably consenting adults. And at the same time, they've made a vow of celibacy. So, I think what's

difficult here is the people that are doing this pretending they're trying to help morality in the church are really just doing it for their creepy political agendas, I think. Well, keep in mind that celibacy in the priesthood is actually a relatively, you know, modern thing. The Council of Trent in 1563. You're going to the Council of Trent? Yes, actually it goes before that. It goes to the Lateran Council of 1139, where they did that.

Everybody, Jeff got into Stanford and I didn't, but go ahead. The Council of Nicaea, which was even before that, which was Constantine, they actually rejected the fact that priests should not be salibate. But the point is, it's not dogma. It is regulation. The Pope tomorrow could say priests could get married,

and that would be fine. So the whole concept of celibacy is a very unusual one, I think. This catching stuff is just, I go on the privacy side. I don't care how hypocritical it is. I think the privacy issues are much more important here in terms of tracking people and being able to use these apps. Let's differentiate between pedophilia and homosexuality. They're totally different things, right? 100% different. Obviously. But this is a bigger, wider problem in the Catholic Church, but it seems like in this case, tracking these priests is as creepy as it is tracking anybody. Absolutely. I'm not

for outing people in any way, shape or form. Yeah, it's an interesting thing. So let's talk about the big Jeopardy controversy. Just to bring everyone up to speed, Sony named the show's EP Mike Richards as the new host, along with Mayim Bialik. Then the report came out in The Ringer about sexist and racist comments he'd made in the past and he stepped down. I just I don't want to talk about it a lot. I don't know if you watch I know some are relatives too. Who are you for as the host? You know I love LeVar Burton. I really like him and I think that he would be great. I don't think his tryout was all that great. I think he stumbled a few times. He also wasn't given the full opportunity. I think he only had five shows versus the 10. But you know, the fact that this guy, Mike Richards, was the executive producer,

and he's the one who chose the people and he chose himself. Well, he supposedly, he put himself out of that. Whatever. I mean, the point is, is that, I mean, you know, I think the whole controversy is kind of silly and overblown. But I mean, what's going to be the next Jeopardy category, like mammary glands, silly names for a hundred, you know, I'll take that for a hundred. This is Jeff referring to a podcast this guy did, which was in plain sight. It's amazing Sony didn't check. Tony Vince Aguero, I know very well, the head of Sony, I'm shocked he didn't check. But nonetheless, you want LeVar Burton and I want Ken Jennings. I think he'd be good. I think it'd be nice to have a woman,

and it'd be great to have a woman of color, too. I mean, I think that'd be fantastic. That is true. They have Mayan Bialik, who is going to be a host of specials or stuff like that. Correct, special stuff. That's Blossom, of course, for those who don't know. She's fantastic. She is, indeed. So lastly, I want to talk mostly about medical stuff. Let's start, the White House is pushing Joe Biden's plan to lower the cost of prescription drugs, letting Medicare negotiate prices with drug makers. The administration is selling this

as a winning issue for House Democrats. Is it a win for patients? What do you think about this? I do, actually, because Medicare, as the rules as they exist, don't allow the government or people to negotiate for drug prices but i don't know if you've looked into it but i'll be 65 in four years and ready for medicare and i'm going to start studying now i mean literally understanding how medicare works between part a part b part c part d so what you're talking about here is the part d part of medicare which is the prescription drug coverage. And it's very complex. And I think that, you know, most people over age 65 are on medication. I mean, I'm on two at age 60, 61. And the importance to the senior population can't be overstated.

So bringing the prices down. Absolutely. And they're a voting bloc. I think if the Democrats can bring in that cohort by helping out their lives, I mean, it's insane what the prices of some drugs are. I mean, like take insulin, which is something that is needed by so many people. The prices have skyrocketed over the years. And that doesn't even count some of these other more expensive medications that many seniors are on. And you were going about delays in getting them because of various things. There was, I think, a hurricane or something like that, or a tsunami at one place where they were making, you're an anesthesiologist a shortage, I mean, of drugs in the operating room. It's insane about which drugs are always on shortage. I get a list every day of what drugs that are basic medications that I, you know, have to come up with alternatives. So will the ability to negotiate help that? Or is that just a function of what?

I don't know about drug shortages. That's more of a function of manufacturing and supply. But I think the drug prices is something which, you know, you negotiate with different insurance companies for different prices. So the same drug, depending on the insurer. There was an article, I guess, in the New York Times yesterday that I read about the price of an MRI, for instance. With the same MRI with different manufacturers, you know, the price by 4X can change the price. Now, that's not the price that the patient pays necessarily, you know, unless it's self by 4x can change the price. Now, that's not the price that the patient pays necessarily, you know, unless it's self-pay. But that's it. But yeah, but that being said, I mean, it's crazy, the system. It's a patchwork system. So you're going to study for four years

and you're a medical doctor before you figure it out? No, no, I don't know many medical doctors who understand Medicare nor understand drug pricing. I mean, we hire people to do this for us to figure out our insurance reimbursement. Okay, Jeff, time for our first big story. The FDA has given full approval to Pfizer's COVID vaccine, which makes it the first COVID vaccine to go from emergency use authorization to full FDA approval. Explain it for the people in very pithy terms. Explain what that means. Okay, so do you remember, well, let's just start with FDA approval of a medication. So the FDA, manufacturers apply to the FDA for approval of a drug, and they have to submit all kinds of data, patient trials, they have to do phase one trials, phase two trials, and it's a huge amount of work and expense to get a drug approved through the FDA. So in this particular case, the mRNAs were really, even though they've been worked on for many years, for other indications.

Like 15 years. Yeah, for a long time. They really rushed and with a lot of data to back it up, the mRNA approval for the Pfizer vaccine. And so they got what's called emergency use authorization. You know, even before that, you can have what's known as compassionate use authorization. For instance, I guess we'll talk a little later about Regeneron. But when President Trump got the antibody cocktail, now this is not the Pfizer drug, but the antibody, he got that under compassionate use before it had the EUA. So Pfizer and all the other mRNA vaccines and the Johnson & Johnson, which is an adenovirus vaccine, has EUA right now, emergency use.

Right, emergency. So what is the difference? Full approval makes people feel like it's real, right? Presumably or something. I guess. I mean, I don't think that most people- Well, they've been using it to say, I'm not going to get the vaccine. I understand. So does it make it easier for schools and workplaces to enforce vaccine requirements? Yes. I think that is important. It gives cover for people to basically say, yeah, we can enforce these vaccine mandates. I mean, my hospital has a vaccine mandate. You know, as of September 20th, I believe you have to be vaccinated. What about peace of mind? You were telling me about people that you were treating

that didn't have the vaccine and what you're seeing in San Francisco. Explain. Not just people I was treating, but I mean, people I work with. I mean, I had a long and very heated conversation with one of the surgical techs the other day. He's not vaccinated. And I was like, why aren't you vaccinated? He says, well, because it's not approved. I said, it is approved under EUA. I said, but a lot of things that you do are not approved. And there's a lot of off-label use of medications. And then he said, well, you know, I don't want to take it because they're making me. And I was like, well, they make you take polio vaccine. They make you take measles, mumps, rubella.

I mean, the list is enormous. If you join the military, it's like 15 vaccines you have to have. Sure. So I don't really understand this argument. I think it's been played out. So what did you tell him? You had heeded.

What, how did you kick him out of the room? No, you know, as of September 20th, he's not going to be able to work there. I mean, this is, you know, but I mean, it's difficult to argue with people who've already made up their mind about something. And, you know, logic doesn't seem to work there. I mean, this is, you know, but I mean, it's difficult to argue with people who've already made up their mind about something and, you know, logic doesn't seem to work on them. Yeah. So what do you do? What do you do? I mean, you're seeing most of the people hospitalized

that you're seeing are unvaccinated, correct? Well, interesting. You know, Israel is the great place to look at for that data because they have the longest history. And we're not talking that long. I mean, remember, this isn't that old of a virus. We're talking about early 2019. So but they got people vaccinated early. And if you look at the Israeli data, right now, it's actually about 5050 unvaccinated versus vaccinated who are getting sick, but still, the vast majority of people hospitalized, hospitalized, hospitalized, not infected, but still the vast majority of people hospitalized. Hospitalized, that's what you're telling me. Hospitalized, not infected, but hospitalized are unvaccinated.

I looked at the numbers from my hospital today, and actually about two-thirds are unvaccinated. One-third is fully vaccinated. So I think as immunity wanes from the hospital, in the hospital, in the hospital, that doesn't necessarily mean in the ICU intubated or prone or anything like that. Those are mostly unvaccinated. Mostly unvaccinated. And then if you look at the death rates, the people who are dying as a result of COVID now, they are the vast majority. We're talking about fractions of percent who are

unvaccinated. Most people are unvaccinated who are dying. Delta is a different beast, though. And I think some of the data coming out of Israel shows that the Delta virus, not only is it more infectious, but it potentially is more lethal as well. More lethal. And you know, I'm stuck. I am not joking. I'm actually, we, someone in our family got COVID, even though he had been vaccinated. And then we had lunch with him outside outside mostly. We were inside for a very short amount of time. But we are sitting here trying to figure out, you know, just getting tested, which is because of the virulence of the infection here.

But the administration is rolling out booster shots for many Americans starting September 20th, speaking of that date. First off, is there a difference between a booster and a third shot? No, it's the same thing. It's the same thing. A booster, I mean, the whole point of a booster is to spike your immune system again. And remember, I mean, unfortunately, immunology is really complex. You know, when you talk about immune status, you're mostly talking about, you know, antibody levels, B cells. Remember, there's another set called T cells, which are T memory cells. So the idea is to spike the immune system by activating T memory cells to produce more antibodies to build your antibody level.

That's what I talked about with Dr. Patrick Soon-Shiong. it's like, oh yeah, I've seen this before. So you produce a lot more of these T memory cells, in addition, T helper cells and all these other things, which I'm not an immunologist, so I don't want to speak out of turn. Do you think, are you seeing line jumping on these, people who just decided, well, I'm just going to get one before there's a rush? You know, what's interesting is if you look at the, you know, Walgreens and, you know, other drugstores, I looked the other day, there's so many open appointments now for the booster shot. I was tempted, you know, I had a break in the operating room to go down and get mine because I got vaccinated in December for my first shot and January for my second. And again,

looking at the Israeli data, we're seeing that they have one of the highest rates now of Delta. I think it's like 650 per million population. And that is a population that is 80% vaccinated. Right. Which have gone along and wear masks, etc. Correct. There's confounding variables, though. So keep in mind that the people who are vaccinated first were the elderly, the immune compromised, etc. So we may see that as a confounding variable in why they're getting sick in Israel. But I would pay attention to the Israeli data. There's a few researchers. And get a booster shot. I would definitely get a booster shot when you're able to. Yes.

Right. So there's so much stress also going back to school now you're talking about with Delta. I just interviewed the head of one of the teachers unions, Randy Weingarten. And particularly in Florida, she was pointing out there's seen a surge in cases. Your wife is a school teacher. She teaches school. What kind of conversations are you having about this? Although schools have proven to be pretty safe in terms of transmission. That's correct. I mean, not only my wife, but my daughter is a school teacher too. She is just starting teaching in Jackson, Wyoming. And my wife teaches second grade and my daughter teaches preschool. You know, it's interesting in Marin County, where I live, we've had very good,

you know, safety measures. In fact, Dana went back teaching in October of last year, she was one of the earliest districts to go back teaching. Now they did it via cohorts, and they had plexiglass barriers, of course, they found that those don't seem to help. In fact, they may hurt. All of the kids are wearing masks, every one of them. All of the teachers are wearing masks. They don't eat lunch together. They eat lunch separately. So they put in basic safety, you know-

Protocols, yeah. Protocols, yeah. Ventilation, better ventilation. And better ventilation, keeping the doors open. And they try to do outdoor teaching as much as they can. I mean, my wife is a big garden advocate, and she's doing a lot of outdoor education about monarch butterflies and gardening, etc. And so they're trying to do, you know, integrate those kind of things in the curriculum. But I have to say, I asked her this morning, when she went off to work, she started last Wednesday,

every single teacher is completely thrilled that they're back in the classroom. Zoom teaching was very hard. And I don't think it served children well. And it certainly didn't. I think a lot of teachers resigned or retired because of it. Yes. We'll be talking about the nursing shortage, but there's a teacher shortage too. It was a really stressful year for them. So in terms of going back, you're not worried about that. Just take the booster and do the same kind of safety things. And schools are shown to be for teachers. The children aren't vaccinated. There's no children under the age of 12 who are, you know, have been vaccinated.

So what to do for parents? Just go wear the masks. Yes, wear the masks. Practice, you know, don't send your child to school if he or she is sick. And remember that signs of COVID are very simple. I mean, it's a coronavirus, right? So, you know, the coronaviruses are the common cold virus. So it mimics and it looks because it is a coronavirus. So children fortunately don't seem to have suffered the consequences as much as adults have as far as morbidity and mortality. Delta may be changing things a bit, though. So we're seeing more children hospitalized

with coronavirus. And they can't get, and that, of course, will be into the fall. Right. Right. That's right. That's right. In the fall, it will get worse because more people are inside. Yeah, right. And we'll see. But good news on that front, the Secretary of Education said that public schools who want to institute mask mandates can't be denied federal funds. Of course, there's a huge argument over mask mandates, people screaming back and forth, the science being thrown around. It's still confusing at best. No matter what the pressures are facing for the state government, Governor Greg Abbott of Texas lost the battle to ban mask mandates in the state Supreme Court. He just did. Let's talk about this guy. He tested positive and then four days later, he posts this video. Let's run it. I am now testing negative for COVID. I'm told that my infection was brief and mild because of the vaccination that I received. So I encourage others who have not yet received the vaccination to consider getting one. My wife also continues to test negative. I will continue to quarantine at the recommendation of doctors. During that time, however, I will continue to work on issues

that are important to the state of Texas, including opening infusion centers for antibody therapy treatment across the entire state of Texas. What's an infusion center? Boy, I'm glad I didn't see that before. I would have gotten nauseous. What's an infusion center? I get this treatment of these antibodies. That's a great thing, right? Well, maybe. I mean, it's what Donald Trump got when he, under compassionate use, the company Regeneron makes, as well as other companies, Eli Lilly, etc. But Regeneron is the one that you hear most in the news. It's a company that makes an antibody cocktail that consists of two monoclonal antibodies that they package into one vial and they inject them into people. Now, you have to go to an infusion center for an intravenous injection. You know, people don't talk about

that, but that's not cheap, right, to go to an infusion center. So even though the drug might be supplied free of charge, I doubt very much going to an infusion center, getting an IV, sitting in a place for an hour and a half to monitor side effects. Better to take the free vaccine, correct? Oh, yeah. I mean, it's like, you know, it's like the whole cows leaving the barn thing. I mean, just shut the door. What do you think? Why is he focused on the infusion centers versus the... He did say to

go get vaccinated. He certainly did. Which is good. I mean, although he didn't used to say that, right? Yeah. And neither did, you know, Trump initially, etc. I mean, all these people, anti-vaxxers, I mean, they created doubt. I mean, this should not have been politicized ever. The same thing with mask wearing, it should not have been politicized, but it was. And as a result of that, we have all these problems now because people are, you know, following their political— And they're focusing on these antibody treatments.

Florida, Missouri, Texas are promising millions of dollars in antibody treatments. Yeah, but these are expensive treatments, Cara. I mean, you know, the actual— Are they effective? Are they effective? They work if you get the—they work 80% of the time if, if you get the within 10 days of having the first infection, or knowing that you have an infection, so you have to not be hospitalized pretty much when you get them. But before you're hospitalized, in fact, there's data to suggest that once you're

hospitalized, and on oxygen, etc, they actually may be harmful. So it's confusing. So the idea is get a vaccine, get a vaccine, it's just it's it's a no brainer. And it's it's confusing. So the idea is get a vaccine. Get a vaccine. It's just, it's a no brainer. And it's so much less expensive. I mean, each of these antibody treatments can cost anywhere from, you know, the actual true cost is about, you know, 5,000 bucks. I mean, Regeneron is a multi-billion dollar company. So it's like doing diabetes treatment when you could start with don't eat so much sugar or whatever and don't eat, they don't have a bad diet. For type 2 diabetes, yeah. Right, yeah, for type 2 diabetes. So it's just, it's a thing that comes way too late.

Correct, right. It's like having the cows leaving the barn, gone in the fields, and then buying a whole bunch of Segways and riding around trying to round up the cows. It's silly, you know? All right, yes. Okay, all right.

So, but when you notice all this as a doctor, and I'm going to get to nurse next story in a second, but the politicization, now medicine has been politicized over years in lots of different ways, and there's political elements have entered it. What is this like as a doctor? Well, it's frustrating. I mean, when you're treating people who could have with a, you know, a lot of prevention stuff is treatable. I mean, massively, you know, morbidly obese people who, you know, you know, they can't always help it. It's, it can be an endocrine issue. A lot of things that it's frustrating. Smoking is a good example. I mean, don't smoke, right? It's not good for you. But, you know, we treat these diseases as a result of, you know, not taking into account the value of prevention,

exercise, the common sense things. But- In this case, it's vaccines. In this case, it's vaccines and social distancing and wearing a mask and common sense thing. Now, keep in mind that masks don't necessarily, they're not, especially surgical masks, not N95s, but surgical masks aren't that good for reception of viral particles

because they've got holes in the sides, et cetera. N95s are a lot better, obviously. But what you're doing is a reverse of the tragedy of the commons, essentially, which is you're wearing a mask to protect other people from you. That's why we wear masks in surgery. I've been wearing a mask every day for the last 31 years as an anesthesiologist. We're trying to prevent my spit from getting into your wound. Not so much that I'm afraid that your bacteria is going to come into me. But that is very important to keep in mind. You are basically just like wearing seatbelts.

You're preventing accidents. You are doing things for the good. Even if you could die. Right. Yeah. It's so weird that it's gotten to be this on something like masks. You're preventing accidents. You are doing things for the good. Even if you could die. Right. Yeah. Yeah. It's so weird that it's gotten to be this on something like masks. By the way, I haven't gotten one cold this in the past 18 months. Neither have I.

Neither have I. I mean, because, you know, again, we're wearing, you know, people are wearing masks in areas. They do that in Japan and China. I mean, this is very common in Asian countries. Yeah, I'm going to be wearing masks a lot more. I think I look good. Yeah. Yeah.

I mean, I would. Asian countries. Yeah, I'm going to be wearing masks a lot more. But I think I look good. Yeah, yeah. I mean, I would. I mean, I think, you know, even in, you know, counties that have, you know, removed the mask mandate, I'm not going to the grocery store without a mask. You know, or places like that. And we have to wear them in the hospital. Forever? Forever? Well, that's a good question. I think, you know, through, you know, I think when I came on Pivot last time, I had a quote that was in one of those little red, you know, rim things in New York Magazine. I said, you know, COVID is going to be with us, you know, 2021 is going to be the year of COVID.

Yeah, it's going to be here. And you said all year. And I said, yeah, all year. Well, I'm going to extend that into next year. This is going to last a couple of years. Endemic. Endemic. You know, the 1918 flu lasted until 1920. I mean, that killed a lot of people. Well, Jeff, you're a bummer. Okay. I know I'm a bummer. Sorry.

All right. Let's go on a quick break. When we come back, our second big story, and then we'll talk to a friend of Pivot, John Carreyrou, when we get back. How exciting. Fox Creative. This is advertiser content from Zelle. When you picture an online scammer, what do you see?

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And when using digital payment platforms, remember to only send money to people you know and trust. their investment approach? What learnings have shifted their career trajectories? And how do they find their next great idea? Invest 30 minutes in an episode today. Subscribe wherever you get your podcasts. Published by Capital Client Group, Inc. Jeff, we're back for our second big story, zeroing in on the many terrible side effects of the pandemic, a nursing crisis reported in stark detail in The New York Times over the weekend. One in five ICUs are at least 95 percent capacity. It makes it difficult to maintain standard of care. Nurses have already been in the trenches for 17 months and the work isn't letting up with the Delta variant.

Nursing shortages were a problem long before the pandemic. As you know, you've talked about it with me. But now a lot of them are retiring, moving to non-emergency room jobs or just getting out. They're also sick of people. You know, you've seen all these amazing interviews with them where they just are so tired of treating people who won't be treated. I just want to play a quick clip from a video log of a Tennessee ICU nurse, Katherine Ivey Sherman. Not everyone has the luxury of being able to stick their head in the sand and ignore the world around them. able to stick their head in the sand and ignore the world around them. I am so tired of the people who are creating their own reality where COVID is not a problem. And then they have the audacity to

get mad at people like me when we try and show them that no, this is real. You are the one living in a delusion. You don't get to be mad at us for figuring out how to deal with the reality. Yeah, it's heartbreaking. Well, there's a lot of that, Jeff. But I've seen so many stories. It's either stories of people who wish they had gotten the vaccine and are dying or these healthcare people.

So how are you and your colleagues seeing this play out in hospitals, especially with nurses who are so critical? You've always been a supporter of nurses compared to most doctors. They're the backbone of the hospital. Nurses and techs. I mean, I don't want to, you know, minimize. I mean, I just give a shout out to the nurses that I work with. I mean, one of the nurses I work with, Kara, is a huge fan of yours, Katie Hacker, and I want to say

hi to her. But these people are tireless, tireless workers. And they deserve everything that they get in terms of compensation and consideration from the hospital. The problem is there is a huge shortage of nursing. And some of it's retirement. Yep, half a million retire. They were baby boomers. There's not a short term. There's an easy fix. And nursing schools are struggling to train.

That's right. There's not enough short term. There's an easy fix. Nursing schools are struggling to train. That's right. There's not enough faculty to teach nurses. You know, for a long time, you know, nurses were recruited from other countries. A lot of Filipino nurses in San Francisco because there's a shortage of nurses, American nurses being trained. And we're seeing that in our hospital. In fact, it directly impacts me in the sense that my surgical schedule has turned into more of a horizontal schedule to a more vertical one. And I'm routinely working late into the evening, 9, 10, 11 p.m.

every night just to get through the elective surgical schedule because we have to close down operating rooms because we can't staff them. This is true of hospital beds. I mean, even though hospitals might not be full to capacity, they have to have nurses to staff the beds. Right. And this is a problem. Yeah. So what are the long-term options? Well, we have to train more nurses.

I mean, you know, maybe we can solve two problems and start recruiting Afghani nurses, you know, from Afghanistan, you know, as immigrants. I think that it's a difficult problem because it takes years to train a nurse and it takes even more years to train a specialist nurse. And so we're behind the eight ball for, you know, many, many, many years behind. So I don't know the solution. I mean, throwing money at the problem seems to be what they're doing right now. You know, traveling nurses, you know, who go from place to place. For people who don't know, they work under contract rather than

in a particular hospital. It's correct. There's real, there's bidding wars for these travel nurses. I mean, I'm hearing numbers, you know, $150 an hour and up for some of these nurses. I mean, that's crazy because this is the problem is the nurses who live and work and are permanent nurses don't get paid anywhere near that. The problem is the nurses who live and work and are permanent nurses don't get paid anywhere near that. And so what they're doing is it's emptying out hospitals and places that you most need it.

Underfunded areas. Right. Which are the hot spots, right? Right. What if a Mississippi nurse or a nurse from Tennessee is looking at California and saying, hey, you know, I can make $150. I'm going to come to California. And believe me, I've seen an influx of nurses from those states working as travelers. They're all wonderful people, and they all are very compassionate and caring people, but there's a limit. Right. And so what can you do? So money is not necessarily a good option. It's a good thing to pay people more, but it creates all kinds of weird incentives.

Yes. Doctors are also affected by this. Is there anything particular that doctors can do or should be doing or the federal government? Well, doctors can write letters to congressmen and to senators, I suppose, and get involved in local politics. I mean, we can support our nurses by not being jerks. That's one of the biggest things that just to respect and it's a collegial environment. And the old school of doctors being captains of the ship, you know, just to respect and it's a collegial environment. And, you know, the old school of doctors being captains of the ship, et cetera, et cetera, that's, you know, that's gone. And, you know, I have a great relationship with the nurses in my hospital because we all understand what our roles are and how we contribute. And nurses are an amazing bunch of

people. They're just amazing people. What would you say to someone who is thinking of doing this? What would be this pitch? What would be the pitch you would make to them to do it? Besides here's some more money. To be a nurse? I would say it's a people job. It's a job where you can use science and your skill. And you're the frontline person dealing with patients. You're a healer. Although what do you say to that woman? She's had it. She's out of Fox, I would say. Out of Fox.

Yeah, she's out of it. I don't blame her. It's exhausting. I think we're in the middle of the crisis. I think that there's going to be a lot of post-mortem analysis, not to use a medical pun, on this crisis when it's over. Is that a medical pun? Well, kind of, post-mortem. Okay.

All right, my last question here, if we get to John. There was a doctor in Alabama who refused to treat people who were unvaccinated. What do you think about that? I had mixed feelings. I'm like, well, okay, that makes sense. You know, I mean, people talk about, you know, I'm writing a piece right now, actually, on the misunderstanding of what the Hippocratic Oath is. I mean, as a physician,

you know, I didn't sign up to say I'll treat some people and not others. I mean, I mean, I, listen, I routinely, when I worked at SF General in trauma, I routinely treated people with, you know, swastika tattoos and murderers. And, you know, you can't look at that. You have to treat people as people. I mean, that's what we do. Right. Yeah. Even when they're saying, what do you think of this doctor when he did this? I mean, he had a very cogent argument about why he didn't want to. ignorance. And they've been fed this ignorance by, you know, people who should know better, you know, people like, you know, Ron DeSantis, and, you know, Abbott and Trump, and, you know, people in the administration. I mean, it's just nakedly political. And, you know, to generate votes among their coalition, I don't know what it's for. But did you ever think as a doctor,

you'd be dealing with that kind of thing? No, no. I mean, you were counting, but I do remember, I, you know, I, I was, I was in medical school during a lot of the early HIV, you know, AIDS crisis. And I, you know, I came out then. And to me, there was no question. There was no issue that you treated these, you know, these, these are people, right. And even though we didn't know a lot about HIV when it, and it first came out you know, that didn't, you know, that didn't stop anybody that I know, any physician I know from treating.

And so you still will, no matter what? Yeah, I will treat anybody, no matter what, whether they're vaccinated or unvaccinated, because that's what I do. Okay. Let's bring our friend of Pivot. what I do. Okay. Let's bring our friend of Pivot, John Carreyrou. John is an award-winning investigative reporter and author of the bestselling book, Bad Blood, Secrets and Lies in a Silicon Valley startup. He was the first to break the scandal of the blood testing company Theranos in 2015 in the Wall Street Journal. I've done a long podcast with him about it, but he's got a new podcast out this week called Bad Blood, the final chapter

about the Elizabeth Holmes trial, which is about to start. In the years leading up to this trial, things have gotten complicated. A missing laboratory database. There are a lot of people who would do anything to destroy all that. Fractured relationships.

The notion of being abused, perhaps mentally, by an older man. And... Total plot twist. Obviously, she was going to get pregnant. Holmes is accused of massive fraud and lies and the capabilities of her technology. John, it's good to have you back. It's good to be here. Thanks for having me. I brought a doctor. He's related to me, but I brought a doctor to help me with this. This is my brother, Jeff, Dr. Swisher. So He's related to me, but I brought a doctor to help me with this. This is my brother, Jeff, Dr. Swisher. So let's just start with, you know, you've reported on the story from the beginning. What new information should we expect to see come to light in the

podcast? Tell me about making this and where we are now. Set the table for us for Holmes and what's going to happen. Right. So we're on the eve of her trial, which starts next week, August 31st. Right. Jury selection is August 31st. And this is a trial that's been a long time coming. You know, I first reported on this in late 2015. So it's been six years. The wheels of justice have turned especially slowly here. We're going to see Holmes walk into that courthouse in San Jose. One big question is whether she's going to be carrying her newborn in a baby Bjorn. She will. There have been, you know,

I talked to a lot of people connected to this case and a lot, there was a lot of cynicism about the timing of this pregnancy. So we'll see if that, you know, if there's theater around that, that plays a role in this trial. In terms of the podcast, yes, there is new material in the sense that I got a lot of, I got my hands on a lot of new material since I wrote my book, which was published three years ago. Basically, I got my hands on almost every SEC case exhibit. As you know, the SEC did its separate civil investigation that resulted in a settlement with Holmes, but Balwani, her ex-boyfriend, never settled, so that case is still ongoing. The SEC case overlaps a lot with the criminal case, at least one aspect of the criminal case, which is the investor fraud charges. So those SEC case exhibits gave me a lot of insight into what's

coming. One of the most fascinating parts is this file with thousands of text messages between Sonny and Elizabeth that span about five years. Some are redacted, but most are not. And those text messages, which are the subject of episode three of my podcast, give you insight into their relationship. And as you know, and we can talk about this, their relationship is going to be front and center at this trial. Right. So let me ask, I'm going to give Jeff a medical question in a minute, but from what we know, what will her defense look like? Is she going to testify? Well, we don't know yet, but it looks like from, you know, filings that have come out, it looks like a central part of her defense is going to be to allege that her ex-boyfriend,

who was a number two of the company, Sonny Balwani, was her Sangali, that he had this psychological grip on her. They may even allege that he abused her physically. They were certainly going to allege that he had a hold on her psychologically, that she was in his thrall, and that as a result, she kind of lost sight of right and wrong. No, he's not being, this is not his case that's coming, correct? Well, they were charged together, but their cases were severed because, precisely because of this, because they've turned on each other. And so he's going to be tried after she's tried at the beginning of next year. So it looks like, I call it the Svengali defense. It looks like she's going

to try to shift a lot of the blame to Sonny. So she'll have to testify. She can't just assert it. Again, we don't know, but I would bet that she does testify because I think it's not going to be enough for a psychologist to examine Holmes to go on the stand and, you know, testify to basically the fact that Sonny allegedly abused her. I think the jury is going to want more than that. The jury is going to want to hear it from her. And I think a juror is going to want to see her go on the stand and explain exactly what this abuse was all about and how it led her to participate in this alleged fraud. Jeff, question? Well, I mean, I'm just amazed that she doesn't go on the stand and test, you know,

and basically try to say that she's insane by basis of sociopathy and severe personality disorder. I mean, I'm not a psychiatrist. That's a good question. And I have never examined her, so as a physician, it's unethical for me to say that. However, you know, I mean, Carrie, do you remember back in All Things Digit, the D conference that she wanted to come? And you asked me very early on about Theranos. And I just basically said, it's insane. I mean, if you told me that an alien race from 10,000 years in the future came back

and gave this technology, I would have believed that more than the technology that they presented. All right, ask a question of John, the expert. Well, I mean, why do you think that no scientist or no physician ever signed on with Theranos at the beginning and blew the whistle on it? Well, there were a lot of experienced scientists and, you know, PhDs who joined the company at various points. And, you know, the reason there weren't any whistleblowers earlier in the history of this company is one, that the stakes were a lot lower when, you know, it was a company in stealth mode that hadn't gone live with its technology, that hadn't, you know, gone to the marketplace and wasn't offering its blood tests to consumers. That only happened in the fall of 2013. That's when the stakes got a lot higher, 10 years into the life of the company. And then it took about a year and a half, two years for

one whistleblower, in particular, the former lab director who had just left the company when I contacted him to, you know, gather up their courage and blow the whistle. You know, why weren't there whistleblowers earlier? I would say it's also because, you know, litigation was always in the air. The threat of litigation was always in the air. At Theranos, Elizabeth had sued employees early on in the early years of the company. And everyone knew that Boyes, you know, was the attorney. David Boyes was the, yeah, was the attorney for the company. She had also sued Richard Fuse, a childhood neighbor, alleging that he had stolen a patent. Sonny was, who was kind of the guy running the company day to day, was very aggressive and, you know,

firing people all the time and screaming at people. So there was a very toxic workplace. And I think there was a lot of fear of retribution. And in fact, I saw it firsthand when I was, you know, doing my first stories for the Wall Street Journal. And then when I went on book leave even to report out the book, a lot of people, you know, were scared to speak to me because Holmes and Balwani had not been indicted yet. And they worried that they might not be and that they'd come for them. And so I had to do a lot of handholding and, you know, convince a lot of people to become sources. One of the things that was very, was the idea of it. You know, Jeff, we talk, I get blood tests all the time.

They're very onerous. Where is the technology right now? Or have you continued, John, to follow where this tech, because this is, there's no technology here, correct? There's nothing to say. Right. I mean, to this day, no one has been able to do what she claimed she had achieved, which is to do hundreds of tests off a tiny pinprick of blood

from a fingertip. There's two basic problems with that. One is that capillary blood, which is the medical term for blood that you get from a finger, is less pure than blood you get from a vein in the arm with a syringe and it's polluted by tissue and cells and those interfere with certain tests. The other issue is that there are basically four big types of blood tests. And when you've used your tiny sample of blood to do, say, a handful of blood tests from one of those four categories, you've exhausted your sample. There's no sample left to then use the completely different methods and laboratory instruments required by those three other classes of blood tests. No one has solved this issue to this day. You know, 2021, she was making these claims in 2013, 2014.

To this day, no one has solved this. Well, John, that goes to my point is that, you know, early on as a physician who basically uses, I'll just take one example, potassium. I mean, potassium is a, you know, ion in the blood, which is critical for cellular conduction, neurochemical conduction, cardiac conduction, et cetera. If the potassium is off by, you know, one or two milliequivalents per deciliter, I cancel a case. And the error bars in that are very small. And if, you know, something, if you dilute a sample out like 50, 100 times, you have to increase the error bars by that same amount.

So we knew this was nonsense from the very beginning from a physician standpoint and then like you say you're talking about eliza tests electrochemical tests you know antibody test all these it's just not if physics is impossible there is no physics on the planet earth that allows uh you know her to do what she said she could do and this was known at the beginning and that's my point is why did no doctor come in and say, this is impossible? Most of them tend to be very respectful and they wait for data before they start, you know, making public claims. And so most, most of those people who were being quietly skeptical were waiting for some sort of study or some sort of data to come out before they said anything.

And, but, you know, when I started my investigation in early 2015, one of the first things I did was I called, you know, the chairs of laboratory departments at big medical academic centers. UCSF was one of them. And, you, you know, these guys, uh, over there were telling me immediately that, you know, that they didn't believe, uh, that this was possible. Um, and, and in fact, in my first story that was published at the end of 2015, I had, uh, one of them expressing very strong doubts about the, uh, feasibility of the technology. Yeah. So what happens beyond Holmes herself, you know, this idea of the reason we didn't cover it was one, Jeff warned me, and two, I didn't think it was technology and I didn't

think I knew enough about it. But what will this mean for Silicon Valley's sort of fake it till you make it culture? There's lots of people who have done things that are fraudulent, obviously not someone that has impact on people's health. But what's the result of your book? What is the conclusion, do you think, your podcast and the book and this final chapter is going to make? Do you believe she's going to be convicted? Or if she isn't, what is that? Whether this has an impact on the fake it till you make it culture of Silicon Valley, I think is the central theme here. You asked me if I think she's convicted. I still think she's going to be convicted if I had to bet on it, because I think the prosecution has so much written evidence documents, but also tons of witnesses. And there's a part of the case that's

that's very hard to defend, which is the patients and the erroneous blood tests that they received. Um, but I think that if she is convicted, then potentially this will be a wake-up call in Silicon Valley for venture capitalists and especially for young entrepreneurs that you can only push the envelope so much. If you hype and you exaggerate to the point that you're outright lying, then it becomes securities fraud. And especially if your product is not software, but it's a medical device where lives are in the balance. If on the other hand, she's acquitted, which is certainly a possibility, then I think this culture is going to continue. There's not going to be a course correction. I think it's probably only going to get worse. You'll have a bunch of young entrepreneurs running around

Silicon Valley saying, yeah, you know, I sort of pushed the envelope, but look at Elizabeth Holmes, look at what she got away with. She ended up doing no prison time, and I'm not as bad as she is, you know, I'm keeping things more under control than she is. And I have one more last quick question. Why her? Because there's so many people, I mean, you can, some of the stuff isn't illegal. Some of these entrepreneurs do, like, it isn't like I'm thinking of WeWork, nothing illegal. He told them what he was doing. You know, it was all out in the open, but it was something. It was a lot of PT Barnum kind of stuff. Why her, do you think? Yeah, I mean, I think that the difference between WeWork and Atherinos and all these other Silicon Valley companies where entrepreneurs also exaggerate

is that this was a medical device. You know, this was a company that was operating in the healthcare arena where the stakes are extremely high. It's not software. It's not a smartphone app. If you release a buggy version, you can't rely on the first people to use it to iron out the kinks. If you're putting out a blood test, a finger stick test with a device that doesn't work, then lives are being affected by that and lives were affected by that. And we're going to hear about, we're going to hear that from about half a dozen patients at trial. One of whom was falsely diagnosed by Theranos with HIV when she was perfectly healthy. You know, a couple other patients had viable pregnancies and were told that they'd lost their babies. So those are, there are real, really stark real world consequences to, you know, adopting the software culture and applying it to medicine. And there's more to that to come, by the way. Is that what you're working on next?

What are you working on next? I think there's more of that to come in the sense that Silicon Valley used to be, you know, Silicon Valley was the computer industry. And increasingly, we're seeing Silicon Valley set its sights on other arenas, such as, you know, self-driving and, you know, drones and smart homes and medicine. drones and smart homes and medicine. And, you know, if entrepreneurs from Silicon Valley keep applying the fake it till you make it, the software ethos to these new arenas where lives are actually, you know, at stake. I mean, if you think about that Uber car that ran over a woman a couple of years ago in Tempe, Arizonarizona yeah so there are very real real world consequences to some of the things that silicon valley you know is doing these days it's no longer just software or computer hardware and so yeah i think it's a trend that that that

convergence of these other industries with silicon valley is going to continue and i think it's going to potentially create more of these situations which is why i think it's important for there to be a guilty verdict in this case um otherwise this won't be a cautionary tale so we're going to watch this podcast is going to go on until the the case that's right ended correct this bad blood the final chapter and where's the movies there were like like, there was a movie, Kate McKinnon. There was Jennifer. My book was optioned by Legendary Pictures and by Adam McKay. And the movie is still in development. We have a screenplay that will probably get touched up by McKay based on what happens at the trial. Jennifer Lawrence is still attached to Playhome.

Attached. She's attached. And yeah, it's still moving forward. McKay's production company and Jen Lawrence's production company will produce. The studio is legendary. And I'm actually expecting some news on that front in the next couple weeks. All right. Well, we will be listening to Bad Blood, the final chapter. People can't get enough of this story. She's become some sort of symbolic icon in a way that's really fascinating, and

watching her walk into this courtroom, I think she hasn't changed one little bit, I suspect. Yeah. That's my feeling. Sorry, Jeff, go ahead. Thanks for your book. Yeah, thank you so much. bit, I suspect. That's my feeling. Sorry, Jeff. Thanks for your book. Thanks for your book, John. That was a fantastic book, and it was very well researched and, from a medical standpoint, extraordinarily accurate. So, thank you. Thanks very much. That's great to hear. All right. Thank you so much, John. Thank you.

All right, Jeff. That was fascinating. God, I am such a huge fan of his. He's really, he did an amazing reporting job. He's a great reporter no matter what he covers. One more quick break. We'll be back for wins and fails. Support for this podcast comes from Anthropic. You already know that AI is transforming the world around us, but lost in all the enthusiasm and excitement is a really important question. How can AI actually work for you?

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I think that the big winner are the teachers and the nurses. I think that specifically, you know, of course, near and dear to my heart because of my wife and daughter. But the teachers have really, I think, are the big heroes. I remember when we started with this COVID thing, there was the nightly howl for the doctors and the caretakers. I think we should reinstitute a nightly howl for teachers and for nurses because they need it. They need our support and they're my big win. All right. And what's your fail? Oh, there's so many this past week. I mean, I, you know, I wanted to say that the media, how they're portraying the Afghan withdrawal and, to lay the blame on Biden is, I think that's a horrible fail. Your mom is doing that, just so you know.

Of course, I know she is. You know, remember in 1979 when the Soviets invaded Afghanistan, I was a sophomore in college. And, you know, there was a history before that, obviously. college. And, you know, there was a history before that, obviously. And, you know, friends of mine who may or may not have worked for the CIA, went in, were with the Mujahideen, who were the freedom fighters, right? Well, that's the Taliban that we know today. This is such a complex history. And I think the media is not doing anybody any service. Yeah, I mean, it's just heartbreaking what we're seeing. But that's, I think the big fail is how they're basically simplifying it. I mean, keep in Yeah, there's a lot of visuals that are... Nobody could not have dropped this. And I'm not saying that, you know. I don't know if that's true. I think there. Well, listen, I think that I think that, you know, certainly as president, he's responsible

for what happens on his watch. And I think that some of the messaging coming out of the administration was not good. But but the Afghan problem is very complex. And I think that the fail is of the media trying to portray it in a more simplified matter. The other fail is DeSantis and Abbott. I mean, those guys are just losers with a capital L. Okay. All right. And I give my win is the FDA approval for the Pfizer-BioNTech coronavirus vaccine and the others are to come. I got that vaccine. I actually interviewed the creators of it. And I actually emailed them to thank them for it when I got it.

And I plan to get a booster and everything else. I think that's really the win. And I think I hope they get vaccines for young people, younger people. When is that coming for people who have children under 12, Jeff? I'm going to guess it's not going to be for a while because they have to get enough. Like I mentioned about FDA trials, it's not going to be for a while because they have to get enough, like I mentioned about FDA trials. It's not going to be for several months, if not longer, before we have an under 12. It'll be age 5 to 11.

They do this in cohorts. So the next cohort is going to be 5 to 11-year-olds. But I wouldn't anticipate we're going to see it until late, you know, maybe mid-next year. Oh, wow. That makes me worry. And I have small children, as you know. Yeah, I know you do. Yeah. She's gorgeous, by the way.

Yeah. Yeah. So we'll see how that goes. Jeff, I really appreciate it. Thank you so much. I appreciate being here. I mean, hopefully that I made some sense and I didn't confuse people.

Yes. And you also took the place of Andrew Ross Sorkin, whose power went out in the Henri. I think it's Henri. Yeah, what an august company. You've had some great guests. I do miss Scott, though. I think I really miss Scott.

Everybody does. But, you know, having Preet Bharara and having, you know, George Conway and all these people. We've got some more coming up. Stephanie Rule. And you. Ben Smith and Baratunde. And you, my fine brother, my fine brother. Yes.

Well, I'm always happy to come back, Cara. All right, great. We'll be back on Friday, by the way, for more. I think Sorkin is probably coming back for that. Go to nymag.com slash pivot to submit your questions for the Pivot podcast. The link is in our show notes. Jeff, do you have the script and you can read us out? I do.

So go ahead. Go for it. I will. Today's show is produced by Lara Naiman, Camila Salazar, Evan Engel, and Taylor Griffin. Ernie Endredot engineered this episode. Make sure you're subscribed to the show on Apple Podcasts. If you're an Android user like I am, check us out on Spotify or, frankly, wherever you listen to podcasts. And if you liked our show, recommend it to a friend.

I know I'm going to recommend it to all my friends who are going to get sick of me telling them about it. Thanks for listening to Pivot from New York Magazine and Vox Media. We'll be back later this week for another breakdown of all things tech and business. Support for this podcast comes from Anthropic. It's not always easy to harness the power and potential of AI. For all the talk around its revolutionary potential, a lot of AI systems feel like they're designed for specific tasks, performed by a select few. Well, Claude, by Anthropic, is AI for everyone. The latest model, Claude 3.5 Sonnet,

offers groundbreaking intelligence at an everyday price. Claude's Sonnet can generate code, help with writing, and reason through hard problems better than any model before. You can discover how Claude can transform your business at anthropic.com slash Claude. I just don't get it. Just wish someone could do the research on it. Can we figure this out? Hey, y'all. I'm John Blenhill, and I'm hosting a new podcast at Vox called Explain It To Me.

Here's how it works. You call our hotline with questions you can't quite answer on your own. We'll investigate and call you back to tell you what we found. We'll bring you the answers you need every Wednesday starting September 18th. So follow Explain It To Me, presented by Klaviyo.