Sawbones: A Marital Tour of Misguided Medicine - Sawbones: COVID Lies, Darned Lies and Statistics

Episode Date: May 1, 2020

Two doctors made headlines this week by trying to construct the narrative that the COVID-19 pandemic has been overblown by the hospital system in pursuit of more profits. This week, Dr. Sydnee and Justin explain why their numbers don't add up, and how you can combat this narrative if it, depressingly, sticks around.Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We saw through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Wow. Hello everybody and welcome and welcome to Saul Bones, a battle to work with Miss Guy to Medicine. I'm your co-host Justin McElroy. And I'm Sydney McElroy. Sid, aren't you relieved that this whole thing has been blown out of proportion, and it is going to be smooth sailing from here on out?

It's all conspiracy, it's all scam. And I I for one in feeling pretty good about it. I'm going to get my beach body right, get it out there to them all. I'm going to beach the beach here and have them with me. Gonna start licking phone poles again. So how fast into the episode should you clarify that you're being facetious? It's actually this exact moment. Okay. I, there's... Just in case somebody like decides to stop and send us

an angry email right now. Can you clarify what I'm pretending to talk about because you said I was not allowed to watch it because I'm impressionable and easily swayed? Moreover, it's already been removed from YouTube. Oh, really? How bad did you gotta be? Oh, listen, y'all, I've seen some things on YouTube.

Some things. Yeah, there was a video circulating that hopefully, I don't know, I always say hopefully you haven't watched, but at the same time, it's not that I don't think, I don't believe in censorship, but they are doctors spreading misinformation and that is dangerous to the public health.

So I don't believe that censorship to say, well, we shouldn't let, I mean, if I ran a video platform, I wouldn't want that video up there because they're endangering lives with misinformation. And that's different. I mean, to me, that's more akin to yelling fire in a theater than it is. Oh, I don't like what you have to say. But these two doctors that we're talking about, COVID, and it made quite a stir, but I think that you'll see some of their talking points and some of their, their quote, unquote data regurgitated. And I'd use that word specifically in the, the, the public and the media. So we wanted to kind of give you, or Sid will, I will sit calmly and make fart jokes,

give you the tools that you needed to sort of work against that and sort of unearth where things are just a little bit sketchy with some of those points they're bringing out. So in this video, two doctors who identify themselves as emergency physicians, that is the specialty they pursued, but they currently work running a system of urgent cares. So they own multiple locations of urgent cares. And I think it seems like they spend more time in the administrative running a business

and then actually face-to-face patient care. Dr. Kelsey, that's not Dr. Cox. Yeah, yeah. I get that impression from what they're saying, but this is how they self-identify and they put all this out there and they make clear too. They actually do say to be fair

that they have seen a much lower patient volume and their business has been hurt. So it's out there. I mean, that's not conjecture. I bet their business has been hurt by the shutdown. It's weird. The only one. They've lost money.

And they held a press conference that was widely aired. And then I think like CBS aired it or one of the major broadcasting stations aired it and there were news reports on it and then there were bottles to it and then it was on YouTube and then it was taken down which only really fan the flames of like kind of a right-wing conspiracy network basically saying these are the two truth tellers who the liberal media is trying to shut down and so now they've kind of become like like darlings of that side of things. It's amazing. A cycle I've never seen before. I don't even know why I'm calling it a cycle It's the first time and I think the reason that what they said there are several reasons that what they said was taken so Seriously even though it flew in the face of what

All other medical experts were saying so we are But I think I think one of the reasons that I wanted to break down is that they use a lot of numbers. And I think that statistics in particular, it can get very dense. It is a hard thing. I know that it is something that we are part of our medical education is, you know, used to focus on because we're supposed to read, be able to read studies and interpret them and just tell if they're valid or not. And that's a hard thing to do, even I know with the education I've had, specifically looking

at that. So if you've never had a class in statistics, it could seem like they know what they're talking about. Like, you could do some simple math based on what they're saying and it sounds accurate. And that's very intentional. And so I thought it was worth breaking down some of the numbers and then talking a little bit about some just like bold faith lies. Why don't you start by framing it as to what is their thesis statement for people who are uninitiated? Their thesis is that first of all our

reaction to coronavirus as a nation has been a huge over reaction That there is no need to continue the shutdown that we have done basically more damage than was necessary to the economy And we should immediately open everything back up and They're basing that on a couple of points one One, they think way more people have already had coronavirus than we know. They're just walking around, already had it, maybe had no symptoms or so mild symptoms, they didn't go to a doctor,

and therefore they are now immune. And also that coronavirus is not nearly as deadly as we are being led to believe. He thinks that the death numbers are inflated and he has several reasons that he lays out for how he thinks and why he thinks they're being inflated. But basically that we should all go back to our lives because most of us are going to get this virus, but such a small percentage of us are going to die that it doesn't matter, basically, that it's the flu.

He compares it to the flu. He said it is very much like the flu, and in some ways, not as bad as the flu. Still a wild line of reasoning for what it's worth as a humanist. I think that's still a wild kind of stance to take, but sure. If it wasn't any more deadly than the flu, I mean, we don't shut down for the flu, right? We have a flu vaccine. Yeah, but sometimes the flu vaccine doesn't protect everybody.

And sometimes we do get hit. What I'm saying is if you really, truly bought into that lie, which it is, it's a lie that it is the same as the flu. It is absolutely not. But if you bought into that lie, the rest of the House of Cards he builds makes more sense. And the numbers that he puts forth at the very beginning of the video are the foundation of this House of Cards. Which I call, I thought it was worth mentioning. I called this episode, lies, darned lies, because I can't say the other D word, because this is a family-friendly

show and statistics, which is a quote I had heard on West Wing, but I looked it up to see where it came from, and it looks like we're not exactly sure the first person to say this. There are a couple different people who it's been attributed to. I think Mark Twain made it very popular, although it was not, it did not originate with Mark Twain, but those are the three types of lies, lies, darned lies and statistics. That is what, that's where that quote comes from. Thank you West Wing for sharing it with me.

And thank you Sidney for sharing it with me. No, I saw West Wing too. Okay, so he starts off with a bunch of numbers. He starts off with the tests that have been done at their locations, their data. That's what he, that's his whole thing. I have data. I have this system of urgent cares at which I've done testing. And I can tell you the data, the hard data. Here are the numbers I have. We've tested this many people and we have this many positives. And he comes up with a number from that, a percent based on that, that he then extrapolates out to the state of California to the country as a whole.

That is where all of his numbers come from. So like he talks about the state of California, there have been 33,865 COVID cases at the time of the videos being made. 280,000, 280,900 were tested, so that's 12% positive. Now, it is important. Remember, this is the this is the fatal flaw in the entire video that makes everything fall apart. 12% of people tested were positive in this number, in this fraction. He uses that to say 12% of Californians are positive. Now, Justin, do you know why that's a problem? Yes, because the people who would, it's a biased sample because the people who would be seeking out testing are already sick.

And as we know, there are a ton of asymptomatic spreaders with COVID, I've seen numbers as high as like 50% maybe exhibit no symptoms. Yes. So there could be, we have no idea. There could be, there could be, it's a much higher ratio because you have people who are sick who are seeking out tests. So a higher percentage. So, so if 12% of people who are the, if you remember when we first started testing in this country,

it was really hard to get a test, still hard to get a test in some places, but it was really hard to get a test at first because you had to have traveled to China or had been directly in contact with somebody who had just traveled to China or a case. So the people who were getting tested initially were the absolutely most likely people to have it and of the absolutely most likely people to have it 12% were positive. So why would we think that of the people who were less likely to have it a higher percentage or even the same? No, a much lower percentage.

That number is actually comforting in some way that only 12% of the absolutely most likely people to have had it have had it or actually had it. That shows a much lower prevalence, depending on how you look at it. That is the error that everything is based on, because once you see that part of his data is wrong, everything crumbles. Because what he takes from that is he then says, well, if that percent of the country is infected, and so far we have had, I mean, at that point, it was 50,000 some deaths in the

country, then what that means, comparing the population of the United States to the death rate that it is point O3 percent fatal I mean it's just that's put it on par or less than the seasonal flu It's just not but there's but it because of what you said earlier. It doesn't make sense Right, but but if you bought those numbers that he puts out in the very beginning then all the sudden the death rate is so low, you would ask yourself, but why don't we do this for the flu then? So, the numbers are specifically being used to bolster a case that is false. So the math is bad.

I think that's the first thing you need to know. The second is, he obviously doesn't understand a randomized sample as we spoke to. The people who are coming to urgent cares to be tested cannot be considered a randomized sample of the American people, especially early on if we're talking about people who had classic symptoms or known exposures where the only ones being tested.

So the example that I came up with for this is, let's say I wanted to know how many people in this country liked my podcast solbons. Our podcast, I guess. That's fun. So let's say there, I guess the best way to do this would be like what? I send out random emails, except that would only be people who have emails. So maybe I would need to send out some emails and then also go door to door and then also send out some letters and then also make some phone calls. Right? Like it would take a while to generate a random sample of the entire country from different locations, different ages, different genders to find out what percent of the country

likes my podcast solbons. Okay. Now, what if instead the next time, whenever that day comes, that we get to go on tour for my brother and my brother in me show, I wait until there's a line outside the theater and I walk down that line and I ask everybody in the line for your show at which saw bones opens if they like my podcast or not.

Well, you're going to get a much higher hit right there. And then I say, guess what? Guess what everybody? My podcast is popular with literally half the country. Or maybe more, I don't know, I don't know how many people come to Mubim Bam shows like Solbans, but. But sell, the point is. So the point is it's cherry picking. Right. And that's, that doesn't make sense.

That's bad data. That's not a random, I sample anybody can tell that. So, except this guy apparently. Yeah. We know it's weird to intentionally not any people we just don't want to give them any more platform than they already have. Right. Right. I also don't want them to like yell at me. Yeah. Yeah. We've been on that for come after me. I just want them to stop telling lies about COVID. So, obviously,

their numbers fall apart from there because that's their whole case. It's built on that. The other thing is, you know, if you want to get into some of this, the tests we need, the tests themselves that we're doing right now, I think it's important to note, is a test that tells you if you are positive, if you have the virus right now. And this is a really big problem because all of his arguments about how prevalent this is are based on this concept of point prevalence, at this exact moment in time, this many people tested positive.

This completely excludes people who may have already recovered from the illness, who will now test negative, or people who haven't gotten it yet, but will get it maybe tomorrow, who are going to test positive tomorrow. And then also the fact it excludes a very scary question mark that's in the back of a lot of doctor's minds, which is we think you are immune to coronavirus for a while after you have recovered from it. We believe that is likely to be true, not long lasting life, long immunity, but at least some period of time. But we don't know that. We don't know that. So it's even more dangerous to say, all you people have had it and also you're fine now that you've had it.

Yeah. We don't know that. We hope that. We think that, but we people have had it and also you're fine now that you've had it. We don't know that. We hope that. We think that, but we don't know it. Antibody testing could do a little more of what he's trying to do, but that's not at all what he's using. When antibody testing is still, there's still problems. There are still issues with rolling that out.

Which leads me to the flu comparison. So in the worst years of flu, in the worst years, of seasonal influenza, it can kill up to 60,000 people in a flu season. Okay, those are the worst years. Anywhere from 10 to 60,000 is what we estimate the mortality of the flu is going to be in a given year. That is with no social distancing. That is also with a vaccine, by the way. So with absolutely no, absolutely no social distancing with no other measures taken with nothing else we're doing, it's still going to kill that many people. Now, COVID has killed that many people with lockdowns, with social distancing, with travel bands, with businesses being shut down. We have already had 60,000 plus people die.

But without a vaccine. In a shorter period of time. Yes. You brought the vaccine into it. I think that that's like, Well, I want to give hope. I think the vaccine because the vaccine makes a huge difference. Right. But my point is, COVID is worse than flu.

It's worse than flu. It's statistically, it is categorically worse than flu. Okay, but what if we had not done social distancing? We have to deal with the vaccine thing though, because you said the vaccine, so we have to deal with that. Like, how much is that blunting the impact of seasonal flu? Well, I'm certain it is. So how can we say that COVID is worse if the, if the season flu has a vaccine? Because even in years when we didn't have a vaccine for the flu, I mean,

we haven't always had a flu vaccine. It didn't kill as many people. Really? Yeah. I mean, not all. There have been pandemics. We talked about 1918, 1918, there have been, there have been flu's that have killed this many people and more, but not the typical seasonal flu. Right. But my point is that with social distancing, we have reduced that the number of deaths we've had so far is equal to the absolute worst years of seasonal flu with all these measures. If we had not taken these measures, how much worse would it have been? And it's not done. Right.

Like that number's unfortunately going to go higher. So the comparison to the flu, it's really, it's like closing your eyes. It's, you're not paying attention to reality. He says things like, and both sides, 96% of Californians are going to recover from this and there will be no long lasting complications. That is a, it's a great move because that's such an impressive number, right? Well, what's the big deal? If you're saying that 4% of people die, that's a huge number, right? Well, what's the big deal? If you're saying that 4% of people die,

that's a huge number, man. I saw somebody on Twitter, I forget just like, why don't, when said all these depressing numbers, why don't we focus on this number? It's like 97% recovery. And I'm like, that's very bad. That's so many people. I know over a hundred people, right? 3% of the people just like died today. I'd be like, hmm, good one anyway. I'm off to bed. Like it's wild. It's like a sense. Those numbers are huge. And he even says I think he said 92% of New Yorkers are recovering. A squeak of ab. 8% so we're just willing to say that's no big deal 8% Refrain 8% of grandmas like what are you doing like 8% of all grandpas are now are about to die But that's fine. It's good, but he's hoping you won't think about the flip side of the numbers

He's assuming you want he's also by the way There are a lot of people who are still sick and we don't know what their outcomes going to be. So to sit here and talk about recovery rates, like we're in the middle of it, man, you can't take a view as if it's history when it's happening. And that's, and sometimes that's what he's, that's what he's trying to do. He also calls into question all of the projections that were given early on. Remember the early graphs that they showed us where like a hundred thousand, 200,000,

how many people are going to die in the US? Yeah. More than that even. And then he said, and then we were told like, oh, it's lower, it's lower, it's lower, and he's like, see, they just made up all these numbers to scare you and all their projections were wrong, all their stupid models, blah, blah, blah.

And obviously, I think it, you might already know this, but the truth is, those were projections used to show us what would happen if we didn't take social distancing seriously. It's the parachute thing, right? Yes. The parachute, I fell out of the plane. I'm falling slowly.

I'm gonna cut these parachute strings because I never needed them in the first place. Exactly, exactly. And then the last big numbers issue that I wanted to get into is he has this little thing about Sweden and Norway. And I don't know if you've been following the situation in Sweden, but they decided not to do any social distancing,

which sounds like a really heavy charge for me to lay at their feet with all I've said about being in favor of social distancing. But there was a thought in the beginning of this, like, could we do a herd immunity thing? Could we let everybody go about their lives? And enough healthy young people will get sick, get better, be fine, that they'll protect the elderly and at risk in our population. It looks like that's not a good idea, but that was the track they decided to take.

And so he compares Sweden and Norway, Norway where they have done all of the social distancing and the things that we've been doing here. And he looks at the number of deaths that they've had in each country and says, and that difference is insignificant. Now, it is worth noting that first of all, I think what he's talking about is statistically significant. And if you, and that's a, that's a term we use to determine if we have like a control group and then a group in which we've done some sort of intervention in a study. And then the control group has this many that got sick. And the group in which we

gave the intervention has this many that got sick, we have to do an analysis between those two numbers to see, is that difference real and was it due to whatever we did to the medicine or the vaccine or whatever, or is it just chance? Because one number could be higher than the other purely out of chance, right? I mean, you have to control for chance. So I think that's what he's saying is that the difference between these two numbers is just chance. And the way he arrives at them again

is by dividing the number of people who die by the entire population of the country, which doesn't make any sense. But even if he did the math, it is statistically significant. It is a statistical, it's statistically significant difference. Unfortunately, a statistically significant higher number of people in Sweden have died from COVID than Norway, and Sweden did not do these things and Norway did. Now, I would not use any of those numbers where I'm making an argument because they're bad numbers.

His math is bad. That's not how you figure out death rate. None of that makes sense. It's bad math. But even if you use his math, he just lies at the end of it. No, there is a difference. Social distancing did work in Norway.

Fewer people did die. He just said they didn't. It's wild. It's anyway. That's why I want to hear more of Sydney. I'm going to get out of the math because I know the math is heavy. Yeah, I'm like struggling with it. Well, I know that's why the statistics are presented like that because they can lead you down a path and you don't remember how it started.

If you're not somebody who likes this,, I am not, I like math okay, but I'm not in love with statistics. If you don't love this stuff, it can get, it can lead you the wrong direction. But as long as you're feeling malleable and open to suggestion, why don't we? Head to the billing department. Let's go. The medicines, the medicines that ask you let God, for the mouth. All right, Sid, you promised me a math free back half. So he says a couple things that aren't based on math to help support his, his argument.

Some of it is political. There's definitely that undertone there. There's a lot of talk about they they The the mysterious they who want you to be scared he talks a lot about they use the word they use the word safe And when they say safe they really want you to be under their control and that's a I don't know that so obviously there are some deeply held political ethical, I don't know, some sort of beliefs that underpin this argument. And as I've said, he's very honest that they've lost money.

So that is part of what is happening here. But then he says that the reason the death rate might be wrong. He thinks we are saying that so many more people are going to die of COVID than actually are, and that that's not true, and it's not that dangerous, is because it's being over reported. And the way he says that, and the way he bolsters that claim is by saying that doctors that he has spoken to all of because all ER doctors talk to each other every day, I guess, at least in his world, that they are, they told him that they're being pressured to put COVID on death certificates by their hospitals because they get paid more. I should start with, there is no, I could not find any evidence for this.

I could not find any. And this is a hard thing to disprove, right? It's hard to prove an negative. Like nobody's pressuring anybody to code COVID. But that was really difficult for me to find. And I do think, but I could find no incident of that. I didn't find any evidence that that is happening Right now the thought is we're under reporting COVID deaths

I don't know if you looked recently but the number of people who have died in general in the US is way higher than normal even excluding COVID So we might we're probably missing at home deaths and also not everybody could get tested or could can still get tested. So we're probably missing a lot of COVID deaths is the truth. And you don't test somebody after they've died, because we don't have enough tests to use them for that purpose. So all that aside though, um, I think it's important to know. First of all, when it comes to death certificates, and I don't know if this is interesting to hear, but I've found that a lot of people who don't have to interact with them don't always know how that document is. I was interested when you told me I was interested.

Okay. So, when one of, as a family physician, if one of my patients that I take care of pass away, they will actually send me the death certificate most often. Occasionally, they'll fill it out in the hospital if it happened in a hospital, but a lot of the times it ends up with me, even if I, I mean, unfortunately, sometimes that's how I'm notified is receiving a death certificate, if a family member doesn't call me. And I will then have to try to figure out what happened retroactively to fill out the death certificate most of the time.

Sometimes the doctor in the hospital or the ER wherever will fill in some of the information, but the vast majority of us don't get an autopsy. So as far as like the death certificate providing some sort of new information, it really doesn't for the vast majority of us. It's just what we think based on what we saw, what happened at the end, the tests that were done, if there were any, here's what we think happened. That's it, there is no.

It's interesting, because I always thought of them as like a, you see them presented a lot in like legal contexts or contexts or like, you know, you think of them more as like evidence, like proof for that. But it's, it gets really difficult. Like I said, if there's not going to be an autopsy and you have someone who, who goes suddenly and not after like a protracted course of disease with a certain thing, I mean, it's really, they're really difficult sometimes

to fill out and that doesn't mean like, so they're invalid, but like the idea that ER doctors are spending a lot of time writing COVID on deserterificates, or certainly urgent care doctors who probably aren't, that this is all, this is their all wild conjecture. But aside from the deser the death certificate part of it, so this is sort of like he has taken a lie, but he wrapped it in just enough half truth

that if you try to research this for yourself, you might find something that leads you to believe it's true. And I think you have to understand the really messed up American healthcare system and the way that healthcare is billed for to understand it. So if you come into the hospital and you come into the ER because you have a fever and you're short of breath and when you come in that's what you say. I have a fever I'm short of breath of coughing. I have fever I'm short of breath of coughing. Those kind of things. You don't try to play my role in the role play. And I say, I'm short of breath. I'm coffee.

And I do a chest x ray. And I find that you have pneumonia. Oh, it's cold. The x-ray plate is cold. And I take your vital signs. And I find that your oxygen's low, your blood pressure's low, you're pretty sick, right? I do some blood work, it doesn't look good. I do a bunch of stuff. The new discover I have, new pulse, and I rise. This is not the direction, this was going. But let's say that I do all that.

But then when I go to write my note about what I just did and I give you all the right stuff and I get you admitted to the hospital, you're doing fine. But then when I go to write my note, I write fever and shortness of breath. I gave oxygen, some medicine monitor, continue to monitor. Do you write that in charge of some medicine? No, but you know what I mean? Let's say that I did that. Well, first of all, I would probably get a call from administration. But secondly, the people, there are people in the hospital whose job it is to take whatever I put in my note and turn it into money.

They're going to take the words that I put and turn them into billing codes. Because I don't type billing codes in my note. I type words. because I don't type billing codes in my note. I type words, but then there's someone whose job it is to look at that and turn that into a code, which they will then send your insurance company, which will mean a certain amount of money gets paid back to the hospital. Okay. So if you have all of that, and all I document is fever, the hospital doesn't get paid very much.

The reason for that is the thought is, well, you're not gonna have to use very many resources for this patient. If you just have a fever, you won't use as much medicine. You won't use as many person hours. You won't have to get checked on as much. You won't need like an ICU bed. I didn't say anything about you need an oxygen support. All these extra things, and your length of stay

probably won't be very long, maybe just a couple days. Right. And they put all that together and then give the hospital some money. And then you stay much longer because actually you had all that other stuff and so the hospital's upside down on you. Does that make sense? Yes. I know this is gross. I understand that this is medical care. The system is gross. We've been clear about this for a very long time.

It's all gross, but this is how it, I'm just explaining that this is how it works. Can I try to extrapolate just based on what you're saying? Yes. So basically instead of fever, if you see a cluster of symptoms that could be COVID, and there's a lot of tests to go around, the coding person could just put COVID because there'd be more resources for it, right? Sort of. person could just put COVID because there'd be more resources for it, right? Sort of. So that was the sentence. Well, sort of the coding person is not going to put COVID. They can't do that. The doctor would put in their note, suspected COVID, rule out COVID.

If you're getting admitted to the hospital and you're that sick, you're getting a test, by the way. But the the what I think this is is let's say I didn't put that in my note because I just put pneumonia or whatever and then your COVID test came back later, I would probably get a call from the coder to say, hey, do you mind adding COVID to your note? This happens all the time. This is, they're not just about COVID. Not just about COVID. There are people in the hospital, this is their job, this is what they're trained to do,

they go to school to do this to learn these codes. And when they look at your note, and like the example I gave you, and I just put fever, I'll get a nice little note or call or task or something that says, it seems like this patient had severe sepsis with community acquired pneumonia. Could you please document that if that is accurate?

I mean, that's always the thing. It's not, put it in there if it's not. It's, if it's accurate, would you put it in there? Because then we'll put that, we'll give that to the insurance company, and the insurance company will pay us for the actual amount of resources that went into caring for this patient.

Worth noting that these coders are not the bad guys either. I mean, we have, they're just doing their job as part of this system. We have family that do this job. This is not a, you know, they're just doing their job as part of this, this, this, this system. We have family that do this job. This is not a, you know, they're not like the pencil pushing like squeeze every dime out. They're, they're just doing their gig. The system is broken, of course, but if they didn't do that, hospitals would go under in a week. That's why they have a job is they realized doctors are never going to be good

at doing. I mean, there are some doctors. I know some who are very good at this. I'm not good at it. I suck at it. And these people reminding me or suggesting, hey, it looks like this is in your note should it be in there. It makes the hospital enough money to stay afloat. You can make arguments about where all the money goes, but still the point is that is how you get paid for the actual amount of resources.

That's what you got to look at it, not like, oh, if you're sicker, you get more money. It's because you'll use more stuff, people time longer stay blah, blah, blah, if you're sicker. And we know that patients with COVID tend to use a lot of hospital resources and stay longer, especially if you consider the cost of isolation, PPE, and all the other things. So that is why if you dig into this, you will find that if you code COVID instead of just, I don't know, viral syndrome or pneumonia or respiratory distress, if you code COVID, you'll get the hospital will get reimbursed better.

Not the doctor. There is no there is no pressure on us to code things that are false. In fact, they don't want us to code things that are false because if we do, that's called fraud and We'll get in trouble, but the hospital gets in trouble. Everybody gets in trouble. That's fraud. No one wants us to do that. You are only supposed to code COVID if they actually have COVID. So I think that is the truth in his lie that makes it more believable. And again, it's hard because nobody wants to talk

about all this because the whole system is so gross. But it's logical. wants to talk about all this because the whole system is so gross. Right. But it's logical. If you break it open, what he's saying, like this system, the way it works is a cold business logic that shouldn't have anything to do with medical care, but does in the United States of America. So there is no conspiracy. Doctors are not getting pressured to code COVID more than it's already there. We're probably missing a ton of COVID deaths, unfortunately.

And the number that it is probably more dangerous than we think. Now, when will we finally know how many people got sick and how many people recovered and how many people recovered with lifelong complications and how many people actually died of COVID? When will we know all that? Not for a while. You just, you can't take that. You can't figure those kinds of numbers out in the middle of things. So the idea that he's even trying to as flawed, it's just not possible. We can create models and guesses and try to find ways to mitigate that, but it's impossible to arrive at those numbers. He also says, by the way, that his other argument is that people aren't dying

of COVID, they're dying of like their COPD, and the COVID just made it worse, or they're dying of their heart disease, but the COVID just made it worse. So it's not really the COVID that killed them, it's their heart disease or their COPD. Well, that's kind of like, please, please explain why that's a lack argument. That's equivalent to the fall isn't too bad. It's the landing that gets you right? Like, well, yeah, but the fall is why the landing like, yes, okay, fine. But it's like we know comorbidities are a big, there's a big connection to fatalities with this.

Like it's not, it's not news, right? And many other things. There are lots of conditions that are harder on people with certain comorbidities, not just COVID. And we still consider that their cause. Because the other thing is do you really think all of these patients with chronic but maybe stable heart disease, COPD, whatever are suddenly going to drop dead in that month if they didn't get COVID? No, it was the COVID. This is

that's kind of like diabetes is like that right? Yes, like a huge complication for a lot of different things. But we don't say that like the diabetes is not so bad because you're actually dying of whatever else you're dying of. Right. So COVID is the cause of death in these patients. They would not, and the way you can tell is, would they have died? Had they not gotten COVID?

Well, no. I mean, all of us eventually. But no, not at that moment. So. Well, no, I mean all of us eventually, but no, not at that moment. So so the guy because The death was because of COVID. So it's right there in the zone. Yes. So that's I I don't know he I mean there are other things and there were he talks about like New York wanted 30,000 ventilators, but they only use five I Don't even know where again. I don't know where some of the things it's hard to debunk because I don't I can't even find

What he's might be referencing it sounds like some some guy on the phone told him that and he repeated it Yeah, I don't know that's my conjecture. I have no idea where he got these I imagine there are New Yorkers listening to the show right now who are screaming at the idea That only five ventilators were used so five in a liter five thousand five No, that can't be what he said he said they asked for 30,000. They only needed five now. I think he may mean additional Like they only needed five additional, but that is not I Have not that is not

That is inconsistent with what I have read and observed. But anyway, so the point is the last thing that he calls to other than money and this is overblown, it's a hoax of conspiracy. All this stuff that we've unraveled. The last thing that he mentions is that we've got to get people, we've got to start taking care of people again because there are people who are getting second-line of other stuff because they're not getting proper care. They're not coming to their doctors and getting proper care.

This is a truth. This is a concern. And then he talks about it as if he's the only guy who knew. I'm just this guy who owns a bunch of urgent cares, but I understand this. No one else does. Well, excuse me, sir, I'm a family physician. I think I know that. And so do all of my colleagues. And especially all of us in primary care.

And I would say the medical community at large knows this. Yeah. And also the non-med medical community, it makes sense. It's the secondary effect that can happen with a pandemic. People not going for their routine maintenance visits, people not getting screening tests when they're due for them and missing things in early stages. People who aren't able to get their medicine,

because maybe there's a huge run on their medicine, because maybe somebody says it's a cure for COVID when it's not really a COVID. Who's that supposed to be the best day? I'm saying, I'm saying. We know that this is a problem. There are people thinking about it and talking about it and trying to figure out ways to get these people

who have not been getting their routine care that we know is important, their preventative care, and their maintenance of chronic disease care that they need. We are trying to expand telemedicine. There are people who are thinking and worrying and working on these things. It's not perfect and there will be problems from that. But to think that the solution, especially for people who have chronic disease, that the solution is to just open everything back up and let these people get exposed, is a wild solution.

I mean, it won't work. It'll hurt more people than it will help. We can't sleep it under the rug. No, no. And that was very frustrating to me because I meet with my fellow family physicians in my department every single week. And that question, how do we make sure that all of the stuff that isn't COVID

is still getting taken care of as best as we possibly can while this is happening? That is the central question every week in our discussions and I guarantee you that is true in almost every other medical system throughout the country. As a medical system in this country might be completely screwed up, but all the people who make it up aren't. Some of them, like these two guys, are.

But all the people who aren't, who make it up aren't. There are a lot of good people who are working really hard to try to figure out how to take care of you, even if you don't have COVID right now. I think it's, you know, I think it's my sense is it's unfair, I think, and maybe you're listening at home. It's unfair that you have to be work as hard as you do right now to get to the facts of the matter and the truth of the matter. And I think it is what we've talked about,

I mean, you may be asking yourself, like, why do I need to know all this? Why is this happening? Like, I think that it goes back to a vacuum of leadership. If we had people at the top who were telling, or sorting through this stuff, and who were trustworthy, reliable narrators other than Fauci, of course.

If we had the leadership in place, we wouldn't, this wouldn't be happening because it would be, there wouldn't be someone who is undermining this message while they're putting it out at the same time as our president currently is. And I think that that's why you do have to equip yourself. Like you have to get smarter than you have been about statistics and

this kind of stuff, because you really do have to kind of look out for your own interests and to push back against the ignorance, which is like harder than it ever has been because all of a sudden the stakes are so much higher. I think that's the really important part. It's not just I can I know it can seem like So is this just so when people present this video I can argue back with the right points Which is always nice to be able to do but that's not even The brunt of it. I think we're entering a phase of this for a lot of us in this country not every place But unfortunately where we live in many other places where I

You are going to have to make good decisions for yourself. Yes. More than ever because the advice you're going to be given from the top could be bad. And that is a really scary place to be. Yes. If you're not an expert in these areas, which I'm not either, I'm not an, I'm, you know, I'm not an epidemiologist. I'm not an expert on pandemics. I am a doctor. I know some things, but I am not Anthony Fauci. And I mean, he's maybe the, well, I'm sure there's other people in this country who understand it as well as him, but nobody more. And it's going to be hard to know what the right thing to do is next.

And you're going to have to use your best information and use science and rely on facts so that you're not distracted by. I think the hard thing is, right now, doctors in science, we don't have all the definitive answers yet. We just can't. We're in the middle of it. It's impossible. This is unprecedented. We don't have a roadmap. There's a ton that we don't know. And if you look at me and ask me for a definitive answer, and I can't give you one, I give you the truth, but it's not

definitive, you're going to have a tendency to hear the voice that speaks the loudest with the most certainty, and that also maybe tells you the thing that you'd rather hear. I mean, the facts that we do know are these. Until there is a widely distributed vaccine for COVID-19, there is, 19. There is not you are always going to be you are going to have to take your safety into your own hands every time you leave your house. And the people who are reopening things. And I'm not I'm not trying to make an economic argument here. I understand that you know the the the economic impact has has devastated a lot of people. So I'm not trying to get into that here.

But if there are people telling you that it is like safe, perfectly safe, as safe as it ever was, you know, same as it was before, you have, that should set off alarm bells for you because you have to be responsible for your own safety and the safety of people you care about until there is a vaccine. And I know that's exhausting.

Like when restaurants start opening up here, you know my first impulse is going to be like, let me add that, you know, the bon-off viner schnitzel. Like please, let me get a table over there by the fire. I miss human beings so much. But like, this is the deal. Like this is the journey that we are on. And anybody that tells you differently than that, anybody who says that they aren't taking risks

by reopening things right now is a liar. They're lying to you because it is. They're gambling that they've probably beaten it enough to get things going again economically. And it's, I understand that it's hard. I say that we have a tendency to hear what we want to hear. This is true of me too. I'm not saying we all do.

I'm not Disney Reddit every day. Like, what are you all thinking? 25% max capacity, 50% is Mickey gonna be wearing a mask? Where are we all at? Let's get this thing open. This is quarantine fatigue. This happens over time where you start to convince yourself that maybe the threat isn't that bad.

This is a known problem because it's hard to imagine doing this any longer. And this is where we all are. And as the state start to open up, there are going to be people who are well-meaning, intelligent, people who believe in science and truth, who might take a risk that they wouldn't have taken otherwise because they're just a frickin' tired of staying at home. And that's what you have to be vigilant against right now because we're all going to have that impulse.

I can tell you that when I started hearing the rumor that this has been circulated in the US a lot longer and so many more people have already had this and we're gonna find that like most of us are already immune to it and all that stuff. When I started hearing that theory go around, oh man, I read every article. I wanted that to be true. I read everything I could to try to like show me,

convince me, sell me on it, show me the facts. Man, that would be great. It would be great to think that it's not going to be as bad. And one, the evidence wasn't there. It just wasn't there. As much as I wanted it to be, it wasn't there. And two, how do you look at what's happening in places like New York and say,

well, most of us were immune already? Well, we, obviously we were freaking not. Yeah. That's the sad truth. So you've got to keep as much as you can, we should be staying home. If you're going to go outside the house, you need to maintain social distancing,

you need to wear a mask, you need to keep washing your hands. For now, it's just too, there's too many unknowns, it's too unpredictable. I think there are some glimmers of hope with treatments. We might cover that some more next week. But, and you know what, who knows, maybe we're wrong and it will all be fine. And if it is, that's a win for you too. But don't be the guinea pig. Don't be the canary in the coal mine. Who's like, I'm just gonna get out there and see how things are.

Don't let that be you. No, and I hope, I've said this many times in the last week. I hope I'm wrong. I hope that everybody looks at this podcast and goes, well, she was wrong. Look, it wasn't that bad. But we won't know for a while. So why not play it safe, protect yourself,

protect your family, your community, the people at risk, you know, people with chronic disease and with, you know, other comorbids and the elderly. Why not? You know, we'll be honest with you, we already ate crow and this thing once already, when we were like, eh, well, no biggie, we're chill on it, not gonna be a problem, NBD.

Like, we don't care We'll say right away like I was wrong. It's pandemic a way. We're locked in our house for the next For the future like trust us and it turns around will be the first ones are like everybody barbecue our house. Let's go Thank you so much for listening to our show. We appreciate it. We hope you're staying safe staying hopeful, staying home. Our theme song, thanks to you of our theme song, which is by, these words have gotten jumbled for me. I'm gonna start at the beginning of the words

and see if we're there. Try the words again. Let me try the words again. Thanks to the taxpayers for the use of the song medicines as the intro and outro of our program. That's good. Thanks to maximum fun for having use of the Psalm medicines as the intro now to our program. That's good. Thanks to maximum fun for having us as a part of their extended podcasting family. And thank you to you for listening.

We sure appreciate it. And be sure to join us again next week for saw buns. Until next time, my name is Justin McRoy. I'm Sadie McRoy. As always, don't drill a hole in your head. Alright! Yeah! Maximumfun.org. Comedy and culture.

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