The Wolf Of All Streets - James Todaro, The Physician Who Wrote the Controversial Paper on Hydroxychloroquine That Incited Worldwide Debate on The Attention of The U.S. President, Overnight Censorship, a COVID Second Wave and More.

Episode Date: June 2, 2020

James Todaro, Early Crypto Investor and MD wrote the paper on hydroxychloroquine that sparked an international debate on the usage of the drug for Covid-19 and inspired the President of the United States to both endorse and take the medication. Circumventing traditional publication methods in an attempt to expedite research and save lives, resulted in overnight censorship of his work. James Todaro and Scott Melker further discuss the major misconceptions of the drug, faulty studies and misinformation, a potential second and more deadly wave of Covid-19 and so much more. --- ROUNDLYX RoundlyX allows you to dollar-cost-average into crypto with our spare change "Roundup" investing tool, manage multiple crypto exchange accounts in one dashboard and access curated digital asset content and services. Visit RoundlyX and use promo code "WOLF" to learn more about accumulating your favorite digital assets when making everyday purchases and earn $4 in free Bitcoin. --- VOYAGER This episode is brought to you by Voyager, your new favorite crypto broker. Trade crypto fast and commission-free the easy way. Earn up to 6% interest on top coins with no lockups and no limits. Download the Voyager app and use code “SCOTT25” to get $25 in free Bitcoin when you create your account --- If you enjoyed this conversation, share it with your colleagues & friends, rate, review, and subscribe.This podcast is presented by BlockWorks Group. For exclusive content and events that provide insights into the crypto and blockchain space, visit them at: https://www.blockworksgroup.io

What's up, everybody? This is your host, Scott Melker, and you're listening to the Wolf of All Streets podcast. Every week, I'm talking to your favorite personalities from the worlds of Bitcoin, finance, trading, art, music, sports, politics, and basically anyone else with an interesting story to tell. So sit down, strap in, and get ready, because we're going deep. Let's go. I'd like to thank my sponsors, Round the X and Voyager, for making today's episode possible. We'll hear much more about them later on in the episode. This podcast is powered by BlockWorks Group, the only events and podcast production company I trust. For access to the premier digital asset conferences and in-depth podcast content, visit them at blockworksgroup.io.

I promise you will not be disappointed. Today's guest is a physician with a medical degree from Columbia University and is the managing partner for the cryptocurrency investment fund, Blocktown Capital. He's one of the rare people with knowledge in both the medical and financial fields. So he's the perfect person to speak to on the show about the COVID-19 pandemic and its likely effects on Bitcoin and the market as a whole. He's co-authored papers on the COVID-19 pandemic, including an effective treatment for coronavirus and a two-step strategy to reopen America. In fact, his first paper was the spark that's caused the storm surrounding the use of chloroquine for treating the COVID-19 virus and was also the impetus for President Trump to start talking about the drug in the first place. Please welcome James Todaro to the show. All right, so let's talk about chloroquine. First, can you please tell the story of how your paper reached the president

in the first place and then clarify some of the misinformation and controversy around hydroxy chloroquine in treatment of COVID-19? Sure. Yeah. So I guess the backstory behind the chloroquine paper is that, so I've been closely following the pandemic, if you can talk about that a little bit further and how that kind of ties in with my vision that we, you know, the second paper we put out in April on reopening America. But it was in late February, early March,

that I started to see evidence that chloroquine hydroxychloroquine was being used in treatment of coronavirus. And this was coming from kind of anecdotally as a kind of smattering of conditions. There's already decent in vitro evidence showing that chloroquine was effective in primate cells against coronavirus. And then you had these guidelines coming out of South Korea and China. You get some digging that showed that they were using this treatment

and that it was seemingly effective. And so we felt like there was enough kind of evidence at this point for chloroquine in treatment of coronavirus that Greg Regano and I, who we've been interacting with each other on Twitter for I think over a year now, mostly regarding cryptocurrency projects. We both have a lot of similar interests in this space. But since the COVID-19 pandemic started going on, we started communicating more and more about COVID-19. He had been doing extensive research in chloroquine's antiviral properties for about close to a decade. So he knew that mechanism of action pretty well. And then I am an ophthalmologist by training, so I went to residency for years in ophthalmology

and was very experienced with chloroquine as well and the side effects. And so the picture came together. It seemed a highly viable treatment for coronavirus while a lot of the downsides weren't there because it was a widely used medication. It's medication issued billions of those ship doses described billions of times with with little downside a lot of times and so that's why we then put together this paper that went out there

I think that's the next day after I announced the paper on Twitter that Elon Musk I tweeted out our Google document was in the form of a Google document. We felt like going to traditional publication channels was going to take way too long, and we're going to be dealing with rejections and that slow academic process. So we just published a Google doc. Elon Musk tweeted out. Then it started to make headlines. My colleague, Greg Vigana, went on Laura Ingraham,

and then Tucker Carlson a couple days later. And then the following day, President Trump announced hydroxychloroquine as a treatment to seriously consider for COVID-19. So it was a real whirlwind back in March. It went from, you know, it built up a little bit of a following regarding coronavirus, so I've been talking about it for a while at that point, but it just kind of exploded in March, and we kind of became almost the leaders of this movement of hydroxychloroquine or chloroquine for this pandemic. Moving to today, there's a lot. I mean, this is probably still the most controversial

medication on the planet right now both in terms of I think big pharma as well as politics and I just wanted to I guess clear up some of the misconceptions that are around this drug that happens on and across the spectrum one being this is not a medication that is likely to cause you harm. I think that a lot of people have the impression this is an extremely dangerous medication, particularly focusing on the cardiac side effects. You know, rheumatologists call this a daily multivitamin for lupus, rheumatoid arthritis. Those are its kind of main uses. Most rheumatologists don't even do an EKG before prescribing this medication.

In Dr. Raoult's 3,000, 4,000 patients that he has treated with both hydroxychloroquine and azithromycin, he has not seen, I think, any deaths from torsades or some of the medicine, he has not seen, I think, any deaths from, you know, torsades or some of the cardiac deaths that you're hearing about potentially, more theoretical potentially from this medication. And actually, if you talk to the cardiologists who are actually very knowledgeable about COVID-19 and the disease, of course, they actually think that the, which in their studies that show this, that about 20 to 30% of hospitalized COVID-19 patients have this cardiac inflammation called

myocarditis without any hydroxychloroquine or treatment, and then that can lead to arrhythmias. So I think it's a little bit of this kind of confounded confusion claiming any of the cardiac dysrhythmias on hydroxychloroquine, which it actually is probably largely just a course of the disease in most cases. If I'm too long, when it stops. Absolutely not. No, I'm actually fascinated and I want to hear the entire story. So please.

All right, great. The second biggest misconception that I've been really trying to drive home on Twitter for the last couple months now is this idea that you can use hydroxychloroquine late in the course of disease, and it's going to be some magical cure or help. And that's just not how really any antiviral works for an acute infection. These antiviral effects really only occur within the first 48, 72 hours or a few days of symptom onset. And so

when you look at all these studies that are coming out that are very, very negative against hydroxychloroquine, they are all looking at it in late treatment of very sick hospitalized patients. And this is the VA study that came out last month.

This is the Lancet study that was just published last week. And then even the New York study. So when New York said they had this huge batch of hydroxychloroquine, they're going to start using it in patients, do a study, and assess whether it works or not, the first thing I said was, I suspect they're going to be using it in sick, hospitalized patients, and it's not going to really show any beneficial effect. And I don't know whether their thinking was we want to preserve the hydroxychloroquine we do have for the sickest patients because they need it the most, but that's the population where it's not really indicating it's not going to show any effect, and so in a sense

I think it's wasting the medication, which is what that study ultimately showed, that treatment of those patients who are mostly studies are looking at hydroxychloroquine treatment in patients that are about two weeks out from onset of symptoms. So, 14 days after and they're bad enough where they already need hospitalization. I don't think it works for that. Yeah. So isn't there an issue there then? I mean, the way that this virus in general presents itself obviously is sort of a slow burn. And obviously, you know, with the 14 day potential period before you're symptomatic, and then the way that they're telling people sort of to wait

to get tested, by the time you're probably tested or very sick, is it already too late? So is there some sort of function of the process and the information they've given for how to really identify your symptoms and see if you're actually sick are really prohibitive to, if this did work, taking it early enough? So that's an absolutely great point. And back in March and early April there really wasn't enough testing I think that was happening and rapid enough testing where you're stuck in that exact dilemma you didn't even know you really had COVID-19 until many days after your house by so by then you already were bad enough

hospitalized it was still only three four days or something like that before you tested so you really set up to kind of not be in a situation where you could receive hydroxychloroquine in the right treatment window. I would say in the U.S., the physician that probably has the best approach to this is Dr. Zelenko. He's fairly well-known, definitely well-known during people that support hydroxychloroquine. But what he does is he looks at the patients and sees a patient, and based on symptoms, he looks at who's the highest risk patient. So we've now been able to stratify who is kind of really a danger from coronavirus and who is probably going to, you know, feel sick, feel crappy, but do okay.

And so he stratifies those groups. And then based on symptoms, before the test even comes back they'll test them. Well before the test comes back start a treatment course of hydroxychloroquine. And if the test comes back negative two days later you can stop it and it's extremely unlikely that it did any harmful effects in the two days you were on it but it was kind of those two days faster than a lot of people with this medication. And this isn't unusual in medicine. In ophthalmology, we do this for giant cell arteritis, where before a biopsy, we'll come back and start treatment

with aggressive steroids, high-dose steroids. And then if the biopsy comes back negative, then we stop the steroids, or we slowly taper them off. So it's not unheard of to start a treatment while you're in that waiting period, and then kind of coming off it, especially when the risk of such a short course is so low. So I think that can be a potential route if testing can be done in five minutes or the same day. Understood. So, I mean, it sounds like one of the big risks with hydroxychloroquine or anything else in this situation, I don't even know how to put this.

I guess I should say that doctors fear litigation, right? In general. So 100%. Right. So it would seem that prescribing or giving someone a treatment that has so much controversy around it. And before there's a confirmation of disease or something like that, which I guess could be a case for an ophthalmologist with the steroids or, you know, someone goes in and gets a strep test, but they give them antibiotics in advance, any of these, you know, examples of where

this happens. But I mean, wouldn't you think that doctors would be very fearful of doing something like this, especially in a pandemic where you're not talking about like one experimental patient, you're talking about everyone? I mean, wouldn't it be very hard to convince physicians to do something like this that early? So kind of from the theoretical approach, yes. I would say that physicians are very, your general physicians are very likely just to follow what's considered standard of care. And they only really tend follow what's considered standard of care. And they only really tend to deviate from standard of care is when things are getting worse and you don't really have any good alternatives. And so that's kind of the second factor that goes into all those studies

that are comparing hydroxychloroquine use to non-hydroxychloroquine, where the studies only capture that idea that those patients were sicker and probably the ones that continue to go downhill are the ones that physicians are like, okay, we've got to try something with this patient. And so the liability goes down. When you have a patient that's decompensating or getting worse, you're like, okay, well, this is the best time

I'm going to try hydroxychloroquine. And that shows it doesn't work. Right, it's too late. Right. That said, though, there's a survey, there's a survey, a global survey done by CIRMO that assesses periodically about 6,000 or so physicians, many of them who are treating, actively treating patients with COVID-19. And since we, late March, shortly after you put out our paper, hydroxychloroquine and azithromycin continue to be the most popular used therapy, most commonly used therapies

among physicians treating COVID-19. And it's still, if you go to their survey, they're still at the top. So there are a number of physicians out there that believe in this, despite what I think the media appearances look.

So they are out there and there's a decent number of them. It's far more time on the use of remdesivir or some of the other antibody treatments and plasma therapy. Remdesivir is extremely expensive, right? I mean, even if it worked, it would be prohibitive for a majority of patients. Yeah, remdesivir is just not a real good option for a couple reasons. So the goal with a pandemic, this isn't just like a few people getting sick and you want to treat them. You can treat them late and get better and stuff. This is something where you have a ton of people.

So you want to treat them early. You don't want all these people to get severely ill. And so there's really two options. There's A, they're a vaccine, which there's a lot of research and studies going on that development path. And then secondly, something that can be widely used, something that can be oral, maybe even taken prophylactically, but something that can be used orally in treatment of it. Remdesivir is an IV.

So it's not really conducive to early outpatient treatment. You're not going to have a cough in a sore throat or a cough shortness, but you're probably not going to go to your home and set up an IV for remdesivir, especially if there's a large number of patients that are coming down with it. Secondly, it is most likely going to be much more expensive. So I don't think Gilead has come out with, so Gilead is a manufacturer investor. I don't think they've come out with the exact price of it. I know that there's been investment firms that have analyzed. Yeah, a lot of conjecture.

Right. And so it looks like it costs them maybe what I've read is $10 to manufacture a treatment course for it. But the fair price would be anything below $4,000 per treatment course for a patient. And then they kind of like ICE, the investment firm ICE, kind of landed on their supply charge around $1,000 for a treatment course.

So Gilead has done some great work with antivirals. They're actually the ones that come out with really the first kind of cure for hepatitis C back in 2014, something around then. They charge actually the ones that come out with really the first kind of cure for hepatitis C back in 2014, something around then. They charge about $90,000 for that. So $1,000 isn't actually that much.

It's a lot more than hydroxychloroquine, obviously. $5. So you touched on this earlier, but the Lancet study, which I guess was reported on Friday, said that patients getting hydroxychloroquine were dying at a higher rate than other coronavirus patients. But I actually read that in the last 24 hours, the World Health Organization has stopped their studies completely. So I'm assuming, I mean, you touched on it earlier, the fact that perhaps these people already have the cardiac issues when they present in the first place. I mean, yeah. So I think that the two things we're taking a little bit on is, you know, again, it's late treatment. So I would say that probably realistically, if you had similar groups of patients, if

the two, if the ones who received hydroxychloroquine and the ones who did not were actually similar, I would say it probably should show no effect. But the study didn't show that. The study, like you said, showed that hydroxychloroquine actually made it worse, which even medical professionals and physicians who don't necessarily believe hydroxychloroquine helps, this raises a little bit of – this is, you know, a little bit unusual that this type of medication is going to actually almost double or more your rate of dying, which takes me back to kind of the second

point, which is what type of, so this is a global study. So these researchers don't know anything really about these patients. They weren't the ones actually caring for these patients, kind of a large data set. And so, but if you're actually a physician, you're caring for patients and you're going through that thought process of who is going to get hydroxychloroquine, you know, because it's not standard therapy. You're going to give it to those patients that you're desperate. Those patients that you are like, everything I'm doing is not helping this patient. Let me throw hydroxychloroquine at it.

And you're like, oh, you know, that didn't help either. And so those are kind of your sicker patients whereas the patients that are stable or even improving why would you take a chance on hydroxychloroquine if you're like this patient is stable they're doing fine or they recover and you're not going to go a Hail Mary at that point right and so I think that the study does not and then the study has been analyzed by a number of people very respected physicians not just kind of the general public on Twitter, but there's very smart people on Twitter as well who are not physicians who can catch these things as well. But they show that the study doesn't really actually have a good method for assessing

how sick the patients were between the two groups. And so I have a strong suspicion that the group that received hydroxychloroquine were far worse off than the non-hydroxychloroquine group. That'd be my main complaint with that study. Understood. So going back, you mentioned that you posted it in a Google Doc instead of, you know, taking the time, obviously, and waiting months to be in the New England Journal of Medicine or presenting the paper in some manner like that. But it ended up leading to your google doc being censored and removed

correct why did that happen why did that happen do you believe and and what was that like it's it's unclear they didn't google did not reach out to me my knowledge didn't reach out to greg either um on their reason for how it violated their terms and conditions. It's kind of one of that blanket violating terms and conditions. It does seem, though, to me that YouTube, which is owned by Google, Facebook, and those two seem like they've been very aggressive with censoring anything that is not in line with either the CDC or the World Health Organization recommendations. And I know the CEO of YouTube blatantly stated that, that any recommendation that was made that was not in line with what the World Health Organization recommends, that would be censored. Interestingly, crypto accounts have been getting taken down too.

Right. So this is a problem that you and i and many people in crypto have been aware of for for a long time right now we're seeing it come to the conservative field like medicine or people just um but yeah so something that i'm very familiar with so it was kind of surprising though because a google doc is is uh you know it's a little bit different from a youtube video or maybe a facebook video so you know there's probably not too many Google Docs. I've never heard of that. I've literally never heard of it. Yeah, I have not either. So YouTube and Facebook, sure. Google Docs, that's pretty impressive.

And so, yeah, I think it's unfortunate. I think that, you know, it's really important to get, and the World Health Organization and CDC, like, I don't think there's anyone that would say that they've been right on target all along this pandemic, even people that are still kind of think they are maybe they're late to getting out the right advice. I mean, they've made huge mistakes. I think that I mean, I think you literally just touched on the biggest problem with this entire pandemic, which is, I mean, obviously we're polarized politically and everybody, you know, nobody believes a fact when it's a fact, but

that's a topic for another day, I suppose. But really, I mean, you can even go back to, it was either late February or March. I'll never forget when the Surgeon General tweeted, you know, what are you people out there doing buying masks? Don't buy masks. They're for medical professionals. And then obviously going the other way and saying everybody needs to wear a mask. So it's hard, you know, as like, you want to bang your head against a wall, honestly, when you engage with people, as you know, obviously, on the other side of whatever you believe on Twitter or wherever else. But depending on what you read and when you read it,

how is someone even supposed to know what they are supposed to do or what is true? Yeah. Well, I guess to kind of go back to my first point, I think the first step should not be to remove any information that then goes against, let's say, World Health Organization or CDC. Because, you know, as you said, they were wrong about masks. They were wrong about human transmission

that they put back in early February. They did not say, they said you should not restrict travel. They actually took it a long time to call it a pandemic. Right.

So they kind of each step of the way, they were definitely late to the party, late to recommendations. So anyone that could have said something before that and had been right on

would have theoretically been censored, yet they were just ahead of the curve. And so, you know, it's really, I mean, it's really hard to separate yourself because this has now become, unfortunately, a political issue. It's really quite divided on those lines. And it's unfortunate but i think that you can there's still enough real data out there where you can make informed decisions i would i guess my if you really want to figure out what's going on and have an idea and and to me this was really important because this was affecting a lot of lives i'm a physician and then also i have a lot of lives. I'm a physician. And then also I have a lot of investments. Yeah, of course. We'll get into that.

Right. And so it was like this is, you know, back in February, early March, I was like, this is not going to do great for investments, I think, at least initially. So I think there's enough good information out there. If you're looking for the right metrics, you kind of ignore all the politics, all the fluff, all the headlines and actually get into the real data. I think you can continue to be actually a few weeks or a month ahead of where this pandemic is actually going, what is real, what treatments are actually affecting this country and which ones are not. That makes sense. So let's talk about your second paper, because that sort of leads into the future and what we can do to actually live in this world with this virus. It's called a two-step strategy to reopen America, correct?

Can you tell us about that? Sure, yeah. So this is a paper we put out in, I think, April 23rd, so mid-late April, that we believe, and this is Joey Krug, another cryptocurrency entrepreneur, investor, my colleague Moshe Praver, and then Dr. Zlenko. We put together this paper that basically outlines how we had enough information now at that point on the fatality rate of this disease. What is likely, I still believe this is likely, an effective therapy for early treatment of this disease, hydroxychloroquine, that we could now begin to reopen America. And that is extremely, it was extremely controversial then and still actually is fairly controversial.

That said, I want to kind of take a step back and kind of show that I'm not, I haven't been like, just like, kind of throw caution to the wind and go out there. This is a very careful, when we decided this was very carefully decided. I, so I've been following the pandemic since January. My wife and I took a trip out to Vegas in early February. And we brought in 95 masks and wore them on the plane. Already in February. In early February. Because to me, this virus looked highly infectious. And there's a likely already in the US,

we were behind on testing. And so it was probably already here. So to me, I was like, okay, there's enough of a concern for this. And then fast forward, just a couple of weeks later into late February, we now were seeing outbreaks happening in Europe.

There were still just a handful of cases in the US. I don't think you really have units versus death yet. I think that was February 28th. But that's when we stepped up from social distancing to actually self-quarantine. So we were self-quarantining in late February. This was about three weeks before it became like, yeah, you were a good two or three weeks ahead of the curve. Sure. Yeah.

And to me, it's so people, so people are like, well, why were you so cautious then? But now you're saying we should reopen America. What, what's changed? Well, that is a good question because a lot of people don't see much change because there hasn't been much accurate dissemination of information so and so which I mean I'd actually be right I am yeah okay so so so it came down to so we are doing this was highly infectious I thought that for a long time and I think most would agree about that the question

was you know how how fatal is this? And per our calculations, you know, based on serology studies, based on, you know, case fatality rates, even by the CDC, it's funny, the CDC's most recent report on the infectious fatality rate is actually pretty much the same thing that we put out in mid-April in our two-step strategy, we got a lot of, there's a lot of positive tension, but also a lot of black. People are saying that was way too low. We talked about something like 0.2, 0.3%.

But, so I think those fatality rates are actually much lower than what it looked like before. It looked like it was 3 to 5%. People are dying. You have young people dropping dead on the streets this is just this is crazy but you know when we started to get real data from the u.s and uh kind of data that we're confident in or europe well this this does not appear to be the case and we you know we've i think we've seen kind of the peak at least before maybe the fall, but the peak throughout the summer, I think, is already in. And there's been a lot of, you know, a lot of criticisms on the states that began to open up a month or two ago. And, you know, where do those states stand now? So we could look at

Florida and Georgia. If you don't believe they're cooking the data again, because nobody believes any of the data. Right. So that's something we do know for a fact that Georgia put some dates conveniently out of order to show the curve dropping and that Florida obviously has had some litigation or controversy against DeSantis over his release of the information as well. So for sure. So, so, so talk, so we'll just talk for a second about Georgia and Florida. So, right. So the big thing was they opened up, I don't know, a month. It's been about a month for Georgia. Yeah. Right. And then Florida, when, I mean, they were kind of always loose on restrictions, right? Yeah, exactly.

Okay. So they were always kind of loose on it. And so about a month ago, you had it where, you know, Florida and Georgia, their cases are going to spike. That's going to spike. Just give it a month because it takes time, which sure, it does take time. And so now it's about a month later. And so we really haven't seen that. So now the next step is, you know, are the numbers real?

And so that's a, that's a really kind of tough question to get into, but if you just kind of take a step back and say, okay, maybe some numbers are, are five. You know, you gotta remember Florida has less than one 10th.

The number of, of deaths is New York. So population density, of course, but yeah, huge part of it, of course, no mystery that South Florida is bad and the rest of florida is fine right but florida also then even going further in the mortality but it has an older population yes so there's also that other metric but it's

it's so far less and it's much less than than michigan. I mean, I would imagine Florida has some populations that are close to the density of Michigan maybe. But we're not seeing. So even if you say the numbers are false or they're kind of, you know, mixed up a little bit and stuff, you're not seeing this tremendous spike in cases. And neither in Georgia. You're just not seeing this spike. But it's 30% 30 off i'm assuming that the argument for that is the weather so i think so this is something that i said a long time ago back in early march because i think that the weather is gonna is gonna change things you you're um you know more people are outdoors the

humidity is up the transmission of this this virus going to go down. And, yeah, I mean, that's just like, that's how the flu works, too. It's not, it's not really magic. Flu season is September, October to about March. And so, you know, I think that this idea of states trying to keep these lockdowns in place throughout the summer, you know, it's a losing battle. First of all, you're not going to win it. No, you're not. That's very clear now. I mean, even in the places where it's quote unquote lockdown. I mean, I can tell you in my county, you're supposed to wear a mask legally. They've said that there's an order and I mean, I have not seen a single mask in weeks.

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because i think it's unfortunate because really small businesses are i think getting hurt the most in the states because people are still gathering like you know i have i know a lot of people that went just went to their you know they they family member with the biggest house and with the pool and everyone's postcards partying there i mean so you know people aren't really going to stay socially isolated or even social distancing throughout the summer and so you're going to see more and more so michigan here is probably one of the strictest lockdown we're actually now still a stay-at-home order in effect until June 12th, I think, at this point.

Yeah. But this isn't going to continue throughout the summer. It's not feasible. I think, though, that the interesting thing will be seeing what happens in the fall. Because I think there's a lot of concern about a second wave a lot of people look at the uh i mean there's never been a pandemic in history that didn't have a sizable second wave to basically just dwarf the first wave correct i mean it pretty much is par for the course right so that would be the so right so there

that is i think the the real question at this point i don't think the summer i think people are getting kind of a little bit uh too bent out of shape on like what you're this summer but i think the fall is going to be your first of all i think you're almost certainly going to have a a lot of fear concern um as we enter September. And it'll be very, I think, important to keep a close eye on the real metrics on the number of positive cases, the ratio of tests to positive cases, the number of deaths, to really have a handle on what this second wave is going to look like. Is it, as you said, going to be a very severe wave or is there a chance that maybe the virus

mutated something that's a little bit different from the last few seasons, so a month or two ago? That would be some of the important metrics. I think that knowing that will actually be critical to knowing, say, how the economy is going to be doing or how the S&P or how your cryptocurrency investments will do. Because I think if you have a worse way where you're talking about potentially going back into lockdowns, you know, who knows if we can actually create a vaccine for this. It's actually, you know, it's not like you can create a vaccine for everything.

Right. And how effective that vaccine will be. I mean, people pretend it's like some slam dunk, but there's so many viruses, including basically every coronavirus that have no vaccine. Right. It's like, it's actually very hard to create an effective vaccine. People almost act like it's a given.

I'm sure that the medical researchers and scientists are like, you know, this is actually, this would be a heroic feat if we were able to come up with especially when we have politicians saying by the end of the year but i understand right yeah you might have some you know some basic but and then it takes time even to roll it out if you're going to give it to everyone you'd really rather not find out in a year that they're all dying from it right so there's it's a long, long process on that. So I think that since I know you both do a lot of investments and have an investment audience, I think it'd be very important to keep an eye on what's happening with COVID-19

in the fall, because I think that's going to, again, dramatically affect your Bitcoin cryptocurrency investments as well as maybe traditional stocks. Yeah, I agree. I mean, the market right now is, i don't know what it's smoking but we all need some i mean it's like ignoring every economic indicator in case of data and just i mean it's obviously i mean we all know you know qe and and what's going on and we can all see that that's behind it but i do think that largely at this point, it sees sort of, you know, an optimism about the reopening. It's not pricing in fall, you know, second wave, I don't think. So yeah, as you said, I think it's pretty wise to be cautious and keep your eyes open. So how do you believe that it would affect Bitcoin if there was a second wave or if there wasn't, I guess? Yeah, so if there was, you know, I would affect bitcoin if there was a second wave or if there wasn't i guess

yeah so if there was you know i would say it was the same same effect that i i kind of thought was coming uh in in march um is and i actually said this for three years because a lot of people they would ask you know if um if the economy goes down and stock market crashes you know would bitcoin go up? Well, not initially. I think initially, everything is going to crash. Everything is going to crash. Exactly.

And that's exactly what we saw in March. S&P was tanking. Bitcoin was tanking. And I think we're going to see that same thing potentially in the fall if this second wave comes back in a serious way, I think you're going to have S&P. I think you're going to have Bitcoin that takes a hard hit. It's always difficult, I think, to guess or know the exact bottom.

Definitely can't guess at this point, I would say. But as it gets closer, maybe a better idea. But I think that would be possible. If it doesn't come back, then there's not a lot's not a whole lot of fear around this second wave and, and there really isn't a second wave. Everything should rip. I do think that it has a possibility of a really strong end of year. Yeah,

no, I agree a hundred percent. I'm saying if you're, if, if we're like in Christmas and there's somehow no second wave, I mean, the economy is going to absolutely, I mean,

every, the market, I should say, I don't know about the economy. I don't know if people still have jobs, you know, the important factors, but the market itself, I assume we would be seeing, you know, all time highs if the virus really proves to be gone, some sort of dark magic. I don't know. So really quick, back to the paper that you wrote and actually getting back. So you said, obviously, that you were somewhat, you know, I won't say alarmist, but you were early to go into quarantine and to take this seriously. And now you've written a paper on going back out.

So what are the core elements of what an individual should be doing if they're starting to leave their home and venture back out into the real world? I think it's a lot about protecting the people that are most at risk. So, you know, the fatality rate in the younger, really just healthy people under 50, 60 in general, is actually low. Everyone has the single story, the friend of a friend that was young and didn't do well. Kawasaki, right? Right. And they've had exactly some rare disorders in small kids. But, you know, I even had a case from H1N1 where one of my best friends, a girl at the time, now a wife,

actually caught H1N1 and had to go into induced coma and was on ECMO, which is basically mechanical heart and lungs. So everyone kind of has that anecdote. But if you really look at the numbers, the risk of, I think, having serious morbidity or even mortality from provenant gene is extremely low. So now you're sitting there, okay, so now the people that are at risk are the ones with the comorbidities and older older but even kind of more um targeted than that is is people in nursing homes i mean that is a very small percent of the population but accounts for about 40 percent of the nation's

covid19 deaths yeah i mean once it hits a nursing home, it's just devastating. Right. It's highly contagious. Rips to that nursing home. It has a bunch of highly vulnerable compromised individuals. And that's, I think, where we kind of really failed. And I don't think that the quarantines, you know, at least it doesn't seem like there's any good evidence out there

to show that the quarantines help protect those in nursing homes really at all. Well, if they're locked in with the virus, that's a pretty bad situation. Right, right. And so even in New York, we'll have ordered patients who tested positive to go back to nursing homes. Right, other people assume that they did at least mitigate some risk

by not allowing infected people to come visit. So it could have been much worse in that situation. Right, there's some right moves, but I think a lot of wrong, but so I think first of all, targeting, protecting nursing homes. So this might require frequent testing, testing of staff when there's fever checks or intermittent COVID-19 rapid testing, serology testing, maybe if it, if indeed people have immunity, if people have got this season have immunity

next one I think that would be important to look at but yeah protecting those elderly obviously not sending back nursing home patients who tested positive or were just recently sick with it then moving down to the next tier of the people

that have so I guess it comes a little bit down to my fundamental beliefs. So one of the things that attracted me to Bitcoin six or seven years ago was the censorship-resistant, sound money, giving me the freedom to control my own money, to transfer it wherever I wanted. And so that's kind of my general idea regarding opening up America. Because I think that, you know, I don't think mandatory lockdowns are really the solution.

I think you're applying a blanket kind of enforcement to protect a relatively small percentage of the population, which almost seems a little bit backwards. Wouldn't you almost act like a bodyguard to rather protect that small percent of the population as opposed to enforce you know put masks on four-year-olds um you know no you know enforce social distancing small businesses are going to stay shut down until um there's a vaccine if there is one um it just it doesn't seem like the right path and so I think that basically people with comorbidities, so we're protecting nursing homes. Now you have people with comorbidities.

I think that everyone, you know, they should kind of make a decision on what their plan is. Is their plan, like, do you want to wear a mask? Like, my parents did not want to catch this disease. And so they're basically like, well, if I come around you, I'm going to wear a mask, a 95 mask, because if you have any exposure to protect themselves. And, you know, does that make more sense than saying the entire country has to wear masks? I mean, to me, it does protect that small percent of the population as opposed to basically changing the whole dynamic of America.

Why is a mask such a political statement now? I mean, you know, I've read everything from like wearing a mask will give you cancer to, you know, like if you breathe into a mask, you get to inhale CO2 and die. I mean, it's laughable. There's so many people who wear masks every day. And there's a reason that physicians wear masks, right? I mean, we can't, to say a mask has no purpose. Now, I understand what you're saying, which is that, you know, if you choose not to wear one and you're not the most at risk person, then, you know, YOLO, that's your choice. But it's a bit absurd to say that a mask is useless, correct? Or else doctors and nurses wouldn't wear them in the first place?

I would say mostly, yeah. So first of all, it seems like almost anything can become a political issue now. Oh, yeah. I mean, it's hilarious. And so it's amazing that masks have kind of really been the focal point of that recently. So, a couple comments

on masks. So, you know, it was kind of a little strange to me, the official CDC recommendation is to, you know, make your own homemade mask. Like that doesn't seem terribly professional. Like for a country as wealthy, as, you know, robust as the U.S., where, you know, the cure, the recommendation is to do something that's completely untested, and we're going to enforce that now across the board. It kind of doesn't really make a whole lot of sense.

If it was really that absolutely critical, then I would say you would have a little bit more of a standard guideline. Now, maybe there really is just a shortage of masks, but it's been three months now. You can buy masks on Amazon again. You can buy masks again. You can. This idea of crocheting a mask

or using a bandana or something, I don't know. Does that help? I'm assuming that's just more preventative of touching your face or putting your finger in your mouth or something, but it isn't going to stop the virus. Right. Those barriers are not small to really block the virus.

There is some evidence because it was actually interesting. They did a study. I'm not sure how robust it was, but they basically took a T-shirt fabric and kind of determined how many viral particles and viral sized particles can get through it when they kind of just blew it through it and and there is some some decrease of the the projection of these particles so when you're looking at it purely from a spreading the disease point i think that surgical masks and maybe even some of the homemade masks, especially a little bit thicker material, will decrease the projection of the spread.

So instead of like the six feet, maybe it decreases down to a foot or three feet and then decreases the amount of particles out there. So I can see some evidence for that. Regarding the, you know, you make a great point. It's a little bit double edged regarding masks because doctors who are caring for COVID-19 patients don't wear bandana masks. They don't wear surgical masks. They wear face shields, of course.

They wear N95 masks and then you have some type of face shield for their eyes. So, you know, that's the real protection. If you're sitting there saying, oh, I really want to eliminate spread of this as well as protect myself, you're going to put on an N95 mask.

And then if you're really aggressive, you're going to put on goggles. So like everything, there's kind of a bunch of gray area. Am I a teen mask? Am I not a teen mask? I would say that at this point, when you're comparing bandana masks to no mask, I would say that it's a soft enough call that it really should be up to the freedom of the individual. Right. You were, but you, you personally wore one when you got on a plane as early as February.

So, I mean, you know, Yes. Yep. And that was in 95. That wasn't a bandana mask. Of course. Of course. Yeah. No, I, I understand that all masks are not created equal. I mean, I have, you know, been somewhat outspoken and I guess I approach it from a different way. I agree with all you're saying about its effectiveness. I guess what it comes down to me is like, it's a very small sacrifice even if it's unclear. And, and one that, I mean,

I can say personally, and we don't have to get into whether it should be legislated or not, but like one that I personally, like if there's even the chance one in a thousand that I don't have to get into whether it should be legislated or not. But one that I personally... If there's even the chance, one in a thousand, that I don't randomly infect some stranger because I just put on a mask when I'm in certain places, it just seems like such a small ask for society. That's my position. I understand that other people have a different position.

But when you talk about reopening, I feel like social distancing and reopening are only as good as the person who believes in it the least. So if I'm out there and trying to be somewhat respectful and someone walks up in my face and spits at me because I'm wearing a mask, which I don't think is happening often, but we've seen it obviously. Or just like someone who doesn't believe in it comes up and sneaks me a high five or puts their arm around me or something, right? Then I can't practice my own comfort level of it. So it almost seems like you have to default to small gatherings, six feet away and a mask in public, or at least in a restaurant or in any

private place. Maybe not when you're just like walking around in a park, I don't wear a mask, you know, I guess it all comes down to like how, I guess that cost benefit. Like, um, I think you, you've heard,

you've talked about, uh, having kids on the show, right? Yes. So absolutely. I have young kids and I have immunosuppressed parents. Right.

Okay. Right. So, um, you know, do your kids wear masks? No, absolutely not. But we, we, we're still effectively in isolation. You know, we haven't really, we haven't breached it. I've every meal I've eaten for 10 weeks has been cooked in my

house. We're pretty, you know, like we go out and play in the yard and we run, run around the neighborhood and we'll go to the park and stay away from people. But by and large, we haven't gone to any indoor public places or the kids haven't gone back to school or nothing like that. It'll be an interesting, I think, probably decision for your house whether the kids go back to school or not. I was actually homeschooled my whole life, so I never went to school. Yeah, well, we've already made the decision not to send them to camp.

We have a unique situation where we have help. So we're not desperate. You know what I mean? We can wait it out and let everybody else be the crash test dummies, so to speak. So I think there's no, I'm not going to fall to anyone that's being cautious. I completely consider approaching, you know,

as I said, I was wearing a mask on a plane in early February the one thing I would say again it kind of comes down to that cost benefit like if you know how much you're going to struggle like there's guidelines out there you know kids over two years old if they're going out need to wear a mask

like my five year old my five year old is not going to wear a mask and if she does she's going to stick her fingers in her mouth under it it's just realistic we had a planned trip a family trip to Florida in early is not going to wear a mask. And if she does, she's going to stick her fingers in her mouth under it. It's just realistic. We had a planned trip, a family trip to Florida in early March. And I was like, there's no way my kids are going to be on this plane flight in some

responsible way. And so we just actually canceled the family trip. And so that's like, you know, so how far are people going to be like, are teachers going to spend their entire time in class fighting with the kids to like wear their mask? I mean, the kids are going to be like, why are teachers going to spend the entire time in class fighting with the kids to wear their mask? I mean, the kids are going to get caught if they're sitting there. So there's certain degrees.

As an adult, it's like, yeah, it's no big deal. It's fine for me to wear a mask. And I think that if it even has a small percent of saving one life or preventing one person from being sick, then that's what i mean i've joked like i would wear a pink unicorn hat if if if there was even some evidence that it could like protect my parents or or somebody else in the community i'm just i mean i'm just built that way you know what i mean so it just that's why to me it seems like like i said a small ask but i do get it and i think it's funny because i i people view me as like, that I want to believe people

should stay quarantined forever. I absolutely don't. In fact, it's the opposite. I know that we need to reopen as a result, obviously. I mean, people need to survive. There's bad things happening when people are stuck at home. Those things are very obvious. I just wish that we could do it with a solidified plan in place where I felt like everyone else would be playing by

the same rules as me. Yeah. Yeah. Yeah. It'll stay inside forever. We're not, you know what I mean? Nobody.

No, we're definitely not, which we're seeing this, I guess, like you said, in the summers and break that. Yeah. It'll be interesting.

It comes on the fall, but yeah, at the end of the day you know i think mass it's a personal choice um i i don't think it should be enforced with a fine or or violence um but uh i i know it's an extremely controversial opinion um and i don't think that people are going to be wearing their masks during the summer which where i'm seeing as well i have not seen a single person wearing a mask. So anyone that's on that team, it's kind of a losing battle anyway.

Right. And I'm saying, theoretically, people here, and I think it's absurd, but people are supposed to be fined when they're not. But is a cop really going to walk up to someone without a mask? Let's imagine that police officer actually believes that they should be wearing a mask and needs to be six feet apart. That's asking them to put themselves at risk to give a minor violation. Yeah. Yeah. And yeah, I mean, that, of course, you've seen kind of some of the cases on the news, but I think they're far few and far between. What are the like, I guess, secondary effects of this on the medical system? Obviously, I mean, there's a lot of people

who are decidedly afraid to, you know, visit a hospital for something that actually may be serious, and they may, you know, need to be seen by a physician, but they fear the virus. Yeah, so that's a great question, which actually kind of gets into the whole pros benefits of having such a lockdown in place. And, you know, unfortunately, I don't think we'll have the real good numbers on the impact it's had on actual lives outside of strictly COVID-19 deaths until much later. But I know from the early data that I have seen, it does seem like there's been, I mean, hospitals report a lot less, a lot fewer patients are coming in for screening, a lot fewer patients

are coming in for heart attacks or strokes, which these people are just not getting even now. They're not, it's not like they're no longer getting breast cancer or they're still getting all these things so now you're delaying the diagnosis of these conditions you're kind of maybe leaving that therapeutic window even where um and so like that that's something that takes years before mature a lot of those people are and a lot of those people are diagnosed at routine appointments without you you know, asymptomatic, just, you know, literally finding a lump when you're at a physical. Right. And so if you, you know, acutely, like for the last couple of months, I would say it probably affects the amount of people who went in for strokes or heart attacks.

But if this lockdown continues, we kind of set it all up again in the fall and we go back to that. We're again waiting on that vaccine until mid-2021 or something. Now I think you're going to start to see some kind of real serious lags in diagnosing some of these conditions that will kill people.

Yeah. What's interesting with regard to the second wave, I actually read last week, of course, I was trying to figure out when Gator football would be back and if it would allow people in the stadium or not. The important stuff, right? fall. And there's a lot of universities actually that have said they're going to open August, September, October, and then actually in advance, they've planned to go online after Thanksgiving as a result of an assumed second wave. So, I mean, there's a lot of people who are already reacting to the assumption that that's going to happen. And then there's, of course, there's universities that just aren't going to open at all. And then those that are like, again, who are just going to

go for it and hope for the best. I think one of the things that's interesting about the education thing is I think it was easier to charge people $40,000 a year. And when at least you're going to classes and you feel it, but if you're sitting at home in your pajamas, watching some lecture for two, three hours a day, you're going to start to wonder why you're paying $40,000.

Yeah. And I mean, you can do that on YouTube. Let's be honest. As crazy as it is, like there's a certain level of university, obviously. You went to Columbia medical school. I went to the university of Pennsylvania undergrad. There's a certain level where I don't want to say you're not getting a major education. You are, but where you're paying for the paper at the end, right? The name on the paper. So, you know, I don't see like Ivy League universities, people will continue to pay for those kinds of things. But yeah, for a kid like

at a state school or why would you, why would you even not just punt a year or two and see what happens and, you know, try to learn a craft or start a company or something like that. So I know a lot of smart people that are thinking that is the next plan. And I personally am on board with that as well. I think this, this pandemic is kind of maybe just, uh, open some more eyes to that. Yeah. It's accelerating an existing process. Like we always, my colleagues and I call it the education

bubble where everyone's going to college and tuition is going up every year and I think that even if you want to learn things you don't have to do it in college. Like for medical school to become a physician you have

to. Right, if you want to be a physician or a lawyer or some professional that requires, yeah. But, you know, for most people, like, you don't, you could actually probably be much more effective in learning what you are passionate about or what you want to go into independently, I think. But again, I was homeschooled. Yeah. You think that way. Yeah.

But, but I mean, that's, that's actually really interesting because you obviously got an undergrad. You went to med school at Columbia, which is prestigious and also expensive. But then was it timing and luck that you got into crypto and then you just hit it big with your fund timed correctly in 2017 that you didn't actually have to pursue it after going through all that education? Because, I mean, you're not practicing as a physician right now, correct? I mean, you're more in the finance space. I'm more in the investing. COVID brought me back into medicine. So I first started investing in crypto back in my last year of med school, back in 2013, 2014. So regarding entry points, I'd actually say I was kind of unlucky.

Yeah, you were too early. Fortunately, I didn't actually put too much in at that point. And so I was able to write it down in 2015. And the fundamentals, though, to me did not change at all. And just the more I studied space, and I had a great network of people that were very like-minded and also investing heavily in the space. And so we kept bouncing ideas off each other.

I think it's very easy during fair markets to kind of, you know, we're no longer thinking about it and then you like, you know, you're not thinking about those investments and then you just kind of like, oh, I need to pay my mortgage or whatever. And you just kind of exit the space or you get interested in different types of investments right but we kind of kept a lot of energy there continued to invest really heavily in 2015 and then yeah and when 2017 i came around it was um you know it did very well and so we uh so my my uh, he left medical school. It was a halfway through medical school and he got out. My, um, my other brother was a, um, he went to university of Pennsylvania as well for undergrad

and he was a trader for a city group. And then he, uh, he left and joined a um crypto uh research firm and then i um i finished up residency because i was only i only had like four or five months left after uh in early 2018 but then yeah like you said i stepped away from practicing medicine just focus on managing investments it was just just, it, um, it would have been pretty negligent to not, uh, finish and also not to finish your, uh, if you were a few months out in a residency, I mean, eight, nine years into a extended education story, like your brother drops out of medical school, you finish your residency and then basically say fuck it to medicine and are able to you know go uh play with magic internet money full-time that's right the

thing i will say though that was kind of disheartening about the uh the whole medical field is how much bureaucracy has kind of entered it over the last decade or so where you know a lot of physicians and this is increasingly so feeling like they're not actually making decisions for the patient they're almost uh kind of bureaucratic decisions or quality of care is being handed down to them and that's actually you know what we've seen this pandemic you have physicians that are wanting to prescribe a certain medication that governors or, you know, instructing pharmacies to not fill those medications, threaten license, removing your license or making an amendment on your license if you did so.

And so basically we had physicians who were kind of not really in control anymore of how they cared for patients. And that really came to light during this pandemic, but it's kind of always been the case. And so that's why I chose ophthalmology because it seemed like it was, you did have the most control over caring for your patients still, but so much more of the physicians that are in the hospital systems, you, you really start to lose any of that autonomy or being able to actually

make like, I think your own smart decisions. Yeah. I mean, my father is a ER physician. He ran the emergency room at the university of Florida. And, um, I'll never forget. It must've been 1990, 1991, that he sat my brother who didn't listen. My brother's a ENT, but he sat us down and said, never become a doctor for, for those, for the exact reasons that you just described. And this was in, you know, the late 80s, early 90s. He saw it early. Because he was, you know, running, you know,

when you're, I guess, in an academic setting and seeing how the insurance companies were growing and all those things. But, you know, I can definitely see why you would choose crypto, especially if you had already sort of, you know, hit the jackpot to some degree over the medical degree. And you can always fall back on medicine. What a funny thing to be able to say you can fall back on. Yeah, it's not a bad parachute, I guess. But it's also, it's strange enough, it's been extremely helpful for, like I said at the beginning of this talk, merging COVID-19 medicine and investments. It really kind of came together during this time.

And I think gives a little bit maybe of an advantage in seeing what's going on regarding our investments during this time. So even from an investment side of things, it's improving. Right. I mean, investing is about managing risk, right? I mean, the best traders, the best investors are the ones who have effective, you know, risk management can analyze risk. And I mean, isn't that, I mean, you're in two fields, obviously, that's 100% true for physician, but in life, I mean, it's how you manage risk, that's the decision to wear a mask or go out or if you, you know, all of this sort of comes down to the same principle. So if you have that talent or skill, you should excel in all of these fields. Exactly.

So where can people follow up with you after this? Where can they find you? Where can they keep up with what's coming out? Twitter, James Tadaro, MD. My first name, James, last name, Tadaro, T-O-D-A-R-O, and then MD, the medical doctor, is where I post all my thoughts on COVID-19 pandemic, what I think is going to happen in the upcoming weeks, as well as cryptocurrency. And I'm actually looking forward to kind of getting back into the reason. One of the reasons I've been following this COVID-19 pandemic so closely is because I think, well, there's multiple reasons, but it's also dramatically affecting crypto. And I think that the two are kind of married in that way. And so, but I am looking forward to kind of doing more dives into cryptocurrency. You know, like we did a piece on Bitcoin's hash rate, predicted it declining pretty rapidly after the halving, which it's done.

But yeah, most of what I'm putting out there right now, I think it's COVID-19. Awesome. Well, thank you so much for taking the time. It's really one of my favorite conversations, definitely, that I've had yet. Very, very enlightening. And I think we touched on a lot of things

that people are really wondering about. Thanks so much for having me, Scott. And you have a great afternoon. You too. Speak soon. Let's go. Hey, everyone. Thanks for listening. for having me, Scott, and you have a great afternoon. You too. Speak soon.